Churchill Hospital

About: Churchill Hospital is a healthcare organization based out in Oxford, United Kingdom. It is known for research contribution in the topics: Population & Transplantation. The organization has 3548 authors who have published 5357 publications receiving 304275 citations.

The history of blood transfusion

Abstract: The basic techniques involved in this life-saving procedure are relatively simple and it is thus perhaps surprising that blood transfusion only became a part of routine clinical practice relatively recently. Blood-letting (venesection) was widely practised for a variety of medical conditions from the time of Hippocrates (<430 bc) through to the nineteenth century in Europe and yet transfusion only became a commonplace therapeutic intervention less than 100 years ago. This is because both an understanding of the nature of blood as well the physiology of the circulation were required as a foundation for the development of blood transfusion and these were not forthcoming until the middle of the seventeenth century. The views of the Romans and ancient Greeks exerted a profound influence on both the traditions and practise of Western medicine for nearly 2000 years. The principal beliefs of the ancient Greeks and Romans were based on the writings of Hippocrates. The central doctrine of the humoral theory is set out in the treatize entitled `On the nature of man', in which it was proposed that all living matter is composed of four basic ingredients, namely blood, phlegm, yellow bile and black bile (Lloyd, 1978). Although recognized as a vital element in the constitution of man, blood was certainly not viewed as being more or less important than the other humours. Differences in personality were viewed as reflecting different mixes of humours in people and this belief extended well into the Renaissance period (Fig 1). Indeed, words still used today such as `sanguine', `phlegmatic', `melancholic' and `choleric' can be considered to be linguistic fossils from that era. An important consequence of the acceptance of the humoral theory was that it encouraged a holistic approach to medicine, in which illness came to be regarded as being due to an imbalance of the four humours. Correction of the imbalance was thus required for restoration of health and this could be achieved by attention to diet and environment, although medical procedures such as dieting, purging and blood letting could also be used. Anatomical knowledge was also required for an understanding of the circulation of the blood, the cornerstone for the practice of transfusion. The anatomical knowledge of the Greeks was very limited and they believed that blood simply ebbed and flowed through the peripheral veins with some blood passing through the pores of the interventricular septum to mix with the `pneuma' (or vital spirit) that was inspired with the air and which fed the brain. William Harvey (1578±1657), who studied medicine in Padua after graduating from Cambridge, was the first to understand the circulation of the blood and his treatize entitled `Exercitatio anatomica de motu cordis et sanguinis in animalibus' was first published in 1628.

Comparison of three measures of quality of life outcome in the evaluation of continuous positive airways pressure therapy for sleep apnoea

Abstract: Treatment of obstructive sleep apnoea (OSA) with nasal continuous positive airway pressure (NCPAP) has become a standard treatment since its introduction in 1981. Following such treatment the apnoeas disappear, sleep quality improves as apparently do daytime symptoms of sleepiness. Sleepiness is an unusual symptom and its impact on conventional indices of quality of life has rarely been measured. To allow comparison of NCPAP therapy with treatments for other conditions, measurements of quality of life before and after treatment using standard techniques are required. It is not clear which of the standard measures is most suited to measuring the health gain from nasal NCPAP, and indeed whether the disability of excessive sleepiness is included in all such measures. This study looks at three well recognized quality of life measures in OSA, before and after NCPAP therapy; the Short Form 36 (SF-36), Functional Limitations Profile (FLP), and the EuroQol (EQ-5D). The results were compared with data from normal populations. One hundred and eight patients with OSA undergoing a therapeutic assessment of NCPAP completed the three quality of life questionnaires before and 5 weeks after commencing treatment. Over 90 subjects completed all sections of the three measures on both occasions. The SF-36 revealed substantial adverse effects on subjective health of OSA and that NCPAP treatment produced dramatic positive effects. For example, the effect sizes (difference in score, divided by SD of baseline score) in the Energy/Vitality dimension was 0.98 and for the overall Mental and Physical Component Scores, 0.76 and 0.57, respectively: an effect size over 0.5 is considered moderate and over 0.8 as large. The FLP data showed similar pre treatment decrements in quality of life and substantial improvements following NCPAP. The changes with treatment in the majority of the dimensions from both the SF-36 and FLP were statistically significant (P < 0.01). In contrast the EQ-5D did not show significant improvements with therapy, presumably because of its failure to measure the aspects of quality of life related to severe sleep fragmentation and daytime sleepiness. In conclusion, this study has clearly shown considerable decrements in quality of life in patients with OSA, similar to other chronic disabling conditions. Furthermore, NCPAP therapy returns patients to a quality of life similar to the normal population.

Telomerase activity in bladder carcinoma and its implication for noninvasive diagnosis by detection of exfoliated cancer cells in urine.

Abstract: BACKGROUND Telomerase is an enzyme that can reconstitute the ends (telomeres) of chromosomes after cell division and thus circumvent the cumulative damage that occurs in normal adult somatic cells during successive mitotic cycles. Recently, it has been proposed that this enzyme should, therefore, be detectable in immortal malignant cells but not in their normal counterparts, which stop dividing and senesce. Accordingly, telomerase activity has been reported in many types of malignant tumors, including those of the gastrointestinal tract, breast, and lung but little information was available regarding its status in bladder carcinoma or in exfoliated cancer cells. METHODS In the current study, telomerase activity was examined by a polymerase chain reaction-based assay designated TRAP (telomeric repeat amplification protocol) in tissue samples from 56 bladder carcinomas, 17 nonneoplastic bladder lesions, and 2 dysplastic lesions of the urinary tract. The feasibility of identifying cancer patients by the detection of telomerase activity in exfoliated cancer cells in the urine was also investigated. Such activity was assayed in centrifuged urine cell pellets from 26 bladder carcinoma patients and from 83 patients with no evidence of malignant disease. RESULTS Evidence of telomerase was detected in solid tissue specimens from 48 of the 56 bladder carcinomas (86%) regardless of tumor stage or differentiation, whereas it was not found in any normal bladder tissue specimen. However, it was present in the dysplastic bladder lesions as well as in nearly all Stage I well differentiated carcinomas, suggesting that its activation occurs for the early stages of carcinogenesis and could perhaps be a useful marker for the detection of early primary or recurrent bladder tumors. Telomerase activity was detected with various signal intensities in urine specimens from 16 of the 26 patients with bladder carcinoma (62% sensitivity), whereas only 3 of 83 nonmalignant urine samples showed any activity (96.4% specificity); this was very weak. CONCLUSIONS These results suggest that telomerase could be a good diagnostic marker for the early noninvasive identification of patients with bladder carcinoma by facilitating the detection of exfoliated immortal cancer cells in their urine. Cancer 1997; 79:362-9. © 1997 American Cancer Society.

Management of hyperglycemia in type 2 diabetes: A patient-centered approach: Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

Abstract: Glycemic management in type 2 diabetes mellitus has become increasingly complex and, to some extent, controversial, with a widening array of pharmacological agents now available,1–5 mounting concerns about their potential adverse effects and new uncertainties regarding the benefits of intensive glycemic control on macrovascular complications.6–9 Many clinicians are therefore perplexed as to the optimal strategies for their patients. As a consequence, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) convened a joint task force to examine the evidence and develop recommendations for antihyperglycemic therapy in nonpregnant adults with type 2 diabetes. Several guideline documents have been developed by members of these two organizations10 and by other societies and federations.2,11–15 However, an update was deemed necessary because of contemporary information on the benefits/risks of glycemic control, recent evidence concerning efficacy and safety of several new drug classes,16,17 the withdrawal/restriction of others, and increasing calls for a move toward more patient-centered care.18,19 This statement has been written incorporating the best available evidence and, where solid support does not exist, using the experience and insight of the writing group, incorporating an extensive review by additional experts (acknowledged below). The document refers to glycemic control; yet this clearly needs to be pursued within a multifactorial risk reduction framework. This stems from the fact that patients with type 2 diabetes are at increased risk of cardiovascular morbidity and mortality; the aggressive management of cardiovascular risk factors (blood pressure and lipid therapy, antiplatelet treatment, and smoking cessation) is likely to have even greater benefits. View this table: Table 1. Properties of Currently Available Glucose-Lowering Agents That May Guide Treatment Choice in Individual Patients With Type 2 Diabetes Mellitus These recommendations should be considered within the context …