Biomedical subjects
Publications and source records attributed to P L Cook.
A biopsy of a fifth lumbar vertebral lesion confirmed that an intracranial meningioma had metastasized 12 years after the diagnosis of the primary tumour. A literature review reports 25 cases of extracranial osseous metastases from meningioma. The mechanisms of spread are discussed as is the role of surgery in the seeding of such tumours.
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A negative association has been reported between osteoarthritis and osteoporosis. There are, however, few population based data to support this association. In this study the bone density in the upper femur was compared with the presence and severity of hip osteoarthritis in 314 subjects undergoing radiography for non-skeletal indications. There was a statistically significant negative association between the two disorders. This relation may reflect differences in the cause of these two major musculoskeletal conditions.
A patient exhibiting typical features of classical rheumatoid arthritis and psoriatic spondylitis is described. The patient, a woman, presented at the age of 29 with an inflammatory arthritis. Twenty years later, she developed psoriasis, and after a further 3 years, she was first noted to have rheumatoid nodules and to be strongly seropositive. Now at the age of 60, she has a rigid spine with radiographic changes of spondylitis. Neither rheumatoid arthritis, nor psoriatic spondylitis can account for all the features of her disease and there is evidence to suggest that both conditions combined to damage her peripheral joints.
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The findings on plain radiographs and at water-soluble radiculography are compared with those at laminectomy in 50 patients with lumbar disc protrusions. Predictions of the level of disc protrusion based on the plain radiographic appearances could be made in 71%. Water-soluble radiculography accurately demonstrated 50 of 52 protrusions (96%). No abnormality was found at surgery at three other disc levels where equivocal radiculographic appearances failed to eliminate the possibility of disc protrusion. When all the levels examined surgically are included the water-soluble radiculogram was accurate at 57 levels out of 62 (92%). The immediate morbidity of radiculography is described and significant side effects were shown by 23% of patients.
An increase in the thickness of the soft tissues of the posterior nasopharyngeal wall has been described in patients with a fracture of the skull base (Andrew, 1978). Measurements of this soft tissue layer made in the same way, in Southampton, have shown a striking difference in the mean and in the normal range both in adolescents and adults. The normal measurements overlap those found in patients with a fracture of the skull base and the sign is not therefore a reliable indication of the presence of such a fracture.
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Six neonates are described in whom plain films of the abdomen demonstrated scattered flecks of calcification. Three of the patients had rectal atresia with recto-urethral fistula, one rectal atresia without fistula, one jejunal atresia and one a severe stenosis of the distal small bowel associated with log segment aganglionosis. At operation the calcification was found to be in meconium within the bowel lumen and not as expected to represent serosal plaques following meconium peritonitis due to an intrauterine bowel perforation. Previous case reports are reviewed and possible mechanism discussed.
A description is given of a simple, inexpensive and versatile method for estimating underwater weight. The use of a portable stock tank allows the determination of % Fat by underwater weighing without requiring a swimming pool, built-in tank, or special facility. Twenty-eight college students were weighed on two separate testing sessions 24-48 hours apart. Ten trials were performed at each session. The mean of the last five trials was used in determining underwater weight. The test-retest reliability coefficient was high, r = 0.98, and most of the successive trial correlations were above 0.99. The mean % Fat for the women (N = 9) was 22.2 +/- 5.9 and for the men (N = 19) was 13.7 +/- 5.1.
A 55-year-old man with bilateral cervical chemodectoma is reported. The differences between tumours of the carotid body and those of the glomus intravagale are described and a brief review of the investigation and management of such tumours is given.
A case is presented in which a post-cricoid web was shown arising posteriorly instead of in the almost invariable anterior situation. The patient was not anaemic and some brief comments are made on the inconstant relationship between anaemia and the presence of a web.
3 investigations have been undertaken to study the interrelationship between a bifid pelvicalyceal collecting system, vesico-ureteric reflux and lateral ectopia of the ureteric orifice. Firstly, in 30 families investigated to confirm the familial incidence of bifid and double ureters there were 3 families in which siblings were found with primary reflux. Secondly, reflux was found in 62 of 110 patients investigated with a duplex pelvicalyceal system. Reflux was to the ipsilateral kidney in 48 patients but occurred to the contralateral kidney, unaffected by duplicity, in 14. This high incidence of reflux is related to lateral ectopia of the ureteric orifice which may be either bilateral or unilateral. Thirdly, the incidence of a bifid pelvicalyceal system was determined in the parents and siblings of a series of 32 patients with primary reflux. The results support the hypothesis that primary reflux may be inherited by an autosomal dominant gene of variable penetrance in a manner similar to the inheritance of a duplex urinary tract. Thus there is a direct genetic relationship between primary vesico-ureteric reflux, lateral ectopia of the ureteric orifices and a duplex pelvicalyceal system.
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In patients presenting with suspected spinal dysraphism of the occult type, particularly children, cisternal gas myelography is coming to be accepted as the radiological investigation of choice. The technique of the examination as performed on 40 such patients is described in detail. There have been no complications. Twenty-five patients showed abnormalities of the cord together with low termination and abnormal fixation of the conus. The visualization was excellent in terms both of reliability and detail. The reasons for the difficulties in demonstrating these lesions using positive contrast and for preferring gas myelography are discussed.
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