A patient-powered treadmill--a simple alternative means of assessing heart failure and treatment in family practice.

A patient-powered treadmill was compared with the covered corridor walking test as assessments of exercise capacity in heart failure patients, and used to investigate their sensitivity in discriminating between the effects of xamoterol and placebo. The two methods were comparable, and sufficiently sensitive to demonstrate improvements in exercise capacity on xamoterol. The treadmill was more sensitive and could be useful as an assessment of treatment of heart failure in family practice.

A comparative study of atenolol/nifedipine and atenolol/diuretic in hypertension.

A prospective, randomized, double-blind between-patient study was carried out to compare the efficacy and tolerance of atenolol with nifedipine and atenolol with diuretic. Ninety-eight hypertensive patients inadequately controlled after 1-month's treatment with 100 mg atenolol alone once daily received, in addition, either 20 mg nifedipine twice daily or 5 mg amiloride plus 50 mg hydrochlorothiazide once daily for a further 8 weeks. The results of blood pressure measurements in the lying and standing positions showed that the mean reduction in standing blood pressure from atenolol baseline was 28/12 mmHg for atenolol/diuretic and 18/13 mmHg for atenolol/nifedipine. The only significant difference between treatments in blood pressure control was in lying systolic blood pressure favouring atenolol/diuretic and a trend in favour of this combination for standing systolic blood pressure. Both regimens were reasonably well tolerated, although 19 patients withdrew during the course of the trial because of side-effects (2 on atenolol alone, 10 on atenolol/diuretic and 7 on atenolol/nifedipine).

Who gets renal bone disease before beginning dialysis?

To identify patients at risk from renal bone disease we compared the demographic characteristics of 243 patients with end stage renal failure grouped according to the presence (97 (40%] or absence of severe renal bone disease as judged by histological criteria. Youth, female sex, tubulointerstitial types of nephropathy, and a long duration of uraemia were all identified as significant independent risk factors for the development of bone disease. The relative risks from being female and having tubulointerstitial renal disease were separately identifiable when the estimated observation of renal failure was short (less than four years). The identification of patients at high risk from bone disease may clarify the pathogenesis and treatment strategies of renal osteodystrophy.

Sternoclavicular erosions in polymyalgia rheumatica.

The incidence of erosive arthropathy of the sternoclavicular joints in 25 consecutive cases of polymyalgia rheumatica was studied by means of sternoclavicular tomography. Definite erosions were found in 11 patients. Erosions were most likely to be found in patients whose symptoms had been present for more than 6 months.

A fluoroscopic burn to a patient's right hand sustained in removing a sewing needle--a 22-year follow-up.

Severe radiation burns to the skin and deeper tissues resulting from diagnostic radiology have fortunately been very rare in the United Kingdom. It is hoped they will now be only of historical or academic interest. For this reason a very severe radiation burn to the right hand of a young woman, caused by prolonged fluoroscopy in removing a metalic foreign body, is described. This resulted in a severe sloughing of the skin of the dorsum of the hand that had to be grafted. Subsequently progressive bone necrosis occurred and the hand has never been fully useful since the accident. It is noteworthy that a surgical assistant also sustained radiation burns to the fingers.

Enlarged hilar and mediastinal nodes (and especially lower right hilar node enlargement) as a sign of metastasis of a renal tumour.

Hilar and mediastinal node enlargement may be a manifestation of the spread of renal tumours. However, the author believes the spread to these nodes may occur either via the upper para-aortic nodes or directly by way of lymphatic vessels from the kidneys by-passing the upper abdominal nodes. It seems that in some cases the hilar node may even be acting as a regional lymph node for the kidney. Thus an enlarged hilar node and especially a lower right hilar node may be the presenting feature of a renal tumour.

The 'Jack Stone' or 'Mercedes Benz' sign--anew theory to explain the presence of gas within fissures in gallstones.

Gas within clefts of fissures in gallstones is not a very common finding, but when it occurs is, characteristic and indicates the presence of one or more calculi. It closely resembles the appearance of a 'Jack Stone' but has previously been termed the 'Mercedes Benz' sign. Only a few cases have previously been recognised in the U.K. Most reported cases have been associated with biliary colic or cholecystitis. Various theories have been put forward to explain the presence of gas, but the author believes that the gas is released from solution by negative pressure within cholesterol stones undergoing internal fissuring due to their crystalline structure, i.e. the gas is released from solution from the small amount of fluid trapped in the calculus, in the same way that gas may be 'pulled' out of solution in a joint, a degenerate intervertebral disc or the fibro-cartilage of the symphysis pubis.

Spontaneous pneumothorax and pulmonary malignant disease--a syndrome sometimes associated with cavitating tumours. Report of nine new cases, four with metastases and five with primary bronchial tumours.

Tumours of the lung, primary or secondary, may occasionally be complicated by a pneumothorax, and on rare occasions this may be the presenting feature. Metastatic tumours associated with pneumothorax arise usually from bone or soft tissue sarcomas and hence are more common in the young.