Western Infirmary Research Articles

Dialysis at Home in the West of Scotland: A Comparison of Hemodialysis and Continuous Ambulatory Peritoneal Dialysis in Age and Sex-Matched Controls

To audit the outcome of patients treated at home by hemodialysis and continuous ambulatory peritoneal dialysis (CAPD). Retrospective comparison of nondiabetic hemodialysis patients with age- and sex-matched nondiabetic patients treated by CAPD. Renal Units, Stobhill General Hospital and Western Infirmary, Glasgow, providing the home dialysis service for the West of Scotland. Between 1982 and 1988, 139 hemodialysis patients starting treatment at home, compared with 139 matched patients starting CAPD over the same time period. Patient characteristics and cardiovascular risk factors at the start of home treatment. Patient and technique survival with both forms of dialysis. Patients selected for home hemodialysis were less likely to be smokers (p < 0.02) and to have electrocardiographic evidence of ischemia or left ventricular hypertrophy (p < 0.05) than patients treated by CAPD. Patient survival and technique survival (excluding death and renal transplantation) at 3 years were 93.8% versus 86.2% (p < 0.05) and 94.2% versus 80.8% (p < 0.04) for hemodialysis and CAPD, respectively. Cardiovascular events were responsible for the majority of deaths in both groups, but there was a greater proportion of deaths from other causes in patients treated by CAPD. There was no significant difference in the transplantation rate between the two treatment groups. Home dialysis is an effective method of renal replacement treatment for patients with end-stage renal disease. The results of hemodialysis are superior to CAPD, but this may be partly due to selection bias.

Sudden Death in Epilepsy: An Avoidable Outcome?

In a retrospective survey of mortality among the first 1000 unselected patients referred to the Epilepsy Research Unit at the Western Infirmary in Glasgow between 1985 and 1990, a total of 18 deaths were identified. Three patients had committed suicide and one each had died of status epilepticus in hospital, a subdural haematoma and a myocardial infarction. The remaining 12 deaths (67%) were sudden (median age 32 years; range 22-68 years). Poor seizure control and poor compliance with antiepileptic drug therapy were recorded in only three (25%) of these patients. There was a change in antiepileptic drug regimen in five (28%) in the month before death. Only two (17%) underwent postmortem examination. In nine of the 12 patients dying suddenly, the primary cause of death was not listed as epilepsy but as asphyxia (3), aspiration (2) and one each of ischaemic heart disease, myocardial infarction, asystole and drowning (in the bath). 'Status epilepticus' was assumed to have been responsible for the other three deaths, two of which were unwitnessed. Sudden death in people with epilepsy is an entity of great concern. Appropriate death certification and mandatory postmortem examination are essential to provide a truer picture of this neglected phenomenon.

The Spectrum of Chronic Liver Disease in Renal Transplant Recipients

Chronic liver disease has been reported to be an important cause of late morbidity and mortality in renal transplant recipients. We have examined the prevalence and nature of chronic liver disease among 538 patients with functioning renal allografts managed at the Western Infirmary, Glasgow, between 1980 and 1989. Thirty-seven patients (7 per cent) satisfied biochemical criteria for chronic liver dysfunction. Liver biopsies were obtained from 24 of these, and autopsy tissue was available from three other patients. Chronic hepatitis of variable severity was present in 15 patients, haemosiderosis in 12 patients and nodular regenerative hyperplasia in five patients. Nineteen patients (51 per cent) had serological evidence of infection with the hepatitis C virus, and one of these developed chronic hepatitis B and D infection as well. Although a variety of chronic liver diseases occurred in our transplant population, the frequency of serious sequelae from liver dysfunction was much lower than that reported from transplant centres in other countries.

Comparison of color doppler ultrasound with venography in the diagnosis of axillary and subclavian vein thrombosis : Baxter GM, Kincaid W, Jeffrey RF, et al. (Department of Radiology, Western Infirmary, Glasgow G11, UK). Br J Radiol 1991;64:777–781

Comparison of color doppler ultrasound with venography in the diagnosis of axillary and subclavian vein thrombosis : Baxter GM, Kincaid W, Jeffrey RF, et al. (Department of Radiology, Western Infirmary, Glasgow G11, UK). Br J Radiol 1991;64:777–781

61. Endometriosis and tubal migration of radionuclide

Departments of 1Gynaecology, Western Infirmary, Glasgow, 2Nuckar Medicine, Royal Infirmary, Glasgow and 3West of Scotland Health Boards, Department of Clinical Physics and Bio-Engineering, Glasgow, Scotland

Non‐steroidal anti‐inflammatory drugs and acute renal disease: A case control study

AbstractObjectives: To quantify the risk of acute renal disease in patients exposed to non‐steroidal anti‐inflammatory drugs (NSAIDs). Design: Matched case control study. Subjects: All patients who underwent renal biopsy in Glasgow Royal Infirmary and the Western Infirmary, Glasgow, in 1986 and 1987 were considered as possible cases. Patients with chronic disease, with disease that was clearly not drug‐related, and whose records could not be traced were excluded. For each case in the final group, two controls were matched for age, sex and general practice. All drug exposures in the year before the diagnosis of renal disease were obtained from the general practitioners' records. Results: 27 of the 88 cases (31%) and 38 of the 176 controls (22%) were exposed to NSAIDs (odds ratio (OR) = 1.6; 95% confidence interval (CI) = 0.9, 3.0). No difference in exposure to bronchodilators, tranquillizers, antihistamines or antacids was found between cases and controls. A significant increase in OR was found with histamine (H2) receptor blockers. Of cases where interstitial nephritis was part of the pathological appearance, two were thought to be definitely and six possibly related to NSAIDs. Conclusions: The present study shows that in previously healthy persons, the risk of clinically apparent acute renal disease caused by these commonly used drugs is likely to be extremely small. The attributable risk of acute renal disease is of the order of one case in 100,000 patients treated with NSAIDs.

Homoeopathy and hayfever

Clinical & Experimental AllergyVolume 21, Issue 6 p. 752-753 Homoeopathy and hayfever D. Taylor Reilly, D. Taylor Reilly University Departments of Medicine Glasgow Royal Infirmary, Glasgow G3I 2ERSearch for more papers by this authorM. A. Taylor, M. A. Taylor University Departments of Medicine Glasgow Royal Infirmary, Glasgow G3I 2ERSearch for more papers by this authorC. McSharry, C. McSharry University Departments of Bacteriology and Immunology, Western Infirmary, Glasgow Gil 6NTSearch for more papers by this authorT. Aitchion, T. Aitchion Department of Statistics, University of Glasgow GI2 8QQSearch for more papers by this author D. Taylor Reilly, D. Taylor Reilly University Departments of Medicine Glasgow Royal Infirmary, Glasgow G3I 2ERSearch for more papers by this authorM. A. Taylor, M. A. Taylor University Departments of Medicine Glasgow Royal Infirmary, Glasgow G3I 2ERSearch for more papers by this authorC. McSharry, C. McSharry University Departments of Bacteriology and Immunology, Western Infirmary, Glasgow Gil 6NTSearch for more papers by this authorT. Aitchion, T. Aitchion Department of Statistics, University of Glasgow GI2 8QQSearch for more papers by this author First published: November 1991 https://doi.org/10.1111/j.1365-2222.1991.tb03207.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume21, Issue6November 1991Pages 752-753 RelatedInformation

Medical treatment of peptic ulcer

Department of Medicine and Therapeutics, Gardiner Institute, Western Infirmary, Glasgow, UK and Division of Digestive Diseases and Nutrition, University of South Carolina, Columbia, South Carolina, USA

Central venous cannulation: two complications

AnaesthesiaVolume 45, Issue 11 p. 998-999 Free Access Central venous cannulation: two complications D.L. Paul, D.L. Paul Western Infirmary, Glasgow G11 6NTSearch for more papers by this author D.L. Paul, D.L. Paul Western Infirmary, Glasgow G11 6NTSearch for more papers by this author First published: November 1990 https://doi.org/10.1111/j.1365-2044.1990.tb14670.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume45, Issue11November 1990Pages 998-999 RelatedInformation

Outcome of renal replacement treatment in patients with diabetes mellitus.

To compare the outcome of renal replacement treatment in patients with diabetes mellitus and in non-diabetic patients with end stage renal failure. Retrospective comparison of cases and matched controls. Renal unit, Western Infirmary, Glasgow, providing both dialysis and renal transplantation. 82 Diabetic patients starting renal replacement treatment between 1979 and 1988, compared with 82 matched non-diabetic controls with renal failure and 39 different matched controls undergoing renal transplantation. Patient characteristics, history of smoking, prevalence of left ventricular hypertrophy and myocardial ischaemia at start of renal replacement treatment; survival of patients with renal replacement treatment and of patients and allografts with renal transplantation. The overall survival of the diabetic patients during the treatment was 83%, 59%, and 50% at one, three, and five years. Survival was significantly poorer in the diabetic patients than the controls (p less than 0.001). Particularly adverse features for outcome at the start of treatment were increasing age (p less than 0.01) and current cigarette smoking (relative risk (95% confidence interval) 2.28 (0.93 to 4.84), p less than 0.05). Deaths were mainly from cardiac and vascular causes. The incidence of peritonitis in patients on continuous ambulatory peritoneal dialysis was the same in diabetic patients and controls (49% in each group remained free of peritonitis after one year), and the survival of renal allografts was not significantly worse in diabetic patients (p less than 0.5). Renal replacement treatment may give good results in diabetic patients, although the outlook remains less favourable than for non-diabetic patients because of coexistent, progressive vascular disease, which is more severe in older patients.

Comparison of Bupivacaine and Bupivacaine with Fentanyl in Continuous Extradural Analgesia During Labor

Department of Anaesthetics, Royal Infirmary; Department of Anaesthetics, Western Infirmary; and Medical Statistics Unit, Edinburgh University Medical School, Edinburgh and Glasgow, Scotland

A comparison of remote afterloading and manually inserted caesium in the treatment of carcinoma of cervix

Between 1982 and 1985, 240 patients with carcinoma of cervix were treated by radical radiotherapy, 140 using the selectron at the Royal Beatson Memorial Hospital (RBMH) and 100 with conventional caesium at the Western Infirmary. To allow for the increased dose rate to point A (1.2-1.4 Gy/h) during selectron treatment the overall intracavity dose was reduced by a mean value of 25%. Local recurrence rates were similar: 15% (selectron) against 14% (conventional). Three-year survival with local control was somewhat worse in the selectron group (77% against 81%) mainly because of an increased frequency of metastatic disease with local control (19.3% against 12.0%. The use of remote afterloading has not increased late morbidity (15.7% selectron, 15.0% conventional). The introduction of the selectron has brought about a marked reduction in staff radiation exposure. At the RBMH the mean recorded dose to nurses fell from 19 mSv in 1981 to 2.4 mSv in 1985.

Appropriateness of hospital referral for hypertension.

To examine the efficiency of referral to an outpatient clinic and particularly the differences between referrals from general practitioners practising in health centres and those from other general practitioners. Retrospective audit of referral letters and case notes by comparison with externally set standards of appropriateness of referrals over two years. Outpatient hypertension clinic at Western Infirmary, Glasgow. 306 Consecutive new referrals of patients over two years (1 May 1986 to 30 April 1988), for whom case notes were available in 298. Congruence of referrals with each of two standards of appropriateness based on published opinion on specialist referral (standard 1 was stricter than standard 2) and completeness of referral letters. Of the 298 referrals, those from general practitioners accounted for 205, from other hospital departments 68, and from other sources 25. Overall, 84 referrals of the 205 from general practice met the first standard and 134 met the second, more lenient standard. 58 Referral letters from outside the hospital had some item missing. Referrals from general practitioners working in health centres (a fifth of the total) were significantly more likely to meet both standards (p less than 0.01) and to send a complete referral letter (p less than 0.001) than the 145 referred by other general practitioners. According to the standards used, general practitioners in health centres made more appropriate referrals, and further investigation is needed to identify the underlying factors responsible.

Central effects of endothelin-1 on cerebral blood flow in the rat

University Department of Medicine and Therapeutics, Gardiner Institute, Western Infirmary, Glasgow G11 6NT †Wellcome Surgical Institute and Hugh Fraser Neuroscience Laboratories, Garscube Estate Glasgow, G61 1QH, UK

New drugs in the treatment of gastroduodenal disorders

University Department of Medicine and Therapeutics, Western Infirmary, Glasgow, UK and Division of Digestive Diseases and Nutrition, University of South Carolina School of Medicine, Columbia, South Carolina, USA

Thomas Kennedy Dalziel 1861-1924. Chronic interstitial enteritis.

T. Kennedy Dalziel, the son of a farmer, was born in Scotland at Merkland, Penpont, Dumfriesshire. He received his early education at a private school in Dumfries and studied medicine at Edinburgh University, graduating in 1883. He continued his medical studies in Berlin and Vienna, where he specialized in experimental surgery and pathology. In 1885 he began his practice in Glasgow, and in 1889 he joined the surgical staff of the Western Infirmary. In 1891 he joined the staff of the Royal Hospital for Sick Children. In his early years, Dalziel did considerable lecturing, first as Lecturer on Anatomy at the Western Medical School, and later as Professor of Medical Jurisprudence and of Surgery in Anderson's College. At the beginning of World War I he was called to represent Scotland on the Advisory Council to the Diretor-General of the Royal Army Medical Corps. For his services, the king conferred on him the honor of knighthood. His successes and the public position he attained were the result of an unusual combination of qualities—charm, kindliness, extraordinary teaching skills, and marvelous manipulative dexterity. He was considered the best technical surgeon in the West of Scotland. His contributions to the medical literature were considerable, dealing mainly with abdominal surgery. His writings, including this “classic” paper, demonstrate a concise grasp of a new disease entity, chronic interstitial enteritis, later to become known as Crohn's disease. It is generally believed that Dalziel was the first to “draw attention to this condition”. T. Kennedy Dalziel died on February 10, 1924, in his 64th year.

Role of inflammatory cytokines in experimental enteropathy: [formula omitted], Department of Bacteriology and Immunology, Western Infirmary, Glasgow G11 6NT, Scotland

Role of inflammatory cytokines in experimental enteropathy: [formula omitted], Department of Bacteriology and Immunology, Western Infirmary, Glasgow G11 6NT, Scotland

The effects of secondary transport on critically ill patients.

This study examined the effect of secondary transport on critically ill patients and the effectiveness of a regionally based intensive care service. Four hundred and ninety-five patients were studied retrospectively over a 2-year period. Eighty-two were transferred from peripheral hospitals in a mobile intensive care unit while the remaining 413 were admitted directly to the intensive therapy unit at the Western Infirmary, Glasgow. The severity of illness in both groups was assessed using the APACHE II scoring system. The transferred group were scored before and after the journey, while the directly admitted group were scored only on admission. The results show that the transferred patients exhibited a consistent cardiorespiratory response to transport irrespective of their severity of illness, and that the mortality in both groups of patients in the intensive therapy unit was not significantly different. The results also suggest that in the transferred group, the outcome is not only dependent on the severity of illness but also on other factors, such as the hospital from which the patient was referred and the duration of the pretransfer admission.

Does adenocarcinoma of uterine cervix have a worse prognosis than squamous carcinoma when treated by radiotherapy?

Between 1964 and 1980, 1878 patients were considered for radiotherapy at the Western Infirmary, Glasgow, of whom 1673 (91.8%) had squamous tumors and 120 (6.6%) adenocarcinomas. Of these, 1505 squamous carcinomas (92.5%) and 95 (5.8%) adenocarcinomas were treated by radical radiotherapy. The treatment given to either histological type assigned to the same tumor stage was identical. The actuarial 5-year survival (all stages) for squamous (Sq) tumors was 54.6% and adenocarcinomas (Ad) was 54.0%. When analyzed by tumor stage 5-year survival is similar for patients with either tumor type—Stage I Sq 79.9%, Ad 81.8%; Stage II Sq 61.9%, Ad 65.9%; Stage III Sq 39.9%, Ad 29.8%; and Stage IV Sq 14.3%, Ad 21%.

Cardioplegia

AnaesthesiaVolume 43, Issue 10 p. 899-900 Free Access Cardioplegia C.D. Miller, C.D. Miller Western Infirmary, Glasgow G11 6NTSearch for more papers by this authorJ.R. Dougall, J.R. Dougall Western Infirmary, Glasgow G11 6NTSearch for more papers by this author C.D. Miller, C.D. Miller Western Infirmary, Glasgow G11 6NTSearch for more papers by this authorJ.R. Dougall, J.R. Dougall Western Infirmary, Glasgow G11 6NTSearch for more papers by this author First published: October 1988 https://doi.org/10.1111/j.1365-2044.1988.tb05629.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume43, Issue10October 1988Pages 899-900 RelatedInformation