bluuebunny/crossref_metadata_2025 huggingface dataset:
Endothelial Fibrinolytic Activity in Hypercholesterolemic and Diabetic Rats; Effect of Stanozolol, Streptozotocin, Dexamethasone and Hypophysectomy
Authors: Smokovitis A. A. , Auerswald W. , Binder B. R.
Published: January 2017

In genetically hypercholesterolaemic rats (RICO) the intimal plasminogen activator activity (PAA) at the nonbranching regions of the aorta, but not at the branching regions, was markedly lower than in controls.

In alloxan-induced diabetes in rats, the pattern of changes in tissue PAA was different in different tissues.

The anabolic steroid stanozolol induced in male rats a dose and time dependent increase in the tissue PAA; this increase was varying from one tissue to another.

The antibiotic streptozotocin, at a diabetogenic dose, induced a 200% increase in the intimal PAA of the aorta in RICO rats and by 100% in controls ( normal rats) ten weeks after a single injection. Administration of dexamethasone in normal rates 24 hours and 3 hours before streptozotocin injection prevented the enhancement of PAA. However, administration of dexamethasone simultaneously with streptozotocin did not affect the enhancement of the intimal PAA.

The hypophysectomy induced in rats significantly increased PAA in the intima of the aorta.
The Role of Stanozolol in the Treatment of the Postphlebitic Syndrome
Authors: Jarrett P. E.
Published: January 2017

The postphlebitic syndrome is a result of previous deep vein thrombosis and presents with oedema, pain, induration, pigmentation and ulceration. Extravascular deposition of fibrin is associated with reduced fibrinolytic activity in these patients. In a double-blind crossover study there was evidence of benefit from stanozolol which enhanced fibrinolytic activity. No side effects of any consequence were noted with a dosage of 5 mg twice per day.
Long-Term Treatment of Hyperlipidaemic Patients with Stanozolol and Phenformin
Authors: Sznajderman M. , Rymaszewski Z. , Berent H.
Published: January 2017

The effect of combined stanozolol-phenformin therapy was assessed in 21 patients with Types IIB, IV and V primary hyperlipoproteinaemias. Three-months treatment resulted in marked reduction of serum triglycerides, less distinct decrease of serum cholesterol and significant augmentation of blood fibrinolytic activity.
The Myasthenic (Eaton-Lambert) Syndrome Associated with Carcinoma. Enzyme Induction as a Possible Mechanism of Paraneoplastic Syndromes
Authors: Simpson J. A.
Published: January 2017

A myasthenic syndrome associated with small-cell tumours of the bronchus and with autoimmune diseases (Eaton-Lambert syndrome) has been attributed to diminished probability that a nerve action potential will release acetylcholine (ACh) from terminals of cholinergic nerves (somatic motor and autonomic) This model derives from evidence for reduced quantal content of the transmitter released by a nerve impulse The test procedure implies certain constancies of postsynaptic response Abnormal responses to ACh-agonists indicate that receptor response is not normal It is suggested that all previously described neuromuscular responses are compatible with a new model: the subsynaptic apparatus produces excess acetylcholinesterase (AChE) which limits the endplate conductance changes produced by normal output of ACh This model is supported by earlier ultramicroscopic studies which cannot be accounted for by the contemporary model.

It is proposed that enzyme induction by peptide or immunoglobulin may also be responsible for other paraneoplastic syndromes.
Treatment of Small Cell Carcinoma of the Bronchus by Combined Chemotherapy—Clinicopathological Correlation with Response
Authors: MacNee W. , Maloney D. , Lamb D. , Sudlow M. F.
Published: January 2017

Thirty-seven consecutive patients, referred to a respiratory unit with a histological diagnosis of small cell carcinoma of the bronchus, were treated with a combined chemotherapy regime of adriamycin, vincristine and cyclophosphamide. Palliative radiotherapy was given for the control of symptoms. Thirty of 37 patients responded to treatment, 11/37 having a complete and 19/37 a partial response. The median survival of those patients with a complete response was 55 weeks, significantly higher (P<0.01) than either those with partial or no response to treatment. Those patients with limited disease survived longer. A high proportion of patients relapsed at the primary site of the tumour in the lungs.

The relationship between the therapeutic response and the histological subtype of small cell carcinoma suffered from the limitations of the available pathological material. However, more of the patients with a complete response were of the lymphocytic-like pattern of small cell carcinoma.

Useful survival in these patients with inoperable small cell carcinoma was achieved using this regime of chemotherapy, even in those patients with extensive disease, five of whom had survived for over one year.
Adult Still's Disease
Authors: Larkin J. G. , Sturrock R. D.
Published: January 2017

Adult Still's disease is a recently recognised syndrome which is an important and often unrecognised cause of pyrexia of unknown origin. A knowledge of the clinical features of this disease may save patients with undiagnosed fever from prolonged and invasive investigations. The condition usually responds to conservative therapy with non-steroidal anti-inflammatory agents and bed rest, although in a minority of patients more toxic drugs may be required. The prognosis is usually good although long-term follow-up studies of these patients are small in number, and the most recent review sounds a warning as to the incidence of chronicity. Sufficient evidence now exists to identify Still's disease as a separate nosological entity in adults. It should be added to the ever-expanding list of causes of pyrexia of unknown origin.
Has Modern Perinatal Practice Caused the Fall in Perinatal Mortality? The Experience of a District Maternity Hospital
Authors: Shepherd R. C. , Ridley W. , Struthers Jean O.
Published: January 2017

During the first 12 years of operation the perinatal mortality rate in Paisley Maternity Hospital fell steadily from 27 per 1,000 in 1970 to 10 per 1,000 in 1981. During this period the nulliparous birth rate remained constant, but the parous birth rate fell. Improved survival of premature babies, falling numbers of babies with neural tube defects and reduction in intrapartum asphyxia are identified as responsible for this fall. Unexplained intra-uterine death remains an unsolved problem.
Cognitive Functioning of Solvent Abusers
Authors: Mahmood Z.
Published: January 2017

Cognitive dysfunction and solvent abuse have been found to be closely related, but the precise nature of this relationship remains obscure. Twenty eight non-active solvent abusing and 20 non-abusing adolescents were given tests of non-verbal and verbal intelligence, arithmetic, literacy level and learning ability. In addition, they were asked three standard questions about their spare time activities and future orientation.

The results clearly indicated that, while the two groups did not significantly differ in potential abilities, the abusers performed significantly poorly on all but one test of acquired abilities. The abusers were found to be less future orientated, were ‘bored’ with themselves. The aetiological implications of the study are discussed.
The Prognostic Significance of Dysrhythmias in the Healthy Elderly
Authors: Clee M. D. , Smith Norma , Clark R. S. , McNeill G. P.
Published: January 2017

Fifty healthy, elderly subjects in whom a cardiovascular assessment, including 24-hour ambulatory electrocardiography had been performed, have been followed until death, or if surviving, for five years. Eight patients have died and 88 per cent of the survivors have had repeated 24-hour electrocardiography. Coronary death and the development of cardiovascular or neurological symptoms were not related to the presence in the original recording of significant dysrhythmias including frequent ventricular and supraventricular premature beats, R on T phenomena or sinus arrest. Treatment of these and other dysrhythmias in the asymptomatic elderly individual to prevent development of serious clinical sequelae is not justified.
A Single-Blind Study of Naproxen Sodium and Mefenamic Acid in Minor Trauma
Authors: Macintyre I. M. C. , Fink P. , McGrouther R. , Spence A. , Zarifa Z.
Published: January 2017

In a single-blind, parallel, randomised trial the efficacies of naproxen sodium and mefenamic acid were compared in the treatment of musculoskeletal injuries. The daily dosages used were 1100 mg naproxen sodium and 1500 mg mefenamic acid. Patients were assessed before, during and after four days' treatment, with respect to pain, tenderness, swelling and limitation of function of the injured part.

Two hundred and eighty-one patients entered the study and 217 were included in the analysis, 106 in the mefenamic acid group and 111 given naproxen sodium. Both groups showed an improvement in symptoms under treatment but there was no significant difference between the two groups in terms of any of the measurements of efficacy. There was no significant difference between the numbers of side-effects reported in each group, although more were seen in the naproxen sodium patients.

In this study, both drugs were equally effective in relieving the symptoms of musculoskeletal injuries.
Possible Hepatoxicity of Tocainide
Authors: Farquhar D. L. , Davidson N. McD.
Published: January 2017

A case of a woman on tocainide who developed abnormal liver function. A causal relationship is postulated.
Sotalol Induced Torsade De Pointes
Authors: Beattie J. M.
Published: January 2017

Torsade de pointes is an uncommon ventricular tachyarrhythmia precipitated by a variety of metabolic and pharmacological conditions and requiring unconventional antiarrhythmic therapy. A case is presented demonstrating the occurrence of torsade de pointes following sotalol overdosage and specific features enabling recognition and treatment of this life-threatening arrhythmia are discussed.
Headache and Temporal Arteritis
Authors: Wykes W. N. , Cullen J. F.
Published: January 2017

A patient presented with headache, soreness over her scalp and general malaise. She was treated for hypertension, but later went blind in one eye. Following referral to the Eye Department, she was treated successfully for six episodes of blindness in her second eye. The case highlights the ways in which temporal arteritis may present. Prompt treatment will save vision, but a missed diagnosis may result in blindness.
Membranous Nephropathy in a Patient with Nail-Patella Syndrome Nephropathy
Authors: Mackay I. G. , Doig A. , Thomson D.
Published: January 2017

Membranous nephropathy is described in a patient with nail-patella syndrome who also had the characteristic changes of nail-patella syndrome nephropathy on electron microscopy. This combination has not previously been reported. Nail-patella syndrome nepthropathy is reviewed in relation to other glomerular lesions which have been reported.
A Comparison of Atenolol and Long-Acting Trimazosin in Mild to Moderate Essential Hypertension
Authors: Webb D. J. , Hutcheson M. J. , Robertson M. P. , Murray G. D. , Lorimer A. R. , Robertson J. I. S.
Published: January 2017

In a 12-week double-blind randomised study the efficacy of atenolol and a new longer-acting formulation of trimazosin were compared when given once daily in patients with mild to moderate hypertension. Two parallel groups, each consisting of 18 patients, were studied. At randomisation the two groups were well matched for age and sex distribution. They were also well matched for blood pressure, pulse rate and body weight; these latter measurements were recorded at regular intervals during the 12 weeks of study.

Atenolol produced substantial reduction in both systolic and diastolic blood pressure, and in heart rate, during 12 weeks of treatment. This therapeutic effect was maintained until the next dose after 24 hours. Trimazosin, by comparison, failed to reduce either systolic or diastolic pressure, or to alter heart rate.

Side effects were minor with both agents and compliance with treatment was good. Atenolol caused significant elevation of plasma concentration of triglyceride, with reduction in high density lipoprotein concentration when compared with trimazosin.

In conclusion, atenolol was confirmed as an effective agent for the treatment of mild to moderate hypertension. By comparison trimazosin in the longer-acting formulation was ineffective in this study. However, trimazosin may still find a place in treatment if used at higher dose.
Gastric Outlet Obstruction Secondary to a Distal Duodenal Stenosis
Authors: Mackay A. , Graham L. , Macleod I. B. , Matthews J. D.
Published: January 2017

A case is presented where gastric outlet obstruction was found to be secondary to carcinoma of the distal duodenum in a patient with acute on chronic duodenal ulceration. The fallibility of barium studies in this condition is discussed.
Use of Nifedipine as the Drug of Third Choice in Management of Hypertension
Authors: Roulston J.E. , Wathen C.G. , Muir A.L.
Published: January 2017

Nifedipine has been used in the management of hypertension in 36 consecutive patients who could not tolerate, or were not controlled by, atenolol and thiazide diuretics. Mean supine blood pressure was reduced from 193/110 ± 5/2 (SEM) mmHg to 162/91 ± 5/2 mmHg at eight weeks and remained at that level for the six months of follow-up. Blood pressure reduction at four weeks was not always a predictor of final BP level. Eight patients could not tolerate atenolol, nine patients could not tolerate thiazide diuretics and four patients could not tolerate nifedipine. No significant changes in plasma urea, creatinine, sodium, potassium urate, ‘total CO2’ or glucose were observed.

We conclude that nifedipine is a well-tolerated drug and may be useful after beta-blockers and thiazide have been tried in the management of hypertension.
Nontraumatic Rhabdomyolysis and Acute Renal Failure
Authors: Forwell Margaret A. , Hallworth M. J.
Published: January 2017

Four cases of acute renal failure occurring in association with unusual causes of nontraumatic rhabdomyolysis are reported. Three of the four were associated with drug overdoses.
Severe Pre-Eclampsia in Multiparous Women: Indication of an Environmental Triggering Agent?
Authors: Kilpatrick D.C. , Jazwinska E.C. , Liston W.A. , Smart G.E.
Published: January 2017

Two case histories are described with conflicting implications for the etiopathogenesis of pre-eclampsia. In both, typical proteinuric pre-eclampsia developed despite a history of previous normotensive pregnancy. In the first case, the disease was associated with a change of husband, consistent with the view that pre-eclampsia arises from an inadequate maternal immune response to paternal antigens inherited by the fetus. The second case, however, concerned a woman who developed pre-eclampsia for the first time in her third pregnancy by the same reproductive partner. We conclude that either more than one underlying cause can result in the clinical syndrome of pre-eclampsia, or that pre-eclampsia is caused by an environmental factor. The possibility that pre-eclampsia may be initiated by an infectious agent is briefly explored in the light of the clinical histories described and well-established epidemiological, clinical and laboratory data.
A Flexible Loading Dose Schedule for Warfarin Therapy
Authors: Fergusson R.J. , Eade O.E. , Logie A.W. , Gaddie J.
Published: January 2017

A flexible loading dose schedule for inducing anticoagulation with warfarin was assessed in 31 consecutive patients. 55% reached the therapeutic range (prothrombin ratio between 2 and 4:1) by Day 2 (40 hours after the first dose) and this figure rose to 77% on Day 3 and to 87% on Day 4. All patients had a PTR between 1.7 and 4.2 on Day 5. Patients with evidence of cardiac failure and abnormal liver function, and those taking medications known to interact with warfarin required lower doses and ran a higher PTR when compared with the total group of patients. This schedule offers a useful means of safely and rapidly inducing warfarin therapy in all patients.
Digital Subtraction Angiography
Authors: Reid A.W.
Published: January 2017

Digital Subtraction is a computerised radiological technique to demonstrate the vascular tree by removing unwanted background information and enhancing dilute contrast medium within the blood vessels. Contrast may be introduced intravenously or intra-arterially. The relative merits of these two methods, together with the advantages and limitations of the technique are discussed.
Methaemoglobinaemia Produced by Phenazopyridine (Pyridium) in a Man with Chronic Obstructive Airways Disease
Authors: Chakraborty T.K. , Filshie R.J.A. , Lee M.R.
Published: January 2017

Life threatening methaemoglobinaemia developed after prolonged therapeutic use of phenazopyridine (Pyridium) in a patient with chronic obstructive airways disease. The combination of chronic obstructive airways disease and oxidant drugs (methaemoglobinaemia) may be lethal. The use of phenazopyridine should be abandoned. Certainly there is no indication to use it for more than a few days in any patient.
Demands on Clinical Chemistry Services Caused by Drug Related Diagnoses
Authors: Stewart M.J.
Published: January 2017

The changing incidence of any given pathology in the catchment population leads to altered demands on the diagnostic services. Since two perceived problems in Glasgow have been solvent abuse and more recently drug abuse, a study was made of the change in numbers of requests to the clinical biochemistry services generated by patients with a diagnosis related to ingestion of drugs. The figures indicate that alcohol abuse leads to the greatest demands on the service and that this trend is increasing. Solvent abuse is a minor problem and in cases of abuse of hard drugs biochemical analyses other than the screening for drugs themselves seem to be required infrequently.
Haemorrhage from an Adhesion-Related Mesenteric Varix in a Patient with Portal Hypertension
Authors: Crawford D.J. , MacKay C. , Burnett R.A.
Published: January 2017

We report a case of profuse gastro-intestinal haemorrhage from an ileal varix, in a segment of bowel adherent to the site of a previous incisional hernia repair, in a patient with portal hypertension. This is a rare but recognised complication of portal hypertension. Localisation of the bleeding point was achieved by radionucleide scanning and the segment of abnormal bowel was successfully resected.
Hypomagnesaemia in Elderly Digitalised Patients
Authors: Martin B.J. , McAlpine J.K. , Devine B.L.
Published: January 2017

Hypomagnesaemia and hypokalaemia are known to predispose to digoxin toxicity. Elderly patients receiving diuretics may be at special risk. A 12-month survey of all patients receiving digoxin at the time of admission to our Geriatric Assessment Unit revealed 16% were hypomagnesaemic, whereas no patient was hypokalaemic. There is a need for greater awareness of the risk of magnesium depletion in elderly patients receiving concurrent diuretic and digoxin therapy.
Aldosterone Deficiency in Infancy
Authors: Glass I.A. , Wallace A.M. , Beattie T.J.
Published: January 2017

Two infants with a chronic salt wasting state secondary to a rare defect in mineralocorticoid synthesis are described. Management difficulties are illustrated highlighting the need for early definitive diagnosis based on measurement and correct interpretation of plasma renin, plasma aldosterone and urinary steroid metabolite concentrations.
Acute Torsion of the Gallbladder
Authors: McGregor J. R. , Akyol M. , Macpherson S.G.
Published: January 2017

Acute torsion of the gallbladder is an acute surgical emergency which may be encountered more frequently in the presence of an ageing population. We report a 98-year-old patient in whom the diagnosis was made at exploratory laparotomy performed for unexplained peritonism. Emergency cholecystectomy was followed by an uncomplicated post-operative recovery.
Cryptosporidiosis in the West of Scotland
Authors: Shepherd R.C. , Sinha G.P. , Reed C.L. , Russell F.E.
Published: January 2017

During the two years 1986 and 1987 83 cases of cryptosporidiosis were identified by the finding of oocysts in the faecal samples submitted to a single microbiology laboratory. There were 58 children and 25 adults. Cryptosporidiosis was the commonest cause of gastrointestinal infection identified in children and the third commonest overall. Spring and autumn peaks were identified. The main symptoms were diarrhoea (median 10 days), vomiting (median seven days), abdominal pain (median seven days) and fever (median three days). A variety of other less common symptoms were noted including reactive arthritis. Three cases occurred during late pregnancy and the puerperium. Contact tracing supported both person-to-person transmission and an animal origin for cases within the group. Cryptosporidiosis is shown to be an important cause of traveller's diarrhoea. The incubation period was from two to 11 days.
Bleeding Colonic Varices Controlled by Propranolol
Authors: McAlpine L.G. , Birnie G.G. , Hilditch T.E. , Dagg J.H.
Published: January 2017

A 64-year-old man with hepatic cirrhosis developed severe haemorrhage from oesophageal varices. He underwent a course of sclerotherapy injections which successfully obliterated the oesophageal varices and prevented further oesophageal bleeding. He later developed serious bleeding from a site in the region of the ascending colon; angiography and radionuclide imaging suggested that varices were present in that region. Therapy with oral propranolol was effective in preventing any recurrence of gastrointestinal bleeding.
The Basic and Advanced Cardiopulmonary Resuscitation Skills of Trained Hospital Nursing Staff
Authors: Seidelin P.H. , McMurray J.J.V. , Stolarek I.H. , Robertson C.E.
Published: January 2017

The cardiopulmonary resuscitation skills of 105 trained hospital nurses were tested. Both basic and, for the first time in the UK, advanced skills were examined; basic skills were assessed by practical evaluation with a standard manikin and advanced knowledge by multiple choice questionnaire. No nurse adequately performed all four practical skills tested. Knowledge of the ventilatory aspects of resuscitation, defibrillation and advanced technique and drug management were also found to be poor.

The findings add further support to adequate training of nurses in resuscitation skills. We describe a solution to overcome the heavy demands of such teaching and suggest that the same model be applied to the training of medical staff in resuscitation skills.
Malignant Angioendotheliosis — An Unsual Cause of Stroke
Authors: Lennox I.M. , Zeeh J. , Currie N. , Martin G. , Adams J.H.
Published: January 2017

We report a case of malignant angioendotheliosis in a 63-year-old female who presented with a right hemiparesis. This diagnosis should be considered when multi-focal neurological signs develop in association with a progressive deterioration of mental state and conscious level.
Scottish Head Injury Rehabilitation: An Historical Account
Authors: Pentland B. , Boake C. , McKinlay W.W.
Published: January 2017

During the Second World War two units were established in Scotland for the rehabilitation of head injured patients which were ahead of their time in philosophy and practice. Despite advice to the contrary, these two facilities were not maintained in the ensuing post-war years and while other countries have expanded and improved upon the concepts of care for the traumatically brain injured no specific unit for head injury rehabilitation exists in Scotland today.
Intravenous Drug Misusers Presenting to the Accident and Emergency Department of a Large Teaching Hospital a Failure of Clinical Management?
Authors: Stone M.H. , Stone D.H. , MacGreggor H.A.R.
Published: January 2017

The records of all 77,686 attendances at or via the accident and emergency department of the Glasgow Royal Infirmary in 1986 were examined. Of these, 488 (0.6%) contained evidence of intravenous drug misuse (IDM). Most (68%) of the 354 attenders were male. The mean age of attenders in both sexes was 22 years. Over half of the presenting conditions were ‘surgical’ (mainly abscesses), while ‘psychiatric’ (including explicitly drug-related) conditions comprised about 30%. In almost two-thirds of cases, patients were discharged without specialist follow-up or care. Only 5% were referred for specialist assessment of their drug misuse. About a fifth were admitted. It is argued that these findings appear to represent a serious failure of clinical management requiring an urgent remedy, particularly in the light of the growing problem of HIV transmission in this group.
Atrial Myxoma as the Cause of Acute Lower Limb Ischaemia in a Teenager
Authors: Weerasena N.A. , Groome D. , Pollock J.G. , Pollock J. C.
Published: January 2017

We report a case of a previously well teenager presenting with a sudden cardiovascular collapse due to a saddle embolus. This required immediate surgical interventiion. Histology of the embolic material showed it was myxomatous. Echocardiography confirmed the diagnosis and the patient made an uneventful recovery following excision of the right arterial myxoma.
Fine Needle Aspiration Cytology of Lesions of the Head and Neck and Factors Affecting Outcome
Authors: Morton K.D.
Published: January 2017

Fine Needle Aspiration Cytology (F.N.A.C.) has been used as a diagnostic tool by the ENT departments in Tayside since the end of 1985. This paper discusses the results of our initial experience with this and outlines some of the diagnositc pitfalls. This is a useful and accurate procedure with many advantages over diagnostic biopsy.
Coronary Risk Factor and Lifestyle Variation across Scotland: Results from the Scottish Heart Health Study
Authors: Tunstall-Pedoe H. , Smith W.C.S. , Crombie I.K. , Tavendale R.
Published: January 2017

Between 1984 and 1986 the Scottish Heart Health Study recorded coronary risk factors and lifestyle in 10,359 men and women aged 40–59 years across 22 districts of Scotland — districts whose standardised mortality ratio for coronary heart disease in men varied from 61 in Eastwood to 136 in Monklands. This paper presents the results by district. Cigarette smoking levels showed the greatest variation, from 29% to 52% in men and 24% to 51 % in women. Blood pressure means varied but were not high (129–138mmHg systolic in men, 126–137mmHg in women, 81–88mmHg diastolic in men and 77–84mmHg in women). Mean serum cholesterol values were high and varied little by district in men, (6.1 to 6.5mmol/l), although there was more variation in women (6.3 to 1.0mmol/l). Body mass index (25.3 to 26.6kg/m2 in men and 24.8 to 26.3kg/m2 in women) also varied little. Distribution of other lipids, fibrinogen, exercise levels and fruit and vegetable consumption is also described. When district mean levels of major coronary risk factors are entered into predictive formulae, cigarette smoking and blood pressure could explain part of the regional variation in mortality, but much remains unaccounted for. Nonetheless, these levels provide data for local preventive initiatives. While the overall pattern and interaction of the factors will repay further study, the high levels of serum cholesterol in all districts, and the level and variation in cigarette smoking, are a challenge for action.
Idiopathic Myoglobinuria in the Early Puerperium
Authors: Owens O.J. , Macdonald R.
Published: January 2017

Myoglobinuria is rare in association with pregnancy. We report a case of idiopathic myoglobinuria in the early peurperium in a patient who had a spontaneous vaginal delivery. Acute muscular pain and port wine staining of the urine should alert the clinician.
Synchronous Colonic Adenocarcinoma and Extragenital Malignant Mixed Mesodermal Tumour
Authors: El-Jabbour J.N. , Helm C.W. , McLaren K.M. , Smartt G.E. , Aitken J.
Published: January 2017

A synchronous occurrence of large bowel adenocarcinoma and extragenital malignant mixed mesodermal tumour (MMMT) is reported. This case represents the sixth extragenital MMMT reported in the literature.
Multiple Gastric Carcinoid Tumours Associated with Atrophic Gastritis
Authors: Stewart D.A. , McGowan A.R. , Roberts M.A.
Published: January 2017

A case of multiple gastric carcinoid tumours is described in an elderly man with atrophic gastritis and hypergastrinaemia. This case provides further evidence of an association between hypochlorrhydric states and some gastric endocrine tumours.
Fifty Years of an Organized Blood Transfusion Service in Scotland
Authors: Girdwood Ronald H.
Published: January 2017

The activities of an enthusiastic Edinburgh dentist in recruiting donors in the early 1930s led up to the establishment of a Scottish National Blood Transfusion Association in 1940. From this has developed the present Service with five Regional Centres and a major manufacturing Protein Fractionation Centre.
Survival Associated with Renovascular Disease in Glasgow and Newcastle: A Collaborative Study
Authors: Isles C. , Main J. , O'Connell J. , Brown I. , Findlay J. , Stewart R. , Wilkinson R.
Published: January 2017

Data from 121 consecutive patients with hypertension and renovascular disease, first diagnosed between 1975 and 1982 in Glasgow and Newcastle, were analysed retrospectively to determine the factors which influenced their outcome. Thirty-six patients died between the date of arteriography and 1st January 1987, giving five and ten year survival rates of 83% and 67%. Survival was greatly reduced in comparison with that of age-sex-matched controls in the general population of the West of Scotland, and was also less than that of essential hypertensives matched for age, sex, initial diastolic blood pressure and smoking habit who had attended the Glasgow Blood Pressure Clinic during the same period. Multivariate analysis showed that age, cigarette smoking and presence of atheromatous disease were significantly and independently related to outcome among the patients with renovascular disease, whereas male sex, centre of origin, severity of hypertension when first seen, initial renal function and presence of bilateral disease were not. Despite a trend towards benefit from surgical intervention (ten year survival in medical group 62%, in surgical group 71%; p=0.19) our data do not prove that intervention is better than medical treatment, largely because the decision on intervention was not randomised. A prospective trial would be required to answer this important question.
Mortality and Increasing Drug Use in Edinburgh: Implications for HIV Epidemic
Authors: Skidmore C.A. , Robertson J.R. , Savage G.
Published: January 2017

Mortality among a group of known drug users shows small numbers of deaths from AIDS so far but increasing deaths from overdose, especially in young women. Steadily rising numbers of drug injectors are observed. The need for a distinctly different educational approach in areas of very high seroprevalence is discussed and the requirement for close co-operation between prescribing sources identified.
Contact Lens Related Problems Presenting in Casualty
Authors: Sanders R. , McIlwaine G. , Barrie T.
Published: January 2017

The use of contact lenses in preference to spectacles has gained much popularity over recent years. This, however, is not without its complications and eye departments are now seeing an increasing number of contact lens related eye disease. This study seeks to show the range of complications seen, their treatment and outcome. It also outlines the types of contact lens in popular use, the reason for wear, the duration of wear and the sex, age and professional distribution of contact lens wearers.
Alcohol Intoxication and Alcoholism in Acute Male Medical Admissions
Authors: Trevett A. J. , Currie N. M. , MacConnell T. J.
Published: January 2017

In order to assess alcohol related morbidity in male hospital patients we studied all acute male admissions over a period of three months. 9.3% of patients were found to have detectable alcohol on admission (level >4 mmol/l). A total of 28.3% of admissions were judged to be alcoholic by questionnaire (Michigan Alcohol Screening Test). These results suggest that acute intoxication in male hospital admissions is not as common as previously recorded. The prevalence of alchololism, however, was disturbingly high and has significant implications for in-patient management.
Exchange Transfusion of Whole Blood in the Treatment of Cerebral Malaria
Authors: Elder A.T. , Croughan M.J. , Boulton F.E. , Brettle R.P.
Published: January 2017

A case of cerebral malaria in a young British traveller, successfully treated by exchange transfusion of whole blood, is reported and the literature regarding the use of this technique in P. falciparum malaria is briefly reviewed.
Decisions to Limit Treatment in a Neurosurgical Unit: An Aspect of Audit of Mortality
Authors: Barlow P. , Jennett B.
Published: January 2017

The monthly audit of deaths in this regional neurosurgical unit notes decisions to limit treatment recorded in the case-sheet. In 1988 a treatment-limiting decision was noted in 67 of 131 deaths (51%). In 40% of these the decision was made soon after admission; in these patients the mean time to death was 1.5 days (median one day). When the decision was made later, the mean time from admission to death was 6.8 days (median five days). Regular audit provides an opportunity to discuss the appropriateness of such decisions in various circumstances.
What Do Scots Die of When Abroad?
Authors: Paixao M.L.T. D'A. , Dewar R.D. , Cossar J.H. , Covell R.G. , Reid D.
Published: January 2017

Information was obtained on 952 persons who travelled from Scotland between 1973 and 1988 and who died while abroad. In the older age group cardio-vascular disease was the major cause of death whereas in the younger group traumatic deaths were commonest. Most died in the holiday resorts bordering the Mediterranean and the question is posed on the need for specific advice to those who are most vulnerable before embarking on overseas travel.
The Natural History of Dilated Cardiomyopathy — A Community Study
Authors: Herd R. , Hillman R. , Irving J.B.
Published: January 2017

The incidence, clinical features and natural history of dilated cardiomyopathy within a clearly defined population of Scotland was studied retrospectively. From 1982 to 1986, 57 cases were recorded in a population of 145,00, representing an annual incidence of 7.9 per 100,000 per year. This incidence rate is higher than that reported from other centres, and the overall survival rates were poorer.
Review of 18 Years' Experience of a Diagnostic Geriatric Neurology Referral Service
Authors: Duncan G. , Caird F.I.
Published: January 2017

From 1971 to 1989, 1446 cases were referred from Glasgow and the West of Scotland to the University Department of Geriatric Medicine for neurological diagnosis. In that time, the number increased from one per week to more than two per week, and the proportion from outside Glasgow from 2% to 24%. Eighty-seven per cent had CT scans and 8% electrophysiological studies. One third of patients stayed three days or less, and one third over a week.

Cerebrovascular disease was diagnosed in 637 cases (44%), subdural haematoma or hygroma in 59 (4%), and intracranial tumour in 228 (16%), of which 26 (11%) were benign. In 104 cases (7%) no definite diagnosis was made.

Management was changed in 402 of the 1446 cases (28%). In the 635 (44%) in whom a referring diagnosis was documented, this was not confirmed in 63%; diagnosis and/or management was changed in 80%. The proportions of referring diagnoses of subdural haematoma and intracranial tumour that were confirmed rose with time.

The value of the service lay in the speed and ease of access to it, and the opportunities for teaching and learning it provided. The problems it posed were those of the transfer of ill patients, the distances sometimes necessary, and the need for high standards of communication.
Metastatic Pancreatic Polypeptide Producing Tumour Presenting with Diabetes Mellitus
Authors: Quin J.D. , Marshall D.A. , Fisher B.M. , MacCuish A.C.
Published: January 2017

A metastatic pancreatic polypeptide tumour is described which presented clinically with diabetes mellitus. This is the first case to present this way.
Pancreatic Mediastinal Pseudocyst: Report of Two Cases Simulating Intrathoracic Disease
Authors: Ahmad N. , Auld C.D. , Lawrence J.R. , Watson G.D.
Published: January 2017

Mediastinal pseudocysts of the pancreas are extremely rare. Intra-thoracic symptoms such as dysphagia or dyspnoea due to compression or associated pleural effusions are common and urgent decompression by percutaneous or internal drainage is often necessary.
Concealed Rectal Opiates Presenting as Respiratory Arrest: The Importance of Rectal Examination in IV Drug Abusers
Authors: Stevenson J. , Hume M.A.
Published: January 2017

A case of recurrent respiratory depression due to rectal absorption of concealed opiate drugs in an intravenous drug abuser held in police custody is described. The importance of rectal examination in intravenous drug abusers in police custody is stressed and it is emphasised that drugs may have been concealed in a body cavity at the time of arrest. The use of both the intramuscular and intravenous route for the administration of naloxone in treatment of unconscious intravenous drug abusers suspected of having overdosed on opiates is advocated as these patients frequently discharge themselves from hospital on regaining consciousness and may later present with recurrent respiratory depression.
Malaria in Aberdeen: An Audit of 110 Patients Admitted between 1980–1991
Authors: Nathwani D. , Badial R. , Khaund R.R. , Douglas J.G. , Smith C.C.
Published: January 2017

All 110 patients seen in North East Scotland after contracting malaria from foreign travel were treated in the Regional Infection Unit in Aberdeen. Those patients managed there from January 1980 to March 1991 are described. There were 54 episodes of Plasmodium falciparum malaria (49%) and 26 episodes (23%) of Plasmodium vivax malaria. The remainder had either mixed infection or were diagnosed as malaria on high clinical probability. The majority of the patients were male (80%) and under 40 years of age (84%). Most patients were either Caucasians born in the UK (69%) or native Africans (23%) who were students recently arrived for further education or who had returned from visiting their country of origin for summer holidays. The British residents acquired infection either while on oil related business in West or Central Africa (46%) or after travelling on holiday (30%). The peak incidence of presentation was August and September. 93.5% of patients with falciparum malaria had returned or originated from Africa. 42% with vivax malaria had visited Africa and 27% Papua New Guinea. 70% had been prescribed antimalarial prophylaxis but less than half of these took their medication correctly. The majority of patients with falciparum malaria presented within two weeks of arrival in Britain while patients with vivax malaria presented at varying (but generally longer) intervals, 42% being diagnosed more than three months after exposure.

Falciparum infection was more severe although there have been no deaths in the unit from malaria. Our experience seemed of interest and worth reporting because of the number of patients whose infection reflected travel related to the offshore oil industry, which is centred in Aberdeen.
Streptococcus Milleri and Complex Groin Abscesses in Intravenous Drug Abusers
Authors: Hemingway D.M. , Balfour A.E. , McCartney A.C. , Leiberman D.P.
Published: January 2017

Intravenous drug abuse is an increasing problem. Septic complications occur frequently at the injection site, especially in the groin where large abscesses around the femoral vessels can threaten life or limb. We report four patients with extensive or complex groin abscesses following attempted self-injection into the femoral vein. Streptococcus milleri was cultured from all of these abscesses and prompted a review of the isolation of this organism in this hospital.
“A Beloved Physician” John Abercrombie MD (EDIN) FRCSE, FRCPE, MD (OXON) 1780–1844
Authors: Baxter P. A.
Published: January 2017

This son of an Aberdeen minister, graduating MD in Edinburgh in 1803, established a leading practice in that city, attracting apprentices to study medicine and patients of all classes of society from throughout Scotland. Sir Walter Scott in his later years was one who relied on his medical expertise. Dr Abercrombie, a Fellow of both the Royal College of Surgeons and Royal College of Physicians, Edinburgh, was in the forefront of Edinburgh medicine. An extensive author, primarily on medical subjects and laterally turning to metaphysical, moral and religious works, he gained a reputation among intellectuals world-wide.

A philanthropist, he gave large amounts of financial aid to Missionary Societies, both at home and overseas. A founder member of first President of the Edinburgh Association for Sending Medical Aid to Foreign Countries (two years later renamed the Edinburgh Medical Missionary Society).
Laser Therapy for Endobronchial Tumours
Authors: Chakraverty S.C. , Rafferty P.R.
Published: January 2017

Endobronchial laser therapy has been performed at Knightswood Hospital, Glasgow since 1983. During the period 1983 to 1990, 62 patients underwent a total of 149 laser treatments. The principal indications for therapy were tracheo-carinal stridor (24%), dyspnoea due to bronchial occlusion (60%) and haemoptysis (13%). Squamous carcinoma accounted for 80% of the lesions. Over 75% of patients had already received some form of prior therapy (radiotherapy 71%, chemotherapy 8%, surgical resection 11%). Laser therapy reduced stridor in 67% of patients with tracheal and carinal tumours and produced symptomatic improvement in 72% of patients with bronchial obstruction but without evidence of lobar collapse. Haemoptysis was controlled in all but one of patients treated. Two patients (3.2%) died during laser treatment following severe haemorrhage.
Skin Lesion Removal: Practice by General Practitioners in Grampian Region before and after April 1990
Authors: Brown P.A.J. , Kernohan N.M. , Smart L.M. , Savorgaonkar P. , Atkinson P. , Robinson S. , Russell D. , Kerr K.M.
Published: January 2017

The introduction of new GP contracts in April 1990 incorporated a financial incentive to undertake minor surgical procedures. Previous reports have noted large increases in the number of GP-derived skin specimens after April 1990. Our present study intended to address whether similar changes have occurred in Grampian Region as well as, more specifically, noting whether there have been changes in the quality of practice following the 1st April 1990. A retrospective study of skin biopsies removed by general practitioners in Grampian Region was undertaken. Cases were selected from four periods of six months (1st April to end of September) in 1987, 1988, 1989 and 1990. All skin specimens sent by general practitioners to the Department of Pathology, Aberdeen Royal Infirmary, were included. Following April 1990 there was a two-fold increase in skin specimen numbers—an increase significantly greater than increases observed over previous years (p<0.01). Of particular note was the contribution made to this increase by Aberdeen City GPs whose contribution rose five-fold (p<0.0001). Non-benign lesions (ie malignant plus carcinoma-in-situ-) represented 6% of lesions excised. A non-benign clinical diagnosis or an indication of suspicion was written on only one third of request forms for histopathologically diagnosed non-benign lesions. The proportion of histologically incompletely excised lesions rose over the four years (p <0.01); moreover the increase in total numbers of lesions resulted in a striking increase in the actual numbers of incompletely excised lesions after April 1990.
Prevalence of Maternal HIV Infection in Scotland Based on Unlinked Anonymous Testing of Newborn Babies. Update
Authors: Tappin D.M. , Girdwood R.W.A. , Follett E.A.C. , Kennedy R. , Brown A.J. , Cockburn F.
Published: January 2017

In January 1990, unlinked anonymous testing of Guthrie cards for HIV antibody commenced in Scotland. Ethics Committee approval allowed testing of 99.6% of Scottish births. Twenty-one mothers spontaneously refused to allow testing of their baby's blood. Samples were coded by district postcodes. For 1990 through 1991, eluates of 132,531 dried blood spots were initially tested for HIV-1 antibody with the Fujirebio technique. Of the 49 positive samples 38 were confirmed to be positive by enzyme-linked immunosorbent assay and western blot (seroprevalence 0.3 per 1000). Thirty-five of 38 samples came from large metropolitan areas in Scotland. Prevalences were 2.0 per 1000 for Edinburgh city, 0.7 per 1000 for Dundee and Aberdeen, 0.15 per 1000 for Glasgow and 0.05 per thousand for all other areas in Scotland. Recent spread of HIV infection to Aberdeen may have occurred. These figures do not support an overall increase of HIV infection in childbearing women in Scotland.
A Case of Acute Respiratory Failure Due to Tracheal Compression by a Thyroid Cyst
Authors: Hinnie J. , Lafferty M. , Vasey P , Milroy R.
Published: January 2017

A patient is described who presented with sudden collapse due to acute respiratory failure caused by tracheal compression from a thyroid cyst. He made a complete recovery and the cyst was electively excised two weeks later.
Motor Neuron Disease: A Disease of Old Age
Authors: Chancellor A.M. , Hendry A , Caird F. I. , Warlow C.P. , Weir A.I.
Published: January 2017

There is little information dealing specifically with motor neuron disease (MND) in the elderly. Given current epidemiological trends, geriatricians will be increasingly called upon to diagnose and manage this condition. We report four patients who presented within a six month period to a geriatric medical unit, and place this experience in the perspective of 229 patients from a population-based study of adult-onset MND in Scotland in 1989 and 1990.

In 1990 Scotland had a crude annual incidence of MND of 2.25/100,000; the figure for those over 65 is four times greater. MND is more common in men, but the sex ratio was nearly equal over the age of 65. The risk of presenting with bulbar palsy was greater in women, and even higher in elderly women. This, together with increasing age, is the most important negative prognostic factor in MND.

Problems with the diagnosis and management of MND in the elderly are highlighted.
A Local Census of Dementia Sufferers
Authors: Gordon D.S. , Gillies B.A. , McWilliam N.G. , Spicker P.S.
Published: January 2017

The results of a census of all dementia sufferers known to institutional and community services in Angus are reported. A total of 859 sufferers were identified compared with an expected 1013 based on EURODEM prevalence rates. After allowing for cross-boundary flow to institutions, it was estimated that the true identification rate was 80% (809/1013). Of the estimated total 1063 sufferers (including cross-boundary flow): 26% were in hospital, 27% in residential or nursing homes, 27% in the community and known to services (often the GP), and 19% in the community and not known to services (or, at least, not returned by them in the census). With the co-operation of all concerned, a census approach can yield useful information at a much lower cost than a full survey.
Medical Affairs in the Far East after V-J Day: A Personal View
Authors: Girdwood R.H.
Published: January 2017

The invasion of Singapore and Malaya was delayed because of the reduction in the period of service in the Far East. The atom bombs were then dropped and plans for all services including medical ones had to be altered, their main aim becoming the treatment and repatriation of surviving prisoners of war. The ending of the war did not occur abruptly on V-J day; many Japanese troops had to be convinced that the war was over. Meantime the treatment of diseases in British and other service men continued; reference is made to some experiences in Rangoon. The morale of personnel who now were anxious to return to their homes was low and efforts were made to raise their spirits. In India it was accepted that the days of British rule were over.