Scottish Medical Journal

Radiation under four commercially available phototherapy units was measured over the visual spectrum and demonstrated that between 69 and 87per cent of the radiation was irrelevant to the photodegradation of bilirubin. When infants with moderately severe physiological jaundice were exposed to three of the same phototherapy units under the same conditions there was no demonstrable difference in the apparent rate of decline of serum bilirubin or in length of treatment required.

Electrocardiography is of limited value in pre-operative screening for cardiac disease. A short questionnaire has been shown to be helpful in assessing cardiac status and could permit a 30% reduction in the number of pre-operative ECGs performed.

Three cases of perinatal paroxysmal supraventricular tachycardia are described. In two patients the tachycardia was present prior to delivery; in the third baby, who also had the Wolf-Parkinson-White Syndrome, the time of onset of tachycardia is not known. The risks of this condition to the foetus are largely unknown but severe intra-uterine cardiac failure can occur. Possible lines of management are discussed.

T wave inversion confined to the lateral leads presents one of the commonest dilemmas in the field of electrocardiogram (ECG) reporting. The differentiation between lateral ischaemia and left ventricular hypertrophy is generally based on the presence or absence of the accepted voltage criterion of hypertrophy, even though this is admitted to have a relatively low degree of sensitivity.

In this study the repolarisation pattern in V6 has been analysed in a consecutive series of 100 patients showing T inversion of at least 1 mm in this lead, and correlated with the diagnosis. Patients on digoxin or similar drugs were excluded.

Thirty-four patients were diagnosed as having hypertension or aortic valve disease or a combination of the two conditions: 31 as pure ischaemic heart disease; 24 as a combination of ischaemic and hypertensive or aortic valvular disease and 11 as having miscellaneous diseases.

Two abnormalities of the T wave showed a significant association with aortic valve disease and hypertension; namely marked asymmetry and terminal positivity (overshoot). These features were sometimes seen in these diseases when the commonly acceptable voltage criterion of left ventricular hypertrophy was lacking.

A retrospective review of the value of skull X-rays in the management of1379 patients presenting to an accident and emergency department with minor head injuries was made. Ten skull fractures were identified in this group (an incidence of 0.7%) of which only four were identified by the casualty officer, the remainder being subsequently identified by the radiologist. Some 90 per cent of patients had no history of concussion, and 33 per cent had no external evidence of head injury. All patients with fractures were admitted because of clinical criteria so that skull X-rays played no part in determining whether patients were admitted for observation or not. Only one patient required operative intervention for a compound depressed fracture, and no patient developed an intracranial haematoma.

It is concluded that there is need to educate casualty officers on the indications for, and interpretation of skull X-rays. It is hoped that this might decrease the cost to the Health Service of needless skull X-rays, without detriment to the standards of patient care.

Indwelling central venous catheters were used for vascular access in 25 oncology patients, The lines were used for sampling, administration of blood products, chemotherapeutic agents, parenteral nutrients and occasionally plasmapheresis. The complication rate was no higher than in reported series in which the catheters were reserved for parenteral nutrition. We believe that a central venous cannula can be safely used as the sole means of vascular access in those patients with consequent psychological and practical benefits.

Sixty-four cases of acute haematogenous osteitis have been reviewed. The majority of these patients have been treated by high dose intravenous bolus injection of Cloxacillin. With this regime a primary healing rate of 96.8 per cent was achieved with a surgical intervention rate of 4.6per cent. It is concluded that routine surgery is not required in the treatment of this condition and that the mainstay of treatment should be vigorous antibiotic therapy.

Reliable pre-operative localisation of parathyroid tumours can be of value in surgery for primary hyperparathyroidism, and particularly so where re-exploration of the neck is required. Neck vein catheterisation and parathyroid hormone radioimmunoassay have been suggested as a sensitive means of tumour localisation, and we report our experience of the technique over the last five years.

A total of 46 patients with primary hyperparathyroidism had 50 studies performed with positive localisation and a pre-operative prediction made on 38 occasions (76%). Forty-two operations were carried out and a parathyroid tumour confirmed in 39 cases for a localisation efficiency of 69 per cent. No negative neck exploration followed a positive localisation. Twelve studies were performed in patients with renal osteodystrophy and localisation to a single site was achieved on only three occasions.

It is concluded that neck vein catheterisation and parathyroid hormone assay can correctly localise parathyroid tumours in most cases of primary hyperparathyroidism, but is is suggested that its use be restricted to selected cases such as those subjects with previous negative neck exploration or patients for whom prolonged or repeated surgery may be a particular hazard.

Computed tomography has been employed for the localisation of parathyroid tissue in 26 patients with primary hyperparathyroidism. In 14 of these selective venous catheter studies with parathyroid hormone assay were also undertaken. Computed tomography proved unreliable, identifying only 39 per cent whereas the cervical venous hormone assay studies localised 69 per cent of lesions correctly—a figure which is in agreement with several other groups. On balance our results suggest that neither technique should be routinely employed pre-operatively but that, following unsuccessful parathyroid surgery, the most useful localisation technique remains venous hormone assay.

From January 1979 until December 1980, neutralizing antibody titres to Coxsackie B1-6 viruses were measured in sera from 220 patients presenting to a general medical unit, the majority of whom had chest pain. No four-fold or greater rises in antibody titre were detected in these hospital patients. However, 49 per cent had titres of ⪖256 to one or more Coxsackie B virus types compared with 10 per cent of the 950 persons studied during a ‘normal population’ survey in the West of Scotland. When a more rigorous threshold was adopted, titres ⪖512 were found in 33 per cent and 4 per cent respectively. We conclude that Coxsackie B infections are not uncommon in the practice of a general medical unit and that they may account for more cases of both acute and subacute left chest pain than is usually realised.

Fifty-five patients with ECHO virus type 30 meningitis were admitted to the Infectious Diseases Unit, Edinburgh City Hospital between August and December 1980. There was a preponderance of males and patients aged 10–15 years. The peak admission rate was about two weeks earlier than that recorded for Scotland as a whole. Helpful diagnostic findings were headache, fever, photophobia, vomiting and nuchal rigidity but not Kernig's sign. Only one patient had a rash. The majority of patients were admitted within 48 hours of the onset of symptoms. The CSF pleiocytosis was high and tended to be polymorphonuclear in type. CSF glucose concentrations were all normal. There were no serious sequelae. The considerable morbidity reported after leaving hospital emphasises the importance of adequate convalescence.

Of 16 children with primary duodenal ulcer, 11 had complete relief of symptoms with initial full dose cimetidine therapy. After stopping cimetidine two of these 11 relapsed, six are in remission and three occasionally complain of abdominal pain requiring antacids. The remaining five children showed no improvement al all. Only one out of the 16 children showed side-effects due to cimetidine. Although there was wide variation in dosage of cimetidine and duration of therapy, no significant difference was noted in the dosage regimen of responders and non-responders to cimetidine. We suggest, full dose cimetidine 20 to 40 mg/Kg/dayfor 4 to 8 weeks, followed by 8 mg/Kg nocte daily for another 4 to 8 weeks.

Thermal injuries in childhood occur mainly in the first three years of life and often lead to hospital admission: most are due to scalds in the home. The distress and anxiety of parents bears on the management of the young sick child in hospital, on his subsequent recovery at home and on the welfare of the whole family. To help parents, a weekly meeting was held with a small group of staff in the Burns Unit at which there was free and open discussion of all problems and worries connected with the child's accident. This paper describes the working of the group and the contribution it made to the care of 149 children admitted with burns and scalds during one year.

Measurements of potassium status were reviewed in 23 hypertensive patients receiving metoprolol either alone or in combination with chlorthalidone or chlorthalidone plus potassium over an average period of nine months. There was no statistically significant change in plasma potassium, total blood cell or total body groups developed hypokalaemia (serum potassium <3.0mmol/l) in the absence of significant falls in total blood cell or total body potassium. Thus the use of chlorthalidone plus potassium did not provide adequate prophylaxis against hypokalaemia even in metoprolol recipients. The study confirms that monitoring parameters of potassium handling is still necessary in β-blocker recipients who also receive diuretics alone or in a fixed-dose combination with potassium.

Salmonella virchow, a food poisoning strain previously only sporadically responsible for disease, has recently been isolated with increasing frequency in Scotland.

The experience of infections due to this organism in 1980 in an infectious diseases unit is reported. Nine of 15 patients consecutively admitted with infection due to this organism were found to be septicaemic on blood culture thus highlighting the invasive propensity of this serotype.

Two weeks following a renal arteriogram a 56-year-old man with severe hypertension developed a staphylococcal septicaemia. After six weeks treatment with intravenous fusidic acid and cloxacillin he became icteric, confused and disorientated. The fusidic acid was stopped and the serum bilirubin fell to normal. His confusion persisted and serum cloxacillin levels were found to be grossly elevated. The patient's mental state returned to normal following withdrawal of cloxacillin.

We attribute his jaundice to treatment with fusidic acid and his acute confusional state to cloxacillin neurotoxicity.

A report is presented of a patient who developed the Lupus syndrome while on treatment with hydrallazine. A significant anaemia was present which was fully investigated. The aetiology of the anaemia is discussed.

Eosinophilic gastroenteritis is an uncommon condition which usually affects the antrum of the stomach and may occasionally involve the small or large intestine (1). The main clinical feature is usually that of chronic colicky abdominal pain. We report a case presenting as acute small intestinal obstruction due to isolated involvement of the distal small intestine.