London SE1 Research Articles

Delusional experience of self as receiver of email in schizoaffective disorder

International Journal of Geriatric PsychiatryVolume 22, Issue 5 p. 496-497 Letter to the Editor Delusional experience of self as receiver of email in schizoaffective disorder† Dr Malgorzata Raczek MRCPsych, Dr Malgorzata Raczek MRCPsych Section of Brain Maturation, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UKSearch for more papers by this authorProf. Robert Howard MD, MRCPsych, Prof. Robert Howard MD, MRCPsych Professor of Old Age Psychiatry and Psychopathology, MRC Centre for Neurodegeneration Research, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UKSearch for more papers by this author Dr Malgorzata Raczek MRCPsych, Dr Malgorzata Raczek MRCPsych Section of Brain Maturation, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UKSearch for more papers by this authorProf. Robert Howard MD, MRCPsych, Prof. Robert Howard MD, MRCPsych Professor of Old Age Psychiatry and Psychopathology, MRC Centre for Neurodegeneration Research, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UKSearch for more papers by this author First published: 01 May 2007 https://doi.org/10.1002/gps.1757Citations: 1 † Declaration of conflict of interest – none. This manuscript has not been published elsewhere nor has been under submission elsewhere currently. AboutPDF 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 Volume22, Issue5May 2007Pages 496-497 RelatedInformation

An Unusual Case of Embolic Stroke After Permanent Pacing

HomeCirculationVol. 115, No. 14An Unusual Case of Embolic Stroke After Permanent Pacing Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBAn Unusual Case of Embolic Stroke After Permanent Pacing Tim Lockie, BSc, MBChB, Azad Ghuran, MD and David Hildick-Smith, MD Tim LockieTim Lockie From the Sussex Cardiac Centre, Brighton, United Kingdom. Search for more papers by this author , Azad GhuranAzad Ghuran From the Sussex Cardiac Centre, Brighton, United Kingdom. Search for more papers by this author and David Hildick-SmithDavid Hildick-Smith From the Sussex Cardiac Centre, Brighton, United Kingdom. Search for more papers by this author Originally published10 Apr 2007https://doi.org/10.1161/CIRCULATIONAHA.106.639336Circulation. 2007;115:e386–e387A 54-year-old Caucasian male transatlantic airline pilot with no cardiovascular risk factors presented to a neurology clinic after a transient episode of dysphasia. He reported no additional neurological symptoms. Eleven years previously, he had developed asymptomatic sinus node disease and had undergone implantation of a dual-chamber permanent pacemaker to retain his commercial pilot’s license. He was in sinus rhythm, was normotensive (120/70 mm Hg), and had no cardiac murmurs or carotid bruits. Neurological examination was normal.A computerized tomography scan of his head showed a focal left cerebral infarct. Carotid ultrasonography, holter monitoring, and a thrombophilia screen were normal. A diagnosis of a left-hemisphere transient ischemic event was made. The patient was referred for a transoesophageal echo to exclude an intracardiac source of embolus. Structurally, the heart was normal, but on venous bubble contrast injection from the left arm, there was dense simultaneous opacification of both the left and right sides of the heart, without Valsalva maneuvers (Figure 1). Transthoracic images were subsequently repeated with bubble contrast from the right arm; on this occasion, there was no opacification of the left side of the heart, even with Valsalva maneuvers, effectively excluding a significant patent foramen ovale or intrapulmonary arteriovenous malformation (Movie I). Download figureDownload PowerPointFigure 1. Transesophageal echocardiography and bubble study illustrates bubbles entering the left atrium (LA) before the right atrium (RA). Ao indicates aorta.The patient underwent a venogram from the left basilic vein (Figure 2). This demonstrated a proximal occlusion of the left subclavian vein (in which the 2 pacing leads ran), 2 small collaterals crossing the mediastinum into the superior vena cava (which remained fully patent), and 1 large serpiginous collateral from the subclavian vein at the level of the occlusion draining directly into the left upper pulmonary vein. Download figureDownload PowerPointFigure 2. A, Venogram from the left arm illustrating an occluded left subclavian vein (LSCV) containing the pacing leads, with collaterals and a fistulous connection to the left atrium (LA). SVC indicates superior vena cava. B, Fistula occluded with an Amplatzer vascular plug (AVP).The patient was anticoagulated. In view of likely paradoxical embolization through the venovenous right-to-left shunt, the patient was readmitted for closure of the collateral vessel. A 6-mm Amplatzer vascular plug (AGA Corporation, Plymouth, Minn) was deployed via a guide catheter from the left basilic vein, with complete closure of the collateral channel. Repeat contrast echocardiography the next day showed no residual shunt. The patient remains well with no further symptoms, but he has not been able to return to his former employment.Occlusion of the access vein is a recognized complication of permanent pacing, with an incidence of 15% to 30%,1 unrelated to lead size or number.2 This occlusion rarely causes symptoms because venous collaterals quickly develop. Systemic-to-pulmonary venovenous collaterals have been reported in superior venacaval obstruction3 but not with subclavian vein occlusion alone. It represents a rare but important potential complication from transvenous pacemaker lead implantation.The online-only Data Supplement, consisting of Movies I and II, is available with this article at http://circ.ahajournals.org/cgi/content/full/115/14/e386/DC1.DisclosuresNone.FootnotesCorrespondence to Tim Lockie, BSc, MBChB, Flat 6, 32 Coin St, London SE1 8YG, UK. E-mail [email protected]References1 Rozmus G, Daubert JP, Huang DT, Rosero S, Hall B, Francis C. Venous thrombosis and stenosis after implantation of pacemakers and defibrillators. J Interv Card Electrophysiol. 2005; 13: 9–19.CrossrefMedlineGoogle Scholar2 Bracke F, Meijer A, Van Gelder B. Venous occlusion of the access vein in patients referred for lead extraction: influence of patient and lead characteristics. Pacing Clin Electrophysiol. 2003; 26: 1649–1652.CrossrefMedlineGoogle Scholar3 Ho HT, Horowitz AL, Ho AC. Systemic to pulmonary venous communication (right-to-left shunt) in superior vena cava obstruction demonstrated by spiral CT. Br J Radiol. 1999; 72: 712–713.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails April 10, 2007Vol 115, Issue 14 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.106.639336PMID: 17420355 Originally publishedApril 10, 2007 PDF download Advertisement SubjectsAnticoagulantsCerebrovascular Disease/StrokeEchocardiographyImagingPacemakerTransient Ischemic Attack (TIA)

Bullous acute haemorrhagic oedema of skin in infancy

Clinical and Experimental DermatologyVolume 32, Issue 4 p. 467-468 Bullous acute haemorrhagic oedema of skin in infancy J. E. Lai-Cheong, J. E. Lai-Cheong Departments of Dermatology and Child Health, University Hospital Lewisham, London, UK.Search for more papers by this authorP. Banerjee, P. Banerjee Departments of Dermatology and Child Health, University Hospital Lewisham, London, UK.Search for more papers by this authorV. Hill, V. Hill Departments of Dermatology and Child Health, University Hospital Lewisham, London, UK.Search for more papers by this authorP. Kenny, P. Kenny Departments of Dermatology and Child Health, University Hospital Lewisham, London, UK.Search for more papers by this authorJ. Ross, J. Ross Departments of Dermatology and Child Health, University Hospital Lewisham, London, UK.Search for more papers by this author J. E. Lai-Cheong, J. E. Lai-Cheong Departments of Dermatology and Child Health, University Hospital Lewisham, London, UK.Search for more papers by this authorP. Banerjee, P. Banerjee Departments of Dermatology and Child Health, University Hospital Lewisham, London, UK.Search for more papers by this authorV. Hill, V. Hill Departments of Dermatology and Child Health, University Hospital Lewisham, London, UK.Search for more papers by this authorP. Kenny, P. Kenny Departments of Dermatology and Child Health, University Hospital Lewisham, London, UK.Search for more papers by this authorJ. Ross, J. Ross Departments of Dermatology and Child Health, University Hospital Lewisham, London, UK.Search for more papers by this author First published: 21 March 2007 https://doi.org/10.1111/j.1365-2230.2007.02355.xCitations: 8 Dr Joey E. Lai-Cheong, St John's Institute of Dermatology, Guy's and St Thomas' Hospital, London SE1 7EH, UKE-mail: joey.lai-cheong@kcl.ac.uk Conflict of interest: none declared. Read 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 No abstract is available for this article.Citing Literature Volume32, Issue4July 2007Pages 467-468 RelatedInformation

Intravitreal injection: balancing the risks

Intravitreal triamcinolone (iVTA) had gathered pace in the management of retinal diseases. By simply searching with the string ‘intravitreal triamcinolone’ in PubMed, it returns over 400 publications, with over 300 in the past 2 years. Despite the large number of publications, there are still very limited data on long-term efficacy (over 12 months). Furthermore, if one considers sham-controlled prospective randomised clinical trials (RCT) only, the efficacy is in doubt. One of the original RCT in using iVTA in neovascular age-related macular degeneration (AMD) showed a negative result. Similar results were obtained in a more recent study on central retinal vein occlusion over 4 months. The difference between vision changes was significant only at 1 month. There was no meaningful difference in the occurrence of neovascularisation of the iris between the two groups. The only RCT with positive results is on diabetic macular oedema over 6 months from Jonas et al. The control group was only 12 eyes and laser treatment was not offered. When laser treatment was offered, there were no differences. Furthermore, when macular grid laser was performed 3 weeks after iVTA, visual outcome was better than iVTA alone especially at 6 months. However, the complications of using iVTA are numerous; intraocular pressure rise and cataract are common occurrences. In a retrospective analysis in Southampton, the ocular morbidity is high as well as the case report of ocular perforation and inadvertent administration of intralenticular injection. One would probably consider in the face of the lack of evidence that is unacceptably high. Nevertheless, the introduction of this off-label treatment has not received any political problems in the UK. It is apparent to us that as triamcinolone is widely available in the NHS hospital formulary, is relatively inexpensive and hence can be used without going through any funding request nor special committees. It has become widely available. Nonetheless, failure to communicate to patients that iVTA treatment is off-label, might have medicolegal implication. So are we seeing the same with the introduction of off-label used of Avastin? Several editorials in the UK, including in this journal as well as the British Journal of Ophthalmology, have discussed the issues. As a recap, Avastin and Lucentis have presented with us an unprecedented dilemma. Lucentis is licensed in the US in June 2006 and is likely to be licensed in Europe, including the UK, in the first quarter of 2007. The clinical trial results of Lucentis were nothing short of amazing, with over 95% of patients attaining stabilisation and up to 40% with significant visual improvement. However, Lucentis is considered expensive. In the USA, Lucentis is priced at USD$1950 per single use vial, given either monthly or of injections every 3 months after a three dose loading phase given every month. This reduced dosing regimen led to less impressive results than regular monthly dosing (PIER study, unpublished data). Avastin is derived from the same murine antibody as Lucentis, has similar binding sites, but is a significantly larger molecule with potentially less effective retinal penetration. The affinity to those binding sites are of the order of 16-fold less. Nonetheless, in animal models, Avastin stays in the eye longer, although the half-life of Avastin when administered intravitreously in humans, is yet to be determined, and when given systemically in man for colorectal cancer, the half-life of Avastin has been reported at 21 days, significantly greater than 2 h with Lucentis. Hence, longer eye exposure of Avastin and increased systemic exposure compared to Lucentis might balance out the lower VEGF-binding affinity and the slower retinal penetration. On the basis of small-scale animal studies, Avastin may be safe leading to extensive but short-term, uncontrolled, widespread use in Laser and Retinal Research Unit, King’s College Hospital, Denmark Hill, London SE5 9RS, UK

Head and neck imaging

IntroductionHead and neck imagingS E J Connor and P S RichardsS E J Connor1Neuroradiology DepartmentKing's College Hospital NHS Foundation Trust Denmark Hill London SE5 9RS, 2Department of Diagnostic ImagingBart's and The London NHS Trust Queen Elizabeth II Wing St Bartholomew's Hospital London EC1A 7BE UKSearch for more papers by this author and P S Richards1Neuroradiology DepartmentKing's College Hospital NHS Foundation Trust Denmark Hill London SE5 9RS, 2Department of Diagnostic ImagingBart's and The London NHS Trust Queen Elizabeth II Wing St Bartholomew's Hospital London EC1A 7BE UKSearch for more papers by this authorPublished Online:28 Jan 2014https://doi.org/10.1259/imaging/19171382SectionsPDF/EPUBFull Text ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail About"Head and neck imaging." Imaging, 19(1), p. iv Previous article FiguresReferencesRelatedDetails Volume 19, Issue 1March 2007Pages: 1-iv © The British Institute of Radiology History Published onlineJanuary 28,2014 Metrics Download PDF

Interspecies SCNT-Derived Human Embryos – a New Way Forward for Regenerative Medicine

Stephen Minger Director, Stem Cell Biology Laboratory, Wolfson Centre for Age Related Diseases, London SE1 1UL, UK Tel.: +44 207 848 6169; Fax: +44 207 848 6169; E-mail: stephen.minger@ kcl.ac.uk ‘...until the efficiency of successful somatic cell nuclear transfer in humans can be increased significantly (to perhaps 10–20%) alternative sources of oocytes specifically for this procedure are needed.’

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Homing in on Depression Genes

Homing in on Depression Genes

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Emergency management of arrhythmias and/or shocks in patients with implantable cardioverter defibrillators (ICDs): A statement on behalf of the Resuscitation Council (UK), Heart Rhythm UK (formerly The British Pacing and Electrophysiology Group, BPEG), The Joint Royal Colleges Ambulance Liaison Committee (JRCALC) and the Ambulance Services Association (ASA)

a Wales College of Medicine, Cardiff University, Cardiff CF14 4XN, UK b St George’s Hospital, Blackshaw Road, London SW17 0QT, UK c Newcastle General Hospital, Westgate Road, Newcastle upon Tyne NE4 6BE, UK d Ambulance Services Association, Friars House, 157—168 Blackfriars Road, London SE1 8EZ, UK e Royal Berkshire Ambulance NHS Trust, 44 Finchampstead Road, Wokingham, Berkshire RG40 2NN, UK f Freeman Hospital, High Heaton, Newcastle upon Tyne NE7 7DN, UK

Successful treatment of a recurrent Cesarean scar ectopic pregnancy by surgical repair of the uterine defect

Cesarean-scar pregnancy—which is defined as the implantation of a gestational sac into deficient myometrium at the site of a uterine incision—is a late serious complication of Cesarean section1. There is currently no consensus as to the most effective management of Cesarean-scar ectopic pregnancy, and little is known about the outcome of subsequent pregnancies2. In this report, we present a case of a woman diagnosed with three consecutive Cesarean-scar ectopic pregnancies. She underwent a successful repair of the uterine defect, resulting in normal intrauterine implantation of her subsequent pregnancies. A 39-year-old woman, gravida 3 para 2, attended for an early pregnancy ultrasound scan with a history of vaginal bleeding. Her two children had both been delivered by Cesarean section. On ultrasound scan a diagnosis of a viable 12-week Cesarean-scar ectopic pregnancy was made. The placenta was implanted low within the anterior uterine wall. The myometrium at the implantation site appeared severely deficient, with only a thin layer of tissue separating the pregnancy from the urinary bladder. After discussion she opted for a laparoscopy and suction evacuation of the pregnancy under ultrasound-scan guidance. The procedure was complicated by profuse vaginal bleeding, which was eventually controlled by the insertion of a Shirodkar suture. Five units of blood were transfused peri-operatively. The postoperative recovery was uneventful and she attended for the removal of the cervical suture 5 days later. Ten months later she attended for another scan, which showed a 7-week viable recurrent Cesarean-scar pregnancy. The pregnancy was removed by suction curettage without complications. Six months later she attended again with a 4-week Cesarean-scar ectopic, which was also removed surgically without complications. Three months following her third Cesarean-scar ectopic a laparotomy was performed to repair the uterine-scar defect. The deficient scar was completely excised and the uterine wall was then closed in three layers including the visceral peritoneum. Her postoperative recovery was uneventful and she was discharged a week later. On histological examination, the excised uterine scar tissue contained an old suture remnant and it showed evidence of chronic inflammation and fibrosis. A follow-up scan 2 months after laparotomy revealed a well-healed uterine scar with no evidence of residual myometrial defect (Figures 1 and 2). Transvaginal ultrasound scan showing deficient myometrium at the site of a previous Cesarean scar. Transvaginal ultrasound scan showing a repaired Cesarean-scar defect after laparotomy. Eight months after the operation she had a biochemical pregnancy, which was not detectable on the scan. Following this she had two pregnancies, which were both located normally within the uterine cavity. Although the pregnancies initially contained embryos with evidence of cardiac activity, they both miscarried spontaneously at 7 and 8 weeks' gestation, respectively. Until this case, there have been only two previous reports of recurrent Cesarean-scar pregnancies in the world literature3, 4. This low prevalence of recurrent scar pregnancies indicates that implantation into the scar is more likely to be a chance event, rather than the result of a particular affinity of a pregnancy for implanting into the scar. It is possible that the risk of scar implantation may be proportional to the size of the anterior uterine wall defect. The patient described in this report had a particularly large defect on the scan, which supports this hypothesis. Our case report also shows that laparotomy and repair of a uterine defect may be successful in preventing recurrent Cesarean-scar ectopics. Major open surgery and uterine repair may be complicated by poor scar healing and postoperative intra-abdominal adhesions, both of which may have a detrimental effect on the patient's future fertility. Therefore, we suggest that repair should only be considered in recurrent cases or in women with unusually large uterine defects. J. Ben Nagi*, D. Ofili-Yebovi*, E. Sawyer*, J. Aplin*, D. Jurkovic*, * Early Pregnancy and Gynaecology Assessment Unit, King's College Hospital, Denmark Hill, London SE5 8RX, UK

Welcoming Remarks

Annals of the New York Academy of SciencesVolume 1075, Issue 1 p. xiii-xiv Welcoming Remarks Philip Whitfield, Philip Whitfield Professor and Vice Principal King's College LondonUniversity of LondonLondon, UKSearch for more papers by this author Philip Whitfield, Philip Whitfield Professor and Vice Principal King's College LondonUniversity of LondonLondon, UKSearch for more papers by this author First published: 05 September 2006 https://doi.org/10.1196/annals.1368.048 Address for correspondence: Prof. Philip Whitfield, King's College, London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK. e-mail: phil.whitfield@kcl.ac.uk Read 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 onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume1075, Issue1Circulating Nucleic Acids in Plasma and Serum IVSeptember 2006Pages xiii-xiv RelatedInformation

A promising evidence-based practice for people with intellectual disabilities and mental health issues

Estia Centre, Institute of Psychiatry, King's College London, London, UK Correspondence to Nick Bouras, Professor of Psychiatry, Estia Centre, York Clinic, Guy's Hospital, 47 Weston Street, London SE1 3RR, UK Tel: +44 20 7955 4792; fax: +44 20 7955 4232; e-mail: [email protected]

K. Krishna Rao—a lifetime study of ferredoxins and solar hydrogen

photosynthesis as a renewable energy source, and carried out most of his work in King’s College London with David Hall. Krishna was born in 1928 in the village of Kadakkal, in Kerala state, at the southern tip of India, the son of Kuppan Poti Rao and Bhageerathi Rao. The ‘‘K’’ in Krishna’s name stands for ‘‘Kuppan’’ from his father’s name, according to the local tradition there. His father was a primary school teacher. For his secondary education, Krishna had to move to a larger town, then on to Trivandrum (Thiruvananthapuram) where he studied Chemistry at the University College. He obtained his M.Sc. in 1950 in Travancore (Thiruvithaamkoor, now part of Kerala state), and became lecturer in Scott Christian College, Nagercoil, India, which was run by the London Mission Society. He taught organic, physical and inorganic chemistry to degree level. In 1951, he married the daughter (Retnam) of the professor of chemistry, herself a scientist. In 1962, from thousands of other applicants, he was chosen for a United States State Department Scholarship. He chose to take it at the East-West Center in Honolulu, Hawaii, where the climate was similar to that at home. The State Department at that time was promoting multiculturalism, and scholarship holders were expected to travel around the state and on the mainland, talking to summer schools about their home country and customs, while dressed in their native costume, a duty which Krishna much enjoyed. In the University of Hawaii, he took his Ph.D. with Howard Mower. Ferredoxins had been discovered in plants and bacteria, and were known to be important for photosynthesis and nitrogen fixation. His thesis was on the sequence and properties of the ferredoxin from taro (Colocasia esculenta), a local food plant both in Southern India and Hawaii. At that time, Mower’s group was also working on hydrogenase, a subject that was to play an important part in Krishna’s later career (Ackrell et al. 1966). R. Cammack (&) Department of Biochemistry, King’s College London, Franklin-Wilkins Building 150, Stamford St, London SE1 9NH, UK e-mail: richard.cammack@kcl.ac.uk Krishna Rao in his laboratory in London, UK Photosynth Res DOI 10.1007/s11120-006-9080-x

MSc in clinical and public health aspects of addiction

Further information Dr Kim Wolff (programme leader), National Addiction Centre, Addiction Sciences Building, Institute of Psychiatry (P048), 4 Windsor Walk, London SE5 8AF; +44 (0)207 848 0823; www.iop.kcl.ac.uk/iopweb/studying/taught. For students with a medical, nursing, psychology, or psychiatry background who have an interest in the substance misuse field. 2003 to 2005, after six years as a consultant in old age psychiatry. To improve the detection and treatment of alcohol and other drug misuse in older people in my own service, and to integrate research …

Personality Disorders and Unmet Needs Among Psychiatric Inpatients

Personality Disorders and Unmet Needs Among Psychiatric Inpatients

Paying attention to the gastrointestinal system is critical!

St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK Correspondence to Richard Beale, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, Lambeth Palace Road, London SE1 7EH, UK Tel: +44 20 7188 3038; e-mail: [email protected]

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