Radcliffe Infirmary Research Articles

Letter by Herring and Paterson Regarding Article, “Common NOS1AP Variants Are Associated With a Prolonged QTc Interval in the Rotterdam Study”

To the Editor: We read with interest the recent study by Aarnoudse et al,1 which provides convincing evidence for an association between 2 common single-nucleotide polymorphisms in the neuronal nitric oxide synthase (nNOS/NOS-1) activator protein gene and prolongation of the heart rate–adjusted QT interval on ECGs from subjects in the Rotterdam study. This study builds on the findings of a recent genome-wide association study showing a similar link.2 These results are both surprising and clinically relevant, as it is not immediately …

Outcomes in squamous cell carcinoma with advanced neck disease.

Treatment of advanced neck disease (N2c/N3) in head and neck squamous cell carcinoma is contentious. The aim of this study was to review the survival outcome following surgical excision of neck disease and the complications of this surgery. A retrospective review of the case notes of 39 patients treated at the Oxford Radcliffe Infirmary Head and Neck Unit with squamous cell carcinoma and advanced neck metastases confirmed as either pN2c or pN3 on histological examination was performed. Patients were treated with surgery and, in some cases, with adjunctive postoperative radiotherapy at the centre between August 1996 and November 2004. The study sought to establish the demographics, UICC staging/pathology, method of treatment, complications, recurrence and survival. Kaplan-Meier curves were used for statistical analysis of survival. Comparisons were then made between the cohort and historical control groups. All patients were UICC stage IV disease. The 2- and 5-year overall survival in patients with resectable disease was 63% and 52%, respectively. Patients with advanced neck disease have traditionally been thought to have terrible prognosis and, therefore, treatment is controversial. In treating advanced head and neck cancer, there has been a recent trend away from surgery towards chemotherapy and/or radiotherapy. Comparing this study group to historical controls that include chemotherapy and/or radiotherapy, the outcomes appear favourable. The use of a combination of radiotherapy and surgery is advocated; it is suggested that advanced neck disease can have an acceptable prognosis and morbidity and that local disease control may be achieved.

Sharing knowledge to improve practice

Welcome to this brand new issue of Gastrointestinal Nursing. As mentioned in the last edition, the World Council of Enterestomal Therapists conference took place from 27−28 September in Brighton. Over the two days, a selection of speakers presented a broad spectrum of topics with reference to gastrointestinal issues.These included intestinal failure and nutrition related to high output ileostomy.The latter presentation, by June Beharry, Dietitian at Oxford Radcliffe Hospitals HS Trust, touched on the need for diet to be taken into account when ileostomy output is high. There is a surprising number of dietary options for this problem, but all are individualised to the patient, taking into account their lifestyle and preferences. The conference programme also included discussion of the role of the inflammatory bowel disease nurse specialist and a presentation of a new teaching tool and pre−p DVD for patients about to have stoma surgery. This highlighted the importance of informing patients about their condition before and after their operation, and how knowledge about something as basic as changing their appliance can help patients to cope with living with a stoma. Theconference was well attended and provided the opportunity for professionals to learn from, and discuss practice and knowledge with, their peers.

Charles Alan Blake Clemetson

Charles Alan Blake Clemetson (“Alan”) was born in Canterbury, England, on 31 October 1923 and went to preparatory school—Wootton Court, Wootton, Kent—from 1930 to 1935 and later to King's School,...

Combined approach tympanoplasty for cholesteatoma: impact of middle-ear endoscopy

The aims of this study were (1) to explore whether the experience at the Radcliffe Infirmary (Oxford, UK) supported the use of combined approach tympanoplasty for cholesteatoma, by determining the rate of disease at subsequent surgery, and (2) to assess whether this rate differed from findings reported elsewhere in the literature, possibly due to the effect of using an oto-endoscope. Retrospective case review, with data entered prospectively for operations performed by a single surgeon. Tertiary referral hospital. Between January 1998 and December 2004 inclusive, 66 patients underwent 68 primary procedures, with data available for all 'second looks'. Diagnostic and therapeutic operations for cholesteatoma were performed. All patients in this study attended follow up and underwent a second look operation, during which the rate of residual and recurrent cholesteatoma was determined. An oto-endoscope was used at all primary and subsequent surgery. The mean interval between the first and second combined approach tympanoplasty procedures was 16 months, and that between the second and third such procedures was 19 months (10 patients). One patient underwent a fourth combined approach tympanoplasty procedure, 17 months after a third such procedure. The rate of cholesteatoma at second combined approach tympanoplasty was 20.6 per cent (14/68); this was judged to be residual in 10 ears (14.7 per cent) and to be recurrent, with the redevelopment of retraction pockets, in four ears (5.9 per cent). The rate of cholesteatoma at third combined approach tympanoplasty was 20 per cent (two of 10); of these two, one patient had a small pearl in the middle ear removed with the aid of a potassium titanyl phosphate laser. There was no disease present in one patient at a fourth combined approach tympanoplasty. Only four patients required a modified radical mastoidectomy. Cholesteatoma remains a disease with significant morbidity. Endoscope-assisted surgery may decrease the morbidity of second look surgery and may improve the clearance of disease in appropriately selected patients.

Book reviews

Developmental Medicine & Child NeurologyVolume 42, Issue 6 p. 431-431 Free Access Book reviews First published: 13 February 2007 https://doi.org/10.1111/j.1469-8749.2000.tb00132.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 onFacebookTwitterLinked InRedditWechat Abstract Books reviewed in this article: National Perinatal Epidemiology Unit -1998 Report Oxford: Radcliffe Infirmary. Childhood Epilepsies and Brain Development Edited by A Nehlig, J Motte, SL Moshé, P Plouin Volume42, Issue6June 2000Pages 431-431 RelatedInformation

INV 23 Granulocyte-macrophage colony-stimulating factor (GM-CSF) as adjuvant therapy of melanoma

Oxford Radcliffe Hospitals, Cancer Research UK Medical Oncology Unit, Churchill Hospital, Oxford, UK Email: [email protected] Abstracts of the Sixth International Conference on the Adjuvant Therapy of Malignant Melanoma

Congenital myotonic dystrophy: prenatal ultrasound findings and pregnancy outcome

The objective of this study was to assess the maternal and prenatal ultrasound findings and outcome in pregnancies complicated by congenital myotonic dystrophy Type 1 (DM1). A retrospective chart review of all patients with a diagnosis of DM1 and pregnancy presenting to the Oxford Radcliffe Hospital between 1990 and 2004 was undertaken. Obstetric case notes were reviewed and details of all pregnancies obtained. This included data on prenatal diagnostic tests and obstetric ultrasound scans performed as well as pregnancy complications and pregnancy outcome. Maternal and fetal CTG expansion size was also recorded where available. Maternal genetic case notes were reviewed for details of maternal grip myotonia. Sixty pregnancies among 26 couples in which one of the parents was a carrier of DM1 were identified during the study period. These resulted in 36 (60%) pregnancies affected by congenital DM1 and 19 (31.7%) unaffected pregnancies. There were four miscarriages and one termination of pregnancy for non-medical reasons. Nineteen of the 36 affected pregnancies ended in termination following the antenatal diagnosis of congenital DM1 by either chorionic villus sampling (CVS) or amniocentesis. In the remaining 17 affected pregnancies (16 singleton and one twin) there was one miscarriage of an affected fetus with co-existing Down syndrome and eight perinatal deaths. The principal cause of perinatal death was respiratory failure in the early neonatal period. Antenatally noted clinical/sonographic abnormalities in these pregnancies included polyhydramnios (100%), talipes (26.6%) and borderline ventriculomegaly (13.3%). Uni- or bilateral talipes was noted at delivery in 10 of 16 (62.5%) neonates. Maternal grip myotonia was present in all but one of these cases. The antenatal findings of polyhydramnios and talipes should prompt a search for maternal grip myotonia. If present, definitive testing for congenital DM1 should be considered.

Primary Prevention and Health Services Delivery

Stroke remains the third leading cause of death in the US and other Western countries,1 and at least 1 population-based study found that the incidence of stroke was greater than that of acute coronary syndromes.2 Although there have been substantial falls in stroke incidence in some countries over the last 2 decades,3 a large US study found that the advances in stroke prevention during the 1990s were not associated with decreases in the rate of stroke hospitalizations or in case-fatality rates between 1993 and 1999.4 Moreover, based solely on demographic changes in the population of selected countries within the European Union, the World Health Organization predicts a 27% increase in stroke events between the years 2000 and 2025.5 The proportion of deaths attributed to stroke is even higher in Asian countries.6 Although much of stroke risk may be related to socioeconomic factors, more effective prevention strategies are critical. Several studies have contributed to the body of knowledge related to primary stroke prevention over the last year. Numerous studies support an association between elevated homocysteine levels and atherosclerotic disease.7 The B vitamins (folic acid, B12, and B6) reduce homocysteine serum levels raising the hope that treatment would be associated with reduced risk. That hope was diminished with publication of results of the Vitamin Intervention for Stroke Prevention (VISP) trial in 2004.8 Although a secondary rather than a primary stroke prevention trial, VISP had compared high- and low-dose B-vitamin supplementation and found no treatment effect on the risk of recurrent stroke (risk ratio [RR] 1.0; 95% CI, 0.8 to 1.3), or in the combined risk of any stroke, coronary heart event, or death (RR, 1.0; 95% CI, 0.8 to 1.1). The difference in homocysteine levels between treatment groups, however, was small …

Royal College Recommendations to Improve Academic Anesthesia in the United Kingdom: How They Compare with United States Proposals

Royal College Recommendations to Improve Academic Anesthesia in the United Kingdom: How They Compare with United States Proposals

Congenital absence of continuity between small and large intestine, with abnormal blood-supply of the proximal colon

Journal Article Congenital absence of continuity between small and large intestine, with abnormal blood-supply of the proximal colon Get access Herbert Haxton Herbert Haxton Department of Surgery, Radcliffe Infirmary, Oxford Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 32, Issue 128, April 1945, Page 540, https://doi.org/10.1002/bjs.18003212833 Published: 12 December 2005

Anatomy for Anaesthetists. Second edition. By Harold Ellis, M.A., D.M., M.Ch., F.R.C.S., Professor of Surgery, Westminster Hospital Medical School, and Margaret McLarty, D.A. (Edin.), B. Litt. (Oxon.), Medical Artist, Radcliffe Infirmary, Oxford. 8¾ × 5½ in. Pp. 342+x. Illustrated. Oxford: Blackwell Scientific Publications Ltd. 55s

Anatomy for Anaesthetists. Second edition. By Harold Ellis, M.A., D.M., M.Ch., F.R.C.S., Professor of Surgery, Westminster Hospital Medical School, and Margaret McLarty, D.A. (Edin.), B. Litt. (Oxon.), Medical Artist, Radcliffe Infirmary, Oxford. 8¾ × 5½ in. Pp. 342+x. Illustrated. Oxford: Blackwell Scientific Publications Ltd. 55s Get access Anatomy for Anaesthetists. Second edition. By Ellis Harold, M.A., D.M., M.Ch., F.R.C.S., Professor of Surgery, Westminster Hospital Medical School, and McLarty Margaret, D.A. (Edin.), B. Litt. (Oxon.), Medical Artist, Radcliffe Infirmary, Oxford. 8¾ × 5½ in. Pp. 342+x. Illustrated. Oxford: Blackwell Scientific Publications Ltd. 55s. British Journal of Surgery, Volume 56, Issue 10, October 1969, Page 798, https://doi.org/10.1002/bjs.1800561029 Published: 07 December 2005

The management of closed chest injuries.

Journal Article The management of closed chest injuries Get access J W Lloyd, J W Lloyd The Nuffield Department of Anaesthetics, The Radcliffe Infirmary, Oxford Search for other works by this author on: Oxford Academic Google Scholar M A Rucklidge M A Rucklidge The Nuffield Department of Anaesthetics, The Radcliffe Infirmary, Oxford Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 56, Issue 10, October 1969, Pages 721–722, https://doi.org/10.1002/bjs.1800561005 Published: 07 December 2005

Abnormal levels of catecholamine metabolites in a resected coarctation of the aorta.

Journal Article Abnormal levels of catecholamine metabolites in a resected coarctation of the aorta Get access L P O'Gorman, L P O'Gorman Departments of Chemical Pathology, Cardiothoracic Surgery, and Anaesthetics, The Royal Infirmary, Sheffield Search for other works by this author on: Oxford Academic Google Scholar A M Wilson, A M Wilson Departments of Chemical Pathology, Cardiothoracic Surgery, and Anaesthetics, The Royal Infirmary, Sheffield Present address: Nuffield Department of Anaesthetics, Radcliffe Infirmary, Oxford. Search for other works by this author on: Oxford Academic Google Scholar J Castillo-Olivares J Castillo-Olivares Departments of Chemical Pathology, Cardiothoracic Surgery, and Anaesthetics, The Royal Infirmary, Sheffield Present address: Alcantara 35, Madrid, Spain. Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 56, Issue 3, March 1969, Pages 183–186, https://doi.org/10.1002/bjs.1800560308 Published: 07 December 2005

Hospital admissions for acute cholecystitis: changes in the age and sex distribution in Oxford in the post-war period.

Admissions for acute cholecystitis to the Radcliffe Infirmary, Oxford, during the period 1974-1978 have been reviewed and compared with figures previously published for the period 1953-1962 (1). There was a small overall increase in the annual rate of female admissions for acute cholecystitis between the two periods and this increase can be accounted for by population changes in all age groups above the age of 40 years. However, there was a significant increase in the admission rate of women under the age of 40 which could not be accounted for by changes in population alone. This apparent increase in acute gallbladder disease in young women coincides with the growth between 1960 and 1970 of the number of women taking oral contraceptives, and is further evidence of a causal relationship between the use of the contraceptive pill and the development of gallstones. Women taking oral contraceptive steroids had a higher rate of common bile duct exploration and of sphincteroplasty than did those not taking oral contraceptives. The annual rate of male admissions almost doubled between the two periods and this increase cannot be accounted for by population changes. There has also been a virtual disappearance of acute cholecystitis in children over the same time.

Thorotrast pyograms in cerebral abscess

Journal Article Thorotrast pyograms in cerebral abscess Get access G K Tutton, G K Tutton Department of Surgery, Radcliffe Infirmary, OxfordDepartment of Radiology, Radcliffe Infirmary, Oxford Search for other works by this author on: Oxford Academic Google Scholar W H T Shepherd W H T Shepherd Department of Surgery, Radcliffe Infirmary, OxfordDepartment of Radiology, Radcliffe Infirmary, Oxford Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 36, Issue 143, January 1949, Pages 240–256, https://doi.org/10.1002/bjs.18003614303 Published: 06 December 2005

Intra-osseous lipoma of rib.

Journal Article Intra-osseous lipoma of rib Get access R H Cowdell R H Cowdell Department of Pathology, the Radcliffe Infirmary, Oxford Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 41, Issue 170, May 1954, Pages 664–665, https://doi.org/10.1002/bjs.18004117026 Published: 06 December 2005

The Principles and Practice of War Surgery. With Special Reference to the Biological Method of Treatment of Wounds and Fractures. By J. Trueta, M.D., Assistant Surgeon (E.M.S.), Wingfield-Morris Orthopædic Hospital, Oxford; Acting Surgeon-in-Charge, Accident Service, Radcliffe Infirmary, Oxford; Formerly Director of Surgery, General Hospital of Catalonia, University of Barcelona. 9 1/4 × 6 1/8 in. Pp. 391 + xvi, with

The Principles and Practice of War Surgery. With Special Reference to the Biological Method of Treatment of Wounds and Fractures. By J. Trueta, M.D., Assistant Surgeon (E.M.S.), Wingfield-Morris Orthopædic Hospital, Oxford; Acting Surgeon-in-Charge, Accident Service, Radcliffe Infirmary, Oxford; Formerly Director of Surgery, General Hospital of Catalonia, University of Barcelona. 9 1/4 × 6 1/8 in. Pp. 391 + xvi, with

Smooth-muscle tumours of the gastro-intestinal tract.

Journal Article Smooth-muscle tumours of the gastro-intestinal tract Get access R H Cowdell R H Cowdell Department of Pathology, The Radcliffe Infirmary, Oxford Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 38, Issue 149, July 1950, Pages 3–11, https://doi.org/10.1002/bjs.18003814903 Published: 06 December 2005

Bile peritonitis.

Journal Article Bile peritonitis Get access H Ellis, H Ellis Senior Lecturer in Surgery, Formerly Surgical Tutor Westminster Hospital, LondonThe Radcliffe Infirmary, Oxford Search for other works by this author on: Oxford Academic Google Scholar K Cronin K Cronin Surgical Registrar The Radcliffe Infirmary, Oxford Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 48, Issue 208, September 1960, Pages 166–171, https://doi.org/10.1002/bjs.18004820818 Published: 06 December 2005