Digital ischaemia as a presenting feature in metastatic ovarian cancer.

A woman in her 50s presented with acute pain and discolouration in the fingertips of both hands, without other features of connective tissue disease. The history was otherwise significant for abdominal bloating, altered bowel habit, urinary urgency and fatigue. Inflammatory markers, antinuclear antibodies, serum protein electrophoresis and complement levels were all normal.

Development of an evidence-based regimen of prednisolone to treat giant cell arteritis - the Norwich regimen.

We have reviewed the literature to form a bespoke regimen for daily oral prednisolone (DP) in GCA. Initial DP in clinical trials is 40-60 mg daily, but relapse rates are 67-92%. Cumulative prednisolone (CP) of 3.

Benchmarking: the five year outcome of rheumatoid arthritis assessed using a pain score, the Health Assessment Questionnaire, and the Short Form-36 (SF-36) in a community and a clinic based sample.

Background: Treatment, and therefore outcome, of rheumatoid arthritis (RA) will improve in the next few years. However, improvement in outcome can only be judged against the probability of certain outcomes with current conventional treatment.

Aim: To document the five year outcome of RA in the late 1990s.

Reducing waiting times for sleep apnoea hypopnoea syndrome and snoring using a questionnaire and home oximetry: results of a second audit cycle.

As a result of a previous audit on the management of sleep apnoea hypopnoea syndrome (SAHS) which showed long waiting times that were primarily due to unnecessary interspecialty referrals, a change in practice was adopted. All referrals are now sent a questionnaire about symptoms suggestive of SAHS, the Epworth Sleepiness Scale score and their body mass index (BMI) which when returned are categorized into having a high, intermediate or low risk of SAHS. Those patients with a high probability have home overnight oximetry and those with intermediate probability have video oximetry.

Corticosteroid injection for the treatment of carpal tunnel syndrome.

Objective: To compare low and high dose, and short and long acting corticosteroids in the treatment of carpal tunnel syndrome.

Methods: A randomised, controlled, single blind trial with electromyographic and subjective outcome measures.

Results: 25 mg hydrocortisone is as effective as higher doses or long acting triamcinolone at a six week and six month follow up.

A diagnostic algorithm for carpal tunnel syndrome based on Bayes's theorem.

Objective: To construct a diagnostic algorithm based on Bayes's theorem and using simple clinical tests to allow accurate diagnosis without resort to nerve conduction studies.

Method: A cohort of patients being referred with possible carpal tunnel syndrome had clinical and electrophysiological testing, from which the simple calculations for sensitivity, specificity and prevalence were made and subsequently used in the formula of Bayes's theorem. The algorithm was then tested prospectively in a further cohort of similarly referred patients.

Systemic vasculitis and atypical infections: report of two cases.

Two cases of systemic vasculitis are described; one presenting with adult Henoch-Schonlein purpura secondary to a concomitant Chlamydia infection and the other with leucocytoclastic vasculitis and mesangioproliferative glomerulonephritis secondary to a recent parvovirus B19 infection. Association of chlamydial infection has not previously been described with Henoch-Schonlein purpura and this infection should, perhaps, be added to the list of aetiologies of this disease. Parvovirus B19 causing significant urinary sediment abnormalities associated with mesangioproliferative glomerulonephritis and leucocytoclastic vasculitis has also not been described previously.

Putative analgesic activity of repeated oral doses of vitamin E in the treatment of rheumatoid arthritis. Results of a prospective placebo controlled double blind trial.

Objective: Vitamin E, the most potent naturally occurring lipid soluble antioxidant has been suggested to possess both anti-inflammatory and analgesic activity in humans. This double blind and randomised study used a broad spectrum of clinical and laboratory parameters to investigate whether there was any additional anti-inflammatory or analgesic effects, or both, of orally administered alpha-tocopherol in rheumatoid arthritis patients who were already receiving anti-rheumatic drugs.

Methods: Forty two patients were enrolled and treated with alpha-tocopherol (n = 20) at a dose of 600 mg twice a day (2 x 2 capsules) or with placebo (n = 22) for 12 weeks.

Healthcare information. Slow to learn.

Access to information in the NHS is in need of huge improvements. In 1992 more than half of all staff had no access to a library service geared to their requirements. NHS libraries are now expected to serve patients and managers as well as clinical staff.

A longitudinal study of anticardiolipin antibody in polymyalgia rheumatica and giant cell arteritis.

Objective: To determine the incidence of elevated levels of anticardiolipin antibody (aCL) in patients with newly diagnosed polymyalgia rheumatica (PMR) and/or giant cell arteritis (GCA); and to determine the relationship between these antibodies at diagnosis and subsequent course of the disease over a period of 2 yrs.

Methods: Ninety-eight consecutive patients with PMR and/or GCA were examined for the presence of aCL, at presentation and every 6 mo for 2 yrs. Sixty-four patients had PMR alone, 22 had coexistent PMR and GCA, and 12 presented with pure GCA.

A single infusion of bisphosphonate AHPrBP in the treatment of Paget's disease of bone.

Objective: To assess the efficacy of single infusion of bisphosphonate AHPrPB (APD) (60 mg) in active Paget's disease of bone.

Methods: Twenty-six patients with symptomatic Paget's disease of bone were treated with a single infusion of APD (60 mg) over 12 h and were assessed for clinical as well as biochemical improvement for a mean period of 2 years. Treatments were repeated if relapse occurred during followup.