Long-term follow-up of a recurrent multifocal desmoid tumour treated with tamoxifen: a case report.

We report a long-term follow-up of a female patient with a multifocal extremity desmoid tumour. She had 3 local recurrences after excision and developed a second unresectable pelvic tumour that has remained unchanged in size for 14 years since starting tamoxifen treatment.

Osteitis--an under-recognised association with seronegative spondyloarthropathy?

AIM: To emphasise osteitis as a feature of the spondyloarthritides. METHOD: We describe four cases spanning a spectrum of the spondyloarthritides in which osteitis was a feature. RESULTS: One patient had psoriatic arthritis with palmar-plantar pustular psoriasis and extensive osteitis involving the tibia and fibula. This case provides a link with two cases with SAPHO syndrome (synovitis, acne, pustulosis hyperostosis, osteitis) who had palmar-plantar pustulosis and osteitis. Many now argue that this syndrome is a form of spondyloarthritis. The fourth case, which was of particular interest to us, had enteric reactive arthritis and scintigraphic changes strongly suggesting the presence of osteitis of individual bones in the wrist. CONCLUSION: We propose that these four cases demonstrate that osteitis may be another feature common to the spondyloarthritides and SAPHO. Awareness of this may facilitate better documentation of this feature of the disease.

Early intervention for alcohol misuse: encouraging doctors to take action.

AIMS: An early intervention programme was introduced to improve the detection and management of problem drinkers admitted to acute orthopaedic wards at Dunedin hospital. METHOD: Intervention included brief staff education and the integration of an alcohol screen into the general patient assessment form used by junior doctors. Two hundred sets of patient records were examined, half before, and half after the introduction of these changes. Information was collected on the adequacy of alcohol history taking, whether alcohol misuse was identified, and how misuse was addressed. RESULTS: The proportion of patients with an adequate, quantitative alcohol history recorded increased from 37% to 84%. Although the detection of hazardous drinking increased only slightly, the proportion of cases where some form of action was taken increased from 14% to 71%. The majority of cases referred for follow up in the latter period were younger, nondependent problem drinkers. The programme was initially successful, but over time practices tended to revert when active encouragement was withdrawn. CONCLUSIONS: Our findings, consistent with those obtained overseas, indicate a striking plasticity of hospital junior doctor practice. Improvements in the detection and management of alcohol misuse are possible, but appear to require dedicated input and coaching. When such input is withdrawn, reversion can be disappointingly rapid. We suggest that if improved practices are to be sustained, preventive approaches need to be given greater emphasis in medical school curricula, and promoted by both senior medical staff and hospital management.

Three-dimensional collagen architecture in bovine articular cartilage.

The three-dimensional architecture of bovine articular cartilage collagen and its relationship to split lines has been studied with scanning electron microscopy. In the middle and superficial zones, collagen was organised in a layered or leaf-like manner. The orientation was vertical in the intermediate zone, curving to become horizontal and parallel to the articular surface in the superficial zone. Each leaf consisted of a fine network of collagen fibrils. Adjacent leaves merged or were closely linked by bridging fibrils and were arranged according to the split-line pattern. The surface layer (lamina splendens) was morphologically distinct. Although ordered, the overall collagen structure was different in each plane (anisotropic) a property described in previous morphological and biophysical studies. As all components of the articular cartilage matrix interact closely, the three-dimensional organisation of collagen is important when considering cartilage function and the processes of cartilage growth, injury and repair.

Osteophytes and the osteoarthritic femoral head.

The study describes the topography, morphology and growth of osteophytes in forty femoral heads removed from patients presenting with advanced osteoarthritis of the hip. In addition to standard histological techniques, radiography of serial bone slices in vivo bone labelling with tetracycline and 32P were used. The pattern of major osteophyte formation appeared to be influenced by the direction, degree and rate of displacement of the femoral head in relation to the acetabulum; four principal patterns of growth were noted. Osteophytes form part of extensive osteogenic processes that involve bone structure in the osteoarthritic joint.