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Biomedical subjects

R Shields

Publications and source records attributed to R Shields.

At least 19 recordsLinked to original sources
PubMed1992

Management of massive upper gastrointestinal haemorrhage from multiple sites of peptic ulceration with somatostatin and octreotide--a report of five cases.

Surgical management of massive upper gastrointestinal bleeding after failed medical treatment may be hazardous because of diffuse bleeding from several sites, further complicated in some patients by intercurrent disease, age, or previous surgery. Experience with combined somatostatin and octreotide therapy in five such patients is described. All were treated initially with either intravenous somatostatin (250 micrograms/hour) or octreotide (Sandostatin) (50 micrograms/hour) for periods ranging from three to five days, after which they were given subcutaneous octreotide (50 or 100 micrograms three times daily). Bleeding was controlled by this regimen in all cases. The patients were all discharged from hospital on either ranitidine (n = 4) or omeprazole (n = 1). Repeat endoscopy at the end of the treatment period with somatostatin and octreotide (n = 1) or four weeks after discharge (n = 3) showed complete healing of the bleeding sites. Somatostatin and octreotide may be of value in controlling severe upper gastrointestinal bleeding in patients in whom surgery is hazardous because of bleeding from several peptic lesions further complicated in some by intercurrent disease or age.

Adult↗
PubMed1992

The management of persistent or recurrent variceal bleeding after injection sclerotherapy by somatostatin.

Sixteen patients with persistent (n = 11) or recurrent (n = 5) variceal bleeding after injection sclerotherapy and balloon tamponade were treated with an intravenous infusion of somatostatin 250 micrograms/h. Somatostatin infusion successfully controlled the bleeding in 15 of the 16 patients but one rebled after 72 h of treatment. In one patient with poor liver function (Child's C) bleeding was not controlled by somatostatin, further injection sclerotherapy or balloon tamponade of the oesophagus. The results of this study, although uncontrolled and with a small number of patients, suggest that somatostatin is a very effective treatment for the control of post-injection sclerotherapy variceal bleeding.

Adult↗
PubMed1979

Oestrogen receptors and prognosis in early breast cancer.

In a study of the role of oestrogen-receptor analysis in early breast cancer the oestrogen-receptor content of the tumour was estimated in 286 patients undergoing mastectomy. These patients were followed for up to 39 months, and the recurrence of disease was noted in relation to the presence or absence of oestrogen receptor.Recurrence-rates were significantly higher in patients whose tumours did not contain receptors than in those whose tumours did. This same relationship was seen when women with and without axillary metastases were considered separately. The highest rates of recurrence were in women with axillary lymph-node involvement whose tumours lacked oestrogen receptors. Women without axillary-node involvement whose tumours lacked oestrogen receptors showed the same high rate of recurrence as all women with axillary-node involvement. The oestrogen-receptor content of a primary breast cancer appears to be an independent guide to early recurrence of the disease.

Breast Neoplasms↗
PubMed1979

Early postoperative feeding with elemental diet.

The value of early postoperative feeding with an elemental diet was assessed in 30 patients after major gastrointestinal operations. The patients were allocated at random to conventional treatment (control group) or feeding with the elemental diet (ED group). The clinical and metabolic course of the 15 patients in the ED group was significantly better than that of the controls. Patients in the ED group lost less weight and had a shorter stay in hospital. Negative nitrogen balance was more pronounced in the control group throughout the seven postoperative days. Energy intake was higher in the ED group. Provided elemental feeding is used with caution, it may be given from the first postoperative day. Patients do better metabolically and require shorter stays in hospital.

Body Weight↗
PubMed1979

A comparison of xenon-133 clearance with electromagnetic flowmeters and an indicator dilution method for the measurement of liver blood flow.

Measurement of liver blood flow has been carried out by three different methods in 14 dogs to assess the accuracy of xenon-133 clearance following portal vein injection. Electromagnetic flowmetry with flow probes on the hepatic artery and portal vein resulted in a mean value of 121.9 +/- 39.3 ml min-1 100 g-1. An indicator dilution study utilizing chromium-51-labelled red cells gave a mean value of 119.4 +/- 31.4 ml min-1 100 g-1 and the xenon-133 clearance following portal vein injection, 120.3 +/- 33.8 ml min-1 100 g-1. One-way analysis of variance showed no statistically significant variation between these three groups. There was a close correlation between xenon-133 clearance and electromagnetic flowmetry and between xenon-133 clearance and the indicator dilution technique. These data suggest that xenon-133 clearance following portal vein injection gives an accurate assessment of liver blood flow and this technique (as well as direct parenchymal injection) can be adapted for clinical use.

Animals↗
PubMed1979

Emergency treatment of variceal haemorrhage.

For the initial control of haemorrhage from oesophageal varices, two methods of vasopressin administration have been compared--the conventional bolus of 20 units and a low dose infusion of 0.4 units per minute. Twenty patients bleeding from oesophageal varices, confirmed by endoscopy, were allocated into either treatment group (10 in each). Vasopressin infusion stopped bleeding in 86 per cent of the episodes in contrast to 12.5 per cent (P less than 0.01) with bolus doses. Balloon tamponade with a Sengstaken-Blakemore tube was used to control bleeding in only 2 episodes in patients on infusion and in 10 episodes in patients on bolus doses of vasopressin (P less than 0.05). Our study confirms that low dose vasopressin infusion in more effective in controlling bleeding from oesophageal varices than conventional bolus doses.

Blood Transfusion↗