Scottish Medical Journal

Radiological and endoscopic shrinkage of the antrum of the stomach may occur in the elderly and following gastroenterostomy. We describe this in 18 subjects, of whom 17 had a gastroenterostomy with or without vagotomy. Shrinkage can appear within two years of operation and is usually associated with a well-functioning stoma. Reflux biliary gastritis occurred in almost all and in nine out often tested the acid secretion in response to pentagastrin was virtually nil. Dyspepsia and bile vomiting were frequent indications for endoscopy. No patient had jejunal ulceration. In the majority radiological interpretation was correct.

Continuous intra-arterial blood pressure recordings have been performed in 37 untreated ambulatory hypertensive subjects, who were investigated on an outpatient basis. Hourly data analysis demonstrated a circadian variation of both blood pressure and heart rate which were highest during the morning and fell during the late afternoon to reach a nadir during sleep. Prior to waking there was an increase in blood pressure, but not heart rate; however both blood pressure and heart rate increased briskly shortly after waking. Chronic therapy with oxprenolol (in 10patients) reduced daytime blood pressure, but had little effect during the night-time or early morning.

Direct intercellular communication (cell to cell coupling) is a mechanism for the local transit of information between cells and supplements the endocrine and nervous systems. Electrophysiological, biochemical, histological and cell culture techniques have established the widespread existence of coupling in mammalian tissues, and the importance of the gap junction has been recognised. Information is carried in the form of ions and small molecules between cells, and sensitive apparatus exists within each cell for controlling the permeability of the junctional membrane.

The system may be important in the control and co-ordination of cellular metabolism and growth in the embryo and in adult tissues.

Disorders of direct intercellular communication may be important in the pathogenesis of some diseases, in particular cancer.

A dynamic test for the antenatal diagnosis of placental sulphatase deficiency was examined in ten patients, selected on the basis of low urinary oestrogen levels (i.e. below the 10th centile at between 30 and 40 weeks gestation). The test consisted of measurement of plasma oestradiol levels over a period of 120 min after an i.v. injection of dehydroepiandrosterone sulphate. The oestradiol response was vigorous in seven patients, absent in two and small, but significant, in one. The three patients with reduced oestradiol response were also found to have raised levels of urinary steroid monosulphates and thus were probably placental sulphatase deficient.

The overall clinical importance of placental sulphatase deficiency and the value of the dehydroepiandrosterone sulphate loading test in antenatal diagnosis are discussed.

Ringworm formed almost 70 per cent of all superficial mycoses diagnosed. The feet and nails were most frequently affected and a single species, Trichophyton rubrum was responsible for the majority of infections that required specialist attention. Scalp ringworm which, until the middle of this century, was the most common form of the disease now constitutes only 5 per cent of infections and the majority of these are caused by the zoophilic fungus Microsporum canis. The anthropophilic dermatophytes which were once so prevalent as the cause of scalp infections are now rarely encountered.

Yeasts, especially Candida albicans were most frequently encountered as a cause of mucosal infections but were not unimportant as a cause of disease of skin and nail.

One hundred and two admissions of VLBW babies to the Baby Unit at Raigmore Hospital were studied over a six-year period. The neonatal death rate was 53 per cent. Twenty three survivors weighing 1.36 kg. or less were examined at an average age of 3 years 11 months and 22 of these underwent cognitive assessment. All but one had normal or superior I.Q. assessments. Two were regarded as having significant or profound handicap. Possible reasons for the relatively low survival rate, but acceptable handicap rate are discussed.

One hundred and ninety six Asian, 89 African, 96 Chinese and 98 Scottish children from 173 families were studied to assess growth in relation to country of birth, time of parental residence in Scotland, child order in family, social class, living conditions and dietary factors. The growth measurements (standardised height, weight and bone age) differed between ethnic groups. The Africans were the tallest and Scottish the shortest. In all immigrant groups, children born in Scotland were on average, taller and more advanced in bone age than those born in their country of origin. In this study, there was no demonstrable effect on growth of social class or of living conditions. Dietary variable showed a lack of coherent effects on growth.

Four cases of hyperthyroidism were observed in a series of 135 males with a past history of malignant teratoma of testis. None of the patients had evidence of tumour recurrence at the time of diagnosis of hyperthyroidism. Possible mechanisms for this association are discussed.

Spinal epidural abscess is a rare condition requiring prompt diagnosis and neurosurgical intervention if permanent neurological sequelae are be avoided. A patient is described who presented with meningism due to an acute spinal epidural abscess extending from the cervical to the lumbar region and which was managed non-operatively.

An elderly woman, resident throughout her life in Scotland presented with abdominal pain and diarrhoea. A provisional diagnosis of ulcerative colitis was made on sigmoidoscopy. At post mortem Entamoeba Histolytica was demonstrated in considerable numbers in the mucosal ulcers. It would appear though extremely rare that amoebiasis should be considered in the differential diagnosis of colonic ulceration.

Spontaneous rupture of the spleen is an unusual complication of leukaemia. We report a case of splenic rupture as the initial presenting feature of chronic myeloid leukaemia, with a successful surgical outcome.

An account is given of the life and work of Sir Byrom Bramwell (1847–1931), and his son Professor Edwin Bramwell (1873–1952). They were outstanding as clinical observers and teachers.

Byrom Bramwell began his professional work in his father's practice in North Shields. After a brief period of hospital work in Newcastle he moved to Edinburgh. His early struggles in consulting practice were combined with prolific writing of papers and books. He became the leading physician in Scotland.

Edwin Bramwell received extensive postgraduate training as a neurologist and returned to practise in Edinburgh. He became Moncrieff-Amott Professor of Medicine, and was widely known as a clinician, lecturer, and writer on medical subjects. He was particularly active in postgraduate teaching.

Both of the Bramwells became, in their turn, President of the Royal College of Physicians of Edinburgh. Edwin Bramwell was also President of the Association of British Neurologists. They shared an interest in angling which was their principal recreation. Their work is reviewed and considered in its historical perspective.