Telemedicine for multidisciplinary lung cancer meetings.

According to recent UK guidelines on the management of lung cancer, all cases should be reviewed prospectively by a lung cancer multidisciplinary team (MDT) and a thoracic surgeon should be readily available to liaise with the MDT. However, there is a shortage of thoracic surgeons in the UK. Over a one-year period, 28 MDT meetings were held at a district general hospital in Southend, at which 62 patients were presented to a tertiary cardiothoracic centre in London, 80 km away, via ISDN videoconferencing at 384 kbit/s.

Sacral insufficiency fractures: an unsuspected cause of low back pain.

We describe 10 cases of sacral fractures diagnosed within the rheumatology department at Southend Hospital over the last 5 yr. All presented with sudden-onset low back pain. The majority were elderly, frail, with chronic inflammatory disease (six with rheumatoid arthritis, one with polymyalgia rheumatica, one with vasculitis) and had received steroids.

Polyarteritis nodosa and the antiphospholipid syndrome.

We describe a case of classical polyarteritis nodosa (PAN) with visceral aneurysms presenting with renal infarction and hypertension. The female patient also had all the laboratory features of the antiphospholipid syndrome (APS) and 2 months into her illness developed a large iliofemoral thrombosis. She responded well to immunosuppressive therapy and anti-coagulation.

Ultrasonographic features of diabetic cheiroarthropathy.

Ultrasonography was used to measure flexor tendon sheath thickness in 14 insulin-dependent (IDDM) diabetics with diabetic cheiroarthropathy (DCA) and compared to 17 IDDM patients without DCA along with 10 healthy volunteers. Assessment was also made of the presence of systemic diabetic microvascular disease complications. A blinded visual 'eyeball' report on the ultrasound scans by a radiologist found hypoechoic thickening of the flexor tendon sheaths in 12 of the 14 patients with DCA, three of the 17 unaffected diabetics and two of the healthy volunteers (Fisher's exact, P < 0.