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Biomedical subjects

A E Read

Publications and source records attributed to A E Read.

At least 73 records · Page 4Linked to original sources

Physician's use of laparoscopy.

The role of laparoscopy in medical practice was assessed by studying 238 consecutive laparoscopies performed under local anaesthesia by physicians in a single teaching hospital. Indications for laparoscopy were assessment of possible and known hepatic disease, possible disseminated abdominal malignancy, abdominal mass, and conditions such as ascites and splenomegaly. A definitive diagnosis was reached in 223 cases (76.5%). No organic disease was detected in 41 patients, though findings were false-negative in two of them (0.8%). The procedure failed in 15 (6.3%), mostly because adhesions from previous surgery hindered adequate visualisation. Six patients (2.5%) had complications, one of whom subsequently died. If patients are appropriately selected laparoscopy is relatively free of postoperative complications, and is an effective diagnostic procedure in abdominal malignancy and decompensated liver disease. Cost-effectiveness is an additional advantage.

Abdominal Neoplasms↗

Colonscopy for investigation of unexplained rectal bleeding.

215 colonsocopic examinations were performed on patients with rectal bleeding whose cause had not been determined by barium enema. The probable or definite source of the bleeding was diagnosed in 41% of cases. 13% had a carcinoma, 14% had one or more colonic polyps, 7% had previously unrecognised inflammatory bowel disease. The remainder had various other colonic conditions. The source of bleeding was twice as likely to be found by colonoscopy in patients presenting with frank rectal blood-loss as in those with occult blood. A carcinoma was found twice as often in those patients with diverticular disease as in those without this condition. A lesion was discovered in the majority of patients who had had two or more negative barium enemas. These results emphasise the importance of rectal bleeding as a symptom of colonic abnormality and the value of colonscopy in its investigation in patients where the results of radiology are negative.

Colitis↗

Radioimmunoassay of lactoferrin in pancreatic juice as a test for pancreatic diseases.

Lactoferrin, a protein present in pancreatic juice and other exocrine secretions, was measured by radioimmunoassay in pure pancreatic juice obtained by endoscopic cannulation of the pancreatic duct. Lactoferrin concentrations were high in pancreatic juice from patients with chronic pancreatitis, but they were considerably lower in juice from control subjects and patients with carcinoma of the pancreas. The measurement of lactoferrin concentrations in pure pancreatic juice may be useful in the diagnosis of pancreatic diseases.

Chronic Disease↗

The endoscopic, radiological, and surgical findings in chronic duodenal ulceration.

A prospective study of the endoscopic, radiological, and surgical features of chronic duodenal ulceration has been performed. Double contrast barium meal and upper gastrointestinal endoscopy were both performed within five days of elective surgery for chronic duodenal ulceration on 50 patients. The surgical diagnosis correlated with endoscopy in 88% and radiology in 82%, but if both techniques were employed, an accurate pre-operative diagnosis was achieved in 96% of cases. There was poorer correlation in determining the position of the ulcer within the bulb, with only 41% correlation between all three parameters and complete disagreement in 24%. Surgery correlated with endoscopy in 71% but with radiology in only 41%. The correlation between endoscopy and surgery in the diagnosis of duodenitis was only 42%, suggesting that this should be a histological diagnosis. This study suggests that endoscopy is slightly more precise than radiology in the diagnosis of chronic duodenal ulceration, but with a combination of the two techniques almost 100% accuracy can be achieved.

Duodenal Ulcer↗

Respiratory disease associated with practolol therapy.

Six patients who had surgical treatment for sclerosing peritonitis caused by practolol now have a respiratory disorder characterised by dyspnoea, extensive fibrotic pleural thickening, and lesions in the lung parenchyma. Respiratory disease appears to be a further feature of the practolol syndrome.

Aged↗

Sclerosing peritonitis due to practolol: a report on 9 cases and their surgical management.

Nine patients with an unusual and serious intraabdominal complication of the beta-adrenergic blocking agent practolol seen since 1973 are reported. The striking and bizarre peritoneal changes induced by the drug have distinctive features that are not shown by other forms of peritoneal disease. The cases presented with small bowel obstruction, usually chronic in type and often associated with profound weight loss and an abdominal mass. Characteristic radiological features were present. The abnormalities at laparotomy were impressive, with a gross proliferation of the visceral peritoneum which formed a dense white cocoon which encased, constricted and markedly shortened the small bowel, usually from the duodenojejunal flexure to the ileocaecal valve. The obstruction was relieved by mobilizing the small bowel from the ensheathing tissue. Restoration of alimentary function after surgery was delayed but the long term result was satisfactory with full relief of symptoms and the absence of recurrent obstruction during the follow-up period. This complication may arise after treatment with the drug has been stopped, and although long term oral therapy has been discontinued, further cases will almost certainly present for some time to come.

Aged↗

Practolol peritonitis.

Barium examination of the small bowel revealed fixation, dilation, separation of bowel loops and delayed small intestinal transit in nine patients with practolol induced peritonitis. The diagnosis may be first suggested by this examination, and a history of prolonged therapy with beta-blocking agents should be sought in patients showing these changes where no other cause for them can be found. Symptoms may develop up to a year following cessation of therapy so that further cases may still come to light despite the withdrawal of practolol for long-term use. Small bowel barium examination is indicated in patients who have received practolol therapy and who develop suspicious alimentary symptoms.

Aged↗

Carbohydrate content of endoscopic gastric biopsies in carcinoma of the stomach.

An investigation of the glycoproteins of gastric mucus from biopsies of patients with gastric cancer has shown a change in certain carbohydrate components. There is a significant increase (P less than 0-001) in mannose and a significant decrease in N-acetylgalactosamine in both secretors and non-secretors from cancer-free and cancer-bearing regions of the stomach as compared with normal stomachs. The possible reasons for this change and its relation to two possible glycoprotein fractions are discussed.

Acetylgalactosamine↗

Practolol peritonitis. A study of 16 cases and a survey of small bowel function in patients taking beta adrenergic blockers.

Sixteen patients with practolol peritonitis are described. Dense peritoneal thickening and adhesions caused small bowel stasis and obstruction with characteristic radiology and histology. The disease was best treated by surgery though complications were frequent and three of 16 patients died. Ocular and skin involvement were common. Fifty four asymptomatic patients who had taken a beta adrenoceptor blocking drug for more than 12 months were studied. Seven were found to have radiological abnormalities of the small bowel. These changes were associated with propranolol, oxprenolol and practolol therapy. It is not known whether they are related to practolol peritonitis.

Aged↗

Superficial carcinoma of the stomach.

Nine cases of superficial gastric carcinoma have been detected with upper gastrointestinal endoscopy in Bristol in the past two years. This contrasted with only six cases found from postoperative gastrectomy specimens examined in the previous eight years. It is often difficult to distinguish a superficial carcinoma from a benign ulcer, and endoscopic diagnosis is effective only if multiple biopsy specimens are taken. Endoscopy should also be repeated and multiple specimens taken until the lesion has healed; even malignant ulcers may heal, and any healed area that is depressed with interrupted mucosal folds should be suspected of malignancy. The endoscopic and histological appearances, the age of the patients, and the clinical behaviour of the disease resembled descriptions of the disease, principally from Japan. Superficial gastric carcinoma is probably under-diagnosed in Britain.

Aged↗

The clearance of antipyrine and indocyanine green in normal subjects and in patients with chronic lever disease.

The pharmacokinetics after oral administration of 1,200 mg antipyrine and intravenous administration of 0.5 mg/kg indocyanine green have been investigated in 6 normal subjects and in 20 patients with chronic liver disease of varying etiology. Severe impairment of liver function associated with a decrease in serum albumin, elevation in serum bilirubin, or prolongation in prothrombin time correlated with a fall in the clearance of both drugs. The clearance of the two drugs correlated well in normal subjects and in patients with chronic liver disease. The presence of a surgical portacaval anastomosis was associated with a lower indocyanine green clearance for comparable clearance of antipyrine. The concept of functioning hepatic parenchymal mass is proposed as a common rate-limiting parameter for the elimination of the two drugs.

Adult↗