St Bartholomew's Hospital

About: St Bartholomew's Hospital is a healthcare organization based out in London, United Kingdom. It is known for research contribution in the topics: Population & Cancer. The organization has 11054 authors who have published 13229 publications receiving 501102 citations. The organization is also known as: St. Bartholomew's Hospital & The Royal Hospital of St Bartholomew.

Third degree obstetric anal sphincter tears: risk factors and outcome of primary repair

Abstract: Objectives To determine (i) risk factors in the development of third degree obstetric tears and (ii) the success of primary sphincter repair. Design (i) Retrospective analysis of obstetric variables in 50 women who had sustained a third degree tear, compared with the remaining 8553 vaginal deliveries during the same period. (ii) Women who had sustained a third degree tear and had primary sphincter repair and control subjects were interviewed and investigated with anal endosonography, anal manometry, and pudendal nerve terminal motor latency measurements Setting: Antenatal clinic in teaching hospital in inner London. Subjects (i) All women (n=8603) who delivered vaginally over a 31 month period. (ii) 34 women who sustained a third degree tear and 88 matched controls. Main outcome measures : Obstetric risk factors, defaecatory symptoms, sonographic sphincter defects, and pudendal nerve damage. Results - (i) Factors significantly associated with development of a third degree tear were: forceps delivery (50% v 7% in controls; P=0.00001), primiparous delivery (85% v 43%; P=0.00001), birth weight >4 kg (P=0.00002), and occipitoposterior position at delivery (P=0.003). No third degree tear occurred during 351 vacuum extractions. Eleven of 25 (44%) women who were delivered without instruments and had a third degree tear did so despite a posterolateral episiotomy. (ii) Anal incontinence or faecal urgency was present in 16 women with tears and 11 controls (47% v 13%;20P=0.00001). Sonographic sphincter defects were identified in 29 with tears and 29 controls (85% v 33%; P=0.00001). Every symptomatic patient had persistent combined internal and external sphincter defects, and these were associated with significantly lower anal pressures. Pudendal nerve terminal motor latency measurements were not significantly different. Conclusions Vacuum, extraction is associated with fewer third degree tears than forceps delivery. An episiotomy does not always prevent a third degree tear. Primary repair is inadequate in most women who sustain third degree tears, most having residual sphincter defects and about half experiencing anal incontinence, which is caused by persistent mechanical sphincter disruption rather than pudendal nerve damage. Attention should be directed towards preventive obstetric practice and surgical techniques of repair.

European guidelines for quality assurance in breast cancer screening and diagnosis. Fourth edition - summary document

Abstract: Rak piersi jest najczestszą przyczyna zgonu wśrod kobiet i stanowi istotny problem kliniczny. Wczesne wykrycie raka piersi dzieki regularnie prowadzonym badaniom przesiewowym za pomocą mammografii umozliwia rozpoznanie choroby w stadium, w ktorym leczenie jest skuteczniejsze i zazwyczaj wiąze sie z lepszą jakością zycia. Jednakze mammografia moze byc przyczyną niepotrzebnego stresu, dolegliwości, kosztow finansowych oraz narazenia na promieniowanie jonizujące. Z tego powodu nalezy polozyc mozliwie najwiekszy nacisk na kontrole jakości. Opracowanie Europejskich zalecen dotyczących kontroli jakości badan przesiewowych i rozpoznawania raka piersi bylo inicjatywą programu Europa przeciwko rakowi . Czwartą edycje interdyscyplinarnych zalecen opublikowano w 2006 roku. Sklada sie z okolo 400 stron podzielonych na 12 rozdzialow przygotowanych przez ponad 200 autorow i wspolautorow. Interdyscyplinarna rada wydawnicza przygotowala streszczenie dokumentu w celu przedstawienia podstawowych zasad i zalozen, na ktorych powinny opierac sie badania przesiewowe oraz diagnostyka raka piersi. Opracowanie zawiera takze tabele podsumowującą wskaźniki wydajności, aby szersze grono naukowcow moglo sie z nią zapoznac.

Guidelines for Acromegaly Management: An Update

Abstract: Objective: The Acromegaly Consensus Group reconvened in November 2007 to update guidelines for acromegaly management. Participants: The meeting participants comprised 68 pituitary specialists, including neurosurgeons and endocrinologists with extensive experience treating patients with acromegaly. Evidence/Consensus Process: Goals of treatment and the appropriate imaging and biochemical and clinical monitoring of patients with acromegaly were enunciated, based on the available published evidence. Conclusions: The group developed a consensus on the approach to managing acromegaly including appropriate roles for neurosurgery, medical therapy, and radiation therapy in the management of these patients.

Being epileptic: coming to terms with stigma

Abstract: Most commentators on the stigma associated with epilepsy have assumed that the psycho-social distress sufferers experience derives wholly or largely from the discriminatory attitudes and behaviour of normal people. This ‘orthodox viewpoint’ is assessed and found to be lacking in empirical support. A study of the impact of epilepsy upon the lives of sufferers is reported, special attention being paid to coping strategies developed in the family and at work. A distinction between ‘enacted’ and ‘felt’ stigma is introduced and utilized in the generation of a new model of people's responses to ‘being epileptic’ which appears to have more explanatory power than the orthodox viewpoint.