Organisation of services for acute stroke in Scotland--report of the Scottish stroke services audit.

An audit was undertaken of hospital service provision for acute strokes in Scotland, using as a template key recommendations in the four SIGN guidelines on management of stroke. A questionnaire and structured interview was undertaken of key personnel in the 43 Trusts and three directly managed units providing in-patient stroke care in Scotland, and the 15 Health Boards commissioning stroke care. All Trusts and Health Boards participated and a complete set of information for each was recorded on a data-base and analysed. This report gives an overview for 14 key components of an integrated stroke service with results presented in four bands according to Trust type determined by the number of strokes admitted. No Trust provided all key components and for a few components a lack of provision was widespread, e.g. fast-track assessment clinics for TIA and minor stroke, access to CT scanning within 48 hours. Variation occurred between Trusts of similar size, between Trusts of different sizes. Overall the Health Boards were at a preliminary stage in the development of stroke specific service specifications. The results of the audit are a view of stroke services around April 1998, and should enable commissioners and providers to consider how to progress implementation of the clinical guidelines on stroke care.

Miliary tuberculosis in an in-vitro fertilization pregnancy: a case report.

A 33-yr-old woman with primary infertility of no known cause of 10 years duration underwent in-vitro fertilization. Mild flu-like symptoms and intermittent vaginal bleeding developed, and miliary mottling was seen throughout both lung fields. At 14 weeks she aborted a normal male fetus; urine culture was positive for M. bovis. Six months later, after a course of antituberculous drugs, the patient was symptom-free.

Diet, absorption, and hormone studies in relation to body weight in obstructive airways disease.

Sixteen male patients with stable chronic obstructive airways disease were separated into two groups of eight according to arterial carbon dioxide tensions. Hypercapnia was associated with lower arterial oxygen tensions, higher red cell volume, and increased weight, while normocapnic subjects were decidedly thin. The considerable difference in body weight between the two groups could not be explained by variation in caloric intake, and malabsorption was excluded as a cause of weight loss in the underweight subjects. Serum tri-iodothyronine, thyroxine, cortisol, and oestradiol concentrations were similar and normal in each group, but both groups had significantly low testosterone values as compared with controls, values in the hypercapnic being appreciably lower than in the normocapnic group. The adrenal androgen dehydroepiandrosterone was significantly high in the normocapnic group and low in the hypercapnic group compared with controls. Serum pituitary luteinising and follicle stimulating hormones were normal, but three hypercapnic individuals had high serum prolactin values. Early morning urinary aldosterone values were significantly higher in the hypercapnic than in the normocapnic group. Such hormone comparisons have not previously been made in subjects with chronic obstructive airways disease grouped according to arterial blood gas values, and it is concluded that major alterations in adrenal and testicular function may occur, possibly due to pituitary suppression from hypoxia. Such hormonal changes might in part account for the contrasting alterations in body habitus found in this condition.

Alpha-1-antitrypsin deficiency and chest disease a clinical and physiological study.

Four families with alpha-1-antitrypsin deficiency have been identified. Of 7 homozygous subjects 5 smoked and had chest disease while the 2 non-smokers were unaffected. Productive cough was a feature in 4 of the 5 affected homozygotes and symptoms commenced earlier than is usual with chronic bronchitis and emphysema. Of 11 heterozygous subjects only 5 who smoked had symptomatic or laboratory evidence of obstructive airways disease, in each case less marked than that of their homozygous smoking relatives. Severely affected subjects were underweight, the degree of weight loss being related to the measured severity of airways disease. A survey of emphsematous patients screened for alpha-1-antitrypsin deficiency is described. The natural course and significance of this enzyme deficiency are examined with reference to previous literature.