Biomedical subjects
G Holdstock
Publications and source records attributed to G Holdstock.
Open-access endoscopy service for general practitioners.
An open-access general-practitioner referral service for endoscopy of the upper gastrointestinal tract was established in a district general hospital, and the impact of the service over three years was assessed. The reason for referral, duration of symptoms, and amount of disease detected were the same in patients referred by general practitioners and those attending from hospital outpatient departments. Despite a steady increase in the number of patients referred for endoscopy, the number of barium-meal examinations performed did not correspondingly decrease. The number of ulcers and cancers detected in each six-month period of the study did not increase, and the combined overall pick-up rate for these two conditions fell from 25% to 13%. All general practitioners in the area were sent questionnaires. Most thought that clinic referral had been reduced and patient management helped as a result of the introduction of the service. While the value of negative endoscopic findings cannot be assessed, there is little objective evidence of benefit. Hence the large increase in numbers of endoscopies performed as a result of the introduction of the service cannot be justified.
Bottle feeding, early gastroenteritis, and inflammatory bowel disease.
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Endoscopic duodenal biopsies in coeliac disease and duodenitis.
Endoscopic duodenal biopsies were taken from 27 patients with suspected coeliac disease and compared with intubation capsule jejunal biopsies. The specimens were reported without knowledge of the patients' names or symptoms. In 24 patients (89%), coeliac disease could either be diagnosed or excluded with 100% accuracy, despite the inability to orientate the biopsies correctly. Six biopsies were considered technically unsatisfactory, but only in three (11%) was it impossible to exclude coeliac disease. Duodenal biopsies were also taken from 118 consecutive patients attending for routine upper gastrointestinal endoscopy, and 1 patient with coeliac disease was discovered. We conclude that endoscopic duodenal biopsies are a reliable and worthwhile screening test for coeliac disease in certain patients attending for routine upper gastrointestinal endoscopy.
Jejunal biopsy without the need for screening.
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The magnitude of the bradycardia induced by face immersion in patients convalescing from myocardial infarction.
Twenty patients who had suffered myocardial infarction within the previous 3 to 13 days performed face immersion with breath-holding. The maximum reduction in heart rate was 17 +/- 9 beats-min--1 (mean +/- SD). When compared with 24 patients without evidence ischaemic heart disease, they behaved more like younger patients (22 +/- 6) than patients in the same age range (7 +/- 6). A greater vagal response for age after infarction may reflect persistent hypersensitivity of a reflex designed to protect the myocardium during cardiogenic shock.
Prevalence of diverticular disease of the colon in patients with ischaemic heart disease.
In view of the similar patterns of incidence of diverticular disease of the colon (DD) and ischaemic heart disease (IHD) in different communities, the prevalence of diverticular disease was investigated in male patients after recovery from acute myocardial infarction. A significantly higher prevalence of DD was found among infarct patients (57%) than among male control subjects (25%) matched for age and social class.
Comparison of mortality of patients with heart attacks admitted to a coronary care unit and an ordinary medical ward.
During a 32-month period 2047 patients suspected of having heart attacks were admitted to hospital and were followed up prospectively. Out of 1480 eventually found to have definite or probable myocardial infarction, 483 had initially been admitted to an ordinary medical ward because of the shortage of coronary care unit (CCU) beds. More patients aged over 65 had been admitted to a ward than to a CCU, and more patients aged 65 or less had been admitted initially to a CCU. Within each age group, however, patients admitted initially to a CCU were clinically similar to those admitted initially to a ward. There was a higher proportion of successful resuscitations among patients admitted to a CCU, but there was no significant difference in mortality in either age group between patients admitted to a CCU and a ward.
Erythrocyte-sedimentation rate before and after in-vitro defibrination: A rapid and simple method for increasing its specificity.
The erythrocyte-sedimentation rate (E.S.R.) was measured before and after in-vitro defibrination in 107 patients with high E.S.R.S. The reduction in E.S.R. on defibrination correlates with the fibrinogen level while the post-defibrination E.S.R. correlates with the globulin level. The ratio between the post-defibrination E.S.R. and the pre-defibrination, or standard, E.S.R. varies with different diseases; it is highest when an excess of globulins is the cause of the high E.S.R. and lowest when there is an excess of fibrinogen. Measurement of the post-fibrination E.S.R. is quick and easy and may help in the initial investigation of a high E.S.R.