Northwick Park Hospital

About: Northwick Park Hospital is a healthcare organization based out in London, United Kingdom. It is known for research contribution in the topics: Population & Blood pressure. The organization has 4387 authors who have published 4184 publications receiving 192933 citations.

Clinical and economic impact of stress echocardiography compared with exercise electrocardiography in patients with suspected acute coronary syndrome but negative troponin: a prospective randomized controlled study.

Abstract: Aims Patients attending hospital with suspected acute coronary syndrome (ACS), non-diagnostic electrocardiogram (ECG), and negative troponin present a diagnostic dilemma for admitting physicians. We sought to determine the clinical and economic impact of stress echocardiography (SEcho) when compared with exercise ECG (ExECG) in the assessment of these patients. Methods and results Following pre-test assessment by (Thrombolysis in Myocardial Infarction) TIMI score, patients were randomized to ExECG ( n = 218) or SEcho ( n = 215). Subsequently, low-risk patients were discharged; those considered high risk were referred for coronary angiography. Patients were followed-up for cardiac events and a cost-analysis performed. SEcho was superior to ExECG in stratifying patients as low risk (77 vs. 33%, respectively, P < 0.0001) with no difference in cardiac event rate (5 vs. 3%, respectively). SEcho classified fewer patients as intermediate risk (3 vs. 39%, respectively, P < 0.0001) and fewer patients required further tests when compared with ExECG (3 vs. 47%, respectively, P < 0.0001). Costs for detection of coronary artery disease were significantly less in patients undergoing SEcho (£366.63 vs. £515.48, P = 0.004). Conclusion SEcho is superior to ExECG in the risk stratification of patients with suspected ACS but negative troponin. SEcho resulted in less diagnostic uncertainty, fewer referrals for further investigation, and hence, a significant cost benefit over ExECG.

Fluorescent Amplified-Fragment Length Polymorphism Analysis of an Outbreak of Group A Streptococcal Invasive Disease

Abstract: Fluorescent amplified-fragment length polymorphism (FAFLP) analysis was carried out for an outbreak of group A streptococcal (GAS) invasive disease. Streptococcal genomic DNAs were digested with endonucleases EcoRI and MseI, site-specific adaptors were ligated, and PCR amplification was carried out with an EcoRI adaptor-specific primer labelled with fluorescent dye. Amplified fragments of up to 600 bp in size were separated on a polyacrylamide sequencing gel which contained internal size markers in each lane. These data were automatically scanned and analyzed, fragments were precisely sized (+/-1 bp), and electropherograms were generated for each genome with GeneScan 2.1 software. All isolates were compared in this way. Among 27 GAS isolates examined, we found 18 FAFLP profiles, compared with 12 macrorestriction profiles by pulsed-field gel electrophoresis. FAFLP readily distinguished genotypes for two clones of GAS serotype M77 which were responsible for outbreaks of invasive disease in a care-of-the-elderly system. It provided an automated analysis of the whole genome of bacterial isolates. It was reproducible, more discriminatory, and capable of higher throughput than other molecular typing methods. Given agreed conditions, FAFLP would be reproducible between laboratories for rapid characterization of outbreak strains.

Usefulness of myocardial contrast echocardiography using low-power continuous imaging early after acute myocardial infarction to predict late functional left ventricular recovery.

Abstract: Microvascular perfusion is a prerequisite for ensuring viability early after acute myocardial infarction (AMI) For adequate assessment of myocardial perfusion, both myocardial blood volume and velocity need to be evaluated Due to its high frame rate, low-power continuous myocardial contrast echocardiography (MCE) can rapidly assess these parameters of myocardial perfusion We hypothesized that the technique can accurately differentiate necrotic from viable myocardium after reperfusion therapy in AMI Accordingly, 50 patients underwent low-power continuous MCE using intravenous Optison (Amersham Health, Amersham, Middlesex, United Kingdom) 7 to 10 days after AMI Myocardial perfusion (contrast opacification assessed over 15 cardiac cycles after the destruction of microbubbles with high energy pulses) and wall thickening were assessed at baseline Regional and global left ventricular (LV) function was reassessed after 12 weeks Out of the 297 dysfunctional segments, MCE detected no contrast enhancement during 15 cardiac cycles in 172 segments, of which 160 (93%) failed to show improvement MCE demonstrated contrast opacification during 15 cardiac cycles in 77 segments, of which 65 (84%) showed recovery of function The greater the extent and intensity of contrast opacification, the better the LV function at 3 months (p <0001, r = -091) Almost all patients (94%) with <20% perfusion in dysfunctional myocardium (assessing various cut-offs) failed to demonstrate an improvement in LV function MCE and peak creatine kinase proved to be independent predictors of functional recovery (p <0001) In conclusion, low-power continuous MCE is an accurate and rapid bedside technique to identify microvascular perfusion after AMI This technique may be utilized to reliably predict late recovery of function in dysfunctional myocardium after AMI

Increase in skin mast cells following chronic house dust mite exposure.

Abstract: SUMMARY Application of inhalant allergens in high concentration to the mildly abraded skin of sensitive patients with atopic dermatitis gave rise to eczematous skin responses at 48 h. These lesions, infiltrated by basophils, eosinophils and mononuclear cells, are examples of cutaneous basophil hypersensitivity. Repeated application of allergen induced an increase in skin mast cells by 6 days, the mast cell hyperplasia replacing the earlier basophil infiltration. No electron microscopic evidence of mast cell heterogeneity among the recruited cells was found.