Journal of the Royal Society of Medicine

In this study quantitative techniques have been applied to smears collected from the buccal mucosa and floor of the mouth. The results display an encouraging success rate for identifying premalignant and malignant lesions. ‘Intrapatient’ normal smears provide a satisfactory control for comparison with pathological smears. Early results indicate that quantitative cytology could be of great value for monitoring and follow-up of suspicious lesions and provide an excellent additional diagnostic test for detecting early oral malignancy.

Although glucocorticoid replacement is conventionally administered twice daily, the pharmacokinetics of hydrocortisone would predict very low levels of plasma Cortisol by mid-afternoon. This study compared plasma Cortisol day profiles in 7 hypoadrenal patients while on twice daily and thrice daily hydrocortisone replacement. The twice daily regimen was associated with very low levels of Cortisol at 16.00 and 18.00 h. This was eliminated by administering the same total dose in a thrice daily regimen. Furthermore, estimates of ‘well-being’ by visual analogue scale correlated significantly with simultaneous plasma Cortisol levels and 5 of the patients expressed a preference for the thrice daily regimen. The findings suggest that thrice daily glucocorticoid replacement therapy should be adopted routinely.

Preoperative anxiety was assessed using the hospital anxiety and depression (HAD) scale, multiple affect adjective check list (MAACL) and linear analogue anxiety scale (LAAS) in 100 consecutive day case patients undergoing termination of pregnancy. The HAD scale, a recently introduced self assessment scale comprising 7 multiple choice questions, was readily accepted and easily understood by patients. There was a high degree of correlation between the HAD scale and both the MAACL (correlation coefficient 0.74) and the LAAS (correlation coefficient 0.67). There was only a moderate degree of correlation between the HAD scale and the anaesthetist's assessment of anxiety (correlation coefficient 0.46). The HAD scale is a useful method of subjective measurement of preoperative anxiety.

The passing of legislation relating to subject access to personal health data has been accompanied by concern about the possible harmful effects of this development on patients. Despite the lack of substantive evidence psychiatric patients have been regarded as the group most at risk. This study investigates the subjective views of patients on access to records on two psychiatric wards.

We report on 14 patients with instability of the cervical spine secondary to rheumatoid arthritis treated by fusion using a combination of traditional bone grafting techniques and methylmethacrylate bone cement. Successful fusion was achieved in all cases with few complications. The high infection rate reported by other authors was avoided by reducing the bulk of the cement mass and the use of antibiotic impregnated cement.

We recommend this method of fusion to all orthopaedic surgeons involved in the treatment of patients with rheumatoid arthritis.

We report a study on 100 patients with severe herpetic keratitis.

Overall, one in three of the study group required a penetrating keratoplasty (PK). These patients required a mean of 18 days as an inpatient and 15 outpatient visits in the year the PK was performed; these figures fell to 1 inpatient day and 8 outpatient visits in the second year after surgery. The financial cost of such therapy is discussed.

A team of lay counsellors was trained by the Nottingham Counselling Centre to provide advice to members of the East Midlands branch of the National Association for Colitis and Crohn's Disease. Initial contact was by telephone and the results of the first 25 client/counsellor discussions are presented. Twenty enquiries were made directly by the patient and 5 by a relative of the patient. AU but two of the patients were women. The median age of the patients was 52 years with a median duration of symptoms of 3 years. A failure of communication between the patient and other people underlay most of the problems discussed. Eighteen people welcomed the opportunity simply to talk; in 10 cases there was little rapport with their own doctor and in 8 cases people felt too embarrassed to discuss their problems with friends or relatives. This sense of isolation had been anticipated by counsellors from their own experience and may be a substantial, but as yet unrecognized problem amongst many patients with inflammatory bowel disease.