Endoscopic injection of adrenaline for benign oesophageal ulcer haemorrhage.
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Adult↗
Biomedical subjects
R J Steele
Publications and source records attributed to R J Steele.
Prediction of recurrent bleeding after endoscopic haemostasis in non-variceal upper gastrointestinal haemorrhage.
Endoscopic haemostasis by injection of adrenaline was attempted in 135 consecutive patients with active upper gastrointestinal bleeding. Initial haemostasis was obtained in 127 patients following injection of 5-15 ml 1:10,000 adrenaline; eight patients in whom haemostasis was not achieved underwent immediate laparotomy. There was further haemorrhage in 25 patients, which was successfully treated by further injection of adrenaline in ten. Fifteen patients had major rebleeding requiring emergency surgery. Stepwise logistic regression analysis identified three factors that, taken together, were highly predictive of the need for surgery: pulse rate on admission, the position of the ulcer and whether the patient was obese. A scoring system was derived from the logistic analysis equation that was found to predict correctly the need for emergency surgery in 84 per cent of patients. In patients with a high probability of rebleeding surgery should be considered after initial endoscopic haemostasis and stabilization. In the majority of patients endoscopic treatment alone is sufficient for permanent haemostasis.
Adolescent↗
Inhibitory effects of the gastrin receptor antagonist CR2093 on basal, gastrin-stimulated and growth factor-stimulated growth of the rat pancreatic cell line AR42J.
AR42J, a rat pancreatic cell line expressing receptors for both gastrin and epidermal growth factor (EGF), has been used to examine the effect of the gastrin receptor antagonist CR2093 on basal, gastrin-17 (G17), EGF and transforming growth factor (TGF)-alpha stimulated growth in vitro. In serum-free conditions, CR2093 reduced the basal growth of AR42J at a concentration known to displace physiological levels of G17 from gastrin receptors and this effect was reversed by G17 at 1 x 10(-9) M. Alone, G17 had little effect on growth, but EGF and TGF-alpha stimulated growth to 181 and 176% of control values, respectively, and marked synergy was observed when G17 was used in combination with both EGF (212%) and TGF-alpha (259%). When CR2093 was added, the synergistic effects of the G17/EGF and G17/TGF-alpha combinations were reduced to basal levels. In addition, CR2093 inhibited the growth stimulation induced by EGF and TGF-alpha alone. When the ability of CR2093 to bind to EGF receptors was assessed in a ligand binding assay, it was found that the antagonist displaced up to 23% of labeled EGF. Thus CR2093 has potent inhibitory effects on the basal growth of AR42J which can be reversed by G17. It can also inhibit type 1 growth factor-stimulated growth, but although this action may in part be related to the antagonist's ability to inhibit binding to the EGF receptor, other mechanisms may be involved.
Amino Acids↗
Graded exercises for basic training in laparoscopic surgery.
A series of graded exercises for use in laparoscopic simulation is described. These exercises are designed to introduce the basic skills required for laparoscopic surgery, and have been found to be useful both for the training of junior surgeons and in workshops.
Education, Medical, Continuing↗
Orthopaedic manifestations of Lyme disease.
Lyme disease is caused by the spirochete Borrelia burgdorferi and is transmitted by the Ixodes tick. Early diagnosis is difficult because the tick bite may go unnoticed and the distinguishing rash, erythema chronicum migrans, often does not occur. Serologic tests are both sensitive and specific in the later stages of the disease but not in stage 1. Thus diagnosis of Lyme disease remains clinical. Knowledge of the orthopaedic manifestations of Lyme disease may aid in early diagnosis and help differentiate from possible cases of juvenile rheumatoid arthritis and septic arthritis. If septic arthritis is suspected, appropriate antibiotic therapy should be initiated while awaiting serology for Lyme disease. Recurrence of Lyme arthritis following antibiotic treatment is rare. Lyme disease should be considered in any patient with arthritis and a history of rash, fever, or neurologic or cardiac abnormality.
Adult↗
Quantitative autoradiographic demonstration of changes in binding to delta opioid, but not mu or kappa receptors, in chick forebrain 30 minutes after passive avoidance training.
Day-old domestic chicks (Gallus domesticus) were trained on a one-trial passive avoidance task in which the aversive stimulus was a bitter tasting substance, methylanthranilate. Thirty minutes later, localization of binding of highly specific ligands (([D-Ala2, Gly-ol]-enkephalin ([3H]DAGO) for mu (mu) receptor sites, [D-Pen2,D-Pen5]-enkephalin ([3H]-DPDPE) for delta (delta) sites, and [3H]-U- 69593 for kappa (kappa 1) sites) to opioid receptors in various regions of the forebrain of methyl-anthranilate trained (M-) and control (water trained (W-)) chicks was determined using quantitative receptor autoradiography. Significant differences in binding to delta ([3H]-DPDPE), but not mu or kappa receptors, were found in several regions of the forebrain, of trained compared to control chicks. There were decreases in binding in the hyperstriatum dorsale of the left hemisphere (14%) and a decrease in binding in the lateral hyperstriatum ventrale of the right hemisphere (14%). However, significant increases were observed in delta binding in the paleostriatum augmentatum of the right hemisphere (16%) and the lobus parolfactorius of both hemispheres (left, 20%; right, 21%). In a control experiment designed to determine whether the taste of methylanthranilate contributed to the increase in 3H-DPDPE binding, there was no significant difference in the level of binding between blindfolded birds in which methylanthranilate was placed in the beak, and blindfolded birds in which water was placed on the bead and inserted into the beak. These findings demonstrate that changes occur in an opioid receptor sub-type in specific regions of forebrain of the chick following passive avoidance training which may be related to events concerned with the process of memory formation.
Animals↗
Nasolacrimal duct obstruction and acute dacryocystitis associated with infectious mononucleosis (Epstein-Barr virus)
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Cefuroxime↗
Continuous single-layer serosubmucosal anastomosis in the upper gastrointestinal tract.
In a 4-year period, 100 anastomoses in the upper gastrointestinal tract were fashioned using a single serosubmucosal layer of continuous polydioxanone. One patient required revisional surgery because of anastomotic stricture after partial gastrectomy, but there was no other complication related to the anastomosis. This technique is simple, safe, and quick to perform.
Anastomosis, Surgical↗
7-Chlorokynurenate, an antagonist of the glycine binding site on the NMDA receptor, inhibits memory formation in day-old chicks (Gallus domesticus).
Unilateral intracranial injection into the left intermediate and medial hyperstriatum ventrale of 100 mumol.liter-1 7-chlorokynurenate, a highly selective antagonist of the glycine site on the N-methyl-D-aspartate receptor, prevents acquisition of memory for one-trial passive avoidance training in day-old chicks, in which the aversive stimulus is an unpleasant tasting substance, methyl anthranilate. Injections were given 30 min pretraining and the chicks were tested 30 min or 1 or 3 h post-training. Unilateral injections into the left intermediate and medial hyperstriatum ventrale were found to significantly block memory acquisition when birds were tested at all three time points, but unilateral injections in the right intermediate and medial hyperstriatum ventrale had no significant effect. Bilateral injections did not significantly increase the memory block. Injections of 7-chlorokynurenate given 5 min post-training failed to produce amnesia for the avoidance task when chicks were tested either 30 min or 1 h after training.
Animals↗
Gastrin antagonists in the treatment of gastric cancer.
The polypeptide hormone, gastrin, is known to promote both the in vitro and in vivo growth of human gastric cancer. This proliferative activity has been shown to be mediated by high affinity, membrane-associated receptors. This has led to the development of agents with the ability to antagonise gastrin receptor binding, which have been evaluated for their potential clinical value. Other anti-gastrin therapies have been investigated. As gastrin may act as an autocrine mediator of gastric tumor cell proliferation, anti-secretory agents have been evaluated, as have agents which induce the production of neutralising anti-gastrin antibodies in situ.
Animals↗
Ileo-caecal ulceration associated with the use of diclofenac slow release.
A 38-year-old man with seropositive arthropathy on long-standing treatment with diclofenac slow release presented with abdominal pain, diarrhoea and anaemia. Upper gastrointestinal endoscopy and barium series were unremarkable. Five months later he presented with a right iliac fossa mass. Investigations revealed discrete ulceration in the terminal ileum and caecum confirmed at laparotomy. Other possible causes of intestinal ulceration were excluded suggesting a diagnosis of non-steroidal anti-inflammatory drug associated intestinal ulceration.
Adult↗
Non-invasive detection of gastro-oesophageal reflux using an ambulatory system.
The aim of this study was the separate measurement of reflux of food and acid into the oesophagus in 37 healthy, ambulant subjects. This was performed by radiolabelling the food and monitoring its reflux with a small directional gamma detector, which was placed externally over the oesophagus, and connected to an ambulatory data recorder. The pH was measured with a conventional oesophageal pH electrode. This method permitted the separate characterisation of acid and neutral (food) components of gastro-oesophageal reflux. The gastric emptying characteristics of the test meal were also monitored by gamma scintigraphy in a separate experiment. The oesophageal pH fell below 4 for 3.2 + 8.6/-2.3% (mean (SD)) of the recording time. Food reflux alone occurred for 17.8 + 53.2/-13.8% of the recording time. Simultaneous food and acid reflux occurred for only 0.95 + 5.2/-1.2% of the time. Not every reflux event detected by a fall in pH was seen as an increase in counts as a result of reflux of food, and vice versa. This poor correlation of food and acid reflux implies incomplete mixing of food and acid in the stomach, and further shows the inadequacy of reflux diagnosis methods that depend on pH detection alone.
Adult↗
Bile reflux in columnar-lined Barrett's oesophagus.
Total and individual bile acid concentrations in the oesophageal aspirates from 30 patients with Barrett's oesophagus were compared with those from 15 patients with oesophagitis and 15 normal subjects. The highest total bile acid concentrations were found in the Barrett's patients and this was statistically significant when compared with controls but not oesophagitis patients. However, when the 95th percentile value of bile acid concentration in the normal subjects was taken as the 'cut-off' level, a significantly higher number of Barrett's patients (15/30) were bile refluxers than were the oesophagitis patients (3/15). Glycocholic and taurocholic acids were the predominant bile acids detected, but taurochenodeoxycholic acid was also present in significant amounts in the patients with oesophagitis. It is possible that bile reflux contributes to the development of Barrett's oesophagus.
Aged↗
There's no quick fix for our health-care system.
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Attitude to Health↗
Predeposit autologous blood transfusion in patients with colorectal cancer: a feasibility study.
Over a 2-year period, a predeposit autologous blood transfusion service was provided for all patients undergoing elective surgery for left-sided colonic or rectal cancer in one hospital. Of 129 such patients, 28 were suitable for autologous donation. Eight of these received autologous blood only, 13 required no transfusion, and seven needed additional homologous blood. Thus, although predeposit autologous transfusion for patients with colorectal cancer is possible, only a very small proportion are likely to derive any benefit which it might confer.
Aged↗
Psychomotor testing and the ability to perform an anastomosis in junior surgical trainees.
Ten junior surgical trainees underwent objective testing of manual dexterity and visuospatial ability and were required to carry out five consecutive anastomoses on fresh porcine jejunum. Anastomoses were scored by a single observer and a cumulative error score (CES) derived for each procedure. In the first anastomosis there was little correlation between the psychomotor test results and the anastomosis scores. In subsequent trials there were significant negative correlations between aspects of manual dexterity and the CES. Over the five anastomoses there were significant negative correlations between improvement and manual dexterity, but there was a positive correlation between improvement and visuospatial ability (rs = 0.76, P < 0.005). Visuospatial skills are more important than pure motor ability in predicting the capacity to perform an anastomosis and tests of manual dexterity may be misleading in this context.
Adult↗
The early diagnosis of oesophageal adenocarcinoma by endoscopic screening.
Oesophageal carcinoma has a very poor prognosis unless detected at a pre-symptomatic stage. This can only be done by screening and patients with Barrett's columnar lined epithelium of the oesophagus (CLO) are high risk candidates for an endoscopic screening programme. Surveillance studies in CLO patients, when reviewed, showed that the incidence of adenocarcinoma was between 1 in 52 and 1 in 81 patient years, with a mean of 1 in 76. This paper describes the Nottingham experience with an endoscopic screening programme that was established in 1976. To date it has detected four adenocarcinomas at a mean cost similar to that of detecting breast cancer by screening.
Adenocarcinoma↗
Assessment of proliferation of squamous, Barrett's and gastric mucosa in patients with columnar lined Barrett's oesophagus.
There is no satisfactory biomarker yet available for predicting the likelihood of premalignant changes or carcinoma developing in Barrett's or columnar lined oesophagus. In this study we have evaluated the proliferation of squamous epithelium, columnar epithelium from columnar lined oesophagus and gastric columnar epithelium from 23 Barrett's patients using positive immunoreactivity with the mouse monoclonal antibody Ki67 (which recognises an antigen associated with proliferative cells) with a view to using this parameter as a biomarker. Squamous epithelium had significantly higher Ki67 immunostaining as compared with columnar epithelium from columnar lined oesophagus (when examining the tissue with greater than 15% cells staining positive for Ki67, Fisher's exact test p = 0.004) but there was no difference found between the epithelium from the columnar lined oesophagus and gastric columnar epithelium. There was no correlation between histological inflammation and Ki67 immunoreactivity of Barrett's mucosa, and the Ki67 immunostaining of two patients with dysplasia was no different from the rest of the group. There was, however, a significant correlation between the Ki67 immunoreactivity of columnar epithelium from columnar lined oesophagus and columnar epithelium from the stomach (correlation coefficient = 0.44, p = 0.03) suggesting that epithelium from columnar lined oesophagus behaves in a similar fashion to gastric epithelium.
Adult↗