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Biomedical subjects

R A Spence

Publications and source records attributed to R A Spence.

At least 91 records · Page 5Linked to original sources
PubMed1984

Histologic factors of the esophageal transection ring as clues to the pathogenesis of bleeding varices.

In the absence of other precipitating factors, such as Sengstaken intubation, there is little evidence for acute esophagitis being a major factor in precipitating hemorrhage from varices. Superficial blood filled channels are described lying within the epithelium. They appear to arise from papillae, extend close to the esophageal lumen and are lined by epithelial-like cells. It is proposed that rupture of these channels may initiate variceal bleeding and, being connected to the underlying larger vessels, give rise to substantial hemorrhage. It is also suggested that these superficial vascular channels may correspond to the cherry red spots seen on endoscopic examination.

Adolescent↗
PubMed1983

Initial experience with indium-111 autologous leucocyte imaging in patients with acute pancreatitis.

Indium-111 labelled autologous leucocyte imaging was used to assess severity in 13 patients with acute pancreatitis. All three patients with severe disease as judged by a prognostic factor grading system had a positive result on imaging. A fourth patient with mild disease as judged by prognostic factors had a positive imaging result and 14 days later developed a pseudocyst. There were no false positive or false negative scans. Evidence from three patients suggested that a positive 111In-leucocyte imaging result implies substantial fat necrosis. In this study imaging was as accurate as prognostic factor grading. The technique may be a useful method of separating mild from severe acute pancreatitis.

Acute Disease↗
PubMed1983

Comparison of infrared coagulation and rubber band ligation for first and second degree haemorrhoids: a randomised prospective clinical trial.

One hundred and thirty seven previously untreated out-patients with first and second degree haemorrhoids were allocated at random to treatment by infrared coagulation (n=66) or rubber band ligation (n=71). Complete follow up was obtained in 122 patients (60 who had undergone infrared coagulation (group 1), and 62 rubber band ligation (group 2)) at periods from three months to one year after completion of treatment. Infrared coagulation produced a satisfactory outcome in 51 patients (85%): 34 were rendered asymptomatic and 17 improved. Rubber band ligation produced a satisfactory outcome in 57 patients (92%): 33 were rendered asymptomatic and 24 improved. Both methods were equally effective in first and second degree haemorrhoids. The incidence of side effects, particularly discomfort, during and after treatment was significantly higher in those treated by rubber band ligation (p less than 0.001). This appeared to be an appreciable deterrent to future patient compliance. The number of patients losing more than 24 hours from work was higher after rubber band ligation than after infrared coagulation. The number of treatments necessary to cure symptoms did not differ significantly between the two methods. Infrared coagulation was significantly faster than rubber band ligation (p less than 0.001). Infrared coagulation is a simple, fast, and effective outpatient method for the treatment of first and second degree haemorrhoids with fewer troublesome side effects and higher patient acceptability than rubber band ligation.

Adult↗
PubMed1983

Oesophagitis in patients undergoing oesophageal transection for varices--a histological study.

Thirty-one oesophageal rings from patients undergoing transection for varices were examined histologically for oesophagitis. Four cases showed neutrophil infiltration but all had recent oesophageal intubation. Fifteen patients had significant morphological epithelial changes of oesophagitis assessed by two sets of criteria. Only 4 of these patients (13 per cent) had no other likely causative factor such as recent sclerotherapy or recent insertion of a Sengstaken tube. Therefore there appears little evidence for oesophagitis as a major aetiological factor in bleeding oesophageal varices.

Adolescent↗
PubMed1983

Reference electrode sites for potential difference measurements in the gastrointestinal tract.

Simpler alternatives to the use of an intravenous reference electrode for potential difference measurement in the gastrointestinal tract were considered. Lancet puncture of the forearm skin, and intradermal injection of 0.1 ml 154 mmol/l NaCl into the forearm were shown to effectively abolish the skin-blood potential difference, thereby rendering such sites suitable for reference electrode placement. Another acceptable method was to use an intravenous "butterfly" cannula filled with heparinized saline. The tip of the electrolyte bridge was inserted into the distal end of the cannula, thereby making indirect contact with the bloodstream. It is suggested that the use of any one of these three methods of reference electrode placement would facilitate the measurement of esophageal or gastrointestinal potential difference during a routine endoscopy without significantly altering the accuracy of the measurements.

Adult↗
PubMed1983

Oesophageal mucosal changes in patients with varices.

Histological examination of oesophageal rings removed at transection for varices reveals dilated intraepithelial blood filled channels. These are present in all oesophageal rings removed at transection for varices. A comparison has been made between rings removed from variceal patients with oesophageal rings removed during resections for oesophageal and gastric tumours. Although a small number of non-varices patients had intraepithelial channels they were significantly larger and more numerous in the varices patients (p less than 0.01). Similarly, the area and number of dilated subepithelial channels (just beneath the epithelium) and the area of lamina propria channels were significantly greater in the varices patients (p less than 0.05). Depth of papillae and thickness of the squamous epithelium were also significantly greater in the varices group (p less than 0.05, p less than 0.01 respectively). Under electron microscopy the channels were lined with flattened cells which were not typical of endothelial cells but stained positively for Factor VIII related antigen using indirect immunofluorescence. These channels may correspond to the cherry-red spots seen on endoscopy and may have a role in the pathogenesis of variceal haemorrhage.

Epithelium↗
PubMed1980

Infection in wounds sutured in the accident and emergency department.

We describe a prospective follow-up study on suturing the wounds of 500 patients treated consecutively in an accident and emergency department. Results were established for 485 patients. Severe infection occurred in 2.47% of patients and there was redness and swelling, possibly from infection, in 4.53%, for a total of 7% of patients with signs of inflammation. The results are compared with previous studies and the techniques and problems of suturing wounds in the accident and emergency department are discussed.

Accidents↗