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Biomedical subjects

J W Cook

Publications and source records attributed to J W Cook.

At least 37 records · Page 2Linked to original sources
PubMed1988

Rapidly growing nontuberculous mycobacteria: a new enemy of the cardiac surgeon.

A review of atypical mycobacterial infections complicating cardiac operations is presented. Proven sources of infections at different institutions include contaminated porcine valves and municipal water supply, but the mode of transmission in the great majority of patients remains unclear. There are two principal clinical forms of atypical mycobacterial infections after cardiac operations--endocarditis and sternal osteomyelitis. The latter has characteristics resembling tuberculotic "cold abscess." Specialized laboratory testing is necessary to confirm the diagnosis, and surgeons may have to take the initiative to request special microbiological investigation in cases where infection is clinically suspected but routine cultures are reported as "negative." The prognosis for patients who have any atypical mycobacterial infection after a heart operation is severe. Those infected with the strain chelonei and those whose cardiac chambers were entered during operation fare worse. This dim clinical prognosis may be improved by appropriate and aggressive antibiotic and surgical therapy. Awareness of the urgency of special bacteriological studies is the key to successful management.

Anti-Bacterial Agents↗
PubMed1987

Cancer in offspring of long-term survivors of childhood and adolescent cancer.

A multicentre retrospective cohort study of long-term survivors of childhood and adolescent cancer identified 7 cases of cancer among 2308 offspring (0.30%) of 2283 case-survivors and 11 cases among 4719 offspring (0.23%) of 3604 controls. Overall, the observed numbers of cases were not significantly different from those expected in the general population. Among offspring of case-survivors observed for the first 5 years of life, the group with the most person-years of follow-up, 5 cancers were reported (3 confirmed), compared with 1.7 expected, a significant excess due mostly to boys whose mothers survived cancer. Some offspring with cancer had known single-gene traits; others resembled previously recognised patterns of family cancer. The remainder may represent chance occurrences or new cancer family syndromes, such as an association with malignant melanoma. The study had an overall 79% power to detect a 3-fold excess of cancer among offspring of case-survivors, but no excess was observed. The number person-years of follow-up in the second decade of life, when most cases of cancer developed, was small.

Adolescent↗
PubMed1987

Indium 111-labeled platelet deposition in woven and knitted Dacron bifurcated aortic grafts with the same patient as a clinical model.

A study was designed to compare platelet deposition between knitted and woven Dacron grafts in the same patient. Twenty patients received aortoiliac or aortofemoral bifurcated Dacron grafts, each composed of one woven and one double-velour knitted limb. External nuclear graft imaging was carried out after injection of autologous platelets labeled with indium 111. The patients were studied postoperatively in time periods ranging from 6 days to 42 months. Platelet accumulation was almost identical in knitted and woven limbs in all patients. This study appears to indicate that there is no difference in thrombogenicity between knitted and woven bifurcated Dacron grafts in the aortoiliac or aortofemoral positions measured by platelet accumulation.

Aorta, Abdominal↗
PubMed1985

The impact of successful laboratory system on the teaching of nursing skills.

The laboratory guided practice approach has been found an effective strategy for teaching nursing skills to large numbers of students. It provides flexibility in meeting individualized needs and serves to decrease stress levels of both students and faculty. At the School of Nursing, University of N.C. at Chapel Hill, it has served to establish more uniform clinical expectations of students and greater correlation between skills level and clinical site placement, as well as integration of skill components into clinical courses. These outcomes and the positive evaluations discussed above help to validate this strategy as a practical and effective way to approach the teaching of clinical nursing skills.

Clinical Competence↗
PubMed1984

The value of thermography in the early diagnosis of postoperative sternal wound infections.

Peristernal skin temperatures were recorded postoperatively by infrared thermography in 150 patients. Persistent elevation of peristernal skin temperature during the 3rd and 4th post-operative week was found in 5 patients, all of whom developed sternal wound infection. A further group of 18 patients, all suspected to have occult wound infection, showed persistent temperature elevation in 7 patients, 6 of these patients were proven later to have manifest infection and needed treatment. Close thermographic scruting of the incision in patients with suspected but not proven infection appears to be useful in deleting early stages of deep seated infections.

Cardiac Surgical Procedures↗
PubMed1981

Technical options in repairing the diseased ascending aorta with aortic valve involvement.

Operative repair of the diseased ascending aorta with aortic valve involvement consists of replacement of the ascending aorta and the aortic valve plus reconstitution of coronary arterial flow. Two basic techniques are presently available. The conventional technique involves separate replacement of the aorta and valve above and below a small segment of retained aorta including the coronary orifices. The second method consists of replacement of the entire ascending aorta and aortic valve with reconstitution of coronary flow by approximation of the coronary orifices to the Dacron conduit or with saphenous vein bypasses. Each method has its merits depending on the exact pathological anatomy encountered near the coronary orifices. Other pathological variables exist that demand additional intraoperative choices in technique. The present report details the operative repair of this lesion and outlines the technical options available for solution of the various problems encountered.

Aorta↗
PubMed1981

Simultaneous revascularization for complex brachiocephalic and coronary artery disease.

We have recently encountered two patients with significant coronary artery disease in addition to complex and extensive brachiocephalic occlusive disease. Both were operated upon successfully with simultaneous repair of both anatomic areas. These cases form the basis of this article. Fourteen additional patients with combined coronary and conventional carotid disease have been operated upon successfully with a simultaneous approach to both lesions. We conclude, until convincing prospective data are available possibly indicating otherwise, that a simultaneous approach to these combined lesions is indicated.

Arteriosclerosis↗
PubMed1979

Thoracoabdominal aortic aneurysms. A review and current status.

Surgical management of the thoracoabdominal aortic aneurysm is a formidable undertaking. Presently two fairly distinct operative methods are available. The conventional technique, pioneered by Etheredge, involves replacement of the aneurysm with a synthetic graft and then, step by step, revascularization of the abdominal organs with prosthetic side limbs taken from the primary graft. Individual organ ischemic time is limited to that time required for the performance of each distal side limb anastomosis. The second operative method, first described by Crawford, consists of proximal and distal control of the aneurysm, followed by its incision to simultaneously expose the origin of all four major intra-abdominal arteries. Replacement is then rapidly performed with a tubular Dacron graft including anastomosis of these major intra-abdominal arteries to four elliptical graft incisions, from within the aneurysm. Total operating time is reduced at the expense of prolonged organ ischemia. The conventional method allows for step-by-step intraoperative planning and action, and this technique is accordingly recommended to most surgeons, who have had little experience with this unusual lesion. Our recent successful experience with two cases of extensive thoracoabdominal aortic aneurysms is described as well as a discussion of additional measures which may become useful in certain cases to favor a successful outcome. Finally the problem of potential resultant paraplegia is discussed.

Angiography↗
PubMed1979

Pectus carinatum.

In the mirror of the pertinent literature, we present our experiences gained in 161 operations for pectus carinatum. The Type I (keel chest) deformity is corrected by bilateral resection of the costal cartilages, transverse osteotomy of the sternum, detachment of the xiphoid process, and resection of the lower end of the body of the sternum. The sternum is maintained in its corrected position by utilizing the pulling force of the rectus muscles through the reattached xiphoid and by tacking the pectoralis muscles together in front of the breast bone. Type II (pouter pigeon breast) is handled by double transverse osteotomy, chiseling off the protuberant portion of the strernomanuberial junction, and by supporting the lower sternal body with either the suspended xiphoid process or with Marlex mesh. Limited forms of Type III (asymmetrical or lateral pectus carinatum) are managed with simple resection of the involved cartilages only. If the anomaly is more extensive, bilateral resection of the cartilages and correction of the sternal axis is carried out.

Adolescent↗
PubMed1979

Sinus venosus type of atrial septal defect with partial anomalous pulmonary venous return.

This report describes our method of repairing the sinus venosus type of atrial septal defects. The superior vena cava is compartmentatlized by means of a single double-armed suture. Caval catheters are used as temporary internal shunts, and a vertical U-shaped patch is incorporated into the atriotomy suture line. The experiences with 27 cases are presented.

Adolescent↗
PubMed1979

Pectus carinatum.

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Adolescent↗