TOWARDS A MEASURE OF PATIENT-PERCEIVED HANDICAP IN RHEUMATOID ARTHRITIS

The impact of chronic disease on an individual depends not onlyon the severity of the disease, but on his/her life role i.e.his/her needs, expectations etc. The World Health Organizationexpresses the impact of chronic disease in terms of impairment,disability and handicap, where handicap is the social disadvantageresulting from disease. This article argues that the assessmentof patient-perceived handicap is essential to the clinical managementof chronic disease because it provides the physician with clinicallyrelevant information about the meaning of disease for each patient,enabling treatment and intervention to be tailored to meet individuals'needs. The development of a method for assessing patient-perceivedhandicap using patient profiles with the object of supplyingthe physician with a simple clinical tool is described. KEY WORDS: Epidemiology, Chronic disease, Quality of life, Questionnaires, Disability evaluation     

Lesions produced by the extravasation of urine from the upper urinary tract

We present six cases which illustrate the spectrum of clinical features, macroscopic findings and light microscopic findings of urine extravasation from the upper urinary tract. The early lesions are characterized macroscopically by an oedematous, glistening or gelatinous appearance to the renal perihilar and peripelvic fat. Light microscopically there is lipolysis with associated foamy macrophages, multinucleate giant cells and lymphocytes. Immunohistochemical staining for Tamm–Horsfall protein is strongly positive in the extracellular space and in the foamy macrophages confirming urine extravazation. Later lesions are characterized by cicatrization of fibrous tissue around the renal pelvis and hydronephrosis. Microscopically there is relatively bland fibrosis with occasional lymphocytes and histiocytic cells. The late lesions are also characterized by extracellular deposits of weakly eosinophilic, granular or hyaline material, the so called 'urinary precipitates'. These deposits stain strongly with diastase PAS and weakly positive for Tamm–Horsfall protein. The staining of these urinary precipitates is analogous to renal tubular hyaline casts, thus supporting the theory that they are derived from uroproteins. We consider that these deposits are pathognomic of past urine extravasation.     

A trial of relapse prevention with severely dependent male problem drinkers

Over the last two decades, relapse prevention has emerged as a major focus of the treatment of drug problems. Few studies have demonstrated any impact on generally high relapse rates. In this paper the outcome of a controlled trial of a relapse prevention programme with male problem drinkers (n=60) attending an Alcohol Treatment Unit is reported. Subjects who met the inclusion criteria were allocated to a relapse prevention (n=20) procedure or a discussion (n=20) or no-additional treatment (n=20) control procedure. Subjects were followed-up at 6 and 12 months by the first author. The relapse prevention programme was associated with significantly greater increases in pre- and post-treatment self-efficacy compared to the discussion control group and significantly greater probability of total abstinence than all controls over the first 6-month follow up. In addition, the relapse prevention programme was associated with significantly longer survival time to an initial lapse and relapse than the controls. At 12-month follow-up, treatment effects had been eroded. It was concluded that the relapse prevention programme was an effective treatment in the short term and that longer-term impact may require greater focus on maintenance factors, such as the individual's environment.     

OUTCOME SERIES SERIES EDITORS: D. L. SCOTT AND A. SILMAN: QUALITY OF LIFE MEASURES

Quality of life measures have become increasingly popular asoutcome measures despite the lack of consensus on a definitionof quality of life. This review describes the most frequentlyused measures, and discusses the conceptual and measurementissues surrounding quality of life measurement. Finally, ittries to place quality of life in the World Health Organization'smodel of disease impact. KEY WORDS: Quality of Life, Outcome measurement, Review     

FINE ADJUSTMENT OF THYROXINE REPLACEMENT DOSAGE: COMPARISON OF THE THYROTROPHIN RELEASING HORMONE TEST USING A SENSITIVE THYROTROPHIN ASSAY WITH MEASUREMENT OF FREE THYROID HORMONES AND CLINICAL ASSESSMENT

Thyroxine replacement therapy for 21 adult patients with primary hypothyroidism was adjusted to the dosage at which each patient had a normal thyrotrophin (TSH) response to thyrotrophin releasing hormone (TRH). Clinical assessment and measurement of TSH (by sensitive immunoradiometric assay), free thyroxine (FT4) and free tri-iodothyronine (FT3) were made at this dosage and at higher and lower doses of thyroxine. Clinical observations, FT3 and FT4 assays were relatively insensitive to small alterations of thyroxine dosage, in contrast to which basal TSH measurements correlated well with TRH responsiveness and were sensitive to fine adjustments of thyroxine dosage.