bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of Transient Hyperprolactinaemia in the Short Luteal Phase
Authors: Coutts J. R. T. , Fleming R. , Macnaughton M. C.
Published: January 2017

Daily plasma analysis of complete menstrual cycles from infertile women (n = 32) revealed transient hyperprolactinaemia in a significant number in comparison with normally cycling women. The prolactin elevations occurred for variable durations at different stages of the cycle. Transient hyperprolactinaemia occurring at mid-cycle was associated with reduced late luteal phase steroid levels and short luteal phases. When the prolactin elevations occurred at other times they were unrelated to ovarian steroid levels.

Treatment of patients with short luteal phases with bromocriptine (2.5 mg/day) normalised prolactin levels but also reduced gonadotrophins. The net result of these changes was a normalisation of the length of the luteal phase which was now deficient in steroid secretion. To alleviate these problems the treatments proposed for the short luteal phase are either bromocriptine (2.5 mg/day) for 7 days over the mid-cycle period only or bromocriptine for 7 days at mid-cycle in conjunction with a follicular stimulant in the early follicular phase.
Overview of Fibrinolysis
Authors: Chakrabarti R.
Published: January 2017

The modern concepts of fibrinolytic activation and inhibition are discussed in this paper and the importance of the complex interlinkage with the kallikrein-kinin, coagulation, complement and immunity mechanisms is underlined.

The importance of the fibrinolytic balance as a protective mechanism in prevention of thrombus formation, in inflammation and in cancer is postulated and in population studies the normal decline with age is standardised.

The possibilities for long term fibrinolytic enhancement by use of a variety of drugs, such as the biguanides and anabolic steroids has been demonstrated.
Potential for Thrombolytic Therapy
Authors: Collen D.
Published: January 2017

The biochemical structure and interaction of the four components of the fibrinolytic enzyme system are described and the mechanisms for regulation and control are discussed.

The potential is defined for enhancement of thrombolysis at various levels by use of a variety of agents some of which have therapeutic potential in the human.
Effect on Blood Pressure of Changing from High to Low Dose Steroid Preparations in Women with Oral Contraceptive Induced Hypertension
Authors: Weir R. J.
Published: January 2017

Thirty women with hypertension induced by oral contraceptives containing 50 μg oestrogen and 1 to 4 mg. progestagen showed a marked significant fall in blood pressure when given either (a) a combination of 30 μg ethinyloestradiol with 150 to 250 μg levonorgestrel or (b) 350 μg norethisterone alone. One year after changing to either of these low dose preparations blood pressure had not fully returned to pre-oral contraceptive levels.
Phenol Cauterisation in the Management of Ingrowing Toenails
Authors: Robb J. E. , Murray W. R.
Published: January 2017

Phenol cauterisation has been carried out on 150 toes in 121 patients with an ingrowing toenail. There was no significant morbidity and the procedure was tolerated well by all patients. Overall recurrence rate was found to be 4 per cent after nine months. This figure compares favourably with surgical ablation techniques and when combined with improved patient tolerance indicates that phenol cauterisation may be the ablation procedure of choice in the treatment of an ingrowing toenail.
Hormone Receptors and Breast Cancer—an Occasional Survey
Authors: Forrest A. P. M. , Hawkins R. A.
Published: January 2017

Hormone receptors are proteins, localised in the membrane, cytosol, mitochondrion or nucleus of target cells; binding of hormone to the receptor leads to alterations in intracellular activity or growth. The development of antagonists which competitively bind to receptor sites has been used clinically to block, for example, the action of androgen, histamine, adrenaline and oestrogen. In patients with breast cancer, measurements of hormone receptor activity are valuable (1) in predicting which patients with advanced disease will respond to endocrine therapy, (2) as an additional independent guide to the patients' prognosis. The anti-oestrogen, tamoxifen has few side-effects and is therefore particularly useful in the treatment of advanced disease. In addition, two trials, performed in the USA, suggest that this receptor-blocker may be valuable in the adjuvant treatment of early disease. In the UK, further trials are underway to confirm this and to assess the relationship of hormone receptor status in the primary tumour to benefit from treatment.
Atherosclerosis in Chronic Renal Failure: A Historical Perspective
Authors: Nicholls A.
Published: January 2017

It is commonly believed that atherogenesis is accelerated in patients with chronic renal failure during treatment by long-term dialysis or renal transplantation. However, several recent studies have failed to confirm this concept, despite the fact that overall atherosclerotic deaths in these patients are much higher than in the normal population. The natural history of atherogenesis in renal failure becomes much clearer if one analyses autopsy series of the pre-dialysis era. It is apparent from such studies that atheroma is frequent in renal failure before the development of terminal uraemia and that hypertension emerges as the major risk factor. Subsequent atherosclerotic deaths during long-term dialysis or renal transplantation may reflect progression of previously acquired atheroma, but do not per se indicate that atherogenesis has been accelerated after the commencement of renal replacement therapy. A proper appreciation of the natural history of atheroma in renal failure may permit a more rational approach to therapeutic intervention.
Cytomegalovirus and its Association with Multiple Infections: A Case Report
Authors: Robertson A. S. , Pennington C. R.
Published: January 2017

A patient is described who developed multiple bacterial and fungal infections following a disseminated cytomegalovirus infection.

The problem of infections in the debilitated host and the role of cytomegalovirus in suppressing immunity are discussed.
Treatment of Intractable Neurogenic Pain with Carbamazepine
Authors: Rapeport W. G. , Rogers K. M. , McCubbin T. D. , Agnew E. , Brodie M. J.
Published: January 2017

Sixteen patients with previously intractable neurogenic pain were treated with carbamazepine (CBZ) for a period of six weeks. CBZ initial daily dosage of 400 mg was increased by a similar amount every second week to a maximum of 1,200 mg. Single dose kinetic studies prior to initiating CBZ therapy showed that these patients metabolised the drug similarly to healthy controls. Side effects, including rash (3) and ataxia (3), necessitated discontinuation of treatment in six patients. A further three patients withdrew because of lack of effect. Of the seven patients who completed the protocol, five showed a significant fall in pain score at all dosage increments with a maximum effect at the highest dose (p<0.01). In the seven patients for whom data was available at all three CBZ dosages, there was a significant correlation between sedation scores and CBZ concentrations (p<0.005). CBZ may be of value in the management of chronic neurogenic pain. Further controlled studies are indicated.
Bone Formation and Resorption as the Determinants of Trabecular Bone Volume in Normal and Osteoporotic Men
Authors: Nordin B. E. C. , Aaron J. , Speed R. , Francis R. M. , Makins N.
Published: January 2017

Trabecular bone volume, forming surface and percent surface resorption have been determined in iliac crest samples obtained post mortem from 43 young men and 49 elderly men and in biopsies obtained from 22 males with spinal osteoporosis. The mean bone volume was significantly lower in the old than in the young controls and significantly lower again in the osteoporotic cases. Forming surfaces were significantly lower in the old than the young controls but were not different as between old controls and cases of osteoporosis. Percent surface resorption was the same in young and old controls but significantly increased in the osteoporotics. Multiple regression analysis showed that trabecular bone volume was a significant positive function of forming surface and a significant inverse function of fractional surface resorption. Age-related (simple) osteoporosis in men appears to be due to reduced bone formation whereas pathological (accelerated) osteoporosis is due to increased bone resorption.
The Effect of Ascorbic Acid on the Seasonal Variations in Serum Cholesterol Levels
Authors: Dobson Hilary M. , Muir Margaret M. , Hume R.
Published: January 2017

One gram of ascorbic acid (Vitamin C) administered randomly to a group of healthy young people (aged 29 ± 5 years) produced a significant mean fall in serum cholesterol of 16 per cent within two months. A similar supplement to a group of healthy older people (aged 58 ± 3 years) produced a significant mean fall in serum cholesterol of 14 per cent but required six to 12 months' administration.

Serial observations on a mixed age group of healthy people (aged 38 ± 12 years) over one calendar year revealed a seasonal fluctuation in serum cholesterol, the lowest levels being in summer (June 5.5 ± 0.7 mmols/l) and the highest levels in winter (January 6.4 ± 0.8 mmols/l), a significant rise of 16 per cent. These changes showed an inverse relationship with the leucocyte and serum ascorbic acid levels which also revealed a seasonal fluctuation, the months April/September being higher than the months October/March.

The administration of 1g of ascorbic acid per day throughout the year abolished the winter rise in serum cholesterol levels.

These results are discussed in the light of the relationship between cholesterol and vascular disease and the observations by Sir Richard Doll that lowering the cholesterol level, whether achieved by drugs or diet, results in a reduction in morbidity from myocardial infarction.
Induction of Ovulation with Gonadotrophins—A Ten Year Review
Authors: West Christine P. , Baird D. T.
Published: January 2017

We describe the outcome of induction of ovulation with gonadotrophins (HMG/HCG) in 46 patients treated over 138 cycles. Ovulation was induced in 88 per cent of cycles and there were 43 conceptions in 33 patients with a cumulative conception rate of 96 per cent. The incidence of multiple pregnancy was 36 per cent of those reaching a gestation of 13 weeks or more and accounted for all the second and third trimester foetal losses. Overall, 61 per cent of the patients have taken home at least one healthy child. Mild symptomatic ovarian hyperstimulation complicated 9.4 per cent of courses and was more frequent among patients with normal pretreatment oestrogen levels. We found continuous biochemical monitoring of follicular growth to be a poor predictor of multiple pregnancy or hyperstimulation. We discuss our local experience with reference to published reports from other centres and in relation to recent advances in management and consider the future role of this therapy.
Pycnodysostosis in a Pakistani Family: Case Presentation and Review
Authors: Kerr Alison M. , Loudon Mary M. , Goel Krishna M. , Connor J. M.
Published: January 2017

Pycnodysostosis is described for the first time in a Pakistani family.

Two cases are presented and are contrasted with cases of osteopetrosis seen in this hospital over a twenty year period.

The possibility of confusion with osteopetrosis is indicated and discussed.
Ischaemic Optic Neuropathy and Retinopathy Associated with Acute Pancreatitis
Authors: Smith W. G. J. , Briggs J. D. , Junor B. J. R. , Jay J. L.
Published: January 2017

A man with previously undiagnosed chronic renal failure developed acute pancreatitis. He had severe abdominal pain and simultaneous loss of vision. Ophthalmoscopy showed pale, swollen optic discs, soft exudates and superficial retinal haemorrhages similar to that of Purtscher's retinopathy. We suggest that the ocular changes may be due to fat microemboli secondary to acute pancreatitis.
Clinical Studies in Adults Presenting with Giardiasis to a Gastro-Intestinal Unit
Authors: Gillon J.
Published: January 2017

Eight adults presenting with giardiasis to a gastrointestinal unit during a two year period were studied in detail. Symptoms were varied, diarrhoea occurring in only five patients. Four of the eight gave a history of travel to endemic zones, and three of those who gave no such history had possible predisposing conditions (gastric surgery (2), and borderline IgA deficiency (1)). Most patients exhibited mild malabsorption of fat and vitamin B12, and some abnormality of jejunal disaccharidases was usual. Jejunal histology varied from normal to partial villous atrophy, and the intraepithelial lymphocyte count was raised in those patients with the most marked histological abnormality. Treatment with metronidazole was uniformly successful, and most of the above abnormalities reverted to normal within a month of treatment.
Hormone Binding Globulins and Anticonvulsant Therapy
Authors: Beastall G. H. , Cowan R. A. , Gray J. M. B. , Fogelman I.
Published: January 2017

Serum sex hormone binding globulin, thyroxine binding globulin, cortisol binding globulin and vitamin D binding globulin, together with total levels of the appropriate bound hormones, were determined in 21 epileptic subjects who had been stabilised by long-term anticonvulsant therapy.

Serum sex hormone binding globulin capacity was higher in these patients than in appropriate control groups (men p<0.05; women p<0.01), and values correlated with serum phenytoin levels in the female subjects (p<0.01). Thyroxine binding globulin levels were unaffected by anticonvulsants, but significant reductions in serum thyroxine (men p<0.05; women p<0.001) and triiodothyronine (men p<0.05; women p<0.01) were observed. Cortisol binding globulin capacity was appreciably elevated in patients of either sex (p<0.001), and in the women this was accompanied by a reduction in serum cortisol (p<0.001) and a significant correlation with the serum phenytoin concentration (p<0.01). Neither vitamin D binding globulin capacity nor serum 25-hydroxycholecalciferol levels were influenced by anticonvulsants in this study.

It is concluded that anticonvulsant drug therapy causes widespread alterations in the normal homeostasis between hormones and their serum binding globulins. Such alterations may well have clinical significance.
Abdominal Thermography in Acute Appendicitis
Authors: Steele R.J.C.
Published: January 2017

Abdominal thermography was carried out in 50 patients with suspected acute appendicitis. Forty of these came to laparotomy and in 32 the diagnosis was confirmed. Thermography was not found to be useful in predicting those patients requiring surgery.
Endoscopic Pancreatography in Cystadenoma of the Pancreas
Authors: Thomson H. J. , Saunders J. H.
Published: January 2017

A case of mucinous cystadenoma of the tail of the pancreas is reported in which endoscopic retrograde cholangiopancreatography was used to define the surgical anatomy prior to operation. The demonstration of a normal proximal main duct allowed simple ligation of the body of the gland when the tail was excised.
Inpatient Cardiology in a Rural District General Hospital
Authors: Tulloch J.A.
Published: January 2017

The pattern of cardiac admissions to a rural district general hospital has been analysed. Coronary artery disease is the major disorder, both as an acute and chronic problem. Other forms of heart disease are relatively uncommon. The absence of hypertension and hypertensive heart disease is striking. The deaths were mainly related to coronary artery disease.
Ultrasound Placental Localisation in Early Pregnancy
Authors: Khan A. T. , Stewart K.S.
Published: January 2017

A retrospective study of 400 consecutive case records was made to establish the clinical significance of the low lying placenta found on ultrasound. Diagnostic accuracy is discussed. 30% of the patients had a low lying placenta on early scan. Of these, 73% had a follow up scan. There was a progressive drop in the incidence of low lying placentae through pregancy until at term, in this study, there was no placenta previa. It is considered that a repeat scan is necessary to exclude placenta previa, but not until 34 weeks gestation. Amongst the patients with early low lying placentae the incidence of antepartum haemorrhage of indeterminate type was significantly high (P<0.001). A careful surveillance of these patients is therefore required. Dynamic placental migration may be the cause of this bleeding. Further study is necessary to determine the effect of early placental position on subsequent fetal development.
Bone Marrow Necrosis in Acute Lymphoblastic Leukaemia
Authors: Habboush H.W. , Hann I.M.
Published: January 2017

Bone marrow necrosis, an uncommon finding in acute lymphoblastic leukaemia, has previously been regarded as a poor prognostic feature. It has been associated with difficulty in establishing the diagnosis, a low rate of remission as well as short remission duration. We report a case of bone marrow necrosis in a girl with acute lymphoblastic leukaemia and good prognostic features who attained complete remission uneventfully and will discuss previous reports of this association in the literature.
Rhino-Orbital-Cerebral Mucormycosis — A Clinico-Pathological Report of Two Cases
Authors: Esakowitz L. , Cook S.D. , Adams J. , Doyle D. , Grossart K.W.M. , Macpherson P. , McFadzean R.M.
Published: January 2017

Rhino-orbital-cerebral mucormycosis is an acute fungal infection of the oropharynx, paranasal sinuses, orbit and intracranial structures. It is rare, occurring mainly in diabetics in ketoacidosis. The clinical presentation is highly suggestive of the diagnosis. Current treatment has resulted in a greatly improved prognosis for survival and clinical awareness of this disease is important for early initiation of treatment with optimal effect. A clinico-pathological report of two cases is presented.
Iatrogenic Buschke's Disease (Michelin Man Syndrome)
Authors: Ahmad N. , Lawrence J.R. , Macdonald J.W.A.
Published: January 2017

Scleroderma adultorum as originally described by Buschke1 in 1900, is cutaneous thickening of unknown aetiology. Since then several cases have been reported which have illustrated different aspects of the disease but the exact aetiology, pathogenesis and prognosis remain uncertain. Disease of possible iatrogenic origin appears not to have been described previously.
Locked Jaw in Polymyalgia Rheumatica
Authors: Lim S.H. , McLeay G.
Published: January 2017

Polymyalgia rheumatica is a common disease affecting the elderly population. Symptoms and signs are often nonspecific, including pain and stiffness in the proximal muscles, anorexia, fatigue, depression, weight loss, fever and temporal headaches. We would like to report a case of polymyalgia rheumatica with locked jaw, a feature yet unrecorded.
Thrombocytopaenia as the Presenting Feature of Persistent Generalised Lymphadenopathy (PGL) in a One Year Old
Authors: Forsyth J. S. , Sharp R. A. , Ghosh S.
Published: January 2017

A one-year-old child who presented with thrombocytopaenia was found to be HIV positive and has now developed persistent generalised lymphadenopathy (PGL).
The Epidemiology of Post Viral Fatigue Syndrome
Authors: Ho-Yen D.O.
Published: January 2017

The epidemiology of the post viral fatigue syndrome was studied for the years 1985–86. With a strict definition of the syndrome, it was found that there were many misconceptions about this illness. The sex incidence was nearly equal with a similar pattern of twin peaks at 25–29 years and 40–45 years. At diagnosis, 56% were ill for three to six months and only 9% for more than two years. It is estimated that this syndrome is more common than infectious mononucleosis.
The Increasing Problem in Tayside of Cervical Cancer in Younger Women
Authors: Dodgson J. , Walker E.M. , Hussein K.A. , Robertson A.J. , Duncan I.D.
Published: January 2017

The incidence of cervical carcinoma in younger women is increasing in Tayside despite a decrease in the overall incidence. However, stage for stage, we did not encounter a poorer survival in younger patients.

A number of patients had been sterilised or had a pregnancy when cytological screening was available and not made use of. There were also some false negative smears which were reclassified for retrospective analysis. We would recommend cervical screening every three years and careful inspection of the cervix and a smear taken in cases of abnormal gynaecological symptoms such as post coital bleeding.
Probable Crohn's Colitis Mimicking Ischaemic Colitis in a Young Adult
Authors: Tsai H.H. , Howden C.W. , Thomson T.J.
Published: January 2017

The features on barium enema of ischaemic colitis is characteristic and the radiological sign of “thumb printing” thought to be almost pathognomonic of the condition. We report a case of inflammatory bowel disease, probably Crohn's disease mimicking these radiological features. This has not to our knowledge been previously documented.
A Survey of Current Use of Angiotensin-Converting-Enzyme Inhibitors by Scottish Physicians in the Treatment of Chronic Cardiac Failure
Authors: McMurray J. , Lang C.C. , Maclean D.D. , McDevitt D.G. , Struthers A.D.
Published: January 2017

318 consultant physicians in Scotland were sent a questionnaire on their use of angiotensin converting enzyme (ACE) inhibitors to treat chronic heart failure (CHF). 229 (72%) replies were received. Of these 91% used ACE inhibitors for CHF; 22% were geriatricians, 58% general physicians and 20% cardiologists. All groups reserved ACE inhibitors for patients uncontrolled by diuretics alone. Compared to general physicians, cardiologists used ACE inhibitors in preference to other vasodilators and digoxin, used higher doses and commenced treatment more often on a day-patient basis. Cardiologists also commonly started treatment with captopril even if continuing with enalapril. Geriatricians used ACE inhibitors as frequently as cardiologists but at lower doses; they did not report side-effects more frequently. Further investigation of the safety and possible cost savings of supervised day-patient rather than in-patient, introduction of ACE inhibitors for CHF is now merited. To avoid an extended period of patient observation after the first dose of ACE inhibitor, captopril might also be given as the initial therapy, even if continuing with enalapril. This policy would also reduce the risk of any hypotensive response being prolonged.
Testing for HIV in Pregnancy: 3 Years Experience in Edinburgh City
Authors: Johnstone F. D. , McCallum L.R. , Brettle R.P. , Burns S.M. , Peutherer J. F.
Published: January 2017

Since HIV testing became available in Edinburgh in September 1985, testing in pregnancy has been offered (after counselling and with informed consent) on a selective or case finding basis. This study reviews the results of the first three years for all Edinburgh city hospitals. HIV serostatus was known for 436 such pregnant individuals during this time, and 79 women were known to be infected with HIV. There was little change in the number of first tests done in pregnancy, a decline in the number of women discovered during pregnancy to be seropositive, and a corresponding increase in women referred known to be HIV infected. With one exception, all seropositive women gave a history of injecting drug use or having a steady drug using sexual partner known to be HIV seropositive. Forty-five per cent of pregnant women with the former risk, and 16% of pregnant women with the latter risk were HIV seropositive. The minimum prevalence of HIV infection for women domiciled in Edinburgh city was approximately 0.4% of pregnancies, with a higher prevalence in women having induced abortion and a lower prevalence in continuing pregnancies. However, HIV serostatus was known in only 1.6% of all pregnancies. HIV infection in pregnant Edinburgh women may be confined largely to a cohort of injection drug users and sexual partners of infected male drug users but total population prevalence data are urgently required.
Recurrent Pneumothorax: An Unusual Presentation of Malignant Mesothelioma
Authors: Handa S.I. , Wilkinson A.G.
Published: January 2017

Malignant mesothelioma is an uncommon condition with about 250 new cases each year in the United Kingdom, most of which present with dyspnoea due to pleural effusion or chest pain.1 We report a case of malignant mesothelioma which presented as recurrent pneumothorax.
An Objective Analysis of an Accident Flying Squad
Authors: Dark P. M. , Little K. , Steedman D. J. , Gordon M. W. G. , Robertson C. E.
Published: January 2017

An objective evaluation of an accident flying squad, in relation to trauma call-outs during a six month period, was performed using the Injury Severity Score and the recently described Revised TRISS methodology. We have demonstrated improvement in patient survival for those trauma cases treated at the scene. This has not been previously documented. Objective evaluation of these squads in relation to medical emergencies is even more difficult. The profile of these call-outs is described. (11.1%) of those treated at the scene for cardiac arrest survived to leave hospital. Ventricular fibrillation was the primary arrhythmia recorded in this group of survivors. This supports the vogue for extended ambulance personnel training.
The Assessment Unit of the Epilepsy Centre, Quarriers Homes
Authors: Gray J.M.B. , Espie C.
Published: January 2017

The work of the Assessment Unit in the Epilepsy Centre, Quarriers Homes, Scotland is described. One hundred and thirty patients with severe epilepsy were admitted over a three year period for investigation of seizures and rationalisation of therapy. The degree of psychomotor impairment due to epilepsy itself, or to anti-epileptic drugs was estimated. Cognitive functioning and levels of ability with interpersonal relationships were measured and plans were drawn up for rehabilitation. A plea is made for NHS funding to support the provision of this service for people with epilepsy.
Politics, Society and Medicine in the 18th Century
Authors: McGirr E.M.
Published: January 2017

Medical theory and practice in the 18th century reflected the thought and culture that the Renaissance had fashioned. This article draws attention to the political and social changes of the period and notes their inter-relationship with the changes that occurred in medicine.
Cerebrospinal Fluid Angiotensin Converting Enzyme Levels in the Diagnosis of Neurosarcoidosis
Authors: Jones D.B. , Mitchell D. , Horn D.B. , Edwards C.R.W.
Published: January 2017

Cerebrospinal fluid angiotensin converting enzyme (CSF-ACE) level was measured in two patients considered to have neurosarcoidosis, three patients with possible neurosarcoidosis and in 38 control patients suffering from prolapsed intervertebral discs. Both neurosarcoidosis patients had elevated levels (1.8 and 5.4 μmol/l/min) while the possible neurosarcoidosis patients had values similar to the control patients (mean 0.59±0.42 μmol/l/min). We suggest that CSF-ACE values may be of use in some patients as a diagnostic test for neurosarcoidosis and provide a reference range of normal controls.
Time Trends and Geographical Variation in Parkinson's Disease in Scotland
Authors: Smith W.C.S. , Mutch W.J.
Published: January 2017

Parkinson's disease is a common and disabling condition which principally affects the elderly. The time and space distribution of Parkinson's disease has been examined to determine if it provides clues as to aetiology and factors affecting its distribution. Previous studies have used mortality data,1 data from epidemiological studies,2 and pre scribing information particularly with regard to the use of levodopa.3 These studies have looked within countries and between countries.
Astrocytoma Presenting with Vasculitis
Authors: Leese G.P. , Jung R.T. , Morley K.D.
Published: January 2017

A cerebral astrocytoma which had remained quiescent possibly for 12 years, presented with blackouts, vasculitis and a lupus-like (L-E like) syndrome. The association between tumours and “L-E like” syndromes is reviewed briefly.
The Changing Role of an Audit Support Group
Authors: Semple E.E. , Gregson K.E. , McEwen J.
Published: January 2017

An audit support group was established within a University Department of Public Health in 1991 to provide a resource for clinical audit. A postal survey of 300 consultants and senior registrars (59% response rate) showed 72% had participated in audit, 47% currently involved, 40% implementing change. 40% had no experience in standard setting or implementing change. Comparison of the workload of the group for August 91 - March 92 and April 92 - March 93 showed 4 requests for support per month, 4/5 from doctors during first period compared with 6 requests per month and 1/3 from doctors during second period. Since the group was established demand from clinicians has decreased and from professions allied to medicine increased. This may reflect either clinicians' increased experience or decline in enthusiasm for audit. Education in the basic skills for audit for all healthcare professionals, improved communications and practical support for clinical audit is necessary.
Frequent Deliberate Self-Harm: Repetition, Suicide and Cost after Three or More Years
Authors: Rodger C R
Published: January 2017

This is a follow-up study of 44 patients who were admitted to the Royal Infirmary of Edinburgh after frequent deliberate self-harm (defined as three or more episodes of deliberate self-harm within one week) at least once between 1982 and 1987. Forty-two patients (95%) were traced after a minimum of three years (range 3yr 1mo 8yr 9mo). Thirty eight patients were known to have repeated self-harm an average of 13 times during the follow-up. Only two patients had died, one of these by probable suicide. The average cost solely attributable to the in-patient accommodation and psychiatric assessment of this group during follow-up was £34,036.60 (1986–87 prices)
Evidence That Oilseed Rape (Brassica Napus SSP. Oleifera) Causes Respiratory Illness in Rural Dwellers
Authors: Parratt D. , Smith W.H. Macfarlane , Thomson G. , Cameron L.A. , Butcher R.D.
Published: January 2017

A study of 25 residents in a small Scottish village over a two-year period investigated respiratory symptom reporting in the presence or absence of oilseed rape. Symptom reporting in the year when oilseed rape virtually surrounded the village, varied during the growing season of the crop and was at its highest coincident with peak flowering. At the same period of the following year when the crop was absent, symptom reporting was significantly lower. The symptoms which correlated most strongly with peak oilseed rape flowering were sneezing, cough, headache, eye irritation and the total of these and other symptoms. Increased symptoms were reported by 12 of the participants though only seven of these were judged to be atopic. The symptoms did not correlate with levels of oilseed rape pollen but there is no clear evidence as to which of the other factors associated with the crop might be the cause.
Risk Factors for Cardiorespiratory and All Cause Mortality in Men and Women in Urban Scotland: 15 Year Follow Up
Authors: Watt G.C.M. , Hart C.L. , Hole D.J. , Smith G.D. , Gillis C.R. , Hawthorne V.M.
Published: January 2017

Study objective: To describe the relationship between risk factors, risk behaviours, symptoms and mortality from cardiorespiratory diseases in an urban area with high levels of socioeconomic deprivation. A cohort study of 15,411 men and women aged 45–64, comprising 80% of the general population of Paisley and Renfrew, Scotland. Outcomes: Mortality after 15 years from coronary heart disease(ICD 410–4), stroke(ICD 430–8), respiratory disease(ICD 460–519) and all causes.

Main results: Mortality rates from all causes were 19% in men aged 45–49, 31% in men aged 50–54, 42% in men aged 55–59 and 57% in men aged 60–64. The rates are considerably higher than those reported in previous UK prospective studies. For women the rates were 12%, 18%, 25% and 38% respectively. In general men and women showed similar relationships between risk factor levels and mortality rates. People in manual occupations had higher mortality rates. Raised levels of systolic and diastolic blood pressure were associated with increased coronary, stroke and all cause mortality rates. Plasma cholesterol had no such association with all cause mortality rates. High and low levels of body mass index were associated with higher mortality rates than intermediate levels. A relationship between short stature and increased mortality rates was observed in men and women. FEV1 expressed as a percentage of the expected value showed the strongest relationship with mortality rates, particularly for respiratory disease, but also for deaths from coronary heart disease, stroke and all causes.

Conclusions A similar pattern of relationship between risk factor levels and mortality rates exists in men and women in Renfrew and Paisley. Respiratory impairment as measured by FEV 1% predicted appears to be the most likely explanation of the observed high all cause mortality rates in this population.
An Evaluation of Integrated Cardiopulmonary Exercise Testing in a Pulmonary Function Laboratory
Authors: Sridhar M.K. , Carter R. , Banham S.W. , Moran F.
Published: January 2017

Clinical exercise testing has been used mainly to assess the cardiac response to exercise. Integrative cardiopulmonary exercise tests (CPET) involving the measurement of the ventilatory, circulatory and metabolic response to exercise has largely been a research tool. We analysed the results of one hundred tests randomly chosen from a total of 472 exercise tests performed between January 1992 and June 1993 as clinical investigation in a pulmonary function laboratory. CPET was used (a) to identify the cause of effort limitation in patients where more than one illness could be relevant (26); (b) to obtain an objective measure of the exercise capacity of patients with respiratory or cardiac disease (31); (c) as monitor of response to treatment (11) and (d) in the investigation of unexplained dyspnoea (32). In 94 of the 100 cases CPET was able to provide an answer to the specific clinical question posed. In patients with unexplained dyspnoea CPET identified a group who exhibit an inappropriate hyperventilatory response to exercise with no supportive evidence of cardiopulmonary disease. In a small minority of cases CPET gave non-specific results. We conclude that CPET is a useful investigation in the management of patients with cardiopulmonary disease and complements the various other investigations offered by a pulmonary function laboratory.
The Röntgen Centenary
Authors: Fleming L. W.
Published: January 2017

One hundred years ago in November 1895, when Wilhelm Conrad Rontgen discovered X-rays, a new scientific age began which has dominated our own century. Rontgen himself was one of the late 19th century physicists involved in the exciting investigations opening up at that time into the possibilities which electrical applications were creating. To understand the significance of Rontgen's discovery, it is helpful to look at the years preceding his discovery and the context within which his work took place.
Hypothermia in the North East of Scotland
Authors: Cross S.J. , Waugh N.R.
Published: January 2017

The aim of the study was to establish the incidence of hypothermia in the Grampian region, and to examine the accuracy of routine reporting of hypothermia on hospital discharge records. From 1990–1994, 167 patients were admitted with an SMRI diagnosis of hypothermia. An admission temperature of under 35°C was recorded in 47 (28%): rectal in 37 (confirmed hypothermia) and not specified on non-rectal in 10 (possible hypothermia). Most admissions were during the winter months In only 18 cases of the 47 patients with confirmed or possible hypothermia was a secondary cause not apparent. Isolated hypothermia is rare in Grampian. In most cases other disease is the underlying cause.
SKI Injuries in Scotland a Review of Statistics from Cairngorm SKI Area Winter 1993/94
Authors: Langran M. , Jachacy G.B. , MacNeill A.
Published: January 2017

Scottish skiing is a growth industry—nearly all acute ski injuries in Aviemore are managed initially by local general practitioners. This study set out to examine the nature and incidence of ski injuries in one Scottish ski resort, and to calculate the additional workload generated for the health centre, ambulance service and local hospital.

During the study period, the winter ski season of 1993–94, a prospective study was made of the 486 acute ski injuries presenting to Aviemore Health Centre. Despite frequently poor weather conditions, the seasons injury rate for Cairngorm was 2.43 per 1000 skier days which compares favourably with statistics from other ski centres world-wide. The anatomical pattern of injuries for both downhill skiing and snowboarding was similar to that of other countries. Knee injuries constituted nearly one third of all cases. 8% of injuries involved the ski lift machinery. 31% of casualties underwent radiographic examination, 17% needed hospital referral and 7% required admission to hospital. The management of acute ski injuries can be performed effectively in the primary care setting. It has significant benefits in rural areas by rationalising the use of ambulance and hospital services.
The Effect of Methadone Prescribing in a Clinic Setting on the Criminal Activity of Drug Users
Authors: Bates M. , Pemberton D.A.
Published: January 2017

The objective was to examine the impact of clinic attendance and methadone prescribing on drug user criminality. Fifty-four consecutive attenders at a Drug Problem Clinic were interviewed by questionnaire. An objective assessment of the criminality on 49(91%) of the above was made by examining their conviction details, before and after clinic attendance. Seventy-seven per cent strongly agreed that fewer criminal charges had been preferred since attendance at the clinic had begun and drugs prescribed. No statistically significant difference was found in the conviction numbers for the group as a whole: mean 3.9 (before) to 3.2 (after): p=0.24, or for the females in particular: mean 2.8 (before) to 5.9 (after): p=0.97. There was, however, a significant drop in the number of convictions amongst the males: mean 4.3 (before) to 2.5 (after): p=0 02. This study confirms an association between methadone maintenance therapy in a clinic setting and a reduction in criminality amongst males.
Epidemiology and Awareness of Malaria in the Lothians
Authors: Wilkins H. , Welsby P.D.
Published: January 2017

Awareness of malaria and its presentation could be improved. Awareness of symptoms, incubation periods and route of transmission was poor, as was compliance with prophylaxis. The mean difference between the time to admission and the time to presentation was 2.9 days which reflects medical rather than patient associated delay.
Information about Antimalarial Chemoprophylaxis in Hospitalised Patients — Is it Adequate?
Authors: Nathwani D. , Spiteri J
Published: January 2017

Malaria remains a huge public health problem worldwide, with over 100 million new cases annually, causing one to two million deaths.1 This global problem spills over into the UK, with around 2000 cases of reported annually.2 The proportion of infections due to Plasmodium falciparum (PF) continues to increase and worse still accounts for five to 12 deaths per year.

In 1992, Nathwani et al reported the 10 year experience of malaria cases admitted to the Regional Infection Unit, in Aberdeen, Scotland-the “Oil Capital”.3 This study was of interest in that 46% of those British residents who acquired infection had travelled to West or Central Africa on oil related business. The Oil boom of the 1980‘ s appeared to very much centred around Aberdeen and the neighbouring hinterland but did not appear to extend to Dundee which was only 60 miles further down the North-East coast. We, therefore, carried out a retrospective study of patients with malaria admitted to the Regional Infectious Diseases Unit in Dundee over a fifteen year period between 1980 and 1994.
Serum Ferritin: It May Guide the Diagnosis of the Anaemic Patient
Authors: Smith A.D. , Cochran K.M.
Published: January 2017

Crohn's disease is often complicated by anaemia. Assessment of iron deficiency may be hampered by modification of the serum ferritin concentration because of the associated acute phase response when disease is active. However a ferritin value of<5 ug/L is indicative of iron deficiency, which is rarely found in Crohns disease.
On Being a Medical Student in the 1930s
Authors: Girdwood R. H.
Published: January 2017

From a Minute Book which has survived the years, an account is given of matters discussed by the Clinical Medicine Board of the Royal Infirmary of Edinburgh in the 1930s. This Board consisted of the senior physicians in the hospital and the records give an indication of the excessively large number of students who were all having their clinical experience in the wards of the one hospital. In addition to the University students there were others studying for the Triple Qualification of the Royal Colleges. The pressure of this teaching on staff and patients was considerable. It was decided to transfer some of the tuition to Craigleith Hospital which became the Western General.

In 1939 the male house doctors were awaiting their call-up. The administrators had to consider arrangements for the continuation of teaching if bombing took place. In March 1941 the Polish Medical School was organised in Edinburgh
Neutralising IL-12 Activity as a Strategy for Prolonging Allograft Survival and Preventing Graft-Versus-Host Disease
Authors: Orr D.J. , Bolton E.M. , Bradley J.A.
Published: January 2017

Interleukin-12 (IL-12) is a key immunoregulatory cytokine which promotes the development of Thl-dependent, cell-mediated immune responses. Acute allograft rejection after organ transplantation and acute graft-versus-host disease (G VHD) after bone-marrow transplantation are generally attributed to cell-mediated immune mechanisms and, therefore, potentially susceptible to immunological intervention at the level of IL-12. Recent data from murine models of transplantation have highlighted the potential of IL-12 as a selective target for immunotherapy. Neutralising endogenous IL-12 for a brief period at the time of transplant promotes long-term deviation from a Thl to a polarised Th2 alloimmune response. This confers lasting protection from GVHD but is less effective at preventing acute rejection, possibly because Th2-dependent immune responses are also capable of effecting graft rejection.
Is the Increase in Asthma Prevalence Occurring in Children without a Family History of Atopy?
Authors: Christie G.L. , McDougall C.M. , Helms P J
Published: January 2017

We investigated the familial associations of asthma and atopic disease in a population in which the prevalence of asthma and atopy is increasing. Interviewer administered abbreviated family history questionnaires were applied in 416 families with a total of 1005 children ascertained through index children attending fracture and dressing clinics. The prevalence of reported asthma (22.5%), eczema (24%) and hay fever (20%) in the children was high but similar to previous studies in this population. Asthma was reported in 20.8% of children of parents without a history of asthma and 18% of children of parents without any history of atopic disease. Logistic regression analysis of outcomes in the index children showed increased risk of atopic disease associated with parental history of the same atopic disease. The presence of an affected sibling was associated with an increased risk of eczema (OR 3.04 CI 1.83–5.05) or hayfever (OR 1.79 CI 0.97–3.3) but not asthma (OR 1.18 CI 0.66–2.08). Increasing number of siblings was associated with reduced risk although this was significant only for hayfever (OR 0.62 CI 0.41–0.86). Although the presence of affected relatives is associated with an increased risk of atopic disease the high prevalence of reported atopic disease, particularly asthma. in children of parents without a family history of atopic disease suggests that much of the increase in asthma prevalence is occurring in children without a significant genetic predisposition. Childhood asthma developing in what would previously have been regarded as low risk families may differ in its aetiology from classical atopic asthma.
Emergency Psychiatric Detentions: Inter Regional Comparison of Sections 24 and 25 of the Mental Health (Scotland) Act 1984
Authors: Stevenson G.S.
Published: January 2017

There are few published studies examining the emergency compulsory admission of patients to hospital under sections 24 and 25 of the Mental Health (Scotland) Act 1984. This retrospective casenote study reviewed 200 casenotes in Fife and Edinburgh to investigate the type of patients detained by general practitioners (GPs) and psychiatrists, in neighbouring health regions in which emergency psychiatric service provision differs. There were significant differences between the patients so detained, with regard to demographic variables and outcome of detention, but not for diagnoses. These were consistent findings for the two health regions investigated. There was evidence of mis-application of the ‘emergency recommendations’. Situational factors are important in the decision to detain a person. Differences in psychiatric provision in the community may have an influence on the outcome of these detentions. Further studies would help to further define these variables. (These data formed part of an M. Phil thesis sbmission, granted by Edinburgh University in 1997)
Right Heart Failure as the Dominant Clinical Picture in a Case of Primary Amyloidosis Affecting the Pulmonary Vasculature
Authors: Chapman A. D. , Brown P.A.J. , Kerr K.M.
Published: January 2017

A 91-year-old female patient died of right heart failure and pulmonary hypertension. The autopsy revealed multi-organ vascular amyloidosis and pulmonary alveolar septal amyloidosis with no evidence of parenchymal myocardial amyloid deposition. This is a rare example of cor pulmonale secondary to pulmonary amyloidosis.
Needle Heating during High-Speed Sewing
Authors: Hersh S. P. , Grady P. L.
Published: January 2017

A review of the literature and extensive field interviews have been conducted on the subject of needle heating in high-speed sewing. As a result of this investigation, a survey of the current state of the art and knowledge available in the field has been completed and is presented in the following categories: (1) the nature of the problem and the difficulties which arise in commercial operations; (2) quantitative methods of measuring needle temperatures; (3) the influence of machine factors such as sewing speed, length of sewing time, and needle design on the heat generated during sewing; (4) the influence of material factors such as fabric structure and finish, layers of fabric, and sewing thread on needle heating; (5) techniques for alleviating needle heating problems; and (6) the mechanism of generation and dissipation of heat in the sewing process. Some heretofore unpublished data are presented.
The Iodometric Determination of P(III) in Flame Retardants for Cotton
Authors: Frank Arlen W. , Vail Sidney L.
Published: January 2017

Three iodometric methods have been investigated for the determination of P(III) in cotton fabrics finished with THPOH/ammonia resins. The iodine method developed previously for Thpc/amide resins gives P(III) values that are much too high. The iodate method gives P(III) values that are too low or too high, depending on whether the cotton substrate is present or absent during the titration of the excess iodate. The preferred method is the peroxide method, which gives P(III) values that do not, within the limits of experimental error, vary with time or disposition of the cotton substrate. When applied to Thpc/amide resins, the peroxide method shows good agreement with the iodine method. The behavior of key resin precursors toward these oxidants has also been investigated.