Biomedical subjects
J Spencer
Publications and source records attributed to J Spencer.
Antibiotic treatment for low-grade gastric MALT lymphoma.
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Postmortem examinations: general practitioners' knowledge, behaviour, and attitudes.
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Fetal reflexes in chronic hypoxaemia.
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Gastric acid and histamine secretion in patients on continuous ambulatory peritoneal dialysis (CAPD).
Gastric secretion was measured in patients with chronic renal failure (CRF) on continuous ambulatory peritoneal dialysis (CAPD), non-uraemic patients with a duodenal ulcer (DU), and healthy volunteers (HV). Basal acid outputs were not significantly different in the three groups. Under pentagastrin stimulation, acid secretion was lower in CAPD patients than in DU patients (p < 0.02) but not different from HV controls. Between CAPD and DU, basal histamine secretion measured in the gastric juice was not different, but the concentration in blood plasma was significantly lower in the CAPD group (p < 0.05). Under pentagastrin stimulation, gastric histamine output and plasma histamine concentration were significantly lower in CAPD patients (p < 0.05, respectively). Both basal and pentagastrin-stimulated gastric acid and histamine outputs were directly related. These results suggest that CAPD patients do not have an increased risk of developing DU, but may need acid blockade if they are treated for hyperphosphataemia with aluminium containing drugs.
Caesarean section in a diabetic patient with a recent myocardial infarction.
This is a report of a 38-yr-old parturient with multiple medical problems including diabetes mellitus, bronchial asthma, chronic myelogenous leukaemia, pre-eclampsia and a recent myocardial infarction. After medical management in the coronary care unit, it was decided to proceed with a Caesarean section. The choice of anaesthetic was made by the patient and had to be modified in accordance with her medical condition. Cardiovascular monitoring included PA catheterisation and transoesophageal echocardiography. A general anaesthetic was performed using fentanyl, thiopentone and succinylcholine. The outcome was satisfactory for both parturient and baby.
Ontogeny of the gut-associated lymphoid system in man.
Immunoperoxidase histochemistry using monoclonal antibodies to lymphoid/myeloid cells has been used to study the development of the human mucosal immune system in frozen sections of foetal human intestine at different ages. A steady progression of development was seen between 11 and 19 weeks' gestation. At 11 weeks, Peyer's patches were identifiable only as aggregates of strongly HLA-DR+ cells. By 16 weeks these aggregates became colonized with T and B cells, without distinct cellular zonation. By 19 weeks primary B-cell follicles were seen and T cells occupied the inter-follicular zones. There was also a steady increase in the numbers of lamina propria and epithelial T cells between 11 and 19 weeks' gestation. As in postnatal bowel, CD8+ cells predominated in the epithelium and CD4+ cells predominated in the lamina propria. Thus the important T- and B-cell compartments of the mucosal immune system are well established in the human foetal intestine by mid-gestation.
Monitoring Peach Harvest Workers Exposed to Azinphosmethyl Residues in Sutter County, California, 1991
Peach harvest workers were evaluated for exposure to azinphosmethyl residues by measuring foliar residues, urinary alkylphosphate metabolites, butyrylcholinesterase (BChE), acetylcholinesterase (AChE), and dermal residues using clothing and skin washes. Workers entered orchards 51 days after application and worked in treated fields for 10 of the next 17 days. Dislodgeable foliar residues ranged from 0.82 to 1.72 microg/cm2 and did not change significantly over the study period. Combined mean dermal exposure for the 3 consecutive monitoring days was 32 mg and ranged from 17.9 to 60.5 mg. Overall mean excretion levels for the 5 monitoring days were 1.7 mg dimethylphosphate and 1.9 mg dimethlythiophosphate. There was no significant difference in BChE between the exposed harvesters and minimally exposed sorters. The exposed group had significantly lower AChE values than the sorters for 2 post-exposure blood draws by three testing methods, while no significant difference was found for the pre-exposure blood draw. The AChE values for the post-exposure blood samples for the exposed workers decreased significantly about 10-20% over the 3-week exposure period but increased or remained constant for the sorters. Urinary metabolite excretion increased with continuous exposure and was inversely correlated with both AChE and BChE but was not correlated with dermal exposure measurements. High correlations were generally observed between AChE measurements taken in the field using a new spectrophotometric kit and laboratory AChE measurements.
What is needed from imaging? The surgeon's point of view.
Abdominal sepsis after surgery is decreasing in incidence but has a high mortality, especially in those with other complicating factors. The most difficult abscesses to localize are those in intermesenteric folds. Pyrexia of unknown origin is much less of a clinical problem since the advent of ultrasound and computerized tomography (CT) scanning. Laparotomy still has an occasional role but laparoscopy should precede it and may be therapeutic using minimally invasive surgical techniques; for example, in appendicitis and cholecystitis. Pancreatitis remains a serious clinical problem in which imaging plays an important role. Percutaneous drainage has a similar morbidity and success rate to open drainage. In certain cases of diverticular disease it may obviate altogether the need for surgical resection. The differentiation between abscess and necrotic tumour is important, and CT is most helpful in this area.
Talk about teeth.
In the designated Year of Oral Health, John Spencer examines the importance of design to effective oral health promotion through use of leaflets, posters and other visual media, and points to some omissions.
Information about patients' deaths: general practitioners' current practice and views on receiving a death register.
BACKGROUND: Although general practitioners are involved in the care of most dying patients, they do not routinely receive information about their deceased patients for whom they did not complete the death certificate, and often they rely upon informal communication channels. AIM: This study set out to assess how general practitioners obtained, recorded and used information about deceased patients and to determine their views on receiving a death register. METHOD: A questionnaire was sent to all 305 general practitioners in the Newcastle upon Tyne and Sunderland Family Health Services Authority areas. RESULTS: A total of 225 questionnaires were returned (response rate 74%). General practitioners usually first learnt about their patients' deaths from hospital discharge summaries (54%) and patients' relatives (46%) and less commonly from newspaper obituary columns (20%) and hospital telephone calls (9%). Two thirds of respondents recorded information about decreased patients, mainly listing personal details and the immediate cause of death. One third or fewer of those recording information listed contributory causes. The information was used mainly for following up bereaved relatives and notifying hospitals and other agencies. CONCLUSION: Current informal systems for handling information about patients' deaths are inadequate. General practitioners need and would welcome prompt, accurate and comprehensive information about all their deceased patients.
Unifying academic general practice. Trainers and tutors should get together.
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The response of cells from low-grade B-cell gastric lymphomas of mucosa-associated lymphoid tissue to Helicobacter pylori.
An association has been shown between colonisation of gastric mucosa by Helicobacter pylori, acquisition of mucosa-associated lymphoid tissue (MALT), and occurrence of primary B-cell gastric MALT lymphoma. We investigated the immunological response of cells from 3 low-grade primary B-cell gastric MALT lymphomas to H pylori type NCTC 11637 and 12 isolates of H pylori from patients without lymphomas. After co-culture of tumour cells with bacteria, cells were examined for phenotypic evidence of activation and proliferation, and supernatant assayed to detect tumour-derived immunoglobulin and interleukin-2 (IL-2). Neoplastic B cells and non-neoplastic T cells proliferated, and IL-2-receptor expression by most cells in the cultures was increased with stimulating strains of H pylori. There were also increases in tumour immunoglobulin and IL-2 release when activation and proliferation were seen in response to stimulating bacteria. Removal of T cells from the tumour cell suspension reduced proliferation and IL-2-receptor expression. In comparison, no responses were seen in cells from high-grade gastric MALT lymphomas or low-grade B-cell MALT lymphomas of other sites. The response of low-grade B-cell gastric MALT lymphomas to stimulating strains of H pylori is dependent on H-pylori-specific T cells and their products, rather than the bacteria themselves.
Density of gamma/delta T cells in small bowel mucosa related to HLA-DQ status without coeliac disease.
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Managing urinary tract infection.
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Activation of mucosal V beta 3+ T cells and tissue damage in human small intestine by the bacterial superantigen, Staphylococcus aureus enterotoxin B.
Staphylococcus aureus enterotoxin B (SEB) was added to explants of fetal human intestine in organ culture or administered into the lumen of fetal small intestine prior to culture. Both routes produced a massive increase in lamina propria T cells expressing V beta 3, and to a lesser extent, those expressing V beta 5 and V beta 12. SEB-activated lamina propria T cells produced interleukin-2 and interferon-gamma and T cell activation was accompanied by tissue damage, which was inhibited by FK506.
Cyclosporin A enhances T cell-mediated induction of E-selectin.
In a fetal intestinal organ culture model of intestinal inflammation, activation of T cells by a lectin, superantigen or anti-CD3 antibodies induces E-selectin expression which peaks 6-10 h after activation and disappears by 24 h. We now show that addition of cyclosporin A (Cys A) increases the number of E-selectin-expressing endothelial cells and the intensity of expression, and it prolongs expression up to at least 60 h after stimulation. The dynamics of E-selectin expression on tumor necrosis factor activated human umbilical vein endothelial cell cultures is not affected by Cys A. Furthermore, other immunosuppressive agents FK506 and dexamethasone inhibit E-selectin expression, indicating that the enhancement observed in the presence of Cys A is not a consequence of general immunosuppression.