Scottish Medical Journal

‘T in the Park’ is the largest annual music festival in Scotland. This paper reports on how an increased attendance and change of location for the 1997 event altered the workload. The influences that affected the pattern of patient presentations and the adaptations made in the medical service provided are discussed.

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.

A retrospective analysis of the epidemiological characteristics of non-accidental head injury (NAHI) in children in Scotland over the last fifteen years from 1981 until March 1996 was performed. The information was provided by the Information and Statistics Division of the Scottish Health Service. The average incidence of NAHI calculated over this period was 0.04 cases per year per 1000 children under 5 years. Fifty-five per cent of all cases occurred in those children who were less than a year old. 41% of cases were inflicted by a parent but in 47% the perpetrator could not be identified. The mortality rate was found to be 2%.

Non-accidental head injury cases identified using the ICD-9 coding classification system gives a surprisingly low incidence. This number is probably an underestimate and the reasons for this are discussed. A prospective epidemiological analysis of NAHI in children in Scotland is being undertaken to determine the true incidence.

Using case note review, a retrospective analysis was carried out of all patients referred with haemochromatosis and suspected hepatocelluclar carcinoma between 1988 and 1997 to define the mode of presentation, management and outcome of such patients. All 12 patients were male with a mean age of 67 years. Four patients presented whilst asymptomatic by alpha-fetoprotein screening. Mean time interval between diagnosis of haemochromatosis and heptocellular carcinoma was 6.7 years. One patient underwent right hepatectomy, seven patients were treated by chemoembolisation and the remaining four patients were treated symptomatically. The median survival of the chemoembolised patients was 13 months. Of those patients treated symptomatically, the median survival was four months.

Screening for hepatocellular carcinoma is often not undertaken inpatients with haemochromatosis. Survival prospects are poor in patients whose tumour presents symptomatically.

Ricketsial diseases are increasingly found world-wide and should be considered in febrile patients returning from abroad. This case report discribes the vasculitic complications of a patient returning from the Republic of South Africa with tick typhus.

Eight case reports of elderly patients with meningiomata are presented. Their mode of presentation to a typical district general hospital in central Scotland and subsequent clinical management is described. The significance of these cases is discussed.

To investigate beliefs about healing in early modern Scotland, records of 61 witch trials were examined. Thirty-three were found to include healing in the charges. Seventeen described cures involving black magic, in which disease supposedly caused by the witch was removed or illness was transferred to another individual. Twenty-two included cures by white magic, ie. herbal remedies and non-harmful magical rites. Most cases citing cures by black magic included charges of other black magic. However, several trials describing white magical cures make no mention of black magic. Most of the accused were probably implicated through confessions by other witches. Others may have had psychiatric problems and made fantastical statements. Some were antisocial individuals reported as witches by neighbours. Few were tried primarily for their healing activities.