Edgware Community Hospital

Attention-deficit/hyperactivity disorder (ADHD) is highly heritable and the most common neurodevelopmental disorder in childhood. In recent decades, it has been appreciated that in a substantial number of cases the disorder does not remit in puberty, but persists into adulthood. Both in childhood and adulthood, ADHD is characterised by substantial comorbidity including substance use, depression, anxiety, and accidents. However, course and symptoms of the disorder and the comorbidities may fluctuate and change over time, and even age of onset in childhood has recently been questioned. Available evidence to date is poor and largely inconsistent with regard to the predictors of persistence versus remittance. Likewise, the development of comorbid disorders cannot be foreseen early on, hampering preventive measures. These facts call for a lifespan perspective on ADHD from childhood to old age. In this selective review, we summarise current knowledge of the long-term course of ADHD, with an emphasis on clinical symptom and cognitive trajectories, treatment effects over the lifespan, and the development of comorbidities. Also, we summarise current knowledge and important unresolved issues on biological factors underlying different ADHD trajectories. We conclude that a severe lack of knowledge on lifespan aspects in ADHD still exists for nearly every aspect reviewed. We encourage large-scale research efforts to overcome those knowledge gaps through appropriately granular longitudinal studies.

OBJECTIVES: To identify the source of an international outbreak of food poisoning due to Salmonella agona phage type 15 and to measure how long the underlying cause persisted. DESIGN: Case-control study of 16 primary household cases and 32 controls of similar age and dietary habit. Packets of the implicated foodstuff manufactured on a range of days were examined for salmonella. All isolates of the epidemic phage type were further characterised by pulsed field gel electrophoresis. RESULTS: 27 cases were identified, of which 26 were in children. The case-control study showed a strong association between infection with S agona phage type 15 and consumption of a peanut flavoured ready to eat kosher savoury snack imported from Israel. S agona phage type 15 was isolated from samples of this snack. The combined food sampling results from the United Kingdom, Canada, the United States, and Israel showed that contaminated snacks were manufactured on at least seven separate dates during a four month period between October 1994 and February 1995. Voluntary recalls of the product successfully interrupted transmission. CONCLUSIONS: Rapid international exchanges of information led to the identification of the source of a major outbreak of S agona in Israel and of associated cases in North America. The outbreak showed the value of the Salm-Net surveillance system and its links outside Europe, both for increasing case ascertainment and for improving the information on the duration of the fault at the manufacturing plant.

In order to test their value in urinary infection a double-blind trial was carried out using ampicillin, cephalexin, trimethoprim-sulphamethoxazole (co-trimoxazole), and trimethoprim. Eighty-three courses of treatment were given to hospital patients, 149 to pregnant women, and 107 to patients with dysuria and frequency seen in domiciliary practice. Thus infections of varying severity in defined groups of patients caused by organisms with different antibiotic sensitivities were treated.Analysis of the overall results (339 courses) was compared with those from the individual groups and considerable variation in response was found. In domiciliary infections and bacteriuria in pregnancy trimethoprim alone proved to be at least as effective as the other three compounds and caused fewer than half the number of side effects. In the hospital patients co-trimoxazole was superior to trimethoprim.The overall results for ampicillin and cephalexin were similar although cephalexin proved to be inferior in treating symptomatic domiciliary infections.

A measured area of blotting paper was used as a vehicle for transferring a constant aliquot of urine on to the surface of a culture medium. The number of bacterial colonies growing in the inoculum area of the medium corresponded to the number of organisms in the urine. One thousand, two hundred and seventy-five urines from women attending an ante-natal clinic were tested by this method, and the results compared with the results of quantitative bacterial counting and of triphenyl tetrazolium chloride (T.T.C.) tests. The method was found to be a simple, cheap, and reliable way of screening urine specimens for significant bacteriuria.

Eighty-eight cases of abdominal wall defect with and without other lesions were ascertained by reviewing all labour room records in the West of Scotland, all surgical admissions to the Royal Hospital for Sick Children, Yorkhill, and all post mortems at Royal Hospital for Sick Children between 1978 and 1981. The affected cases comprised 39 terminations of pregnancy (17 of anterior abdominal wall defect without neural tube defect), 20 spontaneous stillbirths and 29 livebirths. All 10 cases of body stalk anomaly, 37.5 per cent of 16 gastroschisis cases and 53 per cent of 62 exomphalos cases had additional severe abnormalities. Abnormal karyotypes were present in seven out of 19 exomphalos cases but all karyotypes from 10 gastroschisis and 6 body stalk anomaly cases were normal. No correlation was found between the maternal serum AFP levels, the amniotic AFP levels and acetylcholinesterase results and the size of the lesion. It is proposed that anterior abdominal wall defects detected prenatally should have chromosome analysis and careful ultrasound to exclude associated severe anomalies before coming to a decision about termination. This policy was implemented in six pregnancies complicated by fetal gastroschisis without severe associated anomalies which were identified in the second trimester and continued to term. Immediate surgical repair was achieved in each case, although two of the infants succumbed from later complications of gastroschisis closure and one from respiratory distress syndrome. The remaining three infants made a satisfactory recovery.

1. A scheme was started in 1960 with the object of ensuring that the hips of all babies born in the North-Eastern Region of Scotland were examined shortly after birth. 2. 1,671 children with suspected abnormalities have been seen during the ensuing ten years, and the findings are discussed. 3. Clinical examination is essential. Radiographic examination of the newborn is not necessary and may be misleading, but it does prove that some hips with limited abduction but no instability are in fact dislocated. 4. Treatment is not started when the diagnosis is made shortly after birth. The children are re-examined at three weeks, when spontaneous recovery has occurred in about half. The others, whether they show instability or only limitation of abduction of the hips, are treated in a simple splint until they are three months old. Any residual stiffness is an indication for further splintage. 5. The first radiographs are taken when the children are three months old, and no child is discharged until the radiographs show that the upper femoral epiphyses have appeared and are in normal position. 6. We appreciate that we are treating some children who would have recovered spontaneously, but we do not know how to distinguish them. There is no evidence that splintage harms a hip. 7. Eighty-six children (5 per cent of the total) needed operation usually because the diagnosis was missed at birth. 8. Children with familial joint laxity or genu recurvatum should be examined especially carefully for associated hip abnormality. 9. The incidence of abnormality of the hips at birth is about one in fifty live births.

We describe four patients with mixed lympho- and myeloproliferative disorders. One patient had hairy cell leukaemia and acute myelomonocytic leukaemia, another lymphocytic lymphoma in leukaemic phase and chronic myelomonocytic leukaemia and the third patient had chronic lymphocytic leukaemia and polycythaemia rubra vera; none of these patients had received any prior therapy, and in two the diagnosis of the two malignancies was simultaneous. The fourth patient developed acute monocytic leukaemia 4 years after the diagnosis of chronic lymphocytic leukaemia after only 2 weeks of therapy with chlorambucil. The nuber of cases with concurrent or sequential but spontaneous occurrence of lympho- and myeloproliferative disorders reported so far is now 38. The questions relating to the pathogenesis of the two malignancies are discussed.

A prospective questionnaire study with a 6-month follow-up was carried out to determine the incidence of post-prostatectomy impotence. 57% of patients were potent at the time of operation. A man with full potency had a 4% chance of becoming totally impotent and a 3% chance of becoming partially impotent. A man with failing preoperative potency had a 10% chance of becoming totally impotent and a 22% chance of becoming worse. No particular method of operation was at fault. One-third of potent men claimed to have some postoperative ejaculation.

We have studied 73 adults with acute diarrhoea and identified a micro-organism or toxin likely to be the cause in 58%. In addition to routinely cultured bacteria, Campylobacter coli/jejuni and Clostridium difficile were important pathogens in the community. Patients who developed diarrhoea after antibiotic use had a distinctive clinical syndrome and comprised the third largest group of cases. Clinical, epidemiological, and histological features in an additional group with negative cultures and no antibiotic history suggest that an additional bacterial pathogen remains to be identified as a cause of acute diarrhoea in adults.

PRIMARY OBJECTIVE: This paper reviewed the available evidence that patient characteristics may determine the type of intervention that works best in brain injury rehabilitation. REASONING BEHIND LITERATURE SELECTION: A broad search strategy was used to identify papers which enabled conclusions to be drawn about patient characteristics which determined rehabilitation effectiveness. Six main areas were considered: severity of the brain injury, presenting problem, complicating factors, rehabilitation readiness, demographic, and socio-geographic variables. CRITICAL ANALYSIS OF LITERATURE: A levels of evidence analysis was used to evaluate the studies. MAIN OUTCOMES AND RESULTS: Very few studies on rehabilitation effectiveness were found which attempted to define the patient characteristics which predict a good response to rehabilitation. The best evidence relates to injury severity; more intense programmes may be unnecessary for those with less severe injuries. There is some evidence that dysexecutive problems, i.e. difficulties with organization and control of behaviour and emotion, interfere with rehabilitation. CONCLUSIONS: Patient characteristics may well determine individual benefits from particular rehabilitation programmes. However, few studies have attempted to provide evidence about this. As health provision focuses on needs-led services, it becomes paramount to investigate effectiveness from the client's perspective.

The excretion of abnormal quantities of amino-acids in the urine is known to occur in liver disease when the cells of this organ are unable to metabolize normally, and in certain clinical syndromes in which there is a high renal clearance of amino-acids, but it is only recently that definite patterns of amino-acid excretion have become recognized (Dent, 1952-53). Fanconi (1936) first drew attention to the presence of amino-aciduria in a syndrome occurring in children, previously described by several authors including himself, and characterized by dwarfism, vitamin D-resistant rickets, glycosuria of the renal type and excessive excretion of water and phosphate. The amino-acid pattern of the urine in this syndrome has now been shown to be constant

Objective: Psychoeducation forms part of the current practice for ADHD; however, its efficacy is yet to be established. Method: Sixty-nine children/adolescents with ADHD were randomly assigned for their families to receive either a well-structured psychoeducation program ( n = 35), or belong to a control group (treatment-as-usual, n = 34). Results: One-way analyses of variance showed a statistically significant Treatment × Time interaction, for ADHD total symptoms, inattention/cognition, and hyperactivity/impulsivity subdomains according to the parents, the first two with medium-large effect sizes. The effects of the intervention on the ADHD total and the inattention/cognition domain persisted after 6 months follow-up. No significant differences in teacher ratings were found; however, an improvement in clinical functioning as measured by clinicians was observed. Conclusion: This psychoeducation program has shown effectiveness in reducing ADHD symptoms when compared with treatment as usual. Psychoeducation needs to be considered as a valid and additional approach in ADHD.

The aim of the study was to investigate the relationship between myocardial collagen and regional echo amplitude in humans with non-fibrotic myocardium. The ratio of myocardial collagen to total myocardial protein was determined as the hydroxyproline/leucine ratio in endoniyocardial biopsies obtained from the right ventricular side of the interventricular septum in orthotopically transplanted hearts. Regional echo amplitude was measured in the interventricular septum. Patients were studied prospectively. Twenty-five patients (five female, 20 male) who had undergone orthotopic cardiac transplantation were studied 355 to 2939 days (1009±718, mean±SD) post-transplantation at the time of annual cardiac catheterization and endomyocardial biopsy. Patient ages varied from 22 to 62 years (46±11). Donor ages were 14 to 47 years (25±8) and the ischaemic time, 90 to 245 min (151±42). Cardiac transplantation was performed for end-stage cardiac failure in all patients. The aetiology of cardiac failure was valvular heart disease in three, dilated cardiomyopathy in eight and ischaemic heart disease in the remainder. Echo amplitude studies were performed within 24 h of endomyocardial biopsy. All but one patient were on an immunosuppressive regime consisting of cyclosporine A and azathioprine with additional steroids in three. The remaining patient, who was the longest surviving patient in the study group, had never been treated with cyclosporine. This patient was maintained on steroids and azathioprine alone. No patient had clinical or histological evidence for acute cardiac rejection and all were clinically well. Five patients had angiographic evidence of coronary artery disease. All subject studies were performed at Harefield Hospital. Echo amplitude analysis was performed at the Royal Brompton Hospital. Myocardial collagen analysis was performed in the Biochemistry Unit at the National Heart and Lung Institute. End-diastolic echo amplitude was measured in the interventricular septum. A micro-analytical technique was used to measure the myocardial hydroxyproline/leucine ratio. There was a weak but significant correlation between the estimate of myocardial collagen measured by the hydroxyproline/leucmne ratio and end-diastolic echo amplitude (r = 0.41, P = 0.04, y = 3.66x + 4.24). If the five patients with angiographically documented coronary artery disease were excluded from analysis the correlation was substantially improved (r = 0.51, P = 0.02, y=4.19x+3.89). These findings suggest that the variation in collagen in the myocardium is responsible for approximately 20% of the observed variation in myocardial backscatter signal in non-fibrotic hearts. This supports clinical studies which have shown increases in myocardial ultrasonic backscatter in conditions where myocardial fibrosis occurs and also indicates the importance of myocardial collagen in determining the ultrasonic backscatter signal in normal hearts.

To assess the initial phase of a telecardiology diagnostic service for general practitioners (GPs), we provided 93 GPs in 26 health centres with direct telephone access to a cardiologist, and equipped them with hand-held, automatic standard 12-lead electrocardiogram (ECG) transmitters for on-line cardiac consultations and ECG interpretation in their daily practice. Clinical details, reason for consultation and the ECG signal were transmitted from the GPs' practices or the patients' homes. A consultation followed and a full report, including ECG print-out, was then sent to the GP. During an 18-month study period, 2563 consultations were carried out. The system allowed the identification of 479 patients (19%) with urgent cardiac problems and the remaining 2084 (81%) in whom admission or outpatient investigation was unnecessary. Following the study, we distributed a questionnaire asking the GPs to rate the quality, define the use and consider the benefit of the service to their daily practice. We conclude that a telecardiology diagnosis and ECG interpretation service is simple, reliable and efficacious in routine primary care. It offers instant access to cardiac assessment and supports the decision-making process of GPs. A preliminary cost comparison with a conventional referral indicated that a teleconsultation was substantially cheaper. We expect that the future incorporation of teleechocardiography would expand the scope of telecardiology even further and allow comprehensive cardiology consultations.

Summary There has been renewed interest in the concept and diagnosis of bipolar affective disorder in recent years. Previous epidemiological studies have reported the prevalence of the disorder in the USA at 1–2% but further studies have shown that the disorder is underdiagnosed and the true prevalence may be as high as 11%. Despite the stigma attached to mental illness, we have noticed in our clinical practice a new and unusual phenomenon, where patients present to psychiatrists with self-diagnosed bipolar disorder. Here, we explore the background to this phenomenon, the diagnostic challenges and the implications for our patients and practice.

Anaesthetic gases escape into the ambient air mainly from the anaesthetic breathing system but there are many other important sources of anaesthetic pollution. These include the filling of vaporisers, inhalational induction techniques, leaks around the patient's face mask, leaks from monitoring equipment and loose-fitting or perishing equipment. The control of substances hazardous to health (COSHH) regulations together with the recent implementation of the occupational exposure standards (OES) for anaesthetic gases require that any risk to health workers from anaesthetic exposure be assessed, control measures implemented, the environment monitored and OES not exceeded. The installation of costly scavenging equipment is believed to have reduced the levels of pollution in operating theatres, but several independent reports suggest that their use has not been wholly effective. Many sources of pollution remote from scavenging equipment may be responsible for the ineffective control of anaesthetic pollution. During an initial COSHH assessment in our hospital, using an infra-red analyser specifically designed for leak testing and background monitoring, we have identified several controllable sources of pollution. These included leaks from an ill-fitting face mask, loose connections in the anaesthetic breathing system, leaks from the laryngeal mask at the end of the operation and a leak of more than 5400 ppm N2O was found near the unscavenged gas outlet at the back of the multigas monitor. Leak testing, using infra-red analysers with their rapid response, has been recommended as an important aid in the identification of hidden sources of pollution, most of which we believe are amenable to control and remedy.

spring meeting at Bristol on 10 April 1964.

Journal Article Peptic ulceration of the third part of the duodenum associated with islet-cell tumours of the pancreas Get access Frank Forty, Frank Forty Surgeon Edgware General Hospital Search for other works by this author on: Oxford Academic Google Scholar Geoffrey M Barrett Geoffrey M Barrett Physician Lancaster Royal Infirmary Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 40, Issue 159, July 1952, Pages 60–63, https://doi.org/10.1002/bjs.18004015912 Published: 05 December 2005

This paper presents an agent-based software environment for testing Web-based applications. The infrastructure of the system consists of a light weight agent platform that supports agent communication, an ontology of software testing that enables flexible integration of multiple agents, and a formalism using XML to represent both the basic and compound concepts of the ontology. Relations between testing concepts are defined and their properties are analysed. A number of agents are implemented to perform various tasks in testing Web-based applications. Broker agents use the ontology as a means of inferences to manage the knowledge about agents and assign each task to the most appropriate agent.

For 18 years (1969-1986) a casualty station has been operating during all Saturday interschool Rugby matches at a private school. Since its inception, both the diagnosis and the early management have been documented for every injury that presented to this station. Over this period, 1444 boys have been seen, of whom 116 sustained injuries that were classified as being severe; of these, only two injuries--a skull fracture and a fracture--dislocation of the cervical spine--were regarded as clinically serious. Over all, the injury rate was 176/10 000 player-hours, or 1.56/100 player-games; the rate of severe injury was 14/10 000 player-hours, or 0.12/100 player-games. Injury rates were highest in older boys and in those who were in the most advanced grades of play. Fullbacks experienced the most injuries; otherwise, little variation occurred in injury rates by player position. No consistent trend in injury rates was observed over the period of the study.