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Biomedical subjects

R G Springall

Publications and source records attributed to R G Springall.

13 recordsLinked to original sources
PubMed2001

Pressure flow study data in a group of asymptomatic male control patients 45 years old or older.

PURPOSE: The role of pressure flow studies in the routine evaluation of patients with benign prostatic hyperplasia remains a controversial issue in urological practice. There are little data on age matched asymptomatic control groups. We evaluated pressure flow findings in such a group. MATERIALS AND METHODS: A total of 24 male patients 47 to 80 years old (mean age 62.5) attending a general surgical clinic were recruited for study after ethical committee approval. The volunteers had never sought medical attention for urinary symptoms and did not perceive themselves as having a urological problem. Volunteers were assessed by International Prostate Symptom Score (I-PSS) and Madsen symptom score, clinical examination, free uroflowmetry, post-void residual ultrasound, repeat pressure flow studies and transrectal ultrasonography. Pressure flow tracings were manually analyzed for standard urodynamic values and the degree of bladder outflow obstruction according to recognized International Continence Society, Abrams-Griffith nomogram, linear passive urethral resistance relation and urethral resistance factor classifications. RESULTS: Median I-PSS was 2.0 (interquartile range 1.2 to 5.7). For I-PSS quality of life the median was 1.0 (interquartile range 0.75 to 2.0). On pressure flow studies 3 patients (13%) had unequivocal obstruction, 7 (29%) were in the equivocal area and 14 (58%) had no obstruction, while 15 (63%) had unstable contractions on medium fill cystometry. CONCLUSIONS: The data show that a surprising number of apparently normal men are obstructed by commonly used criteria. This finding confirms asymptomatic obstruction, suggesting that obstruction may be less important in the development of symptoms than previously thought. Also, until the natural history of obstruction is more clearly defined surgery in obstructed asymptomatic patients is probably unwise.

Aged↗
PubMed1998

Platelet activation and serotonin release during colorectal surgery.

In vitro studies show serotonin has a profound vasospastic effect on human mesenteric arteries. A similar response has been shown in vivo in atherosclerotic primates. If platelet serotonin stores are released as a consequence of platelet activation during colorectal surgery, a similar effect may significantly alter the perfusion of newly formed anastomoses leading to ischaemia and anastomotic breakdown. Here we have studied the effects of surgery and anaesthesia on intraplatelet and plasma serotonin levels during the peri- and postoperative period following colorectal surgery. A series of six consecutive patients undergoing colorectal resection and anastomosis were selected. Peripheral venous blood samples, taken at specified times before and after surgery and prepared in a platelet stabilizing buffer solution, were analysed using a validated enzyme immunoassay technique. Intraplatelet serotonin levels were seen to fall post-operatively, whilst plasma serotonin levels were shown to rise, implying significant platelet activation and serotonin during the peri-operative period. This study demonstrates the increased bioavailability of serotonin during the peri-operative period in colorectal surgery patients. If the in vitro effects of this amine are mirrored in vivo, increased plasma levels of serotonin may have an important role in anastomotic dehiscence secondary to ischaemia.

Journal Article↗
PubMed1996

Smoking, hypertension, and colonic anastomotic healing; a combined clinical and histopathological study.

BACKGROUND: Large bowel anastomotic breakdown occurs as a result of perianastomotic ischaemia. Preservation of the macroscopic arterial supply to the perianastomotic tissues is vital, but little is known about the influence of microvascular disease on anastomotic healing. AIMS: To study the associations between risk factors for macrovascular disease, the presence of colonic microvascular disease, and the incidence of anastomotic dehiscence. PATIENTS: 147 consecutive colonic surgery patients. METHODS: The prevalence of smoking, hypertension, diabetes, and ischaemic heart disease were established retrospectively from patient notes. These risk factors were correlated with histopathological assessment of resection margin vasculature and clinical follow up. RESULTS: Smoking and hypertension were significantly associated with an increased incidence of anastomotic dehiscence and microvascular disease. Microvascular disease was positively correlated with an increased incidence of anastomotic dehiscence. CONCLUSIONS: Microvascular disease predisposes to anastomotic breakdown. This effect may in part be due to vasospasm in the diseased vessels, which are hypersensitive to serotonin, a vasoactive amine known to be present in increased quantities in the serum of smokers, hypertensives, and after surgery. Treatment with serotonin antagonists in the perioperative period may be beneficial to anastomotic healing, helping to maintain microvascular flow.

Aged↗
PubMed1995

Microvascular disease and anastomotic dehiscence in the colon.

Platelet-derived serotonin released in response to tissue manipulation during surgery may contribute to mesenteric arterial vasospasm leading to postoperative anastomotic leakage after colorectal resection. Organ bath experiments were used to demonstrate the efficacy of naftidrofuryl fumarate (NFT) to oppose serotonin-induced vasoconstriction of human mesenteric arteries. Cumulative dose-response curves were derived with and without NFT at 10(-9) and 10(-6) mol/l concentrations. The difference in maximal contractility between the three sets of curves (n = 8 for each) was significant (P < 0.0001). Sensitivity to serotonin in each of the three curves was measured by calculating the concentration for half-maximal response; differences were again significant (P < 0.0001). NFT reduced serotonin-induced contractility in a dose-dependent fashion in rings of human mesenteric arteries in vitro. This suggests a possible role for NFT in reducing mesenteric vasospasm in colorectal surgery.

Anastomosis, Surgical↗
PubMed1989

The prevention of post-operative adhesions using a gastrointestinal prokinetic agent.

Attempts have previously been made to reduce adhesion formation by promoting early intestinal motility. The prokinetic agent Cisapride was used in an animal model of end-to-end large bowel anastomoses. Twenty Wistar rats receiving Cisapride 1 mg/kg subcutaneously (sc) twice daily for two days post-operatively were compared with 20 controls receiving saline 0.2 mL in a similar regimen. The points of adhesion of the anastomosis to the following structures were enumerated: tubal fat; mesentery; omentum; caecum; small bowel; and abdominal wall. The treatment group had significantly fewer adhesions: 2.8 +/- 0.9 v 4.3 +/- 1.0. This was mainly in the number of small bowel attachments, 3.8% compared with 37.8%. The study was repeated using small bowel anastomoses. Cisapride again reduced the number of adhesions compared with controls: 2.1 +/- 0.4 v 4.2 +/- 1.4. Cisapride therapy resulted in greater post-operative stool weights and food consumption: control, 3.87 +/- 1.1 stool, 17.04 +/- 4.3 g food; Cisapride 4.43 +/- 0.9 g stool, 19.8 +/- 4.7 g food. The enhanced motility did not affect the anastomotic strength of the small bowel; bursting pressures at a constant inflation rate of 1.1 mL/min were: control 212.8 +/- 56.0 mmHg; Cisapride, 215.8 +/- 58.9 mmHg (NS).

Administration, Cutaneous↗
PubMed1988

General practitioner referral of patients with lower gastrointestinal symptoms.

Of 500 consecutive patients with symptoms of colorectal disease referred to a specialist hospital for outpatient assessment, 305 were studied. There was a low incidence of examination by the general practitioner; less than half the patients had a rectal examination and 31% had no examination at all. In cases where GPs made a diagnosis, this was correct in half, which both demonstrates the potential for dangerous misdiagnosis and confirms the fact that many anorectal conditions can be identified by the history alone. It is suggested that direct-access clinics in a colorectal unit would minimize delay in accurate diagnosis. The resource implications for such a system would be limited in terms of special investigations and additional clinic facilities.

Colonic Diseases↗
PubMed1986

Surgical management of nonspecific inflammatory bowel disease.

Nonspecific inflammatory bowel disease is principally represented by Crohn's disease and ulcerative colitis. This article reviews the radical changes in the surgical treatment of these conditions that may avert life-threatening situations and dramatically improve the quality of life.

Colitis, Ulcerative↗
PubMed1981

Computed tomography (CT) of abdominal aortic aneurysms: determination of longitudinal extent.

The aim of this study was to evaluate computed tomography (CT) in the assessment of abdominal aortic aneurysms with particular reference to their longitudinal extent. Twenty-nine patients were examined by CT, 21 of whom came to surgery. Sixteen of these 21 patients were also examined by ultrasound. At CT the relation of the aneurysm to the renal arteries proximally and the bifurcation distally was noted, along with the definition of the aortic outline. At subsequent surgery the longitudinal relations of the aneurysm and evidence of localized stretching of or leakage from the sac were assessed by an observer without knowledge of the CT scan report. Correct extent of the aneurysm in relation to the renal arteries was predicted by CT in 20 out of 21 patients who underwent surgery. CT assessment with respect to the bifurcation was correct in 16. The CT findings proved correct in one patient with localized stretching of one part of the aneurysm and in one patient where leakage was occurring. CT scanning was found to be superior to ultrasound in our preoperative assessment of the superior extent of abdominal aortic aneurysms. CT is considered to be the investigation of first choice when evaluation an abdominal aortic aneurysm.

Aorta, Abdominal↗