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H Sheppeard

Publications and source records attributed to H Sheppeard.

25 records · Page 2Linked to original sources

Osmic acid versus yttrium-90 in rheumatoid synovitis of the knee.

The effectiveness of osmic acid and yttrium-90 in the treatment of synovitis of the knee in rheumatoid arthritis is compared in 126 patients followed-up for 3 years. Ninety-one knees were injected with osmic acid and eighty-four knees with yttrium-90. Osmic acid appeared to be more effective than yttrium-90 throughout the period of the follow-up but the difference only reached statistical significance (p less than 0.05) at 3 years. Both therapies were well tolerated by patients and should be considered as an alternative to operative synovectomy.

Aged↗

A review of early mortality and morbidity in elderly patients following Charnley total hip replacement.

To assess the effects of ageing upon the outcome of total hip replacement, the in-patient records of 100 elderly patients who had undergone Charnley hip replacement procedures within the last decade were reviewed. There were 74 women and 26 men and their mean age was 80 years. Osteoarthritis was the cause of hip disease in 94 patients and rheumatoid arthritis the cause in the remaining six patients. The early mortality and morbidity rates were 4% and 77%, respectively, and the average duration of hospital treatment 42 days. Infection was the commonest post-operative complication followed by mental confusion and adverse drug reactions; multiple complications were a frequent finding. Avoidable complications are indicated and recommendations made regarding the pre-operative, operative and post-operative management of elderly patients.

Aged↗

Intra-articular osmic acid in rheumatoid arthritis: five years' experience.

Two hundred and one patients (305 knees) with rheumatoid arthritis received intra-articular osmic acid in one or both knees. Assessment was based on pain relief, warmth, tenderness, size and presence of effusion, degree of synovial thickening and range of pain-free movement. Satisfactory results were obtained in 61% at one year gradually reducing to 22% over a five-year period. If only those knees with none or minimal joint damage were considered, then a satisfactory result was obtained in a higher percentage, 74% at one year and 38% at five years.

Adolescent↗

Placebo therapy in rheumatoid arthritis.

Few studies have attempted to describe the effect of placebo therapy on chronic pain. In this study pain was assessed daily, for 25 days, in 23 patients with rheumatoid arthritis. Patients received placebo during the last 9 days of the study. Pain scores during the first 16 days acted as a baseline from which each patient's response to placebo could be determined. Patients completed Form B of the Eysenck Personality Inventory on entry into the study, a pre-treatment expectation rating scale and a post-treatment assessment scale. Five patients were excluded from analysis because of trends in their baseline pain scores. Of the remaining patients, nine responded positively to placebo and five responded negatively. Four patients reported no significant change in pain and were found to be more introverted than both the negative (p less than 0.05) and positive placebo responders. Consequently, the degree of extraversion might prove a useful predictor of therapeutic response. No significant relationship was found between the patients expectation of therapy and the observed response which suggests that therapeutic outcome is not pre-determined. However, the patients assessment of therapeutic effect was closely related to the observed response (p less than 0.05). Neuroticism was greater in patients with side-effects than those without (p less than 0.05) and might be utilized as a means of detecting those patients most likely to complain of unrelated symptoms while on a new therapy. The different placebo responses observed draws attention to the difficulties in making therapeutic judgements in clinical practice and of assessing efficacy in drug trials.

Aged↗

Problems associated with pain measurement in arthritis: comparison of the visual analogue and verbal rating scales.

Thirty-seven arthritis patients participating in a drug withdrawal trial, simultaneously completed a 20-point visual analogue scale and 7-point verbal rating scale for pain severity while on active medication and 48 hours following its withdrawal. The relationship between the two scales could be better approximated by a curve than a straight line, and further interpretation suggested that the relationship might be sigmoidal. This indicates that only the middle of the scales are linearly related with a lack of agreement occurring towards the upper and lower ends. Although the visual analogue scale proved superior to the verbal rating scale in its ability to detect changes in pain, until more is known about factors which influence subjective magnitude estimation, this conclusion must remain tentative. The implications of the findings to pain measurement are discussed.

Arthritis↗

Synovial fluid total hemolytic complement activity in rheumatic diseases - a reappraisal.

The varied and contradictory claims made of the clinical value of measuring total hemolytic complement activity in rheumatic diseases prompted a reappraisal of its role, and a review of the literature, taking into account the anomalies of assay and the semi-quantitative nature of the procedure. We found that measurements of synovial fluid (SF) total hemolytic complement activity were of limited value in determining the diagnosis or prognosis of joint diseases. Also there was no significant relationship between SF total hemolytic complement activity and either clinical activity or other laboratory findings. We believe that measurements of SF complement activity will prove of little use as a guide to the effectiveness of drug therapy.

Arthritis↗