Biomedical subjects
Publications and source records attributed to W J Watson.
Postpartum foot drop, caused by trauma to the lumbosacral nerve roots, has been associated with traumatic vaginal birth--fetal macrosomia and difficult forceps deliveries. After a spontaneous delivery a patient developed an L-5 neuropathy. In the modern era of obstetrics, foot drop is a rare complication of vaginal birth and causes significant disability. Although the condition can be permanent, most cases resolve in two to six months.
A prospective analysis was done of the accuracy of fetal weight estimation comparing clinical and ultrasound estimation with actual birth weight in 100 women at term. The mean error of clinical estimation was 277 g, or 79.4 g/kg, for a 7.9% error. The error of ultrasound in the same population was 286 g, or 81.7 g/kg, for an 8.2% error. Analysis of these data revealed no statistical difference between clinical estimation and ultrasound estimation of birth weight in the term fetus, even at the extremes of birth weight.
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Despite steroid therapy and total parenteral nutrition, a patient with severe ulcerative colitis developed a colon perforation with peritonitis that necessitated colectomy at 28 weeks' gestation. The pregnancy was left intact; the postoperative vaginal delivery was uneventful.
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In order to assess the value of a screening urinalysis in the detection of urinary tract infection, the results of routine urinalyses from 1,062 obstetric patients were compared to subsequent culture results. A positive urine culture was predicted by pyuria, bacteriuria and a positive nitrite test; the predictive values were 23%, 21% and 87%, respectively. If all the parameters were negative, 96% of the cultures were negative. These findings suggest that in the interest of cost effectiveness, the urine can be cultured only when the screening urinalysis shows pyuria, bacteriuria or a positive nitrite test.
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A retrospective analysis of 254 term breech deliveries was done, with term breech presentations managed by a protocol in which cesarean section was done for nonfrank breech presentation, or estimated fetal weight in excess of 4000 g. Patients with frank breech presentation were assigned to one of three groups based on x-ray pelvimetry and estimated fetal weight. Of 70 group 1 patients (adequate pelvis with estimated fetal weight less than 3600 g), 79% had a vaginal delivery. Of 21 group 2 patients (borderline pelvis or estimated fetal weight of 3600 to 4000 g), 67% delivered vaginally. In group 3 (contracted pelvis or estimated fetal weight greater than 4000 g), all patients were delivered by cesarean section. The overall cesarean section rate for frank breech infants was 36%. Apgar scores were not significantly different for infants delivered vaginally or abdominally. The crude perinatal mortality rate was 11.8; the corrected perinatal mortality rate was 0. These findings further substantiate the safety of these criteria in management of term breech presentations.
An incidence of postoperative infection of up to 15 percent has been reported following middle ear ventilation tube surgery. This rate of complication would be considered unacceptable following most other operative procedures. A controlled prospective study of 107 children undergoing tympanostomy and tube surgery over a 1-year period was undertaken. Subjects were randomly assigned to receive antibiotic-steroid otic drops at the time of surgery and for 1 week afterward, oral ampicillin for 24 hours preceding and 3 days following surgery, or no prophylactic treatment. The overall infection rate within four weeks of surgery was 12 percent. Purulent otorrhea occurred in 18 percent of those receiving no prophylactic treatment, in 13 percent receiving ampicillin, and in 6 percent receiving antibiotic-steroid otic drops. Postoperative infection was related to preoperative history of status otitis media and to previous placement of ventilation tubes.
Splenosis, the autotransplantation of splenic tissue following traumatic rupture of the spleen, can mimic endometriosis when discovered at laparotomy. The splenic implants are usually widespread throughout the peritoneal cavity. The differential diagnosis includes metastatic cancer, hemangiomas, and accessory spleens as well as endometriosis. The authors present a case of splenosis mistaken at laparotomy for endometriosis, and review the literature on splenosis encountered at gynecologic surgery. As splenosis is usually asymptomatic and may partially compensate for the asplenic state, it is recommended that asymptomatic splenosis not be resected when encountered at surgery.
Prolonged exposure to cold produced a chronic diminution in PS (PS-hyposomnia) primarily in the tonic component of PS. No significant change occurred in the REM (phasic or obligatory) component of PS. An inverse correlation was found in the activity of the pituitary-adrenal cortical system and the level of PS. The classical rebound phenomenon that occurs after PS deprivation was not observed in this study and it is suggested that the rebound effect characteristic of PS deprivation is related not to total PS but to its phasic (obligatory) component.
A plan of management, based on a personal experience of 421 cases, has been developed for the outpatient diagnosis of breast symptoms. In the majority of patients the presence of absence of malignancy can be established with a high degree of certainty before biopsy, and benign masses can be safely excised on an outpatient basis. Only those patients whose breast symptoms and findings suggest malignancy need be admitted to hospital and prepared for major breast surgery. This plan has been shown to be safe, while avoiding unnecessary hospital bed occupancy.
An aged Connemara mare had a neurological illness lasting 3 weeks and characterised by episodes of dullness, head-pressing, staggering gait and hyperexcitability. The signs recurred at intervals of 3 to 4 days, with intervening periods of apparent normality. Post-mortem examination revealed an epidermoid cyst on the dorsal surface of the occipital lobe of the left cerebral hemisphere. The cyst was lined by stratified squamous epithelium and contained desquamated keratinised material and blood. The lesion is considered to be a congenital malformation which enlarges and produces space-occupying signs.
Dextran 70 infusion into dogs prevents platelet adhesion to extracorporeal surfaces as effectively as direct coating of the surfaces with albumin. This is demonstrated by two experimental approaches. One of these involves a detailed analysis in 14 mongrel dogs of the effects of hemoperfusion on the systemic platelet levels, hematocrits, and dextran concentrations. The second approach is in the form of 23 platelet retention tests carried out in four mongrel dogs.
At least two transport systems serve for the entry of l-methionine into Escherichia coli. One of these systems has a high affinity for methionine (K(T) of about 10(-7) M) and is inhibited by methionyl peptides. The other system has a lower affinity (K(T) of 40 muM). Mutants defective in metD lack the high-affinity system and are unable to utilize d-methionine or N-acetylmethionine as methionine sources. A mutant was isolated which not only lacks the high-affinity system, but which also exhibits decreased activity of the low-affinity system. The transport parameters of the activity remaining in this strain were measured. The energy source for transport appears to be the same as that in the parental strain. The loss of the transport activities was not accompanied by major changes in the methionine pool size or in the rate of methionine excretion or synthesis. The analysis of revertants and transduction crosses supports the conclusion that the strain described is a double mutant in both metD (which codes for the high-affinity system) and metP (the low-affinity system). The metD locus was found to lie between tonA (38% co-transduction) and proA (9% co-transduction).