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J D Greig

Publications and source records attributed to J D Greig.

At least 19 recordsLinked to original sources
PubMed2005

The potential for acquiring cryptosporidiosis or giardiosis from consumption of mung bean sprouts in Norway: a preliminary step-wise risk assessment.

The current work evolved from a microbial survey of fruits and vegetables conducted in Norway between 1999 and 2001. This survey found that mung bean sprouts were more likely to be contaminated with Cryptosporidium and Giardia than the other produce included in the survey. To support this observation and to demonstrate to public health officials that this might be a risk warranting further attention, a simple risk assessment was initiated. Assuming that 60,000 people in Norway consume a single serving of bean sprouts per week, and contamination levels are similar to those found in the survey, it was calculated that there could be in the order of 20 cases of Giardia or Cryptosporidium infection per 100,000 population attributable to consumption of mung bean sprouts. A number of assumptions were made for the calculations, including parasite factors (e.g. viability, genotype), product factors (e.g. extent of product contamination) and host factors (e.g. composition and extent of consumer group). These assumptions and areas of uncertainty, where further data would improve the risk assessment, are highlighted throughout. Not only does the risk assessment identify new areas of research, but it also demonstrates how risk assessment can be used as a tool to try to influence public health surveillance.

Animals↗
PubMed1996

Comparison of manual and ultrasonographic evaluation of bladder size in patients prior to laparoscopy.

BACKGROUND: Catheterization of the bladder may reduce laparoscopic complications although an enlarged bladder may be impalpable in overweight patients or following previous lower abdominal surgery. METHODS: This study assessed bladder size by manual examination and transcutaneous ultrasound (US). Consecutive patients (n = 90; median age 55 years [20-85]; 61 females) undergoing laparoscopy were studied prospectively. All patients voided preoperatively and catheterization was performed if estimated US bladder volumes exceeded 300 ml. RESULTS: Manual assessment failed to detect bladder enlargement in any patients (sensitivity: 0%; specificity: 4.4%), whereas ultrasound identified four patients at risk of bladder injury due to unsuspected enlargement (4.4%). Three of these patients were either overweight or obese and one patient had previous lower abdominal surgery. Of 12 patients (13%) catheterized, three had or developed urinary tract infections. CONCLUSIONS: Preoperative voiding does not guarantee bladder emptying. Manual examination does not detect bladder enlargement reliably in the obese patient. Ultrasonography may improve patient selection for catheterization.

Adult↗
PubMed1996

Technique of laparoscopic splenectomy with a powered vascular linear stapler.

The spleen may be removed by a laparoscopic technique, although the benefits and associated morbidity of this approach are unknown. This study reports a series of 28 consecutive patients (15 women; median age 39 (range 17-84) years) considered for laparoscopic splenectomy, because of idiopathic thrombocytopenia in 14, human immunodeficiency virus-related thrombocytopenia in seven, autoimmune haemolytic anaemia in four, lymphoma in two and chronic lymphocytic leukaemia in one. In 23 cases dissection was completed laparoscopically, with the patient in the right lateral position, using a four-cannula technique. Vascular isolation was achieved with an Endo-GIA (powered vascular linear stapler). The spleen was removed by morselation within a retrieval bag (18 patients) or via either a Pfannenstiel or subcostal incision (five). The last 14 procedures have all been completed successfully in a mean operating time of 105 min with discharge from hospital within a median of 3 days. One patient developed a clinically apparent deep venous thrombosis 23 days after operation, for which he required readmission. Elective laparoscopic splenectomy is a feasible although technically demanding operation which may be performed safely and without associated mortality by surgeons experienced in laparoscopic techniques.

Adolescent↗
PubMed1995

Presentation of endometriosis to general surgeons: a 10-year experience.

The presentation and management of 24 patients with endometriosis (median age 34 (range 21-68)years) presenting to general surgeons over a period of 10 years (1985-1994) was reviewed. Patients presented with an abdominal wall swelling related to a previous Pfannenstiel incision (seven patients), umbilical swelling (four), inguinal canal swelling (two), incidentally following appendicectomy (five), terminal ileal obstruction (two), rectal bleeding (two) and urinary symptoms (two). Endometriosis was not suspected in most patients but was confirmed by surgical excision or resection with minimal morbidity. No recurrence occurred during a median follow-up of 53 (range 9-113) months. Endometriosis is a disease rarely seen by general surgeons and is often diagnosed incidentally or on histological examination. Cyclical symptoms associated with menstruation are present in 50 per cent of patients and should suggest the diagnosis in those presenting with scar-related and/or subcutaneous swellings. Simple excision or resection of the presenting lesion provides adequate treatment but, since pelvic endometriosis may be present, referral to a gynaecologist is recommended in every case.

Abdominal Muscles↗
PubMed1995

Carcinoma of the pancreatic head and periampullary region. Tumor staging with laparoscopy and laparoscopic ultrasonography.

OBJECTIVE: The authors performed a prospective evaluation of staging laparoscopy with laparoscopic ultrasonography in predicting surgical resectability in patients with carcinomas of the pancreatic head and periampullary region. SUMMARY BACKGROUND DATA: Pancreatic resection with curative intent is possible in a select minority of patients who have carcinomas of the pancreatic head and periampullary region. Patient selection is important to plan appropriate therapy and avoid unnecessary laparotomy in patients with unresectable disease. Laparoscopic ultrasonography is a novel technique that combines the proven benefits of staging laparoscopy with high resolution intraoperative ultrasound of the liver and pancreas, but which has yet to be evaluated critically in the staging of pancreatic malignancy. METHODS: A cohort of 40 consecutive patients referred to a tertiary referral center and with a diagnosis of potentially resectable pancreatic or periampullary cancer underwent staging laparoscopy with laparoscopic ultrasonography. The diagnostic accuracy of staging laparoscopy alone and in conjunction with laparoscopic ultrasonography was evaluated in predicting tumor resectability (absence of peritoneal or liver metastases; absence of malignant regional lymphadenopathy; tumor confined to pancreatic head or periampullary region). RESULTS: "Occult" metastatic lesions were demonstrated by staging laparoscopy in 14 patients (35%). Laparoscopic ultrasonography demonstrated factors confirming unresectable tumor in 23 patients (59%), provided staging information in addition to that of laparoscopy alone in 20 patients (53%), and changed the decision regarding tumor resectability in 10 patients (25%). Staging laparoscopy with laparoscopic ultrasonography was more specific and accurate in predicting tumor resectability than laparoscopy alone (88% and 89% versus 50% and 65%, respectively). CONCLUSIONS: Staging laparoscopy is indispensable in the detection of "occult" intra-abdominal metastases. Laparoscopic ultrasonography improves the accuracy of laparoscopic staging in patients with potentially resectable pancreatic and periampullary carcinomas.

Adenocarcinoma↗
PubMed1995

Transurethral resection of the prostate in 539 patients at a district general hospital.

This study audited length of hospital stay, mortality and morbidity associated with transurethral resection of the prostate (TURP) in a district general hospital over a 4-year period between 1990 and 1993. Five hundred and thirty-nine TURPs (409 benign and 130 malignant; median age 69 years) were carried out, which represented a twofold increase over the 4-year period. Although the mean duration of stay was 5 days, 92.5% of patients had a hospital stay of less than 7 days. One (0.2%) death occurred in a patient with ischaemic heart disease on the first postoperative day. The commonest cause of morbidity and delayed discharge from hospital was presence of outflow symptoms in nine (1.7%) patients. Transurethral resection of the prostate is a safe procedure in an ever-increasing elderly population with concomitant medical illness, but improved identification of 'at-risk' patients is required in order to further lower the morbidity associated with this procedure.

Aged↗
PubMed1995

Raised carcinoembryonic antigen level as an indicator of recurrent disease in follow up of patients with colorectal cancer.

BACKGROUND: Serum carcinoembryonic antigen level is raised in 80% of patients undergoing colonic resection for cancer. Subsequent elevation in the follow-up period may precede signs and symptoms as an indicator of recurrent disease. there is little evidence that "classical" follow up of patients in the general surgical outpatient clinic improves either survival or quality of life. Regular carcinoembryonic antigen level estimation requested by the general practitioner, allied to day-case colonoscopic surveillance may be a more rational approach. AIM: A study was undertaken to investigate the relationship between raised carcinoembryonic antigen level and the recurrence of colorectal cancer in patients following a curative primary resection. METHOD: Retrospective analysis was carried out on the notes of 125 patients who had attended a dedicated hospital colorectal follow-up clinic between 1988 and 1992. Carcinoembryonic antigen level data were obtained by subsequent examination of the University of Edinburgh Department of Clinical Chemistry (immunoassay section) carcinoembryonic antigen database. RESULTS: A single carcinoembryonic level result of more than 100 ul-1 (normal range less than 60 ul-1) was found to be a highly sensitive (87%), specific (89%), and accurate (88%) indicator of recurrent disease. Raised carcinoembryonic antigen level preceded symptoms in 72% of patients with recurrence of colorectal cancer. CONCLUSION: Sequential laboratory estimation of carcinoembryonic antigen level organized by the general practitioner may represent an accurate method of detecting recurrent colorectal disease. Hospital review could be limited to colonoscopic surveillance and restaging of patients referred with evidence of recurrent disease.

Adult↗
PubMed1994

Laparoscopic ultrasonography in the evaluation of the biliary tree during laparoscopic cholecystectomy.

A prospective comparative study to evaluate operative cholangiography and laparoscopic ultrasonography in the detection of common bile duct (CBD) stones was undertaken in 54 patients undergoing laparoscopic cholecystectomy. Laparoscopic ultrasonography with a 7.5-MHz linear-array probe was performed before gallbladder mobilization. The incidence of choledocholithiasis at operation was 13 percent (seven patients). Cholangiograms were not obtained in six patients, one of whom had common duct stones identified by laparoscopic ultrasonography. Operative cholangiography detected five of the remaining six CBD stones with two false-positive examinations. Laparoscopic ultrasonography detected five of the seven stones with two false-positive examinations. The finding of a CBD diameter of 7 mm or greater and gallbladder stones of up to 3 mm in diameter by laparoscopic ultrasonography would have identified all patients with common duct stones and implies that none of these would have undergone false duct exploration. Laparoscopic ultrasonography is useful in the detection of choledocholithiasis.

Adult↗
PubMed1994

Superior staging of liver tumors with laparoscopy and laparoscopic ultrasound.

OBJECTIVE: The authors describe the technique of staging laparoscopy with laparoscopic contact ultrasonography in the preoperative assessment of patients with liver tumors, and assess its impact on the selection of patients for hepatic resection with curative intent. SUMMARY BACKGROUND DATA: Laparoscopy may be useful in the selection of patients with a variety of intra-abdominal malignancies for operative intervention. Laparoscopic ultrasonography is a new technique that combines the principles of high resolution intraoperative contact ultrasound with those of the laparoscopic examination, and thus, allows the laparoscopist to perform detailed assessment of the liver. METHODS: This study analyzes a cohort of 50 consecutive patients who were diagnosed as having potentially resectable liver tumors, and in whom staging laparoscopy was successfully undertaken. Laparoscopic ultrasonography was performed in 43 patients, and the impact of the ensuing findings on the decision to proceed to operative assessment of resectability is examined. The resectability rate in those patients assessed laparoscopically and subsequently submitted to laparotomy is compared with a preceding group of patients in whom no laparoscopic assessment was performed. RESULTS: Laparoscopy demonstrated factors precluding curative resection in 23 patients (46%). Laparoscopic ultrasonography identified liver tumors not visible during laparoscopy in 14 patients (33%), and provided staging information in addition to that derived from laparoscopy alone in 18/43 patients (42%). The resectability rate was significantly higher among those patients undergoing laparoscopic staging (93%) compared with those in whom operative assessment was undertaken without laparoscopy (58%). CONCLUSIONS: Staging laparoscopy with laparoscopic ultrasonography optimizes patient selection for liver resection with curative intent.

Adult↗