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Biomedical subjects

S R Craig

Publications and source records attributed to S R Craig.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1995

Potential complications of vascular stapling in thoracoscopic pulmonary resection.

In a series of 57 patients undergoing thoracoscopic pulmonary lobectomy, 2 required expeditious conversion to open thoracotomy when a stapling device (Endo-GIA 30 V3; Autosuture, Ascot, UK) used on the main right lower pulmonary artery in 1 case and on the left superior pulmonary vein in the other cut but failed to staple the vessel involved. In both instances the vessel was successfully controlled while a thoracotomy was performed and the involved vessel was oversewn. Both patients made an uncomplicated postoperative recovery. As the number of thoracoscopic pulmonary resections increases, it is likely that similar episodes will occur in the future. These cases strongly emphasize the fact that patients undergoing this procedure should do so in a center specializing in thoracic surgery where there is the necessary surgical expertise and equipment to deal with such potentially life-threatening vascular complications.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed1995

Primary small-cell cancer of the esophagus.

Primary small-cell cancer of the esophagus is a rare tumor that disseminates early with a uniformly poor prognosis if untreated. Sixteen patients with malignant dysphagia referred to the Thoracic Surgical Unit, City Hospital, Edinburgh, within a 10-year period had a diagnosis of primary small-cell cancer of the esophagus. Seven patients underwent subtotal esophagectomy or esophagogastrectomy, either alone or with adjuvant chemotherapy or radiotherapy, with a mean survival of 20 months (standard deviation 35.4 months, range 2 weeks to 96 months). The remaining nine patients had disseminated disease when they were first seen and were treated symptomatically by intubation alone (1 patient), intubation and palliative chemotherapy or radiotherapy (3 patients), palliative chemotherapy (2 patients), palliative radiotherapy (1 patient), or no therapy (2 patients), with a mean survival of 4.8 months (standard deviation 2.6 months, range 2 to 9 months). Patients seen with this aggressive tumor should be assessed urgently for evidence of metastatic spread and then offered resection in combination with chemotherapy if they are otherwise fit for operation. This treatment regimen has given us one long-term survivor (96 months) who, we believe, is the only patient to have been cured of this condition. Patients seen with disseminated disease should have symptomatic treatment of the dysphagia combined with palliative chemotherapy.

Carcinoma, Small Cell↗
PubMed1995

Coconut oil and beef tallow, but not tricaprylin, can replace menhaden oil in the diet of red drum (Sciaenops ocellatus) without adversely affecting growth or fatty acid composition.

The ability of juvenile red drum (Sciaenops ocellatus) to utilize medium-chain triglycerides (MCT) and other saturated dietary lipids was investigated in two 6-wk feeding experiments. Diets contained solvent-extracted menhaden fish meal to which menhaden fish oil (control), coconut oil, corn oil, beef tallow or various levels of MCT as tricaprylin (30, 46, 65 and 80% of total lipid) were added. Diets were fed to triplicate groups of juvenile red drum in aquaria containing brackish (6%) water. In the first feeding experiment, red drum fed the control diet had the greatest weight gains and feed efficiencies. Weight gain, but not feed was slightly, of fish fed corn oil and fish fed coconut oil was slightly (P < 0.05) lower. In the second feeding experiment, fish fed coconut oil and those fed beef tallow had significantly higher weight gains and feed efficiencies than did fish fed the control diet. Fish fed the diets containing tricaprylin at all inclusion levels in both feeding experiments had significantly lower weight gains and feed efficiencies and higher levels of beta-hydroxybutyric acid in plasma. Fish fed diets with high levels of MCT also had lower (n-3) and greater (n-6) fatty acid levels in the neutral lipid fraction of muscle tissue compared with fish fed the control diet. Coconut oil and beef tallow consistently resulted in greater liver lipid deposition but had variable effects on other tissue indices. Saturated dietary lipids had variable effects on fatty acid composition of muscle polar and neutral lipid fractions.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1995

Peroxides in human leucocytes in acute septic shock: a preliminary study of acute phase changes and mortality.

Peroxidation by peripheral blood leucocytes was measured in 15 patients in acute septic shock and 15 uninfected controls, using the probe dichloroflorescein. Mortality in septic subjects was 40%. In 14 of 15 patients from whom serial samples were analysed, periods of increased oxidative activity were detected. Increased peroxidation occurred early in the sequence of clinical changes, at the same time as increases in temperature, blood pressure and C-reactive protein. Peak peroxide production preceded increases in acute phase reactants and changes in leucocyte distribution. Mean peroxide production in leukocytes from patients who died was significantly higher (P < 0.001) than paired controls, and greater (P < 0.05) than peroxide production in patients who survived. The in vitro oxidative response to endotoxin was upregulated in infected patients. This supports the hypothesis that systemic mediators and leucocyte-derived reactive oxygen are involved in the vascular and organ damage associated with fatal septic shock.

Acute-Phase Reaction↗
PubMed1995

Initial experience of video assisted thoracoscopic pneumonectomy.

BACKGROUND: Preliminary experience of video assisted thoracoscopic pneumonectomy in six patients with bronchogenic carcinoma is described. METHODS: Four left and two right pneumonectomies were performed under video thoracoscopic imaging. Thoracoscopic instruments were passed through two separate stab incisions on the lateral chest wall and a separate 6 cm submammary incision was also created to allow further access for instrumentation and removal of the resected lung. In this initial experience resection was restricted to patients with bronchogenic carcinomas of less than 6 cm in diameter who had no involvement of the mediastinum. RESULTS: There were no operative deaths and no complications attributable to the technique. One patient developed postoperative atrial fibrillation and a small sacral sore and one patient was readmitted with abdominal pain and pyrexia which settled following exclusion of post pneumonectomy empyema. The remaining four patients made a rapid uncomplicated postoperative recovery with less pain and discomfort than that normally associated with a standard posterolateral thoracotomy. Postoperatively the mean (SD) patient controlled morphine consumption was 1.36 (1.90) mg per hour in the first 36 hours compared with the unit mean for open thoracotomy of 1.73 (1.68) mg per hour. The mean linear visual analogue pain score was 15.4 (15.6) in the first 24 hours compared with the unit mean for open thoracotomy of 34.5 (8.5). CONCLUSIONS: Video assisted thoracoscopic pneumonectomy can be performed safely in patients who have stage I and stage II bronchogenic carcinomas, up to 6 cm in diameter, with no mediastinal involvement on mediastinoscopy and thoracic computed tomographic assessment. This technique may result in less postoperative pain and discomfort and should allow a quicker return to normal activities.

Aged↗
PubMed1994

The use of bovine internal mammary artery (Bioflow) grafts in coronary artery surgery.

Over a 3-year period 17 patients underwent a total of 25 coronary artery bypass grafts utilising bovine internal mammary artery [BIOFLOW]. Three patients died in the peri-operative or early post-operative period allowing detailed information to be gathered on 14 patients. Seven patients who had had a total of 11 Bioflow grafts implanted underwent post-operative coronary angiography at a mean time of 19 months after surgery revealing occlusion in all the Bioflow grafts. Two patients who underwent aortic valve replacement combined with single Bioflow grafts were symptom-free and refused re-study. Two patients who had three coronary grafts each, including single Bioflow grafts, refused re-study though one of them had recurrent anginal symptoms. Two patients, one with recurrent anginal symptoms, who had a total of four Bioflow grafts were considered unfit for restudy on medical (non-cardiac) grounds. One patient with two Bioflow grafts and recurrent symptoms refused long-term follow-up. Despite reports of good early patency rates with the Bioflow graft, we have not found this to be the case even when patients were anticoagulated post-operatively. We do not recommend the use of this graft as early occlusion is to be expected, which may result in an early return of anginal symptoms.

Aged↗
PubMed1993

Abdominal aortic aneurysm: still missing the message.

Over a 7-month period 50 patients presented to the vascular unit with a ruptured or acute symptomatic abdominal aortic aneurysm (AAA). Information regarding the 24 months before acute presentation was obtained from the patient, family doctor and relevant case records to determine whether an asymptomatic aneurysm had previously been diagnosed but the patient not referred to the vascular service, or whether the patient had undergone an examination at which an aneurysm might reasonably have been expected to be diagnosed. Thirteen patients (26 per cent) had previously had an AAA diagnosed but only five had been referred. Thirteen patients (26 per cent) had had a total of 16 inpatient hospital admissions without an asymptomatic aneurysm being diagnosed. Six patients (12 per cent) underwent abdominal examination for an unrelated complaint by the family doctor without an asymptomatic aneurysm being diagnosed. A significant impact on overall mortality from aortic aneurysm may be made by increasing the number of patients undergoing elective aneurysm repair. All doctors should assess aortic diameter in all patients over 50 years of age who undergo abdominal examination for whatever reason. All patients diagnosed as having an asymptomatic AAA should be referred to a vascular surgeon for assessment.

Acute Disease↗
PubMed1986

When lightning strikes. Pathophysiology and treatment of lightning injuries.

Lightning accidents are responsible for several hundred deaths and thousands of injuries each year in this country. Survivors sustain a variety of cardiac, neurologic, musculoskeletal, and dermatologic injuries. Eye and ear injuries are also occasionally noted. Education on how to minimize the possibility of such an accident is the best method of dealing with the problem. When prevention fails, prompt cardiopulmonary resuscitation and supportive treatment for the patient's particular injury are indicated.

Adult↗
PubMed1985

Comparison of hospitalization between nursing home and community residents.

The authors prospectively identified 96 consecutive nursing home residents (NHR) admitted to the medical wards of their affiliated hospitals to determine the outcome of hospitalization for these patients in comparison with 88 admissions in a similarly aged community residents (CR) population. Nursing home and community resident groups were similar in age, sex, marital status, and distribution among the four study hospitals. Dementia was a more common preexisting diagnosis in NHR than in CR. Reasons for admission differed between the two groups. Although NHR experienced a longer hospitalization than CR, frequency and duration of intensive care unit admissions were similar. Fatal outcome occurred more commonly in NHR compared with CR (27 v 11%, P less than .001). Predictors of mortality were examined. Nursing home residents also experienced a higher mortality than CR within the six months after hospitalization (35 v 20%, P less than .005).

Acute Disease↗