R A Spence

Belfast Healthy Cities, Béal Feirste, Northern Ireland, United Kingdom

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Publications (119)379.42 Total impact

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    ABSTRACT: Epstein-Barr virus positive inflammatory pseudo-tumour (IPT) of the spleen is an uncommon, frequently asymptomatic entity, which is typically picked up as an incidental finding on imaging. We present a case of EBV positive IPT of the spleen which presented as an incidental finding on CT in a patient with a history of malignancy. Splenectomy was performed. IPTs are benign spindle cell lesions of varying aetiology, which can arise in a variety of tissues, including the spleen. In situ hybridisation showed strong staining for Epstein-Barr virus RNA in our case, in common with many similar lesions described in the literature. The differential diagnosis of such spindle cell tumours is discussed. Radiologically, EBV positive spindle cell tumours are indistinguishable from malignant lesions such as lymphoma and diagnosis is made on histology, usually at splenectomy.
    02/2014; 5(4):186-188. DOI:10.1016/j.ijscr.2013.12.006
  • Sadaf Gull, Prashant Patil, Roy A J Spence
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    ABSTRACT: Primary osteosarcoma of breast is rare. The authors present a case of a 51-year-old female who was admitted with a large necrotising tumour involving the right breast. CT scan confirmed chest wall invasion along with a solitary lung metastasis. She underwent a primary mastectomy with chest wall reconstruction. Unfortunately 3 months later she developed local recurrence.
    Case Reports 08/2011; 2011. DOI:10.1136/bcr.03.2011.4015
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    S Gull, R A J Spence, W Loan
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    ABSTRACT: False aneurysms of the palmar arteries are rare. They are usually associated with traumatic injuries to the hand vasculature. We present a case of superficial palmar arch aneurysm (SPAA), complicating carpal tunnel decompression which presented as a pulsatile mass at the site of previous surgery. Initial diagnosis was made on clinical examination and confirmed on doppler ultrasound (US) and computed tomographic angiography (CTA). The feeding vessel of the aneurysm was subsequently occluded using coil embolization.
    Case Reports in Medicine 04/2011; 2011:595120. DOI:10.1155/2011/595120
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    ABSTRACT: The overall aim of this study was to assess the accuracy, reproducibility and stability of a high resolution passive stereophotogrammetry system to image a female mannequin torso, to validate measurements made on the textured virtual surface compared with those obtained using manual techniques and to develop an approach to make objective measurements of the female breast. 3D surface imaging was carried out on a textured female torso and measurements made in accordance with the system of mammometrics. Linear errors in measurements were less than 0.5mm, system calibration produced errors of less than 1.0mm over 94% over the surface and intra-rater reliability measured by ICC=0.999. The mean difference between manual and digital curved surface distances was 1.36 mm with maximum and minimum differences of 3.15 mm and 0.02 mm, respectively. The stereophotogrammetry system has been demonstrated to perform accurately and reliably with specific reference to breast assessment.
    Medical Engineering & Physics 03/2011; 33(8):900-5. DOI:10.1016/j.medengphy.2011.02.005 · 1.84 Impact Factor
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    ABSTRACT: Familial multiple lipomatosis is rare. Several modes of inheritance have been proposed but no conclusive evidence shown, although some families have suggested autosomal dominant inheritance. The authors describe a family with multiple lipomatosis showing clear autosomal dominant inheritance, and no mutations within the NF1, SPRED1 or Cowden disease (PTEN) genes. Familial autosomal dominant lipomatosis is a rare but distinct entity.
    Case Reports 02/2011; 2011(feb17 1). DOI:10.1136/bcr.10.2010.3395
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    ABSTRACT: There are few studies examining breast cancer in women under the age of 40 years, particularly in western European populations. Such tumours are reported to be more aggressive, possibly due to a different pathophysiology compared to older patients. We performed a retrospective review of all women less than 40 years of age, diagnosed or treated with breast cancer, from June 2001 to June 2007 to assess pathophysiological factors that may influence clinical outcome and prognosis including patient demographics, clinical presentation, pre-operative investigations, surgical and pathological findings, treatment and outcome. Fifty-eight women (mean age 34.9 years, range 27-39 years) were identified. One patient was excluded due to incomplete data; 98.2% (n=56) patients presented directly to our symptomatic clinic; 89.5% (n=51) patients had a palpable lump; 71.9% (n=41) patients had no family history. Mammography was less sensitive than ultrasound (64.3% vs. 82.4%) while fine needle aspiration cytology was 92.5% sensitive for malignancy. Twenty-nine (50.9%) patients underwent breast-conserving surgery (BCS) of which 7 proceeded subsequently to completion mastectomy due to involved margins. Twenty-six (45.6%) patients required total mastectomy primarily while 2 (3.5%) patients were treated palliatively due to metastatic disease. The mean tumour size (nearest resection margin) was 2.13cm (2.58mm) for BCS and 3.95cm (6.38mm) for mastectomy. From a total of 55 primary resections, 85.5% (n=47) of tumours were invasive ductal carcinoma; 57.4% (n=31) and 40.7% (n=22) were grade II and III tumours respectively. Lymphovascular invasion was identified in 50.9% (n=28) while 40.0% (n=22) were lymph node positive for metastatic disease. 76.8% (n=43), 39.3% (n=22) and 30.2% (n=16) were oestrogen, progesterone and human epidermal growth factor receptor-2 positive respectively. The mean Nottingham prognostic index was 4.37 (range 2.2-8.4). Neo-adjuvant and adjuvant chemotherapy was administered to 9.3% (n=5) and 80.0% (n=44) of surgically treated patients respectively while 76.4% (n=42) patients received adjuvant radiotherapy. 76.4% (n=42) of patients were treated with tamoxifen. Four patients received Herceptin therapy. Statistically significant univariate factors adversely associated with overall survival were time from referral to out-patient department attendance (p=0.038), administration of neo-adjuvant treatment (p=0.019), surgical intervention (p<0.001), progesterone receptor positivity (p=0.018) and tumour recurrence (p<0.001). 86.0% (n=49) patients were alive at mean follow-up of 52 months; 82.5% (n=47) remain disease free. Our study reports a low familial trait rate combined with a high proportion of hormonally active tumours less than grade III which suggests that breast cancer in this series of young women from Northern Ireland may be less aggressive and more hormonally responsive than anticipated.
    Breast (Edinburgh, Scotland) 04/2010; 19(2):97-104. DOI:10.1016/j.breast.2009.12.002 · 2.58 Impact Factor
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    ABSTRACT: Ultrasound is the first-line breast imaging modality in younger patients and an adjunct to mammography in older patients. The objectives of this study were to evaluate the complementary value of ultrasound to mammography in breast cancer and to investigate the use of ultrasound in patients above and below the age of 50 years. Clinical presentation and investigations for consecutive patients undergoing triple assessment at a symptomatic breast clinic were prospectively recorded between January 2000 and August 2003. Clinical data were compared with pathological findings. Patients were divided into two groups, above and below 50 years of age for subgroup analyses. A total of 999 of 2185 patients had both mammography and ultrasound investigations performed and constituted the study population. Subgroup analysis of the 2185 patients demonstrated that 99 of the 127 patients who were diagnosed with breast cancer had both investigations performed (median age 57.0, range: 34-89 years). Mammography was normal/benign in 14.1%, indeterminate in 29.3% and suspicious of cancer in 56.6% of patients. Adjunctive ultrasound was normal/benign in 13.1%, indeterminate in 6.1% and suspicious of cancer in 80.8% of patients. In these 99 patients, adjunctive ultrasound was more sensitive than mammogram alone (80.8% vs. 56.6%, p < 0.001). Ultrasound upgraded nine of 14 mammographically normal and 16 of 29 mammographically indeterminate X-rays to a cancer. Mammography appeared to be more sensitive in patients over 50 years compared with those patients under 50 years (62.5% vs. 45.7%, p = 0.10). The sensitivity of ultrasound was comparable between patients above and below the age of 50 years (82.8% vs. 77.1%, p = 0.60). Further subgroup analysis demonstrated a higher sensitivity with combined mammography and ultrasound compared with mammography alone in either patient group (below 50: 45.7%-->77.1% and above 50: 62.5%-->82.8%). These results also suggested that the difference in the sensitivities of mammography vs. the combined investigation approach was more marked in patients under 50 years of age (below 50 = 31.4% vs. above 50 = 20.3%). Adjunctive ultrasound assessment improves breast cancer detection in women of all ages and should be routinely used in symptomatic breast clinics.
    International Journal of Clinical Practice 08/2009; 63(11):1589-94. DOI:10.1111/j.1742-1241.2009.02102.x · 2.54 Impact Factor
  • Article: Breast 06
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    ABSTRACT: Background: Folate is required for DNA synthesis, repair and methylation, and low folate status has been implicated in carcinogenesis possibly as a result of higher rate of genetic damage.Aim: To investigate the relationship between DNA damage and folate status in breast cancer and benign breast disease control patients.Materials and methods: Fasting blood samples from 52 histologically confirmed untreated breast cancer patients (mean age: 57 years) and 30 benign breast disease control patients (mean age: 51 years) were obtained. Mononuclear cells were isolated for genetic damage analysis using basic alkaline comet assay (which detects DNA single-strand breaks) and modified comet assay (using endonuclease III and formamidopyrimidine glycosylase (FPG) to recognize oxidatively damaged pyrimidines and purines, respectively). Results are expressed as tail moment.Results: Results were log transformed to normalize the data and presented as geometric mean (95 per cent confidence interval).Conclusion: DNA damage was found to be significantly higher in mononuclear cells of breast cancer patients compared to benign breast disease control patients. Breast cancer patients tended to have lower red cell folate and higher plasma homocysteine concentrations, but these differences were not significant. A mechanistic role for low folate status in the aetiology of breast cancer is under further investigation.
    British Journal of Surgery 01/2009; 89(S1):52 - 52. DOI:10.1046/j.1365-2168.89.s.1.32_1.x · 5.21 Impact Factor
  • British Journal of Surgery 01/2009; 89:73-74. · 5.21 Impact Factor
  • British Journal of Surgery 01/2009; 89:52-52. · 5.21 Impact Factor
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    Roy A J Spence
    The Ulster medical journal 12/2008; 78(1).
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    ABSTRACT: Although the urinary bladder is involved in 1-4% of all inguinal hernias, extensive inguinoscrotal herniation of the bladder, termed scrotal cystocele, is very rare. Most small asymptomatic bladder hernias are commonly encountered and reduced successfully via the same incision during elective inguinal hernia repair. However, larger bladder herniations can be associated with bladder infarction or obstruction, which require urgent intervention to preserve renal function and reduce morbidity and mortality. We present two cases of elderly men presenting with significant scrotal cystocele complications which necessitated urgent surgical intervention. We compare and contrast the two cases and discuss the presentation, investigation, diagnosis and treatment of these pathophysiological conditions.
    Hernia 07/2008; 13(1):81-4. DOI:10.1007/s10029-008-0389-6 · 2.09 Impact Factor
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    Krithika Murugan, Roy A J Spence
    The Ulster medical journal 06/2008; 77(2):132-3.
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    ABSTRACT: Breast conserving surgery (BCS) is increasingly offered to suitable patients diagnosed with early stage breast cancer. Occasionally the pathological margins on specimens following BCS are positive. The objective of this study is to assess the proportion of patients within our unit who required completion mastectomy after BCS and to determine if predictive factors could be identified to assist the breast surgeon identifying those patients at risk of positive margins following BCS. All patients diagnosed with breast cancer between 2001 and 2005 were reviewed. Patients undergoing BCS had their histopathological specimens examined for any evidence of residual tumour at the margins of the resected specimen. These patients then proceeded to completion mastectomy if these margins were positive for residual tumour. Multinominal logistic regression was then performed on clinico-pathological factors for each of these patients to determine if predictive factors existed for determination of residual disease in the mastectomy specimen following BCS. Logistic regression demonstrated that size of the initial tumour was the only significant predictor for the presence of completion mastectomy residual carcinoma (CMRC) (p=0.014) and that tumours with an initial size > 2.5 cm were 15 times more likely to have a CMRC than tumours < 1.5 cm. This prediction model based on the initial tumour size had an 89.5% specificity and 52.2% sensitivity. The odds ratio for CMRC based on histological tumour type for each additional 1cm increase in size of the initial tumour was 2.82 for ductal carcinoma in situ, 2.60 for infiltrating ductal carcinoma and 2.26 for other tumours. This study demonstrates that residual disease in total mastectomy specimens following BCS increases significantly with increasing original tumour size. With current data, surgeons can inform patients of the risks of residual cancer associated with BCS with a view to increase the rate of primary mastectomies in those patients with presenting tumours greater than 2.5 cm.
    The Breast 04/2008; 17(2):199-204. DOI:10.1016/j.breast.2007.10.001 · 2.58 Impact Factor
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    ABSTRACT: An 83-year-old lady was admitted with a 3-day history of non-specific abdominal pain that had rapidly increased in severity on the day of admission necessitating an emergency laparotomy. Intra-operative findings demonstrated a mechanical small bowel obstruction secondary to a chronically inflamed appendix acting as a tourniquet around a loop of terminal ileum. LEARNING POINT: This case highlights an extremely rare and life-threatening complication of appendicitis. True mechanical small bowel obstruction secondary to an acutely or chronically inflamed appendix encircling the distal small bowel remains extremely rare with only ten cases reported in the literature. Clinical assessment remains paramount in the treatment of these patients to facilitate prompt diagnosis and treatment which is vital to provide an optimal platform for post-operative recovery and survival. Although CT imaging is a highly effective investigative modality in these cases, operative treatment should not be delayed for a radiological investigation in the presence of abdominal peritonism.
    Irish Journal of Medical Science 03/2008; 178(1):101-5. DOI:10.1007/s11845-008-0125-3 · 0.57 Impact Factor
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    Somaiah Aroori, Roy A J Spence
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    ABSTRACT: Carpal tunnel syndrome is one of the most common peripheral neuropathies. It affects mainly middle aged women. In the majority of patients the exact cause and pathogenesis of CTS is unclear. Although several occupations have been linked to increased incidence and prevalence of CTS the evidence is not clear. Occupational CTS is uncommon and it is essential to exclude all other causes particularly the intrinsic factors such as obesity before attributing it to occupation. The risk of CTS is high in occupations involving exposure to high pressure, high force, repetitive work, and vibrating tools. The classic symptoms of CTS include nocturnal pain associated with tingling and numbness in the distribution of median nerve in the hand. There are several physical examination tests that will help in the diagnosis of CTS but none of these tests are diagnostic on their own. The gold standard test is nerve conduction studies. However, they are also associated with false positive and false negative results. The diagnosis of CTS should be based on history, physical examination and results of electrophysiological studies. The patient with mild symptoms of CTS can be managed with conservative treatment, particularly local injection of steroids. However, in moderate to severe cases, surgery is the only treatment that provides cure. The basic principle of surgery is to increase the volume of the carpal tunnel by dividing transverse carpal ligament to release the pressure on the median nerve. Apart from early recovery and return to work there is no significant difference in terms of early and late complications and long-term pain relief between endoscopic and open carpal tunnel surgery.
    The Ulster medical journal 02/2008; 77(1):6-17.
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    ABSTRACT: Fine needle aspiration (FNA) is an important adjuvant to the diagnosis of a palpable lesion which often permits the complete assessment of patients. The main objective of this study was to determine the clinical benefit of a dedicated FNA service at a tertiary referral Head and Neck Clinic and to assess if such a service is cost effective. All patients attending the Head and Neck Clinic during 2004 were prospectively assessed in this study. Patient records were analysed regarding investigative modalities including FNA, the subsequent cytology result and the requirement for further histopathological investigations. A cost analysis for all investigative procedures was performed. A total of 135 patients (36 males) had FNAs performed during the study period. The median age was 51.5 years (range 17-92). Patients presented with lesions of lymph nodes (n = 46), thyroid (n = 41), salivary, parotid or submandibular glands (n = 22) and other cutaneous or cystic lesions (n = 26). Cytological grading results were; C1 = 26, C2 = 93, C3 = 8, C4 = 2 and C5 = 6. Patients with lesions C3 or above normally proceeded to further investigations. The overall cost of the FNA per episode in the out-patient clinic was pound114 per episode compared to day case open biopsy per patient of pound333 and an in-patient stay per patient was pound2371. FNA provided sufficient pathological diagnosis to avoid day case surgery in 57 patients (42.2%), and inpatient surgery in 65 patients (48.1%) resulting in a total saving of pound158 372 in 2004. This study demonstrates the clinical benefit and cost-effectiveness of FNA services in a dedicated Head and Neck clinic.
    Cytopathology 02/2008; 20(2):81-6. DOI:10.1111/j.1365-2303.2007.00549.x · 1.47 Impact Factor
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    ABSTRACT: Carpal tunnel syndrome is a common cause of neurological symptomatology. Surgical decompression remains the treatment of choice in patients not responding to conservative therapies. The aim of this study was to assess the effectiveness of standard open decompression by analysis of symptomatic and functional improvement and to assess whether a general surgeon can still perform this operation safely. Patients undergoing standard open carpal tunnel release by a single general surgeon were recruited. A self-administered Boston questionnaire was used to assess symptom severity and functional status pre- and post-surgical intervention. Forty-seven patients (51 hands) underwent carpal tunnel release and 32 patients completed the questionnaire. 88% had a significant reduction in the symptom severity score, while improvement in function status score was achieved in 79% of patients. Mean symptom severity score improved from 3.41 points preoperatively to 1.85 (p < 0.0001) points at the last follow up examination, while the mean function status score improved from 2.73 to 1.99 points (p < 0.0001). Outcome was poor in six patients with slight worsening of either symptom or function status score. Three patients were treated conservatively for minor wound infection without long-term sequelae. Standard open carpal tunnel release still provides efficacious symptomatic relief with a low risk of associated complications when performed by a general surgeon.
    The Ulster medical journal 01/2008; 77(1):22-4.
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    Somaiah Aroori, Roy A J Spence
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    ABSTRACT: Chronic severe pain following inguinal hernia repair is a significant post-operative problem. Its exact cause and lack of evidence-based treatment path present problems in the effective management of this surgical complication. We retrospectively reviewed the records of patients diagnosed with chronic pain following open inguinal hernia repair between November 1995 and November 2000, who were under the care of the senior author. Over the five-year period, 146 patients underwent inguinal hernia repair. 88 (60%) had suture repair (darn & modified Bassini's) and 58 (40%) underwent a Lichtenstein mesh repair. Thirteen patients (9%), (3 in suture vs. 10 in mesh group, p = 0.004) developed chronic severe pain. Examination revealed maximal tenderness over the genitofemoral nerve (GF) distribution (n = 5), over the medial end of the scar (n = 3), over the pubic tubercle (n = 1) and in the ilioinguinal nerve distribution (n = 1) No abnormality was detected on clinical examination in the cases of three patients. Treatment involved GF nerve block (n = 5), local injection of Chirocaine and Methylprednisolone acetate into the medial end of the scar (n = 3), Chirocaine and Methylprednisolone acetate into the pubic tubercle (n = 1), ilioinguinal nerve block (n = 1), re-exploration with re-suturing of the mesh (n = 1), and Amitriptyline (n = 2). At a median follow up of 45 months (range: 24-87), 10 (77%) are completely pain free; two (15.4%) had mild pain and one patient still has significant persistent pain. To conclude, chronic severe pain occurred in nine percent of patients following primary open inguinal hernia repair. The majority of patients were successfully treated by therapeutic injection into the point of maximal tenderness.
    The Ulster medical journal 10/2007; 76(3):136-40.
  • R A J Spence
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    ABSTRACT: Frank Garfield Penman was a solicitor from England who died while on holiday in Cape Town in March 1963. Under a deed dated 9 November 1965, his widow Robina Douglas Penman established a Trust in his memory--the Penman Memorial Foundation. The object of the Foundation initially included scholarships to assist postgraduate medical students from South Africa, and in particular from Cape Town, to obtain teaching and further experience in the UK. Later, the Frank Penman Travelling Fellowship was established (the Visiting Professorship) to advance medical knowledge and practice in surgery by enabling a surgeon from the UK to give lectures and teach for a period of several weeks in South Africa. This paper is based on a lecture given on 20 July 2005 as part of the Penman Memorial Foundation Visiting Professorship to Cape Town.
    South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie 09/2007; 45(3):76, 78, 80-5. · 0.57 Impact Factor

Publication Stats

1k Citations
379.42 Total Impact Points

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Institutions

  • 1990–2014
    • Belfast Healthy Cities
      Béal Feirste, Northern Ireland, United Kingdom
  • 1984–2011
    • Queen's University Belfast
      • Institute of Clinical Sciences
      Béal Feirste, N Ireland, United Kingdom
  • 2008–2010
    • University of Ulster
      Aontroim, Northern Ireland, United Kingdom
  • 1996
    • Queen's University
      • Department of Surgery
      Kingston, Ontario, Canada
  • 1995
    • Queens University of Charlotte
      • Department of Surgery
      New York, United States
  • 1987–1990
    • University of Cape Town
      • • Energy Research Centre (ERC)
      • • Department of Surgery
      Kaapstad, Western Cape, South Africa
  • 1985–1987
    • Groote Schuur Hospital
      Kaapstad, Western Cape, South Africa
    • Royal Berkshire NHS Foundation Trust
      Reading, England, United Kingdom