HONORARY PRESIDENTIAL ADDRESS
THURSDAY, 26TH MARCH 2009
Our Honorary President and Speaker for the evening, Professor Sir Roddy MacSween, was introduced by the President. Professor MacSween has been President of the Royal College of Pathologists and Chairman of the Joint Academy and is responsible for the standard textbook “MacSween’s Pathology of the Liver” – a distinguished career in both pathology and post-graduate training.
His interest in Lister as pathologist as well as surgeon was stimulated by the finding of a microscope with some pathological slides amongst Lister memorabilia dating from Lister’s Edinburgh period from 1853 to 1860. In fact review of the history of microscope and staining technique developments indicated that these could not have been the surgeons own work. Lister’s contact with the development of pathology went back to his father who had been responsible for developing achromatic lenses for microscopy in the 1820’s. As a student Lister had made microscopic examination of specimens. He continued this work in his early years in the College of Surgeons. However staining techniques and then paraffin embedding only developed respectively in the 1860’s and 1890’s.
Lister belonged to a Yorkshire Quaker family who moved to Essex where he had his upbringing. He trained in London at University College and the College of Surgeons before a move to Edinburgh initially for a brief clinical attachment which however led to a permanent post and marriage to the daughter of the then Professor of Surgery, Professor Syme. His work on antisepsis developed during Professorships in Glasgow during the 1860’s and Edinburgh the following decade. He then returned to London as Professor at King’s leading to Presidency of the British Association of Science and the Royal Society, knighthood and peerage. London surgeons were initially sceptical of his views sepsis prevention. It took a few years for him to be fully accepted.
Throughout his career he maintained an interest in pathology which was illustrated by remarkable detail in both drawing and clinical and pathological description of specimens – the latter neatly handwritten on foolscap sheets. Professor MacSween showed a number of examples of Lister’s drawings. These were largely done with aid of the camera lucida, a technique allowing superimposition of the image onto a drawing block to allow copying. Inevitably a lot of the early work prior to the advent of anaesthesia was of skin lesions – psoriasis, icthiosis, scurvy and melanoma. The illustrations covered both macroscopic appearance and cellular microscopy. With the development of anaesthesia more substantial specimens became available – examples included sarcoma and more uncertain cystic bone tumour. Most of these drawings and associated descriptions are housed in the Royal College of Surgeons. The overall impression was of the immense amount of work covered by Lord Lister and the remarkable detail of observation which characterised his approach – an impressive insight into an impressive figure.
Dr Philip Wilson, in proposing a vote of thanks, said he had struggled initially to find common points of interest with Lister but related readily to his non-conformist background and approach to work and teaching, and the remarkable detail of his observations. The President closed the evening by echoing our thanks to Professor MacSween and announcing the date of the Society’s Annual General Meeting – 23rd April.
01 May, 2009
12 March, 2009
From the minutes: Dr MacIntyre's report on our February 2009 meeting
The President welcomed around 50 members and guests and introduced the speaker, Professor Thomas Bourgeron from the Department of Human Genetics and Cognitive Science at Institut Pasteur in Paris. His title of “How far do genes contribute to behaviour” reflects his work in the genetics of neurodevelopment, particularly in relation to autism.
Is there a genetic influence on cognitive function? – yes. The more detailed questions are whether specific genes can be identified influencing specific functions such as language or social interaction, and whether differences in these genes explain behavioural differences. He thought the answer to both questions probably yes. The background to his work is the increasing understanding of the human genome with around 22,000 genes and associated “junk” DNA, the transcription from DNA to protein, and the variable expression of this DNA in different cells in the body. Variations in the DNA are mainly related to Single Nucleotide Polymorphism (SNP) or Copy Number Variation (CNV) where a larger section of DNA is duplicated or deleted. In humans the bulk of the genome is constant – one SNP variability in between 300 and 1200 base pairs. Primates exhibit much more polymorphism. This perhaps reflects the relatively “recent” move of homo sapiens out of Africa with a limited gene pool. One aspect of this work allows identification of which common gene mutations are relatively recent and which date further back in the evolutionary timescale. Some mutations are very common in the population and some much less so. In general the former probably represent low risk mutation and the latter more likely to have high risk to the individual.
Work on autism recognises that it is a spectrum ranging from individual characteristic to full blown disease – we can assess ourselves by looking up the autism spectrum quotient. The work of Professor Bourgeron and his colleagues is exploring the genetic variability that underlies this, looking at CNVs and SNPs in patient groups, mainly from Sweden and France. This work has resulted in identification of many candidate genes and polymorphisms for autism risk. This highlights the general danger of extrapolating predictions from specific gene findings as can occur with the availability of personal genome mapping. He identified five questions which should be applied to any genetic finding – mouse or man?, pilot study or replicated?, frequency and therefore likely impact?, disease specific or found in a range of conditions?, and is it supported by clinical or functional findings?
There is however a developing understanding of what might be going on in autism. Synaptogenesis is the gradual development of neuronal connections increasing from birth through childhood with a decline in adolescence and stability thereafter. Work arising from a number of family groups with autism spectrum has shown defects in proteins involved in creating or stabilising these synaptic connections – specifically neurolipin 4 and neurexan. A mouse model has been created – knock out for neurolipin 4. They appear normal in all respects other than aspects of social interaction. We were persuaded that this included their singing performance with a reduced motivation to vocalise! This may therefore represent a general mechanism for the development of autism influenced by different genetic defects.
Another area of genetic interest relates sleep pattern to autism. Melatonin levels are known to be diminished and it transpires that some autistic patients are deficient in an enzyme involved in melatonin synthesis from serotonin. Melatonin treatment can restore normal sleep patterns in some situations. All this work begins to allow models of understanding of the possible sequences from genetics through biochemistry to functional state. More work is probably needed in identifying different phenotypes in a condition such as autism before trying to link these to particular genetic susceptibilities. The picture is complex, the possible interpretations multiple, and prospects of specific therapies still distant. However Professor Bourgeron is one of an international group of enthusiasts producing rapid progress in this area.
Following a period of question and discussion, Dr MacIntyre expressed the thanks of the Society to Professor Bourgeron for a talk which had covered a complex subject in such a fascinating and stimulating way.
Is there a genetic influence on cognitive function? – yes. The more detailed questions are whether specific genes can be identified influencing specific functions such as language or social interaction, and whether differences in these genes explain behavioural differences. He thought the answer to both questions probably yes. The background to his work is the increasing understanding of the human genome with around 22,000 genes and associated “junk” DNA, the transcription from DNA to protein, and the variable expression of this DNA in different cells in the body. Variations in the DNA are mainly related to Single Nucleotide Polymorphism (SNP) or Copy Number Variation (CNV) where a larger section of DNA is duplicated or deleted. In humans the bulk of the genome is constant – one SNP variability in between 300 and 1200 base pairs. Primates exhibit much more polymorphism. This perhaps reflects the relatively “recent” move of homo sapiens out of Africa with a limited gene pool. One aspect of this work allows identification of which common gene mutations are relatively recent and which date further back in the evolutionary timescale. Some mutations are very common in the population and some much less so. In general the former probably represent low risk mutation and the latter more likely to have high risk to the individual.
Work on autism recognises that it is a spectrum ranging from individual characteristic to full blown disease – we can assess ourselves by looking up the autism spectrum quotient. The work of Professor Bourgeron and his colleagues is exploring the genetic variability that underlies this, looking at CNVs and SNPs in patient groups, mainly from Sweden and France. This work has resulted in identification of many candidate genes and polymorphisms for autism risk. This highlights the general danger of extrapolating predictions from specific gene findings as can occur with the availability of personal genome mapping. He identified five questions which should be applied to any genetic finding – mouse or man?, pilot study or replicated?, frequency and therefore likely impact?, disease specific or found in a range of conditions?, and is it supported by clinical or functional findings?
There is however a developing understanding of what might be going on in autism. Synaptogenesis is the gradual development of neuronal connections increasing from birth through childhood with a decline in adolescence and stability thereafter. Work arising from a number of family groups with autism spectrum has shown defects in proteins involved in creating or stabilising these synaptic connections – specifically neurolipin 4 and neurexan. A mouse model has been created – knock out for neurolipin 4. They appear normal in all respects other than aspects of social interaction. We were persuaded that this included their singing performance with a reduced motivation to vocalise! This may therefore represent a general mechanism for the development of autism influenced by different genetic defects.
Another area of genetic interest relates sleep pattern to autism. Melatonin levels are known to be diminished and it transpires that some autistic patients are deficient in an enzyme involved in melatonin synthesis from serotonin. Melatonin treatment can restore normal sleep patterns in some situations. All this work begins to allow models of understanding of the possible sequences from genetics through biochemistry to functional state. More work is probably needed in identifying different phenotypes in a condition such as autism before trying to link these to particular genetic susceptibilities. The picture is complex, the possible interpretations multiple, and prospects of specific therapies still distant. However Professor Bourgeron is one of an international group of enthusiasts producing rapid progress in this area.
Following a period of question and discussion, Dr MacIntyre expressed the thanks of the Society to Professor Bourgeron for a talk which had covered a complex subject in such a fascinating and stimulating way.
From the minutes: Dr MacIntyre's report on our January 2009 meeting
The joint meeting with the Royal Medico-Chirurgical Society was attended by around 50 members and guests. The President introduced Professor Sir Kenneth Calman who addressed us on Scottish literature and medicine. He was accompanied by Rhona Brown, a colleague from the English Faculty at Glasgow University who illustrated the talk with quotations from the wide range of writers discussed by Professor Calman. It was not an evening to be encapsulated in a brief summary – better to access the Society’s website to appreciate the broad range of literary references. Professor Calman used his study of Scottish literature to comment on a number of health related themes over several centuries – the people of Scotland and their lifestyle, health and health related behaviour, the role and public perception of doctors, description of diseases, and medicines and healing. His authors and poets covered some 600 years – from “the Bruce of the 14th Century” to “Irvine Welsh’s Trainspotting”. This breadth of Scottish reading was clearly well beyond that of most of his audience but he asked us to help him in this continuing study – any new discovery linking literature to medicine would be welcome.
Dr Hazel Scott in giving the vote of thanks reflected on Professor’s Calman’s broad career and range of interests and thanked him for sharing his insight into Scottish literature.
Dr Hazel Scott in giving the vote of thanks reflected on Professor’s Calman’s broad career and range of interests and thanked him for sharing his insight into Scottish literature.
28 February, 2009
Listen to the lecture: How far do our genes contribute to behaviour?
Professor Bourgeron is a world authority on the genetics of neuro-developmental disorders. He discusses the extent to which our genes are known to determine our behaviour, and how modern techniques in this field are advancing our knowledge with particular reference to autism and autism spectrum disorder.
The lecture was given to the Glasgow Southern Medical Society at the Ebenezer Duncan Centre, Glasgow UK on Thursday 26th February 2009.
Download the lecture to your mp3 player or listen online:
The lecture was given to the Glasgow Southern Medical Society at the Ebenezer Duncan Centre, Glasgow UK on Thursday 26th February 2009.
Download the lecture to your mp3 player or listen online:
16 January, 2009
Listen to the lecture: Scottish literature and medicine
Lecture given to the joint meeting of Glasgow Southern Medical Society with the Royal Medico-Chirurgical Society of Glasgow by Prof Sir Kenneth Calman, Chancellor of the University of Glasgow and Dr Rhona Brown, lecturer in Scottish Literature at the University of Glasgow, on Thursday 15th January 2009.
Download the lecture to your mp3 player or listen online:
Download the lecture to your mp3 player or listen online:
12 January, 2009
Notice of meeting: Scottish Literature and Medicine
Professor Sir Kenneth Calman, Chancellor of University of Glasgow
Thursday 15th January 2009
Joint meeting with the Royal Medico-Chirurgical Society of Glasgow
Meetings are at 7pm in the Ebenezer Duncan Centre, Victoria Infirmary, Langside Road, Glasgow.
A buffet supper is available for members from 6.15pm
Guests are welcome to our meetings.
Future Meetings:
Thursday 5th February, 7.30pm.
'Experiences in Iraq'
Dr Duncan Gray, Royal Alexndra Hospital, Paisley
Note: This meeting will be held at The Royal Medico-Chirurgical Society of Glasgow, Royal College of Physicians and Surgeons, St Vincent Street, Glasgow
Thursday 15th January 2009
Joint meeting with the Royal Medico-Chirurgical Society of Glasgow
Meetings are at 7pm in the Ebenezer Duncan Centre, Victoria Infirmary, Langside Road, Glasgow.
A buffet supper is available for members from 6.15pm
Guests are welcome to our meetings.
Future Meetings:
Thursday 5th February, 7.30pm.
'Experiences in Iraq'
Dr Duncan Gray, Royal Alexndra Hospital, Paisley
Note: This meeting will be held at The Royal Medico-Chirurgical Society of Glasgow, Royal College of Physicians and Surgeons, St Vincent Street, Glasgow
07 December, 2008
Listen to the lecture: Sleeping matters - snoring
Lecture given to the Glasgow Southern Medical Society by Mr Brian Bingham on Thursday 13th November 2008 as part of an evening symposium on sleep disorders. Related lectures include sleep breathing disorders and insomnia.
Download the lecture to your mp3 player or listen online:
Download the lecture to your mp3 player or listen online:
Listen to the lecture: Sleeping matters - insomnia
Lecture given to the Glasgow Southern Medical Society by Prof Colin Espie on Thursday 13th November 2008 as part of an evening symposium on sleep disorders. Related lectures include sleep breathing disorders and snoring.
Download the lecture to your mp3 player or listen online:
Download the lecture to your mp3 player or listen online:
Listen to the lecture: Sleeping matters - sleep breathing disorders
Lecture given to the Glasgow Southern Medical Society by Dr Steve Banham on Thursday 13th November 2008 as part of an evening symposium on sleep disorders. Dr Banham is introduced by the President of the Society Dr Douglas McLellan. Related lectures include insomnia and snoring.
Download the lecture to your mp3 player or listen online:
Download the lecture to your mp3 player or listen online:
30 November, 2008
Minute of the Symposium
SYMPOSIUM
13TH NOVEMBER 2008
SLEEP MATTERS
Dr Douglas McLellan, President, welcomed members of the Society, guests and our guest speakers. Dr Steve Banham, based at Gartnavel General Hospital runs the Assisted Ventilation Service for the West of Scotland and is Respiratory Specialty Adviser to Greater Glasgow Health Board. Professor Colin Espie established the Glasgow Sleep Research Centre based at the Southern General Hospital. Mr Brian Bingham is an ENT Surgeon with a long interest in, and experience of, management of snoring.
Sleep Breathing Disorders and Treatments That Can Transform Lives – Dr Banham
Dr Banham briefly reviewed the physiology of breathing at night – reduced ventilation during non-REM sleep and basic patterns of change in ventilation and arterial gases seen in obstructive sleep apnoea and in hypoventilation. Obstructive sleep apnoea is common affecting perhaps 4% of men and 2% of women. The clinical problem it presents is of daytime sleepiness rather than the actual nocturnal events. There is also an association with hypertension and cardiovascular disease. The Epworth sleepiness scale is a useful screening tool. Diagnosis is by overnight sleep study with limited home studies being generally adequate – full polysomnography unnecessary. Management with CPAP overnight ventilation is very effective and successfully tolerated in upwards of 70% of appropriate patients.
He went on to describe the principles of bi-level non-invasive assisted ventilation. Unlike CPAP which overcomes upper airway obstruction, bi-level ventilation increases breath by breath ventilation and hence improves gas exchange in a situation of failing respiration. He explained the use of this support in mechanical Chest Bellows disease, neuromuscular diseases, and some patients with chronic respiratory failure. This treatment has given some patients with chest wall deformity a normal life expectancy and has increased survival in Duchenne muscular dystrophy by around 10 years. Appreciation of the effectiveness of treatment has led to elective monitoring of patients at risk of drifting into respiratory failure.
These forms of overnight ventilatory support can genuinely transform the lives of both patients and families.
Practical Interventions for Insomnia in Primary Care – Professor Espie
Insomnia is common though precisely how common depends on definition. Simple primary insomnia is defined as poor sleep with daytime distress lasting for over a month. If it lasts for six months with the patient increasingly focused on the problem, it is described as psychophysiological insomnia. Around 10% of adults probably have insomnia severe enough to result in daytime consequences. The frequency and importance of insomnia is mirrored in various surveys. Sleep problems closely followed by the commonly associated fatigue are the commonest form of psychological morbidity in general surveys. There is an association between insomnia and depression with the former seeming to pre-date and perhaps predispose to the latter. This observation includes children. Insomnia and fatigue are similarly very common problems following treatment for cancer.
Management options include sleeping tablets and sleep hygiene advice but both approaches are of limited value. Cognitive behavioural therapy techniques have increasingly been developed to manage insomnia and are now of proven success. They underlie the approach of Professor Espie's work at the Sleep Centre. His research activities have now developed to having nurses from General Practice and Cancer Support working as CBT therapists giving a programme for insomnia of five, hour-long, sessions. These programmes improve sleep pattern and symptoms of fatigue, anxiety and depression. At their core is a change in the attitude of the patient to sleep and sleep problems. There may be future drug developments in insomnia management – Circadin which is fairly new can alter the timing of sleep cycles. However he felt that CBT is proven and should be promoted. The problem is how to achieve this with no Health Service funding currently available. His hope is that opportunities for training in this approach might increasingly be taken up.
A History of Surgery and Other Techniques to Resolve Snoring – Mr Bingham
Mr Bingham reviewed the animal kingdom, variations in nasal anatomy and Bernoulli principal in discussing the question of why we snore – the latter explains the flutter mechanism which creates noise from the floppy soft palate. Nasal obstruction, whether anatomical or temporary, increases snoring by change in airflow. Alcohol and sedatives do so by reducing muscle tone and hence increasing narrowing. Is it possible that exercise could reduce snoring by improving tone in neck muscles rather than simply by weight loss?
The other side of the problem is the snoree – why does this noise disturb us when the hearing mechanism is capable of shutting off background noise such as traffic. Perhaps it is the irregularity of the noise. His approach to snoring management started with simple measures such as nasal treatment, exercise and diet. Some of his patients benefited substantially from a simple CPAP type positive pressure mask. Dental splints – mandibular advancement devices – probably only help one third of those who try them. Surgery to the soft palate in appropriate patients is successful at the expense of two weeks of pain. It is important to exclude sleep apnoea first.
The evening was closed by Dr McKean offering a vote of thanks to all three speakers and the President presenting them with the Society's engraved glasses.
D. Macintyre
13TH NOVEMBER 2008
SLEEP MATTERS
Dr Douglas McLellan, President, welcomed members of the Society, guests and our guest speakers. Dr Steve Banham, based at Gartnavel General Hospital runs the Assisted Ventilation Service for the West of Scotland and is Respiratory Specialty Adviser to Greater Glasgow Health Board. Professor Colin Espie established the Glasgow Sleep Research Centre based at the Southern General Hospital. Mr Brian Bingham is an ENT Surgeon with a long interest in, and experience of, management of snoring.
Sleep Breathing Disorders and Treatments That Can Transform Lives – Dr Banham
Dr Banham briefly reviewed the physiology of breathing at night – reduced ventilation during non-REM sleep and basic patterns of change in ventilation and arterial gases seen in obstructive sleep apnoea and in hypoventilation. Obstructive sleep apnoea is common affecting perhaps 4% of men and 2% of women. The clinical problem it presents is of daytime sleepiness rather than the actual nocturnal events. There is also an association with hypertension and cardiovascular disease. The Epworth sleepiness scale is a useful screening tool. Diagnosis is by overnight sleep study with limited home studies being generally adequate – full polysomnography unnecessary. Management with CPAP overnight ventilation is very effective and successfully tolerated in upwards of 70% of appropriate patients.
He went on to describe the principles of bi-level non-invasive assisted ventilation. Unlike CPAP which overcomes upper airway obstruction, bi-level ventilation increases breath by breath ventilation and hence improves gas exchange in a situation of failing respiration. He explained the use of this support in mechanical Chest Bellows disease, neuromuscular diseases, and some patients with chronic respiratory failure. This treatment has given some patients with chest wall deformity a normal life expectancy and has increased survival in Duchenne muscular dystrophy by around 10 years. Appreciation of the effectiveness of treatment has led to elective monitoring of patients at risk of drifting into respiratory failure.
These forms of overnight ventilatory support can genuinely transform the lives of both patients and families.
Practical Interventions for Insomnia in Primary Care – Professor Espie
Insomnia is common though precisely how common depends on definition. Simple primary insomnia is defined as poor sleep with daytime distress lasting for over a month. If it lasts for six months with the patient increasingly focused on the problem, it is described as psychophysiological insomnia. Around 10% of adults probably have insomnia severe enough to result in daytime consequences. The frequency and importance of insomnia is mirrored in various surveys. Sleep problems closely followed by the commonly associated fatigue are the commonest form of psychological morbidity in general surveys. There is an association between insomnia and depression with the former seeming to pre-date and perhaps predispose to the latter. This observation includes children. Insomnia and fatigue are similarly very common problems following treatment for cancer.
Management options include sleeping tablets and sleep hygiene advice but both approaches are of limited value. Cognitive behavioural therapy techniques have increasingly been developed to manage insomnia and are now of proven success. They underlie the approach of Professor Espie's work at the Sleep Centre. His research activities have now developed to having nurses from General Practice and Cancer Support working as CBT therapists giving a programme for insomnia of five, hour-long, sessions. These programmes improve sleep pattern and symptoms of fatigue, anxiety and depression. At their core is a change in the attitude of the patient to sleep and sleep problems. There may be future drug developments in insomnia management – Circadin which is fairly new can alter the timing of sleep cycles. However he felt that CBT is proven and should be promoted. The problem is how to achieve this with no Health Service funding currently available. His hope is that opportunities for training in this approach might increasingly be taken up.
A History of Surgery and Other Techniques to Resolve Snoring – Mr Bingham
Mr Bingham reviewed the animal kingdom, variations in nasal anatomy and Bernoulli principal in discussing the question of why we snore – the latter explains the flutter mechanism which creates noise from the floppy soft palate. Nasal obstruction, whether anatomical or temporary, increases snoring by change in airflow. Alcohol and sedatives do so by reducing muscle tone and hence increasing narrowing. Is it possible that exercise could reduce snoring by improving tone in neck muscles rather than simply by weight loss?
The other side of the problem is the snoree – why does this noise disturb us when the hearing mechanism is capable of shutting off background noise such as traffic. Perhaps it is the irregularity of the noise. His approach to snoring management started with simple measures such as nasal treatment, exercise and diet. Some of his patients benefited substantially from a simple CPAP type positive pressure mask. Dental splints – mandibular advancement devices – probably only help one third of those who try them. Surgery to the soft palate in appropriate patients is successful at the expense of two weeks of pain. It is important to exclude sleep apnoea first.
The evening was closed by Dr McKean offering a vote of thanks to all three speakers and the President presenting them with the Society's engraved glasses.
D. Macintyre
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