What do doctors mean by tenosynovitis and repetitive strain injury?

Confusion exists in both the scientific and the lay press on the meaning of the terms tenosynovitis and repetitive strain injury. The courts are increasingly being asked to make judgements on individual cases but this gives little in the way of guidance to doctors producing reports for the Department of Social Security or solicitors. The aim of this study was to document what such doctors mean by these terms, what diagnostic criteria they use, and to make any necessary recommendations.

An alternative method of occlusal registration for functional appliances.

Although wax is commonly used to record the protrusive occlusal registration for functional appliances, it is not without its disadvantages. In restorative dentistry silicone occlusal registration materials have been developed to overcome some of the drawbacks of wax. This paper presents a method of utilizing these new materials in orthodontics.

What happens to patients following open access gastroscopy? An outcome study from general practice.

Background: Open access gastroscopy allows general practitioners to request a gastroscopy without prior referral to a specialist. The effect of open access gastroscopy upon patient management is poorly explored. Most studies have been hospital based and have focused on diagnostic yields and on means of tightening requests to reduce inefficient use.

Maxillofacial fractures: a study of recurrent victims.

A study of 760 patients treated for maxillofacial fractures over a 2 year period revealed 3 per cent of them to have had one or more previous fractures in the maxillofacial region. This group of patients are nearly all victims of assault but are indistinguishable from a control group of patients with maxillofacial injuries on the grounds of age, sex, anatomical type of injury or socioeconomic status. They are however more likely to have been drinking alcohol at the time of their injury than the control group.

Assessing dyspepsia in general practice.

The value of the symptom pattern in achieving an accurate diagnosis in dyspeptic disease is still controversial. A number of investigators have used it to distinguish those patients who are at a high risk of serious disease (ulcer or cancer) from those who are not. Such findings have important implications for patient management, both in clinical and economic terms.

Steroids in multiple sclerosis.

Steroids are widely used in treating the relapse of multiple sclerosis. There is no place for long term steroid therapy of this disease. Current practice is a short course of high dose methylprednisolone which can be repeated after an interval, has proven safety and objectively accelerates recovery.

Cutaneous leishmaniasis. An unusual cause of facial swelling.

Tropical disease may not figure highly in the differential diagnosis of a facial swelling in the United Kingdom but should be considered in those who have been in a tropical area. This case history documents details of the presentation and investigation of a case of leishmaniasis that appeared as a facial swelling in a 4-year-old boy who had recently returned from the Middle East.

Geographical mapping of diabetic patients from the deprived inner city shows less insulin therapy and more hyperglycaemia.

To determine whether or not economic and social deprivation were associated with different diabetic treatment and metabolic control, data of patients from deprived inner city wards and prosperous wards were compared. A database was obtained for 1528 patients attending our hospital Diabetes Care Centre. Demographic data and postcodes were used to construct geographical maps of disease and deprivation.

Giant cell arteritis presenting as oculomotor nerve palsy with pupillary dilatation.

Acute complete oculomotor palsy with headache is a classical presentation of an extrinsic compression most commonly due to a posterior communicating artery aneurysm. We present a patient with such a presentation but with histologically proven giant cell arteritis. This possibility should be considered especially in the elderly to avoid complications and the need for angiography.

Anterior lumbar fusion. A comparison of noncompensation patients with compensation patients.

One hundred fifty-one patients had an anterior interbody lumbar spinal fusion for intractable back pain. A solid bony fusion was obtained in 76% of the patients. Of patients unemployed before surgery, 50% had returned to work at review.

Informed consent in oral and maxillofacial surgery: a study of the value of written warnings.

Objective: To determine if written preoperative warnings about risks and outcomes of surgery improves patients' recall and recognition of these warnings postoperatively compared to traditional verbal warnings and to determine if the timing of these warnings is significant.

Design: Prospective study of patients given written warnings compared to a control group of patients warned in the traditional verbal way.

Setting: Oral and Maxillofacial unit of a District General Hospital.

Complications of tracheostomy in major head and neck cancer surgery; a retrospective study of 60 consecutive cases.

Employment of tracheostomy in head and neck cancer surgery remains controversial. This study details those cases in which the life-saving potential of tracheostomy placement was considered to outweigh the observed disadvantages. Sixty consecutive cases of tracheostomy in head and neck cancer patients were assessed and revealed a relatively low complication rate (11% of cases).

Aetiology, diagnosis and treatment of low back pain.

A total of 274 patients complaining of low back pain following injury was reviewed. Impact injuries were associated with soft-tissue strain, which was seen less often after twisting injuries. Twisting injuries were associated with disc prolapse more often than falls.

Anterior lumbar fusion: results, assessment techniques and prognostic factors.

One hundred and fifty-one patients underwent anterior interbody lumbar spinal fusion for intractable back pain. A solid bony fusion was obtained in 76%. The method of outcome assessment profoundly affected the results; whereas 68% of patients rated themselves as significantly improved by the procedure, only 40% achieved a good or excellent result on the more objective low-back outcome score.

Methylprednisolone in multiple sclerosis: a comparison of oral with intravenous therapy at equivalent high dose.

A randomised double-blind placebo-controlled trial of intravenous methylprednisolone versus oral methylprednisolone at equivalent high dose was carried out on 35 patients with an acute relapse of multiple sclerosis (MS). After baseline evaluation each was randomly allocated to oral treatment and intravenous placebo or intravenous treatment and oral placebo, receiving 500 mg of methylprednisolone for five consecutive days and with reassessment at days five and twenty-eight. There was no significant difference in response when disability or functional scores were compared in the two groups.

Bilateral parotid swelling associated with chronic obstructive pulmonary disease. A case of pneumoparotid.

Acute enlargement of the parotid glands due to air insufflation is well reported under various names, the most appropriate of which is pneumoparotid. We report an unusual example of pneumoparotid, which was difficult to diagnose, that involved background swelling of the parotids because of the respiratory effort of chronic obstructive pulmonary disease and acute exacerbations associated with episodes of coughing.