bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of Baclofen on the Gait of Hemiplegic Children Assessed by Means of Polarised Light Goniometry
Authors: Minford Adrian M. B. , Brown J. Keith , Minns Robert A. , Frazer P. , Hollway L. , Gibb N. , Campbell L. , Neijerink I.
Published: January 2017

Gait was assessed by polarised light goniometry in 15 hemiplegic children aged 4−15 years. After initial clinical and goniometric assessment, baclofen 5−10 mg/day was started and increased over 4−6 weeks to a dose of 1−1.5 mg/kg/day. Assessment was repeated one week later. A statistically significant decrease in hip and knee flexion at the ‘toe-off’ phase of the gait cycle was found in both legs. Of the nine children who showed most change in goniometric assessment, five showed an obvious clinical improvement, two a slight improvement, one no change and one child's gait deteriorated. Of six children with minimal or no change goniometrically, four showed no change clinically, one minimal clinical improvement and one a deterioration clinically. Side effects included transient sedation (seven children), concentration difficulty (one child), behaviour disturbance (1 child) and nocturnal enuresis (three children). We concluded that although baclofen causes functional improvement in some hemiplegic children, its use should be carefully supervised in view of possible side effects and possible deterioration in gait.
Self Injury in Subnormal Patients
Authors: Primrose D. A.
Published: January 2017

A twenty-one month trial of the use of baclofen (Lioresal) in mental defective patients who exhibit self-injurious or other undesirable behaviour is reported. The first observed effect was in the mood of the patients who mostly became calmer and happier: subsequently many showed a diminution in their undesirable behaviour but hyperkinesis was not helped. A few patients maintained the improvement after stopping the drug, but in most it has had to be continued, sometimes with an increase in dosage. Side-effects are discussed.
Bromocriptine in the Treatment of Parkinson's Disease
Authors: Godwin-Austen Richard B.
Published: January 2017

Bromocriptine has been compared with levodopa in a double blind trial of the management of Parkinson's disease. Both drugs were found to be equally effective when given in optimal dosage and side effects were similar, although the incidence of persistent confusional states was slightly greater with bromocriptine and after its withdrawal than with levodopa. It is in the long term management of severe cases of Parkinson's disease in whom late side effects have occurred with levodopa that there appears to be a definite advantage in combining bromocriptine with levodopa. In particular, the incidence of ‘on-off’ attacks is reduced.
Treatment of Cyclical Breast Pain with Bromocriptine
Authors: Mansel R. E. , Preece P. E. , Hughes L. E.
Published: January 2017

Bromocriptine 2.5 mg. twice daily was given to 38 patients with cyclical breast pain and 15 with a non-cyclical pattern in a double blind trial lasting 6 cycles. Response to treatment was assessed by both clinician and patients independently and serum prolactin levels were monitored. Cyclical breast pain was significantly improved by bromocriptine but non-cyclical pain failed to respond. Although most patients were normoprolactinaemic before the trial, bromocriptine therapy produced a significant depression of the mean serum prolactin level.
Bromocriptine in the Treatment of Acromegaly
Authors: Martyn Christopher N. , Bevan John S.
Published: January 2017

The effects of bromocriptine were studied in 29 patients with acromegaly. The majority showed significant suppression of growth hormone secretion, often with symptomatic benefit.

The drug is a useful adjunct to primary methods of treatment, especially pituitary irradiation, but regular assessment of whether it is continuing to have a suppressive effect should be undertaken.
Validity of Tests of Fibrinolysis
Authors: Hedner Ulla
Published: January 2017

In this paper the conventional tests of fibrinolysis are compared and contrasted. Tests of fibrinolytic potential by venous occlusion and injection of DDAVP are then described and the results of these tests shown in a population of patients at risk from venous thrombosis.
Anabolic Steroid Therapy in Arterial Disease a Review
Authors: Walker Isobel D.
Published: January 2017

Anabolic steroid therapy enhances fibrinolytic activity and it has been suggested that, since degenerative and thrombotic arterial diseases may be associated with impaired plasma fibrinolysis, anabolic steroids may be of potential therapeutic value in these disorders.

The evidence for the use of anabolic steroids in peripheral and in coronary arterial disorders is reviewed.
Clinical Features of Hypertension in Frequent and Heavy Alcohol Drinkers
Authors: Ramsay L. E.
Published: January 2017

An association between regular alcohol use and hypertension is firmly established. The clinical features of hypertensive patients who used alcohol frequently or heavily were compared with those of age and sex matched hypertensive patients who used alcohol only occasionally or never. Regular alcohol use was associated with milder hypertension, lower blood urea concentrations and fewer electrocardiographic abnormalities. However, there was no evidence that major vascular complications, including myocardial infarction, were less common in regular drinkers, perhaps because of their associated heavy cigarette smoking. Regular alcohol users were as likely to give a positive family history of hypertension, but were less likely to have an abnormal intravenous pyelogram. Heavy drinkers were twice as likely to default within one year.
What is the Significance of Raised Plasma TSH Levels after Thyroid Surgery?
Authors: Toft A. D. , Kellett H. A. , Sawers J. S. A. , Sinclair I. S. R. , Beckett G. J. , Brown N. S. , Seth J.
Published: January 2017

Thyroid function was assessed prospectively for five years in 73 patients treated surgically for Graves' disease. No patient developed hypothyroidism after the sixth postoperative month, despite the presence of raised plasma TSH levels in 70 per cent of euthyroid patients at the end of the first year. Indeed, in those with evidence of temporary hypothyroidism (low T4, raised TSH at 3 months but normalisation of T4 at 6 months) plasma TSH continued to fall for up to three years. The majority (6) of patients developing recurrent hyperthyroidism did so within the first year, but in one of three patients who relapsed subsequently, plasma TSH had been elevated at one year.

Plasma TSH cannot be used to predict thyroid status following surgery for Graves' disease. Although regular review remains necessary, it should not include measurement of TSH unless this is needed to confirm the validity of a low thyroxine level after the third postoperative month and before starting permanent replacement therapy.
Fungal Lung Infections Treated by 5 Flucytosine
Authors: Symonds R. P. , Robertson A. G. , Stewart L. M. , Boyd G.
Published: January 2017

5 Flucytosine was used successfully to treat two patients with pulmonary candidiasis and, in combination with Amphotericin B, one patient with invasive pulmonary aspergillosis.
Therapeutic Arthroscopy of the Knee
Authors: Mackinlay J. Y. , Stother I. G.
Published: January 2017

Sixty-six patients were reviewed after 70 therapeutic arthroscopy procedures. The procedures carried out included partial meniscectomy, removal of loose bodies, lateral release and synovial plica division. The commonest procedure performed was partial meniscectomy. The 32 patients undergoing arthroscopic meniscectomy were compared with a similar group of patients undergoing open meniscectomy as regards their duration of hospital stay, operation time and rehabilitation.
Repeat Prescribing in the Elderly. A Case for Audit?
Authors: Nicol Fiona , Gebbie H.
Published: January 2017

An audit of repeat drug prescriptions in 531 elderly patients in an urban practice was undertaken. Two thirds of the patients (64%) were receiving repeat prescriptions at time of review and had been doing so for up to 20 years (mean 5.3 years). Individual practitioners' rates of starting repeat prescriptions and monitoring them were reviewed. The data revealed that drug prescription in this highly susceptible group was not being adequately monitored and stimulated the introduction of repeat prescription cards.
Glycosylated Haemoglobin and Serum Insulin Antibodies in Type I Diabetes
Authors: Gray R. S. , Borsey D. Q. , Duncan L. J. P. , Clarke B. F. , Smith B. F. , Kurtz A. B. , Rainbow Sandra , Elton R. A.
Published: January 2017

Type 1 diabetics receiving once (Group 1, n = 72) and twice (Group 2, n = 48) daily subcutaneous injections of conventional beef insulin were compared, on a cross-sectional basis, in respect of insulin antibody binding by serum and total glycosylated haemoglobin (HbA1). Patients in Group 1 had higher insulin antibody binding (25.2 ± 15.8% vs 17.0 ± 13.9%; p < 0.01) and higher HbA1 levels (12.5 ± 2.0% vs 11.0 ± 1.8%; p < 0.001) than patients in Group 2.

An inverse correlation ( τ = –0.28, p < 0.01) was observed between HbA1 and insulin antibody binding in C-peptide non-secretors of Group 1 but not in Group 1 C-peptide secretors, nor in C-peptide secretors and/or non-secretors of Group 2. It is suggested that in Type 1 diabetics who receive a single daily insulin injection and who have no endogenous insulin secretion, insulin antibodies may aid glycaemic control by prolonging insulin action.
The Medical Career of Dr David Livingstone
Authors: Morris D. E.
Published: January 2017

Some details are given of Livingstone's background and medical training, and some of his correspondence from Africa on medical matters is quoted.
Ketoconazole and Fungal Sinusitis
Authors: Farquhar D. L. , Munro J. F. , Milne L. J. R. , Piris J.
Published: January 2017

A case of a young man with chronic sinusitis. After many years and multiple surgical procedures, fungal hyphae were noted. The patient made a complete recovery with oral ketoconazole.
Reversible Internal Hydrocephalus Complicating Diabetic Keto-Acidosis
Authors: Hayes P. C. , Newton R. W.
Published: January 2017

An uncommon reversible cause of coma, occurring during the treatment of diabetic keto-acidosis, due to internal hydrocephalus is reported.
Consent, Dissent, Cement
Authors: Calman K. C. , McLean S. A. M.
Published: January 2017

The patient-doctor relationship has two fundamental components. The first is the application of the skill and knowledge of the doctor in the care of the whole patient and family. The second is the right of the individual to have information about his or her illness or treatment, and to be involved in decision making. This relationship is built on trust and comes sharply into focus in the area of consent to take part in clinical trials. The argument is put forward that the use of written information should be seen as an extension of the communication between the doctor and the patient, and not as a legally restrictive device. The concept of an agreement, both on the part of the doctor and of the patient, to take part in a clinical trial is developed.
Klebsiella Infection in a Neonatal Intensive Care Unit
Authors: Laing I. A. , Hume R. , Tonkin R. W. , Plenderleith I. , Forfar J. O.
Published: January 2017

Fourteen infants in a Neonatal Intensive Care Unit became colonized with Klebsiella pneumoniae. Ten developed septicaemia. All infants survived the acute infection. Details are given of clinical observations and the control measures that were taken.
The 188th Harveian Oration
Authors: Mitchell R. G.
Published: January 2017

In William Harvey's day, Celtic civilization in Western Scotland was still flourishing and medical practice was ahead of that in other parts of Europe. Reasons are advanced for believing that Harvey knew more about this Celtic world than his biographers indicate. The opportunities he had for acquiring such knowledge are described.
The Results of Coronary Arteriography in Young Men after Myocardial Infarction in North-East Scotland
Authors: Irvine N. , Ward P. R. , Kenmure A. C. F.
Published: January 2017

The case records of 50 consecutive male patients aged 40 years or under who were investigated by selective coronary arteriography after myocardial infarction were reviewed. Fourteen patients had normal coronary vessels and 36 patients had significant occlusive disease. Eighteen were considered to be in need of surgical treatment. The features of myocardial infarction on the ECG were less marked in the group of patients with normal coronary arteriograms. Many of these patients were asymptomatic and had complete resolution of the ECG changes. As well as having normal coronary arteries, many also had normal left ventricular angiograms.

Cigarette smoking was very common in the whole group, 86 per cent of patients being moderately heavy cigarette smokers. Five of the 14 patients in the ‘non-occlusive’ group were non-smokers and only two of the 36 patients in the ‘occlusive’ group were non-smokers (P<0.01). The fasting serum cholesterol was significantly lower in the ‘non-occlusive’ group than in the ‘occlusive’ group. There was no significant difference between the two groups regarding blood pressure, family history of ischaemic heart disease, obesity or alcohol consumption. There was, however, a high incidence of heavy alcohol consumption amongst patients who subsequently required coronary artery surgery.

Many of the patients in the ‘non-occlusive’ group were considered to have had smaller, more localised myocardial infarctions and a lesser degree of coronary disease which may not be detected by coronary arteriography. Others, with more widespread cardiac damage, could be explained on the basis of thrombosis and subsequent recanalisation.
Thyroid Function in Patients with Rheumatic Heart Disease
Authors: Macleod M. D.
Published: January 2017

Thyroid function was assessed in 94 patients with rheumatic heart disease presenting consecutively to a cardiology clinic. Despite previous reports of an association with autoimmune thyroid disease, abnormal thyroid function occurred no more commonly in this group than would be anticipated in a normal population.
Genital Tract Metastases from Renal Cell Carcinoma—A Case Report and Discussion
Authors: Sharma N. D. , McKelvie G. B.
Published: January 2017

A case of renal cell carcinoma presenting with metastases in the female genital tract is reported. Clinical and histological features distinguishing primary and secondary clear cell adenocarcinoma of the genital tract are discussed. It is emphasised that when a clear cell adenocarcinoma is found, particularly in a post-menopausal woman, metastatic renal carcinoma has to be excluded.

Although so far there are 61 cases reported in the world literature from English speaking countries, we believe that this is the first case reported from the United Kingdom.
St Kilda: Childbirth and the Women of Main Street
Authors: Holohan Ann Maclean
Published: January 2017

In the nineteenth century in the island of St Kilda, faced with maternal mortality which reached 107.1 and excessive neonatal mortality, women went to Obe, now Leverburgh, in the island of Harris in the Outer Hebrides to be confined, often marooned therefor many months due to treacherous seas. Using family reconstruction techniques the reproductive history of some of these women is traced and these strategies assessed.
The Effect of Omeprazole on Insulin Induced Gastric Secretion in Man
Authors: Utley R. J. , Wright R. , Beastall G. H. , Carter D. C.
Published: January 2017

The effect of oral omeprazole on insulin induced gastric secretion was studied in 12 healthy subjects. Each subject participated in two secretory tests receiving an intravenous infusion of insulin (0.03 units/kg/h) and being randomly allocated to receive 30mg or 60mg omeprazole suspended in 100ml water containing 16 mmol NaHCO3 on the second study day. Peak plasma concentrations of omeprazole were achieved within 30 minutes of administration in all but one subject and plasma half life was 30 minutes. Mean peak stimulated acid output in the six subjects receiving 30mg omeprazole was reduced to 4.3 ± S.E. 1.8 mmol/h from a control value of 16.8 ± 2.2 mmol/h (p<0.05) and in six subjects receiving 60mg omeprazole, mean peak output fell to 3.4 ± 2.1 mmollh from a control value of 12.3 ±2.6 mmol/h (p<0.05). The two doses of omeprazole produced similar reduction in acid secretion (74% and 73% respectively) but neither dose affected pepsin secretion. Both doses of omeprazole were associated with a small statistically insignificant increase in the plasma gastrin response to insulin infusion.
Acute Chylous Ascites with Carcinoid of the Pancreas
Authors: Varma J. S.
Published: January 2017

Acute chylous ascites is of idiopathic origin in 50 per cent of cases, the remainder being accounted for by trauma and intestinal obstruction (1). It usually presents with acute abdominal pain. Neoplastic disease is much more common in chronic cases, and lymphomas comprise about half of these (2). Chronic chylous ascites usually presents without pain but with inanition and hypoproteinaemia. This report describes acute chylous ascites following trauma in a patient who was subsequently found to have a pancreatic carcinoid, the lymphangiographic findings being of particular interest.
Benign Chronic Bullous Disease of Childhood in an Indian Child
Authors: Lever Rosemary S. , Morley W. N. , Dick Heather M. , Fulton R. A.
Published: January 2017

An Indian atopic child presented with benign chronic bullous disease of childhood (BCBDC). HLA grouping did not show the typical finding of HLA B8 which questions the value of HLA typing in this condition.
Gastrointestinal Tuberculosis
Authors: Galloway D.J. , Scott R.N.
Published: January 2017

In the developed countries gastrointestinal tuberculosis is no longer common in clinical practice. In this setting the importance of the condition lies in the vagaries of its presentation and the fact that it is eminently treatable, usually by a combination of chemotherapy and surgery.

The clinical features and complications of gastrointestinal tuberculosis are highlighted by the seven cases which we report. Diagnosis and treatment of this condition is discussed and attention is drawn to the importance of case notification.

Clinicians should bear in mind the diagnosis of gastrointestinal tuberculosis when dealing with any patient with non-specific abdominal symptoms.
Survival from Extreme Lactic and Keto-Acidosis in Diabetes Mellitus
Authors: Wathen C. G. , Starkey I. R.
Published: January 2017

A case report of extreme acidosis associated with diabetic metabolic decompensation is described. Treatment with conventional therapy and sodium bicarbonate resulted in complete recovery.
The Last Public Execution in Glasgow: The Case of Dr Edward Pritchard, M.D., M.R.C.S., L.S.A.
Authors: Green S.T. , Green Fiona A.M.
Published: January 2017

Dr Edward Pritchard, a Glasgow medical practitioner, was the last person to be executed in public in Glasgow. In a famous trial of the time, he was condemned to death for murdering his wife and his mother-in-law, and he was hanged on Glasgow Green in 1865. An account of Dr Pritchard's life, his trial and his death is given here, together with a reference to the medical examination which was carried out on Pritchard's remains when his grave was exhumed in 1910.
Clinical Effectiveness of Occlusal Splint Therapy in Patients with Classical Migraine
Authors: Lamey P.J. , Barclay S. C.
Published: January 2017

A clinically similar entity to classical migraine is seen in certain dental patients suffering from temporomandibular joint (TMJ) pain dysfunction syndrome. Patients selected for study gave symptoms of classical migraine on waking. Facial pain on waking is typical of some cases of TMJ dysfunction syndrome and the hypothesis was tested that some patients with symptoms of classical migraine were at the extreme end of the spectrum of dysfunction syndrome. However, rather than experience muscle or temporomandibular joint pain these patients had symptoms on waking which were typical of classical migraine. Nineteen patients with migraine symptoms were provided with acrylic occlusal splints for nocturnal wear. A good clinical response with considerable reduction in frequency and severity of pain attacks was achieved.
Abnormal Biochemical and Cellular Parameters in the Blood of Patients with Raynauds Phenomenon
Authors: Belch J.J.F. , Drury J. , McLaughlin K. , O'Dowd A. , Anderson J. , Sturrock R.D. , Forbes C.D.
Published: January 2017

Finger blood flow is decreased in Raynauds Phenomenon (RP). This may be due not only to vasospasm, but also to blood abnormalities. 40 patients with Raynauds Disease (RD), 28 with suspected RP (SS) and 42 with secondary Raynauds syndrome (RS) were enrolled and compared to 50 controls. Results from base-line samples show that those with RP have abnormal haemostasis and rheology whereas those with mild Raynauds, RD do not. Blood sampled after cold challenge in 15 RS patients and 15 controls show that both groups exhibit platelet activation after emersion. The degree of activation however was much more marked in the RS patients. We have shown that abnormalities of haemostasis and rheology are found in patients likely to have endothelial damage (RS). These changes are probably a consequence rather than a cause of the disease. After cold challenge the results become more abnormal and correlate with severity of disease.
Polyarteritis Presenting with Thrombocytosis and Central Retinal Vein Thrombosis
Authors: Leung A.C.T. , McLay A. , Boulton-Jones J.M.
Published: January 2017

We report a case of polyarteritis in a 54 year old woman who presented with marked thrombocytosis and acute blindness in one eye secondary to central retinal vein thrombosis. She also developed bilateral pulmonary infiltrates and renal failure. The diagnosis was confirmed by histological changes in the renal biopsy. Treatment with immunosuppresives, plasma exchange and antiplatelet drugs led to rapid clinical improvement and recovery of renal function and prevented further thromboembolic episodes. Plasma exchange and antiplatelet drugs should be considered in polyarteritis group of systemic vasculitis especially in the presence of thromboembolic complications or thrombocytosis.
The Clinical Importance of Subnormal Folate Levels in Epileptic Patients on Anticonvulsant Therapy
Authors: Nimmo G.R. , Ryan M.J. , Chalmers N. , Patrick A.W.
Published: January 2017

A neurological history was obtained and examination performed on 62 outpatient epileptics on anticonvulsant therapy. Blood counts, folate and B12 assays were performed on all patients and on a control group of 59 adult non-epileptic neurological outpatients. None of the anticonvulsant treated group had clinical peripheral neuropathy; there was one patient with microcytic anaemia and one with normochromic, normocytic anaemia. In 5 of this group the mean corpuscular volume (MCV) was slightly raised but there was no significant overall difference from the control group. In 17 patients serum folate was subnormal and in 7 the red cell folate was subnormal and this was significantly different to the control group (P <0.001). Vitamin B12 levels were normal in all subjects. It is concluded that despite subnormal measured folate levels, there is no increased incidence of clinical peripheral neuropathy or of significant macrocytosis. In view of this, we recommend that folate replacement should not be given to non anaemic asymptomatic patients, with subnormal folate levels, on anticonvulsant therapy.
Alcoholic Ketoacidosis: A Case Report
Authors: McMahon A. J. , Green S. T. , Sandler M. , Hillis W. S.
Published: January 2017

A 43-year-old alcoholic presented in coma with ketoacidosis, after three days of nausea and feeling generally unwell, which had been preceded by a prolonged three-week period of heavy alcohol consumption with poor dietary intake. The acidosis responded rapidly to intravenous dextrose. This is the first Scottish report of a case of alcoholic ketoacidosis.
Bicentenary of Sir John Forbes (1787–1861)
Authors: Sakula A.
Published: January 2017

This year is the bicentenary of the birth of the distinguished Scottish physician, Sir John Forbes, famous for his translation of the great French medical classic, De L'Auscultation Médiate by R.T.H. Laennec, the inventor of the stethoscope.
Carbohydrate Oxidation: Do We Eat Ourselves or Our Food?
Authors: Melville S. , McNurlan M.A. , McGaw B. A. , McHardy K.C. , Fearns L.M. , Garlick P.J.
Published: January 2017

In post-absorptive man, energy is derived solely from oxidation of body stores, mainly by oxidation of fat rather than glycogen.1 Eating changes this pattern so that carbohydrate (CHO) oxidation predominates.1 If during feeding energy intake exceeds energy expenditure, the energy needs of the whole body can in theory be met entirely from the diet. However, it is not clear whether the CHO utilised in the fed state does come directly from the absorbed diet, or whether some continues to be removed from body stores.
The Lister Steam Spray in Aberdeen
Authors: Pennington T.H.
Published: January 2017

A Lister ‘steam spray producer’ in the possession of Aberdeen University is described. The introduction of antiseptic surgery to Aberdeen by Alexander Ogston and the subsequent adoption of the spray and its enthusiastic use by him is recounted, with emphasis on the final years of its employment as part of the antiseptic ritual.
Twenty-Five Years of Respiratory Intensive Care
Authors: Martin L. V. H. , Brown D. T.
Published: January 2017

During the years 1961 to 1986 the four-bedded Artificial Ventilation Unit of the Royal Infirmary of Edinburgh has treated 3046 patients with respiratory problems of all types. There has been a steady increase in the number of patients admitted each year to the present level of 180–190, a fall in mean length of stay from 15 to six days and the mortality rate has been reduced to 13%. The type of case admitted has shown considerable variation over the years with the most significant change being a large increase in the patients admitted post-operatively. The size of the unit has placed severe restrictions on the work that can be undertaken.
Management of Diabetes Resistant to Subcutaneous Insulin with Intravenous Insulin via an Implanted Infusion Pump
Authors: Paterson K.R. , Campbell I.W. , MacRury S.M. , Gilmour D.G. , MacCuish A.C.
Published: January 2017

Diabetes resistant to conventional subcutaneous insulin injection is a rare complication of insulin-dependent diabetes which poses a major management problem. We report three cases treated for a total of over seven patient years with fully implanted insulin infusion devices. Technical difficulties with the devices and their operation have been substantial but the patients are much improved and hospitalisation has been dramatically reduced. We suggest that implanted insulin pumps are a real treatment option for patients with this unusual syndrome.
Non-Hodgkin's Lymphoma of the Lung
Authors: Farquhar D.L. , Crompton G.K. , McIntyre M.A. , Leonard R.C.F.
Published: January 2017

Non-Hodgkin's lymphoma (NHL) commonly presents with extensive disease involving extranodal tissues. Involvement of the mediastinal and hilar lymph nodes, pleura and lung parenchyma are recognised complications although their incidence is uncertain. However pulmonary involvement is undoubtedly much less common than involvement at other extra nodal sites. Histologically proven NHL limited to the lung parenchyma, after full staging including computerised tomography and marrow trephines, is extremely rare. We report on two such cases and review the literature.
Acute Renal Failure Due to Interstitial Nephritis Induced by ‘Glue-Sniffing’ with Subsequent Recovery
Authors: Taverner D. , Harrison D.J. , Bell G.M.
Published: January 2017

We report a case of the deliberate inhalation of a toluene-containing adhesive which caused acute renal failure and hepatic damage. Renal biopsy disclosed a severe tubulo-interstitial nephritis, renal function recovered after 14 days' haemodialysis. The literature on renal complications of toluene exposure is reviewed, this is the only case of acute renal failure due to interstitial nephritis after toluene exposure with subsequent recovery. Recovery in this case may have been related to the avoidance of further toluene exposure.
Angiotensin Converting Enzyme Inhibitors May Cause Renal Impairment in Diabetes Mellitus
Authors: Webster J. , Murchison L.E. , Robb O.J.
Published: January 2017

Angiotensin converting enzyme (ACE) inhibitors have been recommended for the treatment of diabetic nephropathy. However, it should be remembered that diabetic patients may also develop atheromatous renal artery stenosis. In such patients ACE inhibitors may have adverse effects on renal function. Careful investigation and monitoring is essential when ACE inhibitors are used in diabetes.
Mrs Isabella Elder, LL.D., Pioneer and Philanthropist
Authors: McAlpine C.J.
Published: January 2017

Mrs Isabella Elder contributed much during her lifetime to further the education of women of all ages and of all levels of attainment. She gifted North Park House to Queen Margaret College in Glasgow as a home in 1884. With her encouragement a medical school for women in Glasgow was opened in Queen Margaret College in 1890. The standard was high and when women were admitted to the Universities in 1892, the first Queen Margaret medical students were able to graduate in 1894. She pioneered a system of teaching home economics in Govan, assisted the development of a district nursing service and built the Elder Cottage Hospital.
The Influence of Cardiac Staffing Resources on Permanent Cardiac Pacemaker Implantation Rates
Authors: Jacyna M. R. , Main G. , Hanslip J. , Pringle T. H. , McNeill G. P.
Published: January 2017

In Tayside region, from 1976 to 1986, the number of permanent pacemakers implanted per year more than doubled, with the increase particularly marked over the latter five years. In order to determine the factor(s) which had caused this increase in implantation rates, a retrospective analysis of patients undergoing pacemaker implantation during the period 1981–1986 was undertaken. No change in the number of elderly in the population, age of patients, mode of referral, waiting time before insertion or clinical indications for pacing was observed to account for this change. The advent of ambulatory ECG monitoring may have contributed to this increase, but the appointment of an extra cardiologist in Tayside in 1982 was believed to have been more important. These results suggest that the number of pacemakers implanted in a region is highly dependent on the number of cardiological staff in that region available for their insertion.
Phenytoin Monitoring: Clinical or Scientific?
Authors: Fulton J. D. , McGovern E. M. , McCarron B. N. , Carlile A. K.
Published: January 2017

Phenytoin is an established therapy for post-herpetic neuralgia. In order to maintain serum phenytoin levels in the normal therapeutic range, serum phenytoin monitoring is required. This range may, however, be misleading in certain clinical conditions. We report here a patient with hypoalbuminaemia who developed marked clinical phenytoin toxicity despite maintenance of the serum total phenytoin concentration within the therapeutic range.
A Case of Eosinophilic Pleural Effusion Complicating Multiple Myeloma
Authors: Lipworth B.J. , Dhillon D.P.
Published: January 2017

Pleural effusion is a rare complication of multiple myeloma. We report the first case of eosinophilic effusion due to light chain type disease and review the recent literature.
Survival after Massive Overdose of Slow-Release Potassium
Authors: Colledge N. R. , Northridge B. , Fraser D. M.
Published: January 2017

Self-poisoning with potassium salts is uncommon but the consequences are often fatal. Previous reports1,2 describe deaths after ingestion of between 40 and 50 tablets of slow-release potassium but we report a patient who survived after taking approximately 100 tablets.
Chronic Leg Ulceration: Socio-Economic Aspects
Authors: Callam M.J. , Harper D.R. , Dale J.J. , Ruckley C.V.
Published: January 2017

Six hundred patients with chronic leg ulcers were assessed and classified with regard to social class, mobility and employment. It has been shown that there is no increased incidence of chronic leg ulceration in the more disadvantaged socio-economic groups, but when leg ulceration occurs it is more likely to be recurrent and take longer to heal. Although in only 11% of patients was mobility affected by leg ulceration alone, the condition interfered with work and or leisure activities to a moderate or severe degree in 42%.
Methylprednisolone, Etoposide, Vindesine, and Chlorambucil (Peec) Alone or Alternating with Chop as Initial or Salvage Therapy for Non-Hodgkin's Lymphoma
Authors: Leonard RCF , Lucraft HH , Proctor SJ , Allan NC , Dawson AA , Leonard RCF , Lucraft HH , McGillivray JB , Parker AC , Prescott RJ , Proctor SJ , Ritchie GL , Sarkar TK , Scott JS
Published: January 2017

A novel cytotoxic drug combination, PEEC, has been tested in the initial or salvage treatment of lymphomas. The PEEC combination alone is active in high grade or intermediate grade NHL with two complete and two partial remissions out of four patients so treated.

When combined with standard CHOP therapy using an alternating regime, seven out of 11 patients obtained a complete remission and four partial remission. Ten patients were well, off treatment, beyond one year from presentation. The combination was less impressive, however, as salvage therapy with two partial responses in a heavily pre-treated group of nine patients.
Prevention of Haematogenous Infection in Prosthetic Joints
Authors: Ching D.W.T. , Gibson P.H. , Gould I.M. , Rennie J.A.N.
Published: January 2017

A survey was conducted to identify the attitude of consultant orthopaedic surgeons and rheumatologists in Scotland, North East England and Ireland, to the prevention of blood-borne infection in prosthetic joints. Of the 61% who completed the questionnaire, 65% gave advice about intercurrent infection, a similar number gave advice about the use of prophylactic antibiotics before certain surgical procedures, with less than half of the patients receiving any written instructions about inter-current infection, and less than a quarter of the patients receiving any written instructions about antibiotic prophylaxis. 36% of the respondents were confused as to what to advise or ignored the problem. The reality of late infection is discussed and a policy to minimise the risk of late infection in prosthetic joints is presented for consideration.
Necrotising Pancreatitis and Diabetes Associated with Disseminated Small Cell Carcinoma of Lung
Authors: Evans A.T.
Published: January 2017

Although tumour metastases to the pancreas and peripancreatic lymph nodes are found commonly at necropsy in cases of small cell carcinoma of lung, tumour-induced acute pancreatitis is described rarely. A case of metastasis-associated necrotising pancreatitis with the unusual presentation of epigastric pain followed by diabetes is described here. Patients (particularly cigarette smokers) with none of the conventional risk factors for acute pancreatitis merit chest radiography and if indicated prompt cytotoxic treatment.
“Gastrointestinal Endoscopy: Time for Change”
Authors: Baillie J
Published: January 2017

In the thirty years since the flexible fibreoptic gastroscope was introduced, gastrointestinal (GI) endoscopy has undergone a spectacular evolution. The explosion in technology and an ever-increasing demand for procedures has left us poorly equipped to provide the quantity and quality of endoscopy required now and into the next century. With increasing sophistication, the risks of GI endoscopy have become appreciable, particularly in therapeutic procedures. These risks can only be contained by adequate training and experience. The present system of higher training in gastroenterology serves endoscopy badly: there is no structure for developing a career interest in GI endoscopy. This is a waste of limited financial and human resources. GI endoscopy should be identified as an area of gastroenterology requiring additional training. New teaching tools such as computer simulation may provide opportunities to learn endoscopy without patient involvement. Research in GI endoscopy, which has been neglected, should be actively encouraged.
Brain Damage in Fatal Non-Missile Head Injury in Relation to Age and Type of Injury
Authors: Adams J.H. , Doyle D. , Ford I. , Graham D.I. , McGee M. , McLellan D.R.
Published: January 2017

Brain damage in a series of 635 fatal non-missile head injuries has been analysed with particular reference to the age of the patient and the type of injury. The differences in the type of brain damage in relation to age were less than we had anticipated, lending further support to the contention that the aged brain has a reduced potential for recovery. The analysis confirms the relationship between road traffic accidents, diffuse axonal injury, gliding contusions and ‘basal ganglia’ haematomas, and the importance of diffuse brain swelling resulting from a head injury in children.
Post Neonatal Mortality Rates — Scotland
Authors: Gordon R.R.
Published: January 2017

Post Neonatal Mortality Rates in Scotland have been equal to those of North and South England since 1975. In this respect there is no longer any inequality in health. However, Social Class V still has a higher rate than Social Class 1 and the rate for illegitimates is the same as for Social Class V. As a result the illegitimate rate remains much higher than that for legitimates in spite of the enormous increase in illegitimate numbers since 1960. With 18% of all live births now born illegitimate they represent infant (social) deprivation better than Social Class V — Which now constitutes only 5% of live births.
Leptospira Icterohaemorrhagiae Infection Presenting as Acute Renal Failure
Authors: Menzies D. G. , Campbell I. W. , Winney R.J.
Published: January 2017

The features of leptospiral infection should be sought in all cases of acute renal failure since management depends on the recognition of the clinical syndrome and serological confirmation is usually delayed. Hepatic and renal involvement is usual but renal failure without significant derangement of liver function is described.
Hydroxyapatite Associated Disease in an Elderly Female: Differentiation from Aseptic Necrosis
Authors: Smith D.F. , Reid D.M.
Published: January 2017

The crystal arthropathies caused by monosodium urate and calcium pyrophosphate dihydrate are commonly recognised, but the destructive arthropathy associated with the deposition of calcium hydroxy-apatite is less well known in general clinical practice.1 We describe a case with many of the classical features of hydroxy-apatite associated disease and discuss the features differentiating the condition from aseptic necrosis.
Dugald Christie, CMG, FRCS, FRCP Edin Scottish Medical Pioneer in Manchuria (1883–1923)
Authors: Tsai H.H.
Published: January 2017

We recall the phenomenal achievement of Dr Dugald Christie, a Scottish surgeon who pioneered Western medicine in Manchuria and single-handedly set up several hospitals and a medical college in his 40 years in that country.
Primate Bites in Gibraltar — Minor Casualty Quirk?
Authors: Campbell A.C.
Published: January 2017

In one year 55 patients presented to the casualty department of St Bernard's Hospital, Gibraltar, with a primate bite. The implications of such wounds on the health of these patients is contrasted with the morbidity and mortality associated with primate bites in the African subcontinent.
The Endocrinopathy of Poems Syndrome
Authors: Stewart P.M. , McIntyre M.A. , Edwards C.R.W.
Published: January 2017

We describe the clinical features and post mortem findings in a patient with POEMS syndrome (P — polyneuropathy, O — organomegaly, E — endocrinopathy, M — M protein, S — skin changes), with particular emphasis on the evolution of the endocrinopathy over a three year period. In addition to gynaecomastia this case exhibited primary hypothyroidism and primary and secondary adrenal and gonadal failure. The widespread nature of the endocrine changes suggests that a circulating substance interferes with the action of trophic hormones, possibly by inhibiting second messenger production.
Serratia Marcescens Outbreak in a Paediatric Oncology Unit Traced to Contaminated Chlorhexidine
Authors: McAllister T.A. , Lucas C.E. , Mocan H. , Liddell R.H.A. , Gibson B.E.S. , Harm I.M. , Platt D.J.
Published: January 2017

Over an 18-month period we encountered 12 episodes of Serratia marcescens bacteraemia in 10 patients in a paediatric oncology unit. These were associated with long-term indwelling Hickman intravenous catheters (right atrial) and caused three deaths. Seven of the patients had only mild pyrexial illnesses and made a complete recovery. The source was traced to contaminated aqueous chlorhexidine in a bedside container in which plastic clamps were stored. When this was rectified the outbreak ceased. The identity of the causal Serratia strains was confirmed by plasmid analysis and they showed multiple antibiotic resistance, including the aminoglycosides. The study illustrates the emergence of S. marcescens as an opportunistic pathogen and emphasises the dangers of Hickman-associated bacteraemia.
Failure of Somatostatin Analogue Sms 201–995 to Control Cushing's Syndrome Due to Ectopic Release of Acth from a Bronchial Carcinoid
Authors: Burrell L. , Gray C.E. , Thomson J.A.
Published: January 2017

A patient with ectopic Cushing's syndrome secondary to a malignant thymic carcinoid tumour was treated with the somatostatin analogue SMS 201–995. The administration of the drug subcutaneously in increasing doses over a 34 day period failed to control the ACTH or glucocorticoid excess.
Oral Contraception and Post-Operative Thromboembolism: An Epidemiological Review
Authors: Hutchison G.L.
Published: January 2017

It has been stated that oestrogen-containing oral contraceptive medication should be discontinued one month prior to surgery, to avoid an increased incidence of post-operative thromboembolism. Others have suggested that the risk of post-operative morbidity is low compared with the risk of pre-operative pregnancy, and that in most cases no such action should be taken.

The evidence from clinical investigation is reviewed, with particular reference to study design. It is found that all studies so far conducted are subject to sources of bias or confounding which render their results inconclusive.

There is a need for a randomised control trial comparing the effects of discontinuing or continuing oral contraception prior to surgery. Meanwhile, with a post-operative risk inferred but not conclusively demonstrated, if oral contraception is to be withdrawn prior to surgery, great care must be taken to reduce the risk of ensuing pregnancy to as near zero as possible.
Concomitants of Excess Coronary Deaths — Major Risk Factor and Lifestyle Findings from 10,359 Men and Women in the Scottish Heart Health Study
Authors: Smith W.C.S. , Tunstall-Pedoe H. , Crombie I.K. , Tavendale R.
Published: January 2017

The Scottish Heart Health Study is a study of lifestyle and coronary heart disease risk factors in 10,359 men and women aged 40–59 years, in 22 districts of Scotland. The study was conducted during 1984–86, when Scotland had the highest national coronary heart disease mortality reported by the World Health Organisation. A self-completed questionnaire, complemented by a 40 minute visit to a survey clinic, staffed by nurses, enabled the classical major risk factors and some more newly described ones to be measured. The study emphasised quality control and representativeness, and incorporated a World Health Organisation protocol for measurement of key items to allow comparisons in place and time, and therefore also to provide a definitive baseline against which interventions can be assessed. This paper describes the overall findings.

Current cigarette smokers constitute 39% of men and 38% of women, higher levels than those reported in England but lower than previous Scottish reports. Mean blood pressure levels were 134/84 mmHg for men and 131/81 mmHg in women, lower than in British studies of the 1960s and 1970s. Mean body mass index levels, 26.1 Kg/m2 in men and 25.7 Kg/m2 in women, were not high by international standards. However, mean serum cholesterol levels were 6.4 mmol/l in men and 6.6 mmol/l in women — as high as those in previous British studies and high by international standards. Levels of high density lipoprotein cholesterol, non-fasting triglycerides and fibrinogen are also reported. Physical activity both at work and in leisure time was low. Many participants did not eat fresh fruit or green vegetables.

High cholesterol and cigarette smoking levels provide a classical explanation for the excess of coronary deaths in Scotland, justifying action, but other factors, such as the dietary deficiencies, also merit further investigation.
An Unusual ‘Appendix’ Testis
Authors: Wilson-Storey D. , Nour S.
Published: January 2017

A six-week-old infant was seen with bilateral inguinal herniae. It was noted that the position of the right testis within the scrotum varied with the degree of inguinal herniation. At exploration the appendix was found lying within the patent processus vaginalis with its tip firmly adherent to the upper pole of the right testis. Appendicectomy was performed through the same incision. This unusual finding should be considered by the clinician if presented with a child with easily reducible inguinal herniae and a fluctuating testicular position.
Influence of Anaesthesia on Blood Loss in Transurethral Prostatectomy
Authors: Mackenzie A.R.
Published: January 2017

In this study operative blood loss was measured in 177 transurethral prostatectomies performed over a six-year period in one hospital by the author. A comparison was made relative to type of anaesthesia used i.e. general inhalation versus spinal anaesthesia.

The two groups were similar in age and physical condition. Their prostrates were almost the same size and there was negligible difference in the rate of resection between the two groups.

Mean loss and median loss in 113 patients given general anaesthesia were 66.6 and 29.9ml. In 64 patients who had spinal anaesthesia these losses were 35.6 and 22.2ml respectively.

The findings are in agreement with two of the three previous studies devoted to the relationship between operative blood loss during transurethral prostatectomy and the type of anaesthesia used.
A Case of Heavy Chain Disease: Diagnosis and Monitoring Using Assays of Immunoglobulin Heavy and Light Chains
Authors: Mitchell P.E.G. , Ford R.P. , Coughtrie M.W.H. , Heppleston A.D. , Fraser C.G.
Published: January 2017

Heavy chain diseases (HCD) are uncommon. We report the first use of recently developed analytical techniques for the assay of immunoglobulin heavy and light chains in the diagnosis and monitoring of a patient with gamma-HCD.
Coexistent Coronary Artery Disease and Oesophageal Spasm: The Importance of Establishing the Source of Chest Pain
Authors: Hutchison S.J.
Published: January 2017

A 55 year old woman presenting with chest pain was found to have significant triple vessel coronary artery disease. Non-invasive investigations showed that she had a good exercise tolerance without inducible ischaemia. The history was more suggestive of an oesophageal source of pain, an impression supported by manometry. This case illustrates some of the problems encountered during the investigation of chest pain and the need to interpret angiographic findings in the context of the patient's functional state.
To Which Neurotic Patients Do Psychiatrists Prescribe Medication?
Authors: Eagles J.M. , Alexander D.A.
Published: January 2017

Of 318 newly referred neurotic patients, 43% were prescribed medication by their psychiatrist. Medication was more likely to be prescribed to patients who are older, who are married, who have lengthy illnesses and who do not have a history of deliberate self-harm. These findings are discussed in the context of current debate about optimal treatment methods for patients with neurotic disorders.