Willesden Community Rehabilitation Hospital

Inhibition of buffy layer peripheral leucocyte migration by tuberculin purified protein derivative (PPD) from micro-capillaries mounted in small tissue culture chambers correlates in all cases with a positive Mantoux test. This quick and reproducible test of cellular hypersensitivity in man requires only 5-15 ml of blood and is applicable for study in children and in clinical situations where repeated monitoring of cellular immunity may be required.

Sickel cell disease is common in urban areas of Britain and it is estimated that in London alone there are nearly 2000 patients. One hundred and eighty four patients with sickle cell disease are known to the Central Middlesex Hospital, and 155 of those attend the sickle cell clinic regularly. The commonest cause for admission to hospital is acute painful or vaso-occlusive crisis, which accounts for 80% of all acute admissions; 12% of admissions are for acute chest syndrome. Comparison of clinical features in Brent and in Jamaica shows that the Brent patients with homozygous sickle cell anaemia are admitted with painful crises more frequently than Jamaican patients. However, the frequency of admissions for chest syndrome and priapism, and the incidence of splenomegaly are similar. Leg ulcers are uncommon in Brent. Patients with sickle cell haemoglobin C disease appeared more severely affected in Jamaica than in Brent. During the past two years 3165 newborn babies have been screened for sickle cell disease at the Central Middlesex Hospital: five babies with homozygous sickle cell anaemia and three babies with sickle cell haemoglobin C disease were detected. The overall incidence of sickle cell trait was 3.2% and of haemoglobin C trait 0.8%. A significant number of babies with sickle cell disease are born in London every year. It is essential that such babies are detected at birth and offered prophylaxis against pneumococcal infection, which is one of the major causes of infant mortality. Sickle cell disease is becoming an important blood disease in Britain and firm guidelines for the management of acute and chronic complications are required.

This paper examines some of the difficulties of exporting the Western concept of Post Traumatic Stress Disorder (PTSD) to non-Western cultures. Using data drawn from Guatemala where I lived and worked among Quiché Mayan war widows, illustrates how culturally-specific understandings of events and reactions to them affect the well-being (or otherwise) of people exposed to extreme adverse events. The paper turns to the voices of the widows, who experienced and survived intense political conflict, explaining their experiences of violence within their particular context.

Patients attending five Health Centres in areas of NW London with a high Asian population were asked to complete a questionnaire screening for non-psychotic psychiatric illness and to state why they had come to see their doctor. The GPs were also asked to rate the purpose of the consultation for those patients who scored above the cut-off point on the questionnaire. The screening questionnaire revealed equivalent rates of non-psychotic psychiatric morbidity in the White and Asian samples and no differences in the way their symptoms were presented. The differences that did emerge showed that Asian patients scoring above the cut-off for psychiatric caseness were more likely to state that they were consulting their GP about a physical problem and GPs were more likely to identify psychiatric morbidity in White than Asian patients who exceeded the cut-off threshold. The results suggest the possibility of an interaction between the ways in which patients experience and communicate psychological distress, their ethnic origin, and their GP's mode of responding.

SUMMARY This paper will consider the identity of an inner voice that is experienced by everyone, but in very different ways. However, when working in the transference with psychotic patients the boundaries of personal identity and the question of choice and volition are so compromised by the illness that the phenomena are so to speak 'writ large'. This allows the issues to be brought out with great vividness and intensity and it is the struggle with this that has led me to reconsider the identity of the inner voice in a way which I have found useful for the rest of my clinical work. Prior to 1985, my clinical work with patients with psychotic illnesses was undertaken in the in-patient psychotherapy ward at Shenley Hospital that I was responsible for. With the movement of psychotherapy resources out of Shenley to set up the Willesden Centre, our ability to continue with this work was very compromised because the Centre is entirely an out-patient resource. However, a number of us persevered and gradually worked out ways to be able to continue to offer treatment to patients who had psychotic illnesses. This involved the establishment of a case-manager system to enable the therapist to work in the transference. This evolution has occurred in a specialist workshop that I have been running at the Willesden Centre since 1986.

A non-directive programme of prenatal counselling was used during a four year period. Forty-three couples at risk for having a baby with a haemoglobinopathy were identified. Prenatal diagnosis was offered in 19 pregnancies to 14 couples at risk of having a baby with sickle cell anaemia and in two pregnancies in two couples at risk of a baby with beta thalassaemia major, who presented before the 18th week of pregnancy. Six couples at risk for sickle cell anaemia accepted prenatal diagnosis in 10 pregnancies, as did both couples at risk for thalassaemia. Couples who were eligible for prenatal diagnosis but refused it tended not to have been informed about sickle cell disease before counselling, one partner was more frequently absent at the time of the initial counselling session, or they either had no children with sickle cell disease or the children were not severely affected. Other factors influencing their decision included a poor obstetric history and rejection of abortion, mainly on moral grounds. The approximately 50% uptake of prenatal diagnosis in this initial study highlights the complex issues involved. Our experience indicates that with systematic screening and counselling in the antenatal clinic, and with increased awareness of the haemoglobinopathies, couples at risk will be in a better position to make informed decisions.

pressing need for culturally acceptable educational aids that recognise the regional differences between Asian communities.Such aids'shouldencourage a reduced consumption of refined carbohydrates and saturated fats and an increased consumption of unrefined carbohydrates rich in fibre.We gratefully acknowledge research grants from the North

IN 1932 (1) the writer described a case of diabetes mellitus developing in a lad of 16 years of age with pre-existing Addison's disease. Autopsy revealed atrophy of the cortex of both adrenal glands and of the islets of Langerhans. In the present paper 2 further cases of the coexistence of Addison's disease and diabetes mellitus are recorded, one coming to autopsy; and a résumé is given of 15 other cases recorded in the literature, in which autopsies were recorded, and 6 additional cases without autopsies. Adrenalectomy results in lowering of blood sugar, particularly after starvation, and in the terminal phase death from hypoglycemia. In some species, e.g. marmots, other effects on carbohydrate metabolism are depletion of liver glycogen and to a lesser extent of muscle glycogen, increase of blood lactates and increase in the rate of metabolism of glucose (2, 3, 4). These effects are reversed or prevented by the administration of an adrenalin- free extract of the adrenal cortex, or by any of the 11-oxysteroids that have been isolated from the adrenal cortex, e.g. corticosterone, 11-dehydrocorticosterone, and 11-dehydro 17-hydroxycorticosterone (Kendall's compound E). This group of 11-oxysteroids also has a diabetogenic action as has been demonstrated in the partially depancreatized or phloridzinized rat; and the glucose-nitrogen ratio of 3.6 to 1.0 indicates that the source of the extra glucose is protein. There is also a deposition of hepatic glycogen and a depression of glucose oxidation, as shown by lowering of the respiratory quotient. The 11-oxysteroids also counteract the hypoglycemic action of insulin (4, 5, 6, 7).

The studies described here set out to discover what student and qualified nurses understand to be the important attributes of a nurse. The first study was exploratory and used a repertory grid technique to ask 72 students, qualified nurses and nurse lecturers to compare themselves (as a nurse) with a number of other nurses and carers of their own choosing. The constructs that the participants used to make these comparisons were then categorized into attributes. Those attributes that had been used by more than 10% of any of the subgroups were used in the second study as the basis of a questionnaire in which nurses were asked to put these categories in order of importance. The questionnaire was completed by 565 qualified and student nurses. The responses showed a remarkable level of agreement between nurses, irrespective of rank or student status. The only attribute over which there were large differences was intelligence. The study provides strong evidence that the view of the important attributes of a nurse remain unchanged right across the nursing profession, and the discovery of these attributes has important implications for nurse selection and training.

SUMMARY SUMMARY Borderline and psychotic patients especially, but not exclusively, show genuine motivation towards achieving insight and change and then suddenly behave as if these have never been desired. When this shift occurs after a helpful interpretation it can be thought of as a negative therapeutic reaction. Patients can feel taken over by perceptions which drive them to think and behave in ways they later disagree with. These observations have led the author, along with colleagues at the Willesden Centre for Psychological Treatment, to recognise a situation of internal cohabitation of two autonomous minds in the one body which is a development of but not identical to Bion's concepts of psychotic and non-psychotic personalities. Some of the psychoanalytic literature on the different modes of mental functioning are reviewed and problems of appropriate conceptualisations are discussed. Clinical examples are presented to illustrate that differentiating the genuine negative therapeutic reaction from reactions to poor interpretations is facilitated and leads to further understanding of the patient's psychotic personality if the psychotherapist can hold in mind both the patient's and the therapist's psychotic and non-psychotic personalities. Additional informationNotes on contributorsJoscelyn M. RichardsEarlier versions of this paper have been presented at one of the monthly Open Lectures at the Willesden Centre for Psychological Treatment in 1989 and at the Freud Forum of the British Association of Psychotherapists in 1990.

Journal Article Gastroduodenoscopy using an irrigating cystoscope Get access R M Kirk R M Kirk Hampstead General Hospital and Willesden General Hospital, London Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 60, Issue 4, April 1973, Page 292, https://doi.org/10.1002/bjs.1800600411 Published: 07 December 2005

Abstract In this paper, the author presents an account of her work in an NHS Rehabilitation Service. This is followed by a case study of psychotherapeutic work, over a period of 18 months, with a man in recovery from a head injury. She makes the point that the internal response to neurological and physical injuries, in some patients, can produce narcissistic as well as cognitive injuries. All of these factors, together with the patient's internal response to the traumatic event, need to be addressed. The theoretical and clinical approach taken is one of a psychoanalytically informed understanding of the traumatic event. In the course of working with the patient, Mr A, he uncovers links to a previous trauma in his life which he had not been able to come to terms with, and which the author suggests was reactivated by, the more recent trauma of the head injury.

abstract SIR - Squire (1973) described and figured fossil burrows, ascribed to Sabellarites , from the Upper Proterozoic Brioverian Jersey Shale Formation of Jersey, Channel Islands. The meander-like structures are from calcisiltite beds within a turbiditic sequence and were collected from low intertidal reefs. Re-examination by all of us of one of Squire's specimens (Jersey Museum, La Hougue Bie, SJM C 2026; Squire, 1973, plate 1 a) and more decisive material (SJM C 1002, 5 specimens), collected later from the same reefs by Stéphane Rault, confirms that the structures are attributable to modern polychaetous annelids, almost certainly to Polydora sp., an attribution with which Dr J. D. George (Head, Polychaeta Section, British Museum (Natural History)) concurs. Polydora is associated with a wide range of substrate preference, constructing borings in hard calcareous substrates, pseudoborings on the inside of shells and true burrows in loose sediment. In the Jersey material the irregular, but quite typical, U-form tubes have been formed along open joint planes with slight dissolution of the rock, or along thin calcite-filled veins, also with dissolution of the rock. The joints occur at all angles to the bedding. Very pertinent is the attitude of the tubes, which is principally normal to the rock surface rather than to the bedding. No tubes have been seen on freshly broken surfaces and in no instance has a tube been seen to enter the rock, though there are numerous moulds of pyritic concretions which happen to be of about the same diameter as the width of the tubes. Lithothamnium sp. is patchily distributed over the rock surface and locally penetrates into the joints, showing that they were open.

SUMMARY In the course of some eighteen months of psychoanalytic psychotherapy, a young woman of twenty-seven once deemed braindamaged at the age of seven years, has shown herself capable of sustaining once weekly psychotherapy. Against all expectations she has taken responsibility for her own attendance, travelling by public transport alone to her sessions. She has also taken initiatives in relation to finding work for herself. Psychotherapy has disclosed a significant component of autism in the personality which is resorted to regularly and which seems to drag the patient into a passive acceptance of half-life which she tries not to mind. In the course of her sessions the patient has come to take more notice of her predicament and to mind more about the dissatisfactions which she experiences. The case presented here is considered to have the characteristics of a particular group of adolescents. These are often described as “just slow” and are brought for psychiatric or psychological attention by desperate parents urgently concerned about the working future of their children. These are individuals of whom the original definition of mental handicap contained in the Mental Health Act 1913 “a state of arrested or incomplete development of mind” would seem to offer as honest, appropriate and meaningful an assessment as the formal I.Q. score introduced in 1959. Unlike the latter, it is an assessment based on a concept of mental development. Assessment by I.Q. score has led to emphasis on training to compensate for the supposed loss of functioning and also to notions like “training for development” and “education from birth”. In the case described here it was the abandonment of training aims and approaches which produced a dramatic improvement in the well-being of the patient and her family. Treatment is now fostering the potential in this woman to bring her own mind into action and to support in her, her own wish for personal development.

The patient was a woman, aged 53 years, who complained of an increasing swelling of the calf muscles for 10 months. On examination a very hard large mass was found in the gastrocnemiussoleus muscle group, unattached to the bones or the skin.

Journal Article The effect of ultrasound on the gastric mucosa and its secretion of acid Get access A N Smith, A N Smith Department of Clinical Surgery, University of Edinburgh Search for other works by this author on: Oxford Academic Google Scholar G W Fisher, G W Fisher Department of Clinical Surgery, University of Edinburgh Search for other works by this author on: Oxford Academic Google Scholar I B Macleod, I B Macleod Department of Clinical Surgery, University of Edinburgh Search for other works by this author on: Oxford Academic Google Scholar R M Preshaw, R M Preshaw Department of Clinical Surgery, University of Edinburgh Search for other works by this author on: Oxford Academic Google Scholar L S Stavney, L S Stavney Consultant Radiologist Department of Clinical Surgery, University of Edinburgh Search for other works by this author on: Oxford Academic Google Scholar D Gordon D Gordon Willesden General Hospital Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 53, Issue 8, August 1966, Pages 720–725, https://doi.org/10.1002/bjs.1800530819 Published: 06 December 2005

SUMMARY This paper shows some of the complexities of the analytic relationship and processes in psychotherapy by focusing on the concept of countertransference. The development of the related concept of transference is briefly outlined and the history of the concept of countertransference and its place in the practice of psychoanalysis is presented. A clinical example is provided to illustrate some of the complexity of the issues that arise when the countertransference is used as a tool to understand the patient. Attention is drawn to the importance of sustaining the countertransference response until the transference aspects and the patient's unconscious communications have been recognised and understood. It is only at this point that an interpretation meaningful to the patient can be made.

This study shows that solvent-based washing enables safe pipette tip reuse for trace chemical analysis, with EtOH : H 2 O (50 : 50, v/v) providing the best balance of cleaning, and sustainability, reducing plastic waste without performance loss.

SUMMARY The Willesden Centre for Psychological Treatment is a new facility built and funded by the Mental Health Unit in the London District of Brent. The unit was opened for clinical work in June 1985 and is a joint enterprise providing facilities for out-patient psychology services for Brent and a base for psychotherapy resources that were previously located at Shenley Hospital. Shenley is a large Victorian mental hospital situated about 20 miles from London in Hertfordshire and is the designated hospital for acute in-patient psychiatric services for Brent. In the first part of this paper I give an overview of the history of the negotiations that took place to bring about the opening of the Centre and then go on to make some general comments about the nature of the negotiating process itself.

Journal Article Intra-abdominal replacement of the testis as an aid to the repair of difficult and recurrent inguinal hernias Get access R M Kirk R M Kirk Hampstead General Hospital and Willesden General Hospital, London Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 61, Issue 7, July 1974, Page 538, https://doi.org/10.1002/bjs.1800610709 Published: 07 December 2005