bluuebunny/crossref_metadata_2025 huggingface dataset:
Scottish Health Authorities Revenue Equalisation
Authors: Forwell G. D.
Published: January 2017

A working party was set up by the Scottish Home and Health Department to consider the system of allocation of money to health boards. The system advocated (SHARE Report) is predictable from the NHS structure and the analogous report (RAWP) in England. The Secretary of State has announced his decision to accept SHARE in general principle. In principle, the Report is to be welcomed as a first step toward rationalising the distribution of health service money. However, work already published suggests the assumptions in SHARE require examination.

SHARE would encourage individual health boards to plan for their own populations although thereby the greatest improvement in health services in Scotland may not be achieved. The SHARE objective of equal opportunity of securing access is open to various interpretations. Emphasis is laid on the recommendation in the Report for a comprehensive examination of the inter-relationship of social circumstances (in particular, urban deprivation), morbidity and mortality.
Pre-Operative Assessment for Biliary Tract Surgery
Authors: Shields R.
Published: January 2017

The pre-operative approach to the patient with prolonged jaundice due to a long-standing obstruction of the bile duct is, we find, very similar to that of the patient with hepatic parenchymal disease who requires surgery for the treatment of portal hypertension. Complex and sophisticated tests of liver function are not required and a reasonable assessment of the patient's ability to withstand operation may be made by estimating the serum ammonia and bilirubin and the plasma glucose and albumin.

Particularly useful in this assessment is the Child's classification (Child, 1964). This is based on 3 clinical and 2 laboratory tests. On this basis the patient may be assigned to 1 of 3 groups. Patients who belong to Child's group A have good hepatic reserve and are similar to individuals who have been deprived of no more than 30 per cent of their liver function. Patients of Child's group C, on the other hand, are similar to patients who have lost 90 to 95 per cent of liver function and operation in them carries a considerable risk. Moreover, because of their basic disease, the liver may have no regenerative powers and further improvement in liver function cannot be expected. These patients are hardly ever operable, although certain supportive measures may improve their general status and they may eventually be operated upon but considerable risks must be recognised. In an intermediate position are the patients who belong to group B of the Child's classification. These patients have evidence of hepatic dysfunction and require the energetic and detailed preparation described below.
The Development of Permanent Unidirectional Anterograde Block in the Accessory Pathway of a Patient with Wolff-Parkinson-White Syndrome and Observations on the Mechanism of the Ensuing Incessant Circus Tachycardia
Authors: Miller H. C. , Brown G. J. , Lowe K. G.
Published: January 2017

A case is reported, the sixth in the literature, in which permanent anterograde block occurred in the accessory pathway of a patient with Wolff-Parkinson-White syndrome, so that pre-excitation no longer occurred. Retrograde conduction remained intact and the patient developed incessant tachycardia with ventriculo-atrial conduction occurring over the accessory pathway.

Retrogradely conducting pathways are a common cause of supraventricular tachycardia and this case raises the possibility that many of them may previously have had overt pre-excitation.
Chemoradiotherapeutic Prevention of Local Recurrence after Stapled Anastomoses in Rectal Cancer
Authors: Anderson J. M.
Published: January 2017

Continuity of bowel was restored after resection of twelve midrectal cancers (6 Dukes' B, 4 Dukes' C and 2 metastatic to liver) by stapling with the SPTU suture gun, following pre-operative radiotherapy and intraoperative topical chemotherapy with 5-flourouracil and mercuric perchloride. Postoperative contrast radiographs revealed one of the 12 anastomoses to be leaking. Three patients died 18 to 20 months after resection and nine have been followed for two to six years. No clinical, endoscopic or biochemical evidence of local recurrence has emerged. Comparative trials of this type of chemoradiotherapeutic prophylaxis of local recurrence after restorative operations for low rectal cancers are advocated.
Tetanus Prophylaxis and Accidental Wounds
Authors: Morgan W. J. , McGuigan Moira P. J. , Williams S. , Solomon G.
Published: January 2017

Of 400 consecutive patients who had wounds treated in the Accident Department, 200 remembered receiving either booster injections or a full course of tetanus toxoid in the last 10 years. During this period, 182 patients received their initial toxoid injection in association with treatment of a wound in an accident department. Only 71 (38%) of these patients attended for a full course of injections. From our assessment of the wounds and the patient's anti-tetanus immunity, 79 patients (20%) were considered to be at risk of developing tetanus. By further considering the time interval elapsed between injury and treatment, a ‘high risk” group of 13 patients (3%) was recognised. It is recommended that the use of human immunoglobulin shoul I be reserved for the ‘high risk’ group, and that the remainer of the ‘at-risk’ patients should receive penecillin prophylaxis only.
Recovery of Renal Function after Renovascular Surgery
Authors: Mackay A.
Published: January 2017

A 48-year-old woman with generalised atheromatous disease had a right nephrectomy for a renal artery occlusion in 1977. Fourteen months later she presented with severe hypertension and anuria, caused by occlusion of the left renal artery. Emergency reconstructive surgery was successful in bringing about recovery of renal function and lowering of her blood pressure. Because renal function had deteriorated slightly after the first operation and improved after the second, a comparison was made of the effects of unilateral nephrectomy and reconstructive surgery on renal function in a further 26 patients with renal artery stenosis. In 15 patients having nephrectomy, renal function deteriorated in most, while in 11 having reconstruction it improved in nine and remained constant in two.
Familial Polymyalgia Rheumatica
Authors: How J. , Hirst P. J. , Bewsher P. D. , Bain L. S.
Published: January 2017

We report the cases of two sisters of a Scottish family who developed polymyalgia rheumatica at the age of 14 and 72 years respectively. Previous reports of familial polymyalgia rheumatica and giant-cell arteritis have been infrequent, and the patients were of other racial groups. The relevance of these observations with regard to the genetic factor in the causation of polymyalgia rheumatica is discussed.
Tuberculous Meningitis following Pericardiectomy for Constrictive Pericarditis
Authors: Ellis M. E. , Roscoe P.
Published: January 2017

We report a ease of recurrent calcified chronic constrictive pericarditis of 31 years' duration, complicated by the development of tuberculous meningitis two weeks after a third pericardiectomy. It is suggested that all patients undergoing pericardiectomy for constrictive pericarditis should have anti-tuberculous therapy even in the absence of an established tuberculous aetiology.
A Choledochal Cyst in Association with Primary Biliary Cirrhosis
Authors: Douglas J. G. , Feek C. M. , Irvine W. J. , Finlayson N. D. C.
Published: January 2017

A 62-year-old woman is described who was found to have both primary biliary cirrhosis and a large choledochal cyst. This association has not been previously reported. This case also illustrates the need for further investigation of the biliary tract in patients with primary biliary cirrhosis.
Treatment of Postmenopausal Osteoporosis: Some Current Concepts
Authors: Chesnut Charles H.
Published: January 2017

Postmenopausal osteoporosis, a condition of deficient bone mass, is associated with fractures of the spine, distal radius and ulna, and femoral neck. Its pathogenesis may be a disruption (‘negative uncoupling’) of the normal bone remodelling sequence; therapeutic benefit may be achieved with further alteration of this sequence (‘positive uncoupling’). A current therapeutic regimen of increased calcium intake, small amounts of vitamin D, an anabolic steroid (such as stanozolol) and possibly fluoride would appear to be of benefit in postmenopausal osteoporosis.
Infantile Hypertrophic Pyloric Stenosis
Authors: Mitchell K. G. , Cachia Susan M.
Published: January 2017

A brief review of the development of the surgical management of infantile hypertrophic pyloric stenosis is made. The incidence, investigation, management and complications of cases treated at the Royal Hospital for Sick Children, Glasgow over a period of six decades is reported. The mortality fell from 59 per cent in 1925 to 0 per cent in 1975. Pyloromyotomy in infants with hypertrophic pyloric stenosis is shown to be a very effective treatment for this potentially lethal condition and must rank as one of the most cost-effective forms of treatment in medical practice.
Tampon-Associated Toxic Shock Syndrome—A Case Report
Authors: Semple C. G. , Fogelman I.
Published: January 2017

We report a case of tampon-associated toxic shock syndrome occurring in a 16-year-old girl. While this condition has been reported almost exclusively from the USA it is likely that TSS will be recognised elsewhere with increasing frequency as physicians become more aware of its existence. We consider that TSS must be considered in any hypotensive female in the reproductive age group with diarrhoeal illness.
Cholangio Carcinoma Treated by Liver Split and Resection
Authors: Hehir M. , McNeill A. D. , Joffe S. N.
Published: January 2017

A case of cholangiocarcinoma at the liver hilum presenting with jaundice is described. Pre-operative transhepatic cholangiography, hepatic arteriography and splenoportography led to liver split, with successful resection of tumour and triple hepatico-jejunostomy. Despite tumour recurrence eight months of palliation were achieved. Current methods of treating the condition are discussed.
Small Bowel Lymphoma Presenting as Chronic Adult Intussusception
Authors: Youngson G. G. , Scotland A. D.
Published: January 2017

Two cases of chronic intestinal intussusception are reported in adults suffering from gastrointestinal lymphoma. Radical resection without reduction and staging are recommended for the operative management of adult intussusception.
Streptococcus Faecalis Meningitis: A Salutary Case
Authors: Ellis M. E. , Glover S. C. , Smith C. C. , Reid T. M. S.
Published: January 2017

Streptococcus faecalis is a rare cause of bacterial meningitis and carries a poor prognosis. A source or underlying disease process is almost invariably found. We present details of a patient in whom no precursor was found. Diagnosis was delayed because Gram staining of the CSF did not permit differentiation from Streptococcus pneumoniae. The institution of correct antimicrobial therapy was therefore delayed.
John Carswell: A Pioneer in Scottish Psychiatry
Authors: Sclare A. B.
Published: January 2017

John Carswell was an outstanding pioneer in Scottish Psychiatry in the latter 19th and early 20th century. His innovative work at a time of benevolent custodial care entailed the development of new patterns of psychiatric service, notably the inception of psychiatric treatment in the context of the general hospital. He also displayed an advanced awareness of community aspects of psychiatric illness.
Shrinkage of the Gastric Antrum following Gastroenterostomy
Authors: Rose J. D. R. , Sircus W.
Published: January 2017

Radiological and endoscopic shrinkage of the antrum of the stomach may occur in the elderly and following gastroenterostomy. We describe this in 18 subjects, of whom 17 had a gastroenterostomy with or without vagotomy. Shrinkage can appear within two years of operation and is usually associated with a well-functioning stoma. Reflux biliary gastritis occurred in almost all and in nine out often tested the acid secretion in response to pentagastrin was virtually nil. Dyspepsia and bile vomiting were frequent indications for endoscopy. No patient had jejunal ulceration. In the majority radiological interpretation was correct.
Antenatal Diagnosis of Placental Sulphatase Deficiency
Authors: Wallace A. M. , Stromberg P. , Rao L. G. S.
Published: January 2017

A dynamic test for the antenatal diagnosis of placental sulphatase deficiency was examined in ten patients, selected on the basis of low urinary oestrogen levels (i.e. below the 10th centile at between 30 and 40 weeks gestation). The test consisted of measurement of plasma oestradiol levels over a period of 120 min after an i.v. injection of dehydroepiandrosterone sulphate. The oestradiol response was vigorous in seven patients, absent in two and small, but significant, in one. The three patients with reduced oestradiol response were also found to have raised levels of urinary steroid monosulphates and thus were probably placental sulphatase deficient.

The overall clinical importance of placental sulphatase deficiency and the value of the dehydroepiandrosterone sulphate loading test in antenatal diagnosis are discussed.
Superficial Mycoses in the West of Scotland
Authors: Gentles J. C. , Scott Elizabeth
Published: January 2017

Ringworm formed almost 70 per cent of all superficial mycoses diagnosed. The feet and nails were most frequently affected and a single species, Trichophyton rubrum was responsible for the majority of infections that required specialist attention. Scalp ringworm which, until the middle of this century, was the most common form of the disease now constitutes only 5 per cent of infections and the majority of these are caused by the zoophilic fungus Microsporum canis. The anthropophilic dermatophytes which were once so prevalent as the cause of scalp infections are now rarely encountered.

Yeasts, especially Candida albicans were most frequently encountered as a cause of mucosal infections but were not unimportant as a cause of disease of skin and nail.
The Prognosis for Very Low Birth Weight Babies in the Highlands of Scotland
Authors: Galloway C. A. S. , Robertson G.
Published: January 2017

One hundred and two admissions of VLBW babies to the Baby Unit at Raigmore Hospital were studied over a six-year period. The neonatal death rate was 53 per cent. Twenty three survivors weighing 1.36 kg. or less were examined at an average age of 3 years 11 months and 22 of these underwent cognitive assessment. All but one had normal or superior I.Q. assessments. Two were regarded as having significant or profound handicap. Possible reasons for the relatively low survival rate, but acceptable handicap rate are discussed.
Growth of Immigrant Children in the Centre of Glasgow
Authors: Goel K. M. , Thomson R. B. , Sweet E. M. , Halliday S.
Published: January 2017

One hundred and ninety six Asian, 89 African, 96 Chinese and 98 Scottish children from 173 families were studied to assess growth in relation to country of birth, time of parental residence in Scotland, child order in family, social class, living conditions and dietary factors. The growth measurements (standardised height, weight and bone age) differed between ethnic groups. The Africans were the tallest and Scottish the shortest. In all immigrant groups, children born in Scotland were on average, taller and more advanced in bone age than those born in their country of origin. In this study, there was no demonstrable effect on growth of social class or of living conditions. Dietary variable showed a lack of coherent effects on growth.
Silicate Nephrotoxicity in the Experimental Animal: The Missing Factor in Analgesic Nephropathy
Authors: Dobbie J. W. , Smith Mary J. B.
Published: January 2017

Three silicon-containing compounds (magnesium trisilicate BP, crushed quartz and crushed Arran granite) were added to the drinking water (250 mg/l) of three groups of male guinea pigs for four months. At autopsy all animals receiving magnesium trisilicate showed a focal tubulo-interstitial nephritis mainly affecting the distal nephron. Similar but less intense lesions were encountered in two animals receiving crushed quartz. No renal lesions were found in the control group or in animals receiving crushed Arran granite.

The concentration of soluble silicates in drinking water, measured as elemental silicon (Si) by atomic absorption spectroscopy (AAS) was determined for twenty-eight locations in different regions of Britain.

Following ingestion of magnesium trisilicate, significant increases in urinary excretion of Si were demonstrated in two healthy adults using atomic absorption spectroscopy.
Molecular Biology and the Clinician
Authors: Bostock C. J. , Harding N. G. L.
Published: January 2017

Molecular biology has uncovered informational processes which broadly apply in medicine. The points of attack range from diagnosis at the most fundamental levels of information flow to the production of therapeutic agents. This is promoting movement from serendipitous strategies of advance to those of predictive rational clinical design. Specific examples show how three principal types of molecular probe are benefitting a wide range of clinical disciplines and thereby blurring interdisciplinary boundaries.

There are signs that current medical training is not making the best use of contemporary molecular biology. The identification of areas in which molecular biology can be usefully applied to medicine requires medical practitioners to be aware of its diagnostic and prognostic potential. Equally, advances are delayed by gaps between laboratory workers and their clinical colleagues. The dilemma is that by creating a specialist discipline of clinical molecular biology we risk it becoming isolated and delay the impact of molecular biology in medicine as a whole. An alternative is to find a means for raising molecular consciousness throughout all disciplines in medicine.
The Incidence of Occult Bleeding per Rectum in a General Practice in Scotland a Study Using Haemoccult
Authors: Lawson Anne H.
Published: January 2017

Haemoccult (Eaton Laboratories) was offered to all 405 subjects aged 45 to 65 years in a Scottish, rural general practice as a screening test for occult bleeding per rectum. Subjects contacted verbally had a compliance rate of 85.2 per cent and those by post 59.5 per cent—2.6 per cent (7) returned positive tests. Of these seven, one refused follow-up. Two had diverticular disease, one had haemorrhoids, one had a possible polyp, one had ingested aspirin and also had a few diverticula. In one patient, no cause of bleeding was found. The last two and one with diverticular disease were negative on re-testing. In general, the test was aesthetically acceptable to undertake for both patient and doctor and provided a suitable screening technique for occult bleeding.
Neonatal Embryonal Rhabdomyosarcoma of the Bladder
Authors: Harvey Janina M. , Scott Jean M.
Published: January 2017

A case report of neonatal rhabdomyosarcoma of the bladder is described. The literature reveals only one other report nearly 40 years previously. The epidemiological study of childhood rhabdomyosarcoma of the bladder shows a greater incidence in Scotland compared to the United Kingdom as a whole.
Syngeneic Bone Marrow Transplantation in T-Cell Acute Lymphatic Leukaemia
Authors: Parker A. C. , Sainsbury C. , Innes E. M.
Published: January 2017

A case of bone marrow transplantation in a child aged seven years from his identical twin is described. The features of interest are that this was a patient with a T-cell lymphoblastic leukaemia transplanted in remission with very rapid recurrence of leukaemia following transplantation.
Haemophilic Arthropathy: A Ten Year Radiological and Clinical Study
Authors: Brown I. S. , Toolis F. , Prescott R. J.
Published: January 2017

A ten-year retrospective study has been undertaken on a group of ten haemophiliacs for whom previous haematological and radiological data was available. Radiological and clinical assessment of their knees and elbows (40 joints) have been correlated to the accurate recording of all haemarthroses suffered by these joints. There is a statistically significant association between the number of haemarthroses and the radiological change in the joint, as determined by a radiological scoring system. The knees, but not the elbows, show a significant association between number of haemarthroses and deterioration in clinical function. Several bleeds can occur in a haemophilic joint without necessarily causing permanent radiological change; this new finding in adults may be due to modern therapy.
Parkinson's Disease: Long-Term Results of Levodopa Therapy
Authors: Pentland B. , Matthews D. , Mawdsley C.
Published: January 2017

The long-term results of levodopa therapy in Parkinsonian patients is described. Between January 1969 and December 1972, dopaminergic therapy was started in 186 patients with Parkinson's disease. Their progress after six months, five years and in the autumn of 1980, was assessed. The initial benefit in the majority of patients was followed by a gradual loss of efficacy in most patients with increasing side effects of central-mediated type. We suggest that it may be wise to delay the onset of levodopa therapy until progress of the disease makes treatment imperative.
Angioneurotic Oedema in the Elderly
Authors: Brettle R. P. , Dunmow R. E. , Milne L. A. , Yap P. L.
Published: January 2017

A patient presented at the age of 72 years with a life long history of at least 60 years of abdominal crises described by the patient as ‘bilious vomiting or migraine’. However, a careful clinical and family history suggested a diagnosis of hereditary angioneurotic oedema and this was confirmed by complement studies. Treatment with oral ethinyltestosterone (Danazol) was successful in abolishing her attacks, initially at a dose of 600 mg. per day and latterly at the low dose of200 mg per day.
Factors Determining the Use of the Emergency Recommendation for Compulsory Psychiatric Care
Authors: Masterton G. , Gallagher J. , Timbury G. C.
Published: January 2017

The factors determining the use of Section 31 admissions and reclassifications at a district psychiatric hospital were investigated prospectively over an eight month period. Thirty-six per cent of patients failed to meet the criteria laid down for full detention and, particularly with reclassification. Section 31 was invoked to secure treatment. While the Emergency Recommendation is not used as the legislators intended, a seven day detention order appears more relevant to modern psychiatric practice than the full detention procedure.
Self Poisoning in a Rural District General Hospital
Authors: Tulloch J. A.
Published: January 2017

The admissions to Stracathro Hospital due to self poisoning during 1981 have been reviewed and compared with earlier years. Self poisoning is becoming more common and involves a wide age range. Suicide is intended by a high proportion of the subjects.
Danazol and Oral Anticoagulants
Authors: Small M. , Peterkin M. , Lowe G. D. O. , McCune G. , Thomson J. A.
Published: January 2017

A case report of overt bleeding in a young woman on warfarin given the anabolic steroid danazol for menorrhagia is reported. This interaction appears to be poorly recognised and we suggest that when commencing such a treatment the dose of anticoagulant should initially be halved and thereafter tailored to the thrombotest.
Pulsed Doppler Imaging for Carotid Artery Disease
Authors: Murie J. A. , Sheldon C. D. , Forrest H. , Quin R. O.
Published: January 2017

Ultrasonic imaging using a six-channel pulsed Doppler system combined with Doppler spectral analysis of 65 carotid bifurcations has been studied in a prospective clinical trial. The results were compared with X-ray contrast angiography. An overall sensitivity in excess of 90 per cent was achieved using the ultrasound technique, with a specificity of 89 per cent in the detection of significant stenosis or occlusion of the internal carotid artery. The ability to recognise significant arterial stenosis with a non-invasive system suggests that it has a major part to play in screening patients with suspected carotid artery disease.
Bone and Joint Tuberculosis in Glasgow: The Present Situation
Authors: Sammon D. J.
Published: January 2017

A retrospective survey of bone and joint tuberculosis in the City of Glasgow over the decade 1966–75 has been carried out. Its object is to chart the changing pattern of clinical presentation of this disease, and details of 129 patients are presented.

The numbers of children and adolescents are relatively low: Asian immigrants and the elderly are now the higher risk groups. A positive culture was obtained from 60 per cent of the bone and joint lesions and in every case the organism was human Mycobacterium tuberculosis.

Tuberculosis complicating a closed fracture is a very rare occurrence; this series includes one further such case.

Delay in diagnosis was evident in a significant number (11%) of patients. We must bear in mind the fact that we still have with us not only the great Victorian architecture, but also the great Victorian disease.
Dr Harvey Pirie and the Scottish National Antarctic Expedition (1902–4)
Authors: Bernstein R. E.
Published: January 2017

Shortly after receiving a science and medical degree at Edinburgh, Dr Harvey Pirie joined the Scottish National Antarctic Expedition (1902–4) under Bruce. The naturalist team explored East Falkland, Laurie Island in the South Orkneys, and made the first oceanographic investigation of the Weddell Sea. After sighting Antarctica and naming the coast seen Coats Land, they returned to the Clyde via Gough Island and Cape Town. After a period in Scottish private practice, Pirie became a bacteriologist; he joined the Colonial Medical Service in 1913 and served in Kenya. In 1918 he organised the bacteriological services at the South African Institute for Medical Research in Johannesburg, and became deputy-director, 1926–41.
Successful Postmortem Caesarean Section following Maternal Intracranial Haemorrhage
Authors: Watt A.H.
Published: January 2017

A case is reported of a successful post-mortem caesarean section, following maternal death due to intracranial haemorrhage. The factors favouring a successful foetal outcome are briefly discussed.
Lactic Acidosis and Beer Drinking
Authors: Evans J. R. , Main Janice , Mitchell P. E. G. , Tulloch J. A.
Published: January 2017

A patient is reported who developed lactic acidosis, hyponatraemia and features of the Wernicke-Korsakoff syndrome following long term excessive ingestion of beer and lager. Intramuscular thiamine caused a rapid correction of the lactic acidosis, and the hyponatraemia was corrected by intravenous therapy. On discharge after six weeks of intramuscular Parentrovite the patient still retained some chronic features of the Wernicke-Korsakoff syndrome.
Familial Hodgkins Disease
Authors: Martin B.J. , Lennox I.M. , McGowan Angela
Published: January 2017

Three cases of Hodgkins Disease in one family are described. The index case presented with pyrexia of unknown origin and the diagnosis of Hodgkins Disease was made at post mortem. Two other members of the family had died of a similar cause many years previously. Triple occurrence of Hodgkin's Disease within one family is very uncommon as is a long time interval between cases.
Migraine, Head Trauma and Sport
Authors: Ashworth B.
Published: January 2017

In some people an attack of migraine may be provoked by heading a football or a blow on the face in a rugby tackle. The attack is sometimes alarming and clearly cannot be explained on a basis of trauma alone. Some people only have attacks in this particular circumstance but the majority have spontaneous episodes at other times. The presentation is usually in childhood or early adult life. The syndrome is discussed in relation to reports of seven patients to illustrate the variations which include migraine without headache and persistent features after the attack.

The condition is benign but may cause the patient to give up playing football.
Migraine — Treatment of Acute Attack
Authors: Wilkinson Marcia
Published: January 2017

The treatment of an acute attack of classical or common migraine is sleep, an antinauseant such as metoclopramide, an analgesic, either aspirin or paracetamol, and in some patients 1 or 2 mg of ergotamine tartrate. Treatment should be given us early in the attack as possible and all drugs should, if possible, be given in a soluble or effervescent form. When vomiting occurs early in the attack, treatment is best given by suppository, inhalation or intramsucular injection. Ergotamine tartrate is only necessary in about one third of attacks and when used is best given by suppository or inhalation. Doses of ergotamine tartrate higher than 2 mg per attack or 6 mgs per week may cause toxic symptoms as may the abuse of analgesics.
Dermatomyositis—Polymyositis in Children
Authors: Goel K. M. , King M.
Published: January 2017

Sixteen cases of dermatomyositis-polymyositis in children (dermatomyositis 15; polymyositis 1) have been reviewed. Proximal muscle weakness with a characteristic skin rash was vital for diagnosis in the majority of children. The positive laboratory tests such as creatine phosphokinase (CPK), electromyography (EMG) and muscle biopsy were helpful but results were normal in some cases even in the acute phase of the illness. All but one had been treated initially with high dose corticosteroids followed by a low dose maintenance for a prolonged period. Two in addition had had cytotoxic agents. Thirteen of the sixteen were currently in remission. In the other three cases, one with polymyositis only, the disease remained active and the two with dermatomyositis died. Only three of the patients were incapacitated by residual fixed contractures and extruding calcinosis. On the whole the prognosis of dermatomyositis is good.
Enalapril following Captopril-Induced Nephrotic Syndrome
Authors: Webb D.J. , Atkinson A.B.
Published: January 2017

The development of proteinuria, and more rarely nephrotic syndrome, has been seen with the use of the first orally active converting-enzyme inhibitor captopril. Both of these side effects appear to occur more frequently when the drug is used at higher dose, particularly in the presence of renal impairment.

We have used enalapril, a new orally active converting-enzyme inhibitor in the treatment of a patient with drug-resistant hypertension and renal impairment who previously developed nephrotic syndrome with captopril. Recurrence of the nephrotic syndrome was not seen in this patient during a period of 20 months on enalapril. On the contrary, urinary protein excretion over the same period was reduced to around 1 g in 24 hours.

Our experience would suggest that enalapril may usefully be substituted for captopril in the treatment of hypertensive patients in whom the latter has caused proteinuria or nephrotic syndrome.
Drinking Patterns and Alcohol Related Admissions of Acute Medical Patients in Stracathro Hospital
Authors: Tulloch J. A.
Published: January 2017

A study has been made of the drinking patterns of male and female patients admitted to the acute medical wards of a rural district general hospital. Thirty-four per cent of males and 18.5 per cent of females were regular drinkers, while 54 per cent of males and 70.5 per cent of females never, or rarely drank. The young drank more frequently than the elderly. Alcohol ingestion was the determining factor in 7.9 per cent of the male admissions and 7.5 per cent of the female admissions. Drug overdosage was the single most common associated problem.
An Unusual Presentation of Variant Angina
Authors: Simpson I.A. , Hutton I.
Published: January 2017

A previously well 46-year-old man presented with ventricular fibrillation as an initial complication of Prinzmetals variant angina. Coronary angiography subsequently demonstrated normal coronary arteries.
ST Kilda: Emigrants and Disease
Authors: Holohan Ann Maclean
Published: January 2017

During the nineteenth century the inhabitants of the remote island of St Kilda persisted in their belief that they were susceptible to disease if exposed to infection brought by visitors; these ideas were the source of much ridicule. The emigration of thirty-six islanders to Australia in 1852 resulted in excessive mortality during the voyage compared with other Highland emigrants, and the 1930 evacuation to the mainland of Scotland also revealed their susceptibility to tuberculosis.
The Clydesdale Experiments: An Early Attempt at Resuscitation
Authors: Pattison F.L.M.
Published: January 2017

An account is given of an attempt, early in the last century, to resuscitate an executed criminal by electrical stimulation.
Admissions of Drug Addicts to a General Hospital: A Retrospective Study in the Northern District of Glasgow
Authors: Horn E.H. , Henderson H.R. , Forrest J. A. H.
Published: January 2017

Medical and surgical admissions of drug addicts to Stobhill Hospital, Glasgow in the period 1980–1984 were reviewed. Admission numbers, which totalled 123, rose markedly over the period of the study, particularly in the final year. The mean age of addicts was 21 years. Ninety-two per cent abused heroin but many abused combinations of drugs. Inadvertent narcotic overdosage was the commonest diagnosis amongst medical admissions followed by deep venous thrombosis. A small number of cases of staphylococcal endocarditis presented particular problems in diagnosis and management. The commonest reason for surgical admission was abscess formation. Whilst 85% of addicts showed markers of past infection with hepatitis B, chronic carriage of surface antigen occurred in only 10%. Few addicts had withdrawal symptoms although the practice of narcotic and/or tranquilliser prescribing varied. Many admissions were of short duration with 36% ending in patients taking their own discharge. Only 16% of addicts were notified to the Home Office.
Seminoma of Testis: The Value of Aggressive Therapy, and Risk of Late Bilateral Involvement
Authors: Johnston D.H. , Kyle J. , Rankin R.
Published: January 2017

The results of aggressive therapy for seminoma of the testis have improved dramatically during the past decade. A patient who eight months after orchidectomy had a pulmonary metastasis excised and who nine years later developed a seminoma in the contralateral testis is described. One consequence of the much longer survival time now attainable is that an increasing number of cases with metachronous testicular seminomas may be encountered in the future.
Acth Deficiency: Hypothalamic or Pituitary in Origin?
Authors: Gordon D. , Beastall G. H. , Thomson C. , Thomson J. A.
Published: January 2017

The level within the hypothalamic-pituitary axis at which isolated ACTH deficiency occurs, can be more clearly identified by assessing this axis with corticotrophin-releasing factor (CRF) and insulin induced hypoglycaemia. We report a case where lack of response to both tests, suggests a pituitary origin for this rare endocrine deficiency.
Hyperprolactinaemia and Nonpuerperal Lactation Associated with Clomipramine
Authors: Fowlie S. , Burton J.
Published: January 2017

Clomipramine in therapeutic dose was associated with nonpuerperal lactation and an elevated plasma prolactin. Both features resolved within weeks of discontinuing the drug.
A Case of Eye Disease Due to Dietary Vitamin a Deficiency in Glasgow
Authors: Buchanan N.M. , Atta H.R. , Crean G.P. , McColl K.E.L.
Published: January 2017

A 22 year old Caucasian girl living in Glasgow presented with eye disease due to Vitamin A deficiency. There was no evidence of liver disease or malabsorption and the vitamin deficiency was found to be due to her bizarre dietary habit.
A Retrospective Survey of Asthma Management in Hospital
Authors: Bucknall C. E. , Moran F. , Stevenson R. D.
Published: January 2017

A retrospective survey of asthma admissions to general medical units during 1983 is described. 127 cases occurred, of whom 52 were males (44%). The average age was 45.2 years. Forty-eight per cent were receiving inhaled steroids or cromoglycate before admission and 16% regular oral steroids. Initial assessment seldom included peak flow measurement although these were made subsequently in 57%. No steroids were used in 32% of cases. No oxygen was given in 48% of cases and when used was usually at low flow rates. Apart from a reducing course of steroids, 46% of cases were discharged with no increase in pre-admission maintenance treatment and although follow-up was planned for 76% it was for an average 4.9 weeks later. This survey suggests a tendency to under-treatment and undersupervision of asthma patients admitted to acute general medical wards which may well be a cause of unnecessary morbidity.
Crigler-Najjar Syndrome: Treatment at Home with Phototherapy
Authors: O'Reilly C. , Dixon R.
Published: January 2017

An infant became jaundiced in the neonatal period. The serum bilirubin failed to fall with phototherapy. A diagnosis of Crigler Najjar type 1 syndrome was made by exclusion and confirmed by liver biopsy. The infant has been successfully treated at home with phototherapy. Liver transplantation remains a therapeutic option.
Unilateral Pleural Effusion as the Presenting Feature of Ovarian Hyperstimulation Syndrome
Authors: Anderson K. , Haxton M. , Banham S. , Black W.P.
Published: January 2017

Ovarian hyperstimulation syndrome occurred in a 32-year-old woman who presented with symptoms from a large unilateral pleural effusion which was the predominant feature in her case. The aetiology of the effusion was initially uncertain in view of the relative absence of ascites suggesting that the effusion arose because of a primary pleural abnormality.
Air Gun Pellet Embolism
Authors: Taggart D.P. , Mackenzie I.
Published: January 2017

Air gun injuries are traditionally regarded as trivial unless they penetrate vulnerable superficial organs such as the eye, and demands for tighter controls have been largely disregarded. We report a unique complication of a penetrating air gun pellet which emphasises the potential lethal capability of these weapons.
Beware Beta-Adrenergic Blockers in Patients with Severe Urticaria!
Authors: Howard P.J. , Lee M.R.
Published: January 2017

The risks of beta-blockers in asthmatics are well known. However, there are increasing reports of severe, and often refractory, anaphylaxis in patients taking beta-blockers who experience other allergic phenomena. We describe the case of a 69-year-old lady with long-standing recurrent angio-oedema and giant urticaria who was placed on atenolol. Mechanisms whereby beta-blockers may precipitate or exacerbate anaphylaxis are outlined and the treatment of patients with anaphylaxis, taking beta-blockers, is discussed.
Alexander Wood (1725–1807): Deacon of the Incorporation of Surgeons, Surgeon-in-Ordinary, Edinburgh Royal Infirmary, and ‘Doctor of Mirth’
Authors: Rix K.J.B.
Published: January 2017

This account of the Edinburgh surgeon, Alexander Wood (1725–1807), brings together information from a number of sources including the diaries of his friend and patient, James Boswell, and anecdotes recorded by James Paterson who wrote the biographical notes for Kay's Portraits. Wood was a fashionable eccentric who took a sheep and raven on his home visits and he was as popular with the poor and working classes as he was with more well-to-do patients. He was a Deacon of the Incorporation of Surgeons and one of the first Surgeons-in-Ordinary at Edinburgh Royal Infirmary. His clinical skills were admired by patients and colleagues alike and he did much to enrich the life of the Edinburgh medical fraternity.
Benign Monoclonal Gammopathy in the Elderly — A Prevalence Study and Review
Authors: McMurdo M.E.T. , Mitchell P.E.G.
Published: January 2017

Monoclonal gammopathy of uncertain significance (MGUS) may present the clinician with diagnostic difficulties. This paper reviews the literature relating to MGUS, presents findings of a local prevalence study, and provides advice on monitoring.
Ophthalmopathy in Early Thyrotoxicosis — Relationship to Thyroid Receptor Antibodies and Effects of Treatment
Authors: Atta H.R. , McCreath G. , McKillop J.H. , Forrester J.V. , Thomson J.A. , Wilson R. , Gray H.W.
Published: January 2017

A prospective study of 25 newly diagnosed thyrotoxic patients was undertaken to determine the incidence and severity of ophthalmopathy in the early stages of the disease. A quantitative analysis of the ocular muscle changes was made using B scan ultrasonography, and the effects of treatment for the thyroid disease on the course of the eye changes was assessed. Although the majority (75%) of patients showed only mild clinical signs of ophthalmopathy (Werner Class 3 or less), 92% had ultrasonographic evidence of ocular muscle enlargement. Clinical involvement of the extraocular muscles was seen in 12% of the cases. There was an inverse correlation between the serum level of thyroid stimulating hormone receptor antibody (TR Ab) and the size of the extraocular muscles. Recovery of the euthyroid state with treatment was accompanied by a decrease in orbital infiltration in some cases, both clinically (reduced amplitude of intraocular pressure rise on elevation of the globe) and by ultrasonography, but the improvement was not statistically significant.
Diverticulosis of the Appendix
Authors: Sharp J. F. , Nicholson M. L. , Fossard D. P.
Published: January 2017

Diverticulosis of the appendix is rarely reported. Two cases with this condition, including a unique example of appendiceal diverticulosis presenting at herniorrhaphy, are described. The aetiology of the condition and factors involved in incidental appendicectomy are considered.
The INR — A Help or a Hindrance to Warfarin Dosage?
Authors: McQuaker G. , Morrison M. , Caldwell A. , Fitzsimons E.J.
Published: January 2017

We have examined the INR values of 128 warfarin patients obtained by four different techniques in common use in Scotland namely venous and capillary Thrombotest and venous and capillary Prothrombin Time (PT). The PT INRs were carried out using Manchester Reagent thromboplastin. Discrepant INR values were obtained. The mean Manchester venous INR values were lower than those obtained by the other three methods (p<0.0001). This suggests that patient's dosed by reference to Manchester venous INR are liable to receive more warfarin than those dosed by the other methods.
Neutrophil Count and Activation in Vascular Disease
Authors: Jackson M.H. , Collier A. , Nicoll J.J. , Muir A.L. , Dawes J. , Clarke B.F. , Bell D.
Published: January 2017

An elevated peripheral leucocyte count is associated with an increased risk of myocardial infarction and progression of coronary artery disease. The aim of this study was to determine neutrophil count and activation, measured as an increase in plasma neutrophil elastase, in patients with stable ischaemic heart disease, insulin-dependent diabetes mellitus and essential hypertension compared with a comparable group of control subjects. Neutrophil count and neutrophil elastase were raised significantly for patients with ischaemic heart disease (p< 0.005; p< 0.002), diabetes mellitus (p< 0.001; p< 0.01) and hypertension (p< 0.05; p< 0.0001) respectively compared to the control subjects. Neutrophil elastase did not correlate with subject age or leucocyte count. This study confirms the association between leucocyte count and vascular disease, and is consistent with neutrophil activation contributing to the progression of vascular disease.
A Review of Caesarean Sections at 30 Weeks Gestation or Less in the West of Scotland 1988–1989
Authors: Dodgson J. , Mackenzie F. , Forrest C.A.
Published: January 2017

A retrospective study was carried out of caesarean sections at 30 completed weeks of gestation or less between 1/1/88 and 31/12/89 in Glasgow and The West of Scotland.

One hundred and thirty-three caesarean sections were carried out resulting in 150 babies. Fifteen (11.3%) of these were classical sections. There were 30 neonatal deaths. The perinatal mortality rate was 170 per 1000. Survival was related to increasing gestation from 27 weeks onwards and also to birthweight from 900 grams onwards. In-utero transfers fared badly with seven out of 21 babies (33%) failing to survive beyond the neonatal period. Although survival continues to improve in newborns, the use of caesarean section should still be viewed with caution as the benefits in the very premature situation with regard to infant survival may be outweighed by the increased maternal morbidity both in the present pregnancy and future pregnancies.
Use of Beta-Blockade in a Patient with Phaeochromocytoma and Asthma
Authors: Bevan E G , McInnes G T
Published: January 2017

This case report describes a patient with co-existing phaeochromocytoma and bronchial asthma. She had no asthmatic symptoms at the time of diagnosis of phaeochromocytoma; her asthma recurred after adrenalectomy. Despite concern about the use of a beta-blocker in a patient with asthma, pre-operative tachycardia was successfully treated with the beta-1-selective adrenoreceptor antagonist, metoprolol.
Small Bowel Adenocarcinoma Complicating Crohn's Disease
Authors: Ellamushi H.E. , Smith I.S.
Published: January 2017

Crohn's disease of the small intestine is usually managed by medical therapy with surgery being reserved for obstruction or fistula formation. A patient is described who developed small bowel obstruction due to an adenocarcinoma of the ileum after over twenty years of medical therapy for Crohn's disease, originally diagnosed at a laparotomy for acute abdominal pain. The possibility of malignancy in such long-standing disease should be considered.
Scottish Women Medical Pioneers: Manchuria 1894 — 1912
Authors: Tsai H.H.
Published: January 2017

In Edwardian Britain, less than 2% of all registered medical practitioners were women. Yet during that era, women played a significant role in providing medical care and education in what were lonely, harrowing and difficult conditions in the Third World. This is the story of how a group of Scottish women doctors brought Western medicine to a remote region of Manchuria between 1894 and 1912.
Atrial Myxoma: A Rare Cause of Progressive Exertional Dyspnoea
Authors: Gray J.B. , Bridges A.B. , McNeill G.P.
Published: January 2017

A 40 year old man suffered eight years of vague but disabling symptoms, initially thought to be related to post viral fatigue syndrome, but ameliorated by the removal of a large atrial myxoma. The diagnosis of atrial myxoma is notoriously difficult, but should be excluded by echocardiography if there are predominant symptoms of progressive exertional dyspnoea, even in the absence of cardiological signs.
Computerised Tomography and Stroke
Authors: Cassidy T.P. , Lewis S. , Gray C.S.
Published: January 2017

To evaluate the utilisation of CT diagnostic imaging in patients admitted to hospital with a clinical diagnosis of stroke, and to identify factors which influence the use of CT imaging in stroke.

Two hundred and fifty consecutive (155 females) stroke patients were assessed median age 76 years (range 39–95y). Ninety-seven patients underwent CT scanning; median time to scanfrom admission was two days (range 0–43). The time to CT scanning was significantly shorter in patients aged <65 years (p<0.001), and in patients with a non-disabling stroke (p<0.05). The factors (odds ratios and 95% confidence limits) significantly associated with CT scanning were male sex (2.21: 1.31–3.74); normal Glasgow coma score (2.48: 1.59–3.85); Rankin score 1 – 3 (6.40: 1.74–23.56); age <65 years (10.23: 4.49–23.32) and no previous cerebrovascular event (1.97: 1.10–3.51).

In this study, those patients who would benefit most from medical intervention with antiplatelet agents to reduce the risk of recurrence were more likely to receive CT diagnostic imaging.