Scottish Medical Journal

Sixteen cases of dermatomyositis-polymyositis in children (dermatomyositis 15; polymyositis 1) have been reviewed. Proximal muscle weakness with a characteristic skin rash was vital for diagnosis in the majority of children. The positive laboratory tests such as creatine phosphokinase (CPK), electromyography (EMG) and muscle biopsy were helpful but results were normal in some cases even in the acute phase of the illness. All but one had been treated initially with high dose corticosteroids followed by a low dose maintenance for a prolonged period. Two in addition had had cytotoxic agents. Thirteen of the sixteen were currently in remission. In the other three cases, one with polymyositis only, the disease remained active and the two with dermatomyositis died. Only three of the patients were incapacitated by residual fixed contractures and extruding calcinosis. On the whole the prognosis of dermatomyositis is good.

Acute myocardial infarction is associated with a high incidence of occluding coronary arterial thrombi. Thrombolytic therapy has been advocated to restore coronary artery blood flow and to reduce myocardial damage. Coronary arteriography and intracoronary thrombolytic therapy was administered to 61 patients admitted to a Coronary Care Unit within eight hours of symptoms. Successful reperfusion was obtained in 38 of 46 single vessel occlusions associated with a first coronary attack. Failure of reperfusion occurred in patients with two vessel occlusions or with cardiogenic shock. This study demonstrates the feasibility of applying this technique within a Coronary Care Unit with low capital and running costs, and suggests that its widespread application is possible even within the setting of a District General Hospital.

The development of proteinuria, and more rarely nephrotic syndrome, has been seen with the use of the first orally active converting-enzyme inhibitor captopril. Both of these side effects appear to occur more frequently when the drug is used at higher dose, particularly in the presence of renal impairment.

We have used enalapril, a new orally active converting-enzyme inhibitor in the treatment of a patient with drug-resistant hypertension and renal impairment who previously developed nephrotic syndrome with captopril. Recurrence of the nephrotic syndrome was not seen in this patient during a period of 20 months on enalapril. On the contrary, urinary protein excretion over the same period was reduced to around 1 g in 24 hours.

Our experience would suggest that enalapril may usefully be substituted for captopril in the treatment of hypertensive patients in whom the latter has caused proteinuria or nephrotic syndrome.

A study has been made of the drinking patterns of male and female patients admitted to the acute medical wards of a rural district general hospital. Thirty-four per cent of males and 18.5 per cent of females were regular drinkers, while 54 per cent of males and 70.5 per cent of females never, or rarely drank. The young drank more frequently than the elderly. Alcohol ingestion was the determining factor in 7.9 per cent of the male admissions and 7.5 per cent of the female admissions. Drug overdosage was the single most common associated problem.

A previously well 46-year-old man presented with ventricular fibrillation as an initial complication of Prinzmetals variant angina. Coronary angiography subsequently demonstrated normal coronary arteries.

The isolation of an erythromycin-resistant Streptococcus pyogenes from a leg ulcer is reported and its implications for antibiotic therapy discussed.

Two cases of severe aortic stenosis presenting with pure right heart failure and unimpressive cardiac murmurs are reported. Both responded well to aortic valve replacement. The mechanism of right heart failure is discussed as is the need for urgent surgery.

An excellent response to treatment with thiazide diuretic for twelve years is described in a patient with Gordon's Syndrome, the first to be reported from Scotland, and only the second to manifest the full clinical picture of short stature, hypertension, hyperkalaemia and hyperchloraemic acidosis without renal failure. The hypertension and biochemical abnormalities were reversed during therapy. Temporary withdrawal after seven years was followed by the immediate return of all the biochemical abnormalities, but not of the hypertension.

Gallstone ileus is a well recognised entity and is responsible for approximately 3 per cent of intestinal obstructions. It is, however, quite rare for a a gallstone to cause numerous ulcerations of the bowel mucosa and perforation especially in the absence of prior clinical or radiological signs of obstruction (1). We report a case of ulceration and perforation of the ileum by a gallstone and presenting as acute peritonitis rather than obstruction.

During the nineteenth century the inhabitants of the remote island of St Kilda persisted in their belief that they were susceptible to disease if exposed to infection brought by visitors; these ideas were the source of much ridicule. The emigration of thirty-six islanders to Australia in 1852 resulted in excessive mortality during the voyage compared with other Highland emigrants, and the 1930 evacuation to the mainland of Scotland also revealed their susceptibility to tuberculosis.

An account is given of an attempt, early in the last century, to resuscitate an executed criminal by electrical stimulation.