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PubMed2001

The life and work of Dermot Hedley ("Derek") Williamson (1929-1998).

Derek Williamson's scientific career spanned the "Golden Age" of research into metabolic regulation, to which he made an important and sustained contribution. Derek joined Hans Krebs' laboratory at Sheffield University in 1946 and moved to Krebs' MRC Unit in Oxford in 1960. He elaborated an enzymic method for the determination of acetoacetate and 3-hydroxybutyrate [Williamson, Mellanby and Krebs, Biochem. J. (1962) 82, 90-96], which opened up the field of ketone body metabolism and its regulation and became a Citation Classic. Another Citation Classic followed [Williamson, Lund and Krebs, Biochem. J. (1967) 103, 514-527]. He moved with Krebs to the Metabolic Research Laboratory at the Radcliffe Infirmary in 1967, where he blossomed, formulating his ideas about the integrated regulation of metabolic pathways, particularly with regard to fatty acid oxidation, lipid synthesis and ketone body metabolism. His success was illustrated by more than 200 publications. Derek implanted and nurtured a sense of the excitement of scientific discovery in his colleagues and students, and he worked hard to provide a friendly, supportive and encouraging environment. Many lives have been enriched by the privilege of working with him.

Biochemistry↗

PubMed2001

The effect of the menopause on prolactin levels in patients with hyperprolactinaemia.

OBJECTIVE: Microprolactinomas have been reported to resolve spontaneously after pregnancy and there have been suggestions that oestrogen therapy increases the size of microprolactinomas. Little is known, however, about the effect of the menopause in patients previously known to be hyperprolactinaemic. The aim of this study was to find out if pregnancy or the menopause leads to an alteration in prolactin levels. DESIGN: We conducted a retrospective study of 148 case notes of patients with hyperprolactinaemia and microprolactinomas treated at the Radcliffe Infirmary during the period 1976-96. Sixty-nine female patients who had not had pituitary surgery as treatment for microprolactinoma were used as a control group. None of this group became pregnant or reached the menopause. They were compared with 25 female patients who became pregnant, 11 who became menopausal and 11 who were male. Subjects were excluded from the analysis if there were no follow-up data off dopamine agonist treatment or if they were surgically cured. Data were gathered on demographic parameters, treatment given, scan abnormalities, prolactin levels at diagnosis and last follow up, prolactin levels pre- and postpregnancy as well as pre- and postmenopause. The pregnancy, postmenopausal and male patient groups were compared with the control group and each other to see if they had a higher frequency of normalization of their prolactin levels during follow up. Various factors were examined as possible variables for the normalization of prolactin, including the detection of scan abnormalities at diagnosis, prolactin levels at diagnosis as well as treatment with dopamine agonists and duration of follow up. RESULTS: Forty-five percent of the menopausal group, 24% of the pregnancy group and 18% of the male group subsequently normalized their prolactin levels during the period of the study in comparison with 7% of the control group. The menopausal groups had a significantly higher chance of normalizing their prolactin compared to the control group (P < 0.005), whilst the pregnancy group showed a non-significant trend towards normalizing their prolactin (P = 0.06). The detection of scan abnormalities, treatment with dopamine agonist therapy and duration of follow up were not associated with normalization of prolactin levels. CONCLUSION: Female patients with hyperprolactinaemia who pass through the menopause have a significant chance of normalizing their prolactin levels. Females who pass through pregnancy may have a higher chance of normalizing their prolactin levels. The menopause is an indication for reassessment of the need to continue to treat hyperprolactinaemia and microprolactinoma.

Adult↗

PubMed2005

Vertebral artery aneurysm causing contralateral cerebellopontine angle mass effect.

OBJECTIVE: A vertebral artery aneurysm mimicking a contralateral cerebellopontine angle tumor is described. This is only the second reported case of this in the literature. STUDY DESIGN: Case report. SETTING: Radcliffe Infirmary, Oxford, United Kingdom. PATIENT: Seventy-year-old female patient who presented with a gradually deteriorating right-sided sensorineural hearing loss and a right facial palsy. INTERVENTIONS: Magnetic resonance imaging scan and computed tomography angiography with three-dimensional reconstruction followed-up by endovascular coiling of a vertebral artery aneurysm. MAIN OUTCOME MEASURE: Deterioration in neurologic status. RESULTS: Satisfactory recovery, and at 3 months, the patient is well with no deterioration in facial nerve function. CONCLUSION: Imaging by means of computed tomography angiography complements the standard magnetic resonance imaging scan in the rare event of an aneurysm at the cerebellopontine angle. Endovascular coiling occlusion is a recognized and effective way of managing intracranial aneurysms at the cerebellopontine angle.

Aged↗

PubMedDate not supplied

The thyroid in ulverative colitis and Crohn's disease. II. Thyroid enlargement and hyperthyroidism in ulcerative colitis.

The frequency of thyroid disease has been surveyed in 300 patients with ulcerative colitis (UC) and 600 controls. The controls were drawn from visitors to the general medical wards of the Radcliffe Infirmary and were matched for age and sex with the UC patients. Two observers independently assessed all these subjects for thyroid enlargement of the simple goitre type. Although there were minor variations between the results obtained by the two observers, they found simple goitre in 8.7-6.3 percent among the UC patients compared with 4.3-3.3% percent among the controls; a difference which is significant. A history of thyrotoxicosis was obtained in 3.7 percent of the UC patients compared with 0.8 percent of the controls (p greater than 0.01). In more than half of the UC patients with a history of hyperthyroidism, the hyperthyroidism occurred years before the onset of the colitis. It is therefore highly unlikely that hyperthyroidism is a complication of the colitismpossible reasons for the association of the two diseases are discussed but it is concluded that no satisfactory explanation exists at present.

Adult↗

PubMed1990

Is routine histological examination of nasal polyps justified?

This study aims to assess the indications for histological examination of polypoid lesions removed from the nose. To achieve this we have performed a national survey of consultant ENT surgeons and reviewed 2866 nasal polypectomy operations. The operations were performed between 1982 and 1988 in the Radcliffe Infirmary, Oxford and the Freeman Hospital, Newcastle. One hundred and fifty questionnaires were sent to randomly selected ENT consultants in the United Kingdom. One hundred and seventeen were returned completed (return rate 78%). The questionnaire asked whether or not the surgeon sent all polyps for examination and, if not, what his indications were for so doing. A retrospective review of all nasal polypectomy operations at the two hospitals was performed. The questionnaire revealed that 38% of the surgeons who replied sent all nasal polyps for examination and 62% did not. The commonest indications for requesting histology were unilateral polyps, abnormal appearance and a history of bleeding. The review of polypectomies showed that 74% of cases in Oxford were examined histologically and 33% in Newcastle. Two per cent of polyps were tumours, of which half were malignant. There were no cases in this study in which unsuspected malignancy was found. All cases of nasal tumours, benign or malignant, were diagnosed clinically either in the Outpatient clinic or in the operating theatre. The results of this survey suggest that it is unnecessary to send all nasal polyps for histological examination.

General Surgery↗

PubMed1979

Long-term outcome after severe head injury.

From a consecutive series of 7000 patients with head injuries admitted to the regional accident service, Radcliffe Infirmary, Oxford between 10 and 24 years earlier, every patient was taken who had been amnesic or unconscious for one week or longer. Of these 479 patients, all but ten were traced, and either the cause of death was established or the survivors examined. Ten years after injury 4% were totally disabled, and 14% severely disabled to a degree precluding normal occupational or social life. Of the remainder, 49% had recovered, and the rest were dead. Additionally, a selected series of 64 patients whose unconsciousness had been prolonged for a month or more were studied. Forty of these had survived between three and 25 years after injury and were re-examined. On the basis of age at injury, the worst state of neurological responsiveness, and the duration of posttraumatic amnesia, the outcome of head injury can be predicted reliably in most cases. Patients and relatives need more reassurance and simple psychotherapeutic support, especially in the first few months after injury. Extrapolation from our figures suggests that each year in England and Wales 210 patients survive totally disabled and another 1500 are severely disabled.

Adolescent↗

PubMed1973

Horse-play: survey of accidents with horses.

Horse-riding is increasing in popularity. During 1971 and 1972 154 patients had horse-related injuries of sufficient severity to warrant admission to the Radcliffe Infirmary. The injuries sustained are more common and more severe than generally appreciated and are comparable to those sustained by motor-cyclists. Supervision of children is often insufficient and protective leg and head gear is commonly quite inadequate, even when worn.

Accidents↗

PubMed1961

Pyogenic abscess of the liver.

The author records the case histories of 27 patients suffering from liver abscess admitted during the period 1946-60 to the Radcliffe Infirmary, Oxford. Seventeen were examples of multiple and 10 of single abscess. In most cases the primary source was determinable. Despite there being only one survivor of the 10 patients with a solitary abscess, the author considers the condition easily curable if recognized early.

Abscess↗

PubMed1963

THE COURSE AND PROGNOSIS OF ULCERATIVE COLITIS.

The authors have produced a unique study of 624 patients with ulcerative colitis for they have achieved a 100% follow-up of all these patients admitted to the Radcliffe Infirmary or to the Churchill Hospital, Oxford, from 1938 to March 1962 inclusive or who attended as out-patients during the same period. They are therefore able to present a most important analysis of the natural history of ulcerative colitis as it occurs in the general population. Part I concerns the short-term prognosis in the initial attack, Part II the long-term prognosis; Part III discusses the complications of the disease, and Part IV the risk of carcinoma.

Carcinoma↗

PubMed1978

Tumours of the cauda equina.

A retrospective study of 70 consecutive patients with a cauda equina tumour who were admitted to Neurosurgical Department at the Radcliffe Infirmary, Oxford is presented. The diagnosis of these tumours is often difficult and delayed. The quality of life largely depends upon the neurological disability at presentation. The diagnostic features and investigations are discussed together with the treatment and prognosis.

Adolescent↗

PubMed1981

Predicting outcome in patients with intracranial aneurysms with the help of microsurgery.

A follow-up study of 265 patients treated by microsurgical techniques for ruptured intracranial aneurysms at the Department of Neurological Surgery of the Radcliffe Infirmary, Oxford from 1972 to 1977 showed that prediction of results in terms of mortality, and various measures of morbidity could be achieved by considering before operation several variables in combination. Age, systemic blood pressure on admission and before operation were the most important factors in determining outcome. Inclusion of a variable following operation-arterial spasm-was found to improve prediction somewhat. In addition, spasm was found to be the single most important factor in predicting both mortality and morbidity.

Adolescent↗

PubMed1992

Complications of intrathecal baclofen delivery.

The medical records of 46 consecutive patients who have had intrathecal Baclofen drug delivery systems implanted in the National Spinal Injuries Centre, the Paddocks Hospital Spinal Unit, Princes Risborough, Lodge Moor Hospital Spinal Unit, Sheffield, the Northern Regional Spinal Injuries Unit, Hexham and The Radcliffe Infirmary, Oxford, were reviewed. Patients were contacted to describe their views on the treatment. The complications of the treatment are described. Some, such as overdose and meningitis are particularly hazardous. Others, in particular pump tubing revisions, are more of an inconvenience and time consuming for the patient and physician. If the serious risks of this valuable treatment are to be minimized and the therapy applied most effectively than a well co-ordinated team is essential, involving in particular the physician responsible for the initial assessment and follow-up of the patient and an experienced surgeon. It is recommended that only a small number of centres in the UK undertake these implants.

Adolescent↗

PubMed2006

Notable Australian contributions to the management of ventilatory failure of acute poliomyelitis: with special reference to the Both respirator and Dr. John A. Forbes.

When Australia's 1937 epidemic of poliomyelitis created an urgent need for extra ventilating machines to compensate for respiratory paralysis, Edward Both, an innovative Adelaide biomedical engineer, invented a wooden-cabinet respirator capable of being made relatively quickly in sufficient quantity. His device, here called "the Both", alleviated the problem at Adelaide's Northfield Infectious Diseases Hospital and others, and in late 1938 was introduced into England when Both was visiting there. Appreciating its merits, Lord Nuffield financed assembly-line production at the Morris motor works in Cowley, Oxford. Then, through the Nuffield Department of Anaesthetics in Oxford's Radcliffe Infirmary, he had the Both distributed Commonwealth-wide, as a gift for treating ventilatory failure in polio - especially in children. For the 1937 epidemic in Victoria, and to the design of Melbourne University's Professor of Engineering, Aubrey Burstall, nearly 200 of another wooden-cabinet respirator were ultimately built. Some were installed at the Acute Respiratory Unit of the Infectious Diseases Hospital at Fairfield, then others "all over Australia". However, by the early 1950s, the Both had replaced Fairfield Hospital's "Burstall", which had functioned as Victoria's favoured respirator since 1937. Dr John Forbes at Fairfield became the foremost Australian clinician for expertise with the Both. Before the advent of intermittent positive pressure ventilation, the Both's usefulness had seen it tried for ventilatory failure in some non-polio conditions, but uptake of that application was limited. Nonetheless, Nuffield's philanthropy with the (Nuffield-)Both ultimately furthered progress along the 20th century pathway to intensive care medicine.

Acute Disease↗

PubMed1990

Peripheral T-cell lymphoma associated with hemophagocytic syndrome.

Nine patients with an acute disease characterized by high fever, loss of weight, prominent hepatosplenomegaly, slight or no lymphadenopathy, abnormal liver function tests, and profound pancytopenia are reported. In all cases, the disease presented in the absence of any pre-existing disease or immunosuppressive therapy. In seven of the nine patients, survival was very short (mean = 7 weeks). Two patients are still alive: one had a relapse 24 months after the initial diagnosis, while the other is in complete remission. The main pathological feature was the infiltration of the marrow, spleen and liver by neoplastic T cells, accompanied by an exuberant hyperplasia of benign-looking, hemophagocytizing histiocytes. The term "peripheral T-cell lymphoma with hemophagocytic syndrome" is proposed for this condition. Retrospective analysis of stored paraffin material (1949 to 1965) from the Radcliffe Infirmary files suggests that at least some of the cases designated as "histiocytic medullary reticulosis" by Scott and Robb-Smith were examples of the syndrome herein described.

Autopsy↗

PubMed1990

Making resource management work.

Following Government pressure for more resource management, nurses at the Radcliffe Infirmary set up a pilot scheme putting the system into action. This, the first of a two-part series, describes how ward sisters assumed responsibility for budgeting their wards.

Health Resources↗

PubMed1990

Resource management in action on the ward.

The implementation of resource management at the Radcliffe Infirmary made clinical managers responsible for their ward budgets. This article describes how a nursing system was developed to facilitate the planning and management of resources at ward level.

Budgets↗

PubMed1987

The surgical treatment of a pharyngeal pouch: inversion or excision?

Twenty eight patients with pharyngeal pouches were treated at the Radcliffe Infirmary, Oxford, between 1975 and 1985. Nineteen of these patients had the pouch excised and 9 patients had the pouch inverted. Preoperative and postoperative cine barium swallows were obtained on all patients. The results show pouch inversion to be an effective method of treatment with a low recurrence rate, and fewer complications compared with pouch excision. Inversion of a pharyngeal pouch with a cricopharyngeal myotomy is therefore recommended as a safe, satisfactory treatment.

Adult↗

PubMedDate not supplied

Cerebellar astrocytomas. Part I. Macroscopic and microscopic features.

Some of the pathological features of 112 cerebellar astrocytomas seen at The Radcliffe Infirmary between 1938 and 1984 have been described. These include the following: Macroscopic appearance: Cerebellar astrocytomas, when compared to other gliomas, have an unusual tendency to become cystic. Thus, if all ages are considered only 22% are total solid tumors while the others have either a large solitary cyst or many smaller ones. Although patients with cystic tumors remain free of recurrence far longer than those with totally solid astrocytomas, the proportion of cystic and solid elements does not significantly influence the overall survival period. Moreover, the degree of tumor demarcation is not an absolute indicator of the degree of malignancy. Extent of disease: Approximately 8% of cerebellar astrocytomas infiltrate the brainstem and these cases are associated with the poorest prognosis. Supratentorial invasion is very rare and CSF dissemination is very uncommon. Only one example of the latter was recorded in the present study. It is important to note that subarachnoid spread may also occur from histologically benign tumors as well as malignant cerebellar astrocytomas. Classification by growth pattern: The classification of cerebellar astrocytomas by "growth pattern" is clearly of limited use. This is due to the presence of substantial transitional forms in both the "juvenile" and "diffuse" as well as in the "fibrillary" and "protoplasmic" classifications. Confusion also arises because of the disregard for the quantity and distribution of certain features which, in turn, limits the usefulness of the "A" and "B" type classification system. Failure to define rigorously the cell type which predominates in the "cerebral" and "diffuse" forms also creates substantial difficulties in using Ringertz' nomenclature. Further problems are caused by Zülich's "polar spongioblastomas" since cerebellar astrocytomas are not composed of primitive spongioblasts, the "polar spongioblastomas" merely representing one subtype of cerebellar astrocytoma, namely the piloid or pilocytic variety. Attempts to classify cerebellar astrocytomas in a manner which does not rely upon any specific cell type but which depends instead upon the degree of homogeneity or heterogeneity of cell growth is of limited value. Grading schemes: Although the tumors studied in the present report were not graded, previous authors have shown that "grading schemes" are of little predictive value in assessing the behavior of cerebellar astrocytomas.(ABSTRACT TRUNCATED AT 400 WORDS)

Astrocytoma↗