Showing papers by "Cyrus Cooper published in 1990"

Defining osteoarthritis of the hip for epidemiologic studies

Abstract: The authors compared seven radiologic indices of hip osteoarthritis to establish which provided the best definition of the disease for epidemiologic purposes. Hip joints were assessed from intravenous urograms taken in a British hospital between 1982 and 1987 in 1,315 men aged 60-75 years. The indices examined were an overall qualitative grading of osteoarthritis, four measures of joint space, the maximum thickness of subchondral sclerosis, and the size of the largest osteophyte. Minimal joint space (i.e., the shortest distance between the femoral head margin and the acetabulum) was the index most strongly associated with other radiologic features of osteoarthritis. Among a subset of 759 men who answered a questionnaire about symptoms, the overall qualitative grading, minimal joint space, and thickness of subchondral sclerosis were the radiologic indices most predictive of hip pain. Within- and between-observer repeatability were tested in a subset of 50 subjects. Measures of joint space were more reproducible than other indices. These data suggest that, at least in men, minimal joint space is the best radiologic criterion of hip osteoarthritis for use in epidemiologic studies.

Trends in admissions for hip fracture in England and Wales, 1968-85.

Abstract: should be provided in all cases. The high incidence of patients seeking advice from the general practitioner or district nurse after their return home was worrying and is not a problem of which we are aware in our normal practice. Complications perceived by patients may not necessarily be regarded as complications by a surgeon but, nevertheless, we were unhappy to discover potential infection rates of around 15% after inguinal hernia and varicose vein surgery. Patients having this type of surgery remain in hospital for only a day or so. Inflammatory and infective sequelae are likely to have resolved and may be forgotten by the patient by the time of the surgical outpatient review at two or three months. We intend to survey our patients treated locallv to see if the trend can be confirmed. Transient testicular swelling in three patients after inguinal hernia repair was attributable to one surgeon whose practice was probably to overtighten the internal inguinal ring. Personal technique has been modified. An unexpected finding highlighting the cost of waiting lists was that 13 patients (11 5%) awaiting routine elective surgery claimed that they were unable to work. Though patients rated the scheme highly, the scheme was not without difficulties. Nevertheless, the apparent success of the scheme challenges the traditional approach of initial assessment, operation, and follow up being performed by the same surgical team. Problems might be expected in matters of contentious management and certainly some patients had slightly different operations from those recommended by the referring surgeon. The preoperative ward round must therefore be conducted with the importance and the duration of the outpatient consultation. When complications occur they are best dealt with by the operating surgeon and may not be appreciated when review is carried out elsewhere. Patients were generally allocated for transfer to Wroughton by availability and geographical clustering rather than by the nature of the operation and expected duration of the procedure. Problems were therefore encountered with the content and duration of some operating lists. It is crucial for the efficient use of theatre time and the appropriate allocation of surgical staff that case selection should be made by the operating consultant surgeon and not by administrative personnel. Selection of patients with regard to their fitness for an anaesthetic before transfer is important to spare patients disappointment and a wasted journey. Four patients in our series were returned home without an operation despite prior assessment at the review clinic. An ideal scheme should include advice from the anaesthetic department of the receiving hospital of local criteria and thresholds for deferring operation in the presence of conditions such as hypertension or glycosuria. With regard to overall surgical performance it is not possible to get something for nothing. The rate limiting step in surgical performance in this military hospital is operating time rather than bed space, and as a result of operating on 112 patients from another region the same number of local NHS patients in Wiltshire were deferred. From the operating team's point of view there was no training benefit. The type of routine, repetitive surgery transferred was that which will inevitably be found at low priority on all surgical waiting lists and which we see regularly from day to day. The hospital gained because the Crewe Health Authority contributed £36 per patient per day based on recovery of minimal costs. This amount might seem to undersell the services offered but compared favourably with the existing arrangements of non-sponsorship of local NHS patients. If similar financial arrangements were to be negotiated with health authorities in the local area then there would be no reason to receive elective surgical patients from far away.

Clinical assessment of osteoarthritis of the knee.

Abstract: The repeatability of physical signs used to assess osteoarthritis of the knee has not been systematically examined. The within and between observer variation of 10 commonly used physical signs to determine osteoarthritis of the knee has been assessed here. The results obtained show variation in the repeatability of these signs. For those examining the tibiofemoral joints the repeatability was greater than for those examining the patellofemoral joint. It would therefore seem vital to take note of the repeatability of physical signs in determining the number of subjects to be studied in epidemiological studies and therapeutic studies in osteoarthritis.

Water fluoride concentration and fracture of the proximal femur.

Abstract: STUDY OBJECTIVE--The aim of the study was to examine the relationship between water fluoride concentration and the incidence of hip fracture, since evidence on this is at present inconsistent. DESIGN--Numbers of hospital admissions for fractures of proximal femur were obtained from hospital activity analysis data for the years 1978-1982. The fracture rates were compared with water fluoride concentrations in 39 county districts of England and Wales (fluoride concentrations had been measured in these districts between 1969 and 1973 as part of the British Regional Heart Study). PATIENTS--During the study period, 4121 men and 16,272 women aged 45 years and over were discharged from hospital after hip fracture. RESULTS--Poor correlations were found between discharge rates and both total (r = 0.16, p = 0.34) and natural (r = 0.01, p = 0.95) water fluoride concentrations. CONCLUSIONS--Water fluoridation to levels of around 1 mg/litre is unlikely to reduce hip fracture incidence markedly in this country.

Sedentary work in middle life and fracture of the proximal femur.

Abstract: Hip fractures in the elderly are a major public health problem.1 Their incidence is associated with osteoporosis and a tendency to fall,2 both of which may be increased by physical inactivity. Before the age of 65, occupation is a major determinant of total physical activity. To examine the influence of work on later risk of hip fracture, we have compared occupational activity at age 50 in a series of elderly men and women with hip fractures and in controls selected from the same community.

The risks of local and systemic corticosteroid administration

Abstract: The pattern of use of corticosteroid therapy differs widely in rheumatology. The prevalence of steroid use in rheumatoid arthritis, for example, may vary markedly in different countries. Within Britain, beliefs about the uses of corticosteroid therapy are strongly held by rheumatologists, yet show wide variation (Byron and Mowat, 1985). Our knowledge about the efficacy and risk of corticosteroid administration remains in large part suboptimal. As might be expected with any group of drugs that exert a wide range of pharmacological actions and are routinely used in a variety of pathological conditions, reports of adverse effects of corticosteroids are frequent. However, much literature on the subject is derived from case reports and uncontrolled studies. In the case of several potential adverse effects, careful review of the evidence leads to the conclusion that the risk of their occurrence, if present at all, is small. The purpose of this review is to consider these adverse effects in relation to the three common routes of administration: oral, intravenous pulse and intrasynovial. Corticosteroids are among the most effective agents currently available for the alleviation of symptoms attributable to inflammatory arthritis. The discovery of some of these effects by Hench at the Mayo Clinic over forty years ago (Hench, 1952) was rapidly followed by the widespread use of corticosteroids in rheumatoid arthritis. The optimism that cortisone might be a cure for the condition quickly evaporated as some of the toxic effects of systemic corticosteroid therapy came to light over the ensuing decades. There followed a backlash as the more serious of these effects, particularly at the high doses being used, were set against a failure of steroid therapy to alter longer term progression of rheumatoid arthritis. The tone of much subsequent debate on the balance of risks and benefits of corticosteroid therapy has been clouded by the emotional arguments of these earlier years.

Brown's syndrome: an unusual ocular complication of rheumatoid arthritis.

Abstract: A 55 year old man with rheumatoid vasculitis and an apparent left inferior oblique palsy is described. This unusual extraocular complication of rheumatoid arthritis probably resulted from a tenosynovitis of the superior oblique tendon sheath, and resolved with steroid treatment.