R A Spence

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

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Publications (53)193.73 Total impact

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    ABSTRACT: Within a case-control study of postmenopausal breast cancer patients (n = 99) and matched healthy controls (n = 105), thyroid hormone levels were compared and correlated with toenail selenium concentrations. Plasma triiodothyronine (T3) was significantly lower in cases (1.4 +/- 0.4 nmol/l) than in controls (1.6 +/- 0.4 nmol/l), and a strong inverse relationship with breast cancer was observed with an odds ratio of 0.17 (95% CI = 0.08-0.36) in the highest compared with the lowest tertile of T3. Plasma thyroxine and thyroid-stimulating hormone concentrations were similar between cases and controls. Plasma T3 concentration was positively associated with toenail selenium in cases (age-adjusted regression coefficient = 0.049) and controls (age-adjusted regression coefficient = 0.036). Toenail selenium concentrations tended to be lower in cases than in controls, but the differences did not reach statistical significance. Although the disease process per se may explain the lower plasma T3 concentrations, it is also possible, inasmuch as these patients were in early-stage breast cancer, that selenium status may be influencing T3 levels via changes in the activity of the selenoenzyme type 1 iodothyronine deiodinase.
    Nutrition and Cancer 02/1997; 27(1):48-52. · 2.70 Impact Factor
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    ABSTRACT: The aim of this investigation was to document hereditary breast cancer in Northern Ireland. Family history details from over nine hundred women were obtained by postal survey and one hundred and twenty nine home visits were carried out to collect pedigree information. The families documented varied in the number of affected women from three, which was the minimum criteria for inclusion, to a maximum of nine and many families described other features of hereditary disease such as bilateral breast cancer, ovarian and gastrointestinal malignancies.
    The Ulster medical journal 12/1996; 65(2):113-7.
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    ABSTRACT: In this study, over 1000 women with breast cancer were contacted by questionnaire and 164 families with a strong history of breast cancer were identified. Home visits to obtain full pedigree details took place for 123 women, and members of 24 families gave venous blood samples. The extracted DNA was typed by polymerase chain reaction amplification and the derived haplotypes submitted to linkage analysis which confirmed that in 12 families breast cancer susceptibility could be traced to BRCA1. The study demonstrates the number of women at risk of breast cancer in the population, illustrates the complexity of genetic analysis for hereditary breast cancer and demonstrates the problems of predictive analysis in clinical management.
    British Journal of Surgery 09/1995; 82(8):1086-8. · 4.84 Impact Factor
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    ABSTRACT: In this study, over 1000 women with breast cancer were contacted by questionnaire and 164 families with a strong history of breast cancer were identified. Home visits to obtain full pedigree details took place for 123 women, and members of 24 families gave venous blood samples. The extracted DNA was typed by polymerase chain reaction amplification and the derived haplotypes submitted to linkage analysis which confirmed that in 12 families breast cancer susceptibility could be traced to BRCA1. The study demonstrates the number of women at risk of breast cancer in the population, illustrates the complexity of genetic analysis for hereditary breast cancer and demonstrates the problems of predictive analysis in clinical management.
    British Journal of Surgery 01/1995; 82(8):1086-1088. · 4.84 Impact Factor
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    Biochemical Society Transactions 03/1994; 22(1):19S. · 2.59 Impact Factor
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    ABSTRACT: Thirteen nuclear and cellular morphometric variables were measured in 312 cases of colorectal adenocarcinoma. All variables, except nuclear shape factors, differed significantly (P < 0.001) between normal colorectal and tumor tissue. In adenocarcinomas, epithelial nuclei in well-differentiated mucosa tended to be elliptic, while those in poorly differentiated mucosa were more spheric. Increasing values of maximum nuclear and elliptic diameter were associated with progression from none to simple tubule configuration (P < 0.001), none to easily discerned nuclear polarity (P < 0.001), and expanding growth pattern (P < 0.001). Univariate survival analysis revealed that none of the morphometric variables was significantly related to patient survival. Multivariate regression analysis showed that no morphometric variable could add significantly to a model containing the variables of patient age, Dukes stage, and tumor differentiation. Morphometry may be useful in distinguishing malignant from normal tissue and degrees of differentiation, but it is of little prognostic value in colorectal adenocarcinoma.
    Diseases of the Colon & Rectum 05/1993; 36(5):450-6. · 3.34 Impact Factor
  • Breast. 01/1993; 2(3):200-200.
  • Article: Oesophagus
    Irish Journal of Medical Science 11/1992; 161(11). · 0.51 Impact Factor
  • Irish Journal of Medical Science 11/1992; 161(11). · 0.51 Impact Factor
  • Irish Journal of Medical Science 09/1992; 161(10):600-619. · 0.51 Impact Factor
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    ABSTRACT: In this study we describe the investigation and treatment of 14 patients with primary hepatocellular carcinoma. Patients were treated with intra-arterial infusion of iodized oil and doxorubicin hydrochloride. Five of these patients were alive after 1 year. Twelve patients showed a fall in alpha-fetoprotein, and in seven of these patients, the fall in alpha-fetoprotein was greater than 50%.
    Surgery 07/1991; 109(6):694-7. · 3.37 Impact Factor
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    ABSTRACT: The 19 patients who underwent 22 postoperative repairs of bile duct stricture in our institution between 1973 and 1984 were evaluated to assess whether the recognition of the tenuous blood supply of the supraduodenal bile duct in 1979 had improved the results thereafter. Thirteen of these 22 operations followed a previous biliary tract repair; in 10 of the operations a low anastomosis had been performed without taking blood supply into account. Follow-up was complete and ranged from 5 to 15 years. There were no operative deaths and minimal morbidity. There were three deaths at a later time. Five of the 11 patients treated by surgery to 1979 had a clinically unsatisfactory result: recurrent strictures developed in all five patients. All but one of the eight patients receiving a high hepaticojejunostomy from 1980 had a clinically satisfactory result with no recurrent strictures. The one exception was the patient who had a second repair with separate high right and left hepatic duct anastomoses and who has ongoing symptoms from preexisting secondary sclerosing cholangitis. The results in the five high repairs performed for low strictures were particularly striking: All five were asymptomatic. This study lends support to the hypothesis of an ischemic basis for biliary strictures and to the recommendation that strictures be repaired with a high hepaticojejunostomy.
    Surgery 12/1990; 108(5):828-34. · 3.37 Impact Factor
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    ABSTRACT: Factors affecting the outcome of acute variceal haemorrhage treated by injection sclerotherapy were analysed. The data on 82 patients undergoing their first admission for acute variceal bleeding were collected prospectively. Using multiple logistic regression analysis and multiway contingency table analysis only the presence of ascites and an elevated serum bilirubin value contributed independently to survival out of a total of 26 discontinuous and 12 continuous variables. A derived regression equation was constructed to predict survival using the data from the 82 patients and this was tested against the observed outcome in a different group of 113 patients also undergoing their first variceal haemorrhage treated by injection sclerotherapy, the data from whom were also collected prospectively. Using a cut-off point of P = 0,71, the equation accurately predicted death for 91% of patients who died and accurately predicted survival for 65% of patients who survived. Overall accuracy of prediction was 73%.
    South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 05/1990; 77(7):334-8. · 1.70 Impact Factor
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    ABSTRACT: Oesophageal function after sclerotherapy for varices in 29 patients was compared with that in 15 patients with untreated varices using a scintigraphic technique. The first group had significantly longer transit times in each third and also in total time compared with a control group of 32 subjects (upper-third P = 0,02; middle-third P = 0,01; lower-third P = 0,0001; and total transit time P = 0,0001). Minor abnormalities of transit were found when the untreated group was compared with controls (increased total transit time P = 0,02). These results indicate that abnormalities of transit are increased after sclerotherapy for varices.
    South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 03/1990; 77(3):138-40. · 1.70 Impact Factor
  • G T Deans, R A Spence, G W Johnston
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    ABSTRACT: Seventy-three patients who had received portasystemic shunts were reviewed to assess the current role of this procedure in the treatment of portal hypertension. Survival at 1, 5 and 10 years was 85%, 68% and 45% respectively. Survival was significantly greater (P less than 0.001) in Child's grade A patients compared with Child's grade B patients and in non-alcoholics compared with alcoholics. Previously absent encephalopathy developed in 43% of those with non-selective shunts compared with 21% of those with selective shunts. Six of the 12 patients who experienced recurrent variceal haemorrhage had associated shunt thrombosis: five of these required further shunts or oesophageal transection to control their bleeding and the other patient died before further surgery could be instituted. Shunt surgery still has a role in the treatment of a small number of carefully selected patients with portal hypertension.
    Journal of the Royal College of Surgeons of Edinburgh 03/1989; 34(1):37-9.
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    The Ulster medical journal 11/1988; 57(2):212-4.
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    ABSTRACT: During a 3-year period (June 1981-July 1984), 70 patients who presented with an endoscopically proven variceal bleed were randomized to receive either fiberoptic injection sclerotherapy (FIS, 36 patients) or a rigid scope technique (RIS, 34 patients), using ethanolamine oleate as the sclerosing agent. After discharge, patients entered into a chronic injection sclerotherapy program. Control of the acute bleeding episode (FIS, 91%, RIS, 95%) and the first hospital admission mortality (FIS, 34%, RIS, 44%) were similar. Eradication of varices was achieved in 16/19 and 13/16 cases in the two respective groups of patients who survived longer than 3 months, and only 2 of these patients (both of whom were in the RIS group) had a further major variceal bleed. The overall complication rate per injection was significantly lower in the FIS group (p less than 0.005). Twenty-six patients (14 FIS, 12 RIS) were alive at the end of the 4-year trial period. Of the total of 44 deaths, only 3 were not associated with a bleeding episode. Only five of the 29 patients who had their varices eradicated died during the trial period (median follow-up of 16 months). FIS has become the preferred method of treatment at the Groote Shuur Hospital, particularly in the long-term management of these patients. The procedure is safe, does not require a general anesthetic, and in long-term management, most patients can be treated on an outpatient basis. RIS should be reserved for the difficult recurrent acute bleeder, where the more controlled situation with a rigid scope under general anesthesia may provide safer and more effective sclerotherapy. The study stresses the importance of achieving eradication of all varices to prevent rebleeding and its attendant high mortality.
    Annals of Surgery 09/1988; 208(2):175-8. · 6.33 Impact Factor
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    ABSTRACT: Hepatocellular carcinoma is often an aggressive tumour and, if unresectable, carries a poor prognosis, especially in the presence of jaundice. We report on a jaundiced patient with an unresectable fibrolamellar hepatocellular carcinoma treated with intra-arterial lipiodolised doxorubicin (Adriamycin). The initial response of the patient has been encouraging. This form of therapy deserves further evaluation in patients with unresectable hepatocellular carcinoma.
    South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 12/1987; 72(10):701-3. · 1.70 Impact Factor
  • R A Spence, J Terblanche
    British Journal of Surgery 09/1987; 74(8):659-60. · 4.84 Impact Factor
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    ABSTRACT: A preliminary, double-blind placebo controlled trial of cisapride in reflux oesophagitis was conducted. Eighteen patients were allocated to treatment with either placebo or cisapride, 10 mg three times daily, orally, before meals. Gastric emptying of a scrambled egg meal, oesophageal transit of a liquid bolus and ambulatory monitoring of oesophageal pH were assessed before and after four weeks' therapy. Overall, gastric emptying rates were not influenced by cisapride, although a small but significant reduction in gastric isotope retention, 20 minutes after meal ingestion was observed in patients on the active drug. Oesophageal transit times were not altered by cisapride. A small but significant reduction in the duration of gastro-oesophageal reflux followed cisapride therapy when compared with placebo.
    Hepato-gastroenterology 07/1987; 34(3):113-6. · 0.77 Impact Factor

Publication Stats

351 Citations
193.73 Total Impact Points

Institutions

  • 1987–1997
    • Belfast Healthy Cities
      Béal Feirste, N 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
  • 1984–1993
    • Queen's University Belfast
      • Institute of Clinical Sciences
      Belfast, NIR, United Kingdom
  • 1987–1990
    • University of Cape Town
      • Department of Surgery
      Kaapstad, Western Cape, South Africa
  • 1985–1987
    • Groote Schuur Hospital
      Kaapstad, Western Cape, South Africa