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Buckinghamshire, United Kingdom

Waldegrave E.,Wycombe Hospital | Avann F.,Wycombe Hospital | Bhamra K.,Wycombe Hospital | Stevens R.,Amersham Hospital
BMJ Case Reports | Year: 2011

An 81-year-old man presented to accident and emergency with a recent history of rapidly progressive bilateral hearing loss. Further questioning revealed recent sinusitis, fevers and general malaise. Initial bloods showed raised infl ammatory markers, raised creatinine, low albumin and urine dip was positive for blood and protein. Chest x-ray showed faint bilateral mid-zone infi ltrates. He was treated with intravenous methylprednisolone (500 mgx3) for presumed Wegener's granulomatosis which was later confi rmed by c-anti-neutrophil cytoplasmic antibodies testing (proteinase-3 positive) and supportive fi ndings on CT chest and sinuses. He was discharged after 10 days in hospital on oral prednisolone and cyclophosphamide. He is continuing treatment and seen regularly in outpatient follow-up. Unfortunately his hearing has not fully recovered and he is awaiting a hearing aid. Copyright 2011 BMJ Publishing Group. All rights reserved. Source


Best W.,University College London | Greenwood A.,Amersham Hospital | Grassly J.,University College London | Herbert R.,University of Sheffield | And 2 more authors.
Cortex | Year: 2013

Introduction: The majority of adults with acquired aphasia have anomia which can respond to rehabilitation with cues. However, the literature and clinical consensus suggest change is usually limited to treated items. We investigated the effect of an experimentally controlled intervention using progressive cues in the rehabilitation of noun retrieval/production in 16 participants with chronic aphasia. Method: Participants were sub-divided relative to the group according to performance on semantic tasks (spoken/written word to picture matching) and phonological output processing (presence/absence of word length effect and proportion of phonological errors in picture naming) in order to investigate outcome in relation to language profile. Cueing therapy took place weekly for 8 weeks. Results: Intervention resulted in significant improvement on naming treated items for 15/16 participants, with stable performance on control tasks. Change occurred at the point of intervention and not during pre-therapy assessments. We predicted particular patterns of generalisation which were upheld. Only participants classified as having relatively less of a semantic difficulty and more of a phonological output deficit demonstrated generalisation to untreated items. Outcome did not relate to traditional aphasia classification. Conclusion: A cueing hierarchy can improve word retrieval/production for adults with aphasia. In some cases generalisation to untreated items also occurs. The study demonstrates that the results of behavioural testing can be used to guide predictions of recovery with intervention. © 2013 Elsevier Ltd. Source


Orton D.,Amersham Hospital | Basketter D.,DABMEB Consultancy Ltd.
Contact Dermatitis | Year: 2012

Although the large majority of users do not experience adverse skin reactions to hair dye products, a minority do. Most serious among these are allergic skin reactions, commonly to p-phenylenediamine and its derivatives. The consumer or hairdresser is expected (by the manufacturer) to limit the chance of expression of allergy by conducting a 'sensitivity test', which should provide the consumer with an alert for possible allergic reactivity. However, a self-conducted consumer test can only be useful if it meets a number of important criteria, including evidence that the test protocol works, that it can and is likely to be used successfully by the consumer or hairdresser, and that it does not present a significant health risk (e.g. an increased risk of developing allergy). In short, as with any in vivo test, the benefit must outweigh the risks. In formulating such a test, it should be determined in advance what are the acceptable levels of specificity (correct identification of negatives) and sensitivity (correct identification of positives). It is our view that any hair dye sensitivity test, whether supplied by the hair dye manufacturer or a third party, should be able to answer these questions. © 2012 John Wiley & Sons A/S. Source


Willis C.M.,Amersham Hospital | Britton L.E.,Amersham Hospital | Harris R.,Cancer and Bio detection Dogs | Wallace J.,Center for Statistics in Medicine | Guest C.M.,Cancer and Bio detection Dogs
Cancer Biomarkers | Year: 2010

In a previous canine study, we demonstrated that volatile organic compounds specific to bladder cancer are present in urine headspace, subsequently showing that up to 70% of tumours can be correctly classified using an electronic nose. This study aimed to evaluate the sensitivity and specificity which can be achieved by a group of four trained dogs. In a series of 30 double-blind test runs, each consisting of one bladder cancer urine sample placed alongside six controls, the highest sensitivity achieved by the best performing dog was 73% (95% CI 55-86%), with the group as a whole correctly identifying the cancer samples 64% (95% CI 55-73%) of the time. Specificity of the dogs individually ranged from 92% (95% CI 82-97%) for urine samples obtained from healthy, young volunteers down to 56% (95% CI 42-68%) for those taken from older patients with non-cancerous urological disease. Odds ratio comparisons confirmed a significant decrease in performance as the extent of urine dipstick abnormality and/or pathology amongst the control population increased. Importantly, however, statistical analysis indicated that covariates such as smoking, gender and age, as well as blood, protein and /or leucocytes in the urine did not significantly alter the odds of response to the cancer samples. Our results provide further evidence that volatile biomarkers for bladder cancer exist in urine headspace, and that these have the potential to be exploited for diagnosis. © 2010/2011 - IOS Press and the authors. All rights reserved. Source


Wong T.,Amersham Hospital | Orton D.,Amersham Hospital
Clinics in Dermatology | Year: 2011

Allergic reactions to sunscreens are relatively rare. However, as the public become more conscious of the dangers of excessive sunlight exposure, the use of sunscreens is increasing. They are also being incorporated into general cosmetics on a more frequent basis. Sunscreens contain a variety of potential sensitizers which may lead to contact and/or photocontact allergic dermatitis, and as pharmaceutical companies continue to manufacture and incorporate new UV filters it is crucial that we remain up to date and aware of these agents to include in patch and photopatch testing batteries. Furthermore, the creation of a European consensus statement regarding methodology in photopatch testing has enabled greater standardization and comparison of patch test results across centers. © 2011 Elsevier Inc. Source

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