bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute Abdomen as a Cause of Death in Sudden, Unexpected Deaths in the Elderly
Authors: Ng CY , Squires TJ , Busuttil A
Published: March 2011

Aims

This study profiles patients aged 70 years or above dying suddenly of an ‘acute abdomen’ and investigates the specific features associated with the conditions and their diagnoses.

Methods

A retrospective study using data obtained from autopsy and police reports held in the Forensic Medicine Section of the University of Edinburgh.

Results

From 1997 to 2000, out of 2121 autopsies of patients aged 70 or above, an ‘acute abdomen’ was considered as a primary cause of death in 111 cases. The number of cases increased over the period of study. Peptic ulcer disease was the commonest underlying cause of death. Twenty-nine (26.1%) cases were due to its complications, namely gastrointestinal haemorrhage and perforation. Sixty-nine (62.2%) patients were seen by a medical practitioner in circumstances arising from the onset of acute abdomen. In 27 (39.1%) cases a provisional diagnosis was recorded.

Conclusion

The ‘acute abdomen’ is still an appreciably frequent cause of death in sudden, unexpected deaths in the older age group. Some of the deaths may have been preventable with an early diagnosis. A high level of vigilance and early attention to an ‘acute abdomen’ by medical practitioners is therefore advocated.
Oxidase Activity of Ceruloplasmin and Some Acute Phase Reactant and Trace Element Concentrations in Serum of Patients with Chronic Lymphocytic Leukemia
Authors: Gundogdu M , Kaya H , Gulcin I , Erdem F , Cayir K , Keles M , Yilmaz A
Published: March 2011

In the present study, we aimed to investigate the parameters in serum of patients with chronic lymphocytic leukaemia (CLL) and correlate with the cancer stage. The serum concentrations of ceruloplasmin, a-1-acid glycoprotein, albuminumin, transferrin, copper, zinc, manganese, and ceruloplasmin oxidase activity were measured, and compared with those from a healthy control group. The serum from 34 patients with CLL were extracted before chemotherapy. Serum transferrin, albuminumin and Zinc concentrations were lower in patients with CLL while serum a-1-acid glycoprotein, ceruloplasmin, copper concentrations, and ceruloplasmin oxidase activity were higher in CLL patients when compared with the control group. Although serum manganese concentration was lower in CLL groups than in the control group, the difference was not statistically significant. Serum transferrin concentration was lower in the early stage group compared with the advanced stage. Serum ceruloplasmin level positively correlated with serum ceruloplasmin oxidase activity in patients from the early stage group. Serum ceruloplasmin level positively correlated with serum ceruloplasmin oxidase activity in patients with advanced stage. In conclusion, increased serum ceruloplasmin oxidase activity, ceruloplasmin, a-1-acid glycoprotein, copper levels and decreased transferrin and albuminumin, unchanged manganese levels are associated with CLL and appear to be a consequence of the disease itself.
Presence of Herpes Simplex Virus on the Oral Mucosa in Patients Undergoing Chemotherapy
Authors: Djuric M , Pavlica D , Jankovic Lj , Milasin J , Jovanovic T
Published: March 2011

Background

The aim of this study was to confirm the presence of herpes simplex virus type 1 and 2 on the oral mucosa, in patients undergoing chemotherapy, by means of polymerase chain reaction (PCR).

Methods

The research was carried out on 40 patients receiving chemotherapy as treatment for different malignancies. The status of oral mucosa and viral presence were assessed in all patients at the initial examination (prior to chemotherapy), and at the control examination (two weeks after the initiation of the chemotherapeutic cycle).

Results

The presence of HSV-1 was detected in 28 patients (70%) prior to chemotherapy, of whom 7 (25%) manifested oral complications. The control examination showed the presence of HSV-1 in 35 patients (87.5%), of whom 23 (65.7%) presented oral mucosa changes. HSV-2 has not been detected in any of the patients.
Helen Wingate: Pioneering a Woman's Role in Urology
Authors: Ramsey S , Aitchison M
Published: March 2011

When the British Association of Urological Surgeons was founded in 1945, 2 female founder members registered. One of these was Helen Wingate, Associate Specialist in Urology at Glasgow Royal Infirmary and Consultant Urologist and General Surgeon at Redlands Hospital for Women, and a pioneer of women in urology. The early days of urology as a specialty at Glasgow Royal Infirmary, and the pioneering role played by Dr Wingate as a female consultant in a new surgical speciality are described in this article.
Shedding Light on a Dark Case
Authors: Paterson E W , Chapman A D , Dempsey O J
Published: March 2011

Endobronchial metastases should be considered in the differential diagnosis of an endobronchial mass. This case report describes an endobronchial presentation of malignant melanoma. The importance of immunohistochemistry techniques in securing a diagnosis are discussed.
Birth Weight and Maternal Glycated Haemoglobin in Pregnancies Complicated by Type 1 Diabetes
Authors: Kernaghan D , Penney GC , Pearson DWM
Published: March 2011

Aim

To re-examine the relationships between birth weight and maternal glycated haemoglobin (HbA1c) concentration at different time points in pregnancies complicated by pre-gestational type 1 diabetes.

Methods

A dataset was collected prospectively on all deliveries in Scotland to women with pre-gestational type 1 diabetes occurring during two 12 month periods (01/04/98 to 31/03/99 and 01/04/03 to 31/03/04). Relationships between standardised measures of birth weight and HbA1c at each time point were examined using correlation analysis.

Results

Standardised birth weights (Z scores) were calculated for 338 singleton live born infants. HbA1c concentrations were available for: 204 women (pre-pregnancy), 297 women (1st trimester), 314 women (2nd trimester) and 303 women (3rd trimester). Standardised birth weight showed a unimodal distribution shifted to the right relative to a reference population (Mean, +1.62 S.D). There was a significant negative correlation between pre-pregnancy HbA1c and birth weight (Spearman's Rho -0.138; p=0.049).

Conclusions

Standardised birth weights of the infants of diabetic mothers are higher than those of a reference population. There is no simple relationship between maternal glycaemic control and birth weight, but the previously described paradoxical inverse relationship between pre-pregnancy glycaemic control and birth weight has been confirmed using a larger dataset.
Vasectomy Reversal: Is the Microscope Really Essential?
Authors: Gopi SS , Townell NH
Published: March 2011

Objective

To evaluate the outcomes of bilateral vasectomy reversal procedure in relation to the macroscopic technique, surgical time and duration of obstructive interval.

Materials and methods

We performed a retrospective study over a twelve-year period using a macroscopic technique. All cases of vasectomy reversal were consecutive and performed by the same surgeon. The procedure was performed using a single layer, spatulate end to end anastomosis technique using 6×6-0 prolene. No loupe magnification was used.

Results

The median age of the men was 42 years (range 30-56). The median obstructive interval in years was 8.5 years (range 2-23). The procedure was a day case and the median surgical time under general anaesthetic was 75 minutes (range 45-90). None of the patients required hospital admission following discharge. 63 of the 70 patients had positive patency test postoperatively (90 %). The sperm count was more than twenty million /ml. The pregnancy rate was 54 % and the miscarriage rate was 7.1%.

Conclusion

The outcomes of macroscopic vasectomy reversal performed by an experienced surgeon can have a high success rate using the macroscopic single layer spatulate end to end anastomosis technique. This technique is easy to learn compared to the learning curve involved in microsurgery and is an effective means of “re- establishing” fertility in vasectomised men.
Clinical Audit: Optimal Positioning of Endotracheal Tubes in Neonates
Authors: Whyte KL , Levin R , Powls A
Published: March 2011

Background

The malposition of endotracheal tubes (ETTs) can be associated with endo-bronchial intubation or accidental extubation. A variety of methods have been reported for predicting insertional length (IL) including weight, nasal-tragus length (NTL) and sternal length (STL) measurements. In our unit no consistent predictor method was being used.

Aim

To audit the proportion of endotracheal tubes that required a significant position change after oral intubation. Our standard set was that the endotracheal tube should be in a satisfactory position in >80% of cases. If not met, practice would then be re-audited after a consistent predictor method had been implemented.

Methods

Data regarding changes in endotracheal tube position were collected. Significant position changes were defined as adjustments>0.5 cm.

Results

Twenty two babies were included in the initial audit, and only 73% of endotracheal tubes had a satisfactory position. Thirty six babies were included in the re-audit and when the nasal-tragus length predictor was used, 94% of endotracheal tubes had a satisfactory position, meeting the standard.

Conclusion

The nasal-tragus length predictor improved the accuracy of endotracheal tube positioning after oral intubation. It is a simple, fast, reproducible method and can be used in everyday practice to help avoid significant endotracheal tube malposition.
Nitrofurantoin-Induced Chronic Active Hepatitis In An Elderly Woman
Authors: Galperin I , Sonnenblick M
Published: March 2011

A 78 year-old lady who received nitrofurantoin for two years developed chronic active hepatitis. In spite of withdrawal of Nitrofurantoin her condition continued to deteriorate, and a liver biopsy revealed severe chronic active hepatitis. She was treated by prednisone which resulted in improvement in her liver function tests and her general condition. However, two months later the patient developed a relapse of severe hepatitis with hepatic failure and she died in spite of treatment.
Antıphospholıpıd Syndrome Wıth Lupus Erythematosus Presentıng Wıth Myocardıal Infarctıon.
Authors: Kaynar Kubra , Ulusoy Sukru , Gul Semih , Kılıcarslan Fatma , Oztuna Funda , Ahmetoglu Ali , Omay Serdar Bedii
Published: March 2011

Arterial and venous thrombosis is a prominent feature of antiphospholipid syndrome together with antiphospholipid antibodies. We report generalised thrombosis in a 28 years old male patient with antiphospholipid syndrome associated with lupus erythematosis. Firstly the patient had myocardial infarction. Eight months later he started to complain about oedema which was found to be secondary to nephrotic syndrome. In his third hospital day he developed pulmonary emboli. Tomographic angiography revealed left renal vein thrombosis, portal vein thrombosis, right renal infarct, pulmonary emboli. His tests for antinuclear antibody, anti dsDNA antibody and antiphospholipid antibody IgM were positive. After anticoagulation therapy and immunosupressive therapy he could have been disconnected from mechanical ventilator and his oedema nearly disappeared. This case clearly highlights the fact that antiphospholipid syndrome with systemic lupus erythematosus can present with myocardial infarction in young patients.
Wegener's granulomatosis presenting as polyneuropayhy – a case report and review of the literature.
Authors: Cunningham Caroline , Cleland Steve , Wilson Hilary , Barnetson Robert
Published: March 2011

We report a clinical case of a young, previously well woman who presented with multiple neuropathies, both peripheral and cranial and who was subsequently confirmed to have Wegener's Granulomatosis with minimal respiratory symptoms or renal involvement. The case illustrates the difficulties in diagnosing this rare condition when the cardinal features are not present, but serves to illustrate the importance of disease identification when other, atypical sites, that have a particular preponderance for morbidity i.e. the nervous system, are involved.
Spontaneous pregnancy fifteen years after diagnosis of premature ovarian failure
Authors: Wijesiriwardana A , Shetty A
Published: March 2011

We report an unusual case of spontaneous conception, occurring over fifteen years after the initial diagnosis of premature ovarian failure (POF). Her karyotype was 46XX. Following the diagnosis of POF, our patient was treated with hormone replacement therapy (HRT). Starting at the age of 31, she had several invitro fertilisation (IVF) cycles using donor eggs. She had two live births and one ectopic pregnancy for which she underwent laparoscopic salpingectomy. Between IVF treatment cycles she continued HRT. At the age of forty years she conceived spontaneously. The HRT was stopped at 10 weeks of amenorrhoea. She delivered a healthy baby boy at term. Following the delivery the patient had spontaneous periods every 2-3 months and did not suffer from menopausal symptoms. Her post delivery FSH and LH levels were high. We believe this is the longest interval reported between diagnosis of POF and a spontaneous conception.
Surgical options in Proximal jejunal diverticulum perforation and review of literature.
Authors: Das Diwa N , Walia Jiten , Gone Santosh R , Scobie D J
Published: March 2011

Proximal jejunal diverticula perforation should be treated by primary closure and inversion and omental patch.
Outcome of Aggressive Fibromatosis Treated with Radiation Therapy
Authors: Guney Y , Hiçsönmez A , Andrieu MN , Kurtman C
Published: March 2011

Introduction

The purpose of this study is to report the clinical course and outcome in 7 patients with aggressive fibromatosis.

Material and Methods

Between the years 2000 and 2003, 7 patients who were treated with combined modalities were evaluated retrospectively. Patients' demographic information, including age and gender, tumour characteristics, surgical resection, and the use of radiotherapy were recorded and evaluated.

Results

The mean patient age was 34 years. The median time to follow-up was 15.5 months. Resection was performed with positive surgical margins in three cases. Three patients were evaluated as inoperable and one patient was treated with debulking surgery. All patients received radiation therapy with a median dose of 51 Gy. At followup, three patients had no evidence of disease, three patients were alive with disease, and one patient died 15 days after radiotherapy.

Conclusion

Local control is the primary problem in aggressive fibromatosis. There is no appropriate treatment for aggressive fibromatosis and the type of treatment depends on tumour characteristics and location as well as patient characteristics.
A Survey of Current Surgical Treatment of Acute Gallstone Disease in the West of Scotland
Authors: Campbell E J , Montgomery D A , MacKay C J
Published: March 2011

Background

National guidelines exist for the treatment of acute gallstone pancreatitis, but not for the management of acute cholecystitis (AC).

Aims

To establish the preferred management of uncomplicated AC and adherence to guidelines for the management of mild gallstone pancreatitis in the west of Scotland.

Methods

A postal survey of all 100 consultant general surgeons in the west of Scotland.

Results

67 of 71 responses received were suitable for analysis. For uncomplicated AC, 24 (36%) perform urgent laparoscopic cholecystectomy (LC), 16 (24%) perform same admission LC after clinical improvement. 23 (34%) perform interval LC after discharge. Within this group, 9 surgeons (13%) manage AC conservatively due to insufficient operating time or equipment when on call. In mild gallstone pancreatitis, 33 (49%) perform same admission LC, 13 (19%) perform sphincterotomy, 3 (4.5%) perform one of these depending on the patient and 6 (9.5%) refer to a colleague with an interest in upper gastrointestinal surgery.

Conclusions

The majority of surgeons (over 60%) manage AC with same admission LC. Of those who do not, more than a third report lack of resources as being the reason. The majority of surgeons in the West of Scotland manage mild gallstone pancreatitis in accordance with current guidelines.
Childhood Empyema in North-East Scotland over the Past 15 Years.
Authors: Roxburgh CSD , Youngson GG
Published: March 2011

Introduction

The incidence of paediatric empyema is rising in the United Kingdom and North America. The reasons for increasing admissions are unclear. Management in tertiary units is often required. We report our experience in North-East Scotland over the last 15 years.

Methods

Empyema patients <15yrs admitted to the Royal Aberdeen Children's Hospital between 1st January 1990 and 1st June 2006 were identified using discharge coding. Data was collated from case notes. Patient characteristics, microbiology results, hospital stay and management are studied.

Results

Twenty eight children (M:F=1:1) were admitted. Mean age=6.8 yrs. Twenty seven out of twenty eight presented with localising respiratory symptoms or signs. In 12/28 an organism was isolated. Streptococcus pneumoniae was the commonest isolate, and where polymerase chain reaction (PCR) testing was employed, 3/3 cases were serotype 1. Fourteen out of twenty eight required surgery: open (8/14) or thoracoscopic (6/14) decortication. Two thoracoscopic cases proceded to open decortication. No complications were observed. Mean hospital stay=11.4 days. Twelve were managed in high dependency unit (HDU) with a mean stay of 7.1 days.

Discussion

We demonstrate similar trends in North-East Scotland to those reported elsewhere. Serotype 1 streptococcus pneumoniae is the most isolated. Multi-drug resistance is not seen in our population. A surveillance programme is now established and reasons for the increasing incidence should become apparent.
The Early Impact of the United Kingdom Chronic Kidney Disease (CKD) Guidelines on the Number of New Attendances at Renal Clinics
Authors: Aghaie-Jaladerany H , Cowell D , Geddes C C
Published: March 2011

Introduction

In April 2006 the United Kingdom (UK) Chronic Kidney Disease (CKD) guidelines and laboratory estimated glomerular filtration rate (eGFR) reporting were introduced to encourage identification and appropriate management of patients with CKD. The aim of this study was to assess the early impact of the implementation of the UK CKD guidelines on new patient attendances at nephrology clinics in our unit.

Methods

The number of adult new patients, sex, mean age and number in each CKD stage were analysed in consecutive 6 month blocks from 2000 to 2006.

Results

The number of new attendances gradually rose 2000 to 2006 until an abrupt 48% rise from 333 to 492 patients in the 6 months before and after June 2006. Between the second 6 months of 2005 and second 6 months of 2006 the proportion of females (43.4% to 56.3%; p<0.0001) and mean age (61.3 v 66.4 years; p<0.0001) rose abruptly. The increase was mainly in patients with stage 3B (eGFR 30-44.9ml/min/1.73m2) and stage 4 CKD (15- 29.9ml/min/1.73m2).

Discussion

The data demonstrate that substantial changes in practice can be implemented rapidly within both primary and secondary care. Further studies will determine if this is going to improve outcome in patients with CKD.
An unusual case of aortic graft infection: a case report and review of the literature
Authors: Moyes LH , Majumder B , Leiberman DP
Published: March 2011

Graft-appendiceal fistula is a rare variation of aorto-enteric fistula. We report on the presentation and management of a 70-year-old lady who presented ten years after an aortobifemoral graft with a discharging sinus in her right groin. Investigations suggested aortic graft infection and she was taken to theatre for a laparotomy. An inflamed appendix with a necrotic tip was found in contact with the aortic graft. The infected graft was excised and an appendicectomy was performed. The distal organs were revascularised with an axillobifemoral graft. We review similar case reports.
An Unusual Presentation of Complex Regional Pain Syndrome Type I
Authors: Devine KA , Kong SC , Neilly JB , Forrest EH
Published: March 2011

We report the case of a 38 year-old woman who presented with sensory symptoms of her right foot with no history of trauma. Subsequent nuclear imaging was suggestive of stage 1 complex regional pain syndrome type I (CRPS I).
Drug-Eluting Stents: A Review of Current Evidence on Clinical Effectiveness and Late Complications
Authors: Austin D , Pell JP , Oldroyd KG
Published: March 2011

Drug-eluting stent (DES) use has increased greatly as a result of early trial evidence of a reduction in restenosis. However, thet are expensive and do not improve patient survival. Therefore their use has been rationed in some countries. There is a paucity of clinical evidence for some patient groups such as non-ST elevation myocardial infarction and multi-vessel disease. Recent studies suggest that the early benefits of drug-eluting stents may be offset by an increased risk in late stent thrombosis which is a potentially fatal complication. However, the absolute risk appears low and, as yet, there is no evidence of an increased risk of stent-thrombosis related myocardial infarction or death in patients studied in randomised clinical trials. Long-term use of anti-platelet therapy may protect against the risk of late stent thrombosis but the optimal treatment strategy is currently unclear. The aim of this paper is to provide an up-to-date review of the current evidence on DES; including clinical effectiveness, the limitations of existing trials, the emerging evidence on late stent thrombosis and the potential role of clopidogrel.
Knowledge about Genital Herpes Amongst First Time Attenders at a Department of Genitourinary Medicine
Authors: Ray AG , Mcmillan AM
Published: March 2011

Background and Aims

Genital herpes is the most common cause of genital ulceration in the developed world, and its prevalence in the United Kingdom is rising. Public knowledge of the infection is often limited. We aimed to assess knowledge among patients attending an outpatient genitourinary clinic in Scotland.

Methods

A questionnaire was designed to collect information about educational qualifications and knowledge of genital herpes. In the knowledge section, each correct answer was given a score of 1; thus the maximum possible score was 12. Two hundred and ten individuals who attended as new patients at a walk-in genitourinary medicine clinic were invited to complete the questionnaire.

Results

Two hundred and seven patients completed the questionnaire. Overall 63% of responses were answered correctly. Knowledge of genital herpes was better in patients who worked in healthcare (8.3 v 6.9, p=0.019) and in patients with educational qualifications gained from college or university compared to those gained at school (7.6 v 6.5, p=0.009). Level of knowledge was not related to age or gender; receiving sex education at school did not appear to improve knowledge of genital herpes.

Conclusion

Knowledge of genital herpes among patients attending an outpatient genitourinary clinic in Scotland is reasonable but needs to improve to combat the rising prevalence of the infection. The areas of misunderstanding identified in our study could be targeted for public education.
A Review of Surgical Nutrition
Authors: Moyes LH , Mckee RF
Published: March 2011

Malnutrition remains a common problem in surgical patients and is associated with significant morbidity and mortality. It is imperative that all surgical patients undergo nutritional screening on admission to highlight malnourished or at risk patients and implement a nutritional plan. Nutrition can be delivered by oral supplements, enteral or parenteral feeding, the route depending on an individual's requirements and surgical condition. Enteral feeding has largely been regarded as superior to parenteral feeding, as it is cheaper, safer and “more physiological” but studies show this is not always the case. This article reviews the basics of surgical nutrition and assesses the evidence supporting enteral versus parenteral nutrition.
The Effect of Intra-Neural Local Anaesthetic Infusion on Pain Following Major Lower Limb Amputation.
Authors: Grant AJ , Wood C
Published: March 2011

Background

Critical lower limb ischaemia has an annual incidence of 500 — 1000 per million and around a quarter will undergo a major lower limb amputation. Post operative pain and phantom pain are recognised complications.

Aim

The aim of this study was to assess the role of postoperative intraneural infusion of local anaesthetic in patients under-going major lower limb amputation.

Methods

Between May 1998 and July 2001, following amputation patients either had standard post-operative analgesia or had an intra-neural infusion of 0.5% bupivicaine via an infant feeding catheter connected to a standard syringe pump (Alaris®). This was a retrospective review and clinical notes of these patients were analysed to assess their post operative course, analgesic requirements and to ascertain phantom limb pain/sensation rates. All the data collected was from standard drug charts, case note entries and out-patient letters.

Results

During this time period 64 patients had a major lower limb amputation (31 patients treated routinely and 33 patients had an intra-neural anaesthetic (INA) catheter placed). In the INA group median post-operative opioid analgesia requirement was 10mg versus 74mg (p=0.0002, Mann-Whitney U) and post-operative prescription of amitriptyline for phantom pain was less common (4 patients versus 11 patients; p=0.0281, Mann-Whitney U). There was no obvious increase in complications or significant adverse events.

Conclusions

Postoperative intra-neural local anaesthetic infusion is a safe and effective technique. It reduces post-operative opioid analgesia requirement and seems to reduce phantom pain development.
The Effect of Carnitine on Treatment of Familial Chylomicronemia Syndrome Presenting with Acute Pancreatitis
Authors: Urgancı N , Arapoglu M , AkyıLdız B , Aydın A
Published: March 2011

Familial chylomicronemia syndrome is a disease characterised by hypertriglyceridemia and chylomicronemia. In recent years, carnitine has been used in the treatment of hyperlipidemia and it is reported to be highly effective. We report a patient presenting with acute pancreatitis who through testing was diagnosed with familial chylomicronemia syndrome. We found the use of carnitine treatment in familial chylomicronemia syndrome to be highly effective.
An Entrapped Shelf Pessary
Authors: Popli K , Ranka P , Toop K
Published: March 2011

Although corrective surgery is the definitive treatment for uterine-vaginal prolapse, vaginal pessaries are often used as a non-invasive alternative in the elderly, in women who are at high risk for medical complications with surgery and in women who wish to avoid surgery. Complications can occur with use of these pessaries but are usually rare. We present a case of an impacted shelf pessary, which required a midline episiotomy and incision of the band of vaginal tissue under general anaesthesia for its removal.
A Case of Penile and Scrotal Strangulation by a Metal Ring
Authors: Lim Cs , Tibrewal S , Mok Wlj
Published: March 2011

Strangulation of the penis and scrotum with a constricting device is very rare compared to the penis alone. We report a case of a 47-year-old gentleman who presented with a metal ring constricting the base of his penis and scrotum. The metal ring was successfully removed with a hydraulic-driven cutter. He recovered with no complication.
Let's Get Physical! A Study of General Practitioner's Referral Letters to General Adult Psychiatry — Are Physical Examination and Investigation Results Included?
Authors: Culshaw D , Clafferty R , Brown K
Published: March 2011

Background/Aim

The authors previously conducted a survey of psychiatrists’ attitudes to physical examination and investigations of out-patients. The most common reason for not performing such investigations was the expectation that they had already been undertaken by the general practitioner (GP). We decided to test this theory.

Method

A series of GP out-patient referral letters to general psychiatry was examined to establish whether findings from physical examination and investigations had been included.

Results

One hundred and three letters were examined. None of the letters contained information relating to a physical examination. Only one in twenty had information on investigations despite 4 out of 10 patients in the sample presenting to the GP with somatic symptoms.

Conclusion

Details of physical examination and blood tests are not routinely included in referral letters to general psychiatry. This may lead to missed diagnoses of primary or secondary physical illness in psychiatric presentations. Unless it is clearly stated in the GP referral letter, it is unwise to assume that necessary investigations to exclude physical causes of presenting symptoms have been performed. Suggestions are made to improve communication between GPs and psychiatrists.
Encouraging Attendance at Outpatient Appointments: Can We Do More?
Authors: Henderson R
Published: March 2011

Background and Aims

Non-attendance at new outpatient appointments is a challenge for health services. Patients with treatable morbidity may fail to receive care from which they would benefit, and scarce resources are wasted. Therefore, a literature review was undertaken to assess the effectiveness of appointment reminders as a means of increasing attendance and reducing ‘Did not Attend’ rates at new outpatient appointments.

Methods

Electronic databases were interrogated using a combination of MeSH terms and truncated keywords. In addition, the reference lists of papers were studied to identify additional relevant material.

Results

Telephone and postal reminders appear effective, particularly if received within a day of scheduled appointments. Postal reminders offering a reward for attendance, threatening sanctions for non-attendance, and providing information about the clinic appear more effective than standard reminders. No studies assessing the impact of measures including e-mail or text messaging were identified. Many studies were conducted in psychiatric settings outwith the United Kingdom raising issues of generalisability. In addition, no assessment of how initiatives impact on inequalities in service access were found.

Conclusions

There is scope to increase attendance and reduce non-attendance at outpatient appointments but initiatives should be piloted in conjunction with robust evaluative frameworks.
Knowledge about the Scottish Mental Health Act in a General Hospital Setting
Authors: Baig BJ , Walker J , Crowe ES , MacHale SM , Aditya H , Potts SG
Published: March 2011

Background

Clinical experience suggests that non-psychiatrists' knowledge of mental health legislation in relation to emergency detention is inadequate. However, most nonpsychiatrists will use this legislation at some point in their career.

Methodology

A questionnaire about emergency detention legislation was circulated to non-psychiatric medical staff to test their knowledge of the provisions relevant to the general hospital.

Results

Two hundred and seventy four medical staff replied (a response rate of 82%). Results showed that an understanding of detention procedures and applicability were markedly deficient, irrespective of grade, specialty or experience.

Conclusion

The results indicate a need for increased education and awareness about emergency detention legislation especially in view of the implementation of the Mental Health (Scotland) Act (2003).
Early Neurologic Complications Following Coronary Bypass Surgery
Authors: Jabbour R , Salamoun M , Atweh SF , Sawaya RA
Published: March 2011

Background

Coronary artery bypass surgery is associated with central and peripheral nervous system complications in the period following surgery. Recognising these complications may help in their prevention or early treatment.

Methods

We reviewed medical records of all the patients who underwent coronary artery bypass surgery at our institution over a period of two years. We studied their risk factors, reasons for surgery, operative variables, and post operative neurologic complications.

Results

Of the 587 coronary artery bypass surgeries performed at our centre over a two year period. We found that 2.04% of these patients developed neurologic complication in the two weeks following the surgery. Fifty percent of these patients suffered from cerebrovascular insults and 50% suffered from cognitive decline. No patients in this group developed seizures or peripheral nerve lesions. Patients with renal failure, carotid stenosis, history of cerebral strokes, and redo coronary bypass surgery were more predisposed to develop neurologic complications after bypass surgery. Furthermore, a longer stay in the coronary care unit and the development of arrhythmias predisposed patients to neurologic complications. Mortality for patients who developed neurologic complications post bypass surgery ranged between 16.7% and 33.4%.

Conclusions

Around 2% of patients who undergo coronary artery bypass surgery develop neurologic complications in the period directly after the surgery. Patients with previous history of cerebral, coronary, or carotid disease are more predisposed for such complications, as well as patients who spend more time in the intensive units after the surgery.
Early Discharge Following Liver Resection for Colorectal Metastases
Authors: MacKay G , O'Dwyer PJ
Published: March 2011

Objective

Liver resection is currently the recognised treatment for localised colorectal liver metastases. Hospital stay in recently published series is between seven and 12 days for open surgery and five and eight days for laparoscopic resection. Recently there has been interest in the use of ‘fast-track’ recovery protocols following major abdominal surgery. Our aim was to measure the effect of such a protocol on hospital stay following liver resection.

Methods

Data was collected prospectively from 12 consecutive patients undergoing open liver resection between August 2003 and September 2004. All patients had a large subcostal incision with full mobilisation of the liver. A ‘fasttrack’ protocol was employed consisting of intra venous fluid restriction, patient controlled analgesia and early diet and mobilisation. Data on postoperative complications and hospital stay was recorded.

Results

Twelve patients with a median age of 60 (range 43-74) years underwent liver resection. Resection consisted of one hepatic lobectomy, two trisegmentectomies, three bisegmentectomies and six segmentectomies. Median hospital stay was four (range two to seven) days. One epileptic patient developed carbamazepine toxicity delaying their discharge. A further patient developed a collection requiring no intervention.

Conclusion

Early discharge following major liver resection using a ‘fast-track’ recovery protocol is both safe and achievable.
Recent Advances in Inflammatory Skin Diseases
Authors: Thind CK , Ormerod AD
Published: March 2011

Inflammatory skin diseases are frequently chronic skin conditions affecting many people at all stages of life. This article is a review intended to bring clinicians up to date with recent advances in the knowledge and management of inflammatory skin diseases, conditions that are commonly seen in general medicine and will be encountered in MRCP(UK) PACES and OSCE examinations.
The Burden of Atrial Fibrillation in Unselected Acute Medical Admissions
Authors: Cameron AC , Jenkins SMM , Dunn FG
Published: March 2011

Background

Atrial fibrillation (AF) is the most common cardiac arrhythmia and is of increasing prevalence. The presence of AF complicates the management of patients presenting as medical emergencies.

Objective

To assess the prevalence of AF and current investigation and management strategies in unselected acute medical admissions.

Design

Prospective survey of all acute medical admissions over 22 days.

Setting

Stobhill Hospital – district general hospital in north Glasgow.

Subjects

Consecutive acute medical admissions.

Results

Of the 507 patients, 47 (9.3%) had AF. AF was a new diagnosis in five patients (11.0%). The most common presenting features were dyspnoea and chest pain. The principal underlying medical conditions were hypertension and ischaemic heart disease. AF was the primary reason for admission in six patients (12.8%) and a documented reason for admission in 11 patients (23.4%). Thyroid function tests were or had previously been performed in 45 patients (95.7%). Twenty-four patients (51.1%) underwent echocardiography or had done so previously. Twenty-two patients (46.8%) received anticoagulation with warfarin. Ten patients (21.3%) should have received warfarin by standard guidelines but did not. No patient received warfarin inappropriately. Rate control was used in 40 patients (85.1%). Rhythm control was attempted in four patients (8.5%).

Conclusion

AF is common amongst emergency admissions to district general hospitals and has significant resource implications. Improvements are needed both in the use of echocardiography and in the administration of anticoagulant therapy.
Acute renal infarction due to renal fibromuscular dyplasia: a case of mistaken identity
Authors: Patel RK , Brown MC , Seywright M , Qureshi K , Geddes CC
Published: March 2011

A 53 year old male presented with right sided loin pain in the absence of other distinguishing symptoms, past medical history or examination findings. Investigation, a week later, revealed a right sided renal mass. He underwent laparascopic nephrectomy for presumed renal malignancy. Surprisingly, the mass was an area of infarction and the renal artery had intimal-type fibromuscular dysplasia (FMD). This case demonstrates three important points. Firstly, renal infarction is a cause of acute loin pain. Secondly, delayed investigation can alter the radiological appearance of renal infarction. Lastly, FMD is a rare condition, particularly in men, and can cause renal infarction.
‘Haematuria’: A case of mistaken identity.
Authors: McArdle KA , Ray D
Published: March 2011

Although haematuria is the commonest cause of red urine, it is important to recognise that it is not the only cause. We report the case of a 62 year old lady with a prosthetic heart valve who presented to the haematuria service with red urine resulting from haemolysis secondary to a peri-valvular leak.
Glandular tularemia: Uncommon presentation of the cause of lymphadenopathy in two children
Authors: Orbak Z , Tan H , Ziraaatci O , Turgut A , Gursan N , Alp H , Karakelleoglu C
Published: March 2011

This report details the clinical and histopathological characteristics and course of glandular tularemia, an uncommon but significant cause of cervical lymphadenopathy in two children. Tularemia should be considered in the differential diagnosis of cases with non-tuberculosis, suppurative cervical lymphadenopathy, particularly in those not responding to penicillin treatment.
Tuberculosis in Somalia
Authors: Turpie ID
Published: March 2011

This is a description of a tuberculosis treatment programme in a country at war where security and the absence of order pose problems to health care delivery. It is also a description of an epidemic of tuberculosis where treatment and diagnosis are difficult and the methods used have changed little in many years. More international pressure is needed.
Infant Feeding Intentions of Scottish Adolescents
Authors: Foulkes JL , Dundas KC , Denison FC
Published: March 2011

Despite its health benefits, only 63% of women in Scotland will attempt to breastfeed. Our aim was to investigate future feeding intentions and attitudes in adolescents in the south east of Scotland. Of the 757 adolescents questioned, 78.8% of girls (n=430) and 61.6% of boys (n=130) stated an intention to breastfeed or to encourage their partner to breastfeed. Knowledge of being breastfed as an infant was the only factor associated with a higher Iowa Infant Feeding Attitude Score and proportion that either intend to breastfeed or support breastfeeding in the future.
History of Dyspepsia in Scotland
Authors: Baron JH , Sonnenberg A
Published: March 2011

Introduction

The aim of the study was to assess whether the rise in the occurrence of dyspepsia in Scotland during the eighteenth century was a true epidemiologic phenomenon or just an increase in medical awareness.

Methods

Admissions for dyspepsia to the Edinburgh Royal Infirmary from 1729 until 1830 were analysed by consecutive five-year time periods. The titles of MD theses on dyspepsia from 1726 to 1823 were extracted from the Edinburgh University index. Monographs and articles on dyspepsia from Britain during the same time period were sought in the Catalogues of the US Surgeon-General's Library.

Results

During the eighteenth century, the annual number of dyspepsia patients admitted to the Edinburgh Royal Infirmary showed an extraordinary increase from none in 1730 to 900 per million population in 1760. About 4000 MD theses were presented to the Edinburgh University between 1726 and 1823. There were none on dyspepsia or gastritis between 1726 and 1749, after when it gradually started to rise. British publications on dyspepsia similarly appeared only in the 1790s and then rapidly increased.

Discussion

We suggest that the rise in MD theses and publications on dyspepsia were responses to a real increase in dyspepsia during the mid eighteenth century.
Giant angiomyofibroblastoma of the vulva.
Authors: Indraccolo Ugo , De Sanctis Enzo , Liberati Fabrizio , Ippolito Mario , Indraccolo Salvatore Renato
Published: March 2011

Background. Angiomyofibroblastoma is a rare tumour which generally arises in women in fertile age upon the cutis of the perineal or vulvar region and usually concerning a size of just a few cm in diameter. Case. In this case report, it is described the unusual occurrence of a giant angiomyofibroblastoma of the vulva (weighing 4,800 g) which has prevent the patient for walking. Conclusion. We should reckon that angiomyofibroblastoma may grow up to a very large size.
Concurrent Ipsilateral Acute And Chronic Ectopic Pregnancies
Authors: Alsammoua S , Kennedy J.H , Tolhurst J , Liptak P , Alexander-Sefre F
Published: March 2011

Introduction

This report describes a unique case of concurrent chronic and acute ectopic pregnancies in an ipsilateral tube.

Case History

A 33-year-old woman presented with symptoms suggestive of miscarriage that resolved on conservative management, resulting to normal βhCG level. However, she was readmitted 5 weeks later with vaginal spotting, right iliac fossa pain and slightly elevated βHCG. A diagnosis of pregnancy of unknown location was made and she was managed conservatively. Four weeks later the patient presented once again with vaginal bleeding and a positive pregnancy test. Her serum βhCG level was elevated and her pelvic ultrasound scan showed an adnexal mass. The patient therefore underwent laparoscopic salpingectomy. Histopathological examination showed two ectopic pregnancies within the same tube; an older (chronic) ectopic positioned within proximal end of the tube and a more recent one at the distal end.

Conclusion

This case highlights the difficulty in diagnosing chronic ectopic pregnancy and the increased risk of recurrence after conservative management.
Duodenal Dieulafoy's Lesion: A Case Report
Authors: Siddiqui T , Parnaby C , Mackay C
Published: March 2011

Dieulafoy's lesion is an uncommon but important cause of recurrent upper gastrointestinal bleeding. Extragastric location of Dieulafoy's lesion is extremely rare. We report a case of upper gastrointestinal haemorrhage due to Dieulafoy's lesion of the duodenum and discuss the management of this extremely uncommon entity.
CMV Infection In Multiple Pregnancy — The Unpredictability Of Infectivity And Affectivity
Authors: Mcgavigan CJ , Sivaprakasam V , Aitken C , Mackenzie F
Published: March 2011

Congenital CMV infections are the commonest congenitally transmitted infections affecting 0.5 to 2 % of all live births around the globe.1 Here we report a case of congenital CMV infection in a woman with a triplet pregnancy with variable outcomes in all three fetuses.
Two Unusual Cases Of Calcific Uraemic Arteriolopathy
Authors: Connor A , Menon MS , Taylor JE
Published: March 2011

Calcific uraemic arteriolopathy is a small vessel vasculopathy occurring almost exclusively in patients with renal failure. Violaceous mottling of the lower limbs, buttocks or lower abdomen precedes the development of painful, necrotic, non-healing ulcers. We report two atypical manifestations of calcific uraemic arteriolopathy and highlight a condition which is seen increasingly frequently as the number of patients undertaking dialysis continues to rise.
Thigh Compartment Syndrome: Return to Competitive Sport is Possible
Authors: Tollan Cj , Macdonald D J M , Kelly Michael P
Published: March 2011

Thigh compartment syndrome is a relatively rare but potentially devastating condition. We present three cases in semi-professional soccer players and demonstrate that satisfactory results can be obtained with timely surgical intervention. Clinicians and team doctors should have a high index of suspicion for thigh compartment syndrome following blunt trauma and should be aware that it can develop many hours or days after injury.
Non Ketotic Hyperosmolar Hyperglycemia presenting as Epilepsia Partialis Continua. (An unusual presentation of a common disorder)
Authors: Kamha A
Published: March 2011

We report a patient with epilepsia partialis continua (EPC) associated with non ketotic hyperosmolar hyperglycemia. EPC is uncommon presenting clinical finding during nonketotic hyperglycemia. This case was reported in Medical Intensive Care Unit (MICU) in Hamad Medical Corporation, Doha, Qatar.
Amyloidoma: A Rare Cause of Soft Tissue Swelling in the Thigh
Authors: Tan SZ , Ng CY , Nawroz IM , Jamieson KA , Marks RC
Published: March 2011

Soft tissue amyloidoma of the extremities is extremely rare and there are only 12 reported cases in the English literature to date. We present a case of soft tissue amyloidoma of the thigh in a 74-year-old lady.
Malignant Peritoneal Mesothelioma in a Hemodialysis Patient with Familial Mediterranean Fever: A Case Report and Literature Review
Authors: Sengul E , Yildiz K , Topcu Y , Yilmaz A
Published: March 2011

Malignant mesothelioma is a rare tumor. The most common localization of mesothelioma is pleura. It rarely arises from the peritoneum. It has been suggested that familial Mediterranean fever (FMF) may cause the development of peritoneal mesothelioma. We describe a case of malignant peritoneal mesothelioma in a hemodialysis patient with FMF. The patient was a 56 year old female. A history of FMF was present since her childhood. She did not use colchicine and suffered from recurrent ascites. To the best of our knowledge, this is the seventh case of FMF diagnosed as having malignant peritoneal mesothelioma in the medical literature.
Changes in Undergraduate Clinical Psychiatry Teaching in Scotland since “Tomorrow's Doctors”
Authors: Wilson S , Eagles JM
Published: March 2011

This paper reviews the factors which have driven changes in undergraduate education in psychiatry since the 1993 publication of “Tomorrow's Doctors”,1 after which it describes current undergraduate curricula in the four Scottish medical schools teaching clinical psychiatry. Reasons underlying the differences between curricula are discussed. The authors suggest that research in medical education, alongside communication and debate between medical schools and across specialties, would lead to more uniform and evidence-based curricula.
An Overview of Colorectal Cancer Screening
Authors: Goodbrand SA , Steele RJC
Published: March 2011

Colorectal cancer ranks highly amongst all cancer sites in incidence and contributes to a substantial number of cancer related deaths in the United Kingdom. However, screening of average risk individuals has been shown to reduce both disease associated mortality and incidence. This paper provides an overview of both current and future screening methods for colorectal cancer, as well as current practice for screening in both average and high risk individuals.