Search PubMed⌕ Search

Biomedical subjects

S R Craig

Publications and source records attributed to S R Craig.

At least 19 recordsLinked to original sources
PubMed2000

Lymphocyte responses following open and minimally invasive thoracic surgery.

BACKGROUND: Immunosuppression associated with surgery may predispose to increased tumour growth or recurrence. Lymphocytes are central components of the immune network, signalling specific and non-specific responses in tumour immunosurveillance. This study was therefore designed to compare the effects of minimally invasive and conventional approaches to major thoracic surgery on lymphocyte populations and oxidative activity. PATIENTS AND METHODS: The effects of conventional and minimally invasive video-assisted thoracic surgery (VATS) on the numbers and types of circulating lymphocytes and on lymphocyte oxidation were compared in a prospective randomized study of 41 patients undergoing lobectomy for peripheral bronchogenic carcinoma. Blood taken pre-operatively and on days 2 and 7 post-operatively was analysed for T (CD4, CD8), B (CD19) and natural killer (NK) (CD56, CD16) cell counts and for lymphocyte oxidative activity. Leucocyte numbers were compared with pre-surgical values and oxidative rate with healthy donor controls. RESULTS: Lymphocyte counts fell after surgery; VATS was associated with less effect on circulating T (CD4) cells at 2 days and on NK lymphocytes at 7 days post-surgery. Lymphocyte oxidation was less suppressed in the VATS group 2 days after surgery. In general, post-surgical changes in key cells of cellular immunity were smaller in the VATS group, and recovery to normal levels was more rapid. CONCLUSION: The degree of invasiveness of thoracic surgery may influence the extent of immunosuppression in patients undergoing pulmonary lobectomy for pulmonary neoplasm.

Aged↗
PubMed2000

Blood cholesterol screening influence of fasting state on cholesterol results and management decisions.

OBJECTIVE: To compare fasting and nonfasting total and high-density lipoprotein (HDL) cholesterol values in adults and to determine how closely classification into risk groups for coronary heart disease based on nonfasting blood tests compares with classification based on fasting studies. DESIGN: Cross-sectional study. SETTING: A community hospital general internal medicine clinic. PATIENTS: One hundred eighty-one patients at least 20 years of age receiving medical care at a community hospital general internal medicine clinic. INTERVENTIONS: Total and HDL cholesterol levels were measured twice in each patient within 7 days, once while not fasting and once after a minimum 12-hour fast. MEASUREMENTS AND MAIN RESULTS: Fasting and nonfasting total and HDL cholesterol values were compared, patients were classified into desirable, borderline-high, and high cholesterol groups on the basis of fasting and nonfasting blood studies. There were small, statistically significant but clinically insignificant differences in fasting and nonfasting results for total cholesterol. Nonfasting HDL cholesterol levels were similar to fasting HDL levels. The agreement in classification of patients into desirable and high-cholesterol groups between fasting and non-fasting blood testing was 86.7% and 89.5%, respectively. In the borderline-high group, for whom levels of HDL cholesterol are important in determining subsequent management, there was 95% agreement between fasting and nonfasting HDL cholesterol results. Only a small fraction of the patients were classified into lower-risk groups by the nonfasting assessment, creating the potential for less-rigorous monitoring and treatment of their cholesterol status than if fasting results were utilized. These findings were confirmed in this study also for the subgroups of men aged 35 years and older and women aged 45 years and older. CONCLUSIONS: Screening nonfasting adults for total and HDL cholesterol is appropriate for making decisions about primary prevention of coronary heart disease.

Adult↗
PubMed1999

Merkel cells in the human oesophagus.

Merkel cells (MCs) are well recognized in the basal layers of the skin and oral mucosa, but this paper describes for the first time the presence of MCs in the human oesophagus. These cells are not identified in neonatal oesophagus, but are seen singly and in clusters in adult specimens. Application of stereological techniques shows that MCs are more numerous in the mid-oesophageal region. Cells expressing established markers of MCs have also been demonstrated in two out of six primary small cell carcinomas of the oesophagus. Further investigation of the role of MCs in oesophageal innervation and epithelial biology will be of interest.

Adult↗
PubMed1998

The "annular sandwich": a simple method of reinforcing a friable mitral valve annulus.

In 6 patients undergoing prosthetic mitral valve replacement a ring of Teflon felt, instead of conventional Teflon pledgets, was used because of concern about seating a new prosthesis in a disrupted friable mitral valve annulus. The technique avoided the potential risk of pledget loss in the event of suture breakage and, in these patients, prevented postoperative paraprosthetic mitral valve regurgitation.

Echocardiography, Transesophageal↗
PubMed1998

Effect of blood transfusion on survival after esophagogastrectomy for carcinoma.

BACKGROUND: There is growing evidence that blood transfusion is associated with clinical factors that can lead to transfusion-induced immunosuppression. This effect can be beneficial or deleterious. METHODS: The effect of perioperative allogeneic blood transfusion on survival was studied retrospectively in 524 patients who were discharged from the hospital after esophagogastrectomy for carcinoma performed in a single unit over a 10-year period. RESULTS: The median operative blood loss for the series was 500 mL (range, 50 to 3,750 mL). Three hundred thirty-five patients (64%) received a perioperative allogeneic blood transfusion related to esophagogastrectomy, and 189 (36%) did not. The median perioperative blood transfusion administered was 900 mL (range, 300 to 12,950 mL). Perioperative allogeneic blood transfusion was associated with reduced survival for patients in stage III (p < 0.05) at 1 year, but no significant difference was found in this stage at 3 or 5 years after resection. Stage III disease accounted for 250 (48%) of the 524 patients discharged. CONCLUSIONS: Although perioperative allogeneic blood transfusion does not affect long-term survival after esophagogastrectomy for carcinoma, it does have a significant association with short-term survival in a group whose overall survival is often limited after resection. Attention should be directed toward minimizing operative blood loss and transfusing only for factors known to be clinically important, such as oxygen delivery and hemodynamics, not arbitrary hemoglobin levels.

Adenocarcinoma↗
PubMed1997

A proposed anatomical classification of the pulmonary fissures.

No method of classifying pulmonary fissures currently exists, however, the nature of the fissure is of great importance in planning operative strategy for thoracoscopic pulmonary resection where an incomplete fissure may contribute to post-operative air leakage. In order to provide a framework for description of operative technique and to allow meaningful comparison between different surgical series, we propose a fissural classification based on both the degree of completeness of the fissures and the location of the pulmonary artery at the base of the oblique fissure. Completeness of a fissure is graded in four stages: grade 1--complete fissure with entirely separate lobes; grade 2--complete visceral cleft but parenchymal fusion at the base of the fissure; grade 3--visceral cleft evident for part of the fissure; grade 4--complete fusion of the lobes with no evident fissural line. The relationship of the pulmonary artery to the oblique fissure is described by the term 'fissural balance'. The pulmonary artery lies centrally to the oblique fissure in a 'normally balanced' fissure. Anterior or posterior displacement of the artery is referred to as anterior or posterior 'imbalance'.

Endoscopy↗
PubMed1996

Arachidonic acid activation of monocyte and neutrophil reactive oxygen in lung cancer patients undergoing pulmonary resection.

Reactive oxygen intermediate (roi) generation was investigated in phagocytes of 39 patients undergoing pulmonary resection for lung cancer and 39 paired healthy controls. Generation of roi in monocytes and neutrophils was monitored using 2',7'-dichlorofluorescin diacetate. Activation associated with hydrophobic interactions was probed by analysis of phagocyte roi activation by arachidonic acid and gamma-linolenic acid. Patient roi was measured pre-operatively and 2 and 7 days post-operatively. Elevated (P < 0.01) roi production was detected in neutrophils of lung cancer patients. Surgery was associated with an increase (P < 0.05-P < 0.01) in phagocyte roi at 2 and 7 days post-op. Phagocyte roi was stimulated by arachidonic acid and gamma-linolenic acid (1-40 microM) both pre- and post-operatively. Differences in arachidonic acid and gamma-linolenic acid stimulation between patient and control and pre- and post-op patient phagocytes suggest arachidonic acid involvement in phagocyte activation during reactive responses to lung carcinoma and surgery.

Arachidonic Acid↗
PubMed1996

Esophagectomy for carcinoma in the octogenarian.

BACKGROUND: Esophageal carcinoma is predominantly a disease of the elderly, a group often only considered for palliative therapies. METHODS: A case note review identified 31 octogenarians undergoing resection for carcinoma of the esophagus or gastric cardia over a 12-year period ending December 1994. RESULTS: Nineteen patients made either an uncomplicated postoperative recovery (n = 12) or suffered minor complications (n = 7). Of the 12 patients who suffered moderate or severe complications, 5 died (in-hospital mortality, 16%). The deaths included 2 of 3 patients who underwent emergency operation for esophageal perforation and 3 of 28 patients who underwent elective esophagectomy (elective mortality rate, 10.7%). Nineteen of the 26 survivors (73%) experienced no further dysphagia. The 5-year survival rate was 17%. CONCLUSIONS: Elective esophageal resection can be performed safety in selected octogenarians who have no or few coexisting medical problems and present with a localized carcinoma that is technically easy to resect. Patients undergoing emergency operations or in whom moderate or severe postoperative complications develop often have poor physiologic reserve and are therefore at risk of early postoperative death.

Adenocarcinoma↗
PubMed1996

Video-assisted thoracoscopic pulmonary surgery--current status and potential evolution.

The current status of video-assisted thoracoscopic surgery (VATS) of the lung has been reviewed. The published data support the view that VATS pulmonary surgery is feasible and safe. It is associated with decreased perioperative pain and opiate requirement, better postoperative pulmonary function, and probable overall neutral cost impact. A VATS approach is functionally superior to open thoracotomy for wedge resection, pneumothorax surgery and bullous lung disease and may allow surgical intervention in patients with pulmonary function which is in adequate for open resection. Major VATS pulmonary resection with lobectomy and pneumonectomy can be performed for early malignant disease without compromising established surgical principles. Specific training is needed in VATS surgery and background skills in general thoracic surgery are necessary to underwrite major interventions. Decreased cytokine activation and enhanced post surgical immune function may prove to be long-term benefits of VATS surgery.

Endoscopy↗
PubMed1996

Dietary choline requirement of juvenile red drum (Sciaenops ocellatus).

A 6-wk feeding experiment was conducted to determine the maximal dietary choline requirement of juvenile red drum (Sciaenops ocellatus). Diets were formulated to provide 35 g crude protein/ 100 g dry weight from solvent-extracted lyophilized red drum muscle and an amino acid premix. This premix provided methionine precisely at the minimum requirement determined for red drum so that potential synthesis of choline from methionine would be limited. Menhaden oil and dextrin were added to all diets to provide 13.8 kJ metabolizable energy/g diet as estimated by physiological fuel values. The diets were supplemented with choline chloride to provide 0, 250, 500, 750, 1000 and 1500 mg choline/kg diet. Each diet was fed to triplicate groups of red drum initially averaging 5.5 g/fish in a closed, recirculating system consisting of 110-L glass aquaria. Dietary choline concentration significantly (P < 0.05) affected weight gain, feed efficiency, total lipid in liver and plasma, as well as plasma cholesterol ester, triglyceride, cholesterol and phosphatidylcholine concentrations. Least-squares regression of these responses yielded requirements ranging from 330 to 676 mg choline/kg diet. Based on weight gain data, a maximal requirement estimate (+/- SEM) of 588 (+/- 35) mg choline/kg diet was established. Red drum appear to differ from other animals in regard to the response of total lipid in liver because fish fed choline-deficient diets had reduced liver lipid rather than lipid accumulation. Cultured red drum normally store high levels of lipid in the liver.

Animals↗
PubMed1996

A prospective randomized study comparing stapled with handsewn oesophagogastric anastomoses.

One hundred patients with carcinoma of the distal oesophagus or gastric cardia undergoing oesophagogastrectomy were randomized to receive either a stapled or handsewn oesophagogastric anastomosis. Five patients died in the early post-operative period at a mean of 16 days (in-hospital mortality 5%) allowing detailed follow up on the remaining 95 patients who were followed up to death or for a minimum of 36 months. A stapled anastomosis was quicker to perform (P < 0.001), resulting in a shorter operative time (P < 0.005) and was associated with decreased blood loss (P < 0.05). The number of anastomotic leaks, length of in-patient stay, stricture formation and survival in the two groups was not statistically different. A stapled oesophagogastric anastomosis fulfills all of the requirements for routine use in thoracic surgical practice when performing oesophageal resection for carcinoma of the distal oesophagus or gastric cardia. It is quick to perform allowing a shorter operating time and lower blood loss and does not appear to be associated with a previously noted increased incidence of benign anastomotic stricture formation when compared with handsewn anastomoses.

Aged↗
PubMed1996

Oesophagogastrectomy for carcinoma in patients under 50 years of age.

Oesophagogastrectomy for carcinoma of the oesophagus or gastric cardia has been reported as being associated with a poorer outcome in young adults than in older patients in an Oriental population. A retrospective analysis of 597 patients who underwent oesophagogastrectomy for carcinoma was undertaken to ascertain if resection in younger Scottish patients was associated with the same poorer outcome. Forty-seven patients aged less than 50 years were compared with 323 patients aged 50-69 years and 227 patients aged 70 years and older. Young patients had a higher incidence of distal third oesophageal tumours than older patients, who tended to have carcinomas of the gastric cardia. There were no differences with regard to tumour pathology, stage, extent of resection, hospital mortality or survival. In Scotland, carcinoma of the oesophagus or gastric cardia in young adults behaves similarly to that in older patients, and survival following resection is independent of age.

Adult↗
PubMed1996

A comparison of flow and image DNA cytometry in prediction of patient prognosis in surgically resected small cell lung cancer.

We have previously reported that flow cytometric tumor DNA content may be of prognostic significance in surgically resected small cell lung cancer (SCLC). We are particularly interested in determining prospective parameters for better selection of 'good prognosis' patients to proceed to surgery. Since flow cytometric measurements are poorly, if at all, applicable to endoscopic biopsy and cytology specimens we compared an image cytometric system to flow cytometry and clinical parameters in an extended series of surgically resected SCLC. Clinical follow-up was obtained on 75 patients having surgical resection for SCLC in the years 1981-92. Paraffin blocks were prepared for cytometry in standard fashion. Flow DNA histograms were characterised as diploid/tetraploid (n = 45) or DNA aneuploid (n = 27). DNA histograms obtained by image analysis were divided into type I (peridiploid n = 43) or type II (non-diploid with a minority of cells in peridiploid region; n = 31); 5c exceeding rate, 2c deviation index and malignancy grade were also computed. Overall two year survival was 27/75 patients (36%). Stage of disease was confirmed as a predictor of outcome with only 3/17 (18%) N2 patients surviving for 2 years as compared to 24/52 (46%) patients with N0/N1 disease. Image cytometric histogram classification just reached statistical significance with type I histograms indicating a better prognosis (20/43 survivors (47%) versus 7/31 (23%) patients with type II profiles, P < 0.05). Flow cytometry, 5cER, 2cD1 and malignancy grade were not useful in predicting prognosis. The results do not indicate a significant role for cytometry in SCLC.

Carcinoma, Small Cell↗