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Plymouth, United Kingdom

Guly H.,Derriford Hospital

Death from exposure to cold has been recognised for thousands of years but hypothermia as a clinical condition was not generally recognised until the mid-20th century and then only in extreme conditions such as immersion in cold water or snow. In the UK, hypothermia in less extreme conditions was not generally recognised until the 1960s. Recognition of hypothermia required the temperature to be measured and this did not become a clinical tool until the late 1800s and it was not used routinely until the early 1900s. Although John Hunter and James Curry did some physiological experiments in the 1700s, detailed physiological experiments were not done until the early 20th century and the use of therapeutic hypothermia for malignancy and in anaesthesia in the 1930s and 1940s provided more impetus for investigating the physiology of hypothermia in humans and familiarising the medical profession with measuring core temperatures. © 2010 Elsevier Ireland Ltd. Source

Purpose: To provide a revised definition, process and purpose of triage to maximise the number of patients receiving intensive care during a crisis. Methods: Based on the ethical principle of virtue ethics and the underlying goal of providing individual patients with treatment according to their best interests, the methodology of triage is reassessed and revised. Results: The decision making processes regarding treatment decisions during a pandemic are redefined and new methods of intensive care provision recommended as well as recommending the use of a 'ranking' system for patients excluded from intensive care, defining the role of non-intensive care specialists, and applying two types of triage as 'organisational triage' and 'treatment triage' based on the demand for intensive care. Conclusion: Using a different underlying ethical basis upon which to plan for a pandemic crisis could maximise the number of patients receiving intensive care based on individual patients' best interests. © The Author(s) 2010. Source

On the Belgica expedition (1897-1899), Dr F.A. Cook described a disease that he called 'polar anaemia' and on this expedition it affected most of the expedition members and caused one death. The symptoms were shortness of breath, abnormalities of the pulse and oedema (swelling of the legs) and the disease was clearly cardiac failure. During the heroic age of Antarctic exploration a similar disease affected at least eight other expeditions causing five other deaths. This disease was very similar (and probably identical) to a disease affecting (mostly) Scandinavian seamen and called 'ship beri-beri'. Both diseases were almost certainly what is now called wet beri-beri due to thiamine (vitamin B1) deficiency though most sufferers were probably also vitamin C deficient and some may have had both beri-beri and scurvy. It may have been exacerbated by invalid diets. This paper describes the disease and how it was considered and treated at the time. © 2011 Cambridge University Press. Source

Hilton D.A.,Derriford Hospital | Hanemann C.O.,University of Plymouth
Brain Pathology

Schwannomas may occur spontaneously, or in the context of a familial tumor syndrome such as neurofibromatosis type 2 (NF2), schwannomatosis and Carney's complex. Schwannomas have a variety of morphological appearances, but they behave as World Health Organization (WHO) grade I tumors, and only very rarely undergo malignant transformation. Central to the pathogenesis of these tumors is loss of function of merlin, either by direct genetic change involving the NF2 gene on chromosome 22 or secondarily to merlin inactivation the genetic pathways and morphological features of schwannomas associated with different genetic syndromes will be discussed. Merlin has multiple functions, including within the nucleus and at the cell membrane, and this review summarizes our current understanding of the mechanisms by which merlin loss is involved in schwannoma pathogenesis, highlighting potential areas for therapeutic intervention. © 2014 International Society of Neuropathology. Source

Ayling R.M.,Derriford Hospital
Annals of Clinical Biochemistry

Most abdominal disorders present with a limited number of overlapping symptoms. Blood tests are not routinely available for use in diagnosis and so investigation tends to require complex imaging procedures or endoscopy and biopsy. These are invasive for the patient, may be associated with morbidity and mortality and have considerable resource implications. Biochemical tests on a single sample of faeces are therefore a valuable alternative. Measurement of faecal calprotectin has been shown to have a role in the diagnosis of inammatory bowel disease and in its monitoring. Lactoferrin is also of benefit used in this way. Faecal elastase has been demonstrated to be of use in the diagnosis of pancreatic insufficiency. A number of faecal markers have been explored in colorectal cancer. Faecal occult blood testing is used for population screening, but the metabolomic marker tumour, M2-pyruvate kinase, has potential for use in both diagnosis and screening. DNA testing has advantages in colorectal cancer but the exact applications of such tests require further evaluation. Source

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