Journal of the Royal College of Physicians of Edinburgh

Weekend admission is associated with higher in-hospital mortality than weekday admission. Whether providing enhanced weekend staffing for acute medical inpatient services reduces mortality or length of stay is unknown

Patients with cardiac failure require careful evaluation to determine the precise nature of the cause of their illness. Genetic causes of dilated cardiomyopathy are well known but inherited conditions may lead to unexpected consequences through intermediate mechanisms not readily recognised as a feature of the inherited disorder. We describe a case of dilated cardiomyopathy resulting from prolonged hypocalcaemia due to previously undiagnosed hypoparathyroidism resulting from DiGeorge Syndrome and describe the features of this case and the treatment of hypoparathyroidism.

A 22-year-old female migraineur presented with recurrent convulsive status epilepticus and ataxia. Her epilepsy proved refractory to treatment, necessitating the use of five anti-epileptic drugs and a course of steroids. Genetic testing revealed compound heterozygosity for two mutations of the polymerase-γ gene. The case highlights the clinical features and therapeutic challenges associated with this relatively common, but probably under-recognised, mitochondrial disease.

Analgesic drugs, as well as providing pain relief, can cause a range of other symptoms and side effects, most notably on the gastrointestinal system. Conversely, gastrointestinal disease will often require analgesia, and this can be complicated by the fact that the gut is the site of absorption of oral drugs. This paper discusses some of the effects of common oral analgesic drugs on the gastrointestinal tract and their role in managing some of the most common, non-malignant, chronic gastrointestinal disorders in adults.

Although Renaissance artists were skilled in representing normal anatomy, a close look at some paintings reveals anatomical variations in the depiction of the feet of human figures. A systematic review has identified 25 paintings by five artists in which the presumptive medico-artistic diagnosis of congenital or acquired foot deformity seems to be varyingly present. The connection between these five painters and what factors have influenced artists’ style in the depiction of such deformities is discussed. The possible iconography and medical–historical meaning of such variations, as well as the possibility of artistic licence and real representation that drove the painters to depict these deformities, is explored and debated.

From the 1820s to the 1840s, one of the most recognisable figures in Edinburgh was the eccentric John Sheriff, generally known as Dr Syntax. He was a talented amateur artist, whose work provides a fascinating and strange insight into the mind of a troubled man and, because of his interest in medicine, into the history of medicine in Scotland at the time. This paper seeks to show that Sheriff and his pictures deserve to be remembered, since they offer intriguing insights for anyone interested in the history of medicine and of Edinburgh at the end of its Golden Age.

Edinburgh-born Muriel Spark is one of modern Scotland's greatest writers. Examination of her work reveals that the subjects of madness and psychiatry are recurrent themes in her writing. She herself had a mental breakdown when she was a young woman and she took an interest in the world of psychiatry and psychoanalysis. In her short stories, Spark approaches the subject of madness in a variety of ways: she relates it to the supernatural; to writing fiction; and to religion. She frequently juxtaposes secular and supernatural explanations of mental disturbance. Spark adopts a sceptical and, at times, mocking view of psychiatrists and psychiatric treatment. Both psychoanalysis and pills are seen as problematic.