Biomedical subjects
W A Cook
Publications and source records attributed to W A Cook.
1990 Henry F. Smyth, Jr. Award Lecture. Criteria for occupational exposure limits by selected countries.
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Bilateral transpedicular decompression and Harrington rod stabilization in the management of severe thoracolumbar burst fractures.
Fifty-eight patients with severe thoracolumbar burst fractures were treated with bilateral transpedicular decompression, Harrington rod instrumentation, and spine fusion. Spinal realignment and stabilization was achieved by contoured dual Harrington distraction rods supplemented by segmental sublaminal wiring. Posterior element fractures were noted in 25 patients, 9 of whom had associated dural tears. Computed tomography was performed to assess the cross-sectional area of the spinal canal before surgery and after decompression. Patients at initial evaluation averaged greater than 67% spinal canal compromise. After surgery, successful decompression was accomplished in 57 patients. One patient required staged, anterior thoracoabdominal decompression and fibula strut grafting. At follow-up (average, 43 months; range, 25-70 months), neurologic improvement was found in 77% of the patients who initially presented with neurologic deficits. Thirty-four of 40 patients with incomplete paraplegia improved one or more subgroups on the Frankel scale. A solid fusion was attained in all 58 patients. No patient had a significant residual kyphotic deformity. Single-stage bilateral transpedicular decompression and dual Harrington rod instrumentation reliably provides decompression of the spinal canal and restores spinal alignment. The procedure allows early mobilization and provides an environment for solid fusion and maximum neurologic return.
Fetal posterior urethral valve syndrome: a prospective application of antenatal prognostic criteria.
A case of posterior urethral valve syndrome is presented. Four weeks after a normal 24-week ultrasound examination, diminished amniotic fluid, megacystis, and renal hyperechogenicity were observed. A repeat ultrasound examination at 30 weeks' gestation identified oligohydramnios and increased renal echogenicity. These findings prompted the performance of a percutaneous cystocentesis to assess fetal renal function indirectly. The specimen was evaluated for osmolality and sodium and chloride concentrations. The urine electrolyte concentrations (sodium 115 mEq/L; chloride 93 mEq/L) and the osmolality (230 mOsm/L) were elevated, suggesting impaired renal function and a poor prognosis. Despite these findings, aggressive management was used, including administration of antenatal corticosteroids and elective preterm delivery. A percutaneous cystocentesis was required during the infant's initial resuscitation, followed by a difficult urethral catheterization. Ultimately, a vesicostomy performed on day 4 of life was associated with prompt return of renal function (serum creatinine 0.7 mg/dL at the time of discharge). At 6 months of age, normal renal function has been documented and the vesicostomy has been closed. This case demonstrates the potential limitations of available prognostic criteria in evaluating fetal urinary obstruction and residual renal function. In selected cases (when the onset of obstruction is documented in the third trimester), refinement of these prognostic criteria may be indicated. Similar cases may be best managed by preterm delivery and prompt postnatal decompression.
Occupational exposure limits for carcinogens--variant approaches by different countries.
The differences in treatment of occupational exposure limits for carcinogens by 24 countries is described along with a discussion of the American Conference of Governmental Industrial Hygienists (ACGIH) threshold limit values (TLV) treatment, the similar treatment of the new Occupational Safety and Health Administration (OSHA) standard, and the treatment by provinces of Canada. The unique listing by the Federal Republic of Germany of so-called technical guiding concentrations of a group of carcinogens is discussed with the note that Austria used this same system. Publications on justification for establishing occupational exposure limits for certain carcinogens are discussed also.
Massive retroperitoneal hemorrhage owing to a ruptured adrenal cyst.
We report a rare case of massive retroperitoneal hemorrhage owing to rupture of an adrenal cyst after blunt abdominal trauma. A large retroperitoneal hematoma was evacuated and subtotal adrenalectomy was performed. Convalescence was uneventful. Histology revealed an endothelial-lined adrenal cyst suggesting a vascular or lymphatic etiology.
An impression of Alice Hamilton--physician, industrial hygienist, crusader and friend.
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Segmental neurofibromatosis.
Of the various forms of neurofibromatosis, the best known are peripheral neurofibromatosis (von Recklinghausen's disease) and central neurofibromatosis. There is a rare form called segmental neurofibromatosis, in which the cutaneous and neural changes are limited to one sector of the body and with which there is usually no family history of neurofibromatosis. We report four patients with this disorder and stress the value of repetitive, limited excision of peripheral nerve tumors in their management.
Self-report of depressive symptoms in low back pain patients.
Two studies designed to examine the self-report of depressive symptoms in low back pain patients are presented. Symptoms of depression were assessed with the Beck Depression Inventory. In the first study, a sample (N = 134) of patients who presented for neurosurgical evaluation were evaluated. In the second study, a subgroup of patients found to have lumbar disc protrusion were compared to a subgroup with few or no positive physical findings at the time of physical examination. If the cut-off scores recommended by Beck were used, patients in both studies would be classified as mildly depressed. Both studies found that patients were significantly more likely to report somatic than cognitive symptoms of depression. Patients with multiple physical findings or a disc abnormality at the time of operation were not found to be more likely to report somatic symptoms than patients with few physical findings.
Depression, pain, and pain behavior.
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Asymmetrical gonadal enlargement in adolescent true hermaphrodite with bilateral ovotestes.
A case of gynecomastia and asymmetrical gonadal enlargement in a thirteen and one-half-year-old "male" true hermaphrodite with biopsy-proved bilateral ovotestes is presented. The pathology, genetics, endocrinology, and management of this entity are discussed and compared with instances of hermaphroditism in which there is distinct separation of the ovarian and testicular tissues.
Ultrasound-guided percutaneous nephrostomy in the pediatric patient.
Percutaneous nephrostomy drainage may be established rapidly using ultrasonic guidance in severely ill pediatric patients with obstructive uropathy. B-mode ultrasonography has proved to be rapid, accurate and free of irradiation hazards, making it applicable to children with little or no sedation.
Reduction of postoperative lumbar hemilaminectomy pain with Marcaine. Technical note.
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Dysgerminoma associated with pregnancy.
From a review of 26 reported case (our case being the 27th) of dysgerminoma associated with pregnancy, several salient facts are evident. Torsion and incarceration are common among these rapidly enlarging tumors. Obstetrical complications occurred in nearly half and fetal demise in one quarter of the reviewed cases. Our case was typical of patients presenting with this vexed problems: The patient was under 25 (as were 70%); nulliparous (as were 67%); and the tumor appeared confined to one ovary (as in 89%). Authorities are in dispute as to the treatment of stage IA dysgerminomas, and the association of pregnancy complicates this debate even further. The results of conservative treatment in this series were jarring: There were recurrences in 30% of the 23 stage IA tumors, and the recurrences were all following unilateral oophorectomy. In our case, the grossly normal contralateral ovary was infiltrated with dysgerminoma cells. While treatment of a young woman with a dysgerminoma of 1 ovary is a matter of perplexity, we believe that a unilateral operation should be limited to those women who desire above all earthly things to retain their childbearing capacity.
What's right with America's industrial hygiene?
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Adhesive straps in electronic fetal monitoring.
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Laceration of a placental vein: an injury possibly inflicted by the fetus.
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