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.

Cigarette smoking and risk of osteoarthritis in women in the general population: the Chingford study.

Abstract: Previous studies have suggested that smoking might be protective against the development of osteoarthritis (OA) of the knee. A group of 1003 women aged 45-64 years (mean 54.2 years) from the Chingford general population survey were studied to examine the effect of cigarette smoking on the prevalence of radiologically confirmed OA at different sites. Standard anteroposterior radiographs of the hand and knee were available in 985 women. Disease classification was made on the basis of radiological OA and symptomatic radiological OA. Odds ratios were calculated and adjusted for age and body mass index. A total of 463 (46.2%) women were ever smokers compared with 540 (53.8%) non-smokers. Ever smokers had consumed an average of 14.9 cigarettes a day for a mean of 25.7 years. For radiological OA of the distal interphalangeal joint (DIP) (140 women), proximal interphalangeal joint (40 women), carpometacarpal joint (160 women), and knee joint (118, women) there was no reduced risk of OA in ever smokers. In the small number of subjects with generalised OA (22 women) there was a non-significant 40% reduction of radiological OA in ever smokers (odds ratio 0.63; 95% confidence interval 0.24 to 1.68). Results were similar for subjects with radiographic clinical OA, except the DIP joint which showed a positive association between smoking and Heberden9s nodes (odds ratio 2.02, 95% confidence interval 1.89 to 3.42). Results were similar when analysed using current smokers against never smokers. These results do not support an inverse association between cigarette smoking and OA in women. A possible inverse relation with the small subgroup of women with generalised OA and an effect of cigarettes on disease severity cannot, however, be discounted.

Role of MR imaging in the selection of patients with early cervical carcinoma for fertility-preserving surgery: initial experience.

Abstract: PURPOSE: To assess whether magnetic resonance (MR) imaging can be used for reliable prediction of proximal extension of cervical carcinoma into the myometrium MATERIALS AND METHODS: Thirty patients with early cervical carcinoma underwent MR imaging with use of a 15-T magnet prior to surgery The MR images were analyzed by two radiologists, unaware of the histopathologic findings, for the relationship of the tumor to the internal os and extension of the tumor into the myometrium Findings at MR imaging were compared with those at histopathologic examination RESULTS: At MR imaging, 24 patients were considered not to have tumor extension proximal to the internal os and into the myometrium All tumors were confirmed histopathologically In six patients thought to have myometrial tumor invasion at MR imaging, five tumors were confirmed histopathologically; in one, tumor extended up to the internal os but did not involve the myometrium CONCLUSION: This is a small study, but MR imaging appears accurate in th

Four-marker serum screening for Down's syndrome

Abstract: The value of measuring the separate sub-units of human chorionic gonadotrophin (free α-hCG and free β-hCG) instead of total hCG together with alpha-fetoprotein (AFP) and unconjugated oestriol (uE3) was examined to determine the effect on the performance of serum screening for Down's syndrome between 15 and 22 weeks of pregnancy. The study was based on stored serum samples relating to 75 singleton pregnancies with fetal Down's syndrome and 367 unaffected singleton pregnancies, matched for maternal age, gestational age, and duration of storage of the serum sample, supplemented by data from 970 white women with unaffected pregnancies. Using the four serum markers AFP, uE3, free β-hCG, and free α-hCG, in addition to maternal age, 65 per cent of Down's syndrome pregnancies were detected for a 5 per cent false-positive rate compared with 59 per cent with the conventional triple test (AFP, uE3, total hCG with maternal age). If gestation was based on an ultrasound scan examination, the detection rate was 72 per cent using the four serum markers compared with 67 per cent with the triple test. As an alternative illustration, if the detection rate was kept at 60 per cent and gestation was estimated by an ultrasound scan examination the four-marker test reduced the false-positive rate by one-third from 3 per cent using the triple test to 2 per cent with the four-marker test. Screening performance was hardly affected by adjusting marker levels for maternal weight. The four-marker test is, both from a medical and from a financial perspective, the most effective method of prenatal screening for Down's syndrome suitable for routine use.

Optimal response criteria for the human CRH test in the differential diagnosis of ACTH-dependent Cushing's syndrome

Abstract: The CRH test is in widespread use for the differential diagnosis of ACTH-dependent Cushing's syndrome (CS). Despite the greater availability worldwide of human-sequence CRH (hCRH), there are no large series reporting the response criteria that best discriminate between Cushing's disease (CD) and the ectopic ACTH syndrome (EC) when using hCRH, rather than ovine-sequence CRH. We have, therefore, analyzed retrospectively the serum cortisol and plasma ACTH responses to hCRH in patients with ACTH-dependent CS, to develop response criteria that best discriminate between CD and EC. One hundred fifteen consecutive patients with proven ACTH-dependent CS were studied: 101 with CD (78 females; mean age, 40 yr; range, 10-73) and 14 with EC (7 females; mean age, 46 yr; range, 32-69). The response to hCRH was also studied in 30 normal volunteers (NVs; mean age, 29 yr; range, 20-44) with no clinical evidence of CS, and the results were compared. Following basal sampling at -15 and 0 min, hCRH (100 microg iv) was administered via an indwelling forearm cannula at 0900 h and serum cortisol and ACTH were measured at 15-min intervals for 2 h. The mean basal, peak, incremental, and percentage change in the serum cortisol and ACTH at all time points, and combination of time points, were calculated and analyzed to establish the best criteria to discriminate between CD and EC, and also between CD and NVs. The mean serum cortisol concentration in samples obtained at 15 and 30 min after CRH increased by at least 14% above the mean basal in 85 of 100 patients with CD, but in none with EC, giving a sensitivity of 85% at a specificity set at 100%. In contrast, the best plasma ACTH response of a rise of 105%, calculated from the maximal rise, gave only 70% sensitivity at 100% specificity. In the NVs, the maximum cortisol at the mean 15+30 min time point was 615 nmol/liter. Using the 15 and 30 min time points as the reference point, 71 of 100 patients with CD had a rise of serum cortisol greater than 14% and also showed an absolute cortisol level more than 615 nmol/liter. Serum cortisol responses to hCRH can be used to suggest the diagnosis of CD in the majority of patients with this condition, but it should only be used in conjunction with other biochemical and imaging modalities in establishing this important diagnosis. The measurement of plasma ACTH was less helpful in making this distinction, although it may have additional value in excluding ACTH-independent causes of CS. Although we believe that bilateral inferior petrosal sinus sampling remains the single most useful test in discriminating CD from EC in patients with ACTH-dependent CS, hCRH offers rapid diagnostic information and is a useful adjunctive test in establishing the presence of a possible ectopic source.

Adjuvant psychological therapy for patients with cancer: Outcome at one year

Abstract: Patients attending the Royal Marsden Hospital with newly diagnosed cancers or first recurrence were screened for psychological morbidity. A total of 174 patients who met the inclusion criteria were randomly allocated to either adjuvant psychological therapy, a brief, cognitive—behavioural treatment specially designed for cancer patients, or a routine care control. This paper reports the results of the study one year after the baseline assessment. A total of 134 patients completed questionnaires at one year. Patients who received therapy showed significantly less psychological distress measured on the Psychological Adjustment to Illness Scale. There was a tendency for patients in the therapy group to show more change on measures of helplessness and anxiety. Using the criteria for psychological morbidity employed at the time of entry into the study, at one year only 19% of therapy patients were still in the clinical range for anxiety compared with 44% of the control patients; 11% of therapy patients were in the clinical range for depression compared with 18% of the control patients. This study demonstrates that a brief psychological intervention can produce improvement in psychological functioning which persists up to 10 months after the end of the intervention; in particular, the number of patients who would still meet criteria for ‘caseness’ is reduced. These findings justify further investigation of the efficacy of adjuvant psychological therapy in cancer patients.