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Biomedical subjects

M C Crowson

Publications and source records attributed to M C Crowson.

At least 19 recordsLinked to original sources
PubMed1998

Screening for abdominal aortic aneurysms does not increase psychological morbidity.

Screening can lead to harmful psychological effects in the screened population--an argument used against abdominal aortic aneurysm (AAA) screening. However, there is no evidence for this in AAA screening. We applied the Hospital Anxiety and Depression Scale (HADS) to a group of men undergoing screening for AAA. The HADS questionnaire was completed by subjects found not to have AAA, subjects with known small aneurysms attending for follow-up scans, subjects with known AAA on waiting lists for surgery, and controls not involved in the screening programme. The groups were well matched for age and the number of additional diseases. There was no significant difference in the distribution of patients for anxiety and depression according to the HADS questionnaire (chi 2 test, P > 0.1). The results from this study suggest that AAA screening does not increase anxiety or depression in the screened subjects--contrary to the argument put forward against screening for this condition.

Aged↗
PubMed1996

Colour flow duplex in the assessment of recurrent varicose veins.

Recurrent varicose veins represent a common clinical problem. They require accurate assessment of all sites of reflux before surgery to ensure the correct surgical approach and reduce further recurrences. We report our experience of colour flow duplex in 190 legs with recurrent disease with reference to the pattern of reflux seen. We found that multiple sites of reflux were common, and that neovascularity and calf-perforators were most frequently seen. Our observations compare favourably with previously published data. Despite the reported greater accuracy of phlebography for detection of incompetent perforators, its invasive nature and potential contrast reactions have prompted us to use colour flow duplex routinely for the assessment of recurrent varicose veins.

Adult↗
PubMed1992

Blood transfusion: an overused resource in colorectal cancer surgery.

The use of blood transfusion was examined in 476 patients who underwent curative surgery for large bowel cancer. Of these patients, 128 were not transfused while 348 received a total of 1174 units of blood. A patient was considered over-transfused if the predischarge haemoglobin was more than 12 g/dl. Using this criteria and accepting that single unit transfusions should be avoided, transfusion could have been avoided in 30% of the patients and a total of 377 units were given unnecessarily. Major under-transfusion did not occur; no patient being discharged with a haemoglobin of less than 9 g/dl. This study shows that blood transfusion is overused and the reasons for its use rarely recorded. In view of the morbidity related to transfusion, it is suggested that surgeons and anaesthetists reappraise their transfusion policy and the first step in this must be to record the reason for transfusion.

Aged↗
PubMed1991

Failed femorocrural reconstruction does not prejudice amputation level.

From January 1985 to December 1989, 500 consecutive patients presented to a single vascular unit with limb-threatening acute or critical ischaemia. Vascular reconstruction was attempted unless the patient had insufficient viable tissue to permit weight bearing or complete absence of run-off vessels in the calf. Fifty patients underwent a primary amputation and 450 patients underwent vascular reconstruction, of whom 265 had a femorocrural bypass. Sixty secondary amputations were performed following femorocrural bypass failure. The below-knee amputation to above-knee amputation ratio (BKA:AKA) was 2.0 in the primary amputation group and 1.1 in the secondary amputation group. Direct comparison between the two groups is not valid as they are clinically different. The combined BKA:AKA ratio was 1.4. This compares favourably with the BKA:AKA ratio of recent published series and figures from the National Amputation and Limb Fitting Services. It suggests that an unselective policy of vascular reconstruction for critical ischaemia does not lead to a higher proportion of above-knee amputations.

Acute Disease↗
PubMed1991

Iloprost improves femoro-distal graft flow after a single bolus injection.

A double-blind, randomised, placebo-controlled trial was conducted to study the effect of the stable prostacyclin analogue iloprost on femoro-distal graft blood flow. After completing femoro-distal reconstruction, 3000 ng of iloprost or placebo was injected into the graft over 2 min. Graft blood flow, measured by electromagnetic flowmetry, increased by a mean (range) of 94% (12 to 192%) in patients receiving iloprost (n = 15) compared to 6% (-34 to 53%) in controls (n = 16; p less than 0.0001, t-test). Increased graft flow, measured by duplex ultrasound, was maintained in the iloprost group over a 7 day period postoperatively (F = 5.2, p = 0.03; analysis of variance) and remained higher at 7 days (p = 0.007, t-test). Iloprost produces an immediate, sustained increase in graft blood flow after femoro-distal reconstruction and may therefore be of benefit in reducing the incidence of early graft failure.

Aged↗
PubMed1991

Haemoccult testing as an indicator of recurrent colorectal cancer: a 5-year prospective study.

A prospective study was conducted to assess the value of routine haemoccult testing as an indicator of early luminal recurrence of colorectal cancer. One hundred patients (mean age 72 years) undergoing radical resection (70% Dukes' B and 30% Dukes' C) for colorectal carcinoma were asked to provide 3-monthly haemoccult tests to a special follow-up clinic for a minimum of 5 years. Positive tests underwent further investigation with barium enema and colonoscopy. Patient compliance was 84%. Positive tests were obtained in 14 asymptomatic individuals, five of whom proved to have anastomotic recurrence. Recurrence was also identified in a further patient despite a negative haemoccult test. Three patients with anastomotic recurrence were able to undergo further radical surgery; two were still alive over 5 years after detection of recurrent disease. Haemoccult screening appears to detect increased numbers of patients with luminal recurrence (7.2%) when compared to historical controls (2.1%). Larger studies will be needed to determine if this increased detection rate results in improved long-term survival.

Aged↗
PubMed1990

Vertical Silastic ring gastroplasty: a 6-year experience.

Vertical Silastic ring gastroplasty was carried out in 71 patients as treatment for morbid obesity. The mean excess weight loss at 6 months (59 patients) and 2 years (43 patients) was 48 per cent and 65 per cent respectively. Subsequently the weight stabilized around this level with 58 per cent of the excess weight lost at 5 years (14 patients) postgastroplasty. Five patients (7 per cent) failed to lose weight. Sixteen patients (23 per cent) required revision for technical complications but continued to lose weight or to maintain a satisfactory weight. Vertical Silastic ring gastroplasty is an effective surgical method of achieving sustained weight loss.

Adolescent↗
PubMed1989

Selective conversion from azathioprine to cyclosporin for steroid-resistant rejection in renal transplants: an alternative therapy.

In 153 consecutive renal allograft recipients whose initial immunosuppression was prednisolone and azathioprine, 41 developed acute rejection episodes that were not reversed by 5-9 g of intravenous methylprednisolone. Renal histology showed cellular rejection in ten patients, vascular rejection in 12, and mixed cellular and vascular rejection in 16. Thirty-one patients were converted to cyclosporin in the first month post-transplant and ten in the second month. At the time of conversion, 20 patients were dialysis dependent and in the remainder the mean serum creatinine was 353 mumol/l (range 139-548 mumol/l). Renal function improved in 31 patients after conversion. Ten patients lost their grafts, of whom seven were on dialysis. There were no deaths and the 1-year graft survival was 75%. These data suggest that conversion from azathioprine to cyclosporin because of steroid-resistant rejection is an effective and safe strategy in patients whose initial immunosuppression is prednisolone and azathioprine.

Adolescent↗
PubMed1986

In vivo studies on the uptake of radiolabelled antibodies by colorectal and gastric carcinoma xenografts.

A number of criteria have been investigated to try to improve the uptake of radiolabelled antibodies by colorectal carcinoma xenografts. The in vivo behaviour of four antibodies was compared and found to vary. Two antibodies, 11-285-14 and 14-95-55, demonstrated specific uptake by the tumours. 11-357-5 was lost from the tumour after 72 h and the fourth antibody could not be iodinated without loss of activity. Neither increased time nor increased dose were shown to increase the uptake of antibody by tumours although the clearance of antibody from blood was shown to be more rapid than from tumour resulting in clearer backgrounds. Increased tumour:blood ratios were demonstrated by particular combinations of antibodies but the extent to which this occurred varied with the epitopes recognised. High carcinoembryonic antigen expressing xenografts did not show significantly higher uptake of antibody. This was shown to be due to the smaller size of these tumours and associated decreased vascularity.

Animals↗
PubMed1986

A phase II study to evaluate tamoxifen in pancreatic adenocarcinoma.

Oestrogen receptors have been demonstrated in pancreatic adenocarcinoma and it has been suggested that tamoxifen increases patient survival. This study of 14 patients with unresectable carcinoma of the pancreas fails to demonstrate any objective response from endocrine manipulation using tamoxifen.

Adenocarcinoma↗
PubMed1985

Perforation of the acalculous gallbladder following renal transplantation.

Two acalculous renal transplant patients, of more than 1,000 performed at this center, suffered early infarction and perforation of the gallbladder following operation. This rare complication may be related to both postoperative stress and the immunocompromising drugs given to renal transplant patients.

Cholecystitis↗