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.

Dynamic Imaging of Functionalized Multi‐Walled Carbon Nanotube Systemic Circulation and Urinary Excretion

Abstract: Intravenously administered multi-walled carbon nanotubes, functionalized with DTPA and radiolabeled with Indium-111, were dynamically tracked in vivo using a microSingle Photon Emission Tomography scanner. Imaging showed that nanotubes enter the systemic blood circulation and within 5 min begin to permeate through the renal glomerular filtration system into the bladder.

Prospective study of the extent of internal anal sphincter division during lateral sphincterotomy

Abstract: PURPOSE: The aim of lateral internal anal sphincterotomy when treating anal fissure is to divide the distal one-third to one-half of the internal anal sphincter. This study aimed to evaluate prospectively the extent of disruption to the internal anal sphincter following lateral anal internal sphincterotomy and also to establish the prevalence of symptoms of anal incontinence in these patients. METHODS: Fifteen patients with anal fissure (ten females and five males) had bowel symptoms assessed and anal endosonography performed preoperatively and two months after lateral internal anal sphincterotomy. RESULTS: Anal endosonography was normal preoperatively in all but two females who had anterior external sphincter defects (presumedly from previous obstetric trauma). Postoperatively, apart from one male in whom no defect could be identified, all had an internal anal sphincter defect corresponding to the site of lateral internal anal sphincterotomy. In nine of the ten females, the defect involved the full length of the internal anal sphincter, but in the other four males, the defect involved the distal internal anal sphincter only. All were continent preoperatively, but after lateral internal anal sphincterotomy, three females became incontinent to flatus (two of whom had a preoperative external sphincter defect). CONCLUSION: In contrast to lateral internal anal sphincterotomy in males, division of the internal anal sphincter in most females tends to be more extensive than intended. This is probably related to their shorter anal canal. In some females, lateral internal anal sphincterotomy may compromise sphincter function and precipitate anal incontinence, particularly in the presence of other sphincter defects. Care should be exercised especially in the presence of previous obstetric trauma, as internal anal sphincter division may further compromise sphincter function.

The induction of a specific protease for insulin-like growth factor binding protein-3 in the circulation during severe illness.

Abstract: The insulin-like growth factors (IGF-I and IGF-II) are almost completely bound in the circulation to specific binding proteins (IGFBPs). These IGFBPs appear to play a pivotal role in maintaining circulating levels and modulating the delivery of the IGFs to the tissues. A large proportion of the circulating IGFs are bound with high affinity to one of the binding proteins. IGFBP-3. The mechanism by which these IGFs are transferred from the circulatory pool to the tissue receptors is at present unclear. Recent studies in late pregnancy have demonstrated the presence of specific proteases which may modify the IGFBPs such that their affinities for the IGFs are reduced. In this paper, we have demonstrated the presence of a heat-sensitive cation-dependent proteolytic enzyme specific for IGFBP-3 in the serum of five severely ill patients. The activity of this protease was found to vary in these patients, becoming more apparent during fasting than when studied after commencement of parenteral nutrition, indicating that one of the influencing factors in the activity of this protease is the nutritional intake of the patient. Age- and sex-matched healthy adults were also studied in a similar protocol, but no proteolytic modification of any of the IGFBPs was found in any of the samples examined. As the levels of both IGF-I and IGF-II were found to be low in the patients, the presence of a circulatory protease suggests that this may be an adaptive response to increase the bioavailability of the IGFs and possibly to improve the nitrogen retention and counter the catabolic state in severe illness.

Use of leucocyte‐poor blood components and HLA‐matched‐platelet donors to prevent HLA alloimmunization

Abstract: Recent studies have shown that the incidence of alloimmunization due to repeated platelet transfusions from random donors may be reduced by the use of leucocyte-poor blood components. These results were confirmed by this study, where 16% of patients with acute leukaemia undergoing initial chemotherapy and receiving leucocyte-poor blood components developed lymphocytotoxic antibodies, compared with 48% of patients in a control group receiving standard (non-leucocyte-depleted) blood components. In a third group, who received leucocyte-poor blood components and HLA-matched platelets, none of the patients developed lymphocytotoxic antibodies. There was a low incidence of platelet-specific antibodies (8%) but no difference between the three groups. Improved methods of removing leucocytes from blood components appear to offer the best approach for minimizing HLA alloimmunization, as the provision of HLA-matched platelet donors for prophylactic platelet support of all patients is not feasible.

Hyaluronic acid in the treatment of osteoarthritis of the knee.

Abstract: Objectives. We examined the eYcacy, safety and patient satisfaction of intra-articular hyaluronic acid (HA) in patients with osteoarthritis of the knee. Methods. One hundred patients with mild to moderate osteoarthritis of the knee entered a randomized blind-observer trial of 6 months HA vs placebo. Primary eYcacy criteria were pain on walking, measured with a visual analogue scale, and the Lequesne Index. Results. For pain on walking, a significant diVerence in favour of HA was found for completed patients at week 5, the end of the course of injections, and at month 6, the end of the study (P= 0.0087 and P= 0.0049, respectively). Further analysis using the Last Observation Carried Forward (LOCF ) also showed a significant benefit favouring HA at month 6 (P= 0.0010). For the Lequesne Index, a significant diVerence in favour of HA was found at week 5 (P= 0.030) and at month 2 (P= 0.0431), but this was only of borderline significance at month 4 (P= 0.0528). Patients’ global assessment of eYcacy favoured HA at month 6 (P= 0.012). Improvement in other secondary criteria was generally superior in the HA group compared to placebo both at week 5 and month 6. Adverse events, mainly local injection site reactions, occurred in both groups with equal frequency. Conclusions. The study demonstrated that five weekly intra-articular injections of sodium hyaluronate (HyalganA) were superior to placebo and well tolerated in patients with osteoarthritis of the knee with a symptomatic benefit which persisted for 6 months. Osteoarthritis (OA) of the knee is very common and toms in patients with OA of the knee [3‐5]. This type very important. Population surveys have shown that of action is characteristic of a group of compounds radiographically determined OA of the knee is present called ‘slow acting symptomatic drug for osteoarthritis’ in between 15 and 30% of subjects aged over 45 yr, and [6 ] to distinguish them from NSAIDs. thereafter increases steadily with age [1, 2]. Current HyalganA, used in this study, is a highly purified, treatment is usually disappointing and most rheuma- concentrated (10 mg/ml ), viscous solution of natural tologists do not follow-up patients once the diag- HA with a molecular weight in the range of 500‐ nosis is made. Non-steroidal anti-inflammatory drugs 730 kDa, extracted from rooster combs. In studies (NSAIDs) have been the mainstay of drug treatment in reported to date [3‐5], HyalganA has been very well knee OA, as in other types of arthritis, but have obvious tolerated with no significant side-eVects apart from the limitations. The elderly are most at risk from serious possibility of transient localized pain after the injection. adverse eVects of these drugs, particularly peptic ulcer- While most studies have found HyalganA to be eVective, ation, bleeding or perforation. Intra-articular steroids Henderson et al. [7] failed to show a diVerence in a are used in OA, but their long-term eYcacy is not well placebo-controlled study. This 6 month study of 91 established. patients had a high percentage of withdrawals (38%) Intra-articular sodium hyaluronate (hyaluronic acid; and local adverse eVects (pain and/or swelling: 47% in HA) oVers the prospect of another approach to the the HA group and 22% with placebo). This may have treatment of OA. Studies have shown that a course of resulted in an insuYcient power to detect a diVerence five injections of HA provides prolonged relief of symp- in the completed patients. The question, therefore,