Intravenous MRI contrast enhancement of inflammatory synovium: a dose study.

A dose study was performed of MRI intravenous contrast medium enhancement of rheumatoid synovium in the knee, comparing the enhancement with gadoteridol at doses of 0.1 and 0.3 mmol/kg.

Prognostic value of contrast enhanced Gd-DTPA MRI for development of bone erosive changes in rheumatoid arthritis.

Conventional radiograms have been used to quantitate the progression of rheumatoid arthritis, mainly through the assessment of bone erosions, but this approach has many limitations. It has been suggested that an advantage of contrast-enhanced Gd-DTPA MRI over radiography may be its prognostic value due to its ability to show the natural history of active destructive to inactive fibrous pannus. The aim of this study was to evaluate the possible prognostic value of MRI for future development of bone erosive changes in small hand joints in patients with RA.

Informed choice for users of health services: views on ultrasonography leaflets of women in early pregnancy, midwives, and ultrasonographers.

With the aim of promoting the informed choice of pregnant women, staff and pregnant women at two urban hospitals were offered leaflets summarising the best available evidence about the effectiveness of routine ultrasonography in early pregnancy. Ultrasonographers doubted the credibility of the evidence and were concerned that the leaflets would raise women's anxiety, reduce uptake of scans, disrupt hospital organisation, and reinforce media messages about the poor safety record of ultrasonography. Midwives thought that the leaflets would inform women, help them to talk about their care with health professionals, and help them to get better care.

Supporting consumer involvement in decision making: what constitutes quality in consumer health information?

The promotion of consumer involvement in decisions about individual health care is now high on many health policy agendas, but the structures to support it are not all in place. While it is generally accepted that information to support consumer involvement should be of good quality, the question of what constitutes quality in such information packages is far from settled. Debate around this issue should consider the various theoretical perspectives which relate to the nature and purpose of consumer involvement in health care decision making, and the contexts in which information is used.

[Arthritis: imaging and therapy. Past, present and future].

Osteoarthritis (OA) and rheumatoid arthritis (RA) are chronic diseases in which pathological anatomy changes very slowly. Whilst clinical and laboratory measures can be used to evaluate therapeutic response, assessment of disease progression requires imaging. Conventional radiography has performed well in RA but is too insensitive in OA.

[MR imaging in seronegative spondyloarthritis].

In twenty-five patients with a clinical diagnosis of suspected sacroiliitis conventional radiography, CT and MRI were performed. In ten patients no abnormalities were demonstrated. In thirteen cases CT and MRI revealed sacroiliitis.

Advantages of an increased dose of MRI contrast agent for enhancing inflammatory synovium.

MRI intravenous contrast enhancement of inflammatory synovium has been studied at two different doses to determine to what extent enhancement is dose dependent. 19 patients with clinically active rheumatoid arthritis involving a knee were scanned twice, one week apart, using 0.1 mmol/kg of gadoteridol (ProHance) on the first occasion and 0.

Media coverage of the Child B case.

The case of a girl with leukaemia, known as Child B, hit the headlines in March 1995 when her father refused to accept the advice of doctors who counselled against further treatment and took Cambridge and Huntingdon Health Authority to court for refusing to fund chemotherapy and a second bone transplant for her in the private sector. British national newspapers varied greatly in the way they covered the case. Some paid little attention to clinical considerations and presented the case as an example of rationing based on financial considerations.

Magnetic resonance imaging of patellar tendonitis.

The radiological and MRI appearances of 24 knees with patellar tendonitis resistant to conservative therapy were analysed to identify the characteristic MRI appearance and to determine if the patellar morphology was abnormal. A significant thickening of the tendon was found in all cases; this was a more reliable diagnostic feature than a high signal within the superior posterior and central aspect of the tendon at its proximal attachment. The site of the lesion shown by MRI is more compatible with impingement of the inferior pole of the patella against the patellar tendon than a stress overload of the tendon.

A systematic review of the effectiveness of health service interventions aimed at reducing inequalities in health.

Objective: To review the available evidence in order to identify effective interventions which health services alone or in collaboration with other agencies could use to reduce inequalities in health.

Methods: A search of the literature was undertaken using a number of databases including Medline (from 1990), Applied Social Science Index and Abstracts (1987-1994), and the System for Information on Grey Literature in Europe (1984-1994), on a large range of key words. Studies were included if they assessed interventions designed to reduce inequalities in health or improve the health of a population group relevant to the review, and could be carried out by a health service alone or in collaboration with other agencies.

The value of MR imaging in the diagnosis of the os trigonum syndrome.

Objective: The objective of this study was to evaluate the value of magnetic resonance (MR) imaging in the diagnosis of the os trigonum syndrome.

Design: Sagittal and coronal spin echo MR sequences of the ankle were acquired along with sagittal images in both dorsiflexion and plantar flexion.

Patients: Three consecutive patients presenting with posterior triangle pain were assessed.

Distinctive radiological features of small hand joints in rheumatoid arthritis and seronegative spondyloarthritis demonstrated by contrast-enhanced (Gd-DTPA) magnetic resonance imaging.

A series of patients with clinically early inflammatory joint disease due to rheumatoid arthritis, psoriatic arthritis and Reiter's syndrome were examined by plain film radiography and magnetic resonance imaging (MRI). The spin echo T1-weighted precontrast, T2-weighted, and, especially, T1-weighted postcontrast images demonstrated distinct differences in the distribution of inflammatory changes, both within and adjacent to involved small hand joints. Two major subtypes of inflammatory arthritis were shown, thus providing a specific differential diagnosis between rheumatoid arthritis and some patients with seronegative spondyloarthritis.

Extensive infiltration of bone with marrow necrosis in a case of hairy cell leukaemia.

This 32-year-old patient with hairy cell leukaemia demonstrated extensive bony involvement in a pattern not previously described. Although the disease continued to progress during interferon treatment, a change to a regime of deoxycoformycin resulted in an excellent response.

A continuing role for pre-operative cervical spine radiography in rheumatoid arthritis?

Pre-operative cervical spine radiographs are routinely requested for patients with rheumatoid disease, prior to elective orthopaedic surgery, but no guidelines exist governing the indications for this investigation. One hundred and twenty-eight such patients were reviewed retrospectively. No patient had signs or symptoms attributable to cervical cord compression.

Assisted conception techniques. On what basis do health technologies become routinely available when they have been assessed as effective?

The possibility of restoring fertility among some infertile couples through assisted reproductive technology has led to questions about the terms under which such treatments should be made available. Although there is now evidence on their effectiveness, there is considerable variation in the availability of these treatments under the U.K.

Dissemination: implementing the findings of research.

There is an increasing interest in dissemination among researchers, policy makers and information scientists. Dissemination, in the context of health services, can be taken to mean the process of implementing the findings of research. Currently there is a considerable delay in the adoption of evidence on the effectiveness of interventions by professionals in the NHS and other health systems.

Health and health care of rural populations in the UK: is it better or worse?

OBJECTIVE--To review available evidence on the problems facing rural health care in the UK. In particular, to determine whether the health of rural populations is worse than that of town dwellers and how the quality of health care is influenced by rurality. CRITERIA FOR INCLUSION AND EXCLUSION OF ARTICLES--A wide variety of publications and data sources were used.