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Biomedical subjects

P F Schofield

Publications and source records attributed to P F Schofield.

At least 73 records · Page 4Linked to original sources
PubMed1987

Quantitative magnetic resonance imaging in rectal carcinoma.

T1 and T2 relaxation times have been calculated in 30 patients with rectal carcinoma and seven patients with a fibrotic pelvic mass. The relaxation times were calculated using a multipoint iterative method with data from seven total saturation recovery and six spin-echo sequences. The results show that the calculated T1 relaxation value is a useful discriminant between carcinoma and pelvic fibrosis and should improve the detection of early tumour recurrence.

Adenocarcinoma↗
PubMed1987

Angiogenic activity in human wound fluid.

Wound drainage fluid from postoperative patients was examined for its ability to induce blood vessel growth using the chick chorio-allantoic membrane (CAM) assay. Sixteen samples from 12 patients were tested. The tests were performed on both whole unfractionated fluid and fluid after separation using diethyl aminoethyl cellulose (DEAE) ion exchange chromatography. All 16 samples were inactive before DEAE-chromatography but a fraction, eluting at between 300-400 mM salt, induced neovascularization in 15 out of 16 samples. These differences were statistically highly significant (p less than 0.001). Angiogenic factor (AF) was detected in fluids obtained from both clean and contaminated wounds, and in patients with benign and malignant disease. As mentioned earlier unfractionated wound fluids were nonangiogenic by themselves and their addition to the active fractions greatly reduced the angiogenic effect of the latter. Therefore we suggest that wound fluid contains both promoters and inhibitors of angiogenesis. The local balance between these may govern the rate of vascularisation during healing.

Angiogenesis Inducing Agents↗
PubMed1986

Expression of HLA-D sub-region products on human colorectal carcinoma.

The major histocompatibility complex (MHC) status of normal, inflamed, pre-malignant and malignant epithelia of the human gastrointestinal tract was investigated by immunocytochemical methods using monoclonal antibodies (MAbs) directed against heavy (alpha)- and light (beta 2m)-chain Class-I molecules and sub-locus products (DP, DQ, DR) of the HLA-D region. Class-I expression on epithelial cells appeared to vary little with pathological status except in the case of 4/32 (13%) colorectal carcinomas in which the antigens were undetectable or scanty. The pattern of Class-II expression was more complex. The antigens were readily detectable on normal stomach epithelium, in villous adenomas and in inflammatory bowel mucosa. In each of these situations DR was the predominant specificity, followed by DP and DQ. Expression on normal colonic epithelium was usually negative but, in the vicinity of a neoplasm or an area of marked leukocyte infiltration, Class-II molecules (DR greater than DP much greater than DQ) were detectable. A similar pattern of non-coordinate expression was found on 23/32 (72%) colorectal carcinomas, but on the remaining 28% no Class-II products were detectable, under conditions wherein stromal leukocytes were strongly stained. The data suggest that in a significant proportion (nearly 30%) of primary colorectal carcinomas, the capacity for Class-II induction, a constitutive or acquired feature of normal colorectal epithelium, is either diminished or lost. Also, tumor Class-II status is not correlated to Dukes' stage or differentiation.

Adenoma↗
PubMed1986

Management of the septic complications of diverticular disease.

One hundred and five patients underwent surgical treatment of septic complications of diverticular disease. In nine cases, operation was carried out for acute large bowel obstruction and in the remainder for peritonitis. An inflammatory mass and/or localized abscess was found in 23 cases. Free pus without evidence of 'communicating' perforation was found in a further 33 and 'communicating' perforation in 40. Treatment by primary resection or by transverse colostomy and drainage were both associated with significantly lower mortality from sepsis than treatment by drainage alone. In cases without 'communicating' perforation, there was no difference in mortality between primary resection and transverse colostomy with drainage. Although the advantage of primary resection was most apparent in cases with 'communicating' perforation, it did not reach statistical significance. In three cases treated primarily without resection the pathology was subsequently found to be that of carcinoma. In 'favourable' circumstances, i.e. without 'communicating' perforation, defunctioning colostomy with drainage has an acceptably low mortality rate and may be undertaken by a less experienced surgeon to avoid a difficult resection. Ideally these problems should be dealt with by an experienced surgeon; we prefer to treat the septic complications of diverticular disease by primary resection.

Abscess↗
PubMed1986

Gold induced enterocolitis.

A case of gold associated enterocolitis is described. A review of all 27 previously reported cases revealed that the syndrome induced has common characteristics. The reaction occurs within three months of instituting gold therapy, is characterised by profuse diarrhoea and vomiting with abdominal pain, fever, and sometimes eosinophilia. Petechial changes are prominent on endoscopy and the endoscopic and histological features of the gut lesion do not resemble inflammatory bowel disease. The overall mortality is 26% but has decreased in recent years. There is no specific therapy but in severe cases diversional surgery may be justified.

Adult↗
PubMed1986

Microvascular studies in non-specific inflammatory bowel disease.

The microvasculature was investigated in the normal bowel and in ulcerative colitis and Crohn's disease. Tissue samples from postoperative colectomy specimens in which the microvasculature had been perfused with barium sulphate suspension were examined. Microradiography was used to study intramural vascular pattern which was abnormal in both disease states. A recently described radiograph fluorescence system was used to estimate barium concentration and hence microvascular volume in tissue samples. Highly significant negative correlations were demonstrated between barium concentration and age in normal bowel (n = 44; r = -0.669; p less than 0.001) and in segmental Crohn's disease (n = 11; r = -0.698; p = 0.017). Barium concentration was significantly reduced (p less than 0.05) in segmental Crohn's disease (n = 11) but remained normal in diffuse Crohn's disease of the colon (n = 6) and ulcerative colitis (n = 7). It is postulated that ischaemia may be a factor in the pathogenesis of segmental Crohn's disease in older patients.

Adolescent↗
PubMed1986

Indications for and results of operation in inflammatory bowel disease.

Of 363 patients with inflammatory bowel disease presenting between 1972 and 1983, 166 required definitive operation. A classification by histological type distinguishes Crohn's disease (CD) from ulcerative colitis (UC) and indeterminate inflammatory bowel disease. CD is divided into predominantly ileal disease (81), total or subtotal colonic disease (74) and distal disease (22), whilst UC is classified into colonic (95) or distal disease (63). Most patients with ileal disease required operation for chronic persistent symptoms. In patients with total colonic involvement a greater proportion of patients with CD than those with UC came to surgery. Very few patients with distal disease required surgery. After resection for ileal disease there was a low incidence of anastomotic leakage (3%) and no operative mortality. There was an overall operative mortality of 8% after colonic resection. This was much lower in the non-urgent cases but rose to 12% in urgent cases.

Colitis, Ulcerative↗
PubMed1986

Is it acute cholecystitis?

In a prospective study of 100 patients presenting with acute right hypochondrial pain and diagnosed clinically by a qualified surgeon as having acute cholecystitis, we have shown that the diagnostic error can be considerable. Twenty-five of these patients were found to have a different diagnosis on subsequent investigation and in a further 11 patients, no definite diagnosis could be established. This emphasises the need for careful investigation of patients with this presenting complaint.

Abdomen, Acute↗
PubMed1986

Ischaemic dilatation of the colon.

The present paper describes the presentation and management of 9 patients who developed dilatation in the colon during the course of spontaneous ischaemic colitis. The length of history varied from 16 hours to 6 weeks. The patients usually had diarrhoea and abdominal pain but no bleeding and posed a difficult diagnostic problem. At laparotomy, three distinct types of colonic dilatation were recognised. Dilatation of non-diseased colon proximal to localised ischaemic segments occurred in 2 patients, 3 patients exhibited dilatation of obviously gangrenous colon, 4 patients showed dilatation of ischaemic but possibly viable colon, yet in 1 of these, multiple sealed perforations were present. Resection of the obvious or possibly gangrenous colon was the treatment used but in the 2 patients with dilatation due to stricture, transverse colostomy alone was employed.

Adult↗
PubMed1985

Resection of 'inoperable' rectal cancer following radiotherapy.

Forty-two patients with fixed inoperable adenocarcinoma of the rectum due to local extension in the pelvis have been treated using high dose radiotherapy followed by surgery when possible. Inoperability was determined initially by laparotomy in 15 patients and in the remainder by examination under anaesthetic. Twenty-nine patients underwent laparotomy following radiotherapy and resection was performed in 18. In three of these cases there was no residual tumour in the operation specimen. The median survival of the resected group was 28 months compared with 7 months for the unresected group. Treatment related mortality in the resected group was confined to five patients, two postoperative deaths and three small bowel fistulae which developed as late complications. Analysis of prognostic factors indicates that patients most likely to benefit from this approach are those with no evidence of distant metastases or of urinary obstruction at presentation. Patients who have a good clinical response to radiotherapy are more likely to achieve resection and subsequent long-term survival.

Adenocarcinoma↗
PubMed1985

Platelet count in radiation bowel disease: an aid to diagnosis.

This study reports the results of serial observations of simple haematological indices (haemoglobin concentration, white cell count and platelet count) in 25 patients who developed radiation bowel disease as a late complication of pelvic radiotherapy for malignancy. It is compared with a control group of 25 women patients who received pelvic radiotherapy but did not develop radiation bowel disease. There is a highly significant elevation in the platelet count (P less than 0.0001) at a time when the patients develop radiation bowel disease. The platelet count returns to normal after successful excision of the disease but the elevation recurs if further radiation disease develops in the urinary or gastrointestinal tracts. It is suggested that the platelet count may have a useful role in the diagnosis of radiation bowel disease.

Female↗
PubMed1985

Vascular changes in radiation bowel disease.

A series of 20 cases of radiation bowel disease (RBD) was studied qualitatively and the arterial changes were studied quantitatively. A control series of 45 cases was studied. In the control cases there were positive correlations between the medial thickness of all vessels studied and the diastolic blood pressure as well as the incidence of intimal fibrosis in both intramural and extramural arteries. The medial thickness in all the arteries in cases of RBD was significantly higher than in the controls. This was probably due to the large number of fibrin thrombi which increased the vascular resistance. The degree of intimal fibrosis of the intramural arteries and arterioles was significantly greater than in the controls. Similarly the incidence of intimal fibrosis in all arterioles and intramural arteries was greater than the control group. The degree of intimal fibrosis was related to the dose of radiation received. The effect of radiation was an on-going process since the percentage of arterioles with intimal fibrosis increased with the time after radiotherapy. Blood pressure and age played no part in these correlations in RBD. The most consistently observed qualitative changes in RBD were in the arteries, arterioles and to a lesser extent the veins. These showed fibrin thrombi, fibrinoid necrosis, subendothelial oedema and fibrin. Various stages of healing were seen in the vessels. We believe that the blood vessels are the main site of injury in RBD and that the endothelial cell is the initial target for radiation damage.

Adolescent↗