Journal of the Royal College of Physicians of Edinburgh

Diagnosis of inherited arrhythmia syndromes, including long-QT syndrome (LQTS), is challenging; however, early detection and initiation of therapies can reduce otherwise high rates of mortality.

Two months following the birth of her first child a previously well 21-year-old female experienced four episodes of transient loss of consciousness (TLOC).

The history was atypical for seizures but a video electroencephalogram (EEG) captured an episode with abnormal bifrontal epileptic discharge. She was commenced on levetiracetam.

Within weeks of the birth of her second child she experienced five further episodes. During the subsequent hospital admission an electrocardiogram (ECG) recorded polymorphic ventricular tachycardia (VT) during a typical TLOC event. Other ECGs recorded a prolonged QT interval. A diagnosis of LQTS was made and TLOC episodes ceased on commencement of nadolol.

The patient experienced 22 TLOC episodes before diagnosis - most likely from self-terminating VT.

With widespread availability of effective treatments to reduce the risk of sudden cardiac death in such conditions, clinicians should always remember how the ECG is an essential investigation every time a patient presents with TLOC.

Spontaneous pneumomediastinum (SPM) is an uncommon finding and clinicians must consider this during their clinical evaluation. High degree of suspicion and appropriate investigations play key roles in early diagnosis and avoiding potential life-threatening complications. SPM usually presents without any comorbidities (primary) or due to an underlying pathology (secondary), such as underlying asthma, barotrauma, valsalva manoeuvre or an oesophageal rupture. Patients can have varying clinical symptoms; the majority will have subcutaneous emphysema and Hamman's sign (mediastinal crunching sound on auscultation). The prognosis of SPM is usually good with resolution in most cases, and it has a low recurrence rate. We report a case of SPM in a young 19-year-old male who presented with symptoms of acute severe asthma and who made a complete resolution with conservative management.

Posterior reversible encephalopathy syndrome (PRES) is a completely reversible neuroradiological entity caused by accelerated hypertension, eclampsia, certain cytotoxic drugs and acute renal failure. PRES involves posterior circulation of the brain resulting in various manifestations, hence the name. Acute vision loss is one of the manifestations that occurs owing to the involvement of the visual pathway. However, loss of vision due to a lesion involving the lateral geniculate body alone is unusual. We report one such case of a young female who developed acute bilateral painless loss of vision without any other symptom during postpartum period. MRI brain showed features of PRES involving bilateral lateral geniculate body, hippocampus and brainstem. There was no involvement of retrogeniculate visual pathway, i.e. parieto-occipital cortex. The patient improved with optimal blood pressure control and was discharged after 5 days.

Levodopa is the most effective medical treatment for Parkinson's disease (PD) to date. As dopamine is known to increase cardiac inotropism and vasomotor tone, peripheral dopamine decarboxylase inhibitor is coadministered to suppress the peripheral conversion of levodopa to dopamine. Levodopa poses potential cardiovascular risks, thus its use in patients with existing coronary artery disease needs to be carefully monitored. We report a case of an elderly male with newly diagnosed PD who developed non-ST-elevation myocardial infarction following levodopa (Madopar) initiation.

Simulation is a method or technique to produce an experience without going through the real event. There are multiple elements to consider for a simulation programme, and technology is only one of the many dimensions. The ultimate goal is to engage learners to experience the simulated scenario followed by effective feedback and debriefing. Simulation is a useful modality to supplement training in real clinical situations because it enables control over the sequence of tasks offered to learners, provides opportunities to offer support and guidance to learners, prevents unsafe and dangerous situations, and creates tasks that rarely occur in the real world. It is also an effective method for interprofessional education. To use simulation effectively for education, particularly interprofessional team training, adult learning theory needs to be applied and effective feedback given. Future development in simulation depends on overcoming issues related to technology, research, cost and faculty development.

Healthcare in Iraq has seen significant decline over the past few decades. Political instability coupled with austerity due to conflict and war has become a major obstacle in the transition needed to restore acceptable healthcare standards.

Respiratory medicine had remained under developed despite the potential benefit it could offer to many people suffering diseases of high prevalence.

A dedicated team of experts carried out a feasibility study to create a specialist respiratory centre, ThiQar lung diseases (TQLD). Equipped with advanced diagnostic equipment, a paperless hospital information system and staff trained by specialists from the UK, the centre has reduced a significant healthcare gap. It now serves a large population catchment area and has helped offer people an alternative to seeking healthcare abroad.

Petr Skrabanek (1940-94) was a Czech-born doctor, polemicist and literary scholar. He qualified in medicine in Ireland, and spent most of his career at the Medical School of Trinity College Dublin. He was an outspoken critic of modern medicine, particularly of what he called ‘coercive healthism'. Skrabanek's sceptical and iconoclastic ideas are more relevant today than ever. This essay aims to rekindle interest in his life and work.

A neurosurgical unit was established in Aberdeen Royal Infirmary (ARI) in 1948 with the appointment of Martin Nichols as its first full-time neurosurgeon. Despite there being no formal neurosurgical ward or specialist dedicated to neurosurgery in ARI prior to this, a number of neurosurgical procedures were undertaken between 1920 and 1940. From 1923 to 1932, the procedures were predominantly cranial and were performed by general surgeons. The operations evolved in 1933 to include the spine and peripheral nerves after the arrival of Sir James Learmonth. This paper chronicles the development of surgical neurology at the ARI in the 30 years preceding a formal unit. It considers the factors and background that enabled neurosurgical practices to be undertaken and led to evolution of neurosurgery from general surgery.

Thomas Wharton Jones (1808-91), described as a ‘genius’ by his famous pupil Thomas Henry Huxley, was an Edinburgh medical graduate. At the age of 19 years he was appointed anatomy demonstrator to the infamous Dr Robert Knox so unwittingly becoming caught up in the Burke and Hare scandal. Escaping to Glasgow, and then to Cork and London, Jones eventually became an outstanding physiologist and ophthalmologist. His seminal observations included scholarly treatises on the vasculature in inflammation together with descriptions of the contractile movement of white blood cells, as well as studies on regeneration and repair, astigmatism and retinitis pigmentosa. He was admitted as a Fellow of the Royal Society in 1840. One of his seminal contributions was his detailed description of ‘granular cells’ in the blood of a large number of animal species, including man. His illustrations suggest strongly these were eosinophils, predating Paul Erhlich's definitive studies (using aniline dyes) by 33 years. In later life he was found destitute in his London home and ‘rescued’ by friends and colleagues. William Gladstone was persuaded to give Jones a civil list pension. He lived out the rest of his life in Ventnor on the Isle of Wight.

Colonial physician and father of tropical medicine Sir Patrick Manson (1844-1922) is most closely associated with his research in China or teaching at the London School of Tropical Medicine, which he founded in 1899. This paper reconsiders Manson's life and work through a new spatial lens - that of his home at 21 Queen Anne Street. Drawing on glimpses of Manson's London house from his biographies and surviving archives, 21 Queen Anne Street is presented as a hybrid space - drawing together scientific, clinical and social networks and activities. Taking the form of a tour, this paper interrogates the internal divisions of the five-story building - focusing in particular on Manson's home laboratory, the ‘muck room', and his consulting room. It explores how boundaries between spaces within the house were managed but also transgressed by Manson and his imperial family. It suggests the need to think more broadly about the spatial contexts of medical practice and research in late nineteenth and early twentieth centuries.