Assessment of cutaneous sensory and autonomic axon reflexes in rheumatoid arthritis.

OBJECTIVE--To assess sensory function in skin overlying the joints of patients with rheumatoid arthritis, in relation to the pain and tenderness which commonly arises in structures not directly involved in the inflammatory process. METHODS--An intradermal injection of capsaicin 0.05 microgram in 10 microliters was made over the wrists and forearms of 40 patients with rheumatoid arthritis and 46 control subjects. Axon reflex vasodilatation was measured using laser Doppler flowmetry. Cholinergic sympathetic function was assessed by measuring axon reflex sweating induced by a single intradermal injection of nicotine 0.5 microgram in 0.1 ml. RESULTS--Capsaicin induced axon reflex vasodilation over the wrists was found to decrease with age in normal subjects (r = -0.62, p < 0.001). In patients with rheumatoid arthritis, capsaicin induced axon reflex vasodilatation was significantly greater over the wrists, but not the forearms, when compared with age matched normal controls (p < 0.01). A minimal correlation between axon reflex vasodilatation and visual analogue pain score was apparent in the rheumatoid group (r = -0.37, p < 0.05). Nicotine induced sweating responses were similar in the rheumatoid and normal groups, and both showed a linear age related decline. CONCLUSIONS--The results show a selective increase of capsaicin induced vasodilatation in skin overlying joints in patients with rheumatoid arthritis. This suggests that the activity of a sub-population of periarticular small sensory fibres is altered, which may explain, at least in part, some of the clinical findings in this disorder.     

Pathogenesis and changes in the aetiology of arterio-venous fistulae

There has been a marked shift in the causes of arterio-venous fistulae. Gunshot and stab wounds used to be the most frequent cause but iatrogenic fistulae, especially those arising as a result of reconstructive skeletal operations or following diagnostic and therapeutic procedures, are now becoming increasingly common. If morphological vascular changes have not yet occurred and cardiac volume overloading has not led to permanent damage, a recently established arterio-venous fistula can be easily corrected by resection and oversewing of the artery and vein. The special cases of arterio-venous fistulae arising as a result of catheter procedures in the groin have to be identified in terms of cause and morphology in order to facilitate early surgical correction.     

Initial experience with Tc-99m-HM-PAO in the study of brain tumors

A preliminary study of the distribution of the 99mTc complex of hexamethylpropylene amine oxime (HM-PAO) in 12 patients with brain neoplasms before, during, and after radiotherapy has been performed. Untreated brain tumors were found to exhibit a range of 99mTc-HM-PAO uptake, varying from areas of markedly increased isotope activity to photopenic areas, when compared to normal brain tissue. A ratio of 99mTc-HM-PAO tumor uptake to contralateral normal tissue uptake was calculated prior to and during radiotherapy. This ratio tended to return towards unity in lesions responding to therapy. A predictable alteration in whole brain 99mTc-HM-PAO uptake during radiotherapy was not demonstrated. Unlike the radiolabeled amines, 99mTc-HM-PAO localizes in primary tumors, probably indicating that its uptake mechanism is independent of non specific amine receptors. 99mTc-HM-PAO may be useful in the study of brain tumor physiology and response to therapy.     

Experience in hemoconcentration by ultrafiltration in operations using artificial circulation at the All-Union Scientific Center of Surgery of the USSR Academy of Medical Sciences

The article deals with the results of using ultrafiltration hemoconcentration in 649 operations conducted on the open heart with extracorporeal circulation at the All-Union Scientific Center of Surgery, USSR AMS during 1983-1989. The method allows control of hemodilution and colloid-osmotic pressure of plasma during the indicated interventions, lessens the loss of blood, and reduces the expenditure of donor blood.     

Hip fracture incidence in the canton of Vaud,Switzerland, 1986–1991

The objective of this study was to estimate the incidence of hip fracture in the canton of Vaud, Switzerland (total population 584 000), for the period 1986–1991 using routine hospital discharge data collected by the Cantonal Service of Statistical Research and Information (SCRIS). For the survey period, the estimated average annual crude incidence rate of hip fractures was 167 per 100 000 persons aged 20 or older (241 for women and 84 for men). For the population aged 50 years or older, the crude incidence rate was 388 per 100 000 persons (546 for women and 185 for men). The average annual age-specific rates rose exponentially by successive 5-year age groups. The median age of patients at the time of the fracture was 82 years in women and 74 years in men. There was no significant difference between the total number of cervical and trochanteric fractures. Between the ages of 20 and 84 years, the cumulative risk for a woman to be admitted to hospital with a hip fracture was twice that of a man (15.8% vs 7.8%). From 1986 to 1991, the age- and sex-adjusted incidence, like the ratio of cervical to trochanteric fractures, did not show any significant trend, although it was consistent with an increase in men (p=0.09). However, the annual number of fractures rose from 644 to 776, particularly among very aged men. The mean length of stay in the acute care hospital fell from 38 days in 1986 to 25 days in 1991. Finally, the comparison of these results with those obtained in 1986 for the same population from more exhaustive sources has confirmed the provision of a consistent, although overestimated, assessment of hip fracture incidence by means of these routine hospital statistics in the canton of Vaud, Switzerland.