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Biomedical subjects

S A Crane

Publications and source records attributed to S A Crane.

11 recordsLinked to original sources
PubMed1998

A randomized, prospective, double-blind comparison of midazolam (Versed) and emulsified diazepam (Dizac) for opioid-based, conscious sedation in endoscopic procedures.

OBJECTIVE: We completed a prospective, randomized, double-blinded clinical trial to compare the quality of sedation with two benzodiazepines (emulsified diazepam and midazolam) for endoscopic procedures. METHODS: Adult patients undergoing esophagogastroduodenoscopy or colonoscopy were eligible. Exclusion criteria included: drug allergies, altered mental status, untreated glaucoma, active pancreatitis, hyperlipidemia, resident physician training, or cases done outside the Endoscopy unit. Nurses began the sedation process by administering an opioid followed immediately by administering study drugs until patients were adequately sedated. At completion of the procedure, both the physician and the nurse rated whether the patient's sedation appeared to be adequate. In addition, before discharge, patients were asked to rate the quality of sedation. RESULTS: A total of 111 patients were randomized to the emulsified diazepam group and 100 to the midazolam group. There was no difference in the physician's assessment of quality of sedation between the groups (p > 0.05). The length of time to sedation, total procedure time, and recovery time were similar between both groups. The estimated cost of using emulsified diazepam was approximately 50% less than that of midazolam, with an equal quality of sedation. CONCLUSION: Neither the physicians, nurses, nor the patients could detect a difference between sedation produced by the drugs. We conclude that both drugs were equally effective for sedation for both upper and lower endoscopic procedures. Based on the results of this trial, we suggest that increased use of emulsified diazepam would markedly reduce the cost without altering the quality of sedation. The cost savings would be at least $50,000/yr at our institution.

Adult↗
PubMed1990

Peritoneal fluid values from healthy foals.

Peritoneal fluid was analysed from 17 foals, aged 13 to 134 days with a mean age of 68 days. Cytologically, the peritoneal fluid was characterised by a mean total cell count of 0.45 x 10(9)/litre (range 0.06 to 1.42 x 10(9)/litre), rare eosinophils, rare cytophagia and variable percentages of neutrophils and mononuclear cells. These data indicate that peritoneal fluid nucleated cell counts over 1.50 x 10(9)/litre in the foal should be interpreted as elevated. Biochemical evaluation revealed a mean biuret protein level of 12 g/litre, mean refractive index protein level of 16 g/litre and urea nitrogen concentration of 1.96 mmol/litre. There was no correlation between the foals' white blood cell and peritoneal fluid nucleated cell counts. Results of this study indicate that adult horse reference values for evaluation of peritoneal fluid are of questionable validity for foals. Diagnostically, the most important observation was that maximum peritoneal fluid nucleated cell counts in healthy foals were much lower than reported maximal reference values for adult horses (1.5 x 10(9)/litre versus 5.0 x 10(9)/litre or 10.0 x 10(9)/litre).

Animals↗
PubMed1989

Cytologic and bacteriologic evaluation of tracheobronchial aspirates from clinically normal foals.

Thirty-eight tracheobronchial aspirates (TBA) were collected from twenty 1 to 6-month-old foals, which were free of clinical signs of respiratory tract or other infectious disease. We collected TBA from 9 of the foals 3 times when they were approximately 8, 16, and 24 weeks old. Aspirates were examined cytologically after staining with modified Wright-Giemsa, Gram, toluidine blue, and prussian blue stains. Aerobic bacterial culturing was performed on all aspirates. Of the 20 initial TBA, 4 (20%) were normal cytologically on the basis of previously defined criteria for TBA from clinically normal horses, 6 (30%) had a high percentage of eosinophils (greater than 5%), 8 (40%) were classified as indicative of subacute inflammation, and 2 (10%) were classified as indicative of acute inflammation. Nine (45%) were positive for mast cells and none were positive for hemosiderin-laden macrophages (hemosiderophages). Of the 9 foals from which samples were collected at 16 and 24 weeks of age, results were similar, except for an increase in the number of TBA classified as indicative of chronic inflammation (33% and 22% respectively) and the number positive for hemosiderophages (33% and 88%, respectively). One TBA was considered nondiagnostic because of pharyngeal contamination. Culturing of 12 of the 37 aspirates (32%) yielded a potential microbial pathogen. Only 2 were positive cultures from the same foal. The following organisms were isolated: beta-hemolytic Streptococci spp (4), Actinobacillus/Pasteurella spp (4), Rhodococcus equi (2), unidentified nonenteric Gram-negative rod (1), and Escherichia coli (1). Thirty-four of the 37 aspirates (92%) yielded light growth of various organisms considered to be nonpathogenic and normal inhabitants of the upper respiratory tract.

Animals↗
PubMed1988

Failure of a cytoprotective dose of Arbacet to heal acute gastric ulcers.

Twenty outpatients with an endoscopic diagnosis of gastric ulcer were evaluated for 6 wk in a randomized, double-blind trial comparing 15(R)-15-methyl prostaglandin E2 (Arbacet) (10 micrograms, 0.5 h before each meal and at bedtime) with placebo. Endoscopy was performed at 3 wk and 6 wk during the study period. Five of nine patients (56%) taking Arbacet and seven of 11 patients (64%) in the placebo group had complete healing of their gastric ulcer. Healing occurred in four patients from the Arbacet group and three patients in the placebo group at 3 wk. A cytoprotective dose of Arbacet (40 micrograms daily) is not significantly better than placebo in healing gastric ulcers.

Acute Disease↗
PubMed1987

The effect of 15(R)-15-methyl prostaglandin E2 (Arbacet) on the healing of aspirin or nonsteroidal antiinflammatory drug-induced gastric mucosal lesions: an endoscopic study.

Twenty-nine outpatients chronically ingesting daily aspirin or nonsteroidal antiinflammatory drugs for rheumatological disease, who had endoscopically proven gastric mucosal lesions worse than erythema, were evaluated for 4 wk in a randomized, double-blind trial comparing 15(R)-15-methyl prostaglandin E2 (Arbacet) (10 micrograms, 0.5 h before each meal and at bedtime) with placebo. Patients continued their usual daily dose of antiarthritic medication throughout the study period, and an endoscopy was performed on the final day to assess healing. Five of 14 patients (36%) taking Arbacet and two of 15 patients (13%) in the placebo group had complete healing of their gastric lesions after 4 wk. Arbacet at a daily dose of 40 micrograms is not significantly better than placebo in healing gastric lesions caused by aspirin or nonsteroidal antiinflammatory drugs, if antiinflammatory therapy is continued.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1983

Giant duodenal ulcers. Successful healing with medical therapy.

Giant duodenal ulcers (GDU) have been associated with a high incidence of morbidity and mortality unless early operative intervention is undertaken. There are few published reports of successful medical management of GDU. Therefore, we reviewed 14 consecutive patients with GDU at our institution. Excluding the following cases: Two patients who had elective surgery, two patients who died from unrelated causes, and one patient who initially presented with a complication of GDU, complete healing was accomplished in eight of nine patients with cimetidine, antacids, and close observation. We conclude from our review that uncomplicated GDU can be successfully treated with medical therapy.

Adult↗
PubMed1982

Intra-abdominal hemorrhage from ruptured varices.

Three patients with Laënnec's cirrhosis were initially seen with anemia, abdominal pain, and increased abdominal girth. Hemoperitoneum was diagnosed by paracentesis, and laparotomy revealed ruptured intraperitoneal varices. The two patients with more severe depletion died. The other patient, who was initially normotensive but had orthostatic changes, survived. A review of 11 previously reported cases is presented. Abdominal pain, hypotension, and increased abdominal girth were common initial findings, and should lead to early abdominal paracentesis. Suture ligation of the bleeding varix gives the greatest likelihood of survival.

Abdomen↗
PubMed1982

Oxygen uptake and mechanical tension in esophageal smooth muscle from opossums and cats.

In 44 opossums and 4 cats weighing 1.5-2.5 kg, measurements of O2 consumption were made on esophageal muscle strips using a modified Clark-type polarograph. All strips were cut in the transverse axis of the esophagus and comprised the circular and longitudinal muscle layers and intrinsic nerves. Strips were 20 mm long, 2 mm wide, and less than 0.5 mm thick. The average uptake by all strips was less than 5 microliters O2 . mg dry muscle-1.h-1 at 37 degrees C and was temperature dependent (Q10, 2.2). There was no difference in base-line O2 consumption between strips coming from the proximal, middle, or distal third of the esophageal body and strips coming from the lower esophageal sphincter. Increases in length or tension increased the O2 consumption by sphincter strips but had no effect on body strips. Carbachol (10(-5) M) led to increases of base-line muscle tension and O2 consumption in both sphincter and body strips. Isoproterenol (10(-6) M) decreased the baseline tension and O2 consumption in sphincter strips only. The maintenance of a high basal tension by the lower esophageal sphincter is oxygen dependent and therefore an active muscular process. Also, no gradient of metabolic activity can be demonstrated along the smooth muscle segment of the esophagus.

Animals↗
PubMed1979

Long-term cimetidine and anticholinergic therapy in patients with gastrinoma.

Two patients with gastrinomas were treated with cimetidine and an anticholinergic drug for greater than 20 months after exploratory laparotomy disclosed no solitary resectable tumor. Both have done well, and thus this therapy is recommended as a safe and effective alternative to total gastrectomy in reliable patients. Additional therapeutic methods are needed to control tumor growth.

Administration, Oral↗