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Biomedical subjects

R A Spence

Publications and source records attributed to R A Spence.

At least 73 records · Page 4Linked to original sources
PubMed1985

Prolonged ambulatory pH monitoring in patients following oesophageal transection and control subjects.

Prolonged ambulatory oesophageal pH monitoring using a radiopill was carried out in 19 patients following oesophageal transection for varices. The results were compared with 14 asymptomatic control subjects. The duration of oesophageal pH less than five while erect was significantly greater in the post-transection group than in the control subjects. The duration of pH less than 4 while erect was also greater following transection but this did not quite reach statistical significance. The number of reflux episodes did not differ between the two groups. There was no significant difference in duration or number of reflux episodes while supine between the two groups.

Esophageal and Gastric Varices↗
PubMed1985

Twenty-five years of injection sclerotherapy for bleeding varices.

Acute injection sclerotherapy has been used in Belfast for 25 years and the results are reviewed. During this period 264 patients had injection sclerotherapy for acute bleeding from oesophageal varices during 396 admissions; a rigid oesophagoscope was used and 447 injections were performed. The series includes 19 children who received 69 injections. Thirty-eight had extrahepatic portal venous hypertension and the remainder had intrahepatic disease. Overall, 81 were Child's grade A (including the 38 extrahepatics), 82 were grade B and 101 were grade C. Of the 396 admissions, acute injection sclerotherapy controlled bleeding in 362 instances (control rate 91.4 per cent); control rate in the children's group was 97.1 per cent and in the adults 90.2 per cent. The hospital mortality was 14.9 per cent (57 adults and 2 children). Nineteen deaths were due directly to bleeding oesophageal varices, two from bleeding gastric varices and seven directly or indirectly from oesophageal leaks. Most of the remaining deaths were due to liver failure. We consider that sclerotherapy is valuable in the control of variceal haemorrhage where bleeding is uncontrolled or recurs after vasopressin or tamponade in any admission.

Acute Disease↗
PubMed1985

Does age influence normal gastro-oesophageal reflux?

Prolonged oesophageal pH monitoring is being used increasingly to detect abnormal gastro-oesophageal reflux. To assess the influence of age on normal reflux patterns, a group of 13 young asymptomatic subjects (mean age 22 years) was compared with a group of 14 middle aged asymptomatic subjects (mean age 49 years). An ambulatory system using a radiotelemetry capsule and a portable receiving system was used, oesophageal pH being recorded for at least 16 hours during an overnight hospital stay under standardised conditions. There was no significant difference in the duration or frequency of reflux episodes as defined by pH less than 5, less than 4, less than 3, or as a fall in pH of more than two units. It is concluded that it is an acceptable practice to use young volunteers to establish normal values in reflux studies of young and middle aged patients.

Adult↗
PubMed1985

Results in 100 consecutive patients with stapled esophageal transection for varices.

Esophageal stapled transection has a role as an elective procedure in patients with varices who are unsuitable for shunt procedures, namely, the elderly, patients with Child's grade C, diabetics, patients with schistosomiasis and those with previous encephalopathy. It is effective in reducing variceal bleeding in the short term, although increasing rebleeding rates with longer follow-up periods are envisaged. When the alternative of injection sclerotherapy is available, there is probably little place for emergency transection in view of the high hospital mortality. A prospective randomized trial comparing chronic injection with esophageal transection is required.

Adolescent↗
PubMed1985

Peritoneovenous shunting in intractable ascites.

Fourteen patients in whom peritoneovenous shunts were inserted for intractable ascites or malignancy were reviewed.Reduction in ascites was obtained in all patients by the time of discharge with significant diuresis and weight loss. Significant decrease in haemoglobin, packed cell volume, platelet count and prothrombin time also occurred. Coagulation studies were abnormal in 60 per cent of patients in whom they were performed with bruising or detectable bleeding occurring in 28.5 per cent of all patients. Late blockage of the shunt occurred in five patients and was less frequent in Denver than in Le Veen type shunts.Cumulative mortality one month after shunt insertion was 28.5 per cent and at one year was 78.5 per cent reflecting the severity of the underlying disease.Peritoneovenous shunting should be reserved for palliation in patients resistant to full conventional medical therapy.

Adult↗
PubMed1985

Gastro-oesophageal reflux--initial experience with a radiotelemetry system for prolonged oesophageal pH monitoring.

A radiotelemetry system has been used to monitor gastro-oesophageal reflux over a prolonged period in 27 asymptomatic control subjects and in 15 patients with reflux symptoms. In control subjects, the frequency of reflux episodes (pH < 5) ranged from 0.1 - 0.7 per hour of recording (median 0.36) by day, and from 0 - 1.0 per hour (median 0.12) by night. The duration of reflux (pH < 5) per hour of recording ranged from 0.4 - 5.4 minutes (median 2.1) by day and from 0 - 5.1 minutes (median 0.27) by night. Patients with reflux symptoms had more frequent episodes of daytime reflux and a longer duration of daytime reflux than control subjects. The frequency and duration of nocturnal reflux were similar in patients and in control subjects. Of two patients with Barrett's metaplasia of the lower oesophagus, one had markedly increased frequency and duration of both daytime and nocturnal acid reflux, while the other had only a moderate increase in the frequency of daytime reflux episodes.

Adult↗
PubMed1985

Thymectomy for myasthenia gravis.

The results of 14 years' experience in the surgical treatment of myasthenia gravis are reported. Twenty-one patients (14 female, 7 male) underwent thymectomy for myasthenia gravis between 1971 and 1984. The mean age of the patients was 33 years (range 14 - 57 years). The median duration of symptoms prior to surgery was 18 months (range 5 months to 35 years). The mean follow-up was 5.3 years. There were no post-operative deaths: 76% obtained benefit from thymectomy. The patients' age, sex, duration of symptoms and histology of the thymus gland did not correlate with the result of treatment. This series suggests that, while thymectomy is often beneficial in the treatment of myasthenia gravis, there are no accurate predictors of the outcome following surgery.

Adolescent↗
PubMed1984

The venous anatomy of the lower oesophagus in normal subjects and in patients with varices: an image analysis study.

The microvasculature of the lower oesophagus has been studied quantitatively using a computer assisted image analysis system. Twenty normal specimens of oesophagus and stomach were studied and seven further specimens from patients with varices were also assessed. Each specimen could be clearly subdivided into three zones. Zone 1 was the stomach where the mean relative area occupied by veins in the lamina propria was 2.6 per cent (s.e.m. +/- 0.2) in the normal subjects and 3.7 per cent (s.e.m. +/- 0.8) in the variceal specimens. Zone 2 began at the oesophagogastric junction and extended 2-5 cm into the lower oesophagus. The mean area occupied by veins in the lamina propria increased to 19.8 per cent (s.e.m. +/- 1.2) in the normal and 32.8 per cent (s.e.m. +/- 3.9) in the varices specimens. Zone 3 was the remainder of the proximal oesophagus and the mean area occupied by veins in the lamina propria was 4.9 per cent (s.e.m. +/- 0.3) in the normal and 6.1 per cent (s.e.m. +/- 0.5) in the varices specimens. Further analysis revealed that this increase in area occupied by veins in the distal oesophagus was due to an increase in both the number and size of vessels in the lamina propria of Zone 2. These findings may explain the propensity for oesophageal varices to bleed mainly from the distal oesophagus.

Adult↗
PubMed1984

Bleeding oesophageal varices with long term follow up.

Complete long term follow up was obtained in 27 children who had bled from oesophageal varices. Most presented with haematemesis or melaena at an average age of 5.2 years in the portal vein thrombosis group (20 children) and 9.5 years in the intrahepatic group (7 children). All had splenomegaly. Only 6 of 20 children with portal vein thrombosis had a possible precipitating factor. A total of 182 admissions for bleeding are reported, in 68 of which injection sclerotherapy was used to control bleeding. Control rate with injection sclerotherapy was 97%. Shunts performed below age 10 years were associated with a high thrombosis rate. A conservative approach to bleeding varices in children is recommended with transfusion, pitressin, and injection sclerotherapy. Oesophageal transection may have a role in the emergency management of the few children in whom bleeding is not controlled by injection sclerotherapy.

Adolescent↗
PubMed1984

Wound infection following surgery in an accident and emergency theatre.

Five hundred and six clean minor surgical procedures were carried out in an emergency theatre. One theatre was used for both clean and septic conditions; clean cases preceding the septic lesions. Sepsis rates were assessed prospectively and complete follow-up was obtained in 491 patients. Four hundred and fifty (91.6%) patients achieved primary healing. Thirty (6.1%) patients developed a mild serous discharge; three developed wound haematomas and eight (1.6%) patients had severely infected wounds with a purulent discharge. From the acceptably low incidence of severely infected wounds with a purulent discharge. From the acceptably low incidence of severely infected wounds we conclude that there is no need for separate clean and septic theatres in an emergency department provided the clean operations are comparatively short and simple procedures.

Adult↗
PubMed1984

Combined barium meal and cholecystogram--an analysis of 1,444 patients.

Since many dyspeptic patients are still investigated initially by radiology, a policy was initiated whereby all such patients were directly referred for combined simultaneous double-contrast barium meal and cholecystogram. This policy was aimed at reducing patient visits to hospital and increasing diagnostic yield. The results of 1,444 combined procedures are presented. Of these, 310 (25.5%) had a positive finding on barium meal only; 275 (19%) were positive for cholecystogram only; 117 (8.1%) were positive for both examinations; 742 (51.4%) were negative for both examinations. Of all the patients (427) who had a positive finding on barium meal, 27.4% (117) also had a positive finding on cholecystogram. Of all the patients (392) with a positive cholecystogram, 29.8% (117) also had a positive barium meal. Diagnostic yield rose considerably with patient age. It was found that simultaneous barium meal and cholecystogram presented no serious technical difficulties. It was concluded that in patients over 40 years old, this policy improved diagnostic yield as many patients had both gall bladder and upper gastrointestinal pathology. In all other patients this policy markedly reduced the number of hospital visits. Combined simultaneous double-contrast barium meal and cholecystogram is therefore recommended for hospitals which used radiology for the first line investigation of dyspepsia. Also, the general principle of examination of both gall bladder and upper gastrointestinal tract is pertinent where other first line investigations are used.

Barium↗