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Biomedical subjects

R A Spence

Publications and source records attributed to R A Spence.

At least 55 records · Page 3Linked to original sources
PubMed1990

Does preoperative computed tomography scanning aid assessment of oesophageal carcinoma?

In this study 50 patients (36 male, 14 female) with oesophageal carcinoma have been examined preoperatively by computed tomography. Three parameters were assessed, nodal involvement, invasion of adjacent organs, and metastatic disease. For all patients the computed tomography findings were correlated with the subsequent surgical and pathological findings. Sensitivity for both invasion and node involvement is low (36% to 67%). Specificity however, is high (85% to 95%). Computed tomography is therefore relatively reliable when it predicts a 'negative result' for either invasion or node involvement. However, its predictive value for a positive result is not as reliable.

Adult↗
PubMed1990

High or low hepaticojejunostomy for bile duct strictures?

The 19 patients who underwent 22 postoperative repairs of bile duct stricture in our institution between 1973 and 1984 were evaluated to assess whether the recognition of the tenuous blood supply of the supraduodenal bile duct in 1979 had improved the results thereafter. Thirteen of these 22 operations followed a previous biliary tract repair; in 10 of the operations a low anastomosis had been performed without taking blood supply into account. Follow-up was complete and ranged from 5 to 15 years. There were no operative deaths and minimal morbidity. There were three deaths at a later time. Five of the 11 patients treated by surgery to 1979 had a clinically unsatisfactory result: recurrent strictures developed in all five patients. All but one of the eight patients receiving a high hepaticojejunostomy from 1980 had a clinically satisfactory result with no recurrent strictures. The one exception was the patient who had a second repair with separate high right and left hepatic duct anastomoses and who has ongoing symptoms from preexisting secondary sclerosing cholangitis. The results in the five high repairs performed for low strictures were particularly striking: All five were asymptomatic. This study lends support to the hypothesis of an ischemic basis for biliary strictures and to the recommendation that strictures be repaired with a high hepaticojejunostomy.

Adult↗
PubMed1989

A quarter of a century of portasystemic shunting for oesophageal varices.

Seventy-three patients who had received portasystemic shunts were reviewed to assess the current role of this procedure in the treatment of portal hypertension. Survival at 1, 5 and 10 years was 85%, 68% and 45% respectively. Survival was significantly greater (P less than 0.001) in Child's grade A patients compared with Child's grade B patients and in non-alcoholics compared with alcoholics. Previously absent encephalopathy developed in 43% of those with non-selective shunts compared with 21% of those with selective shunts. Six of the 12 patients who experienced recurrent variceal haemorrhage had associated shunt thrombosis: five of these required further shunts or oesophageal transection to control their bleeding and the other patient died before further surgery could be instituted. Shunt surgery still has a role in the treatment of a small number of carefully selected patients with portal hypertension.

Adolescent↗
PubMed1988

Rigid versus fiberoptic endoscopic injection sclerotherapy. A prospective randomized controlled trial in patients with bleeding esophageal varices.

During a 3-year period (June 1981-July 1984), 70 patients who presented with an endoscopically proven variceal bleed were randomized to receive either fiberoptic injection sclerotherapy (FIS, 36 patients) or a rigid scope technique (RIS, 34 patients), using ethanolamine oleate as the sclerosing agent. After discharge, patients entered into a chronic injection sclerotherapy program. Control of the acute bleeding episode (FIS, 91%, RIS, 95%) and the first hospital admission mortality (FIS, 34%, RIS, 44%) were similar. Eradication of varices was achieved in 16/19 and 13/16 cases in the two respective groups of patients who survived longer than 3 months, and only 2 of these patients (both of whom were in the RIS group) had a further major variceal bleed. The overall complication rate per injection was significantly lower in the FIS group (p less than 0.005). Twenty-six patients (14 FIS, 12 RIS) were alive at the end of the 4-year trial period. Of the total of 44 deaths, only 3 were not associated with a bleeding episode. Only five of the 29 patients who had their varices eradicated died during the trial period (median follow-up of 16 months). FIS has become the preferred method of treatment at the Groote Shuur Hospital, particularly in the long-term management of these patients. The procedure is safe, does not require a general anesthetic, and in long-term management, most patients can be treated on an outpatient basis. RIS should be reserved for the difficult recurrent acute bleeder, where the more controlled situation with a rigid scope under general anesthesia may provide safer and more effective sclerotherapy. The study stresses the importance of achieving eradication of all varices to prevent rebleeding and its attendant high mortality.

Esophageal and Gastric Varices↗
PubMed1987

Unresectable fibrolamellar hepatocellular carcinoma treated with intra-arterial lipiodolised doxorubicin. A case report.

Hepatocellular carcinoma is often an aggressive tumour and, if unresectable, carries a poor prognosis, especially in the presence of jaundice. We report on a jaundiced patient with an unresectable fibrolamellar hepatocellular carcinoma treated with intra-arterial lipiodolised doxorubicin (Adriamycin). The initial response of the patient has been encouraging. This form of therapy deserves further evaluation in patients with unresectable hepatocellular carcinoma.

Adult↗
PubMed1987

Popliteal artery trauma: a high risk injury.

The clinical presentation and management of 28 popliteal artery injuries following penetrating and blunt trauma during a 6 year period is reviewed. Clinical and Doppler evaluation identified an arterial injury in 24 (85 per cent) patients. In eight (29 per cent) patients with arteriovenous fistulae or false aneurysms, pedal pulses were palpable during initial assessment. Three (10.7 per cent) patients had limb amputation attributable to delayed vascular repair, crush injury and sepsis. End-to-end arterial repair following blunt trauma resulted in early failure with thrombosis in two patients. Autogenous vein grafting was used in 12 patients and is advocated in all blunt popliteal arterial injuries. Routine repair of associated venous injuries and liberal criteria for early fasciotomy were used. Exoskeletal fixation or skeletal traction for compound and comminuted fractures is recommended for simplicity of application and wound management. The significant functional orthopaedic disability following blunt arterial trauma at the knee is emphasized.

Adolescent↗
PubMed1987

Chemical burns of the oesophagus.

Chemical burns of the oesophagus caused by ingestion of corrosives present a difficult and potentially dangerous problem of management. Initial failure to recognize the seriousness of the injury and inexperience in the handling of the severer burn may result in consequences which are both life-threatening and life-long. Analysis of 95 patients who had ingested caustic substances is presented. Ninty-one sustained burns of the mouth, 39 of the hypopharynx or oesophagus, and 31 had laryngeal burns. Sixty-three were children of 15 years and under. Caustic soda, especially in children, was the most common substance ingested. Severe oesophageal strictures developed early in 17 patients and in a further 21 oesophageal stricturing occurred late. A protocol for the management of these patients is discussed.

Adolescent↗
PubMed1987

Cisapride: influence on oesophageal and gastric emptying and gastro-oesophageal reflux in patients with reflux oesophagitis.

A preliminary, double-blind placebo controlled trial of cisapride in reflux oesophagitis was conducted. Eighteen patients were allocated to treatment with either placebo or cisapride, 10 mg three times daily, orally, before meals. Gastric emptying of a scrambled egg meal, oesophageal transit of a liquid bolus and ambulatory monitoring of oesophageal pH were assessed before and after four weeks' therapy. Overall, gastric emptying rates were not influenced by cisapride, although a small but significant reduction in gastric isotope retention, 20 minutes after meal ingestion was observed in patients on the active drug. Oesophageal transit times were not altered by cisapride. A small but significant reduction in the duration of gastro-oesophageal reflux followed cisapride therapy when compared with placebo.

Adult↗
PubMed1986

Indium-111 autologous leukocyte imaging in pancreatitis.

Thirty-nine patients with acute pancreatitis have been assessed using a prognostic factor grading system, abdominal ultrasound, and autologous leukocyte imaging. Both prognostic factor grading and leukocyte imaging can accurately assess the severity of the disease early in its course. All patients with a negative indium-labeled leukocyte image recovered without sequelae, whereas five of the 12 patients with a positive image developed complications, including two deaths. Abdominal ultrasound is of no value in assessing severity, but is a useful method of detecting those patients with gallstone-associated disease. In patients with suspected abscess formation following acute pancreatitis, indium leukocyte imaging does not differentiate between fat necrosis and abscess formation. In this situation, computerized tomography should be carried out before laparotomy is undertaken.

Abscess↗
PubMed1986

Investigation of non-cardiac chest pain--which oesophageal test?

Five different tests were used to evaluate oesophageal function in 22 patients who presented to a cardiac unit with acute chest pain but whose cardiological investigations were negative. Eight patients had an abnormality on oesophagoscopy, 10 had an abnormal pH monitoring study, six had a positive acid infusion test, 10 had an abnormal manometric study and six had an abnormal oseophageal transit scintiscan. Concordance for the three tests of gastro-oesophageal reflux disease was low at 28%, and for the two tests of oesophageal motility only 55%. Only two patients had normal results in all five tests.

Adult↗
PubMed1985

Long-term survival following cancer of the male breast in Northern Ireland. A report of 81 cases.

Eighty-one patients with cancer of the male breast were studied. The majority (79) presented with a mass in the breast and in 8 patients the tumor was found by chance. Two patients presented with serosanguinous discharge. Average duration of symptoms was 11.9 months. Thirty patients had Stage I, 25 had Stage II, 16 had Stage III, and 8 had Stage IV disease. Fifty-three patients had simple mastectomy, nine had lumpectomy, six had radical mastectomy, and five had biopsy only. Eight had no local surgery. Overall 5- and 10-year survival allowing for all causes of death was 38% and 17%, respectively. Cox's (1972) proportional hazard regression model was used to assess the contribution of various factors to survival. Age at presentation, postoperative hormone therapy, postoperative radiotherapy, site of the primary tumor within the breast, and type of local surgery did not contribute to survival. Only the stage of disease contributed to survival and did so in the expected direction.

Actuarial Analysis↗
PubMed1985

Oesophageal manometry in patients with varices and following oesophageal transection.

Thirteen patients who had recently bled from varices underwent oesophageal manometry. A control group of 13 asymptomatic subjects were also studied. Seven of the thirteen variceal patients had manometry before oesophageal transection and repeat manometry at least 1 month following operation. A further group of 17 post-transection patients also underwent manometry at a mean 27.6 months following operation. Comparison between variceal (13) and control subjects (13) showed that the lower oesophageal sphincter pressure, total length and length of the abdominal and proximal portions of the sphincter were similar in the two groups. Pre- and postoperative manometry (7) revealed a significant reduction in lower oesophageal sphincter pressure following transection. The total length of the lower sphincter was shorter postoperatively compared to the pre-operative length. Both the abdominal and the proximal portion of the sphincter were significantly shorter postoperatively. Comparison between post-transection group (24) and control subjects (13) showed that lower oesophageal sphincter pressure was significantly less following transection. Both total length and the length of the abdominal portion of the sphincter were significantly lower in the post-transection group.

Deglutition↗