Showing papers in "Scottish Medical Journal in 2014"
TL;DR: The spectrum of fractures has changed considerably, and there has been an increase in the incidence of both fragility and non-fragility fractures in all age groups in both males and females.
Abstract: BackgroundFracture epidemiology in adults is changing but there is very little information about the rate of change or whether the change affects males and females equallyMethodsWe have compared fracture incidence in two similar populations 50–60 years apart A study of fractures in Dundee, Scotland and Oxford, England, in 1954–1958, was compared with a similar cohort of fractures in Edinburgh, Scotland, in 2010–2011 Fracture incidence in patients >35 years was recorded in both time periodsResultsThe incidence of fractures increased by 50% between the two time periods, although the increase in males was only 5% compared with 85% in females The spectrum of fractures has changed considerably, and there has been an increase in the incidence of both fragility and non-fragility fractures Analysis showed an increased incidence of fall-related fractures in all age groups in both males and femalesInterpretationThere has been a substantial change in the incidence of fractures in the last 50–60 years These h
48 citations
TL;DR: The anatomical distribution of exostoses varies according to genotype and gender; however, the reason for this difference is not clear and may relate to different biochemical pathways.
Abstract: Background and aimsWe describe the novel anatomical distribution of exostoses in patients with hereditary multiple exostoses according to their gender and genotype.Methods and resultsA prospective database of 143 patients from 65 families with hereditary multiple exostoses was compiled. Patient demographics, genotype and number of exostoses according to anatomical site were recorded. The hand was affected by the greatest proportion of exostoses for both EXT1 (19%) and EXT2 (14%) genotypes and was the most prevalent site for exostoses in patients with an EXT1 genotype (92%). Patients with an EXT1 genotype had a significantly greater number of exostoses compared to those with an EXT2 genotype (2680 vs. 1828, p = 0.006); however, this was only significantly different for 10 of the 19 anatomical regions examined. Male patients with an EXT1 genotype had a significantly (p < 0.05) greater number of exostoses affecting their hands, distal radius, proximal humerus, scapular and ribs compared to female patients wi...
27 citations
TL;DR: Embryology should be taught at the right level, depth and through various methods, including basic concepts in the lower years of medical school and moving into clinical embryology later on, so junior doctors and trainees will have a good foundation of knowledge.
Abstract: Background and aimsEmbryology remains an important tool in medicine and surgery for the management of many clinical conditions. As a subject, it is neither straightforward nor easy to learn and tea...
27 citations
TL;DR: In this paper, the accuracy of colorectal tumor localisation was determined by using colonoscopy for accurate pre-operative colon cancer localisation, but its accuracy for localisation remains undetermined due to limitations of previous work.
Abstract: Background and aimsColonoscopy is essential for accurate pre-operative colorectal tumour localisation, but its accuracy for localisation remains undetermined due to limitations of previous work. Th...
16 citations
TL;DR: The diagnostic difficulties encountered in a case of carcinoid tumour arising from a tailgut cyst in a male patient is reported.
Abstract: A 49-year-old man was referred with constipation that had lasted for a few months. On colonoscopy, a subepithelial tumour more than 4 cm in size was seen in the rectum. He underwent endoscopic ultrasound and pelvic magnetic resonance imaging. He was preoperatively diagnosed with a rectal duplication cyst based on imaging studies. However, the final histopathologic diagnosis after transanal excision of the rectal mass was rectal carcinoid tumour with tailgut cyst. Tailgut cysts are very rare congenital lesions in the presacral area and are most often discovered incidentally in middle-aged women. It is difficult to distinguish the imaging appearance of tailgut cysts from that of many other retrorectal cysts. Malignant transformation of tailgut cysts has been estimated to occur in 2 to 13% of cases. We report the diagnostic difficulties encountered in a case of carcinoid tumour arising from a tailgut cyst in a male patient.
16 citations
TL;DR: The history of cardiac markers is described along with a discussion of the various causes of elevated cardiac troponins outside acute coronary syndrome and the applications and significance of this blood test and the potential uses of positive results with elevated serum Troponin levels are elaborate.
Abstract: Cardiac Troponins are blood markers of myocardial damage and are widely utilised across all acute medical departments. However, with a massive rise in requests for this test, the interpretation of raised serum levels in the absence of cardiac sounding clinical features can become a clinical conundrum. This is especially true if the numerous causes of positive test results are not fully appreciated. A thorough understanding of the strengths and weaknesses of this blood test in light of a patient population living longer, increasing in comorbidities and possible causes of false test results can provide invaluable support in establishing an accurate diagnosis and instigating effective management. This article will describe the history of cardiac markers along with a discussion of the various causes of elevated cardiac troponins outside acute coronary syndrome. It will elaborate on the applications and significance of this blood test and the potential uses of positive results with elevated serum Troponin levels.
16 citations
TL;DR: Seasonal variation in nocturia, but not other frequency–volume parameters, symptom severity or uroflowmetry parameters, is significant in men with lower urinary tract symptom.
Abstract: PurposeThere is a widely held perception that lower urinary tract symptoms may be exacerbated by cold weather. In this study, we examine the effect of seasonal variation in ambient temperatures on ...
15 citations
TL;DR: Better training in blood collection, achieving the standard of professional phlebotomists, will improve validity of diagnostic information; reduce risks of dangerous misinterpretation of results, unwanted anaemia and needlestick injury and decrease laboratory supplies costs.
Abstract: BackgroundIt is estimated that 70% of all health care decisions affecting diagnosis or treatment involve laboratory testing. The pre-analytical phase of the testing process shows the highest preval...
11 citations
TL;DR: The most appropriate educational intervention for patients who have undergone joint replacement would involve written information including advice about type of implant, activity restrictions, dental treatment and airport security detectors.
Abstract: Background and aimsFollowing a hip or knee replacement, patients may have little information about their prosthesis. This can lead to anxiety in the face of media reports about failing implants or ...
11 citations
TL;DR: A 76-year-old female patient treated with right radical nephrectomy because of the tumour mass of the right kidney is reported, the second reported case of kidney metastasis from primary lacrimal ACC.
Abstract: Introduction:Adenoid cystic carcinoma (ACC) is a malignant neoplasm that arises within secretory glands. It rarely occurs in the lacrimal gland. Kidney metastases are very rare.Case presentation:We report a case of a 76-year-old female patient treated with right radical nephrectomy because of the tumour mass of the right kidney. Well-circumscribed, firm, grey mass was found on the lower pole of the kidney. Histologically, tumour was considered to be ACC. Retrospective history data showed ACC of the lacrimal gland surgically treated 14 years before with metastasis to the lung operated seven years before. Our diagnosis was metastatic ACC to the kidney.Conclusion:ACC has a remarkable capacity for recurrence. To our knowledge, in the English-speaking area (PubMed), 10 cases of ACC metastatic to the kidney have been described to date, and this is the second reported case of kidney metastasis from primary lacrimal ACC.
11 citations
TL;DR: A 17 year old admitted with hyperemesis gravidarum was diagnosed with Hamman syndrome after complaining of chest pain due to the presence of subcutaneous emphysema and pneumomediastinum on chest radiograph and then self-discharged against medical advice.
Abstract: IntroductionHyperemesis gravidarum describes persistent vomiting leading to fluid and electrolyte imbalance. It is the commonest reason for admission in the first half of pregnancy. We describe a case of Hamman syndrome secondary to hyperemesis gravidarum. We also discuss Boerhaave syndrome: a particularly rare condition with only a handful of cases being described in the literature.Case presentationA 17 year old admitted with hyperemesis gravidarum was diagnosed with Hamman syndrome after complaining of chest pain due to the presence of subcutaneous emphysema and pneumomediastinum on chest radiograph. She was treated conservatively for potential ruptured oesophagus but then self-discharged against medical advice.ConclusionSubcutaneous emphysema is an alarming finding in any pregnancy and should be treated in a timely and cautious manner. This case report adds weight to the previous literature advocating a conservative versus surgical approach to the management of a woman with Hamman syndrome secondary to...
TL;DR: Langerhans cell histiocytosis is a rare disease in infants and young children, with a variable course ranging from self-limiting to life threatening, requiring intensive chemotherapy and lifelong follow-up in very young children.
Abstract: PurposeTo review the presentation and outcome of patients with Langerhans cell histiocytosis attending The Royal Hospital for Sick Children, Glasgow over a 23-year period.MethodThirty-one children ...
TL;DR: A summary of the evidence base for different pharmacological treatments in the context of chronic pancreatitis has shown that large number trials evaluating their efficacy in managing pain are lacking and offer scope for future research on this topic.
Abstract: Introduction:Chronic pancreatitis is a condition that is rising in incidence in the Western World. It is predominated by severe intractable abdominal pain that presents a significant impact on patients’ quality of life and physical functioning. The pain is persistent in many patients, requiring admission to hospital for the majority at some stage in their illness. There is no current NICE or SIGN guideline with associated grading for the pharmacological management of this symptom. This paper aims to investigate and summarise the current pharmacological therapies for pain control in an attempt to formulate the levels of evidence supporting their use.Methods:The online digital archives PubMed, Science Direct, Medscape and the Cochrane Library were searched for the keywords pain and chronic pancreatitis. Hand searches of relevant journals and citations were used to complete the investigation of current literature on the topic. Relevant articles and studies were critically analysed in a standard format with r...
TL;DR: The majority of patients with amoebic liver abscesses were treated with drug therapy alone, whereas all pyogenic liver absessions required some form of drainage, and Tuberculous abscess was classified as indeterminate.
Abstract: ObjectiveTo study the various types of liver abscesses. This prospective study was conducted over a period of one year, from November 2011 to October 2012, at the Department of General Surgery in Acharya Shri Chander College of Medical Sciences and Hospital Sidhra, Jammu.Materials and methodsThe patients in this study were admitted from the emergency wing, and from indoor and outdoor departments of surgery and medicine over a period of one year (November 2011 to October 2012) to the Department of General Surgery in Acharya Shri Chander College of Medical Sciences and Hospital Sidhra, Jammu. Patients of all age groups and both genders who presented with clinical suspicion of liver abscess, or had already been diagnosed, were included in the study. A definitive diagnosis of liver abscess was made based on compatible clinical features, ultrasonography and aspiration or drainage of pus. Diagnostic criteria for the various types of abscesses were as follows: Amoebic abscess: demonstration of Entamoeba histolyt...
TL;DR: Assessment of surgical staff scrub practice before gowning in operation theatres in a university hospital found mean scrub times were less than WHO guidelines with significant variation in practice across grades of staff.
Abstract: BackgroundSurgical site infections have an incidence as high as 10%. To reduce this, the World Health Organisation (WHO) recommends guidelines for surgical scrubbing.AimsWe assessed adherence of surgical staff scrub practice before gowning to current WHO recommendations.MethodsA prospective study conducted in operation theatres in a university hospital. Participants comprised of consultant surgeons, trainees and scrub nurses. Variables included staff grade, scrub order, length of scrub time and appropriate dress code. Data were collected anonymously and analysed.ResultsWe assessed 303 surgical scrub-episodes (95 scrub nurses, 123 trainees and 85 consultant surgeons). Mean time for first scrub of the day was 239 s, SD = 99, 95% CI 218, 259 and range = 530 (scrub nurses = 297 s, trainees = 204 s, consultant surgeons = 202 s). Mean time for subsequent scrubs was 161 s, SD = 63, 95% CI 152, 170, range = 312 (scrub nurses = 184 s, trainees = 158 s, consultant surgeons = 143 s). Statistical significance was fou...
TL;DR: This case report describes a gentleman with ependymoma and difficult-to-control lower back pain and scrotal pain who was prescribed methadone and then subsequently developed bilateral peripheral oedema, which highlights an important potential adverse effect of methamphetamineadone in a society of increased methad one prescription for pain control.
Abstract: IntroductionMethadone is a synthetic opioid which is being used with increased frequency in the palliative care setting for management of complex pain. There have been cases published reporting the development of oedema with methadone maintenance therapy but no cases on the association with methadone and peripheral oedema in the palliative care setting. As yet, the underlying mechanisms are unclear.Case presentationThis case report describes a gentleman with ependymoma and difficult-to-control lower back pain and scrotal pain. This pain had failed to respond to other strong opioids. He was prescribed methadone and then subsequently developed bilateral peripheral oedema.Case managementPeripheral oedema resolved following cessation of methadone.ConclusionsThis highlights an important potential adverse effect of methadone in a society of increased methadone prescription for pain control. The published literature to date is reviewed and possible underlying mechanisms explored.
TL;DR: Doctors and neurosurgeons should be aware of the quality of information on the internet for trigeminal neuralgia, and appreciate areas highlighted in the DISCERN© instrument in order to provide balanced, reliable, evidence-based information.
Abstract: Trigeminal neuralgia has a variety of treatments with variable efficacy. Sufferers present to a spectrum of disciplines. While traditional delivery of medical information has been by oral/printed communication, up to 50-80% patients access the internet for information. Confusion, therefore, may arise when seeking treatment for trigeminal neuralgia. We evaluated the quality of information on the internet for trigeminal neuralgia using the DISCERN© instrument. Only 54% websites had clear objectives; 42% delivered on these. A total of 71% provided relevant information on trigeminal neuralgia, 54% being biased/unbalanced; 71% not providing clear sources of information. No website detailed the side-effect profile of treatments; 79% did not inform patients of the consequences/natural history if no treatment was undertaken; it was unclear if patients could anticipate symptoms settling or when treatment would be indicated. Internet information on trigeminal neuralgia is of variable quality; 83% of sites assessed were of low-to-moderate quality, 29% having 'serious shortcomings.' Only two sites scored highly, only one being in the top 10 search results. Websites on trigeminal neuralgia need to appreciate areas highlighted in the DISCERN© instrument, in order to provide balanced, reliable, evidence-based information. To advise patients who may be misguided from such sources, neurosurgeons should be aware of the quality of information on the internet.
TL;DR: TPF chemotherapy can be delivered safely in a non-trial cohort of patients and there is, however, a significant reduction in concurrent chemotherapy dose intensity.
Abstract: Background and aimsPhase III trials have shown that the addition of a taxane to cisplatin/5FU-based induction chemotherapy (TPF) improves response rates and overall survival in unresectable stage I...
TL;DR: Findings suggest that there is a significant chasm between the political rhetoric and the reality faced by young people with spina bifida moving to adult healthcare services.
Abstract: Background and AimsLiterature on interventions that enable young people with spina bifida and/or hydrocephalus to have smooth transition, into adult healthcare services, stress the need for the process to start early and to include all family members. The study reported here was set to quantify and articulate the experiences of service users who are or due to be going through the transition process in Scotland today.Methods and ResultsFocus group sessions, in the North of Scotland and in the ‘Central Belt’, captured rich qualitative data. A survey, sent to eligible participants on the Spina Bifida National database, offered complimentary data source. Despite the fact that the number of returned questionnaires was low (n = 20), data analysis identified a number of core recurring themes. These include issues concerning Communications, Respect, Choice and Control. Findings suggest that there is a significant chasm between the political rhetoric and the reality faced by young people with spina bifida moving t...
TL;DR: The strategy aims to create a culture where clinicians view working with Healthcare Improvement Scotland as a worthwhile venture, which offers a number of positive benefits such as training, career development and research opportunities.
Abstract: Clinical engagement can achieve lasting change in the delivery of healthcare. In October 2011, Healthcare Improvement Scotland formulated a clinical engagement strategy to ensure that a progressive and sustainable approach to engaging healthcare professionals is firmly embedded in its health improvement and public assurance activities. The strategy was developed using a 90-day process, combining an evidence base of best practice and feedback from semi-structured interviews and focus groups.The strategy aims to create a culture where clinicians view working with Healthcare Improvement Scotland as a worthwhile venture, which offers a number of positive benefits such as training, career development and research opportunities. The strategy works towards developing a respectful partnership between Healthcare Improvement Scotland, the clinical community and key stakeholders whereby clinicians’ contributions are recognised in a non-financial reward system. To do this, the organisation needs a sustainable infrast...
TL;DR: C Cohort analysis reveals that the establishment of the SSMCN has had a positive impact on the management of Sarcoma, and the number of patients undergoing formal resection by the specialist surgical team has significantly increased while the waiting time from referral to assessment by the sarcoma service has decreased.
Abstract: In 2004, the Scottish Sarcoma Managed Clinical Network (SSMCN) was established with the aim of optimising the management of patients diagnosed with sarcoma in Scotland. Clinical, radiological, oncological and pathological details of all bone and soft tissue sarcomas presenting in Scotland are registered and cases discussed in a weekly multi-centre, tele-link multidisciplinary team (MDT) forum. Sarcoma surgery and pathology assessment is undertaken in three specialist centres, Aberdeen, Edinburgh and Glasgow with oncological services provided within these units as well as in Dundee and Inverness. The aim of this study was to establish any difference in referral patterns, time to specialist review, preoperative magnetic resonance imaging scanning and whether complete margins were achieved on formal resection before and after establishment of the Scottish Sarcoma Network. A database was established of all patients presenting with sarcomas of the trunk or extremity in Grampian between 1991 and 2009. Notes for 158 patients were available for review. Seventy-nine (50%) patients presented prior to the establishment of the Scottish Sarcoma Network. Cohort analysis reveals that the establishment of the SSMCN has had a positive impact on the management of sarcoma. The number of patients undergoing formal resection by the specialist surgical team has significantly increased while the waiting time from referral to assessment by the sarcoma service has decreased.
TL;DR: Primary breast osteosarcoma is a rare breast malignancy that affects elderly patients and can be debatable due to its rarity, non-specific radiological findings and the complicated histopathological subtypes.
Abstract: BackgroundPrimary soft tissue sarcomas are uncommon. We report a case of primary breast osteosarcoma which was treated successfully. This case report is combined with a literature review of this ra...
TL;DR: Forefoot surgery under ankle block alone may be safe and effective and Combined with intra-operative sedation, use of ankle tourniquet and same day discharge, it had very high patient acceptance and satisfaction.
Abstract: BackgroundAnkle block as the sole anaesthetic for forefoot surgery is not used uniformly throughout the UK despite obvious advantages and widespread use internationally.AimEvaluation of safety and effectiveness of performing elective forefoot surgery under ankle block anaesthesia alone in a pilot cohort of patients in a Scottish unit.MethodsData were collected from 81 consecutive forefoot procedures (71 patients) using a standardised questionnaire including incremental pain assessment (0–10; 0 no pain, 10 severe pain).ResultsSeven patients reported pain during surgery; average score 0.17. Average pain scores 6, 12, 24 and 48 h following surgery were 1.5, 3.09, 2.3 and 1.9, respectively. All patients were discharged home and walking on the same day.ConclusionForefoot surgery under ankle block alone may be safe and effective. Anaesthesia obtained permitted routine forefoot procedures and provided lasting post-operative analgesia. Combined with intra-operative sedation, use of ankle tourniquet and same day d...
TL;DR: Thymomas predominantly arising from the thymic cortex are associated with a higher risk of developing other malignancies and with poorer survival, and the cortical origin of thymoma could be considered as a significant prognostic factor.
Abstract: Background and aims:Although the management of thymomas has been extensively evaluated, the value of prognostic factors in the outcome of these patients remains unclear.Methods and results:The medical records of all patients who underwent resection of thymoma between January 1985 and September 2010 at a single thoracic unit were reviewed. Patients were followed up with reference to disease recurrence and development of additional malignancies (AM).Total thymectomy was performed in all 68 cases. Mean follow-up time was four years. Mean survival was 63.9 months. Mean disease-free interval was 13 months. Factors affecting prognosis were Masaoka staging and WHO histological sub-type. Patients with thymomas had a higher risk of developing AM when compared with a control population of individuals with other tumours (p = 0.0002). Among thymomas, the cortical subtype was associated with a higher risk of AM (p = 0.047) and mortality (p = 0.001).Conclusions:This data confirms that Masaoka staging and WHO histologic...
TL;DR: To the best of the authors' knowledge, this is the first report of synchronous presentation of pseudopapillary tumour of the pancreas in the pancreatic head and tail of a 16-year-old female patient.
Abstract: IntroductionSolid pseudopapillary tumour of the pancreas is a rare lesion with low malignant potential occurring predominantly in young women. This is a report of an extremely rare occurrence of sy...
TL;DR: The changing spectrum of Gram-positive organisms has impacted on antibiotic sensitivity patterns, and the local prescribing policy has been adapted in order to manage shunt infections most effectively.
Abstract: BackgroundInfection following ventriculoperitoneal shunt placement remains a significant complication with an incidence of 3–27% cited in literature. Infections cause significant morbidity, and it is important that empirical antibiotic therapy for management is guided by accurate knowledge of prevailing aetiologies and local antibiotic sensitivity patterns.AimsTo establish the incidence of shunt infections in our paediatric population, to identify the causative micro-organisms, and to determine the antibiotic resistance patterns of the responsible micro-organisms.MethodsRetrospective data collection utilising existing databases in the Royal Hospital for Sick Children, Yorkhill, between 1 January 2006 and 30 September 2013.ResultsTotal number of shunt operations was 308 with 28 episodes of infection involving 27 patients (male = 12, female = 15). The incidence of infection was 9%. In all, 79% of the episodes involved a single pathogen with 21% being mixed pathogens. Coagulase-negative staphylococci were th...
TL;DR: This case is reported of a 54-year-old man with insidious changes in personality and behaviour, lacking perceptual abnormalities and delusions, diagnosed with simple schizophrenia and treated with antipsychotics, making a rapid and maintained recovery.
Abstract: Simple schizophrenia is a rarely used and controversial diagnosis. Here we report the case of a 54-year-old man with insidious changes in personality and behaviour, lacking perceptual abnormalities and delusions. He showed progressive inability in general functioning and self-care. He was diagnosed with simple schizophrenia and treated with antipsychotics, making a rapid and maintained recovery. We use this case to illustrate the continued relevance of the diagnosis, and highlight the risks of overlooking these patients, with significant consequences for their ability to function adequately in society.
TL;DR: A few reports of ectopic sebaceous glands in the oesophagus have been reported in the tissues of ectodermal origin this article, however, these reports are limited.
Abstract: IntroductionMost ectopic sebaceous glands have been reported in the tissues of ectodermal origin. However, there are relatively a few reports of ectopic sebaceous glands in the oesophagus, an organ...
TL;DR: Physicians and surgeons need to be suspicious of NSTI in severe cases of soft tissue infection to prevent delay in diagnosis and life-saving treatment.
Abstract: BACKGROUND AND AIMS Necrotising soft tissue infection (NSTI) is an extremely serious condition that relies on a high index of suspicion, prompt diagnosis and emergent radical surgical treatment. We explored the presentation, management and outcomes of NSTI within our department. We also assessed the potential benefit of using risk predictor scoring system. METHODS Retrospective review using departmental electronic database and hospital records. RESULTS Twenty-four patients were treated for NSTI within our department between 2004 and 2010. Seventeen presented in our hospital to various surgical and medical teams. All patients presented with pain, swelling, erythema and tenderness at palpation. Only 40% of necrotising fasciitis and 28.6% of Fournier's gangrene were diagnosed as NSTI at initial assessment. Average mean interval time from admission to primary surgery was 17.7 h and 4 h from diagnosis to primary surgery. There were four mortalities. The average risk predictor Laboratory Risk Indicator for Necrotising Fasciitis score was 7.9. Significant morbidities post-operatively included bowel stoma, long-term urinary catheter and new diagnoses of carcinomas. CONCLUSION Physicians and surgeons need to be suspicious of NSTI in severe cases of soft tissue infection to prevent delay in diagnosis and life-saving treatment. Scoring system can be used judiciously as adjunct to aid diagnosis.
TL;DR: Most trainees believe that research is an important part of training and are exposed to research practices including trial recruitment, however, <50% attend regular journal clubs, a pertinent point, given the current ‘exit exam’ includes the assessment of critical appraisal skills.
Abstract: IntroductionGiven the importance placed on awareness and participation in research by Speciality and Training organisations, we sought to survey Scottish trainee attitudes to exposure to research practice during training and research in or out of programme.MethodsAn online survey was distributed to core and specialist trainees in general surgery in Scotland.ResultsOver a 4-month period, 108 trainees (75 ST/SPRs and 33 CTs) completed the survey. In their current post, most were aware of ongoing research projects (77%) and 55% were aware of trial recruitment. Only 47% attend regular journal clubs. Most believe that they are expected to present (89%) and publish (82%) during training. Most (59%) thought that participation in research is well supported. 57% were advised to undertake time out of programme research, mostly by consultants (48%) and training committee (36%). Of the 57 with time out of programme research experience, most did so in early training (37%) or between ST3-5 (47%). 28 out of the 36 (78%)...