Anne Hospital Research Articles

Size at birth and its relation to muscle strength in young adult women

To assess the relationship between development in utero, assessed by birth weight, and muscle strength in young adult women as assessed by grip strength. A total of 1563 participants aged 20-40 years in the Southampton Women's Survey had their grip strength measured during pregnancy. At recruitment to the survey the women had been asked to recall their birth weight or obtain it from their parents. For 536 women born in Southampton, birth weight was obtained from hospital records. Grip strength was related to birth weight using multiple linear regression analysis, adjusting for age, height, weight and reported physical activity. Grip strength increased with age, height, weight, physical activity and birth weight. In the mutually-adjusted model, grip strength increased by 1.10 kg per kilogram of birth weight (95% CI: 0.58-1.61 kg). In women with hospital birth weight data the relationship strengthened to 1.44 kg per kilogram of birth weight (95% CI: 0.50-2.38 kg). Grip strength in women in their twenties and thirties is at or approaching its peak. The association between grip strength and birth weight was remarkably similar to findings from other studies of women at younger and older ages. This indicates that in utero development has consequences for muscle strength throughout the life course, even allowing for the increase to peak muscle strength and then its decline as a woman ages.

2078: Local Control and Survival After Radiosurgery for Brain Metastases With or Without a 2 mm Perilesional Margin

Evaluation of results in 153 patients with brain metastases treated with Linac Radiosurgery (RS) in St Anne and Tenon hospital, using conformal or a 2 mm margin irradiation, in order to improve local control and possibly the survival.

Stereo-EEG in children

Stereotactic placement of intracerebral multilead electrodes for chronic EEG recording of seizures or stereoelectroencephalography (SEEG) was introduced 50 years ago at Saint Anne Hospital in Paris, France for the presurgical evaluation of patients with drug-resistant focal epilepsy. SEEG explorations are indicated whenever the noninvasive tests fail to adequately localize the epileptogenic zone (EZ). Currently, approximately 35% of our operated-on children require a SEEG evaluation. Arrangement of electrodes is individualized according to the peculiar needs of each child, to verify a predetermined hypothesis of localization of the EZ based on pre-SEEG anatomo-electro-clinical findings. Multilead intracerebral electrodes are designed to sample cortical structures on the lateral, intermediate, and mesial aspect of the hemisphere, as well as deep-seated lesions. Stereotactic stereoscopic teleangiograms and coregistered 3-D MRI are employed to plan avascular trajectories and to accurately target the desired structures. Pre-SEEG stereotactic neuroradiology and electrode implantation are usually performed in separate procedures. Electrodes are removed once video-SEEG monitoring is completed. Intracerebral electrical stimulations are used to better define the EZ and to obtain a detailed functional mapping of critical cortical and subcortical regions. Surgical morbidity of SEEG is definitely low in children. SEEG-GUIDED RESECTIVE SURGERY: In 90% of evaluated children, SEEG provides a guide for extratemporal or multilobar resections. SEEG-guided resective surgery may yield excellent results on seizures with 60% of patients in Engel's Class I.

Penicillin Decade, 1941–1951. Sensitizations and Toxicities. By LAWRENCE WELD SMITH, M.D., Medical Director, Commercial Solvents Corporation; and ANN DOLAN WALKER, R.N., formerly Editor, Trained Nurse and Hospital Review. 5 1/2 × 8 3/8 in. Pp. 122 + viii. 1951. Washington, D.C.: Arundel Press Inc.

Penicillin Decade, 1941–1951. Sensitizations and Toxicities. By LAWRENCE WELD SMITH, M.D., Medical Director, Commercial Solvents Corporation; and ANN DOLAN WALKER, R.N., formerly Editor, Trained Nurse and Hospital Review. 5 1/2 × 8 3/8 in. Pp. 122 + viii. 1951. Washington, D.C.: Arundel Press Inc.

The mental health policies of Trinidad and Tobago

The Republic of Trinidad and Tobago is the most southerly of the Caribbean island states. Trinidad is just 14 km from the coast of Venezuela. Trinidad covers an area of 4828 km2 while Tobago, the sister isle, has an area of 300 km2. The total population is approximately 1.3 million; 40.3% of the population is of East Indian descent, 39.6% of African descent, 18.4% mixed and 1.7% belong to other ethnic groups (Central Statistical Office, 2001). St Ann's Hospital in Port of Spain, the capital, was established in 1900 and is the country's only psychiatric hospital. There are two general hospitals, one in the north, at Port of Spain, and the other in the south, at San Fernando.

THE USE OF ACE INHIBITORS AND STATINS BY GENERAL PRACTITIONERS, INTERNISTS AND CARDIOLOGISTS

11st. Cardiology Internal Dpi, University Hospital, Brno, Bohunice, Czech Republic 21st. Cardioangiology Internal Dpi, St. Ann Hospital, Brno, Czech Republic

Reply

Diabetic MedicineVolume 21, Issue 6 p. 648-649 Reply R. I. G. Holt, R. I. G. Holt University of SouthamptonSearch for more papers by this authorM. A. G. Coleman, M. A. G. Coleman Princess Anne Hospital, Southampton, UKSearch for more papers by this author R. I. G. Holt, R. I. G. Holt University of SouthamptonSearch for more papers by this authorM. A. G. Coleman, M. A. G. Coleman Princess Anne Hospital, Southampton, UKSearch for more papers by this author First published: 19 May 2004 https://doi.org/10.1111/j.1464-5491.2004.1210b.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume21, Issue6June 2004Pages 648-649 RelatedInformation

A postnatal fasting plasma glucose is useful in determining which women with gestational diabetes should undergo a postnatal oral glucose tolerance test.

It is recommended that women with gestational diabetes (GDM) should have a 6-week postnatal oral glucose tolerance test (OGTT). As this test may be unpleasant, time-consuming and has resource implications, we evaluated whether the 6-week postnatal fasting glucose could be used to determine which women should undergo an OGTT. All women with GDM, diagnosed according to the World Health Organization criteria, who were delivered at the Princess Anne Hospital, Southampton between May 2000 and May 2002, were recommended to have an OGTT. The results of the fasting plasma glucose concentration were assessed in relation to the 2-h glucose value. One-hundred and fifty-two women with GDM were delivered. Thirty (19.7%) women refused an OGTT or failed to attend. In the 122 OGTTs, three (2.4%; 95% confidence interval 0.8, 7) women had diabetes, three had impaired glucose tolerance and four had impaired fasting glycaemia. No woman with a normal test had fasting glucose of > or =6.0 mmol/l. Fasting glucose was correlated with the 2-h glucose (r=0.62, P<0.0001). Only 10 (8.1%) of the OGTTs would have been performed if only women with fasting glucose of > or =6.0 mmol/l underwent the test. The sensitivity and specificity of this approach for the diagnosis of postnatal diabetes is 100% and 94%, respectively. Linear regression methods indicate that it would miss fewer than three in 10 000 cases. In our population, a 6-week postnatal fasting plasma glucose is useful in determining which women with gestational diabetes should undergo an OGTT. Consequently we now perform OGTT only in women whose postnatal fasting plasma glucose is > or =6.0 mmol/l.

Morbidity in electroconvulsive therapy

A reply EDITOR: Thank you for the opportunity to answer Dr Meignan's comments. We are grateful to her for informing us of the use of anaesthesia for electroconvulsive therapy (ECT) as early as 1945. This paper refers to other publications describing various attempts at general anaesthesia for ECT as early as 1941 and has probably been overlooked by some English-speaking authors. St Anne's Hospital and its team have indeed been precursors in treating neuropsychiatric patients. We are very impressed by the much lower incidence rate of severe complication following ECT reported by Meignan. However, the discrepancy between studies may result from differences in the way we appreciate how severe a complication is. Confusion after ECT and seizures are mentioned in Meignan's study, but their incidence rate is not reported, except for the three cases of status epilepticus. This is probably explained by the fact that the question of outpatient ECT was not raised in her institution. The classification of laryngospasm, which is a transient event, as a severe complication is subjective. Our concern was that it might have been the clinical sign of a more severe problem, e.g. gastric regurgitation. When excluding such transient (but really frightening) events from our data, severe complications occurred in three of 75 patients, an incidence rate of 4%, which is not much more than the 3% reported by Meignan in her 1998 study. Concerning the choice of anaesthetic drugs, Meignan mentioned that propofol was a perfectly suitable drug and the high number of patients with severe cardiovascular problems motivated her choice of etomidate. Relaxation provided by succinylcholine cannot prevent the regurgitation that triggers laryngospasm, which occurs during emergence when the effect of the relaxant is fading. Thus, we agree that the use of succinylcholine prevents traumatic complications, but not the respiratory problems. The delay in applying the ECT guidelines is explained by the fact that it took some time for the department to be informed of their existence and then to set procedures agreed by all the anaesthesiologists because of concerns about the risks of anaphylactic shock. However, as suggested by clinical practice at St Anne's Hospital as well as by our results, anaesthesia for ECT must be undertaken with the same high standards of care as any other procedure performed under general anaesthesia. Moreover, when informing patients about the risks and benefits of ECT, the risks of anaesthesia should be explained to them. Finally, such results suggest that before extending the indications of ECT, psychiatrists should take into account the risk of the anaesthetic. E. Tecoult Department of Anaesthesia; University College Hospital; London, UK N. Nathan Département d'Anesthésie Réanimation; CHU dupuytren; Limoges, France

Helen Odell-Miller — Interviewed by Rachel Darnley-Smith

Helen Odell-Miller trained as a music therapist in 1976 with Juliette Alvin at the Guildhall School of Music and Drama, and subsequently completed an MPhil in music therapy research with elderly mentally ill people at City University in 1988. She was largely responsible for developing the now extensive music therapy service in Cambridge during the 1980s and, together with Amelia Oldfield, set up the music therapy training course at Anglia Polytechnic University (APU) in Cambridge, which began in 1994. She has been involved with the development of the music therapy profession since her training and was chair of the APMT during the early 1980s. In addition, she was a founder member of the APMT Post-diploma Supervision Scheme. Today, alongside her clinical and research work at Addenbrooke's NHS Mental Health Trust, she is Head of the first UK MA Music Therapy Training, at Anglia Polytechnic University, Cambridge, and Music Therapy Advisor to the Department of Health. Rachel Darnley-Smith is Head Music Therapist for Barnet, Enfield and Haringey Mental Health NHS Trust at St. Ann's Hospital in North London and Clinical Tutor at the Guildhall School of Music and Drama. She was chair of the APMT, 1990–92.

Applications of the Malecot model for allelic association.

Annals of Human GeneticsVolume 62, Issue 5 p. 453-464 Applications of the Malecot model for allelic association. A. COLLINS, Human Genetics, University of Southampton, Level G, Princess Anne Hospital, Southampton, UKSearch for more papers by this author A. COLLINS, Human Genetics, University of Southampton, Level G, Princess Anne Hospital, Southampton, UKSearch for more papers by this author First published: 13 August 2009 https://doi.org/10.1111/j.1469-1809.1998.ahg625_0453_6.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat Volume62, Issue5September 1998Pages 453-464 RelatedInformation

Progress in optimizing dosimetry plans in stereotactic radiotherapy in the Salt Group (Saint-Anne-Lariboisière-Tenon

We began intracranial stereotactic irradiation under the direction of O Betti 11 years ago. At the present time, we believe it is interesting to present the methodologies of the SALT (Saint-Anne-Lariboisière-Tenon) group. Up to the present time we have irradiated 693 patients using a single fraction. Arteriovenous malformations (AVMs) represented the majority (90%) of treated lesions. Irradiation protocol has little changed since 1986, and the localization of the target volume was performed in the neurosurgery department of St Anne Hospital, France. The stereotactic images (computerized tomography [CT], angiography) were sent to the radiotherapy department of Tenon Hospital through the French public digital network NUMERIS. Protocol was realized using the stereotactic ARTEMIS-3D/Dosigray TPS. The lesion volume was filled by one or more spherical or elliptical subvolumes using the "Associated Target Methodology". The interactive adjustment of subvolumes was based on the 3D graphical representations of the lesion. The direct optimization of the irradiation space was performed by managing parameters provided by the DDB (Dosimetric Data Base) such as the number of arcs, their angular position, as well as the starting and the ending point of each arc. The evaluation of the calculated dose distribution was made using quantitative parameters. The second method of optimization was based on the minibeam intensity modulation using a mathematical theory of inverse problems and singular value decomposition (SVD) analysis. At the present time, due to technical reasons, linear accelerators do not permit the modulation of intensity of arctherapy. Thus we transformed the profiles of irregular forms into rectangular profiles of modulated ponderation, with each optimized plan being evaluated before its implementation. The criteria of evaluation were derived from the differential and cumulative dose volume histograms (DVH). The DVHs permitted the evaluation of the volumes of underdosage and overdosage inside the lesion and in the healthy tissue, respectively. Using DVHs, we have defined parameters such as the conform factor and the homogeneity index. We stress that the methodology of protocol optimization is valid for single or multiple fractions as well as for intra- and extra-cranial irradiation.

The Effects of ICI 182,780, a Pure Anti-Oestrogen, on the Hypothalamic-Pituitary-Gonadal Axis and on Endometrial Proliferation in Premenopausal Women

Obstetrics and Gynecology, University of Southampton, Princess Anne Hospital, Southampton; Medical Research Department, Zeneca Pharmaceuticals, Mereside, Macclesfield, Cheshire; and Academic Department of Biochemistry, The Royal Marsden Hospital, London, United Kingdom. Hum Reprod 1994;9:1991-1996

AUTHORS' REPLY

BJOG: An International Journal of Obstetrics & GynaecologyVolume 102, Issue 4 p. 348-348 AUTHORS' REPLY E. J. Thomas, E. J. Thomas Princess Anne Hospital, SouthamptonSearch for more papers by this authorJ. Bridges, J. Bridges Princess Anne Hospital, SouthamptonSearch for more papers by this authorA. Prentice, A. Prentice Princess Anne Hospital, SouthamptonSearch for more papers by this authorP. Englefield, P. Englefield Princess Anne Hospital, SouthamptonSearch for more papers by this authorW. Roche, W. Roche Princess Anne Hospital, SouthamptonSearch for more papers by this author E. J. Thomas, E. J. Thomas Princess Anne Hospital, SouthamptonSearch for more papers by this authorJ. Bridges, J. Bridges Princess Anne Hospital, SouthamptonSearch for more papers by this authorA. Prentice, A. Prentice Princess Anne Hospital, SouthamptonSearch for more papers by this authorP. Englefield, P. Englefield Princess Anne Hospital, SouthamptonSearch for more papers by this authorW. Roche, W. Roche Princess Anne Hospital, SouthamptonSearch for more papers by this author First published: April 1995 https://doi.org/10.1111/j.1471-0528.1995.tb09149.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume102, Issue4April 1995Pages 348-348 RelatedInformation

Ethmoid sinus carcinomas: Results and prognosis after neoadjuvant chemotherapy and combined surgery—A 10-Year experience

From June 1982 to June 1992, 144 ethmoido-sphenoido-orbital tumors have been referred to the neurosurgical department of Ste Anne Hospital. One hundred five of them were malignant lesions, among which 83 were included into our therapeutic protocol (1) neo-adjuvant chemotherapy (CDDP + 5-FU), (2) combined surgical procedure (subfrontal and transfacial), (3) postoperative radiotherapy. Fifty nine percent of the patients had no response to chemotherapy; 19% had a partial response (reduction of the tumoral volume >50% and <100%), 22% had a complete response. One patient had an immediate and transient postoperative rhinorrhea responsible for meningitis (acinebacter) that was cured after a 3-day treatment. Four patients had postoperative meningitis without any cerebrospinal fluid leakage; they were also cured. Five patients had a local suppuration that was treated by subcutaneous drainage (n = 1) or the removal of the cranial basis graft (n = 4). Oncologic results are presented for only adenocarcinomas (n = 63) because they represent the only population of this series large enough to assure significant statistical figures. The global actuarial survival rate was 53% at 3 years and 42.5% at 5 years. The 5-year actuarial survival rate was 80% for T1 tumors, 60% for T2, 40% for T3, and 25% for T4. Patients with an intracranial extension had a 3-year survival rate of 19%; none survived after 4-year follow-up. Neo-adjuvant chemotherapy seemed to influence the survival: 100% survival rate at 5 and 10 years for the complete responders. We discuss the opportunity of intraorbital exenteration, the indications, and the limits of combined surgery. We emphasize the importance of neo-adjuvant chemotherapy and of combined surgical procedures, even when the patients are complete responders to chemotherapy: complete responders who had only a transfacial approach have a 5-year actuarial survival rate of 80% (instead of 100% when a combined procedure was performed). Those who were not operated primarily recurred within 3 years and then had to be operated. We propose to follow such a combined surgery for all large ethmoidal cancers (T3 and T4) and for small tumors (T1 and T2) developed superiorly and posteriorly. Anterior T1 and T2 tumors should be operated through a single transfacial route.

Circadian variation in the time of onset of acute gastrointestinal bleeding

The increased attention to biologic rhythms and clinical manifestations of several diseases has recently led to the Identification of “chronorisks” for certain pathologic events. To evaluate whether a temporal pattern exists for acute gastrointestinal bleeding, 369 consecutive patients with acute testinal bleeding observed at the emergency department (ED) of S. Ann Hospital of Ferrara, Italy, during a 3-year period (1938–1990) were studied. On presentation to the ED, 297 patients had upper gastrointestinal tract bleeding (UGB), and 82 patients had lower gastrointesthal tract bleeding (LGB). In 270 cases of UGB and in 75 cases of LGB, the hour of symptom onset was known and the data were analyzed for the number of observed versus expected events daring the four 6-hour intervals of a day. The majority of events occurred in the morning (32.2% of UGB and 42.7% of LGB). Cosinor analysis yielded a circadian rhythmidty with a peak in the late morning to early afternoon for both UGB and LGB independent of sex and site of bleeding.

News

Art on the tiles: Patients from St Ann's Hospital, in London, aided by art student Sam Taft (above), have designed a range of ceramic tiles to brighten up the hospital's corridors. Twenty patients joined hi the Haringey Community Arts project.

Screening for fetal distress in labour using the umbilical artery blood velocity waveform.

To investigate the potential value of umbilical artery blood velocity wave-form measurement as a screening test for intrapartum fetal distress on admission to the labour ward. Prospective study drawn from the local population of pregnant women. The labour ward of the Princess Anne Hospital, Southampton, UK. 334 women with singleton pregnancies of at least 37 weeks gestation. Emergency caesarean section for fetal distress. There was a twelve-fold increase in the rate of emergency caesarean section for fetal distress (95% Confidence Interval (CI), 4.9-29) among women with a systolic/diastolic (S/D) ratio > or = 3.0, when compared to those with an S/D ratio of < 3.0 (P < 0.00001). Measurement of the umbilical artery blood velocity waveform compared favourably with admission cardiotocography. Umbilical artery blood velocity waveform analysis may be used to screen for fetal distress in labour and appears to be particularly sensitive to problems of placental origin. However, it is not likely to confer benefit in labour wards whose fetal heart rate monitoring policy is determined by pregnancy risk factors and admission cardiotocography.

Towards a more rational policy for colposcopy

The objective of the study was to establish the relationship between the results of positive and abnormal cervical smears and the corresponding colposcopic biopsy results and its relevance to clinical management. A retrospective analysis of linked results was carried out at the Princess Anne Hospital, Southampton. The main outcome measure was the correspondence between a positive or abnormal cervical smear and the related colposcopic biopsy. Colposcopic biopsies were carried out on 1,841 consecutive women. Of these, 1,424 (77.4%) had moderate or severe dyskaryosis on their smears. Of the 1,767 with definitive results on their smear, 1,101 (62%) showed exact correspondence between the cervical smear and the colposcopic biopsy. Ninety-one (26%) of all women with mildly dyskaryotic smears were reported as showing CIN II or CIN III on biopsy. We conclude that women with moderate or severe changes on cervical smear should not be asked to attend for confirmatory colposcopic biopsy prior to treatment, but those with persistent mild changes should be referred for separate diagnostic colposcopy.

Fetal heart rate and intrauterine growth

To assess whether fetal heart rate in early and late pregnancy relates to size at birth. Prospective study of fetal heart rates in early and late pregnancy. Princess Anne Hospital, Southampton. 63 primigravid women. Anthropometric measurements made on the newborn infant. There were no differences in heart rate between the sexes at 18 weeks gestation but by 36 weeks the boys had rates which were 4.4 beats lower than those of the girls. Higher fetal heart rate at 18 weeks was associated with lower ponderal index, smaller head circumference and smaller mid-arm circumference. There were no trends in fetal heart rate at 36 weeks with any birth measurements. Babies born at term who have a pattern of neonatal measurements which reflect growth retardation have raised heart rates in early pregnancy. Influences which impair fetal growth appear to take effect early in gestation.