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It has been proposed that the defining difference between rheumatoid arthritis and spondyloarthropathy (including psoriatic arthritis) is the initial pathological lesion where the emphasis in psoriatic arthritis is on the enthesis and in rheumatoid arthritis on the synovium. Classical radiological descriptions of seronegative spondyloarthropathy include enthesopathy at major entheseal insertions characterised by erosions and exuberant new bone formation. In this study, the plain radiographic features of spondyloarthropathy are compared between psoriatic arthritis, other spondyloarthropathies and rheumatoid arthritis. The CASPAR study collected clinical, radiological and laboratory data on 588 patients with physician diagnosed psoriatic arthritis and 525 controls with other inflammatory arthritis, 70% of which had rheumatoid arthritis. Plain radiographs of the pelvis and heels were part of the study protocol, although radiographs of other potential entheseal sites such as the knee, elbow and shoulder, were interpreted if available. All radiographs were read blind by two observers working in tandem. Significant differences in entheseal erosion and entheseal new bone formation were found between psoriatic arthritis, ankylosing spondylitis, undifferentiated spondyloarthropathy, rheumatoid arthritis and other diagnoses (entheseal erosion, chi-squared 20.8, p = 0.008; entheseal new bone formation, chi-squared 24.5, p = 0.001). These differences were mainly due to a higher proportion of these features in ankylosing spondylitis. No differences in the plain radiographic features of enthesopathy were found between psoriatic arthritis and rheumatoid arthritis except in the case of entheseal new bone formation at sites of attachment of inguinal ligament, sartorius and rectus femoris muscles to the ilium (OR 3.01, 95% CI 1.13–8.02). Very few subjects with symptomatic heel involvement had radiographic changes and minimal differences were found between those with and without symptoms in terms of new bone formation and erosion at either calcaneal site. New bone formation and erosion at major entheseal sites is most commonly seen in ankylosing spondylitis. Plain radiographic features of major enthesopathy are poor discriminators between psoriatic arthritis and rheumatoid arthritis.

The stock structure and movement patterns of broadbill swordfish (Xiphias gladius) in the south Pacific Ocean are uncertain and potentially have important implications for assessment and management. The most recent stock assessment for swordfish within the Western and Central Pacific Ocean (WCPO) was conducted in 2008.Since then, an expanded electronic tagging dataset has become available, and although still limited by small sample sizes, short periods at liberty and infrequent location information, provides evidence for revising spatial assumptions used in the 2008 assessment. Temperate eastern parts of the southwest Pacific appear to be linked to the tropical eastern part of the south-central Pacific, indicating that these areas should no longer be considered separately. Other assumptions from the 2008 assessment are supported, including: (i) no mixing between the southern and northern WCPO, (ii) no mixing between the WCPO and the eastern Pacific Ocean, and (iii) limited connectivity between the eastern and western parts of the Tasman and Coral Seas. Approximate movement rate estimates are provided which may be relevant for future stock assessments, Sí

Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are chronic inflammatory diseases of the musculoskeletal system. Although it seems likely that these conditions have a different pathogenesis, the drugs used to treat them are the same. Our study used a cross-sectional clinical database to compare drug use and side-effect profile in these 2 diseases.The CASPAR study collected data on 588 patients with PsA and 536 controls, 70% of whom had RA. Data on disease modifying drug treatments used over the whole illness were recorded, together with their outcomes, including adverse events, for RA and PsA.For both diseases methotrexate (MTX) was the most frequently used disease modifying drug (39% of patients with PsA, 30% with RA), with over 70% of patients in both diseases still taking the drug. Other drugs were used with the following frequencies in PsA and RA, respectively: sulfasalazine 22%/13%, gold salts 7%/11%, antimalarial drugs 5%/14%, corticosteroids 10%/17%, and anti-tumor necrosis factor (TNF) drugs 6%/5%. Compared to RA, cyclosporine and anti-TNF agents were less likely to be ineffective in PsA. Compared to RA, subjects with PsA were less likely to be taking MTX and more likely to be taking anti-TNF agents. Hepatotoxicity with MTX was more common in PsA and pulmonary toxicity with MTX was found more often in RA.These data provide insight into prescribing patterns of disease modifying drugs in RA and PsA in a large international cohort, together with the differential adverse events of these drugs between these diseases.

BACKGROUND: Groin surgery for recurrent varicose veins can be technically difficult due to scarring from previous surgery. Access to the sapheno-femoral junction (SFJ) can be facilitated by approaching the veins indirectly (subfascially) by first exposing the common femoral artery. The aim of this paper was to document experience with both direct and indirect approaches to the SFJ for recurrent varicose veins. METHOD: A retrospective analysis of all patients having groin surgery for recurrent varicose veins. RESULTS: Of 128 legs having surgery, the approach to the SFJ was direct in 46%, indirect in 53% and unknown in one leg. Complications occurred after 40% of all procedures but were significantly more common following indirect surgery (57% versus 20%, P < 0.001), of which the most frequent were of a lymphatic nature (26% versus 5%, P < 0.001) or wound infection (16% versus 7%, P = 0.05). CONCLUSION: Wound complications are common following groin surgery for recurrent varicose veins especially after an indirect approach to the SFJ.

An audit of 10 years of arterial surgery was undertaken to compare the first 5 years with the second 5 years. The aim was to see if the surgery during the second 5 years was being undertaken to an acceptable standard, and if there had been improvements in haemorrhagic complications and outcome for femoro-crural bypass grafts, which had previously been identified as problem areas during the first 5 years. Between the two 5-year periods, combined general surgical and arterial admissions and operations reduced by 21.8% and 26.2%, respectively, owing to marked reductions in gastrointestinal and biliary patients. At the same time, arterial admissions and operations increased by 55.7% and 46.6%, respectively. Improvements were found in outcome for aortic and iliac aneurysms and lower limb bypasses, in particular crural grafts. Aorto-iliac and aortofemoral bypasses were undertaken less frequently with a higher mortality and more complications, but in the second 5 years these patients were more urgent and more likely to have a threatened limb. There was a reduction in re-operation for postoperative bleeding in the second 5 years (4.6% vs 2.2%). It was concluded that the surgery was being undertaken to an acceptable standard, but that the quantity of vascular surgery during the second 5 years was such that continued single-surgeon practice in the present setting was unacceptable.

Hand-held Doppler (HHD) examination and duplex ultrasound scanning of patients with varicose veins are more accurate than clinical assessment alone. To assess how the introduction of HHD and the availability of duplex ultrasound scanning affects patient management, a retrospective review was carried out comparing the year before the introduction with the subsequent 2 years. Information was extracted from a computer database containing details of all new venous outpatients, their initial management and investigations and subsequent operations. HHD and duplex ultrasound resulted in a marked increase in secondary investigations (16% versus 41%) and fewer patients being listed directly for surgery (47% versus 29%). Operations on the long saphenous vein decreased from 84% to 76% whereas short saphenous surgery increased from 6% to 21% during this time.