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Biomedical subjects

H B Cook

Publications and source records attributed to H B Cook.

At least 19 recordsLinked to original sources
PubMed1991

Colonoscopically detected colorectal cancer missed on barium enema.

The radiographs and clinical records of 26 patients with colorectal cancer missed on barium enema, and subsequently detected at colonoscopy, were reviewed to determine the cause of radiological error. Twenty (77%) of the patients were female. In 24 of 26 patients, anemia and/or rectal bleeding was a presenting feature. Fourteen of the 26 (54%) missed cancers were in the sigmoid colon, 10 (38%) in the ascending colon or hepatic flexure, and two (8%) in the rectum. Tumor size ranged from 20-100 mm. Fifteen were polyps, and 11 annular cancers. Fourteen (54%) were Dukes C or D tumors. Twenty-eight barium enemas in 23 patients were available for review: 86% were double-contrast studies. In 18 (76%), the cancer could be seen in retrospect and, in over half, the tumor was obvious. The dominant perceptive error was due to missing the lesion in the barium pool. Other major errors were missing the lesion en face or in overlapping loops. As most cancers were missed because of observer perceptive error, by both experienced and inexperienced radiologists, the authors recommend double reporting of all barium enemas.

Aged↗
PubMed1988

Defenestration of hepatic sinusoids as a cause of hyperlipoproteinaemia in alcoholics.

The hepatic sinusoidal endothelium separates sinusoidal blood from hepatocytes; changes in the porosity of this endothelium may affect the passage of chylomicrons into hepatocytes and influence lipid metabolism. Chronic exposure to ethanol reduces the porosity of the endothelium; this mechanism may underlie the hyperlipoproteinaemia observed in some people who drink heavily.

Adult↗
PubMed1987

Dientamoeba fragilis: a bowel pathogen?

Although many patients infected with Dientamoeba fragilis suffer gastrointestinal symptoms, controversy still surrounds the pathogenic role of this intestinal protozoan. We describe three patients infected with D fragilis who had gastrointestinal symptoms. In the first patient symptoms resolved with therapy before the protozoan was eradicated from the stool, however in the second, symptoms persisted unabated despite clearing of the organism. In the third patient, symptoms resolution was associated with effective treatment. We discuss the life cycle, diagnosis and treatment of this organism and its role as a pathogen.

Adult↗
PubMed1986

Colonoscopy and bacteraemia: an experience in 50 patients.

There is little consensus concerning the incidence of bacteraemia during colonoscopy and the need for antibiotic prophylaxis in susceptible patients. Hepatic abscesses in one patient which may have been related to prior colonoscopic examinations led the authors to carry out a prospective study of 50 patients undergoing colonoscopy. Multiple blood cultures were carried out to maximise the positive yield of transient bacteraemia and to attempt to determine the time when bacteraemia is most likely to occur. Five patients had positive blood cultures. In two patients S epidermidis was isolated, but only from the precolonoscopic blood sample. In three subjects enteric organisms were cultured from blood samples obtained during the procedure. In one of these three the same organism was cultured from the preendoscopic blood sample so that in only two patients (4%) could the bacteraemia be attributed to the colonoscopy. These results would suggest that the risk of bacteraemia during colonoscopy is low.

Adult↗
PubMed1985

Halothane hepatitis: toxicity or hypersensitivity?

A 32 year old female developed a severe hepatitis (serum bilirubin 544 mumol/l) one week after a halothane anaesthetic. Six months later a general anaesthetic was administered via a halothane free circuit without incident. A year later a further non halothane anaesthetic was administered this time utilising the routine circuit after briefly flushing the rubber tubing with oxygen. That evening she became febrile and the following day abnormal liver function tests were documented. She remained asymptomatic.

Adult↗
PubMed1983

Familial short stature and coeliac disease: a family case report.

A case of coeliac disease associated with growth retardation and pubertal failure in a 19 year old female is reported. Diagnosis was delayed by use of the term 'undiagnosed short stature'. Investigations confirmed severe malabsorption, osteoporosis and marked delay in bone growth associated with small bowel mucosal atrophy. HLA screening of the patient's family led to the identification of coeliac disease in her brother aged 12 years and her asymptomatic mother both of whom were short in stature. The institution of a gluten free diet, appropriate vitamin and mineral supplements has restored growth and sexual development to normal in the affected children. These cases emphasize the variable nature of coeliac disease, its familial occurrence and the need to exclude the disorder in cases of undiagnosed (familial) short stature.

Adult↗
PubMed1982

Clostridium difficile-associated colitis: cross infection in predisposed patients with renal failure.

Four men with renal failure developed Clostridium difficile-associated diarrhoea while being cared for in the same ward at about the same time. Cross infection appeared to play a role. All patients had received antibiotics; three were treated for chest infections and one for a urinary tract infection. The antibiotics implicated were cefoxitin alone in two patients, cefoperazone alone in one patient and cloxacillin, cefoperazone and amoxycillin in the last patient. Two patients had received immunosuppressive agents as well. Clostridium difficile cytotoxin was detected in stools from all patients using a cell culture assay. Pseudomembranous colitis was demonstrated in two patients at sigmoidoscopy and in one at post mortem. All patient were given oral vancomycin. Two died with the disease, one following relapse in the absence of antibiotics, and two patients were cured only to die later of unrelated diseases. Isolation of affected patients seems prudent as the disease may be infectious.

Anti-Bacterial Agents↗
PubMed1981

Comparison of three methods to estimate steatorrhoea.

Faecal fat excretion was estimated in 24 patients using three methods. Quantitative estimations of fat excretion were calculated from both a three day faecal fat collection and a twenty-four hour faecal collection corrected for excretion of a cuprous thiocyanate marker. Breath 14CO2 excretion was measured after ingestion of a liquid meal containing 2.5 microCi of 14C-triolein in an arachis oil emulsion. Peak concentrations of 14CO2 in breath were used as an estimate of the degree of fat absorption. Correlation between the two quantitative measures of faecal fat was good (r = 0.87), 17 patients having steatorrhoea of more than 7 g fat per day by both estimations. Results of the breath test were disappointing. With the standard meal containing 20 g arachis oil the lowest peak 14CO2 excretion rate seen in subjects without steatorrhoea, 3 percent of the dose per hour, was taken as the lower limit of normal. Seven subjects with steatorrhoea as shown by faecal collections excreted normal amounts of 14CO2. When the size of the fat meal was increased to 1.0 g arachis oil per kg body weight in 16 of the subjects previously studied, all patients with proven steatorrhoea excreted less than 3 percent of the dose per hour but three of the subjects without steatorrhoea gave abnormal breath excretion results. It is concluded that the collection of a 24 hour faecal specimen using a cuprous thiocyanate marker provides a more reliable estimate of faecal fat excretion than the 14C-triolein breath test.

Breath Tests↗
PubMed1979

Skin testing for coeliac disease.

Subfractions of gluten from two genetically different New Zealand wheats were injected intradermally in 16 patients with coeliac disease and 20 healthy controls. The coeliac patients as a group exhibited greater skin reactions when examined at seven hours than the controls. However, the skin test did not give sufficient discrimination to make it clinically useful as a screening test for coeliac disease.

Adolescent↗
PubMed1979

Serum bile acids and rountine liver function tests in patients with chronic liver disease and cholestasis.

Serum bile acids were measured in 28 patients with established liver disease. The peak serum level after a meal was as sensitive an index of liver disease as a combination of serum bilirubin, aspartate amino transferase, alkaline phosphatase and gamma glutamyl transpeptidase and was more often abnormal than any one of the four tests. Serum bile acid measurements may be of most value in detecting cirrhosis when the activity of disease is minimal.

Bile Acids and Salts↗