bluuebunny/crossref_metadata_2025 huggingface dataset:
The Importance of Identifying Intracranial Haemorrhage as a Cause of Transient Focal Neurological Symptoms
Authors: MacWalter R.S. , Dutta D. , Fraser H.W. , Nimmo M.J.
Published: January 2017

Until recently, there have been no reports of intracerebral haemorrhage presenting with transient neurological symptoms. We present two cases of intracerebral haemorrhage presenting as transient ischaemic attacks and discuss the radiological changes on early and late CT scans. It would seem justified to scan most patients presenting with TIA early to institute appropriate secondary prevention measures.
Painful Knee — An Unusual Cause Secondary to Pseudomonas Septic Arthritis of the Hip
Authors: Meek R.M.D. , MacSween W.
Published: January 2017

A child presented with knee pain, the cause of pain was found on further investigation to be due chondrolysis of the hip joint secondary to a pseudomonas aeruginosa septic arthritis. The patient functionally did well following a subtotal synovectomy and prolonged treatment with appropriate antibiotics.
The NHS — is Scotland Different? a Case Study of the Management of Health Care in the Hospital Service in the West of Scotland 1947 – 1987
Authors: McTavish D.
Published: January 2017

Management of the health service in Scotland and England, has since its creation, shown both divergence and congruence. In the initial decades in Scotland the executive hospital boards (which contained strong medical professional membership) and central government had a clearer relationship than in England. The health service-civil service machinery in Scotland was without doubt more to the forefront with higher status in the Scottish ‘polity’ than was the case in England. The 1970s reforms also indicated difference: despite the pro managerialist tones of the Farquarson Lang report in Scotland, a managerial emphasis was more apparent in the English reforms. By the 1980s, the government's clear intention that their ‘radical’ agenda should apply in Scotland and England was implemented in many instances: aspects of the new managerialism were applied as vigorously in the case examined than anywhere in England: the attempt to draw clinicians into resource management (as advocated in the Griffiths report) appeared to have advanced further in Scotland until well into the 1990s. Yet in other aspects, Scotland diverged from parts of England in the implementation of the 1980's agenda most notably in the growth of private practice though the case indicated significant Scottish developments here too. The article concludes by speculating on some Scottish differences in the coming years.
Separating Elective and Emergency Surgical Care (The Emergency Team)
Authors: Addison P. D. R. , Getgood A. , Paterson-Brown S.
Published: January 2017

The purpose of this study was to evaluate the influence on general surgical activity following the separation of elective from emergency surgical care in one large teaching hospital. A prospective audit of elective and emergency general surgical activity between 1994 and 1999 inclusive was carried out. Elective and emergency surgical activity was separated in January 1996, with a dedicated ‘Emergency Team’ of one consultant for one week, two registrars, two senior house officers and four house officers for two weeks, in addition to a 20 bed acute admission ward and a 24 hour emergency theatre. The consultant cancelled the majority of his/her elective work during the on—call week. A prospective collection was made of all elective and emergency operations carried out between 1994 and 1999 using the Lothian Surgical Audit system. Out of hours operative activity was analysed retrospectively from data collected using the Operating Room Schedule of Surgery (ORSOS) and outpatient clinic and day case activity collected from the Hospital Administration System. Comparisons were made between years 1994/1995 and 1996/7/8/9. Emergency surgical admissions rose by 86% from 1973 patients in 1994 to 3675 in 1999. During the same period, elective in-patient activity remained fairly steady, but there was an increase in day surgery from 469 to 2089 cases per annum. Despite the on—call consultant cancelling his/her outpatient clinics, overall outpatient activity also increased from 9911 to 12335. However a proportion of this reflects the appointment of two new consultants in April 1998. Emergency operations increased from 941 in 1994 to 1351 in 1999, with a two-fold reduction in operations carried out between 0000–0800 hours from 16% in 1994 to 7.9%) in 1999. A separate and dedicated ‘Emergency Team’ is an efficient method of managing acute general surgical admissions. It permits elective work to carry on uninterrupted, reduces the number of operations performed after midnight, and provides a better environment for teaching and training. This scenario might also be applicable to other medical specialties who have a large emergency committment.
Hyponatraemia in Hip Fracture Patients
Authors: McPherson E. , Dunsmuir R. A.
Published: January 2017

We performed a retrospective review of hyponatraemia in patients with hip fractures, before and after surgery. All patients admitted with fractures of the neck of femur who had a surgical intervention to deal with the fracture were included. Results were determined using two definitions for hyponatraemia. The incidence of preoperative and post-operative hyponatraemia were both 2.8% if hyponatraemia was defined as [Na]<130mmol/l. No cases of hyponatraemia were found pre-operatively when hyponatraemia was defined as [Na]<125mmol/l. Using this definition the post operative incidence of hyponatraemia was 0.93%. The incidence of hyponatraemia in this group of patients is small. However the potentially severe affects of hyponatraemia warrant close monitoring of these patients and the establishment of methods to prevent this problem from occurring.
Glasgow's Community Care Programme: 10 Year Follow up of Discharged Patients with Schizophrenia
Authors: Ward R J , McLaughlin M E , Livingston M G
Published: January 2017

In 1986, the rehabilitation of every long stay psychiatric patient in Glasgow was assessed with a view to reducing bed numbers and developing comprehensive community services. Ten years on, we have attempted to trace 91 patients with a diagnosis of schizophrenia assessed at Gartnavel Hospital, in order to repeat assessments of their psychopathology and levels of functioning. We believe this population represents a unique group in terms of their age, length of hospital stay and chronicity of symptoms. Only two patients were untraced but 36% of the original 91 patients were deceased. Discharge to the community and variations in standards of care appeared to have little impact on the symptomatic presentation of the survivors over ten years. The results provide useful information on the success or otherwise of a large scale discharge and community care programme which is continuing in Scotland.
Inflammatory Pseudotumour of the Caecum: A Case Report
Authors: Ihedioha U , Coldewey J , Murphy D
Published: January 2017

Inflammatory pseudotumors of the caecum are uncommon. They pose problems with diagnosis. We report on a 35 year old female who presented with clinical signs of acute appendicitis. Intra-operatively, a caecal tumour was found with normal appendix and multiple enlarged mesenteric lymph nodes. A right hemicolectomy was performed. Histopathology findings revealed an inflammatory mass with abundant fibroblast proliferation with associated collagen formation, infiltrating bowel wall and pericaecal adipose tissue. She recovered well and was discharged home 5 days post-operatively. A t present, she is free of symptoms.
Coxsackie Virus Infections in Patients with Acute Cardiac Disease and Chest Pain
Authors: Bell Eleanor J. , Grist N. R.
Published: January 2017

During 1964 and 1965 infections with Coxsackie virus types A4, B1, B2, B4 or B5 were diagnosed in 9 cases of acute pericarditis ( 2 with myocarditis), 1 of acute myocarditis, 8 of Bornholm disease and 1 of acute chest pain attributed to myocardial ischaemia. Echovirus 6 was isolated from a case of Bornholm disease with antibody response to Coxsackie B 1 virus. Echovirus type 25 was isolated from an additional case of acute myocarditis.

During epidemics Coxsackie viruses probably contribute significantly to acute cardiac disease. The virological diagnosis is often difficult to achieve, and it is important to attempt virus isolation from early specimens in addition to testing paired sera.
The Management of Ulcerative Colitis
Authors: Watkinson G. , De Dombal F. T.
Published: January 2017

A plea for a combined medicosurgical treatment of ulcerative colitis has been made. While considerable advances in therapy have improved the results of medical treatment in the last 20 years increasing knowledge of the natural history and prognosis of ulcerative colitis has shown that proctocolectomy has been increasingly required in severe colitic attacks, in elderly subjects and in patients with total colonic involvement.
The Place of Relief Colostomy in Resection for Carcinoma of the Left Colon and Upper Rectum
Authors: Samuels M. J.
Published: January 2017

A review of 167 consecutive cases of resection and anastomosis for carcinoma of the left colon and upper rectum over a 5-year period is described. An attempt was made to determine whether relief colostomy was associated with a lower incidence of anastomotic dehiscence.

The overall figures of this survey show a 5-fold increase in anastomotic leaks where proximal decompression had not been used. In all regions relief colostomy was shown to have a protective effect, but this was especially true in the patients submitted to anterior resection for growths in the upper third of the rectum. The subsequent operation for closure of the colostomy did not add to the overall operative mortality in this series.
The Tuberous Sclerosis Complex
Authors: Martin A. J.
Published: January 2017

A typical case of tuberous sclerosis is described with the post-mortem findings. A suggestion is made to aid in the recognition of papilloedema.
Changes in the Electrocardiogram and Achilles Reflex Test during Treatment of Hypothyroidism
Authors: Weir R. J. , Young J. A. , McGuinness J. B.
Published: January 2017

In 10 patients with hypothyroidism, the electrocardiogram and Achilles reflex test have been recorded before and during treatment with l-thyroxine sodium. Aspects of the electrocardiogram affected by hypothyroidism are the rate, duration of PR interval, height of P-wave, of QRS complex and of T-wave and the ST segment. Each of these improved with therapy, the earliest and most sensitive change being the height of the QRS complex. The Achilles reflex time as recorded by the photomotograph also showed a parallel decrease with therapy but this is considered to be less reliable as an isolated test. The prolongation of the PR interval is briefly discussed and a correlation between the changes in skeletal and myocardial muscle is suggested.
The Role of Thyroxine Binding in the Establishment of Thyroid Status
Authors: Harland W. A. , Orr J. S.
Published: January 2017

This paper reviews previously published evidence concerning the view of thyroxine metabolism which holds that thyroxine exchanges rapidly and freely throughout its distribution space. This view is essential for the well known concept of ‘free thyroxine’, that small fraction of the plasma hormone not bound to protein but in equilibrium with the specific binding proteins. ‘Free thyroxine’ is held to be the biologically active fraction of the plasma hormone.

A considerable body of evidence inconsistent with the ‘free thyroxine’ hypothesis is examined and details of experiments indicating the essentially permanent nature of thyroxine binding are reviewed. It is concluded that the ‘free thyroxine’ concept as currently defined, is no longer acceptable. A new model of thyroxine metabolism is presented.
Jaundice in Pregnancy
Authors: Richards R. L. , Willocks J. , Dow T. G. B.
Published: January 2017

In the 5-year period 1964–68, 16 cases of jaundice in pregnancy were encountered in the Queen Mother's Hospital, Glasgow—an incidence of one in 853 deliveries. The cases, classified according to clinical and biochemical findings, showed considerable variation in type. Infectious hepatitis and intrahepatic cholestatic jaundice were the commonest varieties but there were cases associated with acute urinary tract infection, with prolonged vomiting, and due to extra-hepatic biliary obstruction. One patient had afibrinogenaemia, and Factor VII deficiency was present in 5 patients. Liver biopsy during pregnancy was not considered necessary. There were no maternal deaths although many of the patients had a severe illness and one proceeded to develop signs of cirrhosis. The two foetal deaths in the series were in infants delivered before the 30th week of gestation. Premature labour is a risk in jaundice as in any other acute illness in pregnancy.
Increased Antipyrine Half-Life in Women Taking Oral Contraceptives
Authors: O'Malley K. , Stevenson I. H. , Alexander Wilma
Published: January 2017

The plasma half-life of antipyrine has been measured in 18 women taking oral contraceptives and in 19 control subjects. The mean half-life in the oral contraceptive group of 13.2±2.0 hr. was significantly prolonged compared to the control value of 10.5±2.5 hours
Extended Therapy in Patients with Established Urinary Tract Infection
Authors: Lawson D. H. , Gleadle R. I. , Linton A. L.
Published: January 2017

Sixty-six patients with established urinary tract infection were given a 3-month course of antibacterial therapy and the effect of this upon the recurrence rate of urine infections investigated.

Even in patients with no radiological evidence of renal damage the recurrence rate was 40 per cent at 2 years and this rose to 75 per cent in the group with impaired renal function and abnormalities present on intravenous pyelography.

It is concluded that an initial 10 day course of therapy is indicated in females suffering from their first or second attack of acute urinary tract infection. If this becomes established, a 3-month course of therapy is suggested and following this, further recurrences demand careful renal investigation. In the male, all cases of urinary tract infection should be investigated after the initial therapy. Finally, the management of those patients with no anatomical lesion who suffer from recurrent attacks of infection after a 3-month course of therapy has not yet been clearly defined. There is no evidence that either ampicillin, nitrofurantoin or nalidixic acid is superior to sulphadimidine in the treatment of patients with established urinary tract infection.
Coronary Care in a General Hospital
Authors: Shaw Gavin , Groden Bernard , Hastings Evelyn
Published: January 2017

The establishment, staffing and structure and observations made in the first year of the existence of coronary care in an intensive care unit in a general hospital are recorded. Two hundred and twenty eight patients were admitted during the year in whom the diagnosis of myocardial infarction was confirmed. There were 29 deaths in the unit and 14 deaths occurred in the wards of the hospital after discharge from the unit. 49.1 per cent of the patients were admitted within 4 hours of the onset of symptoms and the mean duration of stay in the unit was 86.5 hours. The type of arrhythmia detected in the unit, and the treatment given to the patients both before and after admission to the intensive care unit are described.
Thrombo-Angiitis Obliterans (Buerger'S Disease) in the West of Scotland
Authors: Richards R. L.
Published: January 2017

The available case records relating to all admissions to hospitals in the Western Region of Scotland in which a diagnosis of thrombo-angiitis obliterans had been made in the years 1961–68 inclusive were reviewed. These records referred to 93 patients, 90 of whom were domiciled in the West of Scotland. In 40 cases it was immediately apparent that the diagnosis was incorrect. In the remaining 50 cases the diagnosis was re-assessed using a diagnostic index based on certain well-defined clinical features. When this had been done it was considered that the diagnosis of thrombo-angiitis obliterans was probably correct in 13 cases and possibly correct in a further 14. In those cases in which material obtained by biopsy or at amputation had been examined by a pathologist there was not a good correlation between the final clinical diagnosis and the opinion expressed by the pathologist. It is concluded that thrombo-angiitis obliterans is an extremely rare disease and that although the diagnosis is made much less often than it used to be it is still made too readily. The similarity between the clinical features of thrombo-angiitis obliterans and the manifestations of peripheral arterial disease in diabetes mellitus is stressed.
Changes in Leucocyte Ascorbic Acid during the Common Cold
Authors: Hume R. , Weyers Elspeth
Published: January 2017

Leucocyte ascorbic acid was measured in 7 subjects during the common cold. There was a significant fall in L.A.A. to scorbutic levels within 24 hours of the onset of symptoms. By the fifth day the L.A.A. had returned to normal, which coincided with the cessation of symptoms. Absorption studies suggested 1g. ascorbic acid per day as a prophylactic dose and 6g. ascorbic acid per day as a therapeutic dose. The effect of such supplements of ascorbic acid in 4 episodes of the common cold in 3 subjects suggests that the L.A.A. pattern can be changed by this therapy. The implications are discussed.
An Assessment of Digoxin Radio-Immunoassay
Authors: Whiting B. , Sumner D. J. , Goldberg A.
Published: January 2017

Using a commercially available digoxin radio-immunoassay kit, an accuracy of the order of ±10 per cent has been achieved. Precision could be improved by increasing the ratio (volume of plasma/volume of radioactive digoxin). The assay permitted separation of clinically toxic and non-toxic patients with plasma digoxin values of 3.5±0.6 (S.D.) ng. per ml. and 1.4±0.6 ng. per ml. respectively (p <0.001). A correlation between blood urea and plasma digoxin concentration was demonstrated (r=0.57, p <0.001).

The assay was particularly useful in the confirmation and follow-up of suspected digoxin poisoning in attempted suicide, and in renal failure to arrive at a modified digoxin dosage schedule.
Bone Mineral Content Measured by Direct Photon Absorptiometry in a Normal Population and in Patients on Maintenance Haemodialysis
Authors: Stewart W. K. , Fleming Laura W. , Hutchinson F.
Published: January 2017

Bone mineral assessment, by monoenergetic photon absorption in vivo, has been carried out at a standard site in the radial shaft of 39 male and 54 female control subjects from a normal population, and in 13 patients who have been on maintenance haemodialysis for periods varying between 3 months and 5 years. Mean bone mineral content (±S.D.) was 1.22 ± 0.13 g. per cm. of shaft segment length for the normal male and 0.87 ± 0.08 g. per cm. for the normal female control subjects. Only 2 of the haemodialysed patients had values outwith the 95 per cent confidence limits of the normal range. In the patients a correlation was noted between the current plasma alkaline phosphatase level and the bone mineral content. Bone scanning by photon absorption is recommended as a convenient and sensitive method for routine clinical assessment of bone status.
Urinary Zinc in Hepatic Cirrhosis
Authors: Allan J. G. , Fell G. S. , Russell R. I.
Published: January 2017

Plasma Zinc and renal clearance of Zinc have been studied in patients with various chronic hepatic disorders. Plasma Zinc levels were reduced in patients with all forms of chronic hepatic disease and were of no value in differentiating these conditions.

The renal clearance of Zinc was found to be significantly higher in patients with chronic hepatic disease of alcoholic aetiology (1.25 ml./min.) compared with those of non-alcoholic aetiology ( 0.52 ml./min.) and normal subjects ( 0.33 ml./min.). The renal clearance of Zinc may be of value in identifying chronic hepatic disease in which alcohol is aetiologically involved.
Primary Cardiac Leiomyosarcoma with Pulmonary Metastases
Authors: Burnett R. A.
Published: January 2017

A case of primary cardiac leiomyosarcoma is reported. Tumour growth into the right ventricular cavity led to multiple pulmonary metastases with haemorrhage. Failure of diagnostic procedures including cardiac catheterisation, angiography and thoracotomy is noted. The incidence and presentation of primary malignant cardiac tumours is briefly discussed.
A Single-Use Clinical Thermometer
Authors: McAllister T. A.
Published: January 2017

A disposable clinical thermometer, based on heat-sensitive crystals, was tested in 200 subjects and its performance compared to the available bedside instrument and an accurate British Standard thermometer. It was found to be accurate and reliable and its convenience and ease of reading made it readily acceptable to patients and staff. It has the overwhelming advantage of severance of a link in the chain of hospital cross-infection and merits widespread clinical trial.
Psychometric Assessment of Phobias and Obsessions
Authors: Pinkava V.
Published: January 2017

The possible methods of assessing phobic and obsessional patients psychologically are briefly reviewed. Both general personality inventories and specific goal directed questionnaires are considered. Brief reference is made to possible new approaches to assessment.
A Preliminary Report on the Use of Clomipramine in General Practice
Authors: Wootton L. W. , Bailey R. I.
Published: January 2017

The use of clomipramine in a large suburban general practice is reviewed. Three hundred and fifty patients have been treated to date out of a total practice population of twenty-one thousand. It is argued that phobic anxiety states are much commoner than is normally supposed and that they are usually associated with a history of separation or rejection in childhood. A combined treatment regime is employed for one month thereafter clomipramine alone is used. Side-effects may initially present a problem although they may not all be truly drug induced. Some patients use side-effects to manipulate the clinical situation. However proper interpretative management of side effects can assist the clinicians in persuading patients to continue therapy. Some impressive results have been obtained with clomipramine therapy. Illustrative case histories are provided.
Erythromycin and Anaerobes: in Vitro Aspects
Authors: Watt B.
Published: January 2017

Anaerobic organisms are being increasingly recognised as important causes of serious infection in man. Sampling procedures, transport of specimens and laboratory techniques need to be constantly monitored and improved if the causative organisms are to be consistently recovered from clinical specimens. Once the organisms have been isolated, their susceptibility to antibiotics should be determined so that the clinician can base his antibiotic therapy on reliable laboratory results. There are many variables in the sensitivity testing of anaerobes – these may account for the difficulty reported by some workers in obtaining consistently reliable results with some antibiotics, including erythromycin. These problems can be largely overcome if a standardised procedure is adopted.

It is clear from the published data that erythromycin has considerable in vitro activity against many strains of anaerobic bacteria, both spring and non-sporing. There is a broad spectrum of activity with some strains being very sensitive and a few strains being resistant. M.I.C. values range from 0.04 μg./ml. to 20 μg./ml. or more. Further studies are now needed to assess the role of erythromycin in the treatment of anaerobic infections in vivo.
The Treatment of Gout: A Case for Medical Audit?
Authors: Hernández Luis A. , Dick W. Carson , Mavrikakis Myron E. , Buchanan W. Watson
Published: January 2017

An assessment of quality of drug control of hyperuricaemia in gouty subjects is reported. Twenty seven of 40 patients were found to be hyperuricaemic. Factors influencing compliance with drug therapy included awareness of the nature of gout and excessive alcohol consumption.
Elemental Diet Therapy in the Management of Complicated Crohn's Disease
Authors: Russell R. I. , Hall M. J.
Published: January 2017

The purpose of this report was to study the types of complications of Crohn's disease which may benefit from the use of elemental diets.

The elemental diet Vivonex was used in the management of patients with Crohn's disease with local complications but without nutritional deficiency. Sole treatment of this kind was found to be of value in promoting healing of perianal or anal ulceration and anal fissures; it was also of value in allowing subacute ileal obstruction to settle, thus postponing surgery and allowing better bowel and nutritional preparation for surgery. Patients with bile acid-induced diarrhoea associated with severe ileal Crohn's disease noted improvement in the diarrhoea on the elemental diet, and the treatment was also useful in reducing ileostomy output and helping ileostomy skin lesions to heal in a patient with severe skin excoriation related to leakage of excessive ileostomy fluid output.
Malaria in the North-East of Scotland
Authors: Taylor M. , Smith C. C. , Khaund R. R. , Basu A.
Published: January 2017

In recent years malaria has become the most common imported infection in the United Kingdom. This paper describes the 31 cases diagnosed in the North-East of Scotland between 1974 and 1978. Presentation of this disease in North-East Scotland, exceptional before 1974, has become more frequent recently-and this is largely due to the North Sea ‘oil boom’.
Pseudomembranous Colitis
Authors: Ritchie Patricia H. , Pennington C. R.
Published: January 2017

Nine patients with pseudomembranous colitis (PMC) are described. Eight patients received prior therapy with antibiotics. Pyrexia and polymorph leukocytosis werecommonfeatures. Six relapses occurred in four of the six patients who were treated with vancomycin. Two patients who did not receive vancomycin died.
Psychiatric Aspects of Acute Poisoning with Tricyclic and Related Antidepressants-A Ten-Year Review
Authors: Starkey I. R. , Lawson A. A. H.
Published: January 2017

The incidence of acute self-poisoning with tricyclic and related antidepressant drugs has increased in recent years so that now approximately 20 per cent ofall acute overdoses in patients above the age of 12 are due to this cause. We report the results of a ten-year review of the psychiatric aspects associated with this poisoning in 316 consecutive patients admitted to a District General Hospital. Fifty-four per cent of these patients had sought medical advice in the period immediately prior to the overdosage. The final psychiatric diagnosis following the poisoning is related to the events previously and an attempt is made to judge how appropriate was the original treatment with antidepressant drugs. The important opportunities for prevention of this poisoning are discussed and suggestions made.
Fibrinolysis and Thrombosis: Pathways and Inhibitors
Authors: Samama M.
Published: January 2017

The mechanism of fibrinolysis has been reviewed taking into account its two pathways extrinsic and intrinsic and the important role of α 2plasmin inhibitor. A clear distinction is now well documented on the mechanism of fibrinolysis in a liquid phase and in a solid phase.

The role of fibrin as an important trigger of fibrinolysis in vivo is demonstrated.

Finally a relationship between hypofibrinolysis and thrombosis is highly probable.
Defective Fibrinolysis in Arterial Disease
Authors: Davidson J. F. , Walker I. D.
Published: January 2017

Defective fibrinolysis is a factor in a variety of vascular diseases both arterial and venous. Therapeutic correction of the defect has been shown to be successful in recurrent venous thrombosis, cutaneous vasculitis and liposclerosis. Therapeutic correction in arterial diseases has yet to be fully evaluated.
Δ4-Ethyloestrenol in Recurrent Deep Venous Thrombosis
Authors: Nilsson B. , Nilsson I. M. , Hedner U.
Published: January 2017

Twenty-one patients with recurrent deep venous thrombosis were treated with an anabolic steroid (Δ4-ethyloestrenol) for up to 56 months. All had been shown to have a deficient fibrinolytic response to vascular occlusion and/or low vessel wall plasminogen activator content.

Therapy resulted in improvement in clinical and fibrinolytic parameters and no significant side effects were seen.
Diaphoretic Therapy in Regular Dialysis Patients
Authors: Henderson I. S. , Podmore Patricia , Spence Moira S.
Published: January 2017

Many regular dialysis patients are on severely restricted fluid allowances. We describe how an occasional sauna bath (Diaphoresis) may permit an increased fluid intake in these patients.
The Effect of Megadose Ascorbic Acid Ingestion on the Absorption and Retention of Vitamin B12 in Man
Authors: Watson W. S. , Vallance B. D. , Muir Margaret M. , Hume R.
Published: January 2017

Radiotracer B12 analogues, hydroxy- and cyano-cobalamin have been used to study the effects of megadose L-ascorbic acid (vitamin C) ingestion on vitamin B12 metabolism in man. By employing whole body counter techniques it has been shown that, while absorbic acid can partially inactivate both the important dietary analogue, hydroxycobalamin, and the gastric secretion, intrinsic factor which is essential for B12 absorption, the rapid binding of the B12 analogue to intrinsic factor protects the hydroxycobalamin from attack. As a result, the absorption of hydroxycobalamin is unaffected by the simultaneous ingestion of 1 g ascorbic acid. The absorption of cyanocobalamin, the most stable analogue but not found in quantity in the diet, is slightly increased by ascorbic acid. Whole body retention studies on normal subjects ingesting 2 g ascorbic acid per day show no significant evidence of in vivo destruction of body B12 stores.
Does Hypothyroidism Predispose to Gold-Induced Thrombocytopenia?
Authors: Hunter J. A. , Capell Hilary A.
Published: January 2017

Two patients receiving gold therapy for rheumatoid arthritis suffered from a sudden and unpredictable fall of platelet count. Spontaneous bleeding into the soft tissues occurred in both cases, and nasal epistaxis or macroscopic haematuria complicated each case. Both patients were on long term replacement therapy with thyroxine and it is postulated that changes associated with hypothyroidism may predispose to acute thrombocytopenia due to gold. Patients who suffer from hypothyroidism may require particularly close monitoring whilst on gold therapy.
Endocardial Fibroelastosis Associated with Fatal Adriamycin (Doxorubicin) Cardiomyopathy during Treatment of Ewing's Sarcoma
Authors: Conroy B. , Guthrie W.
Published: January 2017

We report a case of fatal adriamycin cardiomyopathy in a 12-year-old boy treated for Ewing's sarcoma. At necropsy, in addition to the typical changes of advanced cardiotoxicity in the myocardium there was endocardial fibroelastosis, mainly affecting the left ventricle.
The First Scottish “Leopard”?
Authors: Cleland J. G. F. , Mann Linda , Findlay I. , McArthur J.
Published: January 2017

Leopard Syndrome is a rare autosomal dominant condition affecting multiple systems. We report a 35-year-old woman with hypertrophic obstructive cardiomyopathy, pigmented naevi and growth retardation. We are unaware of previous cases reported in Scotland.
Necrotising Enterocolitis Experience with 54 Neonates
Authors: Dolan P. , Azmy A. F. , Young D. G. , Ziervogel M.
Published: January 2017

Fifty-four neonates transferred to the neonatal surgical unit because of acute necrotising enterocolitis (N.E.C.) are presented. Eleven died (20.4%), of whom seven were treated conservatively and four by operation.

Ten patients required surgical exploration because of intestinal perforation, obstruction or suspected perforation. Another five neonates presented with intestinal perforation and were treated by percutaneous catheter drainage of the peritoneal cavity because of their extreme prematurity. Nine patients developed a colonic stricture diagnosed between six weeks and a year after the onset of the disease. Another six patients showed a segment of colonic narrowing detected on barium enema radiography without clinical evidence of bowel obstruction. They were treated conservatively and showed complete resolution at follow up studies.
Purulent Pericarditis following Myocardial Infarction
Authors: O'Neill D. , Brebner H. , Watkinson G.
Published: January 2017

A 75-year-old man required prolonged intravenous drug therapy for post-myocardial infarction arrhythmias and developed infection with Staphylococcus aureus at the site of his indwelling cannula. He received prompt antibiotic therapy but was readmitted to hospital five weeks later with a terminal illness which proved at post-mortem to be a staphylococcal pleuropericarditis. We consider that this fatal infection orginated at his venous cannula site. The problems of diagnosis are discussed.
Can Erythema Nodosum and Reactive Arthritis Be a Sequel to Shigella Flexneri Gastroenteritis?
Authors: Neithercut W. D. , Hudson M. A. , Smith C. C.
Published: January 2017

Erythema nodosum and seronegative arthritis associated with diarrhoea was previously regarded as implying the presence of inflammatory bowel disease. Recently, however, erythema nodosum has been described as a sequel to diarrhoea caused by infection with Salmonella typhimurium, Yersinia enterocolitica and Campylobacter jejuni. We report two patients in whom erythema nodosum and reactive arthritis followed acute Shigella flexneri gastroenteritis, a rare association.
Dundee Chordomas
Authors: Bell B. A. , Jacobson I. , Tromans A. M. , Block J. , Guthrie W.
Published: January 2017

All patients with chordomas that have been treated in the Dundee neurosurgical unit are reviewed. Five intracranial and two sacral chordomas have presented since the unit opened in 1966. Survival has ranged from one to fifteen years following treatment. The difficulties in diagnosis and in assessing treatment of these rare slow growing neoplasms are discussed.
Acute Renal Failure: The Tip of the Iceberg?
Authors: Power D. A. , Haughney J. , Nicholls A. J. , Asfar S. K. , Engeset J. , Catto G. R. D. , Edward N.
Published: January 2017

This study reports the experience, during a six-year period, of the Aberdeen Renal Unit in the treatment of patients with acute renal failure. The combination of a relatively stable population base and a single regional dialysis centre has allowed the incidence of acute renal failure to be assessed. Approximately 30 patients per million population were dialysed annually for acute renal failure; 69 per cent of these patients (20.5 per million population per year) were dialysed for acute reversible intrinsic renal failure (ARIRF) and mortality in this group was 44 per cent. Patients with more severe disease at the time of presentation to the renal unit, as defined by a clinical severity score, had significantly reduced survival rates. However, it was not possible to predict the outcome in individual cases; ten of 24 patients with clinical severity scores which indicated a poor prognosis survived the period of oliguria and were discharged from hospital.

The fact that other renal units dialyse fewer patients per million population per year for ARIRF probably reflects a reluctance to refer patients whose general condition appears poor. As the overall mortality rate reported in this study does not differ significantly from rates reported previously from centres treating a smaller proportion of patients, such decisions may not be correct. It is well known that facilities in Britain for treating patients with end-stage renal disease are inadequate; it now appears likely that some patients who might benefit from acute dialysis are being denied treatment for a potentially reversible disease process.
Therapeutic Drug Monitoring—the Need for Audit?
Authors: Brodie M. J. , McIntosh Morag E. , Hallworth M.
Published: January 2017

The experience of therapeutic drug monitoring (TDM) of seven drugs as part of the normal biochemistry services over the period April 1982–83 is reported. Reagent costs alone for these assays exceeded £15,000. Of 1,841 digoxin estimations, 56 per cent fell within the therapeutic range* whereas 25 per cent were potentially toxic. Fifty per cent of 968 lithium measurements were lower than 4 mg L-1, placing many of these patients at risk of treatment failure. Only 29 per cent and 32 per cent of 369 theophylline and 440 phenytoin concentrations respectively were within their well-established ranges. In only around 20 per cent of requests for theophylline and phenytoin assay was sufficient clinical information supplied to the laboratory. In the majority of patients with theophylline or phenytoin concentrations outwith the therapeutic range, further analysis was not requested and so optimisation of dosage cannot be assumed to have occurred. The wide therapeutic ranges of carbamazepine and phenobarbitone ensured that most patients attained acceptable concentrations. Sodium valproate analysis was requested on 160 occasions despite the poor correlation between the concentration of this drug and its therapeutic and toxic effects. TDM can be an expensive exercise which must be subjected to rigorous cost-benefit analysis. Requests should be made on a customised drug assay form and interpretative advice on individual patient problems made available. Recommendations for the organisation, daily running and clinical supervision of TDM are made.
Intravascular Haemolysis and Acute Renal Failure Induced by Nomifensine
Authors: Fulton J. D. , Briggs J. D. , Dominiczak Anna F. , Junor B. J. R. , Lucie N. P.
Published: January 2017

Nomifensine is a widely used antidepressant agent with few side-effects but haemolytic anaemia with acute renal failure has been reported with both intermittent therapeutic dosage and self-inflicted overdose. We report here a case of acquired immune haemolytic anaemia with acute renal failure induced by second exposure to a single capsule of nomifensine.
Home Monitoring of Blood Pressure: Usefulness as a Predictor of Persistent Hypertension
Authors: Rademaker M. , Lindsay A. , McLaren J.A. , Padfield P.L.
Published: January 2017

We set out to test the hypothesis that home blood pressure reflects “baseline” pressures measured at a general practitioner's surgery or in a hospital outpatient clinic. Twenty patients detected hypertensive during screening in general practice and 30 patients referred to a hospital hypertension clinic for revision of therapy were studied. All were instructed in the use of an electronic semiautomatic sphygmomanometer and measured blood pressure at home for a three day period. Home monitored blood pressure correctly predicted those patients whose diastolic blood pressure fell to below 95 mmHg by the third clinic visit in approximately 90% of all patients. In addition, in those whose blood pressure was high at home it remained so at the clinic or surgery after three visits. These data suggest that home monitoring of blood pressure may be a helpful alternative to repeated clinic visits before embarking on medical therapy.
Fulminant Cardiac Tamponade: An Exceedingly Rare Presentation of Squamous Carcinoma of the Bronchus in a Male Patient
Authors: Morgan R.J. , Maboshe P. , Kirby B.J. , Pagliero K.M. , Amin R.S.
Published: January 2017

A 49 year old man presented with near-fatal, fulminant, haemorrhagic cardiac tamponade. He responded well to emergency pericardiocentesis and subsequent investigation revealed the cause to be an unknown squamous carcinoma of the bronchus with pericardial involvement. He died 13 weeks later. Such a dramatic presentation of this type of tumour in a male patient has not been previously described.
Diabetes Insipidus Developing after Subarachnoid Haemorrhage from an Anterior Communicating Artery Aneurysm
Authors: McMahon A.J.
Published: January 2017

I describe a patient with an anterior communicating artery aneurysm who developed transient diabetes insipidus two days after a subarachnoid haemorrhage. I have reviewed similar cases in the literature and discuss the pathogenesis of the diabetes insipidus in such cases.
Insulin-Dependent Diabetes Mellitus, Myasthenia Gravis, Pernicious Anaemia, Autoimmune Thyroiditis and Autoimmune Adrenalitis in a Single Patient
Authors: Green S. T. , Ng J. P. , Chan-Lam D.
Published: January 2017

Two classical autoimmune polyendocrine deficiency syndromes with heritable tendencies are described, Type 1 diabetes mellitus being associated with the Type 2 polyendocrine deficiency syndrome (Schmidt's syndrome). A man with Type 1 diabetes mellitus is described who developed an unusual combination of five autoimmune conditions (myasthenia gravis, Addisonian pernicious anaemia, adrenalitis and thyroiditis) which did not fit into the Type 1 or Type 2 classical polyendocrine deficiency syndromes. This suggests that the autoantibody, biochemical and haematological screening of affected individuals and their relatives should be extended to anticipate a wider range of potential autoimmune conditions.
The Low Incidence of Alcoholic Cirrhosis in the Islands of Lewis and Harris
Authors: Goodall J.A.D. , Bryan C.
Published: January 2017

The annual incidence of clinically apparent cirrhosis of the liver from all causes in the islands of Lewis and Harris has been found to be 5.5 cases per 100,000 and alcoholic cirrhosis to be 2.76 per 100,000. Sales of alcohol in the island amount to £6.85 million giving a per capita spending on alcohol of £283 in 1984. The incidence of alcoholic cardiomyopathy was found to be 3.7 cases per 100,000 and there were 120 admissions per 100,000 with illnesses directly related to alcoholism. It was suggested that the very low incidence of alcoholic cirrhosis despite the high per capita spending on alcohol could be due to inherited factors, the pattern of drinking and the type of alcohol consumed.
A Case of Coagulated Haemothorax Treated by Intrapleural Varidase
Authors: McGarry G.W.
Published: January 2017

Haemothorax can occur as a result of thoracic trauma or following diagnostic or therapeutic pleural aspiration.1 Early removal of blood from the thoracic cavity is essential to prevent coagulation and fibrin deposition within the pleural cavity. The case described is one in which a large coagulated haemothorax was drained via a standard pleural drain following liquefaction by the use of a proprietary fibrinolytic agent more commonly used in the desloughing of wounds.
Great Doctors and Medical Worthies
Authors: Emslie-Smith D.
Published: January 2017

After Harvey's visits to Scotland with Charles I the formation of a united Caroline University in Aberdeen was thwarted by the Civil War. In Oxford Harvey instituted a group of medical scientists, forerunners of the Royal Society, who almost explained the physiology of respiration. Harvey had several things in common with Dr Samuel Johnson. Johnson's medical knowledge and contacts are emphasised, examples of 17th and 18th century health regimens are given and Johnson's friendship with Scottish medical men and some others connected with the Royal College of Physicians and the Harveian Society of Edinburgh are described.
Lymphomatoid Granulomatosis Presenting with Polyarthritis
Authors: Ralston S.H. , McVicar R. , Finlay A.Y. , Morton R. , Pitkeathly D.A.
Published: January 2017

Polyarthritis in lymphomatoid granulomatosis is rare. In the present report we describe a patient with lymphomatoid granulomatosis who presented with an acute inflammatory polyarthritis three years before the typical skin and pulmonary manifestations of the disease became evident.
Haemangiopericytoma of the Diaphragm
Authors: El-Jabbour J.N. , McLaren K.M. , Sedgwick D.
Published: January 2017

This paper reports the pathological features of a diaphragmatic haemangiopericytoma with a discussion of diagnostic difficulties it may present in relation to other localised mesenchymal tumours of the pleura. The published reports of diaphragmatic haemangiopericytoma in the world english language literature are reviewed.
Argininosuccinic Aciduria — An Underdiagnosed Cause of Neonatal Death?
Authors: White I.H. , Rose S.J. , Lloyd D.J.
Published: January 2017

We describe a case of neonatal argininosuccinic aciduria, a condition we suggest is underdiagnosed. Although the clinical presentation can be of overwhelming septicaemia, certain routine biochemical investigations are indicative of this inborn error of urea cycle metabolism.
Minor Aphthous Oral Ulceration: A Double-Blind Cross-Over Study of Beclomethasone Dipropionate Aerosol Spray
Authors: Thompson A.C. , Nolan A. , Lamey P.-J.
Published: January 2017

A double-blind crossover study is described of the effect of beclomethasone dipropionate aerosol spray in patients with recurrent (minor) aphthous oral ulceration. Patients included in the study had normal haematological parameters of haemoglobin, ferritin, vitamin B12 and corrected whole blood folate. The design of the study incorporated a washout period and duration of effect was evaluated up to six months. Beclomethasone dipropionate significantly reduced ulcer pain severity and ulcer frequency, but had no significant effect on recurrence of oral ulceration. The preparation was associated with a high patient compliance and has benefit in relieving symptoms in patients with recurrent minor aphthous ulceration.
Thyrotropin Receptor Antibodies Associated with Post-Operative Relapse of Thyrotoxicosis in a Pregnancy Complicated by Neonatal Thyrotoxicosis
Authors: Wilson R. , Fraser W.D. , Gray C.E. , Alroomi L.G. , Thomson J. A.
Published: January 2017

This case describes the clinical, biochemical and immunological features associated with relapse of thyrotoxicosis during pregnancy in a patient who had recently undergone a subtotal thyroidectomy for Graves' disease. The baby, shortly after birth, showed clinical and biochemical features of thyrotoxicosis which responded to carbimazole therapy. Thyrotropin receptor antibodies and thyroid stimulating antibodies were present in the blood of the mother and baby. The clinical course of the neonatal thyrotoxicosis correlated with the TSH receptor antibody levels.
Simpson and ‘The Discovery of Chloroform’
Authors: Simpson D.
Published: January 2017

It is widely accepted that Sir James Young Simpson discovered the anaesthetic properties of chloroform and pioneered its application in surgery and midwifery. The name of Simpson is not infrequently also associated with the discovery of chloroform and of anaesthesia. Simpson certainly did not discover the substance chloroform or anaesthesia, there is doubt as to whether he discovered the anaesthetic properties of chloroform, and he may not have been the first person to administer chloroform anaesthesia to a patient. He did, however, play an important role in the introduction of chloroform anaesthesia particularly in midwifery and obstetrics.
A Recurring Question — How Many Beds for Dementia?
Authors: Christie A.B. , Whitfield E.M. , Wood E.R.M.
Published: January 2017

Experience at Crichton Royal in dealing with dementia over a thirty year period has been used to develop two models of bed requirements for dementia sufferers. The first based on results from the periods 1957 to 1959 and 1974 to 1976 and the second on experience in the years 1974–75 and 1984–85. The variables considered were demographic change, admission of a constant proportion of the at risk group and changes in individual patient survival between groups of patients admitted.

Projections based on the earlier model suggested that the SHAPE provision of 10 beds per 1000 of the over 64 population would be insufficient to maintain established standards of care. The later model, however, finds SHAPE numbers appropriate.

The reasons for the change of view — Inaccuracy in estimate of increasing male survival and significant under-estimates of population growth — Nullify each other.

The conclusion is that SHAPE is a useful model provided the demographic changes and patient survival change are carefully monitored.