bluuebunny/crossref_metadata_2025 huggingface dataset:
Lung cancer symposium
Authors: Davidson S
Published: January 2025

In 2006, Scotland took the historic move of banning smoking in public places. However, Scotland continues to suffer from amongst the highest rates of lung cancer in the world, with amongst the worst survival rates. This symposium examined the role of CT in screening for lung cancer, new diagnostic and staging techniques such as endobronchial ultrasound guided sampling as well as reviewing the optimum surgical approach, chemotherapy and radiotherapy for early stage disease. Looking to the future, the place that novel therapies may have in the management of lung cancer patients was examined.
Eponymous doctors associated with Edinburgh, part 2 – David Bruce, John Cheyne, William Stokes,Alexander Monro Secundus, Joseph Gamgee
Authors: Doyle D
Published: January 2025

This, the second in a three-paper series with this title, looks at famous doctors who trained in Edinburgh and their eponyms. With one possible exception, none seems to have sought the eponym, nor awarded it to themselves, nor used it for self-promotion. Unlike those in the first paper, all eponyms in this paper are still in use and their brevity is in contrast to the lengthy description needed if the eponym is not used. Examples are Cheyne–Stokes respiration, Stokes–Adam attacks, Brucellosis and Gamgee dressing. Monro Secundus is included because of his vehement defence of his professional reputation and research findings when he suspected others of trying to detract credit from him, a characteristic seldom reported for the others.
Tricuspid valve endocarditis due to Salmonella typhi
Authors: Kadappu KK , Kainthaje RB
Published: January 2025

Salmonella typhi is a rare cause for infective endocarditis. Seventy five per cent of cases suffering from this condition have an underlying cardiac abnormality such as rheumatic heart disease or congenital heart defect. We report a case of native tricuspid valve endocarditis due to Salmonella typhi. Organism was resistant to chloramphenicol, amoxycillin, moderately sensitive to ciprofloxacin and sensitive Ceftriaxone and Gentamicin. Patient improved with prolonged course of Ceftriaxone and Gentamicin therapy.
Aspirin: old and new
Authors: Musumba CO , Walley T
Published: January 2025

Aspirin (acetylsalicylic acid) is one of the most commonly used drugs today. Initially used as a potent analgesic, anti-inflammatory and antipyretic agent, its uses have expanded considerably over the years, and new therapeutic indications are still being researched. This review looks briefly at the established uses and outlines some of the developing areas.
Solanaceae IV: Atropa belladonna, Deadly Nightshade
Authors: Lee MR
Published: January 2025

The Deadly Nightshade, Atropa belladonna, is a plant surrounded by myth, fear and awe. In antiquity, the Greeks and the Romans knew that it contained a deadly poison. In medieval times, it was widely used by witches, sorcerors and professional poisoners. Linnaeus later codified its remarkable properties as the genus Atropa, the Fate that slits the thin spun life and the species belladonna because of its power to dilate the pupils. In the 1830s, the pure alkaloid l-atropine was isolated from the plant. This proved to be a significant tool in the study of the autonomic nervous system leading to the identification of acetylcholine as an important neurotransmitter in mammals. When pure atropine became available, it caused a large number of deaths, whether by accident, suicide or homicide.
Medicine, meteorology and vital statistics: the influence of the Royal College of Physicians of Edinburgh upon Scottish civil registration, c.1840–1855
Authors: Cameron A
Published: January 2025

The Scottish Registration Act of 1854 introduced compulsory civil registration of births, deaths and marriages under the GROS. The Royal College of Physicians of Edinburgh had long campaigned for such legislation, but was dissatisfied with certain sections of the Act. The College possessed strong views on how causes of death ought to be recorded, on the need for a medical Superintendent of Statistics to tabulate and analyse the causes of death for the GROS, on whether or not doctors should be fined for failing to provide certificates of cause of death, and on the importance of including meteorological data in the GROS’s reports. Its Fellows accordingly strove to have the new registration measures tailored to their specifications. Drawing upon the College minutes, the GROS archives, and other contemporary sources, this article explains how the College succeeded in influencing some, but not all of these aspects of vital registration in Scotland.
Cod And God: Dr Wilfred Grenfell in Newfoundland
Authors: Short C
Published: January 2025

Wilfred Thomason Grenfell (1865–1940) began his medical career working for the National Mission for Deep Sea Fishermen on the North Sea. In 1892, the Mission sent him to Newfoundland to invesitigate the living and working conditions of the fishermen there. He spent most of his life improving conditions for the settlers on the coasts of Newfoundland and Labrador. His unorthodox methods and difficult personality brought him into conflict with the authorities. In spite of this, he achieved significant changes for the Newfoundlanders in medical care, education and economic prospects.
The cost of homoeopathy in Scotland
Authors: Ross S , McLay JS
Published: January 2025

Homoeopathy is a popular form of complementary medicine which is prescribed by 60% of Scottish GPs on the NHS. The aims of this study were, using the PRISMS database, to determine the number of homoeopathic prescriptions issued by Scottish community pharmacies on an NHS prescription, and the associated net ingredient costs over the last five years. In 2005, 48,778 homoeopathic prescriptions were dispensed in Scotland at an ingredient cost of £254,704 (excluding consultation and dispensing fees). During the study period the number of dispensed homoeopathic prescriptions fell by 9%, however the total ingredient costs increased by 28%. Although the amounts spent by the Scottish NHS on homoeopathy are relatively small, with the ever-increasing financial constraints, and demands for the use of cost-effective therapies with proven efficacy, it would seem appropriate to reconsider the position of homoeopathy in the Scottish health service.
Respiratory Medicine Symposium
Authors: Murray M
Published: January 2025

This year’s Respiratory Medicine Symposium encompassed a variety of clinically relevant topics with particular emphasis on current and future management strategies. Commonly encountered clinical scenarios such as the investigation of solitary pulmonary nodules, advising snorers on surgical options and optimising asthma control in both primary and secondary care as well as rarer conditions such as pulmonary arteriovenous malformations were presented. The Robert W Phillip Memorial Lecture focused on the diagnosis of PE.
Poisoning: focus on paracetamol
Authors: Bateman DN
Published: January 2025

Presentations with acute self harm are a worldwide problem. In developed countries drug overdose is a common form of self harm, and in the UK the most frequently involved agent is paracetamol, implicated in around one-third of presentations. Risk factors for paracetamol hepatotoxicity include starvation, eating disorders, and enzyme induction from drugs and alcohol. Treatment is based on assessment of these and time since ingestion. Antidotal therapy is with acetylcysteine. Assessment of treatment efficacy is based on measurement of liver function tests and serum creatinine. Adverse reactions to the antidote acetylcysteine are frequent, thus understanding their mechanisms and treatment is important. Treatment of patients presenting after 20 hours is aimed at preventing hepatic encephalopathy. Patients presenting with severe liver damage should be considered for referral to a specialised centre.
Pulmonary rehabilitation: what is it and why does it work?
Authors: Evans R , Morgan M
Published: January 2025

Chronic lung diseases such as COPD are typically characterised by progressive disability arising from dyspnoea and reduced exercise capacity. Although the underlying cause of disability is the irreversible loss of lung function, there are compounding systemic complications, such as skeletal muscle dysfunction, that contribute. Pulmonary rehabilitation is a therapy that aims to improve physical functioning and health status without necessarily reversing the impairment of lung function. The key components of a pulmonary rehabilitation programme are individually prescribed physical training and self-management education. These therapies are delivered by a multi-professional team in a variety of settings. The physical training generally includes lower limb endurance and resistance exercises. Higher intensity training, where tolerated, will result in greater improvement though some gains can be achieved even with low intensity training. Pulmonary rehabilitation seems to work through a combination of genuine physiological training, reduced dyspnoea, and better self-management. Recent studies have now shown conclusively that a comprehensive pulmonary rehabilitation programme can produce improvements in walking performance and quality of life. These benefits translate to increased activities of daily living, reduced hospital length of stay, and possibly increased survival. Although pulmonary rehabilitation is effective and popular with patients it is not widely available. In future it will be necessary to explore ways of increasing capacity to meet demand.
Vaccination for cervical cancer
Authors: Frazer IH
Published: January 2025

Cervical cancer, one of the most common gynaecological cancers, is the consequence of persistent infection by the human papillomavirus family.This article is an authoritative review on the subject, by Professor IH Frazer, internationally acclaimed for his work on the development of the world’s first cervical cancer vaccine.
Septic deep venous thrombophlebitis and distant emboli in injecting drug users – treatment experience and outcome
Authors: Hakeem MJML , Bhattacharyya DN
Published: January 2025

Injecting drug use is a world-wide problem responsible for numerous minor and major complications which are well recognised. After years of injecting drug use, superficial and peripheral veins may become obliterated and the committed drug user attempts to inject drugs into proximal and more central veins. Besides the potential for mechanical and toxic complications such as vascular injury, intra-arterial drug injection, pneumothoraces, mycotic aneurysms and deep abscess formation, use of large proximal veins may result in life threatening septic deep vein thrombophlebitis.1, 2, 5

Aseptic and septic thrombophlebitis of peripheral veins is a well recognised complication of intravenous catheters and usually responds to removal of the intravascular device. Catheter related septic thrombophlebitis of proximal large veins and great central veins are also widely reported. However septic or suppurative thrombophlebitis of deep veins in IDUs characterised by micro abscess formation within the thrombotic veins and repeated bacterial embolisation into the circulation, is a severe systemic disease which has received little attention in the literature.1, 3

We recently observed ten IDUs (11 episodes) with septic DVT admitted to the infectious diseases unit in Fife, Scotland within a period of 28 months. This report summarises our experience in the diagnosis,treatment and follow-up of these patients.
Prescription errors in patients on an acute medical assessment unit
Authors: Gray E , Ullah S , Lwin A , Sultanzadeh SJ , Farrow C , Loke YK , Southgate J , Jenkins P
Published: January 2025

Errors in hospital patients’ drug prescriptions are common in a wide variety of clinical environments. This study reports a high incidence of prescribing mistakes (45%) in a busy acute medical unit in a university hospital in the UK. Prescription errors arising in a ‘front-door’ department are of particular concern because they may well be perpetuated throughout a patient’s subsequent stay in hospital. In this study, prescription errors of all degrees of seriousness were recorded, and in addition, a failure to document drug allergy was discovered in 13% of the prescription charts studied. We consider this to be a particularly important observation in view of the potential for severe allergic drug reactions. Multiple factors contribute to errors in prescribing and it is suggested that additional resources should be directed at continuous prescription training for clinical staff and this should include audit of individuals’ prescribing habits and error rates.
Edinburgh surgery and the history of golf
Authors: Macintyre IMC
Published: January 2025

Individuals associated with Edinburgh surgery have been involved with the history and development of the game of golf since the fifteenth century. King James IV of Scotland (1473–1513), who ratified the surgeons’ Seal of Cause in 1506, played the game, ensuring its first Royal patronage, and he also became the first named golfer to play at a named location. In the seventeenth century,Thomas Kincaid the Younger (1661–1726) gave the first detailed description of what he regarded as the ideal stance, address and swing. John Rattray (1707–1771) signed the first rules of golf in 1744 and became almost certainly the first person whose life was saved by his golfing connections. In the nineteenth century, Laidlaw Purves (1842–1917) helped establish the Ladies’ Golfing Union and devised the modern rules of handicapping.
Fetal surgical intervention
Authors: Welch CR , Dupuch L
Published: January 2025

Developments in medicine have enabled some surgical procedures to be carried out on fetuses while they are still inside the mother’s womb with the intent of saving the life of the fetus or minimising serious disease. In this article, the authors review these developments and the range of surgical procedures currently being carried out.
Skin infections
Authors: Cox NH
Published: January 2025

A huge number of infections affect the skin either directly, as the primary site of infection, or indirectly, by virtue of causing an exanthem or other secondary eruption, such as erythema multiforme or vasculitis. Space does not permit significant discussion of such indirect associations so most of this review concentrates on direct skin infection and is highly selective. The emphasis is on disorders that are common but that may have significant health implications, and on some rarer but readily diagnosable disorders. Thus, the topics chosen for review are streptococcal cellulitis of the leg, staphylococcal scalded skin syndrome, herpes simplex and varicella zoster infections, and a potpourri of tropical skin infections that may present in returning travellers.
Neurological services in Darfur: a deprived rural community in a tropical zone affected by ongoing armed conflict
Authors: Izzeldin IM , Nagi EA
Published: January 2025

This report, compiled after a short visit to Darfur sponsored by the Association of British Neurologists, describes the status of healthcare in Nyala, the capital of southern Dafur. Four hospitals and 19 consultants supervise the care of over three million people.The most common neurological diseases in Darfur are infections of the central nervous system, characterised by meningitis during the dry seasons and cerebral malaria following the short rainy autumn. Trauma-related neurological disorders are common. Epilepsy, mostly symptomatic, is largely caused by untreated or poorly treated CNS infection, head injury and neonatal/childhood diseases. Epilepsy management is greatly hindered by the fact that the disease is considered to be a social stigma. Uncontrolled hypertension is the leading vascular risk factor, and stroke is frequently seen in younger patients who are not fully investigated. During his visit, the first author saw 46 patients in whom the most common neurological problem was infection and trauma-related epilepsy. The spectrum and presentation of neurological diseases was very different from the usual disease pattern seen by neurologists in the UK. Most components of a multidisciplinary team for neurological patients are lacking; no physical, occupational or speech and language therapy. The medical and neurology services in Nyala desperately need CT scanning to complement a reasonably equipped laboratory service. In addition, there is a need for local clinical guidelines to govern the practice of more junior staff and those working in disadvantaged health units.
The changing face of dermatological surgery
Authors: Naysmith L
Published: January 2025

Changes in clinical practice within dermatology have led to a resurgence of dermatological surgery as a sub-specialty.The dermatologist’s skillset not only includes the diagnosis and management of rashes but also increasingly the diagnosis and appropriate surgical management of both benign and malignant lesions. Skin cancer, particularly basal cell carcinoma, accounts for a large proportion of a dermatological surgeon’s caseload, with choice of treatment ranging from simple cryosurgery and curettage through surgical excision and Mohs micrographic surgery with challenging fascioplastic reconstruction. Although opinions regarding the relative efficacy of Mohs surgery vary, it has revolutionised the management of cutaneous malignancy in the USA and is influencing dermatology worldwide.
Rare and fatal complications of an indolent disease – chronic lymphocytic leukaemia
Authors: Jaggia A , Hamblin M
Published: January 2025

Chronic lymphocytic leukaemia is often considered an indolent disease with a variable course, and patients with this disorder are monitored by general physicians and practitioners. The authors detail two cases of chronic lymphocytic leukaemia with very rare and fatal complications, namely haemophagocytic lymphohistiocytosis and Hodgkin’s transformation. This is followed by a brief overview of these conditions.
A history of James Craig’s hall for the Royal College of Physicians of Edinburgh
Authors: Lewis AR
Published: January 2025

The architectural history of the College’s George Street hall, completed in 1781, has commonly been overlooked because it was demolished and deemed to have been a disappointment to both its owners and its architect, James Craig.1 This article reassesses the College’s ambitions and Craig’s efforts to match them, by accounting for the number of drawings which were made for the site and building, Craig’s sources of inspiration and the building’s appearance and influence. The paper reveals that the hall was actually intended to be part of a larger complex of buildings and rival Register House as the New Town’s most impressive public edifice. The building has not been examined in this way before, and Craig’s use of his library, drawing equipment and knowledge of London’s architects and architecture are discussed to offer insight into his personal vision for the hall’s appearance and meaning.
Medical problems of high altitude
Authors: Peacock AJ
Published: January 2025

As many high-altitude regions of the world become more popular holiday destinations, travellers need to understand how to prepare for highaltitude travel and how to deal with its potential consequences. In this article, Professor Andrew Peacock looks at the effects of high altitude on the human body and discusses how to prevent or treat diseases associated with, or made worse by, high altitude.
Long-term follow-up of survivors of childhood cancer
Authors: Edgar AB , Wallace WHB
Published: January 2025

Today, more than 70% of children treated for cancer will be cured, and attention is focusing on the late effects of treatments for these long-term survivors. Treatment-related morbidity is diverse, with potential effects on the endocrine system (growth, puberty, fertility, pituitary, thyroid and other disorders); cardiovascular, pulmonary and renal complications; second tumours; and cognitive, educational, neuropsychological and social manifestations. Multidisciplinary longterm follow-up of these patients is essential to monitor, treat and prevent morbidity. In this review the authors describe the chronic health problems encountered by survivors and discuss the development of a long-term follow-up service for childhood cancer survivors.
Palmoplantar keratosis as a primary presentation of secondary syphilis
Authors: Ghadiri-Sani M , Mann I , Lobo M , Jawad ASM
Published: January 2025

A 36-year-old man of Bangladeshi origin presented with a febrile illness, arthralgia, generalised lymphadenopathy and palmoplantar keratosis. Initially the patient denied any sexual contact, although investigations went on to confirm a diagnosis of secondary syphilis. Subsequently a sexual history was obtained which revealed he regularly attended male saunas and had receptive anal sexual intercourse.
The investigation and management of erythrocytosis and thrombocytosis
Authors: Culligan DJ
Published: January 2025

Erythrocytosis and thrombocytosis are among the most common reasons for referral to haematology outpatients. Most cases are identified on routine blood counts as part of the investigation of non-specific symptoms. Erythrocytosis is a term used to describe a group of conditions with an increase in circulating red cell concentration leading to an increase in haematocrit and often an increase in haemoglobin concentration (polycythaemia). True erythrocytosis is commonly seen in isolation but may also be associated with thrombocytosis and leukocytosis in the myeloproliferative disease polycythaemia vera (PV). Isolated erythrocytosis may also be a manifestation of myeloproliferative disease but is commonly seen as a secondary response to elevated erythropoietin levels, most frequently because of chronic hypoxia. Recently, an acquired point mutation in the gene Janus kinase 2 (JAK2) has been identified in approximately 95% of cases of PV, and this is a significant development in terms of diagnosis and as a future target for therapy. Persistent thrombocytosis is the hallmark of another myeloproliferative disease: essential thrombocythaemia (ET). The same acquired point mutation in JAK2 is identified in approximately 40–50% of cases of ET. Transient reactive thrombocytosis (days to months) is a common response to a wide range of conditions including acute and chronic blood loss, iron deficiency, malignancy, sepsis, chronic inflammation and temporal arteritis. The identification of the myeloproliferative forms of erythrocytosis and thrombocytosis is important as appropriate therapy will reduce the lifetime risk of arterial and venous thromboembolic disease.
Geriatric symposium report
Authors: Kelman A
Published: January 2025

This symposium aimed to provide a practical ‘toolkit’ for the management of common elderly problems while keeping one eye on future developments. Dizziness, bone disease, age-related macular degeneration and cognitive impairment are a significant cause of symptoms and disability in older people. Treatment and advances in the management of these conditions were discussed. One of the key messages was using both clinical and risk assessment tools to identify those who will benefit from treatment. There is no more difficult a diagnosis than that of ‘frailty’ but compelling evidence was presented that this is a comprehensible and measurable diagnosis, with an interesting insight into the use of a ‘frailty index’. Cardiovascular disease in older people is becoming truly a ‘geriatric giant’. Leading experts discussed the clinical management of common cardiovascular problems presenting in older people with particular emphasis on the dilemmas faced by clinicians in managing these conditions in frail older people.
An unusual cause of dysphagia in a young adult
Authors: Hameed H , Mahmood MT , Yusuf MA
Published: January 2025

We report a case of a young woman who presented to our institution with recent-onset dysphagia. At oesophagogastroduodenoscopy an oesophageal ulcer was found. Biopsies revealed changes consistent with granulomatous inflammation. A diagnosis of oesophageal tuberculosis was made and, following anti-tuberculous medication, the ulcer and symptoms completely resolved.
Ipecacuanha: the South American vomiting root
Authors: Lee MR
Published: January 2025

The story of ipecacuanha, derived from the plant Cephaelis, is a fascinating one. It was discovered in Brazil in the 1600s and then transported to Paris in the latter part of the same century. It was used there by the physician Helvetius on various members of the French royal court to treat the flux (dysentery) with some success. Later, in the eighteenth century, it was taken up by the physician and privateer Thomas Dover and became, with opium, a fundamental constituent of his celebrated powder, which was used widely to treat fevers and agues for the next 200 years. Progress was then delayed until the early 1800s when the School of Chemistry at Paris established that the dried root of ipecac contained two powerful alkaloids, emetine and cephaeline, that consistently caused vomiting and diarrhoea. The discovery of the pathogenic amoeba, Entamoeba histolytica, in the latter part of the nineteenth century, allowed a distinction to be made between the two main forms of dysentery (amoebic and bacillary). Emetine was shown to be active against the amoebic form of dysentery but ineffective against that caused by bacteria. Ipecacuanha, its root and the pure alkaloid emetine have now been abandoned on the grounds of toxicity. They have been replaced by safer, more effective compounds. Nevertheless, they deserve an honoured place in the history of medicine, especially in the search for an effective treatment for amoebic dysentery.
Uptake and perceptions of an e-learning package
Authors: Narayanan RP , Kirk P , Lewis S
Published: January 2025

E-learning packages are increasingly promoted as an effective way of delivering training within the National Health Service in the UK. In response to a recommendation by the reporting body Serious Hazards of Transfusion (SHOT UK) we prospectively evaluated, over one year, the uptake among the 266 Foundation Year-1 (FYI) trainees in Wales of a blood transfusion package developed by the Scottish Blood Transfusion Service. The package consisted of two modules and was made available to FY1 trainees at hospital trust inductions. At the end of FY1 there was a 65% registration rate, with 54% of trainees completing at least one level and 42% completing both. Ninety-three trainees therefore failed to engage with the package. There was enormous disparity in uptake rates between NHS trusts, varying between 0% and 100%. Feedback to trusts in the form of benchmarking appeared to increase uptake. We conclude that this mode of delivery fails to engage a significant proportion of the intended audience and that there is extensive variation between organisations in their ability to deliver such training. Maximising the effectiveness of such packages will therefore require a more complex approach to delivery. Evidence suggests that blending e-learning with other methods could address these issues, and further evaluation of such an approach is recommended.
Changing roles for histology and cytology in the management of patients with lung carcinoma
Authors: Wallace WAH
Published: January 2025

The examination of histological and cytological specimens plays a pivotal role in the diagnosis and staging of lung cancer. This review aims to describe why the correct choice of specimen type may be important in optimising patient management. Tissue biopsies obtained for diagnosis provide specimens that are the most highly sensitive for the diagnosis of malignancy and cell typing. In addition, they provide sufficient material for further detailed studies, either at the time of diagnosis or subsequently during the patient’s management. Cytology specimens, in contrast, have generally lower sensitivities, are recognised to be prone to false positive errors and in many instances provide very limited material for detailed immunohistochemical studies. Cytology specimens will, however, have an increasingly important role in lung cancer staging with the development of minimally invasive endoscopic techniques for sampling mediastinal lymph nodes. Lymph node aspiration, either via the oesophagus or the bronchus, provides a highly sensitive method for the detection of metastatic carcinoma. Furthermore, this allows access to nodal groups not assessable by mediastinoscopy. In future, tissue biopsy for histological assessment should be seen as the ‘gold standard’ for primary diagnosis in lung cancer patients.
Pyothorax-associated lymphoma– the first reported case in the UK
Authors: Adeniji K , Amer K , Bell AJ , Millar JW
Published: January 2025

An 84-year-old man presented with dyspnoea and chest pain, together with a chest X-ray demonstrating a complete white-out of the left hemithorax. Four decades earlier he had been treated for tuberculosis with an artificial pneumothorax. A diagnosis of pyothorax-associated lymphoma (exclusively B-cell non-Hodgkin’s type) was made. Strongly associated with Epstein-Barr virus infection, pyothorax-associated lymphoma is known to develop in the chronic inflammatory environment of a pleural cavity in patients with a long-standing history of pyothorax. Although the condition is responsive to chemo-radiotherapy, overall prognosis is poor (five-year survival of 21.6%). Our patient has demonstrated a remarkable response to surgical decortication and resection with adjuvant rituximab – cyclophosphamide, doxorubicin, vincristine, prednisolone (R-CHOP) chemotherapy – and makes a case for routine debulking as part of the multimodality treatment of this unusual malignant complication of tuberculosis therapy.
Metformin in diabetic pregnancy
Authors: Swaminathan K , Howlett HCS , Campbell IW
Published: January 2025

An ever-increasing number of women with Type 2 diabetes mellitus (DM) are going through pregnancy and, with the current epidemic of obesity, more women are being diagnosed with gestational diabetes mellitus (GDM). Insulin has traditionally been the gold standard in diabetic pregnancy because of its efficacy and the fact that it does not cross the placenta. However, recent data from welldesigned trials and meta-analysis on the use of oral agents in gestational diabetes may mark a significant shift in clinical practice. Evidence for metformin use in GDM has been enhanced by the MiG trial, but a randomised controlled trial in women with Type 2 DM in pregnancy is required. No long-term follow-up data for offspring of mothers receiving metformin have been published, apart from reassuring findings in one study with an 18-month follow-up period. The aim of this article is to review the safety, efficacy and future of metformin in diabetic pregnancy
Absinthe, epileptic seizures and Valentin Magnan
Authors: Eadie MJ
Published: January 2025

Absinthe is an alcoholic liquor containing extracts from the wormwood plant. It was widely consumed in France in the late nineteenth century. Its production was banned in 1915, partly because it was thought to cause neurological disturbances, including mental changes and epileptic seizures. Modern knowledge of an acceptable content of the convulsant a-thujone in absinthe has allowed the lifting of the production bans, and called into question the experimental work of Valentin Magnan in the 1870s, which formed the scientific background to the campaign against absinthe. An examination of Magnan’s published investigations suggests that his science was very adequate by the standards of his time, and that he had shown that an alcohol-soluble component of wormwood did produce lapses of consciousness, myoclonic jerks and tonic-clonic convulsions in animals. Whether that component, presumably thujone, was present at convulsant concentrations in some of the available absinthes of Magnan’s time cannot now be known.
Vex not his ghost: King Lear and end-of-life care
Authors: Jeffrey E , Jeffrey D
Published: January 2025

King Lear is not limited to a single ethical dilemma but is a play about the suffering of mankind. This paper investigates how elements of Shakespeare’s play might enrich our understanding of the challenges and opportunities of modern end-of-life care. The paper addresses the following key questions:

How can King Lear inform our understanding of suffering and pain in a clinical context?

What can King Lear teach the professional in terms of communication with a terminally ill patient and their family?

How does Shakespeare illuminate sensitive areas of the discourse on suicide in the elderly?
Barrett’s oesophagus: an overview
Authors: Watson RGP
Published: January 2025

Barrett’s oesophagus is common and there is evidence that it is becoming more common. This is significant because of the malignant potential of the condition. The professional gastroenterology societies of the UK and USA now recommend 2–3 yearly endoscopic surveillance with systematic biopsies for those diagnosed with Barrett’s oesophagus. However, surveillance is controversial because the number of patients identified with early cancer is relatively small for the large amount of work that is required. In the future it is hoped that new imaging techniques should help target biopsies more effectively and new therapeutic endoscopic techniques should enable some patients to avoid mutilating surgery and offer therapy to patients who had previously been considered unfit for surgery. At present, chemoprevention and population screening for Barrett’s oesophagus offer the best chance of reducing the current considerable national mortality from oesophageal cancer.
Recent advances in the systemic therapy of cancer
Authors: Harrington J , Evans TRJ
Published: January 2025

The current generation of anti-cancer agents, often referred to as molecularly targeted therapies, are based on exploiting our increasing understanding of the molecular and cellular basis of cancer development and progression. This review focuses on these therapies, particularly as many of the drugs concerned have received considerable attention in the popular media.
Neurology symposium report
Authors: Murray K
Published: January 2025

This symposium covered a range of common neurological conditions of interest both to the general physician and neurologist. Neurological problems presenting to acute physicians were highlighted: stroke risk and prevention following transient ischaemic attacks; an update on stroke thrombolysis; when to refer stroke patients to regional neuroscience centres; and epilepsy and its neurological and cardiac mimics. At the other end of the spectrum, the management of chronic neurological disease, including Parkinson’s disease, and end-of-life neurology care were reviewed. Updates on developing patient-centred services for people with neurological impairments were presented. Finally there was a practical guide to driving regulations in a variety of clinical scenarios.
What is cancer anorexia-cachexia syndrome? A historical perspective
Authors: Bennani-Baiti N , Walsh D
Published: January 2025

Cancer anorexia-cachexia syndrome (CACS) is a lethal but poorly defined involuntary wasting disorder. Loss of skeletal muscle and fat distinguishes it from starvation. Cachexia has been described as a clinical syndrome since ancient times, and the poor prognosis has long been acknowledged. In this article we have reviewed historical perspectives on cancer cachexia, and commented on modern definitions. In cancer cachexia, most historical descriptions included anorexia, wasting and a pale complexion. Other associated symptoms, such as fatigue, early satiety and taste changes, were inconsistently described. Newer descriptions have not significantly expanded the clinical picture. Today, there is still no consensus definition, hindering research on early diagnosis and effective therapy. The language descriptors used to characterise the syndrome are important. For example, the word ‘cachexia’ itself may mislead; perhaps cancerrelated wasting syndrome is more accurate. Cancer anorexia-cachexia syndrome is a disorder associated with high morbidity and mortality, and deserves greater attention in both clinical and translational research.
Synchronous gastric polyp and colonic cancer
Authors: Cooper H , Dhar A
Published: January 2025

Systematic studies of synchronous gastric and colonic cancer are rarely described in the literature, and most reports are single case studies. Synchronous cancer may be detected either following the initial presentation with new symptoms or as part of routine surveillance. Treatment options depend on the final diagnosis and staging of the individual lesions. We describe an unusual case of a 78-year-old patient who was diagnosed with a mixed hyperplastic-adenomatous gastric polyp (a premalignant condition) and was subsequently found to have a colonic adenocarcinoma. The simultaneous presentation of an adenomatous polyp in the upper digestive tract and a frank cancer in the lower digestive tract is uncommon. A review of the literature questions the merits of routine surveillance in patients under the age of 50.
Hubert Airy, contemporary men of science and the migraine aura
Authors: Eadie MJ
Published: January 2025

Although there had been occasional references to the visual aura of migraine even in ancient medicine, little attention was given to the phenomenon until the first half of the nineteenth century when French authors began to describe it. In the medicine of English-speaking countries, apart from a few descriptions, it went largely unnoticed until the British Astronomer Royal, Sir George Airy, described his own experience of the visual aura in 1865. Five years later his son, Hubert Airy, also described his experience of it and that of a number of eminent contemporary men of science. The topic of the migraine aura was almost immediately taken up by two of the younger Airy's contemporaries and fellow Cambridge medical graduates, Peter Wallrock Latham and Edward Liveing, in their monographs. Subsequently, migraine with aura quickly became a well-recognised clinical entity in British medicine.
Alcohol-related illness in the hospital
Authors: Hislop WS
Published: January 2025

Alcohol-related illness is a major problem in Scotland. Currently, its treatment in hospital is under-resourced, and patients are scattered around different departments. This review examines how Scotland’s health service can be adapted and redesigned to improve care for patients with alcohol-related illnesses and minimise the disruption they cause in hospitals.
ALLOPURINOL AND STEVENS-JOHNSON RISK
Authors: Perry Martin E
Published: January 2025

Dr Foong helpfully highlights the well-established rare link between allopurinol and Stevens-Johnson syndrome, by reviewing the results of the EuroSCAR study (HBB Foong. Allopurinol and the risk of Stevens-Johnson syndrome and toxic epidermal necrolysis. J R Coll Physicians Edinb 2009; 39:144–5). At rates of two per million population, it remains an extremely unusual phenomenon. His conclusions that ‘more often than not the drug is prescribed for asymptomatic hyperuricaemia’ are erroneous and lack evidence. The retrospective report of eight patients from 23 years ago and literature review which he quotes clearly do not provide a clear enough sample size to form a judgement.

Hypersensitivity of a more benign nature is frequently mentioned as a reason for discontinuing allopurinol. However, it is estimated that 95% of patients are able to tolerate allopurinol.1 Side effects can include rash, diarrhoea, leukopenia, pruritis and fever. If the manifestations are only cutaneous, then desensitisation can be attempted commencing at doses as low as 50 μg and increasing to 100 mg over a four-week period. More than 70% of such patients are able to continue to take allopurinol, although sometimes late adjustment of the dose may be required. Education for practitioners regarding desensitisation regimens should allow more patients to tolerate the drug. Gout is undertreated at present, and patients should be on doses of allopurinol that allow a serum urate of <0.36 mmol/l.2,3 Dose titration can escalate to 900 mg if required. Undertreatment leads to flare and tophaceous disease, with radiographic damage and disability.4

Adverse reactions with allopurinol are unfortunate but extremely rare and should not be used as a reason for lowering the appropriate dosage of allopurinol as agreed in both national and international guidelines.2,3
Author’s reply
Authors: Foong HBB
Published: January 2025

I thank Dr Perry for his interest in my article. I agree with him that if the manifestations of the side effects of allopurinol are mild, then desensitisation can be attempted at a lower dose. However, isolated asymptomatic hyperuricaemia does not warrant the use of allopurinol. One must distinguish the difference between gout and hyperuricaemia. Dr Perry’s references on the rheumatology guidelines for the management of gout apply to cases of gout and not to hyperuricaemia.1 In fact, the indications for allopurinol therapy are tophaceous gout, major uric acid overproduction (proven by urinary excretion >53 mmol/24 hours) frequent gouty attacks, recurrent uric acid renal calculi and prevention of acute urate nephropathy in patient receiving cytotoxic therapy for malignancies.2

In a study by Khoo3 a total of 13 patients were admitted for severe cutaneous adverse reactions to allopurinol during a three-year period. Almost 92% of them suffered from allopurinol hypersensitivity reactions, which included four patients with Stevens-Johnson syndrome. Allopurinol hypersensitivity syndrome, in contrast to other purely cutaneous drug eruptions, deserves special attention because of its multi-organ involvement, the liver and kidneys being most commonly affected. It was interesting to note that none of the 13 patients had clear clinical indications for allopurinol therapy. Asymptomatic hyperuricaemia is not uncommon, affecting an estimate of 5–8% of the population. As the risks, morbidity and mortality outweigh the benefits, it should only be prescribed when it is truly indicated.
Improving the care of patients with advanced heart failure
Authors: Ward C
Published: January 2025

A strategy for managing heart failure based exclusively on conventional treatment results in the majority of patients having inadequate symptom control, a poor quality of life and uncoordinated care. The Scottish Partnership for Palliative Care report Living and dying with advanced heart failure: a palliative care approach advocates that these problems should be addressed by the integration of conventional and supportive care; at present this rarely happens. The report's main recommendations are summarised and their relevance to the natural history of heart failure discussed for the benefit of the general and care of the elderly physicians who are responsible for the in-hospital management of more than 80% of heart failure patients. The recommendations are equally relevant to primary care teams. The problems to be addressed when devising a strategy to implement the recommendations are outlined.
Infectious diseases today – more questions than answers?
Authors: Tonna I
Published: January 2025

Antimicrobials have transformed the management of infections. The emergence of resistance, however, has become a major problem both in primary and secondary care. There is a need for new ways to deal with resistant infections, and the use of newer antimicrobials is only a small part of the solution. Suffice to say that methicillin-resistant Staphylococcus aureus (hospital or community acquired), virulent strains of Clostridium difficile-associated diarrhoea, multidrug resistant tuberculosis and invasive streptococcal infections have continued to increase in recent times, and are associated with significant morbidity and mortality. This symposium dealt with some of these issues and suggested ways to investigate and manage them.
JOHN FOTHERGILL MISIDENTIFIED
Authors: Booth Sir Christopher
Published: January 2025

I read with interest the article by MJ Eadie on men of science and the migraine aura (Hubert Airy, contemporary men of science and the migraine aura. J R Coll Physicians Edinb 2009; 39:263-7). Unfortunately there is a serious misidentification of the Dr John Fothergill whose paper on the subject is referred to in reference l0. There was no such individual as Dr John Fothergill of Manchester in l784. The individual who wrote about the migraine aura was Dr John Fothergill, the famous Quaker physician of London. An Edinburgh graduate of l736, he was the first graduate of the Edinburgh Medical School to be licensed by the Royal College of Physicians of London, wrote a classic book on the malignant sore throat and was the first to recognise the relationship between angina pectoris and disease of the coronary arteries. He was a close friend and physician to Benjamin Franklin. His paper on the sick headache was read to a Society of Physicians in London, of which he was then President, on l4 December l778. After Fothergill’s death in l780, his pupil John Coakley Lettsom wished to publish this paper among his works but was refused permission by his executors. He therefore had to wait until it was published in the sixth volume of the Medical Inquiries and Observations in l784, four years after Fothergill’s death. Fothergill was one of the most distinguished graduates of the early Edinburgh Medical School. He was also a Fellow of the Royal Society and a member of the American Philosophical Society as well as being a strong supporter of the American colonists in their struggle for independence.
INSULIN PEN DEVICES
Authors: Reith Sheila
Published: January 2025

In their recent article (Insulin delivery devices. J R Coll Physicians Edinb 2009; 39:l46-50) Dr Graveling and Dr McIntyre state that insulin pen devices were developed by Dr John Ireland in l98l.

The first pen device was actually designed jointly by John Paton of the Department of Clinical Physics and Bioengineering (DCP&B) in Glasgow, the late Dr John Ireland and myself.1

After the initial trials with the prototype pen, further devices were made by the DCP&B, and then Hypoguard was licensed to produce the first commercial insulin pen with the royalties being paid to the Greater Glasgow Health Board (GGHB), which held the patent on our behalf.

Following this agreement, Michael Forsyth and other MPs tabled an Early Day Motion in the Commons congratulating John Paton, John Ireland and myself on our invention and on this example of co-operation between the NHS and private industry.2 Later, the patent was sold to Novo by GGHB. None of the three inventors received any financial reward.

This letter is not in any way intended to minimise the contribution made by Dr John Ireland to this device, which is widely used today, but simply to set the record straight. I hope that this information will be of interest to readers of The Journal.
PAIN PALLIATION FOR BONE METASTASES
Authors: Syed GMS
Published: January 2025

This refers to the symposium report ‘Palliative care in your hospital’ (Buchanan D.J R Coll Physicians Edin 2009; 39:252-6). In his discussion of new interventions Dr Edwards makes no reference to an important strategy for pain palliation due to skeletal metastases. I am referring to systemic radiotracer therapy. It may not be considered a ‘new’ way as the first therapy was performed in l941.1 There has been significant progress in systemic radiotracer therapy since then with the focus on developing specific and less toxic compounds. While phosphorus-32 has been in use for many decades and revisited,2 newer compounds such as Sr89,3 Sm153 EDTMP,4 Rel86 HEDP and Sn117m pentetate5 have been successfully employed for pain palliation.

Targeted radiotracer therapies can ameliorate pain in 40-80% patients. Therapy is done on an outpatient basis. Onset of relief may take five days. The patient can be pain-free for about three months. Repeat therapies are indicated in patients who benefit from the first dose. Improved performance and quality of life has been reported in several studies. Patients with osteoblastic lesions show good response. Bone marrow suppression is a known toxicity but is usually mild and reversible in the majority. The cost of newer compounds limits frequent use. However, it is worthwhile when one takes into consideration the cost of alternate intervention and the potential benefit to the patient.