London Bridge Hospital

About: London Bridge Hospital is a healthcare organization based out in London, United Kingdom. It is known for research contribution in the topics: Antiphospholipid syndrome & Systemic lupus erythematosus. The organization has 107 authors who have published 122 publications receiving 4523 citations.

‘Seronegative antiphospholipid syndrome’: an update:

Abstract: In 2003, on the 20th anniversary of the antiphospholipid syndrome (APS), we wrote . . . ‘as awareness increases, and the number of patients with APS grows, it comes as no surprise that ‘‘seronegative APS’’ provides the focus of day to day clinical discussion – the patient with migraine, stroke, several previous miscarriages, thrombocytopenia, and livedo reticularis, whose antiphospholipid (aPL) tests are doggedly negative’. This description reminded us of the previous clinical labels in the world of autoimmune diseases – ‘seronegative arthritis’ and ‘seronegative lupus’. History showed that both labels proved both useful and, in fact, more than temporary clinical compromises. Seronegative arthritis, for example, catalysed the description of psoriatic arthritis and of the spondyloarthropathies, while seronegative lupus turned out in many cases to be the Ro-positive variant. The public history of ‘seronegative APS’ has been interesting. Few subjects have triggered so much animated discussion, and at meetings and congresses the topic invariably raises the temperature. Yet in clinical practice, there are at least two observations supporting the concept. Firstly, the clear therapeutic response to anticoagulant treatment when the clinical decision is made to treat, and secondly, the strong family history of APS and other autoimmune conditions in many of these patients – including a small number of identical twins discordant in aPL positivity. What are the possible reasons for ‘seronegative APS’? Firstly, that the diagnosis is wrong – unlikely in the case of the many ‘classic’ features of APS. Secondly, that a previous positive aPL has become negative. Yes, this does happen, but surprisingly uncommonly. Thirdly, and most likely, that our current aPL tests (anticardiolipin, lupus anticoagulant and anti-beta 2 glycoprotein 1 antibodies) are not sufficient in some cases. Over the past several years, new variants in aPL testing have emerged which support the concept of ‘non-criteria’ aPL. Recently, a collaborative USA/UK study analysed a comprehensive panel of ‘non-criteria’ aPL tests in a series of 175 patients from the St Thomas Hospital Lupus Clinic including 68 with the features of ‘seronegative APS’. One-third of the ‘seronegative’ sera gave positive results. The study concluded that patients with clinical features of APS but negative for conventional criteria markers should undergo additional testing for non-criteria biomarkers. ‘Failure to diagnose APS can result in severe clinical consequences.’ One wonders how many patients attending, for example, young stroke clinics, migraine clinics, ‘MS’ clinics and, of course, obstetric departments, would benefit from diagnosis and treatment of ‘seronegative’ APS.

A comparison of epidemiological characteristics in breast cancer patients and normal women in Great Britain and Japan: results of a prospective study.

Abstract: The epidemiological characteristics of normal women and women with early breast cancer in Great Britain were prospectively compared with similar subjects from Japan. The study consisted of 204 women with early breast cancer and 792 normal controls from Great Britain and 200 breast cancers and 335 Japanese controls. The risk factors examined were age, height and weight, menopausal status, age at menarche and menopause, parity, age at first birth, use of oral contraceptives, and family history of breast cancer. The cancers and cases were divided into pre- and postmenopausal groups. There was a striking trend for a protective effect of multiparity in both countries and a weak but inconstant protective effect of age at first birth. In premenopausal British women increase in body mass was significantly associated with a decreased risk of breast cancer but this association was not found for postmenopausal women or in the Japanese women. The results showed that the classical risk factors did not fully account for the differences in breast cancer risk between Great Britain and Japan. The possibility that aetiological factors might be changing warrants investigation.

Rituximab in lupus and beyond: the state of the art

Abstract: On 17th December 2008, nephrologists and rheumatologists gathered at the London Lupus Centre, London Bridge Hospital, to review anecdotal experience and published data concerning rituximab (RTX) in SLE. The meeting, which followed a similar conference held in 2006,1 also examined RTX use in treatment of rheumatoid arthritis (RA), anti-phospholipid syndrome (APS), Sjögren’s syndrome and vasculitis. The presentations underscored the considerable recent progress made in characterising the efficacy and tolerability of B cell depletion therapy (BCDT) in these settings and highlighted some key areas for future research. A consensus emerged that BCDT potentially offers an effective, relatively well tolerated, treatment for SLE and that a need for innovations in management remains.

Fluoroscopy-free AF ablation using transesophageal echocardiography and electroanatomical mapping technology

Abstract: Guidelines recommend that radiation exposure during AF catheter ablation procedures should be ‘as low as reasonably achievable’ (ALARA), particularly since many patients may have multiple procedures. Consequently, avoiding radiation exposure altogether must, if safe to do so, be the ultimate goal. The primary objective was to determine the feasibility and efficacy of fluoroscopy-free AF ablation compared to the fluoroscopy-assisted procedure. Patients underwent AF ablation using commercially available technology with no routine pre-procedural imaging. The use of non-fluoroscopic imaging/mapping technologies permitted us to initially reduce x-ray exposure before eliminating its use altogether. This evolution of our practice proceeded in two stages: a 9-month period of optimising our fluoroscopy-free ablation protocol followed by a 9-month period during which we set out to complete the whole procedure routinely without fluoroscopy. We describe the protocol developed and report salient endpoints, such as complications, procedure times, patient experience, and procedural success rates. During the study period, fluoroscopy-free AF ablation was attempted in 69 patients: 24 in the 9-month ‘development phase’ and 45 in the ‘implementation phase’. During the development phase, 13 of 24 patients (54%) were treated without the use of fluoroscopy. In the implementation phase, 45 patients underwent AF ablation of which 42 (93.3%) were fluoroscopy-free. A detailed description is given of the three cases in which fluoroscopy had to be used despite an intention not to. Fluoroscopy-free complex ablation procedures for the treatment of atrial fibrillation are safe and feasible in most patients.

What is the better treatment for single digit dupuytren's contracture: surgical release or collagenase clostridium histolyticum (Xiapex) injection?

Abstract: The purpose of this study was to compare the initial and final outcome range of motion in the MCP-J and PIP-J of single digit Dupuytren's Contracture treated with either open surgical excision or manipulation after collagenase clostridium histolyticum (CCH; Xiapex) injection. Material: Ten patients in either group. The range of motion measurements were statistically compared using the student t-test with a p-value of 0.05. There was no statistical difference in the pre-treatment status of the total active range of movement (TAM) between the two groups. Results: Open surgical release achieved a statistically better initial outcome in combined total passive range of movement than the xiapex group (p = 0.0047), but at the final outcome the better TAM measurement at the MCP-J after surgery was not statistically significant. However, the total active range of movement was statistically better at the PIP-J level in the xiapex group (p = 0.01) and the MCP-J and PIP-J combined total active range of movement was statistically better in the xiapex group (p = 0.0258). Conclusion: Surgery achieved better initial outcome at both MCP-J and PIP-J levels, and at discharge, only extension in the MCP-J level was statistically better after open excision. However the final outcome was statistically better at the PIP-J level in extension (p = 0.006) and total active movement (TAM) (p = 0.008) after treatment with collagenase clostridium histolyticum. Further studies are required to assess the long-term differences between the two groups and to investigate the outcomes for patients with multi-digit involvement.