Royal Hallamshire Hospital Research Articles

Transglutaminase 6 antibodies in the diagnosis of gluten ataxia

The previous finding of an immunologic response primarily directed against transglutaminase (TG)6 in patients with gluten ataxia (GA) led us to investigate the role of TG6 antibodies in diagnosing GA. This was a prospective cohort study. We recruited patients from the ataxia, gluten/neurology, celiac disease (CD), and movement disorder clinics based at Royal Hallamshire Hospital (Sheffield, UK) and the CD clinic, Tampere University Hospital (Tampere, Finland). The groups included patients with idiopathic sporadic ataxia, GA, and CD, and neurology and healthy controls. All were tested for TG6 antibodies. Duodenal biopsies were performed in patients with positive serology. In addition, biopsies from 15 consecutive patients with idiopathic sporadic ataxia and negative serology for gluten-related disorders were analyzed for immunoglobulin A deposits against TG. The prevalence of TG6 antibodies was 21 of 65 (32%) in idiopathic sporadic ataxia, 35 of 48 (73%) in GA, 16 of 50 (32%) in CD, 4 of 82 (5%) in neurology controls, and 2 of 57 (4%) in healthy controls. Forty-two percent of patients with GA had enteropathy as did 51% of patients with ataxia and TG6 antibodies. Five of 15 consecutive patients with idiopathic sporadic ataxia had immunoglobulin A deposits against TG2, 4 of which subsequently tested positive for TG6 antibodies. After 1 year of gluten-free diet, TG6 antibody titers were significantly reduced or undetectable. Antibodies against TG6 are gluten-dependent and appear to be a sensitive and specific marker of GA.

From ‘Pastoral Contacts' to ‘Pastoral Interventions'

This research collates statistical results of pastoral care contacts undertaken at the Sheffield Northern General Hospital and the Royal Hallamshire Hospital over a twelve month period. The data was found to provide an important overview of chaplaincy work that can be used for future pastoral care management and developing better data collection and quality assurance measurements. The data was subsequently categorised using the World Health Organization (WHO) Pastoral Intervention (PI) Codings to explore the use of a newly developed universal coding system that might allow national and international data collection and comparison. Overall the data from the Sheffield Teaching Hospitals' pastoral data base was found to be easily transferable to the WHO PI codings. This report of the research offers recommendations for recording chaplaincy activity that at present is unrecorded and by doing so might reflect a more accurate picture of the role and demands of chaplaincy services.

The relationship between serum prolactin concentration and pregnancy outcome in women with unexplained recurrent miscarriage

The role of prolactin in early pregnancy is controversial. The aim of this study was to evaluate the relationship between serum prolactin concentration and the risk of miscarriage in women with unexplained recurrent miscarriage (RM). A series of 174 women with unexplained RM, who had serum prolactin concentrations measured from January 2000 to September 2009 at the Recurrent Miscarriage Clinic in Royal Hallamshire Hospital in Sheffield, were included in this study. Among the 174 patients with unexplained RM, 40 patients did not conceive during the study period, 9 were lost to follow-up and 125 patients conceived again. Patients who did not conceive were significantly older than those who conceived (p < 0.05, OR: 1.08, 95% CI: 1.03–1.13). Among those who conceived again, the pregnancy outcome data were available for analysis in 109 patients. Those who miscarried were older (p < 0.05, OR: 1.1, 95% CI: 1.01–1.22) and had significantly lower serum prolactin concentrations (p < 0.05, adjusted OR: 0.99, 95% CI: 0.97–0.99) after adjustment has been made for age, than those who had a live birth. Lower basal serum prolactin concentrations were associated with an increased risk of miscarriage in a subsequent pregnancy in women with unexplained RM.

Prospective Pilot Study Looking at the Size and Variation of the Blind Spot Scotoma in Adults Measured on the Octopus 900 Field Analyser

Aims : Literature regarding the size of the blind spot is old and recorded on instruments no longer in production. This pilot studyto provide normative data for the size of the visual blind spot scotoma in adults measured by the Octopus 900 kinetic perimeter. Study Design: A prospective repeated measures study involving nineteen participants. Place and Duration of Study:Ophthalmology department, Royal Hallamshire Hospital,

Guidelines on the investigation and management of venous thrombosis at unusual sites.

Department of Haematology, Glasgow Royal Infirmary, Glasgow, Department of Haematology, Addenbrooke’s Hospital, Cambridge, Department of Haematology, Aberdeen Royal Infirmary, Aberdeen, Department of Haematology, Imperial College at Hammersmith Hospital, London, Department of Cardiovascular Science, Royal Hallamshire Hospital, Sheffield, and Oxford Haemophilia and Thrombosis Centre, Churchill Hospital, Oxford, UK

Development of an instrument to measure face validity, feasibility and utility of patient questionnaire use during health care: the QQ-10

To develop and establish the psychometric properties of an instrument to measure face validity, feasibility and utility of patient questionnaires used during health care. Our instrument, QQ-10, is a 10-item self-completed questionnaire, which was developed during the evaluation of another questionnaire (ePAQ-PF), to assess patients' views on questionnaire use during health care. Urogynaecology Department, Royal Hallamshire Hospital, Sheffield, UK. The Sheffield maternity patient user group identified 10 key themes relating to patients' views on using questionnaires; these themes translated into 10 statements, each using the same 5-point Likert response scale. Not applicable. Outcome Measures Principal component analysis established the factor structure of our instrument. Internal reliability was assessed using Cronbach's alpha. Construct validity was assessed using Spearman's rho. Factor analysis yielded two meaningful factors: Value and Burden, both achieving Cronbach's alpha scores >0.7. Significant correlations were found between scores for Value and communication experience and between scores for Burden and barriers to health care. Our instrument offers a valid, reliable measure of patients' views relating to value and burden of using health-related quality of life questionnaires. Its two domains show good internal reliability and with its free text items, it may offer a valuable, standardized assessment of face validity and utility of other questionnaires used in health care.

Complementary therapies for people with motor neurone disease: extending a cancer care service

BackgroundCavendish Cancer Care (CCC) is a charitable organisation in Sheffield providing assessment, counselling and complementary therapies for people with cancer and their families. Motor Neurone Disease (MND), is characterised by...

A single centre audit into the outcome of transsphenoidal surgery in the treatment of acromegaly

A single centre audit into the outcome of transsphenoidal surgery in the treatment of acromegaly

An Audit to Investigate HIV Testing in the Department of Infectious Diseases and Tropical Medicine Royal Hallamshire Hospital, Sheffield: Category: Scientific free paper

An Audit to Investigate HIV Testing in the Department of Infectious Diseases and Tropical Medicine Royal Hallamshire Hospital, Sheffield: Category: Scientific free paper

A Retrospective Observational Study of Patient Cancellations on the Day of Surgery in the General Surgical Directorate

'On the day' cancellations carry significant consequences. This article reviews all cases that were cancelled on the day of surgery within the general surgical directorate of the Royal Hallamshire Hospital, Sheffield from 2005 - 2010. 978 cancellations were made on the day of surgery. Most significant reasons were due to patients' fitness (40%) and lack of theatre time (21%). The conclusion is drawn that 80% of cancellations are avoidable or potentially avoidable, and we suggest implementation of further strategies to reduce cancellations.

Value assignment of the WHO 6th International Standard for blood coagulation factor VIII and von Willebrand factor in plasma (07/316).

Value assignment of the WHO 6th International Standard for blood coagulation factor VIII and von Willebrand factor in plasma (07/316).

In vitro comparison of different mechanical prostheses suitable for replacement of the systemic atrioventricular valve in children

The aim of the present study was to compare the hydrodynamics of 4 different mechanical prostheses fitting the atrioventricular annulus in children. We tested different inverted aortic prostheses with a prosthesis-annulus relationship in the mitral chamber of the Sheffield pulse duplicator (Department of Medical Physics and Clinical Engineering, Royal Hallamshire Hospital, Sheffield, UK), analyzed by comparing the prosthetic housing diameter and the predicted annulus diameter based on body surface area (0.8 and 1 m(2) corresponding to an annulus diameter of 18.8-20.2 mm). The On-X 19 (On-X Life Technologies, Inc, Austin, Tex), SJM Regent 19 (St Jude Medical Inc, St Paul, Minn), Sorin Overline 18 (Sorin Biomedica, Saluggia, Italy), and Medtronic Advantage Supra 19 (Medtronic Inc, Minneapolis, Minn) valves with a housing diameter of 19 to 20 mm were hydrodynamically compared. The tests were carried out at increasing pulse rate of 72, 80, 100, and 120 beats/min for a stroke volume of 20 and 30 mL. Therefore, cardiac output ranged from 1.44 to 3.6 L/min. Regardless of the pulse rate and stroke volume, the Medtronic Advantage Supra valve showed the highest mean diastolic pressure difference at each cardiac output (P<.05). The mean gradients were significantly lower for the Sorin Overline valve regardless of the cardiac output, stroke volume, and pulse rate (P<.05). The effective orifice areas observed followed exactly the same behavior: the lowest for the Medtronic Advantage Supra valve and the highest for the Sorin Overline valve. The Sorin Overline valve showed the highest closure volumes (P<.05), and the On-X prosthesis showed the highest leakage volumes (P<.05). The Sorin Overline valve had the highest total regurgitant volume (P<.05), and the Medtronic Advantage Supra valve had the lowest total regurgitant volume (P<.05). The On-X valve showed the highest total energy loss regardless of the pulse rate at 20 mL of stroke volume, which was comparable to the SJM Regent and Sorin Overline valves at increased stroke volume. The Medtronic Advantage Supra valve showed the lowest total energy loss regardless of cardiac outputs (P<.05). This hydrodynamic evaluation model allowed us to compare the efficiency of currently available valve prostheses suitable for atrioventricular replacement in children. Among these prostheses, the Sorin Overline valve showed the best diastolic performance. On the other hand, for total energy loss, the Medtronic Advantage Supra valve demonstrated excellent performance.

Low free testosterone, erectile dysfunction and the rigidity of the erection in 1,706 men

To corroborate the association of low testosterone (LT), erectile dysfunction (ED) and age with the rigidity of erections. Methods Patient records of 1,706 men at the Porterbrook Clinic and the Royal Hallamshire Hospital with erectile dysfunction were analysed for correlation between LT levels and a rating of their erectile rigidity over three age groups: 18-49, 50-64 and 64+ years. The rigidity of erections was rated by the patients as ‘full’, ‘partial’ or ‘absent’ in a variety of situations. Free testosterone was low </8 nmol/L (LT), borderline 8.1-12 nmol/L (BT) and normal 12.1+ nmol/L (NT). Results

Psychogenic nonepileptic seizure manifestations reported by patients and witnesses

Psychogenic nonepileptic seizures (PNES) continue to represent a serious diagnostic challenge for neurologists. Video-electroencephalography (EEG) studies have provided detailed knowledge of the spectrum of visible PNES manifestations. However, little is known about how patients or seizure witnesses experience PNES, although many diagnoses in seizure clinics are made on the basis of self-reported information rather than video-EEG observations. This study describes the range of PNES manifestations as they are reported by patients or seizure witnesses. Three hundred eight candidates for this study were consecutively diagnosed with PNES on the basis of video-EEG recordings of habitual seizures involving impairment of consciousness without epileptic ictal EEG activity at the Royal Hallamshire Hospital in Sheffield and the National Hospital for Neurology in London, United Kingdom. One hundred patients responded to a postal questionnaire and participated in this study. Eighty-four of the questionnaires completed by patients were accompanied by questionnaires completed by seizure witness. The patient questionnaire contained 12 demographic and clinical questions and the 86-item Paroxysmal Event Profile (PEP), asking patients to rate statements about their attacks on a five-point Likert scale ("always,""frequently,""sometimes,""rarely,""never"). The Paroxysmal Event Observer (PEO) questionnaire uses 34-items with the same Likert scale. The PEP questionnaire includes inquiries about symptoms of panic or dissociation as well as symptoms previously found to distinguish between generalized tonic-clonic seizures and syncope or thought to differentiate between epilepsy and PNES. The item-by-item analysis revealed the inter- and intraindividual variability of PNES experiences. The majority of patients with PNES reported some phenomena, which have traditionally been attributed to epilepsy (such as seizures from sleep, experiencing a rising sensation in their body, postictal myalgia). Although most PNES were experienced as striking without warning and reported to cause loss or impairment of consciousness, most patients also reported seizure warnings in at least some of the seizures. Despite the clinical heterogeneity apparent from these findings, a correlation matrix showed that symptoms were not randomly distributed. Significant correlations were seen between duration of seizures and seizures from reported sleep (r = -0.28, p = 0.006), seizure-related motor activity and seizures from reported sleep (p = -0.48, p < 0.001), flashbacks and anxiety (p = 0.44, p < 0.001) or dissociation (p = 0.66, p < 0.001), and anxiety and dissociation (r = 0.53, p < 0.001). The comparison of similarly worded items on the PEP and PEO questionnaires showed that witnesses were more often aware of seizure triggers and a relationship between PNES and emotional stress than were patients (p = 0.001/p < 0.001). These findings based on the self-report of patients with well-characterized PNES and witnesses of their seizures demonstrate why it can be difficult to distinguish descriptions of PNES from those of epilepsy on the basis of factual items. The differences between patient and witness reports suggest that clinicians have to take note of the source of information they use in their diagnostic considerations. The intra- and interindividual variability of reported PNES manifestations demonstrates the clinical heterogeneity of PNES disorders. The positive correlation of symptoms of dissociation and anxiety in these patients may reflect psychopathologic differences between subgroups of PNES patients.

Female urology

Royal Hallamshire Hospital, Sheffield, Yorkshire, UK Correspondence to Professor Christopher Chapple, BSc, MD, FRCS (Urol), FEBU, Consultant Urological Surgeon, Room H26, H-Floor, Royal Hallamshire Hospital, Glossop Road, Sheffield, Yorkshire S10 2JF, UK Tel: +44 114 271 3048; e-mail: [email protected]

Assessment of antithrombin deficiency in the real world

International Journal of Laboratory HematologyVolume 33, Issue 6 p. 659-660 LETTER TO THE EDITOR Assessment of antithrombin deficiency in the real world P. C. Cooper, P. C. Cooper Department of Coagulation, Royal Hallamshire Hospital, Sheffield, UKSearch for more papers by this authorF. L. Coath, F. L. Coath Department of Cardiovascular Science, University of Sheffield, Sheffield, UKSearch for more papers by this authorM. Daly, M. Daly Department of Cardiovascular Science, University of Sheffield, Sheffield, UKSearch for more papers by this authorM. Makris, M. Makris Sheffield Haemophilia and Thrombosis Centre, Royal Hallamshire Hospital, Sheffield, UKE-mail: [email protected]Search for more papers by this author P. C. Cooper, P. C. Cooper Department of Coagulation, Royal Hallamshire Hospital, Sheffield, UKSearch for more papers by this authorF. L. Coath, F. L. Coath Department of Cardiovascular Science, University of Sheffield, Sheffield, UKSearch for more papers by this authorM. Daly, M. Daly Department of Cardiovascular Science, University of Sheffield, Sheffield, UKSearch for more papers by this authorM. Makris, M. Makris Sheffield Haemophilia and Thrombosis Centre, Royal Hallamshire Hospital, Sheffield, UKE-mail: [email protected]Search for more papers by this author First published: 16 June 2011 https://doi.org/10.1111/j.1751-553X.2011.01341.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. Volume33, Issue6December 2011Pages 659-660 RelatedInformation

Improving the interaction between the ophthalmology and histopathology departments

The purpose of this study was to improve communication between the ophthalmology and histopathology departments at Royal Hallamshire Hospital, Sheffield, by effectively changing the structure and completion of the histopathology request form through the process of a successful audit. This aimed to ensure that comprehensive information was made available to the histopathologist. An audit was performed by review of 710 histopathology request forms, completed by the ophthalmology department, over a 1-year period, between July 2005 and June 2006 inclusive. Results were used to re-model the ophthalmic histopathology request form. New forms were circulated and all forms completed over a 3-month period, between January 2008 and March 2008, were reviewed, thus closing the audit loop. On the basis of audit results of 710 histopathology request forms, a new histopathology request form was created, which was easier to complete. Review of the 224 new histopathology request forms showed improved percentages of completion of important sections of the form. Through the audit process we have created a new ophthalmic histopathology request form that is more user-friendly for the ophthalmologist and more consistently provides the necessary information for the ophthalmic histopathologist. This has improved efficiency and effectiveness of communication between the specialities, which should contribute to minimise the chances of medical error and improved turnaround times for the planning and delivery of patient care.

A novel method of draining a peritonsillar abscess

Clinical OtolaryngologyVolume 36, Issue 2 p. 189-190 CORRESPONDENCE: LETTERS A novel method of draining a peritonsillar abscess N. Sivaji, N. Sivaji Department of ENT, Head and Neck Surgery, Royal Hallamshire Hospital, Sheffield, UKSearch for more papers by this authorF.A. Arshad, F.A. Arshad Department of ENT, Head and Neck Surgery, Royal Hallamshire Hospital, Sheffield, UKSearch for more papers by this authorP.D. Karkos, P.D. Karkos Center for Voice and Swallowing, UC Davis, Sacramento, CA, USA. E-mail: [email protected]Search for more papers by this author N. Sivaji, N. Sivaji Department of ENT, Head and Neck Surgery, Royal Hallamshire Hospital, Sheffield, UKSearch for more papers by this authorF.A. Arshad, F.A. Arshad Department of ENT, Head and Neck Surgery, Royal Hallamshire Hospital, Sheffield, UKSearch for more papers by this authorP.D. Karkos, P.D. Karkos Center for Voice and Swallowing, UC Davis, Sacramento, CA, USA. E-mail: [email protected]Search for more papers by this author First published: 25 April 2011 https://doi.org/10.1111/j.1749-4486.2011.02293.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. Volume36, Issue2April 2011Pages 189-190 RelatedInformation

GAD antibody-associated neurological illness and its relationship to gluten sensitivity

The high prevalence of gluten sensitivity in patients with stiff-person syndrome (SPS) lead us to investigate the relationship between gluten sensitivity and GAD-antibody-associated diseases. We used ELISA assays for anti-GAD and for serological markers of gluten sensitivity. Patients were recruited from clinics based at the Royal Hallamshire hospital, Sheffield, UK. Patients with gluten sensitivity were followed up after the introduction of a gluten-free diet and serological testing was repeated. Six of seven (86%) patients with SPS were positive for anti-GAD, mean titre 109 U/ml; This compared with 9/90 (11%) patients with idiopathic sporadic ataxia, mean titre 32 U/ml, 16/40 (40%) patients with gluten ataxia, mean titre 25 U/ml, and 6/10 patients with type 1 diabetes only, mean titre 8 U/ml. None of 32 patients with celiac disease only, and of 40 patients with genetic ataxia were positive for anti-GAD. The titre of anti-GAD reduced following the introduction of a gluten-free diet in patients with SPS who had serological evidence of gluten sensitivity. The same was observed in patients with gluten ataxia and anti-GAD antibodies. This was also associated with clinical improvement. These findings suggest a link between gluten sensitivity and GAD antibody-associated diseases.

Ernest John Wallace Gumpert

John Gumpert (“Wally”) was a highly respected and much loved neurologist and neurophysiologist at the Royal Hallamshire Hospital until retirement in 1995. He was born in Sheffield into a medical...