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Biomedical subjects

C Crane

Publications and source records attributed to C Crane.

At least 19 recordsLinked to original sources
PubMed2006

Recurrence of suicidal ideation across depressive episodes.

BACKGROUND: In recent years it has become clear that depression is a recurrent disorder, with the risk of recurrence in those with two or more episodes being as high as 90%. This has prompted interest in the consistency of individual depressive symptoms across consecutive episodes, an issue that is important for symptoms such as suicidal ideation, where a past history may give important indicators of future behaviour. METHODS: We prospectively examined 69 individuals with a history of Major Depression, over 12 months, 38 of whom experienced a recurrence of major depression during the follow-up period. RESULTS: Spearman's rank order correlations between severity ratings of each symptom of major depression during a previous episode and severity ratings at recurrence showed significant associations for suicidality, guilt or worthlessness and thinking difficulties only. Weighted kappa coefficients indicated relatively low levels of agreement across episodes for most diagnostic symptoms, with suicidality showing the strongest relationship. Using a broad definition of suicidality-- any reporting of thoughts of death or suicide during episode-- a much higher level of agreement (kappa = .64) was found, with 83% of individuals falling into the same category (suicidal/non-suicidal) at both episodes. LIMITATIONS: This study was based on a relatively small sample and examines re-emergence of suicidal ideation in the absence of suicidal behaviour. CONCLUSIONS: This study provides preliminary evidence of cross-episode consistency in the recurrence of suicidal ideation, in line with the differential activation theory of suicidality in depression.

Major Depressive Disorder↗
PubMed2005

Duration of relapse prevention after cognitive therapy in residual depression: follow-up of controlled trial.

BACKGROUND: Although there is good evidence that cognitive therapy (CBT) lessens relapse and recurrence in unipolar depression, the duration of this effect is not known. METHOD: One hundred and fifty-eight subjects, from a randomized controlled trial of CBT plus medication and clinical management versus medication and clinical management alone, were followed 6 years after randomization (4 1/2 years after completion of CBT) and the longitudinal course assessed. RESULTS: Effects in prevention of relapse and recurrence were found to persist, with weakening, and were not fully lost until 3 1/2 years after the end of CBT. Residual symptoms were also lessened. CONCLUSIONS: The effect of CBT in reduction of relapse and recurrence persists for several years. The potential value of subsequent additional CBT some time after cessation should be explored.

Cognitive Behavioral Therapy↗
PubMed2001

Elective groin irradiation is not indicated for patients with adenocarcinoma of the rectum extending to the anal canal.

PURPOSE: To evaluate the inguinal nodal failure rate in patients with locally advanced rectal cancer with anal canal involvement (ACI) treated with pelvic chemoradiation without elective inguinal irradiation. METHODS AND MATERIALS: From 1990 and 1998, 536 patients received preoperative or postoperative chemoradiation for rectal cancer with curative intent; 186 patients had ACI (<4 cm from the anal verge on rigid proctoscopy). Two patients had positive inguinal nodes at presentation. Chemoradiation was delivered preoperatively (45 Gy in 25 fraction) or postoperatively (53 Gy in 29 fractions) with concurrent continuous infusion of 5-fluorouracil (300 mg/m2/d). The inguinal region was specifically irradiated in only 2 patients who had documented inguinal nodal disease. RESULTS: The median follow-up was 50 months. Only 6 of 184 ACI patients who had clinically negative inguinal nodes at presentation developed inguinal nodal recurrence (5-year actuarial rate 4%); 4 of the 6 cases were isolated. Two patients underwent successful salvage. Only 1 died of uncontrolled groin disease. Local control was achieved in both patients with inguinal nodal disease at presentation, but both died of metastatic disease. Only 3 patients with tumors >4 cm from the verge developed inguinal recurrence (5-year actuarial rate <1%). CONCLUSIONS: Inguinal nodal failure in rectal cancer patients with ACI treated with neoadjuvant or adjuvant chemoradiation is not high enough to justify routine elective groin irradiation.

Adenocarcinoma↗
PubMed2001

Improved overall survival among responders to preoperative chemoradiation for locally advanced rectal cancer.

The aim of this study was to determine if the response to preoperative radiation and chemotherapy with continuous infusion 5-fluorouracil (5-FU) was predictive for survival among patients with locally advanced rectal cancer. Preoperative chemoradiation (CTX/XRT) that delivered 45 Gy in 25 fractions over 5 weeks with continuous infusion 5-FU (300 mg/m2/day) was given to 117 patients. The pretreatment stage distribution, as determined by endorectal ultrasound (u), included uT2N0 in 2%, uT3N0 in 47%, uT3N1 in 49%, and uT4N0 in 2% of cases; endorectal ultrasound was not performed in 13% of cases (15 patients). Approximately 6 weeks after completion of CTX/XRT, surgery was performed. Adjuvant chemotherapy, consisting of 400 to 425 mg/m2 of 5-FU plus 20 mg/m2 leucovorin for 5 days, was administered every 28 days for 4 to 6 cycles after surgical resection. Among the 74 patients treated with adjuvant chemotherapy, the preoperative stage of disease was 31 with T3N0 and 43 T3N1. Median follow-up was 46 months (range 2 to 89 months). The pathologic tumor stages were Tis-2N0 in 26%, T2N1 in 5%, T3N0 in 21%, T3N1 in 15%, T4N0 in 5%, and T4N1 in 1%; a complete response (CR) to preoperative CTX/XRT was pathologically confirmed in 32 (27%) of patients. Tumor down-staging occurred in 72 (62%) cases. A sphincter-saving procedure (SP) was possible in 59% of patients. The median DFS and overall survival rates for responders were 46 months and 47 months, respectively; for non-responders these outcome measures were 38 months and 41 months, respectively. Log-rank analysis showed that the distant metastatic-free survival rates improved with any response to CTX/XRT (p < 0.00001), CR to CTX/XRT (p < 0.009) and SP (p < 0.012). Likewise, these parameters also significantly influenced DFS rates (CTX/XRT p < 0.00001; CR p < 0.006; and SP p < 0.008). Control of pelvic disease was influenced by clinical size (p < 0.002) and SP (p < 0.016) on univariate analysis. On multivariate analysis only clinical size (p < 0.002) continued to be a significant factor for local control. Factors on multivariate analysis that resulted in significant improvements in cancer-specific survival included any response to preoperative CTX/XRT (p < 0.017) and administration of adjuvant chemotherapy (p < 0.034). Any response to preoperative CTX/XRT improved distant metastatic-free and disease-free survival rates. Multivariate analysis confirmed that a response to preoperative CTX/XRT predicted for improvements in overall survival among patients with locally advanced rectal cancer. Patients who fail to respond to preoperative 5-FU based chemotherapy given concomitantly with radiation have higher rates of distant metastases with adjuvant 5-FU therapy.

Adult↗
PubMed2001

1st annual oncology update: advances and controversies. Steamboat Springs, Colorado, USA, 13-17 February 2001.

In addition to the scientific component to the meeting, the conference was successful in many social aspects. The setting permitted the conference to be informal, with casual dress and lively audience participation involvement. In general, the conference was able to provide an excellent multidisciplinary overview of a wide-variety of oncology topics.

Education, Medical, Continuing↗
PubMed2000

Phase I study of preoperative oral uracil and tegafur plus leucovorin and radiation therapy in rectal cancer.

PURPOSE: Preoperative combined-modality therapy for rectal cancer may allow for sphincter preservation, while decreasing recurrence rates and improving the overall prognosis. Oral chemotherapy with uracil and tegafur (UFT) plus leucovorin (LV) may reduce costs and complications associated with protracted infusions of fluorouracil. Our goal was to evaluate the safety of UFT plus LV combined with preoperative radiation and determine the maximum-tolerated dose (MTD) and dose-limiting toxicity (DLT) of UFT plus LV in this setting. PATIENTS AND METHODS: Patients with tumor-node-metastasis stage II or III rectal cancer received escalating doses of UFT (starting at 250mg/m(2)/d, with 50-mg/m(2)/d increments between consecutive cohorts) and fixed doses of LV (90 mg/d). The UFT and LV combination was given 5 days per week concurrently with a 5-week course of preoperative radiation totaling 45 Gy (1.8 Gy/fraction). Surgery was performed 4 to 6 weeks after radiation and was followed by four 35-day cycles of fixed doses of UFT and LV (28 days of therapy each cycle). RESULTS: Fifteen patients were treated, and 13 received the full preoperative chemotherapy. All planned radiation was delivered successfully. The MTD of UFT with radiation was 350 mg/m(2)/d with 90 mg/d of LV. Diarrhea was the DLT. Sphincter-preserving surgery was performed in 12 of 14 patients. One patient had progressive disease before surgery. Pathologic evaluation of 14 resected specimens showed a complete response in three cases. CONCLUSION: Preoperative chemoradiation with oral UFT plus LV is feasible and well tolerated and should be further investigated.

Administration, Oral↗
PubMed1999

Preoperative UFT and calcium folinate and radiotherapy in rectal cancer.

Protracted infusions of 5-fluorouracil (5-FU) combined with pelvic radiotherapy have been associated with improved survival and decreased local and distant metastases in the adjuvant therapy of rectal cancer. However, this method of 5-FU infusion requires the inconvenience and expense of central venous line placement and care, infusion pumps, and treatment of catheter-related complications. We previously demonstrated that a completely oral therapy with UFT (uracil plus tegafur in a 4:1 molar ratio) plus oral calcium folinate (Orzel) can achieve pharmacokinetic parameters similar to those associated with protracted 5-FU infusions. This trial examines the feasibility of using UFT plus oral calcium folinate both during preoperative pelvic radiation and postoperatively, and shows that patients can be treated safely and effectively with a completely oral chemotherapy program combining UFT plus oral calcium folinate with pelvic radiation therapy.

Adolescent↗
PubMed1991

Comparative circulatory effects of isoproterenol and dopamine in lambs with experimental cyanotic heart disease.

To determine whether the hemodynamic responses to adrenergic agonists are altered during chronic hypoxemia secondary to an intracardiac right to left shunt, we studied seven lambs with surgically created pulmonic stenosis and atrial septal defect and nine controls during infusions of isoproterenol at 0.1 and 0.5 micrograms/kg/min and dopamine at 5 and 20 micrograms/kg/min. Isoproterenol increased heart rate by 89 +/- 17% in control but only 46 +/- 6% in experimental lambs (p less than 0.05). However, because resting heart rate was higher in experimental lambs (213 +/- 7 versus 177 +/- 12 beats/min, p less than 0.05), maximal heart rates were similar (310 +/- 7 versus 326 +/- 6 beats/min; NS). Cardiac output increased during isoproterenol from 219 +/- 20 to 425 +/- 54 mL/min/kg in experimental lambs (p less than 0.05) and, similarly, from 180 +/- 20 to 425 +/- 71 in controls (p less than 0.05) (experimental versus control; NS). Dopamine also increased cardiac output similarly in both groups, at both doses, but without changing heart rate. Isoproterenol did not alter aortic oxygen saturation and increased systemic oxygen transport more than oxygen consumption. In contrast, dopamine at both doses decreased aortic oxygen saturation in experimental lambs (rest, 71 +/- 2% versus dopamine, 59 +/- 2%; p less than 0.05). With dopamine, the increase in systemic oxygen transport was equalled by an increase in oxygen consumption. Thus, circulatory responses to isoproterenol are similar in lambs with experimental cyanotic heart disease and controls, although higher resting heart rate in the experimental lambs reduces chronotropic reserve.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

Lysis of cells in Elodea leaves by pulsed and continuous wave ultrasound.

Resonance lysis of the cells in the leaves of the aquatic plant Elodea originally reported by Miller have thresholds at intensities of a few W/cm2. With pulsed ultrasound, the resonance behavior vanishes and the thresholds are at much higher amplitudes. This is similar to the characteristics of the thresholds for killing of Drosophila larvae by pulsed ultrasound. Both organisms contain small gas bodies within the tissues which may serve as nuclei for a cavitation related phenomenon. The results suggest that the response of these bubbles to continuous wave fields and very short pulses is qualitatively different.

Cell Survival↗
PubMed1990

Differential regulation of right and left ventricular beta-adrenergic receptors in newborn lambs with experimental cyanotic heart disease.

To determine whether chronic hypoxemia secondary to an intracardiac right-to-left shunt alters regulation of the myocardial beta-adrenergic receptor/adenylate cyclase system, we produced chronic hypoxemia in nine newborn lambs by creating right ventricular outflow obstruction and an atrial septal defect. Oxygen saturation was reduced to 65-74% for 2 wk. Eight lambs served as normoxemic controls. beta-receptor density (Bmax) and ligand affinity (KD) were determined with the radio-ligand [125I]iodocyanopindolol and adenylate cyclase activity determined during stimulation with isoproterenol, sodium fluoride (NaF), and forskolin. During chronic hypoxemia, Bmax decreased 45% (hypoxemic, 180.6 +/- 31.5 vs. control, 330.5 +/- 60.1 fmol/mg) in the left ventricle (exposed to hypoxemia alone) but was unchanged in the right ventricle (exposed to hypoxemia and pressure overload). KD was not different from control in either ventricle. Left ventricular isoproterenol-stimulated adenylate cyclase activity was decreased by 39% (30.0 +/- 4.3% increase vs. 44.1 +/- 9.5% increase) whereas right ventricular adenylate cyclase activity was unchanged. Stimulation of adenylate cyclase with NaF or forskolin was not different from control in either ventricle. Circulating epinephrine was increased fourfold whereas circulating and myocardial norepinephrine were unchanged. These data demonstrate a down-regulation of the left ventricular beta-adrenergic receptor/adenylate cyclase system during chronic hypoxemia secondary to an intracardiac right-to-left shunt.

Adenylyl Cyclases↗
PubMed1977

Natural history of the leg amputee.

For 173 patients undergoing major leg amputations, the operative mortality was 13 per cent. The ratio of below-knee (BK) to above-knee (AK) amputations was approximately unity. Of the 150 patients who survived amputation, 93 were given prostheses. Amoung the latter group, 76 per cent of the unilateral AK amputees and 90 per cent of the unilateral BK amputees had a successful rehabilitation. For those patients who had to be converted from BK to AK unilateral amputations, 40 per cent experienced successful rehabilitation, and for those who had either bilateral BK or bilateral mixed amputations, 45 per cent were successful. The most common contraindications to granting prostheses were debility and dementia. The mean time interval from first amputation to latest observation was 3.5 years (range, 5 weeks to 13.5 years). At three years 49 per cent of the patients survived and at five years 31 per cent survived. Despite major impediments, satisfactory rehabilitation is accomplished frequently enough to justify optimism for a considerable number of geriatric amputees.

Adult↗
PubMed1976

Femorofemoral bypass graft in intra-aortic balloon counterpulsation.

Femorofemoral arterial crossover grafts were used in three patients to avoid or correct limb ischemia during intra-aortic balloon counterpulsation. In retrospec, these grafts should have been used in two earlier patients in whom the balloon was removed prematurely. They are applied to the femoral artery just distal to the site of insertion of the balloon or the the balloon access graft. Removal of the graft at the time of the balloon removal is optional.

Blood Vessel Prosthesis↗
PubMed1976

The predictive accuracy of renal vein renin activity in the surgery of renovascular hypertension.

In a consecutive group of 38 patients undergoing operations for renovascular hypertension, there were 24 arterial reconstructions and 16 nephrectomies. Thirty-two patients were available for late observation, and 25 (78 percent) had a successful result. The renal vein renin ratio (RVRR) correctly predicted successful results in 76 percent of the patients with a RVRR of 1.5 or more but was correct in predicting an unsuccessful result in only one of the six patients with an RVRR less than 1.5. This high incidence of "false-negative" results has appeared in several other reports but has received insufficient emphasis. The presumed causes include inadequate sodium depletion prior to the renal blood vein samplings or, less likely, the effects of renin-suppressing drugs such as alpha methyldopa, propranolol, or reserpine. Because five of the six patients with RVRR less than 1.5 enjoyed a successful result from operation, it is apparent the clinical factors and the aortogram should be determinant when the RVRR, performed under the conditions described, is not diagnostic of renovascular hypertension. Nonetheless, when all diagnostic factors, i.e., the aortogram, the rapid-sequence intravenous pyelogram, and the RVRR, support such a diagnosis, a successful surgical result is nearly certain.

Adult↗
PubMed1975

Mortality and morbidity rates after inferior vena caval clipping.

In 112 patients receiving inferior vena caval, serrated, Teflon clips over a 7 year period beginning Jan. 1, 1966, the operative mortality rate was 6 percent (seven patients) and the 1 to 12 month mortality rate was 9 percent (10 patients). Patients with severe heart disease accounted for eight of these 17 deaths. The mortaligy rate was zero in patients who were free of heart disease, malignancy, sepsis, or massive pulmonary embolism. Recurrent pulmonary embolism was suspected, but not lethal, in four patients and was proved in two. Patients who had leg swelling preoperatively were more likely to have swelling postoperatively than those who were initially free of swelling. Postoperative anticoagulation was ineffective in preventing edema and carried the risk of wound hemorrhage. Twelve months after operation, 12 of the 83 patients available for follow-up had severe lower extremity symptoms and 23 had milder, easily controlled edema. Late stasis changes, therefore, appeared at an acceptably low frequency and could reasonably be expected for patients with lower extremity phlebothrombosis. There was no instance of fatal pulmonary embolism in the follow-up period extending from 1 to 6 years.

Adolescent↗