bluuebunny/crossref_metadata_2025 huggingface dataset:
Some Unresolved Problems in Chronic Respiratory Disease
Authors: Stuart-Harris Charles
Published: January 2017

In this lecture the position concerning some of the present-day problems in the field of chronic respiratory disease have been reviewed. First among these —the differentiation of the 3 components chronic bronchitis, emphysema and asthma—is seen to have been only partly accomplished by accepted definitions. The place of emphysema as a major accompaniment of chronic bronchitis is particularly baffling during life. The controversy regarding the reversibility of airways obstruction is held to affect the definition of asthma and should be a stimulus to renewed efforts to clarify the situation. In both emphysema and asthma attention ought to be directed towards epidemiological studies in order to elucidate aetiological factors.

The second major problem—that of the earliest stages of chronic bronchitis— is important in the recognition of the role of causative factors known to be important at a later stage. Air pollution and infection thus occupy a tentative causative role even before cigarette smoking becomes effective in eliciting mucus production by the airways. The role of genetic factors has been highlighted with the advent of knowledge concerning the serum α 1-antitrypsin globulin. Detailed clinical and epidemiological studies are now required.

The third problem is a prognostic one. In such long-lasting complaints as those under consideration, diagnosis at an early stage might surely lead to attempts to prevent progression. Here the mystery of the variability of the natural history of different individuals is the problem and airways obstruction is seen to be a major determinant of ventilatory/perfusion relationships. These in turn are prognostically related not only to respiratory failure but to pulmonary hypertension and cor pulmonale.
Is Occlusion of the Fallopian Tubes with Tantalum Clips a Reversible and Reliable Method of Sterilization?
Authors: Ma H. K. , Wong V.
Published: January 2017

An attempt was made to ascertain whether the application of tantalum clips on Fallopian tubes is a reliable and reversible method of sterilization. Fifty rabbits were used in the study and the pregnancy rate following the application of the tantalum clip on each Fallopian tube was 29 per cent as compared with the 74 per cent pregnancy rate in the same rabbit colony during the same period of time. Following the removal of the tantalum clips from both Fallopian tubes, the pregnancy rate after 5 months of breeding was only 9 per cent. The reason for the high pregnancy rate in the rabbits with the tantalum clips and the low pregnancy rate following the removal of the tantalum clips is discussed. The view expressed is that more work needs to be done before this method is used as a reliable and reversible procedure for female sterilization.
Determinants of Outcome in a Psychiatric Emergency Clinic
Authors: Babiker I. E.
Published: January 2017

The study describes 85 emergency referrals to the Royal Edinburgh Hospital during June 1973 with special reference to the criteria for hospitalisation. The day of the week, source of referral, employment status and diagnosis strongly influenced outcome; thus the likelihood of selection for hospitalisation was found to be significantly increased by unemployment, referral by a General Practitioner during the week and receiving an affective, organic or neurotic illness label. The implications of these findings are discussed. An attempt is also made to evaluate the work of the emergency service in the light of these findings.
Non-Organ Specific Autoantibodies in Malignant Diseases
Authors: Gray Elizabeth S. , McLay A. L. C. , Thompson W. D. , Donald D. , Horne C. H. W.
Published: January 2017

A significant increase in non-organ specific autoantibodies is demonstrated in 13 per cent of the sera from 202 patients with histologically proven malignancies, as compared with only 4 per cent of sera from 214 age and sex matched control patients. It appears that the incidence of autoantibodies is related to the histological type of the tumour but not to the presence or absence of tumour dissemination.

While the control group shows the expected increase in both incidence and titre of autoantibodies with increasing age, the malignant patients show no such pattern, i.e. in cancer patients autoantibodies occur with equal frequency and at similar titres regardless of age. The absence of an age related increase in incidence and titre of non organ specific autoantibodies does not appear to have been reported previously. Our findings lend support to the hypothesis that cancer is associated with a breakdown of immunological surveillance, not only in old but also in young cancer patients. Thus the finding of non organ specific autoantibodies, especially to smooth muscle antigen, in an apparently healthy adult could be considered evidence of such a breakdown, carrying with it an increased risk of neoplasia.
Cephazolin Treatment of Pneumococcal Pneumonia and Urinary Tract Infections
Authors: Kilpatrick M. , Cesario T. C. , Thrupp L. , Tilles J. G.
Published: January 2017

Ten cases of pneumococcal pneumonia were treated with cephazolin 500 mg. q8h for at least 5 days. In every case therapy was accompanied by clinical improvement and eradication of the organism. Ten patients with E. coli bacteriuria (5 symptomatic) were treated with cephazolin 500 mg. q12h for 7 to 10 days. In every case the pathogen was eliminated during therapy but in one case bacteriologic relapse occurred following cessation of therapy. In 10 cases of bacteriuria caused by P. mirabilis, Klebsiella sp, Enterobacter, and Enterococcus, the urine became sterile during treatment, but relapse was common. Initial and final creatinine clearances obtained in 29 patients who received an average of 12.9 g. of cephazolin showed no tendency toward loss of renal function. Serial serum levels of cephazolin were determined following the first 500 mg. dose in 18 patients. The peak serum level occurred at one hour with a serum half life of approximately 2.2 hours. For 13 of these 18 patients serial serum levels were also obtained following the last dose of cephazolin. At this time the mean peak level occurred at 2 hours but again the serum half life was approximately 1.9 hours.
Comparative Biliary Concentrations of Cephazolin and Cephalothin in Patients with Biliary Tract Disease
Authors: Madhavan T. , Block M. , Quinn E. L. , Cox F. , Fisher E. J. , Burch K. H. , Haas E. J.
Published: January 2017

The concentration of cephazolin in the serum, gall bladder bile, common duct bile, and gall bladder wall were considerably higher than cephalothin especially with IV administration and indicate that cephazolin should be a useful antibiotic in the surgical treatment of acute cholecystitis.
The Medico-Social Aspects of Liquor Licensing
Authors: Clayson C.
Published: January 2017

The present Licensing Law has failed in its stated purpose of diminishing the misuse of alcohol. On the contrary the misuse of alcohol is increasing year by year.

The recommendations of the Scottish Departmental Committee (1971–1973) would, if fully implemented, go far to remedying this defect by providing effective legislative support encouraging improved social attitudes to drink.

The Licensing (Scotland) Bill 1976 will, from a technical point of view, discard much that was obsolete and promote much that is wise in the practice of licensing, but if passed into law unchanged the Bill will not have the full social impact on drinking habits and, therefore, on the misuse of alcohol for which we had hoped.
Villous Papilloma of the Rectum Presenting as Infective Gastro-Enteritis
Authors: Welsby P. D. , Smith C. C.
Published: January 2017

Three elderly patients have recently been admitted as emergencies to the Infection Unit of the Aberdeen Hospitals as presumed cases of infective gastroenteritis. Investigation revealed the presence of a villous papilloma of the rectum in each case.
Some Medical Aspects of North Sea Oil Industry
Authors: Leese W. L. B.
Published: January 2017

Most illness and injury cases seen in the Sick Bays of North Sea Oil Installations are similar to those in industry generally. Some are due to the sea depth and the hostile environment. The course of treatment may be affected by the isolated situation.

The basic plan to meet a disaster situation may in the event be unworkable because of installation air traffic disturbance. Transportation of casualties to pre-arranged destinations may be affected by weather or the availability of suitable helicopters or ships. Practice to meet different medical contingencies is essential. For efficient rescue there must be a reliable, uninterrupted communication system between installation and base.
Augmentin: Laboratory Studies
Authors: Farrell I.D. , Turner P.J.
Published: January 2017

Clavulanic acid is a β-lactam antibiotic which, although it has little intrinsic activity, is a potent inhibitor of bacterial β-lactamases. When combined with amoxycillin its range of activity includes penicillinase-producing strains of Staphylococcus aureus and many of the β-lactamase-producing strains of Gram-negative bacilli. Bacteria sensitive to augmentin include amoxycillin-resistant strains of Haemophilus influenzae and Escherichia coli, in addition strains of Klebsiella aerogenes, Proteus mirabilis, Proteus vulgaris and Bacteroides fragilis are usually sensitive. The β-lactamases produced by Enterobacter spp, Proteus morgani, Serratia marcescens and Pseudomonas aeruginosa are less susceptible to clavulanic acid and these bacteria are usually resistant to augmentin (1).
Pulmonary Hypersensitivity in the Alginate Industry
Authors: Henderson A. K. , Ranger A. F. , Lloyd J. , McSharry C. , Mills R. J. , Moran F.
Published: January 2017

Salts of alginic acid are complex polymerised polysaccharides which are chemically extracted from seaweed. Workers in the alginate industry are exposed to dust from dried milled seaweed and pure alginate compounds. In this survey of one of the two factories in Britain producing alginates, we found evidence of pulmonary hypersensitivity to seaweed dust in seven per cent of the total work force, and evidence of precipitating antibody to sodium alginate and seaweed extracts in the serum of 4.5 per cent of the workforce. Challenge testing of a number of employees with symptoms showed a dual response with immediate airways obstruction, and a later loss of lung volume, with associated impairment of transfer factor.
Acute Infectious Disease Presenting as Acute Renal Failure
Authors: Mactier R. A. , Dobbie J. W.
Published: January 2017

A diverse range of infectious diseases has presented with acute renal failure (ARF) in the West of Scotland in the past five years. Full recovery is possible provided the specific diagnosis is made early and treatment with temporary renal support is combined with effective antimicrobial therapy.
Topical Pramoxine and Hydrocortisone Foam versus Placebo in Relief of Post Partum Episiotomy Symptoms and Wound Healing
Authors: Greer I. A. , Cameron A. D.
Published: January 2017

A double-blind randomised controlled trial, comparing pramoxine hydrochloride 1 per cent and hydrocortisone acetate 1 per cent in a mucoadhesive foam base, with simple aqueous foam (B.P.), in relieving episiotomy discomfort and episiotomy healing in 40 patients was carried out.

Simple aqueous foam was more effective with regard to wound healing and episiotomy discomfort as measured by analgesic consumption. Pramoxine and hydrocortisone foam offers no advantage over simple aqueous foam in the treatment of post partum episiotomy discomfort.
Jejunal Perforation as a Result of Massive Gastrointestinal Bleeding from a Duodenal Ulcer
Authors: Fox J. N. , Thomson J. W. W.
Published: January 2017

A complication of massive upper gastrointestinal bleeding is presented as a case report of a patient who developed a spontaneous perforation of the small intestine as a result of massive bleeding from a duodenal ulcer
A Case of Materno-Foetal Histocompatibility—Implications for Leucocyte Transfusion Treatment for Recurrent Aborters
Authors: Kilpatrick D. C.
Published: January 2017

A cord blood sample obtained after a perfectly normal pregnancy was found to be HLA-A, B, C and DR compatible with maternal HLA antigens. This minority occurrence is discussed in relation to the possible use of tissue-typing to assess risk of spontaneous abortion.
Tuberculosis and Minimal Change Nephropathy
Authors: Jones J. M. Boulton
Published: January 2017

A patient with minimal change nephropathy (MCN) is described who, during the earlier part of his illness, had several relapses each of which promptly responded to treatment with prednisolone but subsequently his proteinuria became refractory to this treatment for nearly two years. Tuberculous osteitis was then discovered and treated. Thereafter, a further course of prednisolone caused a prompt and sustained remission.

The natural history of this patient identifies another cause of failure of conventional therapy to induce remission in patients with MCN; highlights the hazards of that therapy; suggests that neither prednisolone nor cyclophosphamide is capable of inhibiting the mechanism causing proteinuria unless the provoking factor has been eliminated and supports Shalhoub's belief that the T lymphocyte may be important in the pathogenesis of MCN.
Chronic Subdural Haematoma in the CT Scan Era
Authors: Nath F. , Mendelow A.D. , Wu C.-C. , Hessett Cathy , Caird F , Jennett B.
Published: January 2017

One hundred and fifty patients with chronic subdural haematomta were studied with respect to clinical features, investigation and outcome. Those patients aged 65 years and over did not differ significantly in either outcome or clinical features from the rest. The outcome in this series of patients, managed after CT scanning became the standard method of investigation, was no better than in previous studies. The only factor which did influence outcome was the level of responsiveness on admission. The overall mortality in this study was 6 per cent. CT scanning does not therefore result in improved results in patients with chronic subdural haematoma; this may rather depend upon better selection of patients for CT scanning.
Illness Associated with a Package Holiday in Romania
Authors: Grist N.R. , Cossar J.H. , Reid D. , Dewar R.D. , Fallon R.J. , Riding Miriam H. , Bell Eleanor J.
Published: January 2017

A study of 370 holidaymakers returning from Romania revealed that 279 (75%) reported illness. Alimentary symptoms predominated and were recorded either alone or along with other symptoms by 71 per cent of the tourists. The highest illness rate (82%) occurred in those under 39 years of age and those over 60 years had least illness (38%). Most of the tourists attributed their illnesses to the supply, handling or preparation of food and drink.

Twenty-six (21%) tourists had serological evidence of typhoid immunisation out of 121 from whom blood samples were obtained. Most of the tourists studied (85%) were immune to poliomyelitis.
Ocular Complications in Juvenile Chronic Arthritis (JCA)
Authors: Galea P. , D'amato B. , Goel K.M.
Published: January 2017

Fifty-six children with JCA have attended the Rheumatology Clinic at the Royal Hospital for Sick Children, Glasgow, over the past five years. Eleven have monoarthritis, 21 pauciarthritis and 24 polyarthritis. Seven children with pauciarthritis and one with monoarthritis developed ocular complications. Of these six were girls. In six children the arthritis preceded the uveitis. In one child arthritis and uveitis presented at the same time and in another the uveitis preceded the arthritis by one year. All were treated with steroids (7 topically, I systemically) and topical mydriatic agents. After an initial response the uveitis persisted as a low-grade inflammation gradually leading to secondary complications and increasing loss of vision. Only two patients enjoy normal vision at present. The importance of routine slit-lamp microscopy in all children with JCA is stressed, especially in those with pauciarthritis and antinuclear antibodies.
General Practitioner Assistance with Gold and Penicillamine Therapy of Rheumatoid Athritis — A Four Year Prospective Study
Authors: Hunter J.A. , Capell H.A. , Pullar T. , Madhok R.
Published: January 2017

One hundred patients with active rheumatoid arthritis, uncontrolled by symptom relieving agents, were allocated randomly to intramuscular gold or oral penicillamine therapy. Their general practitioners (97 in all) were requested to assist with blood, urine, skin and mucous membrane monitoring. After four years, 16 patients in each treatment group remained on their original therapy, and three-quarters of these continued attending their family doctor for toxicity monitoring. Most GP monitoring problems occurred in the first six months of treatment. Sustained improvement in haemoglobin and ESR was seen in both treatment groups. Second-line drug toxicity monitoring by general practitioners allows specialist time to be diverted to rheumatological problem solving but may make it more difficult to relate rare but serious adverse adverse events to drug therapy.
A Case of Intraveneous and Oral Mefenamic Acid Poisoning
Authors: McKillop G. , Canning G.P.
Published: January 2017

A 22 year old heroin addict was admitted with tonic-clonic seizures, confusion and agitation 10 hours after taking mefenamic acid 5 grams orally and 2.25 grams intravenously. This appears to be the first recorded case of intravenous mefenamic acid abuse and, although not fatal, is a cause of concern. This is a commonly used drug and its seizure inducing potential is well recognised. It may therefore be worthwhile considering the possibility of intravenous abuse of mefenamic acid in heroin addicts admitted with confusion or seizures.
Fatality Due to Massive Overdose of Sodium Valproate
Authors: Connacher A.A. , Macnab M.S.P. , Moody J.P. , Jung R. T.
Published: January 2017

A 40-year-old woman admitted after a massive overdose of sodium valproate was found to have a serum valproate level of 18,900 μmol/1 which is the highest ever reported. She underwent cardio-respiratory failure, bone marrow suppression and neurological depression, subsequently dying. On post-mortem there was haemorrhagic pancreatitis but no histological evidence of hepatotoxicity. Valproate levels measured in various post-portem tissues and fluids indicated a high level in bile (21,375 μmol/1) suggesting that enteral administration of activated charcoal might be of some benefit by decreasing enterohepatic circulation of the drug.
Radiation Induced Carcinoma of the Anus
Authors: LaFerla G.A. , MacKay C.
Published: January 2017

The frequent use of radiation in the treatment of malignancy has resulted in an increased incidence of radiation induced tumours. The distal large bowel appears to be most vulnerable to this complication following radiation treatment to the pelvis. The anal canal is notably spared and radiation induced malignancy is very rare indeed. Only one such case appears in the world literature. We report a patient who developed such a tumour seven years following curative radiotherapy for a cervical carcinoma and succumbed to her anal tumour seven years later.
Hypokalaemia in Alcoholics
Authors: Dominiczak A.F. , Semple P.F. , Fraser R. , Lever A.F. , Wallace A.M.
Published: January 2017

Hyponatraemia has been described in beer drinkers and hypokalaemia resulting from increased levels of aldosterone is well recognised in patients with cirrhosis and ascites. We have encountered episodes of hypokalaemia in alcoholics accompanied by normal or increased serum concentrations of sodium. Despite a resemblance to syndromes of mineralocorticoid excess, increased levels of aldosterone and other mineralocorticoids were not found.
Early Experience with Intra-Arterial Thrombolytic Therapy for Peripheral Arterial Occlusion
Authors: Reid D.B. , Reid A.W. , Cuschieri R.J. , Lowe G.D.O. , Pollock J.G.
Published: January 2017

The authors present their early experience with local intra-arterial thrombolytic therapy for peripheral arterial occlusions causing limb threatening ischaemia, using streptokinase or urokinase. Ten patients were treated in a period of one year. Five patients had successful recanalisation, two patients had partial success and three patients required major amputation. The indications, contraindications and results of this treatment are reviewed.
Haemolytic Uraemic Syndrome: 17 Years' Experience in a Scottish Paediatric Renal Unit
Authors: Hughes D.A. , Beattie T.J. , Murphy A.V.
Published: January 2017

Seventy-nine children with the Haemolytic Uraemic Syndrome were referred to our unit between 1972 and 1988. The typical summer peak incidence was seen. A diarrhoeal prodrome occurred in 71 (90%). Fifty-nine (75%) required dialysis and 74 (94%) blood transfusion. Extra-renal disease was documented: neurological 32 (40%); abdominal 11 (14%); diabetes mellitus one case. Fifty-one (61%) had acute hypertension. The acute mortality rate was 9%. Children with neurological features had greater biochemical disturbances and longer duration of dialysis. Fifty-nine children were followed for a mean 47.4 months. Forty-four (75%) are healthy. Nine (15%) have renal impairment, two have proteinuria, one hypertension and one has a residual hemiparesis. There were two late deaths. Presence of acute neurological features increased risk of early death or survival with sequelae. Prolonged dialysis was significantly associated with poorer outcome. However, there were no reliable early indicators of poor prognosis.
An Unusual Case of Wegener's Granulomatosis
Authors: Amar A. , Henderson A.K.
Published: January 2017

A 58-year-old male developed extensive multisystem Wegener's granulomatosis eight years after pneumonectomy for a large solitary granuloma of the lung. Follow up following pneumonectomy had indicated a very prolonged disease free interval.
Myoclonic Epilepsy — Pitfalls in Diagnosis and Management
Authors: McKee P.J.W. , McGinn G. , Larkin J.G. , Brodie M.J.
Published: January 2017

Three cases of myoclonic epilepsy presenting in adolescence are described. Seizures were uninfluenced by treatment with carbamazepine. Substitution of sodium valproate in early adult life resulted in all becoming seizure-free. A high degree of clinical awareness is required in making the correct diagnosis and in choosing appropriate therapy for this form of epilepsy which can present with generalised tonic-clonic or partial seizures.
Metabolic Control in Diabetic Subjects following Myocardial Infarction: Difficulties in Improving Blood Glucose Levels by Intravenous Insulin Infusion
Authors: Davies R.R. , Newton R.W. , McNeill G.P. , Fisher B.M. , Kesson C.M. , Pearson D.
Published: January 2017

Optimal metabolic control during the first twelve hours after myocardial infarction may be associated with improved survival in diabetic subjects. A comparison of an intravenous insulin infusion regimen aimed at improving blood glucose levels (n = 35), with ‘routine control’ (n = 34) in the post infarction period has been carried out in diabetic subjects admitted to four Coronary Care Units over a two year period. However, glycaemic control was similar in both groups (intravenous infusion regimen, mean ± SD capillary blood glucose 10.3 ± 2.1 mmolll, ‘routine control’ glucose 10.7 ± 3.6 mmol/l). There were no differences in the rates of arrhythmias (31% v 32%), heart failure (46% v 47%) or mortality (17% v 18%). Mortality in diabetic subjects was lower than that quoted in previous studies but was higher than in non-diabetic subjects admitted to the Coronary Care Unit during the same period. Attempts to improve glycaemic control by means of intravenous insulin infusion were unsuccessful.
Composition of Seasonality of Disease
Authors: Douglas A.S. , Allan T.M. , Rawles J.M.
Published: January 2017

The composition of the seasonality of total death was ascertained. Vascular disease seasonality constitutes more than half. The remaining seasonality is influenced by respiratory disease. Surprisingly and of possible importance cancer mortality was not seasonal. Deaths from ‘all other disease’ and from ‘injuries’ is seasonal. Seasonality increases with age.

In coronary and cerebrovascular disease death has a large seasonal fluctuation. On the other hand hospital admissions and survivors have a minor seasonal fluctuation — Only cerebrovascular admissions reaching the chosen level of significance with a small seasonal amplitude. For vascular disease the ranking of seasonal fluctuation from greatest to least is — Death outside hospital, total death, death inside hospital, admissions, survivors. It is death outside hospital presumably ‘sudden’ that imposes seasonality on coronary disease in general.

For respiratory diseases not only death but hospital admissions and survivors have high amplitude seasonality with a much greater fluctuation than for death in vascular disease.
An Unusual Presentation of Sle
Authors: Newnham D.M. , Dhillon D.P.
Published: January 2017

SLE presenting initially with isolated pneumonitis is uncommon. We report a case of SLE which presented as an apparent infective lobar pneumonia without other definite evidence of SLE. Laboratory investigations eventually confirmed the diagnosis and clinical signs developed after the diagnosis was made.
Dr David Kinloch: Mediciner to His Majestie, James VI
Authors: Lowe K G
Published: January 2017

An account is given of Dr Kinloch whose portrait hangs in the library of Ninewells medical school. He led an adventurous life and served the Scottish and French Royal Families. He is remembered as a poet in whose Latin verse is given the first account of obstetric practice in Scotland.
Surgical Correction of Congenital Heart Defects in Adults
Authors: Hamilton D I , Bozkurt A.K.
Published: January 2017

From April 1987 to April 1991, 30 patients over the age of 15 years underwent surgery for congenital heart defects in the adult department of the ***Professorial Unit of Cardiothoracic Surgery, Royal Infirmary of Edinburgh. Eighteen were females (60%) and 12 were males (40%). Ages ranged from 15 to 68 years (mean 38.1). Six patients 20% had undergone previous cardiac surgery. Operative and hospital mortality was zero. Major postoperative complications occurred in three patients. In the follow-up period between three months and four years, there has been one late death. The spectrum of patients with congenital heart defects over the age of 15 was reviewed. The relatively late presentation of these defects and the indications for operating in adult life are discussed.
A Case of Spontaneous Hypothermia
Authors: Ferguson K.M. , Fyfe T , Montgomery J
Published: January 2017

It is important to recognise any condition, however rare, which can be cured. We report a case of chronic hypothermia and its dramatic response to treatment.
An Audit of the Activities of the Paediatric Oncology Unit in Edinburgh, 1982–1991
Authors: Saha V. , Eden T , Stiller C.A. , Brown R.J. , Mackinlay G.
Published: January 2017

The activities of the paediatric oncology unit at the Royal Hospital for Sick Children, Edinburgh during 1982–1991 were audited. There were 254 new patients of whom 240 had a malignancy, seven had Langerhans cell histiocytosis and seven had non malignant tumours. of the 254, 131 (52%), 78 (31%), 14 (65), were normally resident within the Lothian, Fife and Borders regions respectively. Therefore, although the unit is a part of the Lothian Health Board, it is in practice, the referral centre for S.E. Scotland. A majority (92%) of patients were treated according to national or international protocols during the last five years and of the 240 children diagnosed to have cancer, 158 (66%) are at present in clinical remission. These figures compare favourably with national averages for protocol compliance and survival. During these ten years, an additional 69 children with cancer from S.E. Scotland were treated at other centres. Therefore, while the unit justifies its existence it has yet to realise its full potential.
Defibrillation by General Practitioners: An Audit of Resuscitation in a Scottish Rural Practice
Authors: Macdonald J.W.A. , Brewster M.F. , Isles C.G.
Published: January 2017

The objective was to review the outcome of resuscitation attempts in a small remote two-partner practice of 2700 patients in Galloway, South West Scotland during the period 1985–1992. During the study period 15 attempts were made to resuscitate the victims of cardiac arrest. Two sub-groups were identified. in the first, nine out of ten patients whose arrest occurred in the presence of a doctor were successfully resuscitated and all proved to be long term survivors. in the second group of five patients whose arrest took place before the arrival of the doctor there were no survivors. We conclude that defibrillation by general practitioners has a valuable contribution to make in reducing the mortality from myocardial infarction in rural practice.
Reflections on Dr Henderson of Perth's Case of Impracticable Labour: An Early Case (1820) in which the Caesarean Operation was Performed
Authors: Kaufman M.H.
Published: January 2017

The rediscovery of a female pelvis with features characteristic of osteomalacia stimulated an enquiry into the clinical history of the woman involved. It was established that she died in 1820, aged 30. Despite being severely debilitated and confined to bed for some years with increasing skeletal deformities, she became pregnant, and in due course laboured unsuccessfully for about 102 hours. An elective caesarean section was performed, but she died some hours later, though her daughter survived and was appropriately christened Caesar Anna.

This represents one of the earliest cases in which the caesarean operation was performed where the full obstetric history was carefully recorded by the obstetrician involved, Dr Henderson of Perth. The case was clearly considered important, and in 1836 engravings of this pelvis were used to illustrate Professor Hamilton's “Practical Observations of Various Subjects Related to Midwifery”. Such cases are now of great rarity in the developed world.
The Management of Operable Breast Cancer in Scotland Surgeons' Opinions
Authors: Robinson S.M. , Forrest A.P.M. , Stewart H.J.
Published: January 2017

This report gives the responses of general surgeons in Scotland to two questionnaires. Satisfactory rates were obtained: 82% for the more detailed survey in 1988 and 62% for the second survey (1991), where non-respondents were not followed up. In 1988 the rationale was the poor participation in the Scottish breast conservation trial while the 1991 survey further investigated the diversity of surgical opinion identified in the first. The limited trial support in 1988 was mainly due to reluctance to accept all treatment options. The majority were prepared to consider trial participation although 47% believed this compromised doctor-patient relationships. Although breast-conserving therapy was widely supported, many different views on management were encountered, both in the degree of influence of specific factors and in the decisions taken in relation to them. We believe these surveys have re-inforced a need for management guidelines, particularly as around half the patients with symptomatic breast cancer were being treated in non-specialist units.
Realising the Benefits of Resource Management
Authors: Robins J. B. , Anthony G. S.
Published: January 2017

In 1988 Inverclyde Royal Hospital became the pilot site for the resource management initiative in Scotland. Real benefits have been achieved through the implementation of an information system which allows doctors to closely monitor every aspect of health care in the hospital, enabling them to continually reassess and evaluate their own work. The ability of doctors to use the clinical information system to fulfil operational requirements, such as the production of automated discharge summaries, whilst supporting the medical audit process through the same dataset has been a major achievement. Within the hospital the creation of an ‘information flow’ has been helpful to all clinical and medical records staff and at the same time has produced patient based information to support the management process. The availability of over four years of fully costed activity data is a considerable advantage for the Unit as Trust status approaches.
Investigation of Late-Onset Migraine
Authors: Cull R.E.
Published: January 2017

Sixty-nine patients presenting with migraine, with or without aura, after age 40 were investigated with CT or MRI brain scanning, carotid ultrasound and serum antibody studies. A 2:1 female:male predominance was found, the mean age of presentation being 51.6 years. Migraine with aura was reported in 86% of patients. 46% of the females had active menopausal symptoms. No significant haematological or serological abnormalities were detected. CT or MRI brain imaging was normal in 93% of cases; 4 patients had evidence of cerebral infarction. No cerebral tumour or vascular malformation was found. Three patients had evidence of mild — Moderate carotid atheroma on ultrasound scanning. Routine detailed investigation of late-onset migraine is unlikely to be of value unless the history is atypical or abnormalities are present on clinical examination
Aids-Related Cholangitis: Diagnostic Features and Course in Four Patients
Authors: Bird G.L.A. , Kennedy D.H. , Forrest J.A.H.
Published: January 2017

Radiological features of sclerosing cholangitis are an uncommon but well recognised complication of HIV infection in homosexual males. In this report we document the clinical features and course of the disease in four patients. Four homosexual males with established AIDS were referred in 1990–92. Three of the four had intractable upper abdominal pain which was poorly responsive to opiates. Three of the patients had diarrhoea and all had weight loss. The diagnosis of AIDS related cholangitis was confirmed by endoscopic retrograde cholangiography in three cases, but in only one patient was there no evidence of biliary disease on ultrasound scanning. In the two cases with Cholangiographic features of papillary stenosis, endoscopic sphincterotomy was carried out and there was subsequently a dramatic improvement in the abdominal pain. Three of the patients had evidence of gastrointestinal infection with Microsporidia (1) or Cryptosporidia (2). All the patients died within 2–9 months of the diagnosis of cholangitis, but none of the deaths resulted from hepatobiliary disease.
Multiple Sclerosis in Fife
Authors: Grant R.M. , Carver A.D. , Sloan R.L.
Published: January 2017

Patients in Fife with multiple sclerosis were identified from three sources: a postal questionnaire to all general practices in Fife, hospital discharge data, rehabilitation service database. A total of 508 patients were identified in a population of 354, 273 giving a crude prevalence rate of 143/100,000. The Standardised Prevalence Rate was 178/100,000. The sex ratio was 2.43 females to males. The prevalence was higher than identified in southern parts of the United Kingdom and similar to northern Scotland A total of 200 (40%) cases were identified as having relapsing-remitting disease and of these 151 were ambulant, making them eligible for treatment with interferon beta-lb under current licensing criteria. Only 90 (60%) of the 151 currently eligible for the drug were under the care of a specialist and almost half the practices felt that they would change their referring habits. These factors may have implications for the workload of specialist clinics.
Improving Emotional Outcomes following Acute Stroke: A Preliminary Evaluation of a Work-Book Based Intervention
Authors: Morrison V.L. , Johnston M. , MacWalter R.S. , Pollard B.S.
Published: January 2017

Sixteen acute stroke patients (6 males and 10 females) who received a self-help workbook addressing both medical and psychological issues on discharge from hospital showed Significantly lower anxiety and depression levels and a non-significant trend toward greater satisfaction with advice/information than 53 patient controls. (28 male, 25 female) recruited to an earlier study who did not receive the workbook. All patients had been admitted to hospital with a first stroke, were aged less than 80 years, and had a residual disability at discharge. There were no significant group differences in age, sex distribution or neurological impairment measured within 48 hours of admission to hospital, thus our findings suggest that a workbook-based intervention can improve short-term emotional outcomes. A large-scale randomised controlled trial is needed.
Antiplatelet Therapy for Secondary Stroke Prevention
Authors: Forbes C.D.
Published: January 2017

The precise role of antiplatelet therapy in secondary stroke prevention remains a matter of some debate. Although specific antiplatelet agents (notably aspirin, ticlopidine, dipyridamole, and clopidogrel) have been shown to be active in the prevention of secondary stroke, questions remain about the effective dose of these agents and their potential efficacy in combined therapeutic regimens. In addition, haematological and gastrointestinal side-effects of antiplatelet agents remain a significant clinical concern for patients and prescribing physicians. This review article examines research on both monotherapy and combination antiplatelet therapy for secondary stroke prevention, with an emphasis on lessons learned about dosage schedules, treatment protocols, and side-effect profiles.
A reactive flow model for hot-spot ignition of shocked aluminized explosives with small size aluminum grains
Authors: Bai Fan , Liu Yan , Huang Feng-Lei , Hussain Tariq
Published: January 2017

To predict the influence of aluminum contents (particle size <20 µm) on the shock initiation and growth of reaction in an aluminized explosive (CL-20/AL/Binder, 85/15/5), a new numerical model is utilized. The model is based on the elastic-visco-plastic double hollow sphere pore collapse model (DZK model). In the new model, the aluminum powder combustion is assumed to partly occur during the hot-spot formation. By combining the new term of the hot-spot ignition and the reaction growth term at low pressure and high pressure in the DZK model, a new expression of reaction rate has been implemented in a hydrodynamic code (LS-DYNA) as a user-defined equation-of-state. For verification, the new model has been used to simulate the shock initiation of the aluminized explosive. The numerical results show that 4% of aluminum in this explosive reacts at the stage of hot-spot formation. The model can describe the shock-to-detonation transition process of aluminized explosive while considering the influence of the aluminum contents.
Synergistic Effect of Mixed Bases in the Conversion of Cotton Cellulose I to Cellulose II
Authors: Vigo Tyrone L. , Wade Ricardo H. , Mitcham Donald , Welch Clark M.
Published: January 2017

Several aqueous bases were found which swell cotton yarn greatly, but, after their removal from the cotton, leave the x-ray diffraction pattern unchanged from that of native cellulose I. Such bases include 9.5% lithium hydroxide and 35% benzyltrimethylammonium hydroxide. However, the addition of as little as 1.5% lithium hydroxide or 5% sodium hydroxide, to the benzyltrimethylammonium hydroxide causes substantial conversion of cellulose I to cellulose II.

This synergistic effect is attributed to the decrystallizing action of the organic base which, by breaking down the cellulose I lattice, facilitates the action of lithium, sodium, and potassium hydroxides in forming alkali cellulose lattices leading to cellulose II. Rubidium and cesium hydroxides failed to produce this effect when added to the organic base. Cellulose swelling, decrystallization, and recrystallization appear to be distinct steps in lattice conversion. These steps may present greatly different requirements as to optimum cation size and coordination, such requirements being more readily met by mixtures of cations than by any one species. In the absence of the quaternary base, but at alkali concentrations giving maximum fiber swelling, no lattice conversion was produced by lithium or cesium hydroxides, a high degree of conversion occurred with sodium hydroxide, and the other alkalies were intermediate in effect. The strength, elongation, energy-to-rupture, and tenacity of treated yarns varied greatly with the cations present in the alkali. In contrast to yarn, fiber bundles underwent slow and partial conversion to cellulose II by the quaternary base.
The Accessibility and Internal Tensions of Mercerized Cottons, Determined by Means of a Mild Hydrolysis Treatment
Authors: de Boer J. J. , Borsten H.
Published: January 2017

If the effect of mild hydrolysis by acid and steam on the degree of polymerization of cotton is interpreted in terms of reactivity and accessibility and if the reactivity is related to the presence of internal tensions, it is possible to find good agreement between these properties and the structural changes which have taken place as a consequence of different swelling and drying treatments.
A New Chemical Approach to Durable Flame-Retardant Cotton Fabrics
Authors: Aenishänslin R. , Guth C. , Hofmann P. , Maeder A. , Nachbur H.
Published: January 2017

Recent studies of fire accidents in Switzerland involving individuals' wearing apparel have illustrated the importance of a durable flame-retardant finish for cotton textiles. Knowledge of the dynamics and chemistry of pyrolysis and combustion is considered essential to understand the mechanism of flame-retardant systems. A series of N-methylol compounds of dialkyl phosphonocarboxylic acid amides were assessed in relation to established systems based on APO and THPC. A number of these compounds were found suitable for durable flame-retardant finishes on cotton. One compound was chosen to illustrate their performance. It showed excellent fastness to laundering and dry cleaning with acceptable effects on the properties of the fabric.
The Stabilization of Irreversibly Deformed Keratin Fibers
Authors: Weigmann Hans-Dietrich , Dansizer Cornelia
Published: January 2017

The mechanism of recovery of keratin fibers from deformation in aqueous solutions was investigated. Above a transition temperature of ~70°C the deformation of the fibers became at least partially irreversible and the reversibility of the α-β-transformation was completely destroyed. Various levels of an irreversible disorientation of the native structure could also be obtained by holding the fibers in the extended state above the transition temperature for various lengths of time. The level of disorientation obtained under these conditions is reflected in the stress level reached during stress relaxation. Upon release of the fibers, instantaneous recovery occurred which was proportional to the stress just prior to release. The total recovery can be kept at this level if an SH-blocking reagent is added prior to the release of the fibers, indicating that the second, slower phase of recovery is controlled by an SH-catalyzed disulfide interchange mechanism. A similar behavior could be observed for highly reduced fibers, in which case the formation of stable thioether linkages during setting presumably prevents the second phase of recovery. The removal of disulfide bonds from contraction-opposing positions is the rate-determining factor of the second phase of recovery
And What is a Merciful Heart?
Authors: Farley Wendy
Published: January 2017

The negative way, especially as epitomized in the writings of Pseudo-Dionysius, is explored as providing a theological context in which universal compassion can be generated. The way of negation both withholds attributes from God and undermines the structures of dualistic thinking itself. By making relative our ideas about God, negation challenges the grounds on which we construct oppositions among human beings. More profoundly, negation deploys language to move into an awareness of the essenceless mystery of divinity. As we enter into this mystery more deeply we become better prepared to participate in the radical love at its center.
Configuring a Christian Spirituality of Work
Authors: Ligo Vivian
Published: January 2017

The essay addresses the following questions: What constitute the basics of a spirituality of work? Can one draw some criteria by which to adjudicate the coherence, consistency, and adequacy of existing spiritualities of work? What can Christianity offer for developing a spirituality of work? Guided by these questions, the essay begins with identifying the interrelated variables of work itself: product, process, end user, the worker, and the workplace. Each variable has a spiritual dimension. Product points to human creativity; process to the precepts: be attentive, be intelligent, be reasonable, and be responsible. Taken together, the end user, the worker, and the workplace point to the interpersonal dimension of work. The worker is poised toward the need for personal transcendence, as the workplace is the locus for apprehending the presence of grace in our midst.
True Metaphor
Authors: Tuell Steven S.
Published: January 2017

The history of the interpretation of Ezekiel's vision of the dry bones (Ezek 37:1–14) reveals that while this passage is a metaphor for Israel's exile and restoration, it has also served as the source text for Jewish and Christian reflection on the resurrection of the dead. That the same passage can be read in both ways has implications for the way all of Scripture can be read. In the Talmud, Rabbi Judah calls Ezekiel's vision ‘ emeth mashal: a true metaphor. This is an apt image for the entire Bible, as a text both historically specific and theologically multivalent.
City economies and microbusiness growth
Authors: Houston Donald , Reuschke Darja
Published: January 2017

In developed countries, microbusinesses (those employing fewer than 10 people) and home-based businesses have been systematically overlooked in urban economic development thinking. This article assesses the influence of city location and being run from the business owner’s home on microbusiness growth, based on empirical analysis of panel firm-level data over a four-year period during the UK’s long boom. The analysis reveals that cities provide benefits to microbusinesses for turnover growth but not for employment growth – suggesting that the additional growth induced by cities for microbusinesses may be jobless growth. However, in the case of microbusinesses run from the owner’s home, cities facilitate growth into medium-sized businesses (with 50+ staff). In conclusion, microbusinesses, including those run from business owners’ homes, are integral to the evolution and dynamics of urban economies and essential to understanding the nature of growth in cities. Agglomeration theory needs to say more about how urban agglomeration benefits firms of different types and sizes, and small business and self-employment research needs to say more about the influence of location, in particular cities. How businesses use both commercial and residential property are integral to the nature of growth in cities.
The double bind of social innovation: Relational dynamics of change and resistance in neighbourhood governance
Authors: Bartels Koen
Published: January 2017

While current discourse promotes social innovation as a normative good, in practice it is highly contested by institutionalised ways of thinking, acting and organising. Concurrently stimulating and resisting innovation creates a ‘double bind’ of conflicting communicative signals that weaken capacities for joint sense making and sustainable change. I develop a meta-theoretical framework that explains what is involved in these relational dynamics of change and resistance, how these can be assessed and improved, and why the double bind both necessitates and inhibits substantive change. Analysing relational dynamics in a case of neighbourhood governance in Amsterdam, I argue that social innovators should be prepared to constructively confront rationalistic evaluation, defensiveness, and experiential detachment while institutional actors should welcome fundamental relational transformations of hierarchical and competitive dynamics institutionalised in urban governance.