Arthritis in Behcet's syndrome.

The clinical and radiological features of fourteen patients with Behcet's syndrome have been reviewed with particular reference to joint disease. Thirteen patients (93%) suffered recurrent peripheral oligo- or poly-arthritis, this symptom being the presenting complaint in two (14%). There were no radiographic abnormalities in peripheral joints. Ten patients (71%) complained of low back pain and in seven (50%) there was a mild erosive sacro-iliitis. Five patients (36%) had an enthesopathy (calcaneal spurs) one of whom also demonstrated vertebral body squaring. Patients with sacro-iliitis did not possess the HLA B27 antigen. Behcet's syndrome should be entertained in the radiological differentiation of sacro-iliitis with a clinical arthropathy.

Detection of diabetic retinopathy in the community using a non-mydriatic camera.

The role of the non-mydriatic fundus camera in detection of diabetic retinopathy was evaluated as part of a comprehensive screening programme for diabetic complications offered to all diabetic patients in a rural town. Retinopathy was demonstrated in 124/358 (35%) of patients screened. Forty-eight patients (13%) were judged to have sight-threatening retinopathy, of whom 29 patients (8% of the total) were not already under the care of an ophthalmologist. However, in only 66% of patients were photographs of both eyes of adequate quality to assess for retinopathy. The percentage of poor quality photographs increased with age in those aged greater than 50 years. It is concluded that the non-mydriatic camera can increase the detection of sight-threatening retinopathy in the community. Although this method of screening is not perfect, because of the number of poor quality photographs, it may be as good as or better than existing screening practices in unselected diabetic populations.

Use of thrombolysis for acute myocardial infarction in the presence of diabetic retinopathy in the UK, and associated ocular haemorrhagic complications.

Diabetic retinopathy is still regarded as a relative contraindication to the use of thrombolysis for myocardial infarction because of a perceived risk of intraocular haemorrhage. However, this complication has rarely been reported and the risk may be too small to justify withholding thrombolysis. A questionnaire survey was therefore conducted of members of the Medical and Scientific Section of the British Diabetic Association (BDA), to ascertain the exclusion criteria applied to the use of thrombolysis in patients with diabetic retinopathy in the UK and to identify any related ocular haemorrhagic complications. Replies were received from 128 physicians in 107 centres. Exclusion criteria applied were: any retinopathy 7 (5%), proliferative retinopathy and recent vitreous or pre-retinal haemorrhage 74 (58%), recent vitreous haemorrhage only 25 (20%), thrombolysis given regardless of retinopathy 22 (17%). No cases of intraocular haemorrhage following thrombolysis in diabetic myocardial infarction patients were identified. The risks of this complication appear to be very small and probably do not justify withholding thrombolytic therapy from diabetic patients with most forms of retinopathy, including proliferative.

99mTc HMDP bone scanning in generalised nodal osteoarthritis. I. Comparison of the standard radiograph and four hour bone scan image of the hand.

The pattern of joint involvement on conventional radiographs and the four hour gammacamera image of 99Tc HMDP bone scans were studied in 33 patients with generalised nodal osteoarthritis. Both techniques showed the predominant involvement of the distal interphalangeal, scaphotrapezial, and first carpometacarpal joints. Some joints were abnormal just on one investigation: either x ray or scan alone. Others showed a marked dissimilarity in the severity of involvement on x ray compared with scan. This discrepancy between x ray and scan suggests that the scan is imaging a different process than the radiograph and offers a different way of assessing change in osteoarthritis.

99mTc HMDP bone scanning in generalised nodal osteoarthritis. II. The four hour bone scan image predicts radiographic change.

In 14 patients with generalised nodal osteoarthritis a four hour bone scan image was found to predict the changes that occur on the radiograph at follow up between three and five years later. The scan abnormality appeared to precede the development of radiographic signs, and joints abnormal on scintigraphy showed most progression. Normal joints and joints abnormal on x ray alone showed little progression, and those that did subsequently alter became abnormal on scan. Scanning may provide a sensitive technique for monitoring osteoarthritis, it may enable a greater understanding of the underlying disease process, and allow evaluation of modifying therapeutic procedures.

A study of waiting time in an emergency department.

A study was undertaken to determine the time spent by 3459 patients in the Emergency Department of the hospital and also to assess whether full-time physician supervision of interns appreciably influenced this time.The study was divided into three phases, each lasting two weeks. Cases were classified into five graded categories of severity. The data so accumulated were subjected to computer analysis, and time intervals relevant to the study obtained.Mean waiting times compared favourably with those recorded in other studies. Full-time physician supervision of interns was found to produce a small, but none the less appreciable, decrease in this time.

Screening programme for microvascular complications and hypertension in a community diabetic population.

The role of a community-based screening programme for microvascular complications of diabetes and hypertension was evaluated in the semi-rural town of Trowbridge (population 31,000). Of 405 diabetic patients identified (prevalence 1.31%), 358 (88%) attended for screening, 94 (26%) of whom were under hospital review for diabetes. In only 136 patients (38%) were all aspects of diabetes care found to be satisfactory. The remaining 222 patients included 162 patients with poor metabolic control (HbA1 greater than or equal to 12%), 118 who were hypertensive at screening, 13 with previously undiagnosed diabetic nephropathy, and 29 with undiagnosed potentially sight-threatening retinopathy. Overall standards of diabetes care in this community population appear inadequate, and might be improved by introduction of a simple screening programme for diabetic complications.