Scottish Medical Journal - Volume 60, Number 2

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Case report
Available accessCase reportFirst published May, 2015pp. e1-e3
Motor neurone disease presenting with raised serum Troponin T
Jonathan P Mamo
Abstract
Myocardial damage indicated by a rise in cardiac Troponin may not necessarily be due to a cardiac event. Many diseases such as sepsis, pulmonary embolism, heart and renal failure can also be associated with an elevated cardiac Troponin level. This brief report discusses the rare event of a patient with motor neurone disease, where the possible diagnosis of acute myocardial infarction arose due to an elevated cardiac Troponin. A 69-year-old gentleman presented with a history of a central chest ache of mild intensity, lasting a total of 2 h prior to complete resolution. Multiple cardiac Troponin assays were elevated, and echocardiography did not show any acute changes of myocardial damage. His electrocardiogram was also normal. This patient’s raised cardiac Troponin was therefore explained on the basis of his active motor neurone disease. This rare case outlines the importance of considering motor neurone disease as a cause of elevated cardiac Troponin in the absence of clinical evidence of an acute coronary event.
Case report
Available accessCase reportFirst published May, 2015pp. e4-e6
Unilateral subretinal fibrosis and uveitis syndrome
S RehanZ JavaidA Al-Bermani
Abstract
Subretinal fibrosis and uveitis syndrome is a rare, potentially devastating, posterior uveitis of unknown aetiology, characterised bilaterally by initial multifocal choroiditis with later progressive subretinal fibrosis. We report a rare case of unilateral subretinal fibrosis and uveitis syndrome. To date, there are only two case reports of unilateral disease. Our patient presented with unilateral blur and was found to have reduced visual acuity. A Bartonella profile was positive and a diagnosis of Bartonella posterior uveitis was made. Several positive ocular findings in the anterior chamber and on fundoscopy consistent with the syndrome were found. When steroid therapy alone could no longer control active inflammation, the immunosuppressive agent mycophenolate was added. Over time subretinal fibrosis became established sparing the macula and associated complications occurred, but with mycophenolate, at four years, our patient’s visual acuity had improved and remains stable. Moreover, four years after her initial presentation, her condition remains strictly unilateral.
Case report
Available accessCase reportFirst published May, 2015pp. e7-e10
A successfully treated case of hypopituitarism complicated with hyperosmolar hyperglycaemic state and rhabdomyolysis
Yi-Chen WangLi-Chao GaoHui Xu
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Abstract
Introduction
This study aimed to report a rare case of hypopituitarism complicated with hyperosmolar hyperglycaemic state and rhabdomyolysis.
Case presentation
Hypopituitarism is a clinical syndrome in which there is a deficiency in hormone production by the pituitary gland. It often leads to hypoglycaemia, but in this case the patient was complicated with hyperosmolar hyperglycaemic state. The patient received prompt medical treatment, which effectively prevented the occurrence of possible acute kidney failure and other complications.
Conclusion
This is a complicated and rare case. Our report provides some indications for the timely diagnosis and the standardised treatments for a patient who has hypopituitarism complicated with hyperosmolar hyperglycaemic state and rhabdomyolysis.
Case report
Available accessCase reportFirst published May, 2015pp. e11-e13
Acupuncture-induced pneumothorax: the hidden complication
RJ BroganF Mushtaq
Case report
Available accessCase reportFirst published May, 2015pp. e14-e16
Anomalous origin of the right coronary artery from the left circumflex coronary artery: an extremely rare coronary anomaly
Babak BagheriRazhan PiranMaryam Nabati
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Case report
Available accessCase reportFirst published May, 2015pp. e17-e20
Gastric neo-adenocarcinoma arising in a gastric tube after Ivor Lewis oesophagectomy for oesophageal adenocarcinoma
Faisal HanifJoana KerrJames J Going
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Abstract
A 69-year-old man, seven years post Ivor-Lewis oesophagectomy for oesophageal adenocarcinoma, was diagnosed to have a moderately differentiated 4 cm, malignant ulcer within the gastric tube remnant on an endoscopic biopsy. His original presentation was with a T1N0 oesophageal adenocarcinoma, histologically intestinal in type with inflammatory features. He presented with anaemia and melena due to a malignant ulcer in the mid body of his gastric tube on an endoscopy which was confirmed to be a gastric neo-adenocarcinoma on biopsy. He underwent right posterolateral thoracotomy and a wedge resection of the gastric tube including the tumour. Pathology confirmed a T3 N0 (0/7 lymph nodes) with clear margins moderately differentiated adenocarcinoma of intestinal phenotype with papillary features and was reported to be a histopathologically new tumour. Proposed surgical treatments in such patients are dependent on patient’s fitness for major resection and may vary from Endoscopic Mucosal Resection to partial resection with preservation of right gastroepiploic vessels or total gastrectomy with intestinal interposition via a retromediastinal route. We suggest that regular endoscopic surveillance may be indicated in such post-oesophagectomy patients as the number of patients developing gastric tube cancers may increase with improve survival of those patients.
Case report
Available accessCase reportFirst published May, 2015pp. e21-e24
Pericardial,pleural and peritoneal involvement in a patient with primary gastric mantle cell lymphoma
Muzaffer KeklikAfra YildirimErtugrul Keklik
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Abstract
Primary gastric mantle cell lymphoma is a rare form of gastointestinal tumour. Although peritoneal carcinomatosis accompanied by malignant ascites is relatively common, mantle cell lymphoma presenting with ascites is rare. Also, effusions involving pericardial and pleural cavities are uncommon during the course of lymphomas. We report the first case in which pericardial, pleural and peritoneal effusion of a primary gastric mantle cell lymphoma.
Case report
Available accessCase reportFirst published May, 2015pp. e25-e26
Intravesical explosion during transurethral electrosurgery
Kallinikas GeorgiosBoulinakis EvangelosHabib Helai
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Abstract
Intravesical explosion is a very rare complication of transurethral resection of prostate and transurethral resection of bladder tumour operations. In vitro studies have shown that the gases produced during the procedure could result in a blast once they are mixed with air from the atmosphere. A 79-year-old male experienced an explosion in his bladder while undergoing a transurethral resection of bladder tumour. The case is presented as well as the way that it was treated as an emergency. Precautions of such events are finally suggested.
Case report
Available accessCase reportFirst published May, 2015pp. e27-e29
Hepatitis E virus infection presenting with paraesthesia
Susan BennettKathy LiRory N Gunson
Abstract
Hepatitis E virus infection is an emerging disease in developed countries. Acute and chronic infection has been reported, with chronic infection being increasingly reported in immunocompromised patients. Neurological disorders are an emerging manifestation of both acute and chronic hepatitis E virus infection. We report a 77-year-old female presented with paraesthesia and was found to have abnormal liver function tests. Serology was found to be positive for hepatitis E virus IgM, IgG and RNA. Liver function tests normalised after three weeks and her neurological symptoms completely resolved. To our knowledge, this is the first case in Scotland of hepatitis E virus presenting only with neurological symptoms.
Research article
Available accessResearch articleFirst published May, 2015pp. 61-61
Yorkhill Centenary Symposium: Celebrating a century of paediatric care at the Royal Hospital for Sick Children,Yorkhill
Forrester Cockburn
Research article
Available accessResearch articleFirst published May, 2015pp. 62-62
Yorkhill Centenary Symposium: Celebrating a Century of Paediatric Care at the Royal Hospital for Sick Children (Yorkhill): Agenda
Abstract
Available accessAbstractFirst published May, 2015pp. 63-69
Yorkhill Centenary Symposium: Celebrating a Century of Paediatric Care at the Royal Hospital for Sick Children (Yorkhill),Wednesday 15 April 2015
Research article
Available accessResearch articleFirst published May, 2015pp. 70-74
Socioeconomic influence on orofacial cleft patient care
I SmillieK YongK Harris
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Abstract
Background
Cleft lip and palate is the most common craniofacial birth defect in the UK. Orofacial clefts have functional and aesthetic implications requiring intensive multi-disciplinary follow-up to optimise development. Failure to attend follow-up is likely to have a negative impact on patient outcomes. The aim of this retrospective audit is to establish if socioeconomic status influences attendance, DNA and cancellation rates in cleft patients.
Methods and results
A retrospective audit of 74 orofacial cleft patients born and operated on at the Royal Hospital for Sick Children Glasgow between 2006 and 2007. There was higher rate of DNA in more deprived social groups−21% (SIMD 1) against 10% (SIMD 5). A higher rate of DNA in cleft lip and palate patients was noted. This group of patients showed a marked difference in attendance between SIMD 1 (38%) and SIMD 5 (78%).
Conclusion
More deprived areas have a higher outpatient DNA rate for cleft patients resulting in suboptimal follow-up. Ultimately, causation of poorer outcomes in this group is likely to be multi-factorial but the financial implication of travelling to multiple clinics should be considered and it may be that resource reallocation is the answer to address the current inequality of health care provision.
Research article
Available accessResearch articleFirst published May, 2015pp. 75-78
The relationship between deprivation and alcohol-related presentation at Accident and Emergency (A&E) over a three-month period
R DolanB Paterson
Abstract
Objectives
To identify any relationship between deprivation and the level of presentation to Accident and Emergency with alcohol-related conditions in a busy East Coast teaching hospital in Scotland.
Methods
Over an 87-day-period initial screening to determine whether alcohol played a part in each presentation was conducted at triage. These patients were then streamed according to their Paddington Alcohol Test (Pat) score into Pat +ve and Pat −ve groups. The postcode of each patient was recorded before they were assigned deprivation levels using the DepCat scoring system. This information was then compiled in Microsoft Excel 2003 and a graph showing the differences in the number of presentations across the social spectrum was constructed.
Results
Nine hundred and forty four patients were screened as attending due to alcohol with 43.86% being Pat +ve and 56.14% being Pat −ve. Overall 66.42% of the Pat +ve group and 54.42% of Pat −ve were from deprived or very deprived areas.
Conclusions
The use of electronic-based screening was effective at highlighting patients presenting to Accident and Emergency with alcohol-related problems, and these presentations highlighted a direct link between the level of deprivation and attendances.
Research article
Available accessResearch articleFirst published May, 2015pp. 79-84
Complications and early results after operative fixation of 68 pilon fractures of the distal tibia
Adam LomaxAnjani SinghN Jane Madeley
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Abstract
Background and aims
In this cohort study, we present comprehensive injury specific and surgical outcome data from one of the largest reported series of pilon fractures of the distal tibia treated in a UK tertiary referral centre.
Methods and results
A series of 68 closed pilon fractures were retrospectively reviewed from case notes, plain radiographs and computed tomography imaging. Patient demographics, injury and fracture patterns, methods and timing of fixation and clinical and radiological outcomes were assessed over a mean follow-up period of 7.7 months (1.5–30). Overall, deep infection occurred in 1.6% with superficial infection and wound breakdown occurring in 6.3% of cases. Rates of nonunion and malunion were 7.8%. Radiological posttraumatic arthritis was present in 26.6%, which was symptomatic and requiring orthopaedic management in 9.4%. Further surgery for all causes occurred in 26.6% of cases.
Conclusion
Fixation of these complex fractures in subspecialist units can achieve overall low rates of wound complications, with definitive fixation of selected fractures within 48 h of initial presentation achieving comparable results to those fixed in a delayed fashion. However, this injury continues to have a significant overall complication rate with a high chance of developing early posttraumatic arthritis and of requiring further surgery.
Research article
Available accessResearch articleFirst published May, 2015pp. 85-89
Initial experience of direct-to-test endoscopic ultrasonography for suspected choledocholithiasis
Paul LochheadPerminder Phull
Abstract
Background and aims
Endoscopic ultrasound has become an invaluable tool in the investigation of patients with suspected pancreatobiliary disease. We set out to determine whether a “direct-to-test” endoscopic ultrasound procedure could be offered to selected patients with suspected choledocholithiasis.
Methods and results
We included patients referred to our general gastroenterology service with clinical history, symptomatology and/or laboratory results compatible with choledocholithiais. Almost all patients had already had a transabdominal ultrasound performed at the request of their general practitioner. All patients underwent direct-to-test day-case endoscopic ultrasound under conscious sedation. Procedures were performed by a single practitioner using an oblique-viewing radial echoendoscope. The diagnostic yield and frequencies of discharge, onward referral and follow-up were determined. Overall diagnostic yield of direct-to-test endoscopic ultrasound was 61%. The most common diagnoses were cholelithiasis (18%) and choledocholithiasis (11%); one periampullary cancer was also detected. A definitive outcome (discharge or referral for a therapeutic procedure) occurred in 14 of 28 patients (50%). The remaining 14 patients underwent further out-patient evaluation. Eventual diagnoses in this group included autoimmune hepatitis, primary biliary cirrhosis and drug-induced hepatitis.
Conclusions
For patients with suspected biliary disease, direct-to-test endoscopic ultrasound has a high diagnostic yield, and may be an appropriate mode of investigation.
Research article
Available accessResearch articleFirst published May, 2015pp. 90-94
The impact of violence reduction initiatives on emergency department attendance
SR RaineyJ SimpsonS Page
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Abstract
Background
Recent violence reduction initiatives in Glasgow have led to a reduction in recorded levels of violent crime.¹ This study evaluates the impact of these initiatives on assault-related emergency department attendances and admissions.
Methods
A retrospective observational study conducted in Glasgow Royal Infirmary’s emergency department comparing assault-related emergency department attendances and hospital admissions over two 30-day study periods (April 2010 and April 2012). The primary outcome measure was the change in assault-related emergency department attendances. The secondary outcome measure was the impact on assault-related hospital and critical care admissions.
Results
In April 2010, there were 6098 emergency department attendances, 301 (4.9%) were due to assault. In April 2012, there were 7236 emergency department attendances, 263 (3.6%) were due to assault, representing a significant reduction in assault-related attendances (p < 0.01). There were significant reductions in level 1 admissions 2010 n = 56 (19.2%), 2012 n = 36 (14.0%) p = 0.04 and critical care admissions, 2010 n = 5 (1.7%), 2012 n = 1 (0.4%) p = 0.04.
Conclusions
Violence reduction initiatives in Glasgow have contributed to a reduction in assault-related emergency department attendance at Glasgow Royal Infirmary. The reduction in hospital admissions, in particular critical care admissions, suggests a reduction in morbidity and cost to the National Health Service.
Research article
Available accessResearch articleFirst published May, 2015pp. 95-100
Endoscopic retrograde cholangiopancreatography in Ayrshire,Scotland: a comparison of two age cohorts
Stephanos PericleousLaura Isobel SmithMuhammad Ali Karim
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Abstract
Background and aims
There is an increased trend in prevalence of pancreato-biliary disease in the elderly population. Consequently there is an increasing demand for endoscopic retrograde cholangiopancreatography (ERCP). The aims of this study were to compare ERCP outcomes in patients over 80 with those aged between 60 and 79 years and with the published literature.
Methods and results
Data were collected from a prospectively maintained database. All patients over the age of 60 years who underwent ERCP from May 2010 to May 2012 were identified. Two cohorts were formed, group A: 60–79 years (n = 66) and group B: > 80 years old (n = 49). Data on indications for ERCP, outcome, complications and repeat procedures were collected. One hundred and fifteen patients between the age of 60 and 92 years were identified. Group A had a total of 89 ERCPs and group B 69. Cannulation, overall procedure success, complication and mortality rates were comparable between both groups. Group B contained two cases of perforation with one associated mortality (1.4%) which did not reach statistical significance.
Conclusions
ERCP in octogenarians is safe and effective when compared to patients aged 60–79.
Research article
Available accessResearch articleFirst published May, 2015pp. 101-101
Prepublication Announcement
Case report
Available accessCase reportFirst published May, 2015pp. 102-104
Case Reports
J Murie

Volume 60, Issue 2, May 2015