Paul Scott

Takotsubo cardiomyopathy: a diagnostic challenge

The frequency of the diagnosis of takotsubo cardiomyopathy has increased rapidly over the past few years, possibly due to increasing awareness among cardiologists. At initial presentation the diagnosis remains a challenge because of the close similarity between the presentation of takotsubo cardiomyopathy, and that of ST elevation myocardial infarction (STEMI). Recognition of salient aspects of the medical history at presentation are important in order to organise further appropriate investigations such as echocardiography and left ventriculography at the time of coronary angiogram. Takotsubo cardiomyopathy can be easily missed without ventriculography early after presentation because of the transient nature of left ventricular dysfunction, and in many centres left ventriculogram is not done as standard in the setting of STEMI. The authors advocate left ventriculography in all cases of ST elevation who have unobstructed coronaries. The correct diagnosis of takotsubo cardiomyopathy is very important for future advice and management of the patient. The prognosis of this condition is generally excellent with almost all patients returning to normal within a few weeks. This article examines the takotsubo cardiomyopathy literature and discusses the pathophysiology, clinical features, management, and prognosis of this condition in the context of an illustrated case.

Fracture of a GORE HELEX Septal Occluder following PFO closure in a diver

Decompression illness (DCI) is more common in divers with a patent foramen ovale (PFO), and transcatheter PFO closure is being increasingly performed in patients with an episode of DCI who want to continue diving. A range of closure devices are available and the choice in an individual case depends on operator preference and PFO anatomy. The GORE HELEX Septal Occluder, introduced in 1999 primarily for secundum atrial defect closure, is a compliant non self‐centering device composed of a wire helical framework on which a microporous membrane is mounted. The device is fixed in place by a unique interlocking mechanism that passes through the center of the device from the left to the right atrial disc, thereby securing it onto the interatrial septum. Here, we present a case of a locking loop fracture and review the literature concerning this unusual complication.

An Inherent Jurisdiction to Protect the Public Interest: From PII to ‘Secret Trials’

The law of public interest immunity (PII), which permits the non-disclosure of material in evidence where its disclosure would harm the public interest, is well known to public lawyers. A series of cases on the topic of ‘secret trials’—criminal trials held wholly or in part in camera so as ensure the non-disclosure to the public of sensitive information which might otherwise emerge as part of the trial process—shows, however, that the law of public interest immunity should not be understood as a wholly sui generis body of law. Instead it is only one of what is potentially a range of tools possessed by the courts which have in common the end to which they are oriented (the protection of the public interest against disclosure of sensitive information), the mechanism by which they are prompted (a ministerial certificate stating that the public interest requires that certain information not become known to the public at large) and the legal authority by which they take place (the inherent jurisdiction of the courts). This paper in its first part defends that claim by reference to the relevant case law, outlining the law of PII (particularly as it relates to criminal trials) and the emergence alongside it of a body of case law on in camera trials which has at times struggled to differentiate itself from that on PII. By way of explaining that struggle, it explores the commonalities which exist between the two phenomena and argues that to emphasise these commonalities has contributed—and will further contribute in future—to the task of imposing upon the use of in camera trials the sorts of limits which have over time developed to restrict the use of PII. The paper’s second part considers the distinctions between the two mechanisms in terms of the circumstances in which they will be requested and the interaction between them, showing how the emergence of the in camera order alongside the better-known law of PII could make possible prosecutions which would otherwise be abandoned. The third section considers a second set of differences between the two, centred around each ones relationship with the constitutional principles of open and natural justice, and explains how that difference manifests itself in more restrictive criteria for the making of an in camera order than for the grant of PII. Finally, it examines the judicial belief, upon which the possibility of using the inherent jurisdiction to these ends is predicated, that neither of the procedural mechanisms are per se incompatible with the principle of natural justice.

Public interest judicial review in cross-border perspective

This paper assesses challenges in England and in Scotland to the ‘public interest conception’ of judicial review according to which judicial review is intended primarily to promote the public, rather than private, interest. It shows that though recent decades have seen the public interest conception of judicial review in the ascendancy south of the border, there has been in the recent past a changing of the tide: the public interest conception of judicial review has been chipped away by legislative developments which reject the premise upon which it is based – largely by implementing procedural rules which are in significant tension with it. In Scotland, on the other hand, the courts have shown less enthusiasm for that conception, with many of the procedural rules and developments which reflect it having been resisted by the Scottish judiciary or acceded to only belatedly and with some reluctance. On the basis of a consideration of the issues of standing, protective costs orders and third party interventions, it shows that, though the conception of judicial review which sees it primarily as a tool by which the public interest can be pursued and protected is in poor health on both sides of the border, the details of, and reasons for that conclusion, differ in interesting ways.