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Biomedical subjects

R Crawford

Publications and source records attributed to R Crawford.

At least 37 records · Page 2Linked to original sources
PubMed2000

Beliefs among pulmonologists and thoracic surgeons in the therapeutic approach to non-small cell lung cancer.

STUDY OBJECTIVES: The physicians who initially evaluate patients with non-small cell lung cancer (NSCLC) strongly impact the course of therapy. Their beliefs in treatment and prognosis may contribute to practices of variable quality and appropriateness. We sought to better describe beliefs among pulmonologists and thoracic surgeons who were selected for guiding early therapy and referrals in patients with NSCLC. DESIGN: Mail questionnaire focusing on survival estimates, treatment perceptions, and referral patterns. PARTICIPANTS: Twelve hundred pulmonologists and 800 thoracic surgeons who were clinically active members of the American College of Chest Physicians. MEASUREMENTS AND RESULTS: Response rates of 50% for pulmonologists and 52% for thoracic surgeons were obtained after two mailings. Five-year survival estimates for patients with resected stage I NSCLC revealed that 30% of respondents overestimated survival rates and 18% underestimated survival rates. The underestimation of survival rate was found among more respondents who are practicing pulmonology than thoracic surgery (22% vs 10% [corrected], respectively), who were trained before 1980 than after 1980 (29% vs 10% [corrected], respectively), and who were seeing < 10 lung cancer patients annually than those who were seeing > 25 (31% vs 0.14%, respectively). Beliefs in the survival benefit of adjuvant chemotherapy or of radiation in stage I-IIIA disease divided respondents within both specialties. Chemotherapy plus radiation vs radiation alone in unresectable stage IIIA-B NSCLC was viewed as benefiting survival less often by physicians seeing < 10 lung cancer patients annually rather than > 25 (57% vs 77% [corrected], respectively) and by physicians underestimating rather than correctly estimating survival in early-stage disease (58% vs 72% [corrected], respectively). Chemotherapy was believed to confer survival benefits in patients with stage IV disease by one third of respondents. CONCLUSIONS: Certain physician characteristics, particularly the length of time since training and NSCLC patient volume, are associated with beliefs not conclusively supported in the medical literature or with opinions inconsistent within and between specialties.

Adult↗
PubMed1999

Review, critique, and guidelines for the use of herbs and homeopathy.

The number of Americans that use alternative therapies, including herbal products, is increasing by overwhelming proportions. Hundreds of herbal products and homeopathic remedies are available to the consumer, but most of these have not been proved safe or effective. Consumers are now turning to their health care provider for guidance concerning the quality, proper use, adverse effects, and precautions associated with these products. Health care providers must develop a thorough understanding of the available literature concerning herbal products and homeopathy to provide patients with truthful, unbiased information regarding the potential risks and benefits of each herbal product. This article addresses the distinct difference between herbalism and homeopathy, the importance of standardization, and general use precautions concerning herbal products.

Homeopathy↗
PubMed1999

'Popping': a cause of soft tissue sepsis in chronic drug abusers.

Septic complications arising from drug misuse are well documented. It is likely that most complications occur as a result of attempted intravenous (i.v.) injection. We report four cases of soft tissue infections where the patients were unable to obtain i.v. access and gave injections of drugs using a technique known as 'popping'. 'Popping' is the deliberate injection of drugs subcutaneously or intramuscularly when i.v. access is not possible. This practice is further discussed and the literature associated with soft tissue infections from drug misuse is reviewed.

Adult↗
PubMed1999

De novo synthesis of 4,5-dimethoxycatechol and 2, 5-dimethoxyhydroquinone by the brown rot fungus Gloeophyllum trabeum.

The new dimethoxycatechol 4,5-dimethoxy-1,2-benzenediol (DMC) and the new dimethoxyhydroquinone 2,5-dimethoxy-1,4-benzenediol (DMH) were isolated from stationary cultures of the brown rot fungus Gloeophyllum trabeum growing on a glucose mineral medium protected from light. The structure was elucidated by gas chromatography-mass spectrometry through comparison to a synthetic standard. Further confirmation was obtained by forming a dimethoxyoxazole derivative by condensation of DMC with methylene chloride and through examination of methylated derivatives. DMC and DMH may serve as ferric chelators, oxygen-reducing agents, and redox-cycling molecules, which would include functioning as electron transport carriers to Fenton's reactions. Thus, they appear to be important components of the brown rot decay system of the fungus.

Journal Article↗
PubMed1999

Deposition of calcium pyrophosphate in tissue after revision arthroplasty of the hip.

We reviewed histologically the incidence and pathogenesis of the deposition of calcium pyrophosphate dihydrate (CPPD) crystals in the pseudocapsule, femoral and acetabular membranes and periprosthetic tissue at revision of 789 cases of failed total hip replacement. In 13, periprosthetic tissues were found to have deposits of CPPD crystals in areas of cartilaginous metaplasia; four also showed evidence of localised deposition of amyloid. None of the patients had a history of chondrocalcinosis in the hip or other joints. Cartilaginous metaplasia and other changes in periprosthetic tissues may predispose to the deposition of CPPD and associated localised amyloid.

Acetabulum↗
PubMed1999

Does arthritis progress in the retained compartments after 'Oxford' medial unicompartmental arthroplasty? A clinical and radiological study with a minimum ten-year follow-up.

We determined the outcome of 56 'Oxford' unicompartmental replacements performed for anteromedial osteoarthritis of the knee between 1982 and 1987. Of these, 24 were in patients who had died without revision, one was lost to follow-up and two had been revised. Of the remaining 29 knees, 26 were examined clinically and radiologically, two were only examined clinically and one patient was contacted by telephone. The mean age of the patients was 80.3 years. At a mean follow-up of 11.4 years (10 to 14) the measurements of the knee score, range of movement and degree of deformity were not significantly different from those made one to two years after operation, except that the range of flexion had improved. Comparison of fluoroscopically-controlled radiographs at a similar interval of time showed no change in the appearance of the lateral compartments. The retained articular cartilage continued to function for ten or more years which suggests that anteromedial osteoarthritis may be considered as a focal disorder of the knee. This justifies continued efforts to develop methods of treatment which preserve intact joint structures.

Aged↗
PubMed1999

The clinical applications of Ginkgo biloba, St. John's wort, saw palmetto, and soy.

The use of herbal or alternative therapies continues to increase each year. This article extensively reviews four of the more commonly used herbs and dietary supplements: ginkgo biloba, St. John's wort, saw palmetto, and soy. The pharmacology, precautions, therapeutic uses, and adverse effects for each of these therapies are discussed.

Ericales↗
PubMed1999

The clinical anticalculus efficacy of a tartar control whitening dentifrice for the prevention of supragingival calculus in a three-month study.

The objective of this double-blind clinical study was to compare the effect of a new dentifrice (Colgate Tartar Control Plus Whitening Fluoride Toothpaste) for the prevention of supragingival calculus, with that of a commercially available calculus-inhibiting dentifrice (Crest Tartar Control Toothpaste). The study involved adult male and female subjects who had pre-qualified for participation by developing sufficient supragingival calculus (greater than 7.0 on the Volpe-Manhold Calculus Index) during an eight-week screening period. Subjects received a full oral prophylaxis, and were stratified into two treatment groups balanced for age, sex and qualifying calculus score. Subjects were instructed to brush their teeth twice daily (morning and evening) for one minute with their assigned dentifrice using a soft-bristled toothbrush. Examinations for dental calculus were performed after twelve weeks' use of the study dentifrices, using the Volpe-Manhold Calculus Index, Fifty-eight (58) subjects complied with the protocol and completed the entire study. The Colgate Tartar Control Plus Whitening group exhibited a statistically significant (p < 0.001) 34.6% reduction in mean calculus score compared to the Crest Tartar Control group.

Adult↗
PubMed1999

Impact on an accident and emergency department of Glasgow's new primary care emergency service.

OBJECTIVE: To determine the impact, in terms of new attendance figures and types of patients attending, on a city centre accident and emergency (A & E) department following the establishment of out-of-hours primary care emergency centres (PCECs) in Glasgow. METHODS: A questionnaire survey of A&E patients attending out-of-hours at Glasgow Royal Infirmary A&E department, a city centre department with approximately 68,000 new annual attendances, one week before (Group A), twelve weeks after (Group B) and one year after (Group C) the introduction of PCECs. Main outcome measures were attendance numbers within working hours and out-of-hours, reason for A&E attendance, duration of presenting condition, whether primary care services were contacted and awareness of the new primary care emergency centres. RESULTS: In respect of out-of-hours attendances, 612 questionnaires were completed for group A, 715 for group B and 645 for group C. There was no significant difference in the type of presenting complaints between the groups, i.e. illness or injury. The majority of patients presented within 24 hours of the onset of their condition (82%, 79% and 80% of patients in groups A, B and C respectively). There was a reduction in those attending with conditions of more than one week's duration (8% in group A, 7% in group B and 5% in group C). There was a decrease in the number of patients who considered their problem to be non-urgent (27% in group A, 22% in group B and 16% in group C). Prior to the introduction of the PCEC service 18% of patients (108) had contacted their GP before attending, compared with only 9% (63) of group B and 9% (57) of group C patients. Of these patients there was a significant decrease in the number of patients attending following GP referral. Of the patients who had not contacted the primary care services only 35% (201) knew of the introduction of PCECs 12 weeks later, increasing to 52% (291) after one year (p < 0.01). Significance calculations were performed using a Difference of Proportion Test with a 99% significance level. CONCLUSIONS: Our results suggest that the new PCEC service has not had a significant impact on the number or type of patients attending this A&E department, with fewer self-referred patients contacting primary care services after its introduction. Following the introduction of the PCECs there was a trend towards more patients attending A&E following telephone advice although amongst self-referred A&E patients there remained a large proportion who claimed to be unaware of the new service 12 weeks after, and one year after, the introduction of PCECs. Continued evaluation of the effect on A&E of the new centres will be required to plan future resources for the provision of emergency care.

After-Hours Care↗
PubMed1998

Beta 2-microglobulin amyloid deposition in hip revision arthroplasty tissues.

AIMS: Hip joint disease associated with progressive amyloid deposition in uraemic patients receiving chronic haemodialysis treatment often requires treatment by joint arthroplasty. The aim of this study was to determine whether beta 2-microglobulin amyloid deposition occurred in the periprosthetic tissues of arthroplasties that had undergone aseptic loosening and required a revision procedure. METHODS AND RESULTS: Sections of the pseudocapsule, acetabular and femoral pseudomembrane surrounding failed total hip replacements of five uraemic patients known to have beta 2-microglobulin amyloid deposits at the time of primary joint replacement were examined for the presence of beta 2-microglobulin amyloid deposition by Congo red staining and immunohistochemical staining for beta 2-microglobulin and other amyloid proteins. Clinical and radiological features of each case, including postoperative history and extent of osteolysis, were also noted. In all cases evidence of beta 2-microglobulin amyloid deposits were found in one or more of the above periprosthetic tissues. In three of these cases amyloid deposition was extensive. CONCLUSIONS: This study shows that beta 2-microglobulin amyloid deposition occurs in revision arthroplasty tissues. Accelerated loosening of the prosthesis is known to occur in uraemic patients and it is possible that beta 2-microglobulin amyloid deposition may contribute to early arthroplasty failure in uraemic patients who remain on haemodialysis treatment.

Adult↗
PubMed1998

Expansion of an osteoarthritic cyst associated with wear debris: a case report.

We present a case in which the growth of an intraosseous cyst arising from the proximal tibiofibular joint appeared to have been increased by polyethylene wear particles from a medial unicompartmental knee replacement. Histological examination of the cyst wall showed a histiocytic response associated with numerous polyethylene wear particles. This case demonstrates that there is a direct communication between the joint cavity and the cyst. Such communication is probably through openings in the articular cartilage large enough to allow the passage of these particles.

Aged↗
PubMed1998

Efficacy of a dentifrice containing zinc citrate for the control of plaque and gingivitis: a 6-month clinical study in adults.

The objective of this 6-month, double-blind, clinical study, conducted in harmony with American Dental Association (ADA) guidelines, was to evaluate the efficacy of a dentifrice containing 2% zinc citrate and 0.76% sodium monofluorophosphate in a silica base (zinc citrate dentifrice) for the control of supragingival plaque and gingivitis, compared to a control dentifrice containing 0.76% sodium monofluorophosphate in a silica base (control dentifrice). Adult men and women from the Atlanta, Georgia, area were entered in the study and stratified into two treatment groups, which were balanced for baseline Quigley-Hein Plaque Index scores and baseline Löe-Silness Gingival Index scores. Participants received an oral prophylaxis and were instructed to brush their teeth twice daily (morning and evening) for 1 minute with their assigned dentifrice, using a soft-bristled toothbrush. Examinations for supragingival plaque and gingivitis were conducted after 3 months and again after 6 months' use of the study dentifrices. Ninety-nine participants complied with the protocol and completed the entire 6-month clinical study. At both the 3- and 6-month study examinations, the zinc citrate dentifrice group exhibited statistically significant reductions in both plaque and gingivitis compared to the control dentifrice group, based on whole-mouth data. At the 6-month examination, the magnitude of these reductions met or exceeded 18% for both plaque and gingivitis (25.3% for plaque; 18.8% for gingivitis). The effect of the zinc citrate dentifrice was most pronounced on the more severe manifestations of plaque and gingivitis, indicating a statistically significant (50.2%) reduction in severe plaque and a statistically significant (66.7%) reduction in severe gingivitis over the control dentifrice after 6 months of use. Similar findings were observed for data obtained from proximal, lingual, and posterior sites. Among the sites that indicated a tendency toward high levels of plaque or gingivitis based on the baseline scores, substantially fewer sites tended to continue to present such high levels at follow-up exams in the zinc citrate dentifrice group than in the control dentifrice group. Thus, in accordance with the 1986 guidelines published by the ADA and the 1994 revision published by the Task Force on Design and Analysis in Dental and Oral Research, the results of this study support the conclusion that a dentifrice containing 2% zinc citrate and 0.76% sodium monofluorophosphate in a silica base is clinically efficacious for the control of supragingival plaque and gingivitis.

Adolescent↗
PubMed1998

Clinical efficacy of a dentifrice containing zinc citrate: a 12-week calculus clinical study in adults.

The objective of this double-blind clinical study, conducted following the Volpe-Manhold design for studies of dental calculus, was to investigate the efficacy of a dentifrice containing 2% zinc citrate and 0.76% sodium monofluorophosphate in a silica base (zinc citrate dentifrice) as compared to a control dentifrice containing 0.76% sodium monofluorophosphate in a silica base (control dentifrice). Adult men and women from the Northern New Jersey area were provided a full oral prophylaxis and assigned the use of a control (non-tartar-control) dentifrice for 8 weeks. At the completion of this initial period, participants were assessed for baseline Volpe-Manhold Calculus Index scores, provided another full prophylaxis, and stratified into two treatment groups that were balanced for age, sex, and baseline calculus. Participants were instructed to brush their teeth twice daily (morning and evening) for 1 minute with their assigned dentifrice, using a soft-bristled toothbrush. Examinations for dental calculus were again performed after 12 weeks' use of the study dentifrices. Seventy-five participants complied with the protocol and completed the entire study. At the 12-week examination, the zinc citrate dentifrice group exhibited a statistically significant 31.9% reduction in mean Volpe-Manhold Calculus Index score as compared to the control dentifrice group. Thus, the results of this clinical study support the conclusion that a dentifrice containing 2% zinc citrate and 0.76% sodium monofluorophosphate in a silica base is efficacious for the control of the development of supragingival calculus.

Adolescent↗
PubMed1997

RheothRx (poloxamer 188) injection for the acute painful episode of sickle cell disease: a pilot study.

RheothRx (Glaxo Wellcome Inc, Research Triangle Park, NC; poloxamer 188) Injection is a nonionic surfactant with hemorrheologic properties that suggest it may be useful in treating acute painful episodes (vasoocclusive crises) of sickle cell disease (SCD). We conducted a randomized, double-blind, placebo-controlled pilot study to evaluate the safety and efficacy of poloxamer, formulated as RheothRx Injection, in 50 patients with SCD. Patients with moderate to severe painful episodes requiring parenteral analgesics were randomized to receive a 48-hour infusion of either RheothRx or placebo. Pain was assessed every 4 hours. Efficacy endpoints included: (1) painful episode duration, (2) days of hospitalization, (3) quantity of analgesics used, and (4) pain intensity scores. Three subgroups of patients were considered for efficacy analyses based on the actual duration of the study drug infusion and the completeness of pain score data collection. Compared with placebo and depending on the subgroup, RheothRx-treated patients showed a 16% to 45% decrease in duration of painful episodes, a 1- to 2-day reduction in hospital stay, a threefold to fivefold reduction in analgesic requirements, and a 1-point reduction (using a 5-point scale) in average pain intensity scores at 72 hours. RheothRx was well tolerated; no clinically significant differences were observed between treatments with respect to adverse experiences or other safety measures. In addition, there were no differences between treatment groups in the incidence of recurrent painful episodes. In this study, RheothRx significantly reduced total analgesic use and pain intensity and showed trends to shorter duration of painful episodes and total days of hospitalization. In patients with moderate to severe vasoocclusive pain, RheothRx was safe and may offer a therapeutic benefit.

Adolescent↗
PubMed1997

The melanoma-specific XMEL antigen is expressed in dysplastic naevi.

We have previously shown that a novel monoclonal antibody, XMEL, exhibited reactivity with deep primary melanomas while showing no reactivity with other tumours and normal tissue. XMEL was raised against a part of the extracellular domain of Xmrk, a growth factor receptor presumed to mediate melanoma formation in the Xiphophorus fish model. Here we investigate the range of XMEL immunohistochemical reactivity in paraffin sections from human common acquired and dysplastic naevi of both junctional and compound type. The strongest reactivity was observed with the compound dysplastic naevi. We conclude that the antigen recognized by XMEL acts early in the cascade of genetic alterations underlying progression into malignant melanoma. Our results also support the notion that the dysplastic naevus may play a role in progression of human malignant melanoma and may indeed represent the precursor stage.

Antibodies, Monoclonal↗
PubMed1997

Effect of Strathclyde police initiative "Operation Blade" on accident and emergency attendances due to assault.

OBJECTIVE: To review assault victim attendance at the accident and emergency department of Glasgow Royal Infirmary before and after a police initiative to curb knife carrying and tackle violent assaults ("Operation Blade"). METHODS: Assault victim attendance was reviewed for the month before the implementation of Operation Blade and for one month a year later. The number of victims requiring treatment in the resuscitation room for stab wounds before, during, and after Operation Blade was also reviewed as a crude indicator of the frequency of serious assaults in the city. RESULTS: There were no significant differences in the nature or number of assault victims attending this hospital one year after Operation Blade compared with the month before its implementation. Operation Blade reduced the number of serious stabbings for a period of 10 months, but subsequently numbers surpassed those prevailing before its implementation. CONCLUSIONS: Any attempt to combat this complex and multifactorial problem must be addressed through a combined public health and education initiative in conjunction with regular press and police campaigns to achieve a sustained effect.

Abdominal Injuries↗