St Thomas' Hospital

About: St Thomas' Hospital is a healthcare organization based out in London, United Kingdom. It is known for research contribution in the topics: Population & Pregnancy. The organization has 12105 authors who have published 15596 publications receiving 624309 citations. The organization is also known as: St Thomas's Hospital & St. Thomas's.

Increased rate of lupus flare during pregnancy and the puerperium: a prospective study of 78 pregnancies

Abstract: SUMMARY The objective was to determine whether the frequency of flare in systemic lupus erythematosus (SLE) patients is increased during pregnancy and the pucrpcrium. Seventy-eight pregnancies in 68 SLE patients attending the lupus pregnancy clinic, at St Thomas' Hospital, during the last 5 yr were included. The pregnancy period and 8 weeks post-delivery were considered. This group was compared with a control group of 50 consecutive, non-pregnant, age-matched SLE patients attending our weekly lupus clinic. Additionally, 43 of the pregnant patients carried on attending the lupus clinic for the year after puerperium, and their course was compared with themselves during pregnancy. SLE activity was assessed using the Lupus Activity Index (LAI) score. An increase St0.26 in the score was considered as a flare of the disease. Pregnancy and control groups were homogeneous for age, race, disease duration and distribution of autoantibodie s. Sixty-five per cent of the patients flared during pregnancy and/or the puerperium and 42% flared in the control group {P = 0.015).The rates of flare per patient/month were 0.082 ± 0.004 for the pregnancy group and 0.039 ±0.003 for the control group (P < 0.001). The 43 patients whose course was controlled after the puerperium flared more frequently during pregnancy than thereafter (McNemar test, P = 0.003). The rates of flare per patient/month were 0.093 ± 0.006 during pregnancy and the puerperium, and 0.049 ± 0.004 after the puerperium (P «= 0.0015). Kidney and central nervous system involvement was not different between the pregnancy and control groups. In terms of frequency of flares, there was no difference in any of the groups between patients taking and not taking steroids. We conclude that SLE tends to flare during pregnancy. Flares are maximal during the second and third trimester and the puerperium. Flares are not more severe than in non-pregnant patients, and most of the flares can be managed conservatively. Prednisolone does not prevent flares. IN recent years, pregnancy has become an important management focus in systemic lupus erythematosus (SLE) patients. The fertility rate in SLE women is normal [1], improvement in patients' care has provided longer periods of remission and a better quality of life, and the advent of combined obstetric-medical clinics has ameliorated the course and outcome of pregnancy. Clearly, the relationships between SLE and pregnancy are complex, and increasing evidence points to an important role of sex hormones in immunity. Increased prolactin levels have been demonstrated in mice and humans during SLE flares [2-4]. Changes in sex hormone levels during pregnancy and the puerperium are more apparent than in any other period of life. During the last 5 yr, we have prospectively followed a large number of patients with SLE, primary antiphospholipid syndrome and other autoimmune conditions, who have attended our lupus pregnancy clinic at St Thomas' Hospital. In order to assess the interaction of pregnancy and lupus, we have studied 78 pregnancies in SLE patients. We include in our data our experience of lupus in the puerperium.

Pre-, Per- and Postoperative Factors Affecting Performance of Postlinguistically Deaf Adults Using Cochlear Implants: A New Conceptual Model over Time

Abstract: Objective: To test the influence of multiple factors on cochlear implant (CI) speech performance in quiet and in noise for postlinguistically deaf adults, and to design a model of predicted auditory performance with a CI as a function of the significant factors. Study Design: Retrospective multi-centre study. Methods: Data from 2251 patients implanted since 2003 in 15 international centres were collected. Speech scores in quiet and in noise were converted into percentile ranks to remove differences between centres. The influence of 15 pre-, per- and postoperative factors, such as the duration of moderate hearing loss (mHL), the surgical approach (cochleostomy or round window approach), the angle of insertion, the percentage of active electrodes, and the brand of device were tested. The usual factors, duration of profound HL (pHL), age, etiology, duration of CI experience, that are already known to have an influence, were included in the statistical analyses. Results: The significant factors were: the pure tone average threshold of the better ear, the brand of device, the percentage of active electrodes, the use of hearing aids (HAs) during the period of pHL, and the duration of mHL. Conclusions: A new model was designed showing a decrease of performance that started during the period of mHL, and became faster during the period of pHL. The use of bilateral HAs slowed down the related central reorganization that is the likely cause of the decreased performance.

WHO/EORTC classification of cutaneous lymphomas 2005: histological and molecular aspects.

Abstract: The new WHO/EORTC classification for cutaneous lymphomas comprises mature T-cell and natural killer (NK)-cell neoplasms, mature B-cell neoplasms, and immature hematopoietic malignancies. It reflects the unique features of lymphoproliferative diseases of the skin, and at the same time it is as compatible as possible with the concepts underlying the WHO classification for nodal lymphomas and the EORTC classification of cutaneous lymphomas. This article reviews the histological, phenotypical, and molecular genetic features of the various nosological entities included in this new classification. These findings always have to be interpreted in the context of the clinical features and biologic behavior

European guidelines for quality assurance in cervical cancer screening: recommendations for cervical cytology terminology

Abstract: There are many different systems of cytology classification used in the member states of the European Union (EU) and many different languages. The following short annexe to Chapter 3 of the European Guidelines for Quality Assurance in Cervical Cancer Screening provides a framework that will allow different terminologies and languages to be translated into standard terminology based on the Bethesda system (TBS) for cytology while retaining the cervical intraepithelial neoplasia (CIN) classification for histology. This approach has followed extensive consultation with representatives of many countries and professional groups as well as a discussion forum published in Cytopathology (2005;16:113). This article will describe the reporting of specimen adequacy, which is dealt with in more detail elsewhere in Chapter 3 of the guidelines, the optional general categorization recommended in TBS, the interpretation/cytology result and other comments that may be made on reports such as concurrent human papillomavirus testing and the use of automation review and recommendations for management. The main categories in TBS will be described in the context of CIN, dyskaryosis and dysplasia terminologies so that all may be translated into the same framework. These guidelines should allow European countries to adapt their terminology in such a way as to make their screening programmes comparable with each other as well as with programmes elsewhere in the world.