Biomedical subjects
Publications and source records attributed to R C Cook.
Heterotopic gastric mucosa is reported in a sinus present since birth in the midline of the anterior two thirds of the tongue. Current theories concerning the presence of heterotopic mucosa in the oral cavity are presented and discussed.
This study evaluates the safety, efficacy, and technical problems of the new technique of endoscopy-guided balloon dilation (EGBD) in the treatment of strictures of the esophagus and its replacement. Between 1986 and 1990, the authors treated 33 children (aged 3 weeks to 20 years) with EGBD; 18 had esophageal strictures (primary esophageal atresia repair, 13; reflux esophagitis, 5), 13 had anastomotic strictures after esophageal replacement (colon, 12; stomach, 1), and 2 had caustic strictures. The majority (23 of 33) had previously failed to respond to conventional bouginage (mean, 11.2 sessions; range, 1 to 32 sessions). EGBD was performed using flexible endoscopy and flouroscopic screening under general anesthesia. Endoscopy identified and resolved the errors or uncertainties of preoperative contrast studies in 7 patients, 5 of whom had colon interposition. EGBD was achieved in all 31 patients with esophageal or replacement strictures; the mean number of EGDB procedures per patient was 2.1 (range 1 to 7). Symptomatic relief was excellent in 24 and moderate in 7 patients. Both patients with caustic strictures had esophageal perforation from EGBD (excessive inflation, 1; false passage of guide wire, 1). Patients who had experienced both conventional bouginage and EGBD noticed less pain with EGBD and resumed eating sooner. The authors conclude that EGBD is safe and effective for treating esophageal and replacement strictures but not caustic strictures.
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Seven cases of neonatal ovarian cysts that presented over the past seven years were studied. Complications included torsion and rupture and usually occurred in cysts more than 5 cm in diameter. Surgical removal, either oophorectomy or cystectomy, was the treatment of choice. Because even cystectomy results in loss of normal ovarian tissue, and because spontaneous regression of cysts less than 5 cm in diameter can occur, a more conservative approach is now proposed. Regular ultrasonography alone is recommended if the cysts are less than 5 cm in diameter, and aspiration of the cysts followed by regular ultrasonographs if the cysts are more than 5 cm in diameter. Operation should be reserved for recurrent cysts or for those with complications. Cysts diagnosed antenatally may be aspirated in utero if there are signs of thoracic compression.
Cysts and tumours of the ovary are not uncommon in childhood. In 33 years between 1950 and 1982 106 patients were operated on at Alder Hey Children's Hospital and the Royal Liverpool Children's Hospital. Of these 71 were pre-menarchal. The mode of presentation, pathology and diagnostic difficulties of the pre-menarchal lesions are reviewed. The value of ultrasound scanning has become apparent in recent years. Most cysts and tumours are benign, but dysgerminomas are the most common malignant tumours encountered. Even when there is evidence of spread of the tumour the prognosis in these remains reasonably good.
Two siblings are presented in whom a recognized syndrome of functional small-bowel obstruction with malrotation and short small-bowel was diagnosed. The previously described association with pyloric stenosis was not present in our cases. They do, however, support the view that this syndrome has an autosomal recessive model of inheritance. A deficiency of argyrophil neurones in the myenteric plexus has been noted in this syndrome but more precise neurohistochemical studies are required to define the exact deficit involved.
Of 162 children with intestinal malrotation treated during a 13-year period, only 20 were first seen and treated outside the neonatal period. These presented with symptoms that were largely non-specific and there was a delay between the initial consultation and the making of the correct diagnosis of up to 5-years. The clinical features, radiologic findings and management are discussed, the importance of the history and radiographic findings stressed.
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Congenital auricular and preauricular sinuses, while seemingly trivial and often unnoticed or ignored, can give rise to troublesome symptoms if infection supervenes. Nine of 30 patients (30%) operated upon between 1969 and 1981 had postoperative recurrence, two of whom required two excisions. We would recommend aggressive treatment of infection followed by excision in 2-3 weeks before further infection can occur.
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Two tests for penicillin residues in milk using the test organisms Sarcina lutea and Bacillus stearothermophilus var. calidolactis respectively are presented. The test methods are described, the results compared and the advantages of the latter test demonstrated.
Para-chloroamphetamine (PCA) produces short-term decreases in eating and drinking. PCA also chronically decreases brain serotonin concentration following a single peripheral injection. The present investigation assessed short- and long-term effects of PCA on ingestive behavior and body weight in greater detail. Following an adaptation period, PCA, 0.0, 1.0, 2.0, 5.0 and 10.0 mg/kg, were administered IP, to free feeding rats. A decrease in food and water consumption was observed during the 0--24 hr postinjection period. During the 24--48 hr period, water consumption was significantly increased compared to baseline. Food intakes during this same period returned to baseline levels. No long-term effects on ingestive behavior or body weight were seen during the following 30 days.
A case of tracheal compression in an infant after repair of a tracheo-oesophageal fistula and oesophageal atresia is reported. Tracheopexy completely relieved the symptoms of apnoeic attacks, cyanosis, and convulsions. We suggest that tracheal compression in infants and children with repaired oesophgeal atresia can not only cause life-threatening attacks but also be responsible for recurrent chest infections. All infants and children with signs and symptoms of tracheal compression as shown by the presence of a barking type of cough, recurrent chest infections, or persistent mild respiratory symptoms should be referred for thorough investigation of the tracheobronchial tree.
Microbiological surveillance by swabbing meat wholesaler premises revealed ineffective cleaning and build-up of bacteria. Proper cleaning, sanitation and handling resulted in a vast improvement during 1975-77. Beef samples from the neck of carcases in the wholesale trade were investigated by microbiological methods. Excessive total bacterial counts were obtained from numerous carcases. Most carcases carried coliform organisms. Roughly 90% of carcases were contaminated with E. coli I; counts exceeded 10(3)/g in 18% of carcases tested. Twenty serotypes of Salmonella were identified. Salmonella contamination decreased from nearly 5% in 1975 to less than 0,5% in 1977, and S. aureus contamination from 52% to 36% during the same period. Approximately 30% of carcases revealed contamination with unidentified clostridial species. The results indicate the need for stricter control over the production and slaughter of animals and over the handling of carcases in the wholesale trade.
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The Milk Ring, Serum Agglutination, Biological, Mercaptoethanol and Rose Bengal Plate Tests were used in combination to diagnose brucellosis in cows in some herds supplying milk to Johannesburg. The work was done in conjunction with routine testing of bulk milk supplies for public health control. 4 769 cows in more than 76 herds were involved in the tests. Results confirm that no single test can demonstrate all infected cows in a herd and that repeated testing is necessary. In an infected herd in which Strain 19 adult vaccination has been used some negative and suspicious cows will have to be sacrificed in eradicating the disease.