Scottish Medical Journal

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

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

Many of the patients in the ‘non-occlusive’ group were considered to have had smaller, more localised myocardial infarctions and a lesser degree of coronary disease which may not be detected by coronary arteriography. Others, with more widespread cardiac damage, could be explained on the basis of thrombosis and subsequent recanalisation.

An analysis of the pattern of admissions for acute asthma to a respiratory unit which operates a self-referral scheme showed that patients included in such a scheme were admitted to hospital more frequently, and much more quickly. The findings suggested that it is possible to recognise ‘high-risk’ asthmatics and that these patients make full and effective use of well organised self-admission facilities.

An attempt to discover what provoked acute attacks of asthma yielded little useful information except to identify a small group of young women in whom hysterical hyperventilation may have been a relevant aetiological factor.

This study reports the experience, during a six-year period, of the Aberdeen Renal Unit in the treatment of patients with acute renal failure. The combination of a relatively stable population base and a single regional dialysis centre has allowed the incidence of acute renal failure to be assessed. Approximately 30 patients per million population were dialysed annually for acute renal failure; 69 per cent of these patients (20.5 per million population per year) were dialysed for acute reversible intrinsic renal failure (ARIRF) and mortality in this group was 44 per cent. Patients with more severe disease at the time of presentation to the renal unit, as defined by a clinical severity score, had significantly reduced survival rates. However, it was not possible to predict the outcome in individual cases; ten of 24 patients with clinical severity scores which indicated a poor prognosis survived the period of oliguria and were discharged from hospital.

The fact that other renal units dialyse fewer patients per million population per year for ARIRF probably reflects a reluctance to refer patients whose general condition appears poor. As the overall mortality rate reported in this study does not differ significantly from rates reported previously from centres treating a smaller proportion of patients, such decisions may not be correct. It is well known that facilities in Britain for treating patients with end-stage renal disease are inadequate; it now appears likely that some patients who might benefit from acute dialysis are being denied treatment for a potentially reversible disease process.

Thyroid function was assessed in 94 patients with rheumatic heart disease presenting consecutively to a cardiology clinic. Despite previous reports of an association with autoimmune thyroid disease, abnormal thyroid function occurred no more commonly in this group than would be anticipated in a normal population.

Seven male patients with cyanotic congenital heart disease were studied. Serum testosterone, androstenedione, dehydroepiandrosterone, thyroxine and triiodothyronine levels did not differ significantly from control values. Thyroid stimulating hormone and prolactin responses to injected thyrotrophin releasing hormone were normal. Impaired gonadotrophin responses to injected gonadotrophin releasing hormone were noted in two patients. The hypothalmic-pituitary-testicular axis appears to be better preserved in cyanotic congenital heart disease than in chronic obstructive airways disease and restrictive lung disease for a similar degree of hypoxia. Possible explanations are discussed.

Two hundred and thirty patients with genito-urinary tuberculosis presenting between 1970 and 1979 were reviewed. In 22 per cent there was a history of previous tuberculosis and a family history in 14 per cent. Night sweats and weight loss were uncommon. The mean duration of medical treatment was 17 months. Surgery was necessary in 49 per cent of patients but reconstructive procedures were only performed in 7 per cent of cases. The mean follow-up period after diagnosis was 46 months. Patients with initial renal calcification were followed-up for a similar time to those with no calcification. Complications during follow-up were no more common in those with initial renal calcification than in those without this feature. With the exception of 1971 and 1972, there was a steady incidence of 20 or so new cases of genito-urinary tuberculosis per year in Glasgow.

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.

A 78-year-old woman presented with an acute abdomen and was found to have a perforation of her terminal ileum. She did not survive the postoperative period and at necropsy was found to have numerous ulcers of the ileum. In the ulcerated areas there was a transmural chronic inflammatory infiltrate, but no evidence of granulomata. We believe that this ulceration was caused by ingestion of Osmosin tablets containing indomethacin and suggest a possible pathogenesis.

A patient presented with headache, soreness over her scalp and general malaise. She was treated for hypertension, but later went blind in one eye. Following referral to the Eye Department, she was treated successfully for six episodes of blindness in her second eye. The case highlights the ways in which temporal arteritis may present. Prompt treatment will save vision, but a missed diagnosis may result in blindness.

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

Although so far there are 61 cases reported in the world literature from English speaking countries, we believe that this is the first case reported from the United Kingdom.

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.

Membranous nephropathy is described in a patient with nail-patella syndrome who also had the characteristic changes of nail-patella syndrome nephropathy on electron microscopy. This combination has not previously been reported. Nail-patella syndrome nepthropathy is reviewed in relation to other glomerular lesions which have been reported.

In the nineteenth century in the island of St Kilda, faced with maternal mortality which reached 107.1 and excessive neonatal mortality, women went to Obe, now Leverburgh, in the island of Harris in the Outer Hebrides to be confined, often marooned therefor many months due to treacherous seas. Using family reconstruction techniques the reproductive history of some of these women is traced and these strategies assessed.