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Biomedical subjects

J S Kirkham

Publications and source records attributed to J S Kirkham.

At least 37 records · Page 2Linked to original sources
PubMed1986

Nature of the bleeding vessel in recurrently bleeding gastric ulcers.

An unselected consecutive series of 826 patients admitted for acute upper gastrointestinal bleeding underwent urgent endoscopy. Peptic ulcers were found in 402 (49%). Of the 329 ulcer craters that could be fully examined, visible vessels were identified in 156 (47%), other stigmata of recent hemorrhage in 66, and no stigmata of recent hemorrhage in 107. One hundred twenty-nine patients with stigmata of recent hemorrhage (93 of whom had visible vessels) randomly allocated to no endoscopic treatment were observed for evidence of further bleeding. Fifty-four of the 93 patients (58%) with visible vessels rebled, compared with 2 of 36 (6%) with other stigmata of recent hemorrhage. No patient without stigmata of recent hemorrhage rebled. Twenty-seven patients in whom a visible vessel in a gastric ulcer was identified at endoscopy underwent urgent partial gastrectomy because of recurrent bleeding. The vessel identified at endoscopy was found in 26 of 27 resection specimens (96%). The arterial vessel wall protruded above the surface of the ulcer crater in 10 specimens, and clot in continuity with a breach in the vessel wall protruded in a further 10 specimens. Postoperative angiography, when technically possible, showed that the breached artery ran across the base of the ulcer in all of these specimens. Pathological changes were common in the bleeding artery and included arteritis in 24 of 29 (83%) eroded arteries found in these specimens, with aneurysmal dilatation in 14 of 27 (52%) bleeding points that could be fully examined. The ulcer had penetrated to serosa in 13 specimens (45%). The bleeding artery had a mean external diameter of 0.7 mm with a range of 0.1-1.8 mm. This study provides new information about the nature of the bleeding vessel in gastric ulcers, and some of this information is relevant in planning studies of endoscopic therapy for bleeding peptic ulcers. It validates the endoscopic identification of a visible vessel, and confirms that such identification has a high predictive value for the development of recurrent hemorrhage.

Arteries↗
PubMed1986

Evaluation of the nitrosamine hypothesis of gastric carcinogenesis in precancerous conditions.

A 24 hour gastric aspiration study was carried out on nine Polya gastrectomy, eight pernicious anaemia, and nine matched control subjects. Intragastric pH, bacteria, nitrite, and N-nitroso compounds were assessed half hourly whilst ambulant and hourly when in bed. Both total and nitrate reducing bacterial counts were positively related to pH (chi 2 = 279.3; p less than 0.001), as was nitrite concentration (F = 19.1; p less than 0.0001). By contrast, total (F = 40.6; p less than 0.0001) and stable (F = 257.4; p less than 0.0001) N-nitroso compound concentrations were negatively related to pH. Clear differences in these gastric juice factors were not apparent between matched control and either pernicious anaemia, or Polya gastrectomy because the Polya gastrectomy and matched control groups were heterogeneous for gastric acidity. Thus, although eight of eight pernicious anaemia subjects were hypoacidic (defined as intragastric pH greater than 4 for greater than 50% of both daytime and night time periods), only five of nine Polya gastrectomy and two of nine matched control subjects were hypoacidic. When subjects were rearranged into hypoacidic (n = 15) and acidic (n = 11) groups, bacterial counts (p less than 0.01) and nitrite concentrations (p less than 0.01) were higher, whereas N-nitroso compounds tended to be lower (NS) in the hypoacidic group. These data suggest that, although hypoacidity predisposes to bacterial overgrowth and nitrite generation, it does not enhance nitrosation. Instead, this is maximal at low pH, suggesting chemical rather than bacterial nitrosation, contrary to the nitrosamine hypothesis of gastric carcinogenesis.

Aged↗
PubMed1984

Laser recanalization of obstructing foregut cancer.

Palliative treatment of upper gastrointestinal tract obstruction was undertaken by endoscopic laser therapy in 6 patients with carcinoma of the oesophagus or stomach. All had dysphagia for solids on admission and were considered unsuitable for surgery or radiotherapy. Three were in sites unsuitable for placement of an endoscopic prosthesis. The tumours occluded up to 90 per cent of the lumen (2 squamous and 4 adenocarcinomas). Treatment was carried out under direct vision, the laser wave guide being passed through the biopsy channel of a standard endoscope. Superficial tumour vaporized immediately using energies of 2-10 000 J per session, whereas deeper layers sloughed over the succeeding 2-3 days. Two to six treatments were required to relieve dysphagia and there were no major complications. Quantitative barium studies before and after treatment showed a significant increase in luminal diameter. These patients could eat solid food after treatment and all were able to go home.

Adenocarcinoma↗
PubMed1983

Five years' experience of a gastroenterology day-case unit.

An inpatient ward has been converted, at low cost, to a gastroenterology day-case unit, which includes a purpose-built endoscopy room and a day-case area. The presence of a day-case ward permits the nursing establishment to be sufficiently flexible to cover the endoscopy room fully, and the hours are suitable for married nurses with families. Patients remain on the same trolley throughout the procedure so that portering delays are avoided, and a good flow system operated by the unit's staff enables endoscopies to be carried out at the rate of one every ten to fifteen minutes. Admissions rose from 1900 to 2700 per year (an average of 12 X 5 admissions per working day, theoretical bed occupancy = 140%). Cost per patient is about half the estimated cost without a day-case unit. The increasing numbers of routine upper gastrointestinal endoscopies are mirrored by a halving of barium-meal examinations.

Bed Conversion↗
PubMed1982

Malignant phaeochromocytoma: report of a case and a critical review.

A right adrenal phaeochromocytoma is described in a 64-year-old man. Metastases to bone and subsequent death following cord compression occurred within 2 years of diagnosis. Twenty-seven cases in the English literature have been reviewed since 1968. In three of these, the pathological proof was unsatisfactory for the diagnosis of malignancy, and one further case was inadequately documented. The variation in incidence of malignancy found in large retrospective series may relate to inconsistency in pathological criteria, as well as to selective reporting of cases.

Adrenal Gland Neoplasms↗
PubMed1982

Oesophageal varices: evaluation of injection sclerotherapy without general anesthesia using the flexible fibreoptic gastroscope.

A technique of injecting oesophageal varices through a flexible fibreoptic gastroscopic is described and its value in controlling haemorrhage and eradicating varices in 34 patients is considered prospectively. Twenty-five per cent of the patients re-bled during the first emergency admission after injections, but control was achieved in all. Subsequent re-bleeding occurred in 46% and varices were ultimately eradicated in 59%. It ic concluded that the procedure is associated with fewer serious complications compared with rigid oesophagoscopic techniques and may be as effective.

Adolescent↗
PubMed1981

Controlled trial of argon laser photocoagulation in bleeding peptic ulcers.

The efficacy of argon laser photocoagulation in the endoscopic control of haemorrhage from peptic ulcers was tested in a controlled trial at two centres in London. Of 330 patients consecutively admitted with acute upper gastrointestinal tract haemorrhage, 76 were seen at endoscopy to have a peptic ulcer accessible to laser therapy and stigmata of recent haemorrhage. These patients were included in the trial. Identification of the exact source of haemorrhage within the ulcer crater was achieved by use of standard endoscopes with careful washing. Patients were stratified into three groups: ulcers with a visible vessel (52 total, 11 actively spurting); those without a vessel (17); and those with an overlying clot persisting after washing (7). Of the 52 patients with visible vessel, 8 of 24 treated with the laser and 17 of 28 control patients had a further haemorrhage. 7 control patients died after an episode of rebleeding, but no treated patients. Treated and control patients were well matched for other factors known to influence the case fatality rate. This is the first controlled trial to demonstrate a significant reduction in mortality by the use of a non operative treatment in patients with bleeding peptic ulcers.

Acute Disease↗
PubMed1981

Endoscopic prediction of recurrent bleeding in peptic ulcers.

We performed endoscopy within 24 hours of admission in 292 unselected patients admitted to the hospital for acute gastrointestinal hemorrhage. In 132 patients endoscopy revealed peptic ulcers, and in 117 full examination of the crater was possible. Visible vessels were identified in 56 patients (48 per cent); other stigmata of recent bleeding (such as oozing from the ulcer crater) were present in 21 (18 per cent), and no stigmata in 40 (34 per cent). Among the patients with either visible vessels or other stigmata of recent bleeding, 47 were randomly selected to be observed (without treatment) for evidence of further bleeding. Nineteen of 34 patients with visible vessels (56 per cent) had rebleeding, as compared with one of 13 (8 per cent) with other stigmata of recent hemorrhage; no patients with ulcers without visible vessels or other stigmata of recent hemorrhage bled further. We conclude that after bleeding occurs, visible vessels can be identified in a much higher proportion of ulcers than previously reported, and that rebleeding occurs almost exclusively in this type of ulcer, although only half the ulcers with visible vessels do in fact bleed further.

Endoscopy↗