Assessment of the progress of the back-pain patient 1981 Volvo Award in Clinical Science.

Fifteen subjective variables reflecting the severity of back pain, the circumstances exacerbating symptoms, and the impact of the problem on life style were scored on Visual Analogue Scales. It was possible to combine the results from these assessments to provide a global subjective index. Repeated measurements by the same observer showed a high degree of reproducibility, but when performed by separate observers discrepancies arose in certain questions. By improving certain questions and standardizing their presentation to the patient, a considerable improvement in the correlation of results between observers was obtained. Objective assessments of spinal motion and straight leg raising and a global objective index showed a high degree of intraobserver reproducibility. This technique was applied to a study of relief of back pain by lumbar corsets when it was found that there was significantly greater relief of back pain by a corset with a lumbar support than one without a spinal support. We conclude that the emphasis in assessing the progress of the back-pain patient must be on the subjective parameters, and the technique developed offers a useful method for reliably assessing patients and following their progress.

Malignant lymphoma and rheumatic symptoms.

A patient intially thought to have a connective tissue disease, later shown by biopsy to have Hodgkin's disease is described. The progress of her illness suggests that she is suffering from a connective tissue disease, too, or possibly secondary immune complex disease.

Systemic lupus erythematosus and avascular bone necrosis.

Two cases of systemic lupus erythematosus (SLE) developing avascular bone necrosis are described. One case had eight separate areas involved (shouldres, hips, knees and both distal tibiae), which is the largest number in a single case of SLE yet reported. In both cases, at the onset of symptoms of necrosis in a new area, the antinuclear factor increased markedly compared to the preceding level. This indicates that the onset of the pathological process leading to necrosis is due to increased activity of the SLE rather than the steroid treatment.

Molar pregnancy of hyperthyroidism.

A report on a patient with clinical hyperthyroidism associated with hydatidiform mole is presented. Some biochemical characteristics of the thyroid stimulator isolated from the tumour are discussed.

[From spas and convalescent homes to retraining institutions]. / Fra kurbad og rekonvalesenthjem til opptreningsinstitusjoner.

The traditional types of health care institutions, the spas and convalescence homes, were reorganised in Norway in 1992 to become retraining units group I and group II. The new regulations demanded that the institutions should upgrade and strengthen their treatment facilities. The physician in charge of group I institutions has to have rheumatological or physical medical qualifications, and the institution itself has to have sufficient nursing and other medical staff to be able to treat patients in need of a higher level of therapy than required by patients at group II institutions. A survey of the institutions concludes that most of them now conform with the new regulations.

[Virkersund Spa. Changes in patient admission and therapeutic outcome over the last 15 years]. / Vikersund Kurbad. Endringer i pasientbelegget og behandlingsresultatene de siste 15 årene.

Since the spa resort Vikersund Kurbad was reorganised in 1992 as a retraining unit, improvements have taken place. There is now one fulltime rheumatologist, two part-time general practitioners, 14 physiotherapists, one social worker and nurses in a new unit with a hot pool and an occupational therapy department. In this article, assessment data continuously recorded since 1981 are used to find out how the changes have affected patient intake and patient improvement. It was found that the patients now admitted are more disabled, but the number of patients who thrive and improve has increased. However, the intake of rheumatic patients has simultaneously decreased. It is suggested that measures are taken to enable more rheumatics to use the institution.

Pathophysiological classification of Raynaud's phenomenon.

The main types of underlying mechanism in Raynaud's phenomenon were tested separately in thirty-six patients. Within each of three groups of patients who were clinically classified according to strict definitions as having primary Raynaud's disease, systemic sclerosis or rheumatoid arthritis, there was pathophysiological heterogeneity. It is therefore suggested that in studies of treatment, at least when it is aimed primarily at one pathophysiological mechanism, the patients whould be selected according to the mechanism rather than what is commonly done now, according to the associated disorder.

Cutaneous microcirculation in systemic sclerosis and response to intra-arterial reserpine.

The cutaneous microcirculation in the hand was measured in 23 patients with systemic sclerosis, 19 with Raynaud's phenomenon and four without Raynaud's phenomenon, and 20 controls. The patients with Raynaud's phenomenon had a reduced basal blood flow and an exaggerated further reduction on local cold stimulation, though both were normal in patients without Raynaud's phenomenon. Reflex-induced vascular changes by cold stimulation of the contralateral hand showed no differences between the three groups. The blood flows were similar in the affected skin of the anterior chest wall in four patients with systemic sclerosis and peripheral Raynaud's phenomenon and matched controls. In the seven most severely affected patients 1 mg of intra-arterial reserpine produced a prompt improvement in the cutaneous microcirculation which usually lasted one to three weeks but occasionally much longer. By judicious use of repeated injection guided by measurements of the microcirculation it was possible to heal indolent ulcers of the fingers. The results indicate that vascular changes are common in systemic sclerosis but are not fundamental in the pathogenesis of the disease. More probably there is a general soft tissue abnormality that usually but not necessarily affects the vessels.

Behçet's syndrome with perforations of the colon.

A case of Behçet's syndrome with mucosal ulcerations of the ascending colon and three perforations of the caecum is described. It is the first documented case of this syndrome where colitis has occurred without concomitant rectal lesions. The reported cases of Behçet's syndrome with associated colonic lesions make up a heterogeneous group. It is suggested that the different patients may have suffered from pathogenetically different diseases.

Evaluation of low back pain and assessment of lumbar corsets with and without back supports.

A method is described for evaluating the progress of patients with back pain. Various symptoms were scored on analogue scales and spinal motion was measured by various techniques. These data were integrated to make subjective and objective indices respectively. Reasonable reproducibility of the measurements was obtained. This technique was used to elucidate the role of the lumbar support in surgical corsets in relief of back pain. Sufferers from back pain were randomly allocated to corsets with and without lumbar supports. There was significant improvement in those with a support compared with those without. On the other hand objective changes measured with the corset removed did not differ between the 2 groups. This study indicates that the spinal support in a lumbosacral corset makes a significant contribution towards the relief of symptoms.