St Thomas's Hospital Research Articles

Pretreatment of brain dead rabbits with pinacidil before prolonged cold-storage with an extracellular solution alters aortic endothelial function

Objective: Endothelial injury occurs during heart transplantation and contributes to the development of cardiac allograft vasculopathy. We have evaluated in a brain death model in the rabbit whether pre-treatment with the potassium channel opener (PCO) pinacidil before prolonged hypothermic storage with an extracellular solution would improve vascular endothelial recovery. Methods Rabbits were randomized into 4 experimental groups ( n = 8 per group). In the control group (CTRL), abdominal aortic rings were assessed immediately after 90 minutes of anesthesia. In the brain death group (BD), aortic rings were assessed immediately after 90 minutes of brain death. In the STH group, aortic rings taken from brain dead rabbits were stored for 24 hours at 4°C with the extracellular preservation solution of St. Thomas Hospital (STH) before assessment. In the STH + PCO group, the potassium channel opener pinacidil, 1 mg/kg, was administered intravenously to brain dead rabbits 10 minutes before explantation. Aortic rings were then stored for 24 hours at 4°C with the STH solution before evaluation. Brain death was induced by rapid inflation of a sub-durally placed balloon and validated by clinical and electroencephalographic data. Concentration-response curves to acetylcholine (ACH, 10 -9 to 10 -4 mol/liter) and nitroglycerin (NGL, 10 -9 to 10 -5 mol/liter) were constructed in phenylephrinepre-contracted rings. Results ACH evoked a similar concentration-dependent relaxation in the CTRL (E max: 95.8 ± 2.9%; EC 50: -6.86 ± 0.13 log M) and BD groups (E max: 90.8 ± 3.8%; EC 50: -6.75 ± 0.15 log M). The concentration-relaxation curve was shifted rightward in the STH group (E max: 76.7 ± 7.1%; EC 50: -6.75 ± 0.16 log M) in comparison with the CTRL and BD groups, but there were no significant differences in either E max or EC 50 values. After pinacidil pre-treatment, there was a further significant shift to the right of the concentration-relaxation curve to ACH (E max: 77.4 ± 5.0%; EC 50: -6.14 ± 0.19 log M, p < 0.05 vs CTRL, BD and STH). There were no significant differences between groups in the concentration-relaxation curves to NGL in endothelium-intact and endothelium-denuded vascular rings (either E max or EC 50). Conclusion Pre-treatment of brain dead rabbits with pinacidil before prolonged cold-storage with STH solution significantly impaired endothelium-dependent vasorelaxation in comparison to storage with STH solution. The role of PCO pre-treatment in the context of cardiac transplantation needs to be reconsidered.

The Effect of Captopril on Membrane Bound Enzymes in Ischemia—Reperfusion Injury

There is substantial evidence that Na+ K+/Mg2+ ATPase and Ca2+/Mg2+ ATPase enzymes would effect the membrane integrity. Forty guinea pig ( n = 10 in each group) hearts were studied in an isolated Krebs—Henseleit solution perfused Langendorff cardiac model. The first group was utilized as the control group. Group 2 hearts were arrested with captopril (200 μmol/l) added St Thomas Hospital Cardioplegic Solution (STHCS). Group 3 animals were pretreated with oral captopril (0.3 mg/kg/twice a day) for 10 days and then arrested with STHCS. Group 4 hearts were again pretreated with oral captopril (0.3 mg/kg/twice a day for 10 days) arrested with STHCS and reperfused with captopril added Krebs—Henseleit solution (200 μmoi/l). Hearts were subjected to normothermic global ischemia for 90 min and than were reperfused at 37°C. When the treated groups were compared with control, best results were achived by group 4. The Na+ K+ and Ca2+/Mg2+ ATPase levels increased from 466.38 ± 5.99 to 564.13 ± 7.77 and 884.69 ± 9.13 to 1254.29 ± 5.75 nmol Pi/mg/prot/h respectively ( P &lt; 0.05). These results suggest that captopril protects the membrane integrity and thus played a role at the recovery of depressed membrane bound Na+ K+ /Mg2+ ATPase and Ca2+/Mg2+ ATPase activity and also in ischemia—reperfusion injury.

The effect of captopril on membrane bound enzymes in ischemia–reperfusion injury

There is substantial evidence that Na +K +/Mg 2+ ATPase and Ca 2+/Mg 2+ ATPase enzymes would effect the membrane integrity. Forty guinea pig ( n=10 in each group) hearts were studied in an isolated Krebs–Henseleit solution perfused Langendorff cardiac model. The first group was utilized as the control group. Group 2 hearts were arrested with captopril (200 μmol/l) added St Thomas Hospital Cardioplegic Solution (STHCS). Group 3 animals were pretreated with oral captopril (0.3 mg/kg/twice a day) for 10 days and then arrested with STHCS. Group 4 hearts were again pretreated with oral captopril (0.3 mg/kg/twice a day for 10 days) arrested with STHCS and reperfused with captopril added Krebs–Henseleit solution (200 μmol/l). Hearts were subjected to normothermic global ischemia for 90 min and than were reperfused at 37°C. When the treated groups were compared with control, best results were achived by group 4. The Na +K + and Ca 2+/Mg 2+ ATPase levels increased from 466.38±5.99 to 564.13±7.77 and 884.69±9.13 to 1254.29±5.75 nmol Pi/mg/prot/h respectively ( P<0.05). These results suggest that captopril protects the membrane integrity and thus played a role at the recovery of depressed membrane bound Na +K +/Mg 2+ ATPase and Ca 2+/Mg 2+ ATPase activity and also in ischemia–reperfusion injury.

Margaret Joan Godley, frcog, dip ven

Maggie Godley died peacefully at home on 24 January 2000. She was found to have disseminated ovarian cancer in October 1997, and endured extensive surgery and chemotherapy with typical no-nonsense...

Roundtable discussion: Cephalosporins in the 1990s and beyond

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Occupational sensitization to p-phenylenediamine: a 17-year review.

Contact DermatitisVolume 41, Issue 6 p. 348-349 Occupational sensitization to p-phenylenediamine: a 17-year review D. K. B. Armstrong, D. K. B. Armstrong St John's Institute of Dermatology, St Thomas's Hospital, London SE1 7EH, UKSearch for more papers by this authorA. B. Jones, A. B. Jones St John's Institute of Dermatology, St Thomas's Hospital, London SE1 7EH, UKSearch for more papers by this authorH. R. Smith, H. R. Smith St John's Institute of Dermatology, St Thomas's Hospital, London SE1 7EH, UKSearch for more papers by this authorJ. S. Ross, J. S. Ross St John's Institute of Dermatology, St Thomas's Hospital, London SE1 7EH, UKSearch for more papers by this authorI. R. White, I. R. White St John's Institute of Dermatology, St Thomas's Hospital, London SE1 7EH, UKSearch for more papers by this authorR. J. G. Rycroft, R. J. G. Rycroft St John's Institute of Dermatology, St Thomas's Hospital, London SE1 7EH, UKSearch for more papers by this authorJ. P. McFadden, J. P. McFadden St John's Institute of Dermatology, St Thomas's Hospital, London SE1 7EH, UKSearch for more papers by this author D. K. B. Armstrong, D. K. B. Armstrong St John's Institute of Dermatology, St Thomas's Hospital, London SE1 7EH, UKSearch for more papers by this authorA. B. Jones, A. B. Jones St John's Institute of Dermatology, St Thomas's Hospital, London SE1 7EH, UKSearch for more papers by this authorH. R. Smith, H. R. Smith St John's Institute of Dermatology, St Thomas's Hospital, London SE1 7EH, UKSearch for more papers by this authorJ. S. Ross, J. S. Ross St John's Institute of Dermatology, St Thomas's Hospital, London SE1 7EH, UKSearch for more papers by this authorI. R. White, I. R. White St John's Institute of Dermatology, St Thomas's Hospital, London SE1 7EH, UKSearch for more papers by this authorR. J. G. Rycroft, R. J. G. Rycroft St John's Institute of Dermatology, St Thomas's Hospital, London SE1 7EH, UKSearch for more papers by this authorJ. P. McFadden, J. P. McFadden St John's Institute of Dermatology, St Thomas's Hospital, London SE1 7EH, UKSearch for more papers by this author First published: 14 February 2007 https://doi.org/10.1111/j.1600-0536.1999.tb06191.xCitations: 34AboutPDF 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 Volume41, Issue6December 1999Pages 348-349 RelatedInformation

Thomas Peel Dunhill: pioneer thyroid surgeon.

Thomas Peel Dunhill, a name by now almost completely forgotten in his native Australia, was born in 1876 near Kerang in the State of Victoria. Although he qualified as a pharmacist in 1898, Dunhill had already decided to study medicine and graduated in 1903 from the Clinical School of the Melbourne Hospital. He was regarded as an outstanding student. In 1905 Dunhill was invited to join the Senior Medical Staff at St Vincent's Hospital by Mother Berchmans Daly, the then Mother Rectress. In 1906 Dunhill was awarded the MD and in 1907 he performed his first thyroid lobectomy under local anaesthesia for toxic goitre. As early as 1908, Dunhill understood the essentials for successful surgery in thyrotoxicosis--enough thyroid had to be removed to cure the condition. To this end, he advocated a bilateral attack on the thyroid and advocated thyroidectomy in the thyrocardiac patient. He did this before Theodor Kocher, Charles Mayo, William Halsted or George Crile. In 1911 Dunhill visited the USA and England and communicated his results to the thyroid surgeons in both countries (230 cases of exophthalmic goitre operated on with four deaths). The English could not, or would not, believe his results as the mortality of surgery for exophthalmic goitre at St Thomas's Hospital, London in 1910 was 33%. Dunhill served with distinction in the Great War and his abilities favourably impressed George Gask, who was to become the Professor of Surgery at St Bartholomew's Hospital, London. Gask eventually invited Dunhill to join his Unit and Dunhill left St Vincent's Hospital in 1920. Between 1920 and Dunhill's retirement at the age of 60 in 1935, he became the outstanding general surgeon at St Bartholomew's Hospital. Dunhill and Cecil Joll, were regarded as the leading thyroid surgeons in the UK. Knighted in 1933, Dunhill was appointed surgeon to the Royal Household, serving four British monarchs. In addition to his brilliant surgical career, Dunhill maintained a love for the land. He was an expert fly fisherman. Dunhill retired from surgical practice in 1949 and died at the age of 80 in 1957 at his London home. Many eulogies were delivered, especially by Sir James Paterson Ross and Sir Geoffrey Keynes, his former pupils. Dunhill's exploits as a thyroid surgeon in the development of a safe and effective treatment for thyrotoxicosis and in operating on the thyrocardiac enables this modest, courteous and loyal Australian to be included with Theodor Kocher, Charles Mayo, William Halsted and George Crile in the pantheon of pioneer thyroid surgeons.

Relative importance of heritable characteristics and lifestyle in the development of maternal obesity.

STUDY OBJECTIVE: To assess the relative importance of heritable characteristics and lifestyle in the development of "maternal obesity" after pregnancy. SETTING: South east London, in the homes of mothers who...

Cardiovascular effects of dexmedotomidine for ITU sedation: UK results of a multi-centre study (St George's, University College, St Thomas's and Bristol Royal Infirmary Hospitals)

Cardiovascular effects of dexmedotomidine for ITU sedation: UK results of a multi-centre study (St George's, University College, St Thomas's and Bristol Royal Infirmary Hospitals)

The role of azathioprine in the management of retinal vasculitis.

Azathioprine is commonly used as a second-line immunosuppressive agent in the management of patients with retinal vasculitis. The aim of this study was to determine the efficacy of azathioprine by evaluating its effect on relapse rate, clinical outcome and maintenance steroid dose. A retrospective analysis was performed of 34 patients presenting over 15 years to the Medical Eye Unit at St Thomas Hospital. Relapse rate, steroid dosage, inflammatory score and visual acuity were assessed before and during treatment with azathioprine. Thirty-four patients (23 male) aged 17-70 years (median 41.4, median 38) were enrolled. Fifteen had idiopathic retinal vasculitis, 12 had Behçet's disease, 2 sarcoidosis, 2 sympathetic ophthalmia, 1 birdshot retinochoriodopathy, 1 Still's disease and 1 Harada's disease. The principal indications for azathioprine treatment were uncontrolled disease despite appropriate steroid therapy in 28 patients (82%) or to permit a decrease in steroid dosage in 6 patients (18%). Frequency of relapse was assessed in 10 patients whose pre-treatment and treatment periods with azathioprine were of 1 year or greater. All were found to have a decreased relapse rate. In 60%, reduction of steroid dosage was achieved. Ocular inflammatory score decreased in 56% of eyes and visual acuity was improved or maintained in 64%. In 8 patients treatment had to be stopped due to side effects. Within the limitations of a retrospective study, we found azathioprine when used in combination with systemic steroids to be most effective at reducing the relapse rate of retinal vasculitis, but only partially effective in allowing a reduction in steroid dosage.

Intracellular Volumes and Membrane Permeability in Rat Hearts During Prolonged Hypothermic Preservation with St Thomas and University of Wisconsin Solutions

The study aims to determine a possible relationship between intracellular water, energy metabolism, functional recovery and membrane permeability, during and after hypothermic cardiac preservation. Isolated rat hearts were stored for 12 h at 4°C with University of Wisconsin (UW), St Thomas Hospital (ST) and Krebs–Henseleit (KH) solutions, and were reperfused for 1 h. Cellular volumes were measured by1H NMR of water and59Co NMR of the extracellular marker cobalticyanide, and energetic profiles by31P NMR spectroscopy. Storage in ST solution reduced ischemic swelling from 2.50±0.06 to 2.73±0.09 (P<0.001v3.56±0.10 ml/g dry weight in KH), while UW solution caused cellular shrinkage to 2.12±0.08 ml/g dry weight. Intracellular ATP concentrations and pH values were higher in UW as compared to ST solution. At reperfusion, hearts stored in ST shrank while those stored in UW expanded, resulting in similar intracellular volumes. Storage with UW was superior to ST in post-ischemic function 65±5% (P<0.01v49±4% with ST) and in recovery of ATP 46±3% (P<0.001v25±4% with ST). Storage with both ST and UW solutions did not prevent interstitial edema. Sarcolemmal membrane integrity, as assessed by cellular swelling in response to a hypo-osmotic shock (210 mmol/l), was significantly improved by ST and UW solutions as compared to KH (P<0.05). Creatine kinase efflux was reduced by ST and UW as compared to KH (P<0.05), and by UW as compared to ST (P<0.05). Coronary flow was higher following storage with UW than ST solutions, 66±6 and 45±4%, respectively (P<0.01). According to these data, the beneficial effects of UW and ST solutions on hypothermic ischemic storage of rat hearts included prevention of cellular edema and preservation of sarcolemmal membrane integrity. It is concluded: (a) UW and ST solutions reduce ischemic and reperfusion cellular volumes; (b) both solutions, and UW in particular were efficient in preservation of membrane integrity; (c) prevention of cellular edema is not the single or main mechanism responsible for the improved preservation with UW and ST solutions.

Community medicine

I entered St Thomas's Hospital Medical School in 1947 and have had all my experiences, undergraduate and postgraduate, within the NHS. Most of my career has been in research, in epidemiology applied to clinical and public-health issues. Although I have been involved in service delivery and with many governmental and professional bodies that have shaped our public-health system, my contributions have been those of an academic, not of someone at risk of gaining or losing a job

CAGE

International Journal of Geriatric PsychiatryVolume 13, Issue 6 p. 422-422 Correspondence CAGE Alastair Macdonald, Alastair Macdonald UMDS, Guy's & St Thomas's Hospitals, Lewisham Hospital, LondonSearch for more papers by this author Alastair Macdonald, Alastair Macdonald UMDS, Guy's & St Thomas's Hospitals, Lewisham Hospital, LondonSearch for more papers by this author First published: 04 December 1998 https://doi.org/10.1002/(SICI)1099-1166(199806)13:6<422::AID-GPS786>3.0.CO;2-OAboutPDF 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. Volume13, Issue6June 1998Pages 422-422 RelatedInformation

Feasibility of named antenatal HIV screening in an inner city population

The object of this study was to assess the resource use, feasibility, uptake and consumers' perspective of introducing routine named human immunodeficiency virus (HIV) testing into an inner city hospital antenatal clinic (St Thomas Hospital, part of Guy's and St Thomas Hospital Trust). Following the introduction of a new service offering routine named HIV testing at booking appointments, the length of the appointments were recorded over a three-month period and compared with appointment lengths in the previously existing service. Women being offered routine named HIV testing were asked to complete a questionnaire before and after their appointment to assess knowledge, attitudes and acceptability of HIV testing. Subjects were three-hundred-and-eighty-one pregnant women attending the antenatal clinic for their booking appointment. There was no significant difference in the length of the booking appointments following the introduction of offering routine named HIV testing. One-hundred-and-fifty-eight women (42%) consented to testing with no positive results detected. There was a significant rise in the uptake of the test over the three-month period. No other variables (demographics, perceived risk, having read the leaflet) were predictive of uptake. Anxiety scores were significantly less after the booking appointment. Routine named HIV testing was feasibly introduced into a hospital antenatal clinic with minimum resource implications. Further study is needed to monitor the ongoing uptake rate and identification of HIV-positive women before a decision can be made as to the long-term benefit of this new service. Women considered it acceptable to be offered the HIV test and were less anxious after their appointments.

Antenatal HIV testing: current problems, future solutions. survey of uptake in one London hospital

Pregnant women attending Guy's and St Thomas's Hospitals Trust have one of the highest prevalence rates for HIV-1 in inner London (0.53% in 1996).1 In 1992 we showed that this...

Leprosy in Pakistan: LEPRA elective study.

As part of the curriculum, medical students at the United Medical and Dental Schools of Guy's and St Thomas's Hospitals (UMDS), London, are encouraged to spend an elective period of 8 weeks in their final year anywhere in the world, studying any field of medicine they are interested in. Having lived in Tanzania for 10 years, I have had contact with people suffering from leprosy and my interest in leprosy continued after I moved to Europe to continue my education. I therefore decided to use my elective to gain hands-on experience with the disease so that I could understand and appreciate the impact of leprosy in developing countries such as Pakistan.

Development and evaluation of evidence based risk assessment tool (STRATIFY) to predict which elderly inpatients will fall: case-control and cohort studies

Objectives: To identify clinical characteristics of elderly inpatients that predict their chance of falling (phase 1) and to use these characteristics to derive a risk assessment tool and to evaluate...

1.P.96 Plasma lipids and atherosclerosis in froxfield mixed hyperlipidaemic (previously St Thomas Hospital) rabbits

1.P.96 Plasma lipids and atherosclerosis in froxfield mixed hyperlipidaemic (previously St Thomas Hospital) rabbits

Membrane fatty acids in patients with sickle cell disease: Implications for membrane fluidity, cell adhesion and painful crises: ∗Ghebremeskel K, ∗Thomas B, +Fadlon EJ, +Harbige LS, ∗Crawford MA and +Pearson T. ∗Institute of Brain Chemistry and Human Nutrition, University of North London. +St Thomas Hospital, United Medical and Dental Schools, University of London

Membrane fatty acids in patients with sickle cell disease: Implications for membrane fluidity, cell adhesion and painful crises: ∗Ghebremeskel K, ∗Thomas B, +Fadlon EJ, +Harbige LS, ∗Crawford MA and +Pearson T. ∗Institute of Brain Chemistry and Human Nutrition, University of North London. +St Thomas Hospital, United Medical and Dental Schools, University of London

Haemodynamic and Metabolic Effects of Gallopamil as Additive to Calcium-containing and Calcium-free Cardioplegic Solutions in Mature Pig Hearts

Myocardial haemodynamic and metabolic effects of the calcium-channel blocker gallopamil as additive to calcium-containing (St Thomas Hospital, STH) and calcium-free (Bretschneider procaine-containing, BRT) crystalloid cardioplegic solutions were evaluated. Adult pig hearts (weight 0.330 ± 0.033 kg) were randomized to four groups and perfused with 1 litre of cold (4°C) cardioplegic solution; group A: BRT without gallopamil, n = 9, group B: BRT with gallopamil (0.4 μM), n = 8, group C: gallopamil-free STH, n = 8, and group D: STH with gallopamil (0.4 μM), n = 8. After storage at 4°C for 6 hours the hearts were reperfused with blood/Ringer solution in a modified Langendorff model for 60 min. Developed left ventricular pressure, rate-pressure product and +dP/dt were lower in gallopamil-treated hearts during reperfusion (p < 0.05), as were oxygen extraction and oxygen uptake (p < 0.05) and lactate release (p < 0.05). Myocardial blood flow was greater in gallopamil-treated hearts (p < 0.05). In hearts comparable in size and anatomy to the human heart, gallopamil added to both cardioplegic solutions reduced cardiac function and oxygen uptake despite increased myocardial blood flow. The findings suggest reduced myocardial protection after addition of gallopamil to cardioplegic solutions.