Vibration sensibility testing in the workplace. Day-to-day reliability.

Loss of vibration sensibility has been suggested as an early indicator of peripheral compression neuropathy, including carpal tunnel syndrome. Although vibration sensibility has been used frequently to evaluate carpal tunnel syndrome, the day-to-day reliability of vibration measurements in an industrial population measured at the workplace has not been assessed. Vibration sensibility testing was performed at the university ergonomics laboratory on 50 volunteers (100 hands) and at a newspaper company on 50 workers (100 hands). Vibration perception and disappearance thresholds were measured on two occasions separated by 3 to 5 days. Student's t tests indicated no significant differences between the first and second tests or between the two groups. Pearson product-moment correlations for test-retest reliability were lower in the industry group but were relatively high despite the less than optimal testing conditions. Our findings suggest that vibration sensibility measurements are reliable from day to day not only in the laboratory but also in the workplace.

Anti-rheumatic treatment in the elderly.

The elderly are more liable to problems from drugs used systemically. An accurate diagnosis may reveal conditions in which drug treatment is not required, especially those due to faulty habits and environmental problems, and local conditions susceptible to injections or surgery. Obesity, sepsis, hypothyroidism, osteomalacia, unsuspected fractures and drug side-effects may give correctable rheumatological problems. Use of analgesic anti-inflammatory drugs needs great care in the elderly; use analgesics instead when possible. Rheumatoid arthritis in the elderly demands maximum use of nonpharmacological treatment and local treatment. Analgesic anti-inflammatory drugs should be used carefully and sparingly. Use slow-acting drugs as in younger patients.

A double-blind study of benorylate and chlormezanone in musculoskeletal disease.

In a double-blind, cross-over study of 90 patients with degenerative disease of the hip, knee, cervical or lumbar spine, and capsulitis of the shoulder the analgesic drug benorylate (either alone or in combination with chlormezanone, a muscle relaxant anxiolytic drug) favourably modified pain, stiffness, quality of sleep and ability to work. Chlormezanone significantly reduced the number of breaks in sleep. There was no significant difference in the number of patients reporting side-effects on each of the four treatments, but drowsiness occurred significantly more in the chlormezanone weeks. There appeared to be no advantage in adding chlormezanone in patients suffering from osteoarthritis of the hip or knee, lumbar spondylosis or capsulitis of the shoulder, but there was significant improvement in both pain relief and quality of sleep in those patients with neck pain.

The Shulman syndrome: report of a further case.

A 53-year-old woman developed swelling of her hands after strenuous sport. Soon her feet became affected and the swelling spread up the arms and legs making arm movement and walking difficult. No Raynaud's phenomenon appeared or other features of systemic sclerosis. There was eosinophilia and hypergammaglobulinaemia in the peripheral blood. Histological examination of the skin showed an increase in the collagen bundles in the dermis extending down to the adipose tissue. The fascia showed dense fibrous tissue with a perivascular infiltrate of lymphocytes, a few plasma cells and eosinophils. Immunohistology of the skin and fascia were negative for IgA, IgG, IgM, C3, CIq and fibrin. After 4 weeks of prednisolone 40 mg daily there was a great improvement. This continued with further corticosteroid therapy.

The cartoon in doctor-patient communication. Further study of the Arthritis and Rheumatism Council handbook on gout.

A sample of 50 consecutive patients with gout was tested by means of a multiple-choice knowledge-testing questionnaire based on the Arthritis and Rheumatism Council's Gout: A Handbook for Patients. Patients were divided into two groups: (a) those tested with an illustrated booklet containing 89 cartoons, and (b) those tested with an unillustrated booklet with text exactly the same as in the illustrated booklet. No significant difference was observed in either the overall test scores between the two groups or between individual question scores. It was concluded that increasing the number of illustrations in the Arthritis and Rheumatism Council's handbook on gout had not significantly increased the value of this material as a communication aid. Certain sources of error have been discussed including the possibility of an 'interest factor' due to the inevitable interest patients have in reading about their own disease, and also the possibility that technical factors to do with page layout and picture/text imbalance might be responsible for failing to show differences between the two groups.