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Biomedical subjects

D L Crosby

Publications and source records attributed to D L Crosby.

At least 19 recordsLinked to original sources
PubMed1995

Improving the primary management of emergency surgical admissions: a controlled trial.

The initial screening by senior surgical staff of surgical patients referred for emergency hospital admission should result in improved patient management. The present study was undertaken to determine the effects of this policy. The primary outcome measure was hospital admission rates. The number of operations, diagnostic investigations, initial treatments, deaths, length of stay and bed days per 100 referrals were also measured. The results suggest a 20 per cent reduction in emergency surgical admissions, an important potential benefit to the health service, and to individual patients.

Adult↗
PubMed1995

Aspects of hernia surgery in Wales.

The management of elective inguinal herniorrhaphy in Wales was assessed by means of a postal survey of consultant general surgeons. This included technique of repair, length of inpatient stay, follow-up, use of heparin thromboprophylaxis and advice regarding driving, strenuous activities and work. In all, 54 replies (77%) were received. The views of patients on their surgery was assessed by a questionnaire sent to 80 patients treated on a single surgical unit; 60 replies (75%) were received. Waiting times were relatively short among this group, 67.5% of patients being treated within 6 months of seeking medical advice; 16.25% suffered a complication. All wound infections occurred after discharge and 15% of patients had some groin discomfort 6 months after operation. Accuracy of clinical examination of 50 inguinal hernias by different grades of surgeon was assessed. Consultants were significantly more accurate when compared with house officers (P < 0.001). There is a wide range of repair techniques and postoperative advice practised by consultant general surgeons in Wales. Patients' main complaint was that of a sparsity of postoperative advice, although there also appears to be an appreciable postoperative morbidity. Clinical experience plays a significant role in assessment of the suitability of hernias for surgery.

Elective Surgical Procedures↗
PubMed1992

Policy for controlling pain after surgery: effect of sequential changes in management.

OBJECTIVE: To observe the effects of introducing an acute pain service to the general surgical wards of a large teaching hospital. DESIGN: A study in seven stages: (1) an audit of current hospital practice succeeded by the sequential introduction to the general surgical wards of (2) pain assessment charts; (3) an algorithm to allow more frequent use of intramuscular analgesia; (4) increased use of local anaesthetic techniques of wound infiltration and nerve blocks; (5) an information sheet for patients about postoperative pain; (6) the introduction of patient controlled analgesia; (7) a repeat audit of hospital practice. Data were collected on each patient 24 hours after operation. SETTING: University Hospital of Wales, which has both district general and tertiary referral functions. PATIENTS: 2035 patients over nine months from all surgical specialties (excluding cardiac) at the hospital. General surgical operations were studied in detail and separated into major, intermediate, and minor for data collection. MAIN OUTCOME MEASURES: A change in the median visual analogue pain scores 24 hours after surgery for pain during relaxation, pain on movement, and pain on deep inspiration at each stage of the study. RESULTS: There was a reduction in median visual analogue scores during the study. The median (95% confidence interval) scores for pain during relaxation decreased from 45 (34 to 53) in stage 1 to 16 (10 to 20) in stage 7 for major surgical procedures. Pain on movement decreased from 78 (66 to 80) to 46 (38 to 48), and pain on deep inspiration decreased from 64 (48 to 78) to 36 (31 to 38). The reductions in median scores for intermediate and minor operative procedures showed similar patterns. CONCLUSIONS: The introduction of an acute pain service to the general surgical wards led to considerable improvement in the level of postoperative pain as assessed by visual analogue scores. Simple techniques of regular pain assessment and the more frequent use of intramuscular analgesia as a result of using an algorithm were particularly effective.

Algorithms↗
PubMed1992

Non-specific abdominal pain: the resource implications.

Non-specific abdominal pain (NSAP) is responsible for a significant proportion of emergency surgical admissions with resultant resource implications. The extent of the problem was assessed in a consecutive group of 100 patients, aged between 15 and 35 years, admitted with lower abdominal pain to one general surgical firm. No less than 67 of these patients (67%) were diagnosed as having NSAP (13.29% of all general surgical admissions), most (75%) being female and having a mean hospital stay of 4.1 days. Only 11 patients (11%) had appendicitis and the remaining 22 had miscellaneous gynaecological, urological or gastrointestinal problems. Detailed analysis of the resources used revealed that the mean cost to the NHS of each case of NSAP was 807 pounds, the bulk of which was attributable to the hospital stay. Wider assessment of the problem (by means of postal questionnaire) suggests that the cost to the NHS in Wales is in the region of 6 million pounds per year and may be over 100 million pounds per year in the UK as a whole.

Abdominal Pain↗
PubMed1991

Dermatophytosis mimicking Kaposi's sarcoma in human immunodeficiency virus disease.

Kaposi's sarcoma (KS) is an important finding in patients infected with human immunodeficiency virus (HIV), with a distinctive spectrum of clinical presentations. Three cases of dermatophytosis in HIV-infected patients are presented which clinically mimic the appearance of KS. This new observation underscores the importance of histopathologic examination in the evaluation of skin lesions suspicious for the diagnosis of KS. The other clinical mimickers of KS are reviewed.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Concomitant granuloma annulare and necrobiosis lipoidica. Report of a case and review of the literature.

A case of concomitant granuloma annulare (GA) and necrobiosis lipoidica (NL) is presented. The etiology of these two disorders remains obscure. The similarity of the histopathology in GA and NL might suggest a common origin. However, a review of the 5 previous cases of concomitant GA and NL and recent biochemical, immunological and immunohistochemical studies comparing GA to NL indicates an independent etiology for these two histologically related disorders. Some evidence points toward a closer relationship of NL with diabetes than GA, while GA may be related to delayed-type hypersensitivity reactions.

Arm↗
PubMed1990

Electrocardiographic abnormalities after a transient ischemic attack.

I believe this is the first reported case of neurogenic ECG changes following a transient neurologic insult. The profound and long-lasting ECG changes that followed a brief neurologic derangement adds credence to the theory of actual myocardial damage as the genesis of neurogenic ECG changes.

Aged↗
PubMed1990

The role of the high dependency unit in postoperative care: an update.

The current experience of a high dependency unit established 5 years ago for the postoperative care of high-risk patients undergoing surgery is reported. The resource implications and contributions to the safety and quality of post-operative care, particularly pain relief, are described.

Adolescent↗
PubMed1989

Familial koilonychia.

Koilonychia is a well-recognized clinical sign of iron deficiency occurring either with or without anemia. A case of familial koilonychia with an inheritance pattern consistent with an autosomal dominant trait is presented. Comments on inherited koilonychia and other causes of koilonychia are also included. The possible causes of the nail disorder are discussed.

Anemia, Hypochromic↗
PubMed1988

Effects of ribavirin on neutrophil function.

Ribavirin, a broad spectrum antiviral agent, has been shown to exhibit immunosuppressive activity. This property has raised concerns during clinical trials because candidates for antiviral therapy are those who may develop secondary bacterial infection. We therefore investigated a number of parameters of neutrophil function after the in vitro addition of various concentrations of ribavirin. At pharmacologic concentrations (1.25-7.5 micrograms/mL), percent killing of phagocytized bacteria was increased as measured by an acridine orange fluorochrome microassay, significantly higher at a concentration of 5 micrograms/mL (p less than .02). There was no concomitant adverse effect on adherence, random migration, chemotaxis, opsonization or phagocytosis. The present data indicate that ribavirin has no acute suppressive effect on granulocyte function and may even enhance bacterial killing capabilities for treated patients.

Blood Bactericidal Activity↗