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.

123I-metaiodobenzylguanidine (MIBG) scintigraphy for the detection of adrenal and extra-adrenal phaeochromocytomas: CT and MRI correlation

Abstract: Context Evidence regarding the accuracy of [(123)I] metaiodobenzylguanidine (MIBG) imaging for phaeochromocytoma localization is currently limited to small series. Objective We present the largest series of primary phaeochromocytomas in which the performance of [(123)I]MIBG has been evaluated and correlated with cross-sectional imaging. Design We identified 76 patients with both preoperative [(123)I]MIBG and cross-sectional imaging for confirmed primary phaeochromocytoma between 1995 and 2005 at our institution. This comprised 60 adrenal tumours in 55 patients and 33 extra-adrenal tumours in 23 patients (2 patients had both adrenal and extra-adrenal tumours). Phaeochromocytoma metastases were not evaluated. Main outcome measure(s) [(123)I]MIBG studies were independently reviewed and correlated with CT and MRI examinations, as well as tumour functional status, to identify features that may predict a false negative [(123)I]MIBG result. Results The overall sensitivity of [(123)I]MIBG was 75%. Tumour detection was lower for extra-adrenal (58%) vs. adrenal (85%) phaeochromocytomas (P = 0.005). For extra-adrenal tumours, [(123)I]MIBG demonstrated 8 of 14 carotid body, 2 of 2 intrathoracic, 8 of 14 retroperitoneal and 2 of 3 pelvic phaeochromocytomas. Overall, MRI and CT demonstrated 68 of 68 and 72 of 74 primary phaeochromocytomas, respectively. Tumour size correlated with [(123)I]MIBG uptake for adrenal (P = 0.009) but not extra-adrenal tumours. When tumours were adjusted for size, no other imaging feature or functional status correlated with [(123)I]MIBG negativity, although two large [(123)I]MIBG negative adrenal tumours contained large areas of necrosis or haemorrhage. Conclusions Extra-adrenal and small adrenal phaeochromocytomas are more likely to result in false negatives on [(123)I]MIBG. Tumoural necrosis or haemorrhage do not consistently relate to [(123)I]MIBG uptake, although adrenal phaeochromocytomas containing minimal solid tissue due to extensive necrosis may predict a negative [(123)I]MIBG result.

Histopathologic parameters of prognosis in cervical cancer--a review.

Abstract: Apart from clinical stage and lymph node status, acknowledged to be among the most powerful predictors of outcome in cervical cancer, the determination of prognosis and thereby the need for adjuvant therapy in surgically treated patients currently relies on a variety of histopathologic factors. The role of many of these is controversial. This may be because histopathology is genuinely lacking in sensitivity for predicting tumor behavior in vivo. There is, however, wide variation in histopathologic definitions and criteria. This is probably the major reason for both the lack of reproducibility in the reporting of certain factors and in their diminished value in predicting behavior. Tumor type, grade, vascular invasion, pattern of invasion, and depth are all extremely important prognostic indicators when used individually or as a part of a scoring system.

Genetic analysis of a tetracycline resistance element from Clostridium difficile and its conjugal transfer to and from Bacillus subtilis.

Abstract: Summary: A tetracycline resistance (Tcr) determinant from Clostridium difficile strain 630 was cloned into the Escherichia coli plasmid vector pUC13. The resulting plasmid pPPM20, containing an insert of 3.4 kbp, was mapped and a 1.1 kbp SacI-HindIII fragment wholly within the Tcr gene was identified. Dot-blot hybridization studies with the 1.1 kbp fragment showed that the Tcr gene belonged to hybridization class M. Tcr could be transferred between C. difficile strains and to Bacillus subtilis at a frequency of 10−7 per donor cell. The element could be returned from B. subtilis to C. difficile at a frequency of 10−8 per donor cell. This is the first demonstration of C. difficile acting as a recipient in intergeneric crosses. DNA from C. difficile transconjugants digested with EcoRV always has two hybridizing fragments of 9.5 and 11.0 kbp when probed with pPPM20. DNA from B. subtilis transconjugants digested with EcoRV produced one hybridizing band of variable size when probed with pPPM20. The behaviour of the element was reminiscent of the conjugative transposons. Therefore we compared the element to the conjugative transposon Tn916. The HincII restriction maps of the two elements differed and no hybridization was detected to oligonucleotides directed to the ends of Tn916. However, the elements do have some sequence homology, detected by hybridization analysis.

Corticosteroid treatment and surgery

Abstract: The first post-operative death presumed to be due to adrenocortical suppression following corticosteroid therapy occurred in 1952 1. Similar reports followed2-5, but it was not until 1961 that Sampson, Brooke & Winstone 6 demonstrated an abnormally low level of plasma cortisol (hydrocortisone) in a steroid-treated patient who had suffered a severe fall in blood pressure during operation. They reported a similar case the following year7 and recently a third has been recorded8, but these appear to be the only instances in the literature of post-operative collapse unequivocably due to adrenocortical failure. Other conditions, such as unrecognized blood loss, myocardial infarction and septicaemia, can produce a similar clinical picture and in these situations large doses of hydrocortisone will often raise the blood pressure by a direct inotropic action on the heart and other non-specific effectsg~lo. Many reported cases of collapse have undoubtedly been due to causes other than adrenocortical insufficiency and, as Copell has pointed out, ‘the vast majority of such incidents seem to be associated with medical diagnostic, and not adrenal failure’. Nevertheless, it has been the usual practice to give large quantities of steroids to ‘cover’ operations in all patients who have received these drugs within the previous two years59 12. This is obviously undesirable in those with normal adrenal function, since corticosteroids may increase susceptibility to infection 1 315, retard healing161 1 5 , precipitate gastro-intestinal haemorrhage 1 7 ,18 and impair electrolyte balance 1 99 1 8. In this and the following paper an attempt is made to clarify the use of steroid cover, and to answer two questions : 1 Which patients treated with corticosteroid drugs require cover for surgery ? 2 What form should that cover take?