bluuebunny/crossref_metadata_2025 huggingface dataset:
TB across the Globe (3) Tuberculosis in Russia
Authors: Healing T.D. , Peremetin G.G. , Lyagoshina T. , Mishustin S. , Trusov A. , Goncharova K. , Rybka L.
Published: January 2017

This paper was presented in place of one that was to have been given by the late Professor A. G. Khomenko, Director of the Central Tuberculosis Research Institute, Moscow. Professor Khomenko had a long and distinguished career and with his death Russia has lost one of its finest and most active workers in the fight against TB.
Issues Facing TB Control (2.1) Tuberculosis Control in Refugee Populations: A Focus on Developing Countries
Authors: Bodiang Claudia Kessler
Published: January 2017

Today's worldwide tuberculosis epidemic and the movement of a growing number of refugees overlap geographically and have made tuberculosis control in refugee populations an issue of increasing importance. However, in developing countries, where both of these problems are concentrated, tuberculosis control in refugee populations remains a largely unmet need. Experience shows that despite difficult field conditions, tuberculosis control programs can be managed successfully in this setting. The analysis of information available from previous experiences served as the basis for formulating the main policies which, if applied consistently, will reduce morbidity, mortality and transmission of tuberculosis among refugee populations living in camps. The recommendations given are in line with those of the guideline recently produced by the World Health Organization.
The Risks of Ear Piercing in Children
Authors: Macgregor D. M.
Published: January 2017

Body piercing, and particularly ear piercing is becoming increasingly common in young children who may not be capable of properly caring for the pierced site. This may result in infection at the site and embedding of the earring. Infection and the subsequent necessity of removal of such earrings can cause considerable pain and distress. There is also a proven risk of inducing nickel allergy in these children which can be a problem in later life. The potential for serious infection such as Hepatitis B, Hepatitis C and HIV is not appreciated by the parents of these children.
Police Officers' Knowledge of, and Attitudes Towards, Mental Illness in Southwest Scotland
Authors: Carey S.J.
Published: January 2017

Questionnaires were sent to all operational officers in a regional police service regarding their level of knowledge about and attitudes towards, mental illness. It was widely accepted by police officers that mental illness occurred commonly, can be effectively treated in the community and that the main risk of harm is to patients themselves. There was a good knowledge of relevant legislation, but most officers felt they did not have sufficient training in mental illness, and were keen for more. Improved liaison between sector psychiatrists and local police may be of value in the earlier identification and treatment of the mentally ill.
Rediscovering the Joy of Food: The Need for Long-Term Review of Swallowing Ability in Stroke Patients
Authors: Harper J.R , McMurdo M.E. T. , Robinson A.
Published: January 2017

Stroke is commonly associated with dysphagia, which may necessitate the use of enteral feeding best provided by a percutaneous endoscopic gastrostomy (PEG) tube. Resolution of dysphagia complicating stroke is observed in the days, weeks and months following the event. This may allow the resumption of a normal diet, and cessation of enteral feeding. However at the time dysphagia resolves many patients—with enteral feeding still in place—will have been discharged from facilities where expert speech and language therapy is available to assess recovery of swallow. We report three cases of patients with dysphagia following stroke who benefited from long term review of swallowing ability. We then discuss the benefits of such follow-up, and how it might best be achieved in the community.
Fractures in Medieval Scotland
Authors: MacLennan W.J.
Published: January 2017

The prevalence of fractures in medieval Scotland is assessed, particular attention being given to excavations of cemeteries beside three Carmelite cemeteries, at Aberdeen, Perth and Linlithgow, and another one at Whithorn Abbey. In the friaries the prevalence of fractures was 7.6% and in Whithorn it was 5. 0%. These figures are comparable with an estimated prevalence of 7.2% for individuals between 0 and 65 years in present day Scotland. Males were more at risk of fractures than females, but a small group from both genders had been struck on the head by weapons. A study from a rural cemetery in England indicates that both male and female peasants had a much higher risk of fractures than their urban counterparts.
Myocardial Infarction in Men and Women under 65 Years of Age: No Evidence of Gender Bias
Authors: Bannerman A , Hamilton K , Isles C , Barrington H , Donaldson B , Lockhart L , McMeeken K , Mark J , Norrie J
Published: January 2017

We examined short and long term outcomes of MI in a consecutive series of 169 men and 50 women who were followed for an average of 3.5 years. Similar percentages of men and women were admitted to medical intensive care, received in-patient cardiac rehabilitation, quit smoking at one year, were still smoking, were taking a lipid lowering drug or had returned to work at one year, underwent coronary angiography at 3.5 years or had died by 3.5 years. The lack of gender difference in outcome may reflect an absence of gender bias in the management of men and women with MI in southwest Scotland.
Audit of a Change in Otolaryngology Discharge Letters Using the Scottish Intercollegiate Guidelines Network (Sign) Recommendations
Authors: Lee M. S. , Nunez D. A. , Lamont H. J.
Published: January 2017

Hospital and general practitioners should establish good communications so that continuity of care can be maintained when patients are discharged from hospital. A discharge letter was routinely prepared utilizing the standardized morbidity registration forms by the house surgeon for delivery to the patient s general practitioner. The authors developed a new discharge letter, which was sent under separate cover to the general practitioner. The two discharge letters were assessed utilising data fields recommended by the Scottish Intercollegiate Guidelines Network (SIGN).

A total of 162 consecutive paediatric patient discharges were identified. The mean number of items present in the existing and the new discharge letters were 13.7 + 1.8 and 12.2 + 3 respectively. The new discharge letter met the SIGN guidelines more closely than the existing discharge letter.
Cardiac Troponin T in Female Athletes during a Two-Day Mountain Marathon
Authors: Shave RE , Dawson E , Whyte P G , George K , Ball D , Gaze C D , Collinson P
Published: January 2017

Background: Equivocal studies exist on the potential of cardiac damage following prolonged endurance exercise. Aims: The aim of the study was to examine humoral markers of cardiac damage in female athletes during a 2-day mountain endurance race. Methods: Venous blood samples were drawn from seven female competitors prior to, and immediately following day-1 and day-2 of the event. The serum was analysed for total creatine kinase (CK), creatine kinase isoenzyme MB (CKMB), and cardiac troponin T (cTnT). Results: Elevations in CK and CKMB were apparent following day-1 of the event (mean ± SD; CK 84.1±54.6 mg/L vs. 387±276.7 mg/L, CKMB 2±1.7 mg/L vs. 5.9±1.7 mg/L) and subsequently rose further following race completion (CK 743±500 mg/L, CKMB 11.9±4.9 mg/L). Elevations in cTnT were noted in three competitors following day-1 cTnT (range 0.013–0.044 mg/L) and remained elevated in two competitors following day-2 (range 0.014–0.017 mg/L). Conclusions: The elevations in cTnT likely represent release from the cytosolic fraction. The mechanism responsible for such release is yet to be elucidated.
Endoscopic Surveillance Practice for Barrett's Oesophagus in Scotland and Early Experience in Implementing Local Guidelines
Authors: Shen E F , Gladstone S , Milne G , Paterson-Brown S , Penman I D
Published: January 2017

Management of columnar lined oesophagus (CLO; Barrett s oesophagus) is controversial. We prospectively audited surveillance practices in Scotland and prospectively assessed the impact of introducing local guidelines for Barrett s surveillance in Edinburgh. Most respondents were gastroenterologists. The majority take random, not four quadrant, biopsies from the CLO. In Edinburgh during 2000, 80 patients underwent surveillance. The guideline protocol was not followed in 30 (37.5%) patients. Follow up of patients without dysplasia generally conformed to the guidelines. Follow up of patients with low grade dysplasia was highly variable while management of those with high grade dysplasia followed the guidelines. Overall we found a wide variability in the management and surveillance of CLO. Early experience suggests that implementation of guidelines is helpful but there is still variation in practice.
A Comparison of Travel Related Id Admissions in Glasgow: (1985; 1998/99)
Authors: Cossar J H , Wilson E , Kennedy D H , Walker E
Published: January 2017

A comparative study was made of patients admitted over 12 months to the principal infectious diseases unit for Glasgow in 1985 and in 1998/99. During this interval UK travel statistics show a 135% growth in visits abroad and a 5% rise to 17% in destinations with a risk of malaria. Travel associated admissions rose by 96% to a total of 108. Patients of Asian/Oriental ethnicity declined from 55% to 18%, whilst Caucasians increased from 38% to 81%. Travellers aged 20–39 years formed the modal age groups (51% and 50%). Gastro-intestinal problems accounted for the largest single diagnostic category in both study periods, 38% and 40% respectively. In-patients diagnosed with malaria fell by 20%; these figures are cause for encouragement to those involved in the teaching and dissemination of advice on malaria prophylaxis. The findings re-enforce the need for the continuation and expansion of travel health education for both healthcare professionals and the public.
Consultants in NHS Scotland: A Survey of Work Commitments, Remuneration, Job Satisfaction and Retirement Plans
Authors: French F H , Andrew J E , Awramenko M , Coutts H , Leighton-Beck L , Mollison J , Needham G , Scott A , Walker K A
Published: January 2017

Abstract Background and Aims: UK consultants have reported working long hours, increased stress and reduced morale. This study set out to elicit consultants' views on flexible working and to gather data on consultants' workloads, remuneration, job satisfaction and retirement plans. As such it is the first comprehensive study of consultants in NHS Scotland. Methods. The Information and Statistics Division of the Scottish Executive Health Dept provided a list of consultants working in NHS Scotland. Focus groups and interviews informed the design of a postal, self-completion, questionnaire. Results: The response rate was 61%. Almost two-thirds (65%) of respondents felt their workloads were unreasonable and unsustainable and 67% were unable to provide their desired standards of patient care. Two-thirds (67%) did not normally take meal breaks, 63% had insufficient time for outside interests, whilst 44% felt their health was being adversely affected. Many (84%) believed that some of their work could be delegated to someone less qualified but 79% agreed that there were insufficient staff to make this possible. The average planned retirement age was 60 years, with 23% describing their plans as definite and 70% as quite or very likely. When asked what might induce them to postpone retirement, 50% cited reduced workload/work intensity. Conclusions: In 2003, a majority of consultants in the UK voted in favour of the new consultant contract. This will improve consultant pay and introduce a standard 40-hour working week, including worked on-call. This should address tow of the main areas of consultant dissatisfaction in NHS Scotland. However, staff shortages will require to be addressed if the contract is to be successfully implemented.
Improvements in Carotid Endarterectomy in Scotland: Results of a National Prospective Survey
Authors: Pell J P , Slack R , Dennis M , Welch G
Published: January 2017

Abstract Background and aims: The effectiveness of carotid endarterectomy (CEA) depends upon selection of patients with a high absolute risk of stroke, avoidance of delays from initial presentation to surgery and provision of surgery with a low perioperative risk of stroke. We evaluated these aspects of practice in Scottish hospitals and, by encouraging adherence to national (SIGN) guidelines, attempted to improve the effectiveness of CEA. Methods: Prospective independent survey of patient selection, pre-operative delays and surgical performance for all CEAs performed in Scottish National Health Service hospitals over two 13 month periods from September 1997 and February 1999 respectively. Results: Thirteen hospitals performed 485 CEAs in the first period and 392 in the second, equating to an overall annual rate of 79 per million population. During both periods at least 95% of patients reported symptoms of carotid territory ischaemia, but the proportion with stenoses greater than > 70% rose from 89% to 97% (p < 0.0001). The delays between referral, surgical consultation and subsequent surgery fell significantly but remained unacceptably long. The proportion seen by the surgeon within two weeks of referral rose from 36% to 43% (p=0.05) and the proportion operated on within one month thereafter rose from 35% to 49% (p < 0.0001). The perioperative combined major stroke and death rate was 3% in both periods. Conclusion: We demonstrated significant changes in practice, in line with national guidelines, which would be expected to improve the effectiveness of our national programme of CEA. There is further scope for improving performance, particularly in relation to pre-operative delays.
Monitoring Mortality in General Practice in Grampian, Scotland
Authors: Nimmo A W , Peterkin G , Coid D R
Published: January 2017

Information on the distribution of mortality and morbidity in general practice is scarce, and not easily accessible either by health authorities or individual general practices. Although the assessment of population mortality is a standard public health measure, colleagues in public health, information sciences and general practice rarely undertake such activity related to general practice populations. Mortality information can be used for various purposes. Examples are providing background data for clinical audits or alerting practitioners to quality issues in the healthcare industry or even suggesting environmental hazards. We measured the experience of mortality in all generally practices in Grampian in the years 1991 to 1999. All practices were notified of their actual and expected mortality over this period of time and asked for comment. Only three general practices had excess mortality experience in both the periods 1991 to 1995 and 1996 to 1999. Only a minority of practices commented on the results. It appears that a high presence of nursing homes in a practice might skew the results; this phenomenon will be central to further inquiry. Future methodology for recording death in general practice should take account of this, as well as providing an account of the qualitative aspects of patients' need for a dignified, satisfactory death.
Deafness in a Young Musician: A Case of Missed Diagnosis
Authors: Newton J R , Morley K D , Hussain S S M
Published: January 2017

Hearing loss in a young adult can be devastating and prompt diagnosis and treatment of the cause are vital. This case report is of a young musician presenting to the ENT surgeons with deafness and a lower motor neurone facial nerve palsy which was given a presumptive diagnosis of infective pathology but subsequent investigations indicated this was an uncommon presentation of Wegener's Granulomatosis. Treatment involved systemic Cyclophosphamide followed by steroids and Azathioprine. Two years after commencing therapy the disease remains under control but the patient is left with bilateral hearing aids and a grade 3 facial nerve palsy. Diagnosis and treatment of this multi-system disease are discussed.
First Seizures, the Epilepsies and other Paroxysmal Disorders Prospective Audit of a First Seizure Clinic
Authors: McFadyen MB
Published: January 2017

Background: Despite high life time prevalence of first seizures there is a dearth of information relating to uptake and efficient use of resources for first seizure services. Aims: To determine referral pattern, epilepsy and non-epilepsy diagnoses, investigations performed, follow-up appointments generated and resource utilisation at a first seizure clinic. Methods: A prospective study of 200 consecutive attendees was performed over a 16 month period at a first seizure clinic in the Institute of Neurological Sciences, Glasgow. Results: 139(69.5%) patients were general practitioner and 61(30.5%) hospital referrals. Fifty-six (28%) patients were newly diagnosed with epilepsy and 26(13%) with an unprovoked first seizure. Alcohol and/or drug abuse were contributing factors in 23 patients or 19.5% of all seizure cases. Twenty-one (35%) of 62 EEGs contained epileptiform activity which assisted with an epilepsy diagnosis. Overall 22(29%) of 77 CT head scans disclosed abnormalities and 20(36%) of 56 in those with an index event of seizure. Brain tumours were identified in four patients or 5% of all patients who underwent CT scanning. All patients with an epilepsy diagnosis were offered follow up with a consultant neurologist and epilepsy nurse specialist. Late cancellation and non-attendence rates were 35–40% for initial clinic appointments and 16% for first seizure clinic review appointments. Conclusion: With provision of fast track, easy access first seizure services, individuals may be more likely to both attend and present earlier with fewer seizure events at first contact.
Restricting Sales of Paracetamol Tablets: Effect on Deaths and Emergency Admissions for Poisoning in Scotland 1991 – 2002
Authors: Inglis J H C
Published: January 2017

Objective: To identify any effect on deaths and emergency admissions for poisoning resulting from the restriction on paracetamol sales introduced in September 1998. Setting: Scotland Data: Deaths from poisoning were extracted from the General Registrar (Scotland) Office annual reports for 1991 to 2001 and emergency admissions data for 1990/91 to 2001/02 was supplied by the Information and Statistics Division of NHS Scotland. Results: Deaths In the early 1990s, deaths from all poisonings and deaths from paracetamol poisoning were stable. After the restrictions deaths from all poisonings remained stable. Deaths from paracetamol poisoning fell by 45% in 1998 but have risen in each of the three years since to reach pre-restriction levels. Results: Emergency admissions In the early 1990s all poisonings rose steadily. Following the restrictions all admissions fell by 10% and paracetamol poisonings fell by 14%. All admissions remained lower for a further two years but are now rising again. Paracetamol poisonings remained lower for a second year but the last two years have both seen 10% increases to reach record levels. Discussion: The restrictions caused a dramatic 45% fall in deaths from paracetamol poisoning and reversed a relentless upward rise in all admissions for poisoning. The benefits were short-lived lasting about two years. Deaths and admissions are rising again and admissions are at record levels. Conclusions: Restricting paracetamol sales resulted in significant health gain. Further restrictions and public education on this valuable but dangerous drug are both urgently needed.
More Selective Antenatal Coagulation Screening Tests Could Reduce Costs and Save Time without Compromising Maternal Safety
Authors: Murage A , Gaudoin M
Published: January 2017

Antenatal coagulation testing is commonly performed and yet there is no evidence on which to base practice. This retrospective review of testing and the results obtained in a one-year period at the Southern General Hospital, Glasgow, UK, showed that the majority of the tests were normal regardless of the clinical indication for testing. However, there was a significant association between thrombocytopaenia and an abnormal coagulation result (p<0.001). This analysis showed that the platelet count might be used to select patients who require subsequent coagulation studies without compromising maternal or fetal safety and with attendant savings in time and money.
Assessment of Absorption from Small Bowel
Authors: Watson W. C.
Published: January 2017

Malabsorption is suggested by a variety of clinical features. First suspicions are heightened by deficiency states such as anaemia, weight loss, hypocalcaemia, hypoproteinaemia, hypokalaemia and avitaminosis. Corroboration is most surely obtained by estimation of the daily faecal fat excretion, xylose absorption, or both.

Elucidation of the cause of the malabsorption may require a wide range of investigations.
Retinopathy Due to Chloramphenicol
Authors: Lamba P. A. , Sood N. N. , Moorthy S. S.
Published: January 2017

A patient with toxicity due to chloramphenicol is reported. After administration of the drug for 17 days bilateral optic neuritis developed and retinal exudates were found. Haemorrhages were found in the macular area in each eye. There was a partial recovery of vision after stopping the drug. Peripheral neuropathy was observed a fortnight later.
Peptic Ulcer in Central Scotland
Authors: Dunlop J. M.
Published: January 2017

This article concerns the social class incidence, duration of symptoms, age at onset of symptoms and the blood groups of patients who were found during 1962 at Stirling Royal Infirmary to have peptic ulcer. The ulcer was either proven radiologically or was found at laparotomy which was being carried out for perforation, severe haematemesis or some other reason.

A low incidence in males of both gastric and duodenal ulcers was found in Social Class 3 and an increase in incidence in Social Class 4. Gastric ulcer in males tends to occur later in life than duodenal ulcer and in females there is a striking increase in duodenal ulcer in the 40 to 49 decade of life. The hypothesis is advanced that this may be due to hormonal changes. A second hypothesis is advanced that ‘secretors’ of blood group genotype AA, BB, or AB are immune to duodenal ulcer.
The Glasgow-Nairobi Link 1965–67
Authors: Kennedy J. S.
Published: January 2017

A Medical School has been established in University College, Nairobi, and started first year teaching in July 1967, with an intake of 25 students.

The Glasgow-Nairobi link, formed in 1965, has played a major part in this development by providing clinical teaching, based on the main Government Hospital in Nairobi, with volunteer students from Makerere University College Medical School. This arrangement will continue until the Nairobi 1967 intake reaches the clinical part of the curriculum.

It is probable that the link will have to be sustained for at least another 5 years to ensure a proper academic strength in the developing clinical and paraclinical departments.

Provision of new buildings and equipment is reasonably assured. The success of the new Medical School will be dependent on continued provision of adequate academic staff.
Psychiatric Service in 1967 at the Royal Infirmary of Edinburgh
Authors: Aitken R. C. B. , Carstairs G. M.
Published: January 2017

The psychiatric service provided at a large teaching hospital is reviewed. Epidemiological features are reported on the patients seen from 4 sources: poisoning treatment centre; general wards; psychiatric out-patient clinic; and accident and emergency department.

Substantial increase in the referral rates from the first two sources is noted. Distributions of the diagnoses are given, with details of the further management offered.
Negative Association between Allergy and Cancer
Authors: Ure Dorothy M. J.
Published: January 2017

In a survey of 140 patients in the gynaecology wards of a large general hospital, the subjects were asked whether they suffered from any of the common hay-fever type allergies, for example, to flowers, bedding dust, etc. An incidence of 20 per cent was established. Surgical and biopsy reports on this ward population established an incidence of malignant conditions at 28 per cent. These two groups of comparable age turned out to be mutually exclusive.

Reports of pregnancy nausea were also taken. Previous susceptibility to this varied from none to severe, and correlated positively with reports of common allergic type reactions, and consequently, inversely, with liability to gynaecological cancers in later life. The possible significance of this result in the studies of cancer is discussed.
Renal Papillary Necrosis and Aspirin
Authors: Prescott L. F.
Published: January 2017

Unexplained renal papillary necrosis with macrocytic anaemia was present in a 58-year-old man who had taken approximately 7 tablets of aspirin daily for 2 to 3 years. There was no history of regular consumption of preparations containing phenacetin. The blood urea level was never elevated but the creatinine clearance was moderately reduced; there was impairment of urinary concentration and the excretion of titratable acid and NH4+ was abnormally low following administration of ammonium chloride.

There is considerable clinical and experimental evidence of the nephrotoxicity of salicylates and it is possible that the nephrotoxicity attributed to phenacetin could in many cases be due to the salicylate taken with it.
Congenital Dislocation of the HIP
Authors: Mitchell G. P.
Published: January 2017

Treatment of congenital dislocation of the hip depends on the age of the patient and on the assessment of the particular pathological factors present at the different stages of displacement.

Treatment at birth by routine examination for the ‘clunk’ sign is the only reliable method whereby normal joint development can be anticipated in almost every case.

Treatment in the early months of life may be complicated by intra-articular soft tissue obstruction. Particular care is essential to avoid pressure changes in the upper femoral epiphysis and metaphysis.

Dislocation after walking age is invariably accompanied by intra-articular obstruction and altered inclination of the acetabular roof. Traction reduction followed by surgical correction of the secondary pathological changes offers the best result as a routine in this age group.

Treatment of the late painful subluxation is always difficult but satisfactory results can be achieved by the pelvic displacement operation of Chiari.
Urinary Steroids in Depressive Illness
Authors: Sclare A. Balfour , Grant J. K.
Published: January 2017

A longitudinal study of urinary 17-OHCS in 16 depressive patients showed mean values within the accepted normal range. There were no significant differences between pre-treatment and post-treatment values; only the female patients showed a tendency to have somewhat lower post-treatment levels.

17-KS output was measured in 18 depressive patients. The mean values were within the normal range. There was no significant difference between pre-treatment and post-treatment values although the female patients displayed a tendency towards somewhat lower levels following treatment.

DHA and EA excretion were measured in 9 depressive patients. There was a very wide variance in the findings. There was no significant difference between pre-treatment and post-treatment levels.

The significance of the above findings is discussed. It is considered that measurements of urinary excretion of corticosteroids in affective disorders constitute a limited source of information.
The Mesangium of the Renal Glomerulus
Authors: Galbraith S. L.
Published: January 2017

The transport of injected thorotrast across the glomerulus of the frog kidney was studied following destruction of its mesangium. The results suggest that the mesangium contributes to the physiological integrity of the glomerular basement membrane and may therefore be a factor in the aetiology of glomerulonephritis.
Myelolipoma of the Adrenal Gland
Authors: Dean G.
Published: January 2017

Myelolipomas are uncommon lesions of the adrenal gland. Four cases are presented which were found at post-mortem examination and in biopsies received during the last 12 years in the Pathology Departments of the Western General Hospital and of the University of Edinburgh. The pathogenesis of the lesion, which so far has remained an enigma, is discussed in the light of previous reports in the literature. Certain factors emerge which may now be seen to play an important pathogenetic role.
Blood Loss from Cannulation Sites during Haemodialysis
Authors: Lindsay R. M. , Burton J. A.
Published: January 2017

The importance of reducing blood loss from any source in patients on regular dialysis treatment is generally recognised. This minimises blood transfusion requirements, and the consequent risks of serum hepatitis. Blood loss occurring from Scribner shunts and arteriovenous fistulae during routine dialysis has been measured. The blood loss from this source has been estimated as 1 to 2 litres per annum, and this may exceed the loss due to residual blood trapped in coil dialysers. The risks to the patients and staff due to this source of blood loss are emphasised.
Sonar in the Puerperium
Authors: Robinson H. P.
Published: January 2017

Sonar was employed as a diagnostic aid in 112 patients who had bleeding in the postnatal period. A significant quantity of intrauterine tissue was detected in 29 patients and clinical confirmation obtained in all 25 who were subsequently taken to theatre. Eleven of the 83 patients in whom sonar showed an ‘empty’ uterus also had an evacuation performed, and the sonar findings were confirmed in ten.

It is concluded that sonar provides reliable information on the presence or absence of retained intrauterine tissue, and that using this technique the number of unnecessary operations could be reduced.
Epilepsy after Non-Missile Head Injuries
Authors: Jennett B.
Published: January 2017

The incidence and character of epilepsy after post-natal, non-missile head injuries admitted to hospital has been studied in some 2,000 patients. A distinction is made between early epilepsy (first week after injury) and late epilepsy. Factors which predispose to late epilepsy have been identified, and methods evolved by which to calculate the probability that late epilepsy will develop. The significance of early epilepsy lies in the increased risk of late epilepsy, even if only one fit has occurred in the first week and the injury has been trivial.
New Surgical Approaches to Coronary Heart Disease
Authors: Bain W. H. , Lorimer A. R.
Published: January 2017

Coronary heart disease is now the principal cause of death in the Western world. In recent years a new surgical approach to the problem has been developed with encouraging results. The operation of aorto-coronary bypass grafting with autogenous vein relieves angina in the majority of patients. Whether or not the long term prognosis is improved is not yet known. A European multi-centre controlled trial has been organised to answer this question.
The Blood Coagulation and Fibrinolytic Enzyme Systems in Healthy Adult Africans and Europeans — A Comparative Study
Authors: Barr R. D. , Ouna N. , Kendall A. G.
Published: January 2017

In a comparative study of blood coagulation and fibrinolysis in healthy adult East Africans and Europeans, the Europeans were found to have some evidence of a relatively hypercoagulable state, and the European male had significantly reduced fibrinolytic activity and potential when compared to the African male. A parallel is drawn with the known prevalence of atheroma and thrombo-embolic disease in these populations and the suggestion made that the greater fibrinolytic activity of the African, perhaps resulting from a radically different diet, may account in large part for his relative freedom from atheromatous vascular disease.
Renal Effects of Diazoxide and Frusemide and Interrelattonships
Authors: Pohl J. E. F. , Swales J. D. , Thurston H.
Published: January 2017

The successful long-term control of diazoxide-induced Na retention in 52 hypertensive patients (mean creatinine clearance (Ccr) 38 ± 30.6 ml/min, range 1–123 ml/min) by the use of potent diuretics is reported. The mean duration of follow-up was 26.2± 14.4 months with a range of 3–52 months. The mean daily dose of frusemide was 344 mg (range 40–1000 mg). The mean daily dose of ethacrynic acid was 318 mg (range 100–800 mg). Rashes necessitating change of therapy were attributed to frusemide in seven patients.

Diuretic dosage, corrected for patient Na intake, was independent of diazoxide serum levels (S.L.) below 100 mg/litre but was inversely correlated with CCI (rdiuretic, NaCCI(S.L. constant)= −0.33 2P<0.05).

Concordant estimates of patient Na intake were obtained and the estimated mean daily Na intake of 121.2 ±62.1 mEq falls within the normal range. The eight patients with estimated mean Na intakes < 50 mEq/day (mean: 35 mEq/day) had a mean Ccr of 11.04 ± 5.98 ml/min whilst the 31 patients with estimated mean Na intakes > 100 mEqjday (mean: 158.9 mEqjday) had a mean Ccr of 48.92 ± 5.05 ml/min. This discrepancy was interpreted as due to a limitation in the ability to correct diazoxide-induced Na retention in patients with severe renal failure. In practice such patients are kept in balance by the use of more than one diuretic combined with a restricted Na intake.
Enhancement of Renal Blood Flow in Transplanted Dog Kidneys following Perfusion with Frusemide
Authors: Fernando O. N. , Newman S. P. , Hird V. M. , Sampson D. G. , Read P. R. , Moorhead J. F. , Williams H. S. , Hopewell J. P.
Published: January 2017

Frusemide was added to the perfusate used to flush kidneys prior to transplantation. The 133Xe wash-out technique was used to measure renal blood flows before and after transplantation and the clearance curves were analysed into cortical and medullary components. It is concluded that the addition of frusemide to the perfusate contributes significantly to the restoration of a satisfactory blood flow to a transplanted kidney.
Late Follow-up in Spina Bifida Cystica
Authors: Dougall A. J. , Grant J. C. , O'Connor J.
Published: January 2017

The further progress of the survivors in 1969, of a group of 150 babies born with spina bifida cystica in the period 1960–66 is described. Children with a meningocele continued to do well. Those with a myelomeningocele are divided into 2 groups. There were 4 late deaths and a considerable degree of handicap in the group of 23 in whom the spinal cord was exposed on the surface as a plaque at birth. There were 2 late deaths and a much lower incidence of handicap in the group of 25 in whom only ectopic nervous tissue was found in the sac at birth. The incidence and treatment of hydrocephalus is described. Changes in the attitude to the treatment of a neonate with a myelomeningocele are discussed.
The Treatment of Mycoplasma Pneumoniae Infections
Authors: Watson G. I.
Published: January 2017

Apart from several family outbreaks (Watson, 1961), I have encountered two widespread epidemics, each involving about 100 patients in a rural general practice in Surrey, one lasting about 9 months in 1963/64 and the second about 7 months in 1974/75 (Watson, 1967). Twenty-five unselected families in 1963/64 and 31 comparable families in 1974/75 were studied in greater detail than the rest.

This paper presents a comparison between the results of treatment in these two groups. Tetracycline or Oxytetracycline 250 mg. four times a day (q.d.s.) was the usual adult treatment in the first epidemic, with proportionately less of the Oxytetracycline 125 mg. syrup for children under 10 years. In the second epidemic adults were given erythromycin stearate 250 mg. q.d.s., while children received the ethyl succinate suspension q.d.s. in age-related doses. Treatment in both epidemics was usually continued as long as signs in the chest or coughing persisted.

The conclusion was that an erythromycin rather than a tetracycline is the drug of choice for a patient with an acute febrile chest infection by M. pneumoniae because (a) fever and coughing were reduced more quickly, (b) relapses were less frequent, (c) lethargy and slow convalescence were prevented or cleared in a few days, and (d) infectiousness was apparently reduced by erythromycin treatment.
Morbidity and Mortality in Salmonella Food Poisoning
Authors: Dickinson R. J. , Pickens S.
Published: January 2017

Forty-seven new patients with salmonella food poisoning were admitted to the Infectious Diseases Unit at the City Hospital, Edinburgh, during 1975. Although all the patients had diarrhoea at some stage of their illness, the wide variety of presenting symptoms caused some diagnostic difficulties prior to the isolation of the organism. A probable predisposing factor to serious disease was recognised in 15 patients. Twenty patients (42.5%) were seriously ill and 4 patients (8.5%) died. This series stresses the potential severity of this common disease.
Digoxin Therapy: A Clinical Pharmacokinetic Approach
Authors: Whiting B.
Published: January 2017

Within certain limitations, digoxin can be prescribed for individual patients on a sound scientific basis. The use of pharmacokinetic principles and digoxin radioimmunoassay can improve the overall quality of treatment with this drug and reduce the incidence of adverse reactions. Variations in bioavailability and intestinal absorption are important factors in the determination of dosage and should be reduced to a minimum by improved pharmaceutical formulations.
Serial Serum Amylase Levels in Patients with Pancreatic Pseudocysts
Authors: Donaldson L. A. , Joffe S. N. , McIntosh W.
Published: January 2017

The incidence of hyperamylasaemia in serial serum amylase levels from patients with pancreatic pseudocysts is not well documented in the literature. Accordingly serial amylase levels were estimated in 5 patients with proven pancreatic pseudocysts. The majority of the values were normal or only minimally elevated. In contrast the amylase thermolability was persistently elevated and appeared to be a more sensitive measurement than serum amylase activity for indicating the presence of pancreatic pseudocysts.
Sulphonylureas and Cardiovascular Disease: A Problem for Few Diabetics
Authors: Slater S. D. , Ireland J. T.
Published: January 2017

Because of the doubts cast on the safety of the sulphonylureas we analysed 1000 consecutive referrals to a diabetic clinic to identify the number of new patients equally suitable for treatment with a sulphonylurea or insulin. After excluding previously diagnosed and treated diabetics and those with a non-diabetic glucose tolerance test there were 531 new diabetics. Youth and insulin dependency, old age or obesity accounted for 390. A further 40 required diet alone, 50 had concomitant disease or socio-domestic circumstances influencing treatment choice, and 10 had secondary diabetes. Thus, only 41 diabetics ( 7.7% of new patients or 4.1% of total clinic referrals) appeared suitable for optional sulphonylurea or insulin therapy. We conclude that there are relatively few diabetics for whom the questionable safety of the sulphonylureas poses a therapeutic problem, and equally few who would be available for any further long-term, random-allocation trials of their effects upon the cardiovascular system.
The Danger of Hallucinogenic Mushrooms
Authors: Mills P. R. , Lesinskas D. , Watkinson G.
Published: January 2017

There has been a revival of interest amongst young people in the raw consumption of ‘wild’ Psilocybin mushrooms, because of their hallucinogenic properties. Seven cases of mushroom overdosage are described. Whilst the hallucinogenic mushrooms are relatively harmless, the dangers from inadvertent ingestion of commonly occurring poisonous varieties are emphasised.
An Evaluation of the 14C-Glycocholic Acid Breath Test in the Diagnosis of Bacterial Colonisation of the Jejunum
Authors: Watson W. S. , McKenzie I. , Holden R. J. , Craig L. , Sleigh J. D. , Crean G. P.
Published: January 2017

In order to assess the performance of the 14C-glycocholic acid breath test as an indicator of bacterial colonisation of the jejunum, 145 combined breath tests and jejunal aspirate cultures were carried out on a total of 50 subjects who had an increased probability of being colonised. Ninety-one of the 145 cultures were positive while only 31 of the breath tests were positive. This poor performance of the breath test relative to the aspirate culture can be predicted with reasonable accuracy from known bile deconjugating capabilities of bacteria found in the small intestine.
Acute Appendicitis in Pregnancy
Authors: Farquharson R. G.
Published: January 2017

A retrospective study of appendicitis in pregnancy in Aberdeen has been performed. The incidence, symptoms, findings at laparotomy and outcome are described. Delay in diagnosis is stressed as the causal factor in increased maternal morbidity and high neonatal mortality.
The Bone Scan in Clinical Practice
Authors: Fogelman I. , Boyle I. T.
Published: January 2017

Radioisotopic bone scanning using technetium-99m labelled phosphate and diphosphonate compounds is a relatively new method of imaging the skeleton which has rapidly assumed major clinical importance. In this review the pathophysiology of bone uptake of radiopharmaceutical, the relative sensitivity of bone scan and radiograph, and the more important uses of bone scanning in clinical practice are described.
The Treatment of Acute Myocardial Infarction
Authors: Poole N. W. , Wilson F. W. , Barber J. H.
Published: January 2017

A questionnaire on the management of acute myocardial infarction was sent to 100 randomly selected general practitioners. From the replies received, only 42 provided worthwhile information. The approach to the care and treatment of actual patients and their common complications is discussed and recommendations relating to future audits are made.
Andrew Moir: An Aberdeen Anatomist
Authors: Bayliss R. A.
Published: January 2017

Andrew Moir was born in 1806, educated in King's College, Aberdeen and graduated M.A. in 1826. After becoming M.R.C.S., England, in 1828, he was a private anatomy teacher. He opened an anatomy theatre with a group of colleagues, but the hostile public feeling led to a riot in December 1831, and the building was destroyed. Three men were subsequently imprisoned, and there were complaints of official lack of concern.

Moir was popular with medical students, and mentioned in two short-lived journals of 1831 and 1835. He continued to teach and later became lecturer at the revived medical school oj King's College. Moir died in 1844: he was hardworking, appreciative of past anatomists and enthusiastic about practical dissection, vigorously defending his science against detractors.
Clinical Appraisal of Baclofen in the Adult Stroke Patient
Authors: Irani M. S.
Published: January 2017

Little work, using comparable protocols, has been done using baclofen in the management of patients following stroke. Extrapolation from trials in patients with spasticity and other spinal or cerebral pathology is not justified, partly because the symptoms and signs of stroke vary. However the reliable work which has been done indicates that baclofen is superior to diazepam in reducing spasticity and flexor spasms and in improving mobility and self help. Baclofen is as effective as diazepam in relieving clonus and pain associated with spasticity. The effect on bladder function is not reliably known. Unwanted effects are few and not serious: drowsiness is the most common, but occurs more frequently and noticeably with diazepam. Side effects were more likely to occur with doses in excess of 60 mg/day, if dose increments were made too rapidly and in patients with Parkinson's disease. More work is required with baclofen in managing patients after stroke.
The Idiopathic Unstable Bladder and its Management
Authors: Taylor M.
Published: January 2017

The two main types of idopathic bladder instability are described using pressure recordings and the relationship to incontinence defined. In combination with urodynamic studies, using a micturating cysto-urethrogram recorded on videotape for future analysis, it is possible to correlate bladder pressures with physiological events.

Management of the unstable bladder is difficult and a variety of drug regimens have been attempted. Baclofen reduced detrusor-activity and produced a significant benefit in diurnal and nocturnal frequency and episodes of incontinence but not in enuresis. Seventy per cent of patients maintained this improvement three months after stopping treatment.
The Management of Prolactin-Secreting Pituitary Adenomas
Authors: McGregor A. M. , Rodriguez-Arnao M. D. , Scanlon M. F. , Hall K. , Ross W. M. , Hall R.
Published: January 2017

Advances in the investigation and treatment of pituitary tumours over the past decade have necessitated a major reappraisal of the management of these lesions. The recognition that prolactin-secreting pituitary adenomas (prolactinomas) not only represent a further sub-group of secretory tumours but may in fact be the commonest type of pituitary tumour has come at an appropriate time. Refinements in neuroradiological techniques and transphenoidal surgery and the introduction of the dopamine-agonist bromocriptine now offer prospects for early detection and effective treatment, either by selective adenomectomy or by non-invasive therapy with bromocriptine. In a study of 67 patients with large prolactin-secreting pituitary adenomas, 33 have undergone computerised tomography and metrizamide cisternography for assessment of tumour size. In ten of these patients repeat scans following bromocriptine therapy have shown reduction in prolactinoma size in eight. The two patients with no change in tumour size differed from the rest, having received a lower dose of bromocriptine and had prolactinomas as part of the multiple endocrine adenomatosis syndrome (Type I).
Inhibition of Puerperal Lactation
Authors: Walker Sheila M.
Published: January 2017

Bromocriptine has been compared with an oestrogen and a placebo in the management of the inhibition of puerperal lactation. In addition to the resolution of symptoms, the effect on plasma prolactin levels has been studied. Of the regimes employed, bromocriptine was shown to have some advantage and a scheme indicating its place on the general treatment of this condition is outlined.
Defective Fibrinolysis in Venous Thrombosis
Authors: Davies J. A. , Crandon A. J. , McNicol G. P.
Published: January 2017

In previous studies a variety of attempts have been made to define laboratory tests which could predict patients who would develop deep vein thrombosis post-operatively. Such tests included the partial thromboplastin time, haematocrit and platelet adhesiveness. In this study patients undergoing gynaecological surgery were screened in advance with a panel of clinical measurements and laboratory tests and the development of DVT was noted using 125I-fibrinogen leg scanning. The values for the selected variables were analysed using logistic discrimination. The factors with the greatest prediction were the euglobulin lysis time, age, varicose veins, serum FR-antigen and percentage overweight for height.

When this formula was applied to a further group of patients it allowed a ‘high risk’ group to be defined and these were given low-dose heparin with a significant reduction in the incidence of post-operative DVT.

An unexpected finding was that patients who smoked cigarettes appeared to be protected from post-operative DVT.
Recent Advances in the Understanding of the Pathogenesis of Complications in Diabetes Mellitus and Obesity
Authors: Almér L.-O.
Published: January 2017

In diabetes we have demonstrated an abnormal equilibrium between the endothelial F VIIIR: Ag and plasminogen activator. An increased level of F VIIIR: Ag will induce increased platelet adhesiveness, and a decreased plasminogen activator activity of the vascular walls and blood will lead to impaired degradation of thrombi occluding the microvasculature. These findings are common in all diabetics, although they are most marked in obese diabetics. In non-diabetics there is also a significant relation between relative weight and vascular fibrinolytic activity.