Central Middlesex Hospital Research Articles

Jean Ross Colston

Jean Colston was a highly respected consultant rheumatologist at the Central Middlesex Hospital from 1975 until her retirement in 1995. She was born in central London to Eric and Cathie...

Acceptability of intravitreal injections in geographic atrophy: protocol for a mixed-methods pilot study

IntroductionAge-related macular degeneration (AMD) is a common cause of visual impairment, affecting central vision. Geographic atrophy (GA) is an advanced form of the non-neovascular (dry) type of AMD. Late-stage clinical...

Editorial introductions

Current Opinion in Clinical Nutrition and Metabolic Care was launched in 1998. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The fields of clinical nutrition and metabolic care are divided into 15 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS George GrimbleGeorge GrimbleGeorge Grimble graduated from University College London (UCL) and the London School of Hygiene and Tropical Medicine, UK. He has pursued a research and teaching career in clinical nutrition since 1980. At various times he has worked at Central Middlesex Hospital, St Mark's Hospital, Roehampton and Reading Universities, and is now in the Institute of Liver and Digestive Health in the UCL Division of Medicine, UK. George has specialised in nutrition related to gastroenterology, intensive care for preterm and adult humans, ageing, and the problems of poverty and food insecurity. He has co-authored 69 refereed papers, 96 reviews, 2 patents, and is coeditor of 6 books. As may be guessed, he has broad interests gained partly through designing, initiating, and running undergraduate and graduate programmes. Two MSc programmes in Clinical and Public Health Nutrition and in Eating Disorders and Clinical Nutrition at UCL were joined by a third BSc Nutrition and Medical Sciences programme in 2017. The important thing seems to be to consider nutrition from simultaneously a clinical and basic scientific perspective; societal issues naturally follow on from this. James RyallJames RyallJames Ryall was awarded his PhD in the field of skeletal muscle physiology in 2006 at The University of Melbourne, Australia. In 2008 he was awarded a CJ Martin Overseas Biomedical Research Fellowship (NH&MRC) and from 2008–2013 he worked with Dr Vittorio Sartorelli at the National Institutes of Health in Bethesda, MD (USA) on trying to understand the links between intrinsic cell metabolism and the process of myogenic lineage commitment in skeletal muscle stem cells. This work was the first to provide the whole transcriptome of quiescent and actively proliferating muscle stem cells and defined a process of metabolic programming. In 2013 Dr Ryall returned to Australia and The University of Melbourne, where he is now a leading scientist within the Centre for Muscle Research (CMR). Dr Ryall's current research lies in better understanding the link between skeletal muscle stem cells and their metabolic environment as they transition from quiescence to proliferating myogenic progenitor. A better understanding of the link between metabolism and cell identity will lead to improvements in stem cell transplantation and regenerative medicine, nuclear reprogramming, transdifferentiation, and stable ex vivo expansion of stem cells. Luc TappyLuc TappyLuc Tappy graduated from Lausanne University Medical School in 1981 and completed his medical and research training at Lausanne University Hospital, Switzerland, and Temple University Hospital, Philadelphia, USA. He is currently Professor of the Department of Physiology at Lausanne University, and Associate Physician in the Division of Endocrinology, Diabetes and Metabolism at Lausanne University Hospital. His main research interests are the regulation of insulin sensitivity by nutrients, the pathogenesis of the insulin resistance syndrome, and the metabolic responses to stress and aggression. Bettina MittendorferBettina MittendorferBettina Mittendorfer graduated from the University of Vienna in Austria with a MSc in Human Nutrition, and from the University of Texas Medical Branch in Galveston, USA, with a PhD in Nutritional Biochemistry. In 1999 she came to Washington University School of Medicine in St. Louis, USA, for a postdoctoral research fellowship. Currently she is Associate Professor of Medicine and Nutritional Sciences and the Director of the Nutrition and Obesity Research Center Clinical Science Research Core Laboratory at Washington University in St. Louis. Her research interests focus on the regulation of muscle protein and lipid metabolism with special emphasis on obesity, aging and sexual dimorphism, which she studies in vivo in human subjects by using stable isotope labelled tracer techniques.

Helen Margaret Johnson

After training at the Royal Free and Newcastle hospitals, Helen Noble worked in Sunderland, at the Central Middlesex Hospital, and in Coventry, with a varied wartime caseload. After a stint in general practice, she returned to the Royal Free and Gateshead to complete training …

Evaluation of a newly introduced tonsillectomy operation record for the analysis of regional post-tonsillectomy bleed data: a quality improvement project at the London North West Healthcare NHS Trust

The primary objective of this audit and quality improvement project was to retrospectively analyse regional post-tonsillectomy haemorrhage data as per national recommendations. However, this process highlighted the need for high-quality routinely collected data; something that was not always available via retrospective audit and thus does not enable formal aetiological factor analyses. We therefore created further secondary objectives to facilitate our primary audit objective. These secondary objectives were (1) to introduce a standardised tonsillectomy operation proforma to improve completeness and quality of routinely collected data and (2) to evaluate and validate proforma use and usefulness in improving using routine data collection to help with a repeated audit of post-tonsillectomy haemorrhages with the eventual aim to help improve operative outcomes by identifying potential associated factors. The retrospective audit component, the prospective audit and the quality improvement component were all carried out at the Northwick Park Hospital and Central Middlesex Hospital (London North West Healthcare NHS Trust). First, 642 tonsillectomy records (2012–2014) were retrospectively reviewed. Free-text operative documentation and, where possible, potential factors associated with post-tonsillectomy haemorrhages were analysed. In addition, completeness of data available before and after the introduction of (A) a new paper-based and (B) electronic surgical record proforma was reviewed (2014–2015). Over a 2-year period, 62 of the 642 (9.7%) audited tonsillectomy patients had a post-tonsillectomy haemorrhage, and 19 of these (2.9%) had to return to theatre for surgical arrest of the haemorrhage. Bipolar diathermy was the most commonly used technique. During this period, data available from routine operative documentation in the surgical operation notes were variable and thus did not allow identification of potential factors associated with post-tonsillectomy haemorrhage. The completeness and quality of data significantly improved after the introduction of a standardised paper-based proforma with sections for required details based on known risk factors for post-tonsillectomy haemorrhage and required operative details. Quality and completeness of data was further improved after the introduction of an electronic version. This electronic proforma will allow prospective spiral auditing results, early identification of raised bleeding rate, and provide individual surgeon audit results.

A Comparative Observational Study of the Use of Saline Uterine Hydrosonography for the Diagnosis and Assessment of Uterine Cavity Lesions in Women.

Aim of this study was to evaluate the performance of saline hydrosonography (HSGM) (also known as saline infusion sonography (SIS)) against transvaginal ultrasound scan (TVS) and hysteroscopy in the diagnosis of uterine cavity lesions. Diagnostic hysteroscopy with biopsy is considered as the “gold standard” to diagnose intrauterine abnormalities. The introduction of HSGM has improved the diagnostic capability of ultrasound. It is important to establish the efficacy and safety of HSGM before it is widely recommended for use. This retrospective observational data was collected from all 223 patients who underwent TVS, HSGM, and hysteroscopy as part of their gynaecological investigations from 1 January 2008 to 31 December 2010 at Central Middlesex Hospital, London. Endometrial Polyps. TVS: sensitivity 60.53%, specificity 97.06%, positive predictive value (PPV) 95.83%, and negative predictive value (NPV) 68.75% and HSGM: sensitivity 95%, specificity 97.14%, PPV 97.44%, and NPV 94.44%. Submucous Leiomyoma. TVS: sensitivity 57.14%, specificity 93.48%, PPV 84.21%, and NPV 78.18% and HSGM: sensitivity 96.55%, specificity 100.00%, PPV 100.00%, and NPV 97.92%. Diagnostic efficacy of HSGM is superior to TVS for the diagnosis of endometrial polyps and submucous fibroids. HSGM should be considered as an intermediate investigation after TVS to assess intracavity pathology and to confirm the diagnosis; hysteroscopy should become a therapeutic intervention.

Elizabeth (Betty) Raybould OBE 1926-2015

After working as a post office clerk and volunteering with the Air Raid Precautions, Betty Raybould started her nurse training at Central Middlesex Hospital in 1945.

Results from the treatment of refractory diabetic macular oedema with Bevacizumab in a clinical setting

AbstractPurpose To evaluate the outcome of the treatment of patients with refractory diabetic macular oedema with intravitreal bevacizumab (Avastin).Methods Prospective data was entered into an in house database of all patients being treated for refractory diabetic macular oedema at the Ophthalmology Department, Central Middlesex Hospital, London, UK. All patients received bevacizumab on a pro re nata basis after an initial loading phase of three injections. Best corrected visual acuity (BCVA) on the logMAR chart and the central retinal thickness (CRT) on the optical coherence tomography (OCT) scan were recorded at each visit. OCT was performed with the Spectralis OCT device (Heidelberg Engineering, Heidelberg, Germany) using the standard protocol of the clinic. Statistical analysis involved the Wilcoxon signed rank test and Spearman correlation test.Results 64 eyes of 48 patients were included in this study. The mean age was 68 years (range 45 ‐ 87). Patients received a mean of 3 bevacizumab (range 1‐10) injections. The follow‐up time was up to 15 months. The mean logMAR BCVA at baseline for Avastin was 0.74. At 2, 3, 7, and 11 months the mean BCVA was 0.77, 0.75, 0.67, and 0.69 respectively (p=0.01, 0.006, 0.02 and 0.05). There was no significant difference between baseline and any period thereafter during follow‐up to 15 months. Mean CRT at baseline was 527μm. The mean CRT at months 1‐4 were 456, 491, 490 and 480μm respectively and were significantly different for baseline, (p=0.001, 0.01, 0.03 and 0.04). CRT for months 5 to 15 were not significantly different from baseline.Conclusion The treatment of refractory diabetic macular oedema with intravitreal bevacizumab made little difference to improving the BCVA and CRT of the patients.

PARE0021 Challenging Mental Health Disorder in Long Term Rheumatic Disease Clinics

BackgroundThe prevalence of mental health disorder in individuals with Rheumatic disease is higher than that of the general population1,2. An audit of 240 patients attending general and specialist Rheumatology clinics...

AB0795 Hospital anxiety and depression scale (hads) is a ‘non-discriminatory’ patient related outcome measure (prom) in a rheumatology long term condition (ltc) clinic

BackgroundPatient related outcome measures (PROMs) in research settings require vital but often complex activity scores, within which high levels of anxiety and depression scores (HADS) affecting physical and emotional quality...

John M Tomlinson

John M Tomlinson was born and educated in Chester. After house jobs at the Middlesex Hospital, the Central Middlesex Hospital, Queen Elizabeth Children’s Hospital, and the Mother’s Hospital London he...

Peter Graeme Arblaster

Peter Graeme Arblaster trained at University College Hospital, London. He married Dorothy (“Dorsey”) Vaughan Watkins, a ward sister, in May 1944 and one month later joined the navy as a...

RADIOGRAPHIC SIGNS OF STATIC CARPAL INSTABILITY WITH DISTAL END RADIUS FRACTURES: IS CURRENT TREATMENT ADEQUATE?

Patients presenting with distal end radius fractures may have concomitant carpal instability due to disruption of the scapholunate ligament. This study examined the incidence of static radiographic signs of carpal instability in patients with distal radial fractures before and after fracture treatment. We performed a retrospective radiographic study of 141 patients presenting to Central Middlesex Hospital, London between January 2002-May 2004 with distal end radius fractures. We used abnormal scapholunate angle as the primary indicator of possible carpal dissociation. Abnormal scapholunate angles were noted in 39% of patients at presentation and 35% of patients after treatment with no statistically significant intra-patient variability. Persistent static radiographic signs of carpal instability are high in this subset of patients. The long-term morbidity of persistent wrist instability may be avoided by early radiological diagnosis with clinical correlation to identify carpal ligament injuries and initiate treatment that addresses both the bony and ligamentous components of the injury.

A posterior fracture-dislocation of the hip secondary to jogging

Department of Trauma & Orthopaedic Surgery, Central Middlesex Hospital, London Correspondence to Ghias Bhattee, MD, Department of Orthopaedics, Central Middlesex Hospital, Acton Lane, London NW10 7 NS, United Kingdom Tel: +447540237873; fax: 442084240170; e-mail: [email protected]

Sally Patricia Allwork (June 14, 1938–July 12, 2009)

After a short illness of rapid onset, Sally Allwork passed away on the July 12, 2009. Sally achieved her ultimate position as a morphologist despite the lack of an initial traditional university education. Her mother was Italian in origin. She left school at the age of 16 after taking her 'O' level examinations. She became an Almoners' Clerk at The Central Middlesex Hospital, continuing her studies in the evenings so as to obtain the necessary qualifications to become a laboratory technician. She was appointed as a

Stanley Leighton Orr Jackson

Stanley Leighton Orr Jackson was a committed supporter of the NHS from its start. He began postgraduate training in pathology at Central Middlesex Hospital. But, having contracted tuberculosis as a...

Marijuana Use and Sickle Cell Disease

A 45-year old Jamaican man with sickle cell disease came to our clinic complaining of chronic left ankle ulcer for one year. He stated that when he was a young boy he had had several hospital admissions for sickle cell crisis, usually precipitated by physical activity or infection, once or twice per month. We were surprised to find out that he had never had a crisis since the age of fifteen. We doubted his diagnosis yet his hemoglobin electrophoresis revealed HbS was 94.7%, HbF was 0.6% and HbA2 was 4.7%. He denied taking any medication. However, he admitted smoking 4 to 5 cigarettes of marijuana a day for the past 30 years. Cannabis has been used as a medicine even before the Christian era in Asia, first in China then mainly in India. Its use was later spread to the West.The general indications for marijuana were reported as severe nausea and vomiting, weight loss associated with debilitating illnesses, spasticity, pain syndrome, and glaucoma.Numerous Phase I–III studies in 2000 subjects with exposure of Sativex by GW Pharmaceuticals from United Kingdom demonstrated that the patients attained good sleep quality, which may improve patients' quality of life in disabling chronic pain syndromes.We reviewed the literature on any report that cannabinoids could change the severity of sickle cell disease. We found the study from West Indies, which investigated the perception that marijuana use ameliorated the complications of sickle cell disease, in year 2000 and 2004. The study concluded that marijuana smoking is common in adults with sickle cell disease but its usage is unrelated to clinical severity of the disease.We also found a report, from Central Middlesex Hospital in London, United Kingdom, which observed 86 young adults with HbSS, HbSC and HbSbetathalassemia disease, median age being 30 years.Results of this study showed that 31 (36%) had used cannabis in the previous 12 months to relieve the symptoms associated with sickle cell disease. Symptoms related to sedation and mood effects were reported in 77% of patients. The main reasons for use of cannabis were to reduce pain in 52% and to induce relaxation or relieve anxiety and depression in 39%. (5) We wondered if any physicians had observed similar effects of marijuana in sickle cell disease patients in their practice. Could ‘Marijuana Use has beneficial effect on Sickle Cell Disease’ be an interesting topic for a broader clinical trial or a retrospective analysis?

‘Clover leaf’ nuclei in atypical lymphocytes during acute Toxoplasma gondii infection

Clinical & Laboratory HaematologyVolume 12, Issue 1 p. 111-112 ‘Clover leaf’ nuclei in atypical lymphocytes during acute Toxoplasma gondii infection N. Win, N. Win Department of Haematology Central Middlesex Hospital Acton Lane London NWW 7NSSearch for more papers by this authorS.C. Davies, S.C. Davies Department of Haematology Central Middlesex Hospital Acton Lane London NWW 7NSSearch for more papers by this author N. Win, N. Win Department of Haematology Central Middlesex Hospital Acton Lane London NWW 7NSSearch for more papers by this authorS.C. Davies, S.C. Davies Department of Haematology Central Middlesex Hospital Acton Lane London NWW 7NSSearch for more papers by this author First published: March 1990 https://doi.org/10.1111/j.1365-2257.1990.tb01119.xCitations: 4AboutPDF 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 No abstract is available for this article.Citing Literature Volume12, Issue1March 1990Pages 111-112 RelatedInformation

Female genital mutilation: Experience in a West London clinic

SummaryIn 1997, a new clinic was established at the Central Middlesex Hospital to serve the needs of a mainly Somali population who had suffered genital mutilation in childhood. Between June 1997 and January 2005, 4,125 clinic attendances were recorded. A total of 215 reversals of circumcision were carried out (FGM 3), all on a day-care basis. In the majority of cases, an intact and undamaged clitoris was found under the scar tissue. The clinic staff were able to draw attention to cultural and religious issues which proved important in the medical management of these women. The experience of this clinic has shown that where there is a large immigrant population of women from the Horn of Africa, clinics such as this are efficient and cost-effective and encourage women to attend with a variety of health concerns. The clinic also encourages these women to take their health concerns seriously.

Technical Note: Ligation And Stripping Of Short Saphenous Vein In Supine Position

BACKGROUND Ligation and stripping of short saphenous vein (SSV) is commonly performed in the prone position under general anaesthesia .To perform ligation of combined long (LSV)and short saphenous vein , the patient needs to be turned from prone or supine position. This has the disadvantage of respiratory complications whilst in prone anaesthesia, an increase in the operation time and extra staff in theatres to turn the patient. In our technique, we describe stripping the LSV and SSV in the supine position. Our aim is to reduce anaesthetic complications, reduce operation time and free theatre staff. THE TECHNIQUE In patients with symptomatic SSV, preoperative venous duplex scan marking is needed in order to identify the sapheno-popleteal junction (SPJ) and proximal 15 cm of SSV from the SPJ Under general anaesthesia and supine, patients underwent SPJ division and stripping of the SSV first. The knee joint needs to be flexed at a 45-degree angle and stabilised in this position by a towel at the ankle joint 1. Adduct the leg to 15 degrees at the level of the hip joint and ask the assistant to help stabilise the leg in this position whilst operating. Use a stool to sit on, lift the table up to a convenient position so that the knee joint will be at the level of the face (eyes) of the surgeon. Make a transverse incision approximately 3cm at 2 cm below the SPJ duplex marking. Incise through the skin, subcutaneous tissue and fat, use the West retractor to retract the skin and subcutaneous tissue, control the bleeding by diathermy and swab. You are now at the level of the deep fascia, in most cases you will be able to spot a bulge through the fascia indicating the course of the SSV fig 2. Make a careful incision on the fascia and pick the SSV by small artery forceps, clear the way through to the SPJ upwards and use diathermy to control all the branches of SSV. Disconnect the SSV at the SPJ level then transfix it by a 3/0 proline suture. Feed the pin stripper through the tip of the SSV, ask the assistant to let go from adduction position then extend the leg at the level of the knee joint. Proceed by pushing the stripper through the SSV (with out resistance) down towards the ankle joint. make a small skin incision to exit the stripper through the skin then strip the vein with the leg at full extension. Close the skin incision at the top by 3/0 proline stitches. At standing position, level the table down and abduct the leg to perform the LSV stripping in the usual way. DISCUSSION Over the last two years we have used this technique to perform over 150 procedures of stripping combined long and short saphenous vein at the ACAD centre in Central Middlesex Hospital in London . It has proved to be very successful in reducing the operating time (by 35-40 minutes) through avoiding turning the patient to the prone position .This enabled us to increase the number of cases in each list by adding one extra varicose vein operation. In addition using this technique enabled us to avoid the anaesthetic complications of the prone position, such as tube obstruction, injury to the cervical spine and injury to the peripheral nerves through nerve entrapments by the side of the table. It also permit an easy monitoring the patient at the end of the operation whilst still under anaesthesia. Furthermore we were able to free more theatres staff through not moving patients on the table in the middle of the Technical Note: Ligation And Stripping Of Short Saphenous Vein In Supine Position