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Frequencies of pneumococcal types causing serious infections in patients admitted to the Radcliffe Infirmary, Oxford, 1969-77.
During a 7 1/2 year period pneumococci were isolated from body fluids of 124 patients at the Radcliffe Infirmary, Oxford -72 with pneumonia, 26 with meningitis and 26 with other serious infections. Eighty-one (65%) of the patients were over 50, and 33 (27%) were over 70 years old. Of the 124 pneumococcal strains 104 (84%), including 23 (79%) of those from patients who died, belonged to types included in the vaccines successfully used in South Africa and in Papua New Guinea. The relative frequencies of types in the Oxford series and in a larger British series agreed closely with those found in a recent survey of 3644 bacteraemic pneumococcal infections in 10 American cities. Any polyvalent pneumococcal vaccine licensed for use in the United States is thus likely to be relevant to the situation in Britain.
The miracle at the Radcliffe Infirmary. How a son of Adelaide and a mould changed the world.
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Radcliffe Infirmary, Oxford, 1937-8.
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Neurosurgery at the Radcliffe Infirmary, Oxford: a history.
Neurosurgery started in Oxford in 1938. In this article, we commence the story of Oxford neurosurgery with Thomas Willis and trace the historical thread through William Osler, Charles Sherrington, John Fulton, and Harvey Cushing to Hugh Cairns. The department in Oxford is renowned for the training of neurosurgeons. The initial stimulus for this was the abundance of neurosurgical and neurological expertise in Oxford during World War II with Cairns, and this tradition continued with Joe Pennybacker and his successors. The large and ever increasing work load ensures trainees a wide exposure to challenging neurosurgical problems. An increasing emphasis placed on research has resulted in the creation of two posts; each consists of half-time clinical neurosurgery and half-time research. Hugh Cairns organized the department along "Cushing lines." This organization still exists, allowing us to treat a large number of patients with relatively few beds and an average length of patient stay less than 6 days. We look to the future with confidence.
The Radcliffe infirmary: two hundred years.
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[Geriatrics at Oxford. Some remarks on experience gained in the geriatric division of "The Radcliffe Infirmary" in Oxford during the winter of 1959-1960].
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[Radcliff Infirmary (Oxford)].
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[At Radcliffe Infirmary (Oxford). 1].
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Worlds apart: Radcliffe Infirmary, Oxford, UK to Docker River, NT.
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Course and prognosis of Crohn's disease.
During the period 1938-70 there were 303 patients at the Radcliffe Infirmary, Oxford, diagnosed as suffering from Crohn's disease. Of these, 82 have been excluded, leaving 221 with a firm diagnosis. These patients have been divided into 'new cases', in which the disease was diagnosed at the Radcliffe Infirmary, and 'referred cases' in which the diagnosis was already made at the time of referral. In this series, there were three main sites of involvement: small intestinal, large intestinal, and both small and large intestinal. Ileocolitis was the commonest anatomical distribution. The disease showed progression to new, sites in a considerable number of the patients during the period under study. There was a fivefold increase of new cases between the first and third decades covered by the study and this applied equally to patients presenting as an acute abdomen, which supports the idea that the disease is truly increasing. Survival curves have been plotted and compared with expected survival curves. In terms of mortality, Crohn's disease emerges as a disease which becomes progressively more dangerous as the years go by, which is in sharp contrast with the findings in ulcerative colitis in which the main risk of dying is in the early years.
Personnel management: commissioning in Oxford.
In July this year, the closure of Cowley Road Hospital marked the completion of the biggest organisational change in Oxford's hospitals since the Radcliffe Infirmary first opened 200 years ago on St Luke's Day in 1770. The staff and geriatric patients from Cowley Road moved to the partly vacated infirmary and the Churchill Hospital for the purposes of rehabilitation and continuing care. Some of the acute beds had already moved to the John Radcliffe for the integration of general medicine and geriatric admissions, writes David Charles-Edwards, personnel officer, Oxford AHA.
Monozygotic twins discordant for frontonasal malformation.
Frontonasal malformation (FNM), also known as the median cleft face syndrome, encompasses a spectrum of phenotypes that are believed to result from a single underlying aetiology. Over the course of two decades, the Craniofacial Unit at the Radcliffe Infirmary, Oxford has been involved in the management of six same-sex twins where only a single twin is affected. With local ethical committee approval, five sets of twins were traced and consented to participation in this study. Monozygosity of all five twin pairs was confirmed, and the clinical features were reviewed. We discuss the mechanistic relationship between FNM and the twinning process and the genetic implications of this association.
Hospital admissions for acute cholecystitis: changes in the age and sex distribution in Oxford in the post-war period.
Admissions for acute cholecystitis to the Radcliffe Infirmary, Oxford, during the period 1974-1978 have been reviewed and compared with figures previously published for the period 1953-1962 (1). There was a small overall increase in the annual rate of female admissions for acute cholecystitis between the two periods and this increase can be accounted for by population changes in all age groups above the age of 40 years. However, there was a significant increase in the admission rate of women under the age of 40 which could not be accounted for by changes in population alone. This apparent increase in acute gallbladder disease in young women coincides with the growth between 1960 and 1970 of the number of women taking oral contraceptives, and is further evidence of a causal relationship between the use of the contraceptive pill and the development of gallstones. Women taking oral contraceptive steroids had a higher rate of common bile duct exploration and of sphincteroplasty than did those not taking oral contraceptives. The annual rate of male admissions almost doubled between the two periods and this increase cannot be accounted for by population changes. There has also been a virtual disappearance of acute cholecystitis in children over the same time.
Hardware-related problems of deep brain stimulation.
Deep brain stimulation for the alleviation of movement disorders and pain is now an established therapy. However, very little has been published on the topic of hardware failure in the treatment of such conditions irrespective of clinical outcome. Such device-related problems lead to significant patient morbidity and increased cost of therapy in the form of prolonged antibiotics, in-patient hospitalization, repeat surgery, and device replacement. We report a prospective review of our experience at the Radcliffe Infirmary Oxford from the period of April 1998 to March 2001. Overall there is a 20% rate of hardware-related problems in this series, which falls between the 7% and 65% rates reported by other groups. The majority of these failures occurred early on in the series, and numbers declined with experience. Some of the problems may be idiosyncratic to the methodology of individual groups.
Cerebellar astrocytomas. Clinical characteristics and prognostic indices.
The present study has been based on a detailed, computer-assisted, analysis of 112 astrocytomas from patients of all ages seen at The Radcliffe Infirmary between 1938 and 1984. There have been only six studies larger than the present one. From the results obtained in the present study, and the review of the literature, the following conclusions have been reached. Between 70 and 80% of cerebellar astrocytomas are found in children. Few patients are less than 1 year of age or older than 40 at the time of diagnosis. There appear to be no age peaks. Prognosis is poorest at the extremes of life, children less than 5 years old tending to suffer an early recurrence and patients in the oldest age groups having not only a very rapid recurrence but also a very low overall survival rate. In the present study, there was a slight predominance of males although basically, when all studies are considered, the incidence appears to be equal amongst the sexes. Around puberty there appears to be an abrupt drop in the number of tumours in females and a concomitant rise in the number of males. There appears to be no relationship between sex and the length of survival. It would appear that cerebellar astrocytomas can begin either within the vermis or one hemisphere. There appears to be no laterality, the right and left sides of the cerebellum being affected equally. In the present study, the hemispheres were affected three times more frequently than the vermis (34.8%: 12.5%). The rate of recurrence is much faster with tumors of the vermis, whilst the length of survival to death is much longer with tumours of one hemisphere at least up to 10 years after surgery. The most rapid recurrences take place in tumours which involve both hemispheres and the vermis whilst the poorest survival is associated with tumours infiltrating the brain stem. The average length of history is 18.7 months, being under forty-eight months in approximately 60% of patients, but only greater than 60 months in 6.2% of cases. The length of history was not related to either patient age or survival time. Most patients present with obstructive hydrocephalus with or without localising symptoms. The presentation is usually chronic and intermittent but may also be acute.(ABSTRACT TRUNCATED AT 400 WORDS)
Dislocation and fracture-dislocation of the pelvis.
Dislocation and fracture-dislocation of the pelvis is a major injury; the force involved in its production may not only disrupt the pelvis but result in extensive associated injuries. Between 1960 and 1968, 43 patients with this injury were treated in the Accident Service of the Radcliffe Infirmary. Their case records and radiography have been analysed and 29 of the patients re-assessed at a follow-up examination.
Pupillary capture after combined management of cataract and vitreoretinal pathology.
PURPOSE: To report the incidence, pathogenesis, and management of pupillary capture after combined phacoemulsification with intraocular lens (IOL) implantation and vitreoretinal surgery. SETTING: Oxford Eye Hospital, The Radcliffe Infirmary, Oxford, United Kingdom. METHODS: This retrospective case review comprised 12 patients who developed pupillary capture after combined phacoemulsification, IOL implantation, and pars plana vitrectomy (PPV). Eleven IOLs were implanted in the capsular bag, and 1 was sulcus fixated. All patients had a long-acting gas tamponade and were advised to lie face down postoperatively. All patients subsequently had IOL repositioning using a bimanual technique. RESULTS: The incidence of pupillary capture was 8.95% and occurred a mean of 3.25 weeks postoperatively. At least 6 clock hours of the pupillary margin were captured by the optic except in 1 case in which the pupillary capture was total. Half the patients had posterior capsule opacification that required a neodymium:YAG laser capsulotomy after IOL repositioning. CONCLUSIONS: The incidence of pupillary capture after combined phacoemulsification, IOL implantation, PPV, and injection of long-acting gas was high. This complication can be minimized by creating a smaller capsulorhexis, having the patient maintain a strict face-down position, securing wound closure, and injecting an air bubble into the air chamber to push the iris-lens diaphragm posteriorly.