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Biomedical subjects

C Scott-Conner

Publications and source records attributed to C Scott-Conner.

16 recordsLinked to original sources
PubMed2001

Small bowel sarcoma: analysis of survival from the National Cancer Data Base.

BACKGROUND: Small bowel sarcomas (SBS) are rare, accounting for 10% of small bowel cancers. As a result, few studies of SBS have had enough patients to accurately define their natural history and to determine the factors that have an impact on patient survival. The objective of this study was to examine patient and tumor factors in SBS and to determine prognostic factors for disease-specific survival (DSS) using the National Cancer Data Base. METHODS: Data from the National Cancer Data Base for patients diagnosed with primary SBS between 1985 and 1995 were analyzed. The chi2 statistic was used to determine significant differences between groups of patient, tumor, and treatment factors. DSS was calculated for patients diagnosed between 1985 and 1990. Significant differences in survival were determined using the Wilcoxon statistic for univariate analyses and by Cox regression in multivariate analyses. RESULTS: Of 14,253 small bowel tumors diagnosed between 1985 and 1995, sarcomas represented 10.1%. Overall, 5-year DSS was 38.9%, with a median survival of 34.1 months (n = 590). By univariate analysis, patient age, sex, tumor size, tumor grade, histologic type, general summary stage, nodal status, and whether cancer-directed surgery was performed were significantly correlated with DSS. In multivariate analysis, tumor size <5 cm, leiomyosarcoma histology, and localized disease were found to be significant favorable prognostic factors for DSS. CONCLUSIONS: SBS are rare tumors that are challenging in terms of their histopathologic classification, grading, and staging. Patients with SBS were treated predominantly by surgery, with a minority receiving adjuvant therapy. Tumor size, histologic type, and general summary stage were independent prognostic factors for 5-year DSS in patients with SBS, which is improved relative to 5-year DSS seen in patients with small bowel adenocarcinoma.

Adult↗
PubMed1999

The American College of Surgeons Commission on Cancer and the American Cancer Society. Adenocarcinoma of the small bowel: review of the National Cancer Data Base, 1985-1995.

BACKGROUND: Small bowel adenocarcinoma (SBA) accounts for 2% of gastrointestinal (GI) tumors and 1% of GI cancer deaths. The objective of this study was to review the National Cancer Data Base (NCDB) to identify case-mix characteristics, patterns of treatment, and factors influencing survival of patients with SBA. METHODS: NCDB data from patients diagnosed with primary SBA between 1985-1995 were analyzed. Chi-square statistics were used to compare differences between groups. Disease specific survival (DSS) was calculated using the life table method for patients diagnosed between 1985-1990; univariate differences in survival were compared using the Wilcoxon statistic, and multivariate analyses were performed using a Cox regression model. RESULTS: There were 4995 SBA cases reported to the NCDB between 1985-1995, 55% of which occurred in the duodenum, 18% in the jejunum, 13% in the ileum, and 14% in nonspecified sites. The overall 5-year DSS was 30.5%, with a median survival of 19.7 months. By multivariate analysis, factors significantly correlated with DSS included patient age, tumor site, disease stage, and whether cancer-directed surgery was performed. CONCLUSIONS: SBA is found most commonly in the duodenum, and patient DSS is reduced at this site compared with those patients with jejunal or ileal tumors. This reduction in survival was associated with a lower percentage of cancer-directed surgery. Patients age > 75 years had a reduced DSS and more duodenal tumors, and were less frequently treated by cancer-directed surgery than their younger counterparts. This study reflects the experience with SBA from a large cross-section of U.S. hospitals, allowing for the identification of prognostic factors and providing a reference with which results from single institutions may be compared.

Adenocarcinoma↗
PubMed1995

Axillary metastasis from occult breast carcinoma: diagnosis and management.

Axillary metastasis from carcinoma of an unknown primary site is an uncommon and difficult problem. When biopsy of an enlarged axillary node reveals adenocarcinoma, the most likely site (in a female patient) is the ipsilateral breast. From January 1977 to December 1986, 10 patients (eight female, two male) were treated at the University of Mississippi Medical Center for axillary metastasis from carcinoma of unknown primary. Two male patients (ages 60 and 63) were believed to have lung primaries. Both had evidence of distant metastasis at initial diagnosis and died 2 and 7 months after presentation. Of the eight women (ages 40-72, mean 56.5 years), seven developed breast abnormalities between 6 and 39 months (mean: 15 months) after initial diagnosis, and two of these underwent modified radical mastectomy. No primary site was identified in the eight women. Two women had evidence of distant metastases at initial presentation. All patients have died with disease at a mean of 42 months (range: 2-93 months). In contrast with other reported series, the outcome of patients with occult breast carcinoma presenting as axillary adenopathy was not favorable.

Adenocarcinoma↗
PubMed1993

Neovascularization of canine sutured and stapled small intestinal anastomoses.

New blood vessels develop as a gastrointestinal anastomosis heals. The morphologic aspects of this neovascularization were studied in 22 dogs, each of which underwent one sutured and one stapled small bowel anastomosis. At intervals ranging from three to 24 days after surgery, the dogs were killed, and the bowel was injected with Batson's compound or india ink. The pattern of vascular growth across the anastomotic site was studied. Both stapled and sutured anastomoses caused an increase in submucosal capillary density at day three compared with control specimens taken from bowel remote from the anastomotic site. This increase was maintained consistently through day 24 in sutured anastomoses but had decreased by day five in stapled anastomoses. Growth of submucosal vessel across the anastomotic site could be demonstrated by day three in sutured and day four in stapled anastomoses. The more vigorous inflammatory response associated with sutured anastomoses may be responsible for more rapid and prominent neovascularization.

Anastomosis, Surgical↗
PubMed1991

Flexible sigmoidoscopy screening for asymptomatic colorectal disease in patients with and without inguinal hernia.

Several studies have evaluated the diagnostic value of flexible sigmoidoscopy for screening asymptomatic patients before hernia repair. All have shown a 16% to 28% incidence of neoplastic (malignant or premalignant) lesions. None of these studies compared a similar group of asymptomatic patients without hernia to determine whether the incidence is increased in patients with hernias. We reviewed 87 consecutive cases of male surgical patients without hernia or any anorectal disease who had flexible sigmoidoscopy between June 1986 and December 1989 (group 1) and compared them with a group of hernia patients that we previously reported (group 2). Patients with stool positive for occult blood were excluded from this study. Examinations in both groups were done under the direct supervision of an attending surgeon (W.W., C.S.C., or J.K.). No significant difference was noted between group 1 and group 2 in mean age (mean 65.6 vs 59.7 years), rate of normal findings (68% vs 63%), and incidence of neoplastic lesions (14% vs 22%). All patients tolerated the procedure well, and there were no complications.

Adenoma↗
PubMed1991

Choice of anesthetic technique for needle localized breast biopsy.

General anesthesia has been recommended to increase the accuracy and safety of needle localized biopsy (NLB). The authors' NLB experience was reviewed to determine whether the method of anesthesia affected accuracy, yield, complication rate, or cost. All biopsies were performed in a standard operating room using either local anesthesia (Group 1, n = 14), local anesthesia with an anesthesiologist present (Group 2, n = 14), or general anesthesia (Group 3, n = 10). The mean operative times were 54, 59, and 56 minutes for Groups 1, 2, and 3, respectively. In groups 1 and 2, 100 per cent of the specimen radiographs showed the target lesion had been excised, although one biopsy was indeterminate. Among Group 3 two target lesions could not be identified on specimen radiographs and one was indeterminate. There was one malignancy in Group 1 compared with four malignancies in Group 2 and two in Group 3. The average hospital bill was $1,172 for Group 1, $1,418 for Group 2, and $1,488 for Group 3. Anesthesiologists' fees added an additional $224 to Groups 2 and 3. NLB can be performed using local anesthesia without sacrificing accuracy or yield, increasing operative time, or increasing complication rate; the cost is significantly less than with general anesthesia.

Adult↗
PubMed1991

Hypertonic saline resuscitation: efficacy in a community-based burn unit.

Many have discussed hypertonic saline for resuscitation in burned patients only to discourage its use or to emphasize it only as a research tool and not as standard resuscitation. We reviewed the records of 47 adults with burns over 20% or more of the total body surface area (TBSA) in whom hypertonic saline was used as standard resuscitation fluid in a large community burn unit. The solution consisted of sodium, 300 mEq/L, acetate, 200 mEq/L, and chloride, 100 mEq/L, with an osmolality of 600 mOsm/L. The mean TBSA burned was 37% and the mean patient age was 44.8 years. Eighteen patients (mean age 39.7 years, mean TBSA burned 27%) received hypertonic saline alone. They required an average of 75% of the Parkland calculated volume to achieve a urinary output of 1 mL/kg/hr. The mean hematocrit value over the first 48 hours was 44.2% and the mean serum sodium level was 141.6 mEq/L. Twenty-nine patients (mean age 51.8 years, mean TBSA burned 47.8%) received hypertonic saline plus colloid (albumin or fresh frozen plasma). Colloid was used in older patients with more serious burns. This group required 57% of the Parkland calculated volume to achieve a urinary output of 1 mL/kg/hr. The mean hematocrit value was 45.1% and mean sodium level was 143.8 mEq/L. The mean weight gain for both groups was 7.3% of the admission weight. None of the patients had changes in pH or renal function. All patients survived the resuscitation phase of their injury; the overall death rate was 49%. We conclude that hypertonic saline is a safe, effective means of resuscitation even in a community-based unit. It allows less fluid to be delivered for adequate resuscitation. The usual hyponatremia, hemoconcentration, and significant weight gain associated with administration of isotonic solutions was avoided. Colloid may further improve the resuscitation capabilities of hypertonic saline.

Adult↗
PubMed1988

Near-total gastric necrosis caused by acute gastric dilatation.

Gastric dilatation caused by psychogenic polyphagia or bulimia may, under extreme circumstances, progress to total gastric necrosis. We have described a patient in whom acute abdominal symptoms and signs developed while he was receiving psychiatric treatment. Laparotomy showed massive gastric dilatation with near-total infarction. Total gastrectomy with cervical esophagostomy, feeding and decompressing jejunostomies, and wide drainage of the gastric bed were done. After staged reconstruction, recovery was uneventful.

Adult↗
PubMed1985

Methods of splenic preservation and their effect on clearance of pneumococcal bacteremia.

The intravascular clearance of type 3 Streptococcus pneumoniae was studied in Sprague-Dawley rats. Sham celiotomy was performed on 20 animals while another 20 rats underwent splenectomy. Four weeks later, bacteremia was induced by intraperitoneal (IP) injection of S. pneumoniae. Serial cultures of peripheral blood were obtained. Splenectomy produced significant impairment of intravascular clearance of bacteria compared to that noted among control animals (p less than 0.01). Eighty animals were divided into four equal groups: I--splenectomy, II--50% splenectomy with the upper half left in situ connected to the short gastric vessels, III--50% splenectomy with the lower half left in situ connected to the hilar vessels, and IV--splenectomy with implantation of splenic fragments. Pneumococcus was administered IP 16 weeks later. Rats were killed 6 hours after bacterial challenge. Residual splenic tissue was weighed. There was significantly less splenic tissue in Groups II-IV than noted in sham animals after 16 weeks (p less than 0.01). The type of partial splenectomy did not significantly affect the weight of residual splenic tissue 16 weeks later. Implantation did yield viable splenic tissue, though the amount proved significantly less than that resulting from either type of partial splenectomy (p less than 0.01). Mean bacterial counts with time for short gastric (Group II) and hilar (Group III) remnant animals were significantly different from those for the asplenic (Group I) rats (p less than 0.02 and p less than 0.001, respectively). Animals with splenic implants (Group IV) were not significantly different from asplenic rats (Group I). Animals with hilar splenic remnants proved significantly different from those with short gastric splenic remnants (p less than 0.01). Partial splenectomy offers protection against pneumococcal bacteremia, though preservation of the hilar blood supply affords the most benefit. The utility of splenic implantation remains unproven.

Animals↗
PubMed1985

Cryptorchidism: the role of medical education in diagnosis.

The hospital records in a community of 63,000 were reviewed for a five-year period (1978 to 1983) with regard to the diagnosis of cryptorchidism. There were 123 hospitalized patients with unilateral cryptorchidism and 17 patients with bilateral cryptorchidism. The diagnosis was made in 35 newborn infants from a total of 7,380 male births (neonatal incidence 0.48%). The mean age at time of orchiopexy was 7.56 years and only eight of 84 patients were less than 3 years of age at the time of surgery. Inappropriate surgery was done on occasion. A questionnaire mailed to 600 physicians in the region revealed that many were unaware of current recommendations regarding the timing of treatment for undescended testes. Missed diagnosis at birth and uninformed referring physicians appear to be major factors responsible for delayed diagnosis and treatment. Economic factors could not be implicated.

Adolescent↗
PubMed1985

Intraperitoneal splenic implants do not alter clearance of pneumococcal bacteremia.

The effect of intraperitoneal splenic autotransplants was studied in Sprague-Dawley rats. Twenty animals underwent total splenectomy. Splenectomy was performed in another group of 20 rats, after which the spleen was diced into 15 pieces and replaced within the leaves of the small bowel mesentery. Twelve weeks later pneumococcal bacteremia was induced by intraperitoneal injection of 5 X 10(6) Streptococcus pneumoniae. Quantitative blood cultures were obtained from the tail vein 15, 30, 45, 60, 90, and 240 minutes after injection. Mean bacterial counts with time for animals bearing splenic autotransplants were not significantly different from completely asplenic rats. At autopsy, all animals receiving splenic implants were found to have viable splenic tissue among the leaves of the small bowel mesentery. This study shows that even allowing 12 weeks for maximal regeneration, splenic autotransplants fail to significantly alter the clearance of an established bacteremia.

Animals↗
PubMed1982

A comparison of stapled and sutured anastomoses in colonic operations.

Stapled colonic anastomoses can be performed both above and below the peritoneal reflection with complication rates that are comparable with those achieved when these anastomoses are sutured by hand. The new circular stapling instrument may facilitate the performance of a lower colorectal anastomosis than can be done by hand. Operative time, return of intestinal activity and postoperative hospital stay are not significantly affected by the anastomotic technique used.

Adenocarcinoma↗
PubMed1982

A comparison of stapled and sutured anastomoses in gastric operations.

To compare the results of sutured and stapled anastomoses in the performance of gastric operations, 112 consecutive patients, operated upon by the same group of surgeons, were reviewed. Of 80 gastric resections, 44 were done with conventionally sutured anastomoses, while 36 had stapled anastomoses. Of 42 gastrojejunostomies without resection, 18 were sutured and 24 stapled. The incidence of leaks, bleeding and stasis was similar for stapled and sutured procedures. This was true for both gastric resections and gastrojejunal anastomoses without resection. No significant differences were noted between the stapled and sutured procedures with regard to operative time and length of postoperative stay. Patients in the sutured gastrectomy group regained intestinal function more rapidly than when the staples were used, 3.9 compared with 5.1 days. Stapling devices can be safely used to perform gastric operations. Complication rates with these devices are the same as those noted for more conventional suture techniques. Data from this study do not substantiate claims that stapling instruments reduce operative time or speed recovery of intestinal function.

Adult↗
PubMedDate not supplied

Organ donation.

Explore the source record for details and available documents.

Brain Death↗
PubMedDate not supplied

Reprocessing of reusable medical devices.

Advances in medical science and, in particular, minimally invasive surgical and diagnostic procedures have stimulated the development of new and improved medical devices. This has been made possible because of developments in engineering and material sciences. The design of devices for reusability is particularly important in an effort to provide cost effective healthcare. Concerns and issues include the ability to safely and effectively reprocess the devices, infection prevention and control, safety of the patient and healthcare worker, environmental concerns, and effective use of resources. From an infection prevention point of view, present requirements are based upon the intended use of the devices. Critical devices require sterilization. Semi-critical devices require, as a minimum, high level disinfection. Sterilization is, however, preferred whenever possible. Before sterilization or disinfection, devices should be cleaned adequately. Device designs should be readily amenable to cleaning and sterilization. In the past, design requirements focused primarily on the clinical user and device functionality, with reuse considerations left to the user. In the current market, the customer is redefined and, for reusable medical devices, includes all those associated with the device through the reprocessing procedure. In addition, regulations require that manufacturers give detailed instructions for reprocessing medical devices. The device users have the obligation to follow reprocessing instructions. Many choices exist today in device designs, including disposable or reusable devices. The user needs to balance cost versus convenience and reprocessing requirements for reusables. Current trends are to reuse more devices, including many of which were meant to be disposable. Cost effective designs can best be achieved when the user and manufacturer work together on the design.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacterial Infections↗