Scottish Medical Journal

A telephone survey of echocardiography services in district general hospitals in Scotland was carried out in 1999. The study showed wide variation in the echocardiography services among the district hospitals in terms of equipment, personnel and service provision. The number of echocardiograms performed by a centre is partly dependent on the demand but is more critically influenced by the local provision of service. In particular, sufficient numbers of trained technicians hold the key to efficient high output services. The survey has provided a platform for comparison of echocardiography services among the district general hospitals in Scotland. We hope that this will encourage individual district hospitals to audit their echocardiography service with a special emphasis on the role of the technician.

The first part of this study retrospectively compared the discriminatory power of spiral CT versus clinical findings in 112 consecutive patients referred with chest pain or dyspnoea. Spiral CT exhibited a sensitivity 91.9%; specificity 98.7%; PPV 97.1%; NPV 96.1%; accuracy 96.4%. No other test or clinical parameter had acceptable accuracy. The SimpliRED test is a latex method of estimating the level of D-dimer. The second part of this study determined that, in a similar consecutive series of patients referred for lung scintigrams, although SimpliRED tests had a NPV 95.5%, 59/126 (46.8%) consecutive were positive. However on the basis of clinical effectiveness and cost, imaging for suspected pulmonary embolism should be based on a combination of D-dimer estimation and spiral CT.

Body piercing, and particularly ear piercing is becoming increasingly common in young children who may not be capable of properly caring for the pierced site. This may result in infection at the site and embedding of the earring. Infection and the subsequent necessity of removal of such earrings can cause considerable pain and distress. There is also a proven risk of inducing nickel allergy in these children which can be a problem in later life. The potential for serious infection such as Hepatitis B, Hepatitis C and HIV is not appreciated by the parents of these children.

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.

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.

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.

We present the case of a 79-year-old woman who developed a high grade spindle cell sarcoma adjacent to total hip arthroplasty 13 years after the index operation. MRI scan appeared to show a direct communication between the tumour and intra medullary canal through a breach in the femoral cortex.

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.