bluuebunny/crossref_metadata_2025 huggingface dataset:
Course, Management and Outcome of Oral-Anticoagulant-Related Intracranial Haemorrhages
Authors: Berwaerts J. , Robb O. J. , Dykhuizen R. S. , Webster J.
Published: January 2017

The aim of this study was to compare the clinical course and radiological features of oral anticoagulant (OAC)-related intracranial haemorrhages with those of haemorrhages unrelated to OAC use admitted over the last six years to a tertiary care centre in the North of Scotland. We furthermore wished to determine the measures taken for reversal of OAC therapy and the resulting short-term outcome. Sixty-eight patients had been treated with OACs at the time of intracranial haemorrhage (32% subdural, 62% intracerebral). Patients admitted with OAC-related and unrelated haemorrhages did not differ significantly in any of the clinical features considered. On CT scan, there was no significant difference according to OAC use in the mean size of subdural (depth 15 ± 5 vs. 18 ±8mm, p=0.36), or intracerebral haematomas (max. diameter 40 ±21 vs. 41 ±20 mm, p=0.73). No reversal measures were taken in 38% of OAC-treated patients. In-hospital mortality was significantly higher for OAC-related haemorrhages compared to unrelated haemorrhages (38% vs. 18%), p=0.001). To further elucidate the effects of anticoagulant reversal on the outcome of OAC-related intracranial haemorrhages, a large-scale prospective study is warranted.
Effects of Growth Hormone Treatment on Red Cell Plasma Membrane Fatty Acid Constituents in Hypopituitary Adults
Authors: Leese G.P. , Nicoll D. , Jung R.T. , Gallacher C. , Ross P.
Published: January 2017

The effects of replacement with recombinant human GH (hGH) on red cell plasma membrane fatty acid and cholesterol constituents were assessed in nine adult patients with growth hormone deficiency. They were treated with hGH in a dose of 0.125U.kg−1.wk−1 for four weeks and at 0.25 U.kg1.wk−1 thereafter foran overall mean duration 13.5 ±3.9 months (mean ±SD). The relative proportions of the various phospholipid fatty acid constituents and the proportion of cholesterol in the phospholipid bilayer were assayed every six months. At the end of the study, the percentage of arachadonic acid (20:4) in membrane phospholipid was found to rise by an average of 3.7% (P<0.05) and there appeared to be a nonsignificant trend showing an increase in highly unsaturated fatty acids, namely linoleate (18:2) and gamma linolenic acid (18:3) and a corresponding decrease in unsaturated fatty acids, namely palmitate (16:0) and stearate (18:0) and monounsaturated fatty acids such as palmitoleic acid (16:1), oleic acid (18:1) and oleic acid isomer (18:1 iso). In addition, the proportion of cholesterol in the plasma membrane i.e. the cholesterol/phospholipid ratio was found to decrease by 0.84% (P<0.05). There was a significant increase in HbAlc from 4.85 +/- 0.51 to 4.94 +/- 0.45% (P<0.01) by the end of the study.
Lifestyle Influences on Outcome in Rheumatoid Arthritis
Authors: Hamilton J.D. , Thomson E.A. , Porter D. , Hunter J.A. , Madhok R. , Capell H.A.
Published: January 2017

Functional status in rheumatoid arthritis (RA) as assessed by the HAQ is poorer in the West of Scotland than the USA or elsewhere. There is a possible link with social deprivation, which is common within the Greater Glasgow Healthboard area. Our aim was to determine if differences in lifestyle could contribute to the poorer functional outcome found in socially deprived patients.
Nintendonitis? a Case Report of Repetitive Strain Injury in a Child as a Result of Playing Computer Games
Authors: Macgregor D. M.
Published: January 2017

Repetitive strain injury is a common occupational hazard but has not been previously reported in a child. With the escalating use of computers both in the home for recreational purposes and in schools for teaching, the possible incidence of hand and wrist problems may need to be highlighted. Perhaps “hand care” instruction should be implemented in UK schools as prophylaxis.
Empyema of Lung Associated with Streptococcus Milleri Infection
Authors: Palaniappan S. , MacWalter R.S. , Winter J.H. , McGuire B. K. , Benzie A.
Published: January 2017

Empyema of the lung is a very serious illness which must be detected quickly and treated aggressively. We report an unusual case of empyema of the lung associated with a boating accident while the patient was fishing in a sea loch off the west coast of Scotland.
Issues Facing TB Control (5.1) (a) Diagnostic Issues: Laboratory Diagnosis of Tuberculosis Present Techniques
Authors: Watt Brian
Published: January 2017

This paper will briefly review conventional (ie. non-molecular) techniques for the laboratory diagnosis of tuberculosis; the use of molecular technology in laboratory diagnosis will be dealt with elsewhere, as will the problems of applying diagnostic facilities in developing countries.
Improving the Physical Health of Patients with Schizophrenia: Therapeutic Nihilism or Realism?
Authors: Fevre P. D. Le
Published: January 2017

Schizophrenia is associated with a raised mortality due to both an increase in suicide and factors related to poor physical health. The increased rates of gastrointestinal, respiratory and cardiovascular disease in this population are likely to be due to high rates of smoking and obesity accompanied by a poor diet, lack of exercise and the side effects of medication. The evidence suggests that such risk factors in the schizophrenic population are largely ignored by the medical profession. Research to date has failed to address the health needs of this vulnerable population. Systematic research, with the aim of assessing the potential benefits of health improvement measures, should be a matter of priority.
Post Exertional Broad Complex Tachycardia in a Normotensive Patient: A Rare Presentation of Phaeochromocytoma
Authors: Tzemos N. , McNeill G.P. , Jung R.T. , MacDonald T.M.
Published: January 2017

Phaechromocytomas are rare cause of secondary hypertension with significant morbidity and mortality, if left untreated. Paroxysms with hypertension are considered as “textbook” presentations but atypical forms represent considerable diagnostic challenge. We report an unusual association between phaechromocyotoma and post-exertional malignant arrhythmia in a normotensive subject.
An Unusual Cause of Calf Pain
Authors: Aujla K. , Ferguson J.
Published: January 2017

Popliteal artery entrapment syndrome is an unusual presentation of calf pain to an accident and emergency department. We report the case of a 36-year-old man presenting with left calf pain and investigations confirmed the diagnosis of popliteal artery entrapment syndrome. A&E doctors should consider this diagnosis in their differential diagnoses for calf pain in younger patients particularly when obvious trauma is absent.
“And Afterwards Your Body to be Given for Public Dissection”: A History of the Murderers Dissected in Glasgow and the West of Scotland
Authors: Kennedy S. S. , McLeod K.J. , McDonald S.W.
Published: January 2017

Between 1752 and 1832, the bodies of hanged murderers were dissected or gibbeted. During this period, 38 murderers were executed in the West of Scotland. The bodies of at least 23 were dissected in Glasgow. The stories of these murders are recounted. Insight is also given into the attitudes of the public and the anatomists to dissection of executed murderers.
Sudden Unexpected Infant Deaths in Dundee, 1882–1891: Overlying or Sids?
Authors: Williams F.L.R. , Lang G.A. , Mage D.T.
Published: January 2017

Using a cohort study of all deaths in infants under 12 months in Dundee bom between 1882–91 we set out to compare the aetiology of sudden unexpected infant deaths in Dundee at the end of the 19th Century with the aetiology of present day Sudden Infant Death Syndrome (SIDS). During. 1882–1891, 361 infants died suddenly and unexpectedly and without obvious cause while in bed with their parents. The sex ratio of deaths was even (0.51 male) whereas the typical male fraction of SIDS today is 0.61. The mean age at death was almost two and one-half weeks younger in the Dundee cohort than for SIDS in modern Scotland. The infants in the Dundee cohort were discovered more frequently early in the morning than is typical. Their social class distribution was different in that no overlying cases were found in the higher classes whereas SIDS affects all classes. The overlying rate for illegitimate infants was lower than that reported for SIDS today. The epidemiological characteristics of the Dundee cohort and of those dying from present day SIDS differ considerably. The Dundee cohort apparently died from overlying rather than from SIDS as it is classified today. Present day advice that co-sleeping is safe should be given more cautiously until the safety of co-sleeping is resolved. It might be prudent to inform parents that co-sleeping is a risk factor for SIDS and that it should therefore be avoided.
Not the Usual Cause of Superior Vena Cava Obstruction
Authors: Jamieson A. , Ingham D.G. , Dominiczak A.F. , Connell J.M.C.
Published: January 2017

Superior vena cava obstruction has a classical association with bronchial carcinoma. In the presence of Cortisol excess, the diagnosis of small-cell carcinoma and ectopic ACTH production seems likely We present a case where the clinical features did not accurately reflect the underlying pathology.
Reputation and the Legibility of Doctors' Handwriting in Situ
Authors: Cheeseman GA , Boon N
Published: January 2017

The consequences of failed communication can be as disastrous and doctors have a reputation for illegibility. Previous research supports this opinion but little work has been done to assess doctors' legibility in situ. Our study evaluates if doctors deserve their reputation and investigates how legibility is affected by the time taken to write. Sets of in-patient hospital notes were selected at random. The first written entry by a doctor and a nurse in the current admission were analysed. In addition to this, 10 doctors and 10 nurses, unaware of the true nature of the study, wrote out lists of words and the time taken to do the task was recorded. The doctors' handwriting was significantly less legible (p=0.010) and they wrote significantly quicker (p=0.005). However a small minority of the doctors was responsible for the majority of illegible words written by that group.
Playing the Waiting Game … The Asymptomatic Patient with Recurrent Ovarian Cancer Detected Only by Rising Ca125 Levels
Authors: Fleming LW
Published: January 2017

The recurrence of ovarian cancer is usually heralded by an increase in the blood level of the tumour marker Ca125 but most oncologists are reluctant to initiate second-line chemotherapy before there is clinical or radiological evidence in addition to the increasing tumour marker. Thus patients have to spend an indefinite period of time, which can be as long as a year or more, knowing that their cancer has returned, but that treatment will be delayed until they have symptoms. For patients, this situation requires a change of outlook and an abandonment of the idea that early treatment is the best option. A dilemma exists for both oncologists and patients over the best time to begin aggressive treatment in this situation. This article explores some of the arguments for and against early treatment, in the hope that it might provide some insight into patients' concerns, and help patients to enjoy their symptom-free and treatment-free period of recurrence with some measure of tranquillity.
Free Wall Rupture following Rescue Angioplasty and Intravenous Abciximab for Failed Thrombolysis
Authors: Balachandran K P , Oldroyd K G
Published: January 2017

Early thrombolytic therapy reduces the risk of cardiac rupture but delayed thrombolysis may increase this risk, despite improving overall survival. The mechanism appears to be related to both unsuccessful early reperfusion and haemorrhagic transformation following delayed reperfusion. The effect of antiplatelet therapy with glycoprotein Ilb-llla receptor blockers (abciximab) on cardiac rupture is unknown. It is possible that they may contribute to cardiac rupture by promoting haemorrhagic transformation of the infarcted area. In this report we describe a 57 year old man who underwent emergency coronary angioplasty and stenting following failed thrombolytic therapy for an acute anterior myocardial infarction. A suboptimal result was obtained which necessitated an intravenous bolus of abciximab followed by an infusion. He abruptly developed electromechanical dissociation. Echocardiogram confirmed pericardial tamponade and a pericardial drain was inserted but the patient could not be resuscitated. Postmortem examination confirmed a large transmural rupture of the infarcted anterior wall which had undergone haemorrhagic transformation.
Changes in Patterns of Acute Medical Receiving in Scotland 1996 to 2001
Authors: Dorward A.
Published: January 2017

The purpose of this study was to review changes in working practises of physicians and hospitals from 1996 to 2001 in the light of rising medical admissions and published reports into the organisation of acute admissions. Information was gathered by direct discussion with the appropriate lead doctor for each hospital's acute service in February 2001. The results were compared with a previously published study, which recorded the situation as of October 1996.

The hospitals which were studied were the twenty seven Scottish hospitals which admit more than 3000 acute medical patients each year. There has been a 25% increase in number of consultants carrying out receiving duties. Nearly all hospitals now have an acute admission unit. Four hospitals have appointed acute care physicians. Triage of appropriate patients to more specialised ward based care has increased. There has been a rise in geriatricians involvement in acute receiving from four to fifteen hospitals. New developments include early discharge for chronic obstructive airway disease, outpatient management of venous thrombosis, discharge planning and streamlining investigation of chest pain. Two hospitals have specific alcohol support services. There continues to be progress and changes within medical and geriatric services over the last five years stimulated by the continuing rise in number of medical admissions.
Robert Halliday Gunning and the Victoria Jubilee Prizes
Authors: Baillie T W
Published: January 2017

More than a century after the death of Robert Halliday Gunning, a large number of lectureships and prizes bearing his name continue to be awarded by scientific bodies and learned institutions in Scotland. Most of these awards were endowed in HM Queen Victoria s Jubilee year (1887–88) and bear the additional qualification ‘Victoria Jubilee’. An account of the life of Robert Gunning and his various endowments is complemented by an analysis of the factors which determined the nature of his benefactions.
Near Patient Monitoring of Anticoagulant Therapy in General Practice
Authors: Goudie B M , Danskin K L , Al-Agilly S S , Fairfield G , Cunningham A D , McGrego J E , Cachia P G
Published: January 2017

Background and aims: New systems for monitoring anticoagulation in routine clinical practice should be evaluated to inform future service development. The aim of this study was to investigate the workload, patient characteristics and bleeding complications in a nurse run, near patient monitoring service serving a population of 23,368. Methods: Retrospective review of coagulometer and general practice case records. Results: Between 1995 and 2000 workload increased from 154 to 269 consultations per month. Three hundred and forty four patients were followed up during a cumulative period of 664.8 years. The 8 week period prevalence of anticoagulation was 8.6 per thousand patients at the close of the study. The median age at enrolment was 71 years. Eighteen per cent of treatment episodes were started when patients were 80 years or older. The most common indication was non rheumatic atrial fibrillation (NRAF) in 51% of treatment episodes. During the study 49.6% [95% confidence interval (CI) 47.8%–50.6%] of international normalised ratio (INR) tests were within target range and INR was estimated to be within the target range 62% (95% CI 61.8%–62.2%) of the time. INR control varied markedly between individual patients. There were 4 fatal bleeding events (0.6 per hundred patient years) and 14 major bleeding events (2.1/hundred patient years). Conclusion: Demand for anticoagulant therapy with warfarin has increased substantially. Service development is required to ensure that appropriately selected patients have access to adequately resourced monitoring which promotes optimum INR control and a minimum of bleeding complications.
Four-Year Prospective Audit of Tonsillectomy Practice in Argyll and Clyde
Authors: Robertson A , Wallace B , White A
Published: January 2017

Abstract Objective: To assess the practice of tonsillectomy in Inverclyde and Renfrewshire area of Argyll and Clyde Health Board. Design: an audit Setting: Royal Alexandra Hospital, Paisley Subjects: all patients undergoing tonsillectomy were prospectively audited over a four year period. Information audited included: age, sex, length of stay, operator grade, complications, readmissions and prophylactic antibiotic use. Results: 1582 cases were audited. 64% were women. The mean age of the patients was 16.76% of patients were discharged on the first post operative day. The majority of operations were carried out by staff grades and associate specialists. The primary complication rate was very low (1.33%). 3% of patients were readmitted, mostly because of secondary haemorrhage. Prophylactic post operative antibiotics were used in 39% of cases. Conclusions: it is safe to discharge patients on the first day post tonsillectomy, even if they live some distance from the hospital. Prophylactic post operative antibiotic use does not decrease the rate of readmission. Tonsillectomy is carried out safely in Argyll and Clyde.
Prospective Audit of the Management of Head Injuries in a Small District General Hospital
Authors: Stewart D A , Finn P J
Published: January 2017

Abstract Background and Aims: In September 2000 the Scottish Intercollegiate Guidelines Network published their recommendations on the optimal early management of head injured patients. Early identification of significant intracranial pathology through CT scanning is central to these guidelines. At our small DGH, head injured patients are received and managed by general surgeons with no specific training in head trauma. In addition, there is as yet no arrangement in place for urgent CT scanning. Because of these factors, an audit was conducted to determine the extent to which we were able to comply with these guidelines. Methods.: A 2 month prospective audit of the management of head injured patients was carried out collecting data on patient demographics, clinical condition on admission, clinical course, radiological investigations (and difficulty in arranging them) and outcome. Results: Over the 2 month period 52 consecutive patients were studied. Fifteen patients met criteria for CT scanning, of which 9 were ultimately scanned. Tellingly, only one of the fifteen received their scan within the recommended four hour period. In this series, no patient had an adverse clinical event related to delay in scanning. Conclusion: Any hospital admitting head injured patients should have 24 hour access to CT scanning facilities. If such an arrangement is not in place then patients with head injuries should not be admitted to that hospital.
The Chain Saw - A Scottish Invention
Authors: Skippen M , Kirkup J , Maxton R M , McDonald S W
Published: January 2017

The prototype of the chain saw familiar today in the timber industry was pioneered in the late 18th Century by two Scottish doctors, John Airken and James Jeffray, for symphysiotomy and excision of diseased bone respectively. The chain hand saw, a fine serrated link chain which cut on the concave side, was invented around 1783–1785. It was illustrated in Aitken's Principles of Midwifery or Puerperal Medicine (1785) and used by him in his dissecting room. Jeffray claimed to have conceived the idea of the chain saw independently about that time but it was 1790 before he was able to have it produced. In 1806, Jeffray published Cases of the Excision of Carious Joints by H. Park and P. F. Moreau with Observations by James Jeffray M. D. In this communication he translated Moreau's paper of 1803. Park and Moreau described successful excision of diseased joints, particularly the knee and elbow. Jeffray explained that the chain saw would allow a smaller wound and protect the adjacent neurovascular bundle. While a heroic concept, symphysiotomy had too many complications for most obstetricians but Jeffray's ideas became accepted, especially after the development of anaesthetics. Mechanised versions of the chain saw were developed but, in the later 19th Century, it was superseded in surgery by the Gigli twisted wire saw. For much of the 19th Century, however, the chain saw was a useful surgical instrument.
A Costed Profile Audit of the Surgical Management of Female Stress Incontinence
Authors: Tierney J P , Robins J B , Anthony G S , Bjornsson S , Orr G
Published: January 2017

Background and aims: To conduct a profile audit of three surgical treatments for urinary stress incontinence through the application of an episode costing process. Methods: Four stage methodology: (1) construction or a profile of care for each of the surgical approaches (setting the standard); 2) calculation of a theoretical profile cost; (3) calculation of the observed costs from real patient episodes; (4) comparison of observed costs with profile costs, (comparing present practice with established standard). Results: Profiles of care were constructed and compared with 39 actual in~patient episodes. Tension free vaginal tape (TVT™ Gynecare) is the cheapest modality of treatment in terms of both the expected profile cost and also observed (real patient) cost. Colposuspension is the most expensive form of treatment with real costs significantly greater than the expected profile. Clinical issues such as length of stay, duration of surgery, patient selection and complication rates were revealed through the exception reporting process. Length of stay is the main determinant of overall cost. Conclusion: It is possible to construct a costed and auditable standard of care for a surgical procedure. This standard can be compared with real patient costs calculated using the same methodology. Exception reporting based on differences between expected and real costs can be used to facilitate the audit of clinical practice. The technique is limited, however, by the need to collect accurate and detailed activity data.
Helicobacter Pylori in Children is Strongly Associated with Poverty
Authors: Malcolm C A , MacKay W G , Shepherd A , Weaver L T
Published: January 2017

Background and Aims: To examine the association between prevalence of H. pylori colonisation and social deprivation in a sample of children investigated in hospital. Methods: A retrospective review of the hospital records of all children (n = 626) who underwent 13C-urea breath testing for suspected H. pylori infection at the Royal Hospital for Sick Children, Glasgow, Scotland between August 1995 to December 2002 was performed. Prevalence of H. pylori colonisation was measured by the 13C-urea breath test and socioeconomic status was measured by the Carstairs and Morris index of deprivation. Results: The overall prevalence of H. pylori was 26%. There was a highly significant positive association between H. pylori colonisation and poor socioeconomic status (p < 0.0001). The prevalence of colonisation was significantly higher in children from the most deprived areas (DepCat 6 and 7; 34%) compared to children from intermediate (DepCat 3 to 5; 22%) and the most affluent areas (DepCat 1 and 2; 16%) (p < 0.0001). Conclusions: Socioeconomic deprivation in childhood is associated with a high prevalence of H. pylori colonisation. While the incidence of H. pylori may be declining, it remains common in poor families. If the prevalence of H. pylori (26%) in this selected group reflects that of the population at large, then over gooo (5%) of Glasgow's children are at risk of this preventable disease. In a city where the majority of adults are colonised with H. pylori, colonisation in early life adds to the burden of health risks to which deprived children are exposed.
Suspending Tonsillectomy: The Effects on Primary and Secondary Acute Care in Scotland
Authors: Mehanna H , Rejali D , Murray A
Published: January 2017

For the first six months of 2001, tonsillectomy operations were effectively suspended in Scotland. This was due to concern regarding the potential transmission of vCJD prions by surgical instruments, and the subsequent gradual introduction of disposable instruments. The number of patients awaiting tonsillectomy therefore increased and theoretically there should have been an increase in the number of tonsillitis episodes in the community, or even in the number of tonsillitis-related complications seen in secondary care. We examined for these effects using available national data sources which record primary and secondary care activity. No increases in the incidences of acute tonsillitis or tonsillitis-related complications were found for this period. The reasons and implications are discussed.
Human Skeletal Allograft Collection — Room for Improvement?
Authors: Holt G , Arthur A , Frame D , Muirhead A
Published: January 2017

Aim: To assess the efficiency of skeletal allograft collection from patients undergoing primary joint arthroplasty at a District General Orthopaedic Unit. Methods: A two cycle audit was performed. Between cycles procedural changes were implemented to improve the efficiency of allograft collection. The discard rate of donated allograft was also assessed during each cycle. Results: Initially 80 patients were identified. Eight (8/80) did not donate allograft due to medical contraindications. Two (2/80) patients underwent intra-operative autologous born grafting. Allograft was not collected from 22 (22/70) suitable patients. As such only 68.6% of suitable bone was collected by the West of Scotland Blood Transfusion Service (WSBTS). Subsequently 100 patients were studied. Twenty-eight (28/100) patients did not donate allograft due to medical contra-indications. Two (2/100) patients underwent intra-operative autologous bone grafting. Eight (8/70) allografts were discarded as a result of logistical problems. As such 88.9% of suitable allograft was collected. Initially 29% of all allograft donated was rejected due to poor patient selection. This subsequently fell to 9.4%. Conclusion: By auditing the collection process a significant improvement (c2 = 7.17 df = 1 p = 0.001) in the efficiency of allograft collection was achieved. This was complemented by a significant reduction(c2 = 6.09 df= 1 p=0.05) in the proportion of unsuitable allograft donated to the WSBTS.
Improving Thromboprophylaxis in Elderly Patients with Non-Valvular Atrial Fibrillation
Authors: Lowdon D W , Harper J R , Gillespie N D
Published: January 2017

Background: Non-valvular atrial fibrillation (NVAF) is more common in elderly people, and is one of the most powerful independent risk factors predisposing to stroke. This risk increases with age. Despite evidence that full dose anticoagulation reduces this risk, and Scottish Intercollegiate Guidelines, warfarin is still being under prescribed, especially in elderly individuals. Objectives: To audit warfarin prescribing in elderly hospital patients with NVAF, and assess whether audit feedback and evidence based guidelines improved warfarin usage. Methods: Discharge summaries and medical notes were reviewed, and warfarin prescribing identified, for all patients with NVAF discharged from the Medicine for the Elderly Department between January 2001 and December 2002. This was done before (16 months) and after (7 months) audit results were presented at a departmental meeting, and evidence based guidelines were produced. Results: Warfarin prescribing significantly increased from 38/121 (31.4%) prior to audit feedback and the introduction of guidelines to 30/55 (54.5%), Chi2—test, p<0.01 Conclusions: Older patients with NVAF were under prescribed warfarin. Audit feedback and the introduction of evidence based guidelines significantly increased anticoagulation usage.
One-Stop Postmenopausal Bleeding Clinics Reduce Patient Waiting Times and Theatre Costs
Authors: Sulaiman S , Chong K Wei , Gaudoin M
Published: January 2017

Background. Postmenopausal bleeding (PMB) is a common problem and reason for referral to gynaecology clinics. Aims. The aim of this study was to compare patient management and outcomes from a newly developed one-stop clinic for women with PMB with traditional gynaecology outpatient clinics. Methods. Retrospective studying running from January to July 2003 comparing the one-stop clinic with four traditional consultant-led outpatient gynaecology clinics also seeing women with PMB running concurrently in the same hospital. Results. In the study period, 95 and 51 women were seen in each type of clinic. There was no difference in patient demographics but the time from referral to first consultation was shorter in the PMB clinic (p<0.001) and women had fewer visits (p<0.001). The mean time from first consultation to definitive treatment or discharge was also shorter (p<0.001). Fewer hysteroscopies were generated from the PMB clinic (p<0.001) and yet there was no difference in the rates of abnormal histology between the two groups. Conclusions. This study demonstrated that one-stop investigation of PMB, compared to traditional outpatient clinics, reduced waiting times and theatre costs by reducing the number of hysteroscopies.
Hashimoto's Encephalopathy Presenting as an Acute Medical Emergency
Authors: Sommerfield A J , Stimson R , Campbell IW
Published: January 2017

Three cases are described of a reversible encephalopathy, all presenting with marked neurological disturbance. In all three, the diagnosis was not clear at the time of presentation but eventually it was felt all of the cases were consistent with Hashimoto's encephalopathy. The diagnosis of Hashimoto's encephalopathy should be considered in any case of unexplained encephalopathy. Common features are high anti-thyroid peroxidase antibody titres, an abnormal EEC and an elevated CSF protein concentration. The encephalopathy is independent of thyroid hormonal status. Treatment with corticosteroids leads to a prompt resolution of symptoms and long term low dose steroid therapy prevents further neurological recurrence
Small Bowel Obstruction in a Twin Pregnancy Due to Fibroid Degeneration
Authors: Macdonald D J M , Popli K , Byrne D , Hanretty K
Published: January 2017

Small bowel obstruction in pregnancy is unusual. It is a difficult diagnosis to make, as vomiting and abdominal distension are commonly associated with pregnancy, and x-rays are avoided if possible. We present a case of small bowel obstruction caused by uterine fibroid degeneration in a 37 year old with a twin pregnancy. Following a period of observation an x-ray was performed which prompted surgical exploration, relief of the obstruction and myomectomy. This case highlights that x-ray is essential if there is a clinical suspicion of small bowel obstruction in pregnancy as delay in diagnosis can be catastrophic. As childbearing is increasingly delayed into later life it is possible that pregnancy complicated by fibroids will be seen more frequently.
Hiatus Hernia
Authors: Walbaum P. R. , McCormack R. J. M.
Published: January 2017

Hiatus hernia is a frequent cause of distressing symptoms. The present attitude to this condition is reviewed on the basis of reports in the literature and a personal series of 224 patients. Oesophagoscopy must be a routine part of investigation. There is a tendency to persevere too long with medical treatment. Hernia repair is a safe procedure even in the elderly and the results are good. Results of repair of para-oesophageal hernia are almost uniformly excellent and this type of hernia should always be treated surgically. Repair of sliding hernia should be advised if a few months of medical treatment fail to relieve symptoms or if oesophagitis is present, and good results can be expected in about 90 per cent of uncomplicated cases. When an oesophageal stricture has developed the results of hernia repair are less good but a good result is still achieved in 70 per cent of patients. A small proportion of patients with fibrous strictures require resection.
Hypovitaminosis C and Splenic Rupture
Authors: Morrison I. A. , Wosornu J. L.
Published: January 2017

Two cases of splenic rupture in patients with hypovitaminosis C are reported. In Case 1 the deficiency was dietary in origin; this patient also had pernicious anaemia with an associated thrombocytopenia. These 2 abnormalities are considered significant in predisposing to splenic rupture on minimal trauma. In Case 2, in which the vitamin C deficiency was due to dietary deficiency and to malabsorption following partial gastrectomy, the low leucocyte ascorbic acid was the only abnormality detected, and the splenic rupture was spontaneous. A splenectomy was carried out and at operation there was noted to be persistent oozing of blood from muscle and subcutaneous tissue, and post-operatively, from the wound.

It is suggested that in cases of spontaneous rupture of the spleen, as in any case of unexplained haemorrhage, the diagnosis of scurvy should be considered.
Mitral Valve Disease and Hypertension
Authors: Laurie H. C.
Published: January 2017

The case records of 187 patients with mitral valve disease were studied to assess whether hypertension occurred more commonly than in the general population and if so what mechanism might be involved.

Hypertension (diastolic pressure > 90 mm. Hg) was commoner in patients with mitral valve disease only in the presence of atrial fibrillation. Blood pressure values of those in sinus rhythm tended to be lower than those of the general population.

Mitral valvotomy was found to reduce the incidence of hypertension and peripheral embolism even in those with atrial fibrillation.

Post-mortem findings, although small in number, supported the evidence that renal infarction is associated with hypertension in those with mitral valve disease.

We suggest that these findings provide further evidence that hypertension in mitral valve disease results from renal emboli following atrial fibrillation.
Changing Paediatrics
Authors: Riley Ian D.
Published: January 2017

The changes in the types of disease admitted to a childrens' unit over a period of 18 years are reviewed. Tuberculosis and rheumatic fever declined whereas increases took place in renal infections, nocturnal enuresis, poisoning, congenital heart disease, coeliac disease, gastroenteritis and iron deficiency anaemia. The incidence of respiratory disease varied considerably from year to year.

The mortality during this period, fell from 8.7 per cent to 1.8 per cent.

The effect upon the demand for beds was to reduce the numbers required for older children but to increase those required for infants. This made much greater demands upon nursing staff.
The Haemolytic Uraemic Syndrome—An Epidemic Disease?
Authors: Ruthven I. S. , Fyfe W. M.
Published: January 2017

Six cases of the haemolytic uraemic syndrome occurring in the same district during a period of 27 months are described. No aetiological agent was identified. With symptomatic treatment four children recovered completely. Two children died, one after a fulminating illness lasting 6 days and the other after an illness lasting three months.
Experience with Off-Line Processing by Computer of Chemical Laboratory Data
Authors: Whitby L. G. , Proffitt J. , McMaster R. S.
Published: January 2017

This paper reviews experience extending over 18 months obtained with the Elliott Automatic Laboratory Analysis (A.L.A.) system, coupled with a Teletype link for communicating with a computer situated half-a-mile away. The system has been used for the off-line processing by an Elliott 803 computer of data collected from AutoAnalyzers carrying out urea and electrolyte determinations.

The A.L.A. equipment itself has proved reliable, apart from faults in the translator-timers occurring mostly during the first 3 months of routine operation, but the Teletype link has been subject to frequent breakdowns. The advantages of using the A.L.A. system of data-collection and computation have been confirmed, but disadvantages of this off-line system are discussed and reasons given why an on-line system of data-collection from AutoAnalyzers is preferred. The importance of reliable performance of laboratory data-acquisition and data-processing equipment in routine operation, and the need for good servicing arrangements, are stressed. The system described in this paper has been deficient in back-up servicing arrangements in respect of the A.L.A. equipment itself and of the Elliott 803 computer, but most of all in respect of the Teletype units.

Alphabetical coding patterns have proved of little value as a means of reducing the number of reports requiring detailed scrutiny, but they have served to draw attention to markedly abnormal results.
Serum Alkaline Phosphatase Levels in Infective Hepatitis
Authors: Knox J. D. E. , Reid D.
Published: January 2017

The level of the serum alkaline phosphatase showed a better correlation with the age of the patient than with the severity of the illness in a series of 222 patients suffering from infective hepatitis seen in general practice and in hospital. Possible reasons for this are discussed and it is suggested that this test is of practical diagnostic value to the general practitioner when he is faced with the problem of a vague gastro-intestinal illness in a child. Parallel estimations of the 5′ nucleotidase appears to be of value in the interpretation of the results in such patients. Alkaline phosphatase assay might also be of use in epidemiological investigations of this disease.
Teaching without Teachers an Audiovisual Method of Self-Instruction
Authors: Harden R. McG.
Published: January 2017

Thirty-five mm. slides linked with audio-tapes have been used as a method of self-instruction for undergraduate and post-graduate medical students. Impulses recorded on the second track of the tape, during playback, operate a relay which automatically changes the slides. The material can be used either with conventional projectors and taperecorders or with more sophisticated equipment in which projector, synchroniser, tape-recorder and daylight viewing screen are built into one case. The technique has many advantages. With experience material can be produced relatively easily and inexpensively. A good speaker can reach a wide audience and listeners can personally hear the views of experts. The use of sound plus vision has obvious advantages and corrections can be made to either sound or vision independently. Greater use will be made of self instructional aids in the future and more attention should be paid to relatively simple techniques such as the combination of audio-tapes with 35 mm. slides.
Mitral Valve Replacement
Authors: Reid J. M. , Barclay R. S. , Stevenson J. G. , Welsh T. M. , McSwan N.
Published: January 2017

A series of 78 patients with advanced mitral incompetence treated by mitral valve replacement with a Starr-Edwards prosthesis is reported. The overall early mortality was 24 (30.7 per cent) and a further 3 died later. The causes of these early and late deaths are fully analysed. Most occurred in the early part of the series, and there has been a dramatic decline in both mortality and morbidity in the later cases since adoption of continuous clamping of the ascending aorta during the period necessary for excising the valve and suturing the prosthesis in position. The average duration of aortic clamping has been 20 minutes. During the last year (1967) there have been only 5 deaths in 32 patients, representing a mortality of 15.6 per cent. It is emphasised that only patients who have severe incapacity due to mitral incompetence require operation, and neither age nor the degree of pulmonary vascular resistance is a bar to surgery. Advanced renal disease, generalised pulmonary emphysema, and recent myocardial infarction are the only three absolute contraindications.

The 54 survivors from operation have been closely supervised for periods varying from several months to as long as 4 years, and as mentioned above 3 have died during this time. The remaining 51 have shown a striking improvement in exercise tolerance, with reduction in heart size.

The various surgical procedures available for dealing with mitral incompetence are discussed. Plication of the valve would appear in our experience to be limited to a small number with non-calcific, mildly sclerotic, and only slightly distorted valves. Pig aortic heterografts or pulmonary autografts may offer scope in the future, but we contend that the Starr-Edwards ball-valve prosthesis, although admittedly not as yet ideal, is the best available at present. With the introduction of the latest modification of this valve (now marketed in Britain), thrombo-embolic phenomena should be reduced to a minimum.
Acute Intermittent Porphyria with Intestinal Perforation
Authors: Heggarty H. , Ferguson J. C.
Published: January 2017

A case is described of an acute surgical emergency, perforation of the sigmoid colon, in a patient with acute intermittent porphyria.
A Search for Sub-Clinical Rickets in Glasgow Children
Authors: Richards I. D. G. , Hamilton Frances M. W. , Taylor Elaine C. , Sweet Elizabeth M. , Bremner Eleanor , Price H.
Published: January 2017

Two random samples of Glasgow children aged 12 to 24 months were examined for clinical, biochemical and radiological evidence of subclinical rickets. No cases of florid rickets were discovered. One-third of the first sample studied (202 children) were estimated to be receiving less than 100 i.u. of vitamin D daily from all sources except sunshine. A poor dietary intake was most prevalent in the higher birth ranks and in social classes II and III (non-manual).

The mean serum alkaline phosphatase level was 20 K.A. units per 100 ml. (S.D. 8 units) and 11 per cent had levels of 25 K.A. units per 100 ml. or above. No reason, either dietary or clinical, was found which would account for these high levels.

Bone changes were observed in the wrist X-rays of about 9 per cent of children. They disappeared gradually with vitamin D therapy and there is some correlation with a raised alkaline phosphatase level and with tallness. They may be due to a relative insufficiency of vitamin D.

Serum alkaline phosphatase estimations and wrist radiography do not appear to be useful methods for estimating the prevalence of hypovitaminosis D in the community or as screening procedures in the detection of individual cases of subclinical rickets.
The Nonagenarians
Authors: Wigzell F. W.
Published: January 2017

Little is known of the state of health or of the social circumstances of nonagenarians in modern society. As a preliminary step their numbers and location have been described in a major Scottish city.
Avian Tuberculosis
Authors: Edmond E. , Keay A. J. , Wallace A.
Published: January 2017

A girl with cervical adenitis, from which Mycobacterium avium was isolated, and her brother with clinical and radiological evidence of pneumonia presumed to be due to the same organism, are presented. Both progressed satisfactorily after treatment with erythromycin.
Management and Organisation in Medical Care
Authors: Anderson Thomas
Published: January 2017

“ ‘Running a big business’, the Clerk to the Governors of St. Thomas's Hospital was once quoted as saying, ‘is a piece of cake compared with running a hospital’.”

Spencer, J.A. (1967). Management in Hospitals. London: Faber.
The Future of the Private Sector in the Health Services
Authors: Fife R. , Watt J. K.
Published: January 2017

A review of the future of the private sector in medical care is appropriate at this time. The finance involved in private medical care is at present a small fraction of the cost of the National Health Service, but the demand for it is increasing as judged by the rising membership of private insurance schemes. In this country, a shift of the balance in favour of private medical practice could have advantages to patient and doctor and to the National Health Service. The subjects of private health care and health insurance schemes require fresh and constructive thinking.
An Epidemiological Method to Improve Tuberculosis Control
Authors: Hawthorne V. M.
Published: January 2017

An account is given of the prevalence, incidence and decline of tuberculosis in Scotland with particular regard to the West.

It is concluded that there is still considerable morbidity from the disease as measured by a persisting annual attack rate of post-primary tuberculosis of 1 per thousand in Mantoux positive (5 to 20 mm. and exclusive of larger reactors) male and female schoolchildren aged 14 to 15 years with negative chest radiographs 1 year previously.

It is predicted that in 1975 there may still be 160 deaths and 927 new notifications of tuberculosis in Scotland, 460 of which could be detected by the mass radiography service.

A predictive epidemetric model is described whereby the annual radiological surveillance of 18,596 older residents of Paisley would be tested over two years in relation to tuberculin status at initial examination, as a method of intervening in the intergenerational cycle of infection.

If resources are available it is considered that the model is feasible and should be implemented without delay if the present epidemiological situation, particularly in regard to the attack rate in schoolchildren, is unchanged over the next 2 years.

If the model should prove successful then mass radiography resources could concentrate on the annual or bi-annual prophylactic radiological surveillance of older urban populations with positive reactions to tuberculin testing at or just before the critical age for change in tuberculin reactivity.
The Ecology of Drug-Resistant Tubercle Bacilli in Eastern Glasgow
Authors: Tinne J. E.
Published: January 2017

A study was made of cases of tuberculosis treated by chemotherapy in Eastern Glasgow between 1963 and 1968 which developed drug-resistant bacilli. The commonest resistance pattern was to the combination of 3 drugs—streptomycin, p-aminosalicylic acid (P.A.S.) and isoniazid in contrast to resistance to streptomycin alone which predominated 12 years ago. In strains from 6 patients no less than 6 drugs had become ineffective.

Experiments with Escherichia coli confirmed that the ‘high mutation rate’ in the presence of streptomycin, which is characteristic of other tuberculostatic drugs also, is attributable to predictable and progressive mutations.

Six examples are given where outbreaks of cross-infection by drug-resistant bacilli can be assumed.
Viral Meningitis
Authors: Gray J. A. , Moffat Margaret A. J. , Sangster G.
Published: January 2017

From a review of 530 patients with viral meningitis during a 10-year period, no new epidemiological features emerged. Mumps virus was responsible for 24 per cent of the infections and in 20 per cent of these no salivary swellings occurred. Good evidence incriminating a particular virus was found in only 20 per cent of the others.

The paucity of physical signs indicating a specific virus was confirmed; only 5 per cent had rashes and 1.5 per cent pleurodynia. A small number showed temporary encephalitic features, the proportion being higher in mumps infections. In this variety fever tended to be higher and the E.S.R. lower than in enteroviral infections.

The C.S.F. findings confirmed the mixed pleocytosis and the higher but more lymphocytic counts in mumps. Relatively few patients had normal C.S.F. findings within 2 weeks of onset and resolution appeared to be slower in mumps.
Recent Advances in Clinical Medicine
Authors: Goldberg A.
Published: January 2017

We had the problem of the five-year-old boy in the candy store—just too many interesting things to do!

Neil Armstrong, recalling his impressions on landing on the moon.