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Endoscopic examination of the gastrointestinal tract (GIT) for diagnostics and therapy in children has evolved markedly over the last 20 or so years and is now usually undertaken by paediatric endoscopists. Updated diagnostic and management guidelines for common disorders including coeliac disease, gastro-oesophageal reflux disease, eosinophilic oesophagitis and inflammatory bowel disease highlight the central role of endoscopy. Therapeutic endoscopic approaches are also now widely available and further broaden the referral spectrum to include treatment of GIT bleeding, gastrostomy insertion, dilation of strictures and polypectomy. Lastly, the advent of newer technologies allows the examination of hitherto inaccessible areas of the GIT such as the mid-small bowel by wireless capsule video-endoscopy and enteroscopy. We summarise recent current practice and clinical guidelines, focussing on the key indications for referrals that are likely to require endoscopic assessment. [ABSTRACT FROM AUTHOR]

Historically the small bowel has been considered a technically difficult area to examine because of its length (3-5 metres), location and tortuosity. Capsule endoscopy and enteroscopy have revolutionised the investigation pathway of the small bowel in adults. They are now developing increasingly important roles as modalities of investigation in paediatrics. This review appraises the current literature to define the clinical indications and practical aspects of capsule endoscopy and enteroscopy that are of interest to the clinician. [ABSTRACT FROM AUTHOR]

Background: The diagnosis of intraepithelial neoplasia is pivotal for ongoing clinical management decisions in ulcerative colitis. Previous studies have compared the diagnostic yield of endomicroscopy with conventional "white light" endoscopy and hence the overall objective increase of endomicroscopy targeted biopsies as com- pared to chromoscopy guided alone is not apparent. Aims: We performed a prospective randomised controlled study to compare the diagnostic yield of intraepithelial neoplasia and cancer in patients undergoing ulcerative colitis screening using chromoscopy assisted endomicroscopy (group A) versus pan-colonic chromoscopy assisted colonoscopy (group B). Methods: Patients were randomised in a 1:1 ratio to undergo screening colonoscopy using either chromoscopic endomicroscopy or chromoscopy alone with targeted biopsies. Circumscribed lesions were characterised using endomicroscopy and chromoscopy with pit pattern analysis. Targeted biopsies in addition to conventional 10 cm quadrantic biopsies were taken. Primary outcome addressed the number of intraepithelial neoplasias detected in each group. Results: Endomicroscopy targeted biopsies significantly increased the yield of intraepithelial neoplasia as compared to pan-chromoscopy and biopsy alone (p<0.001) and also increased the yield of high-grade dysplastic lesions (p<0.001). Endomicroscopy targeted biopsies increased the diagnostic yield of intraepithelial neoplasia as compared to chromoscopy guided biopsies alone by 2.5-fold. Conclusions: This is the first randomised controlled study to show the true clinical benefit of endomicroscopy for the in vivo detection and characterisation of intraepithelial neoplasia in chronic ulcerative colitis surveillance colonoscopy. Endomicroscopy with targeted biopsy may potentially be the "gold standard" for the detection of intraepithelial neoplasia in ulcerative colitis. [ABSTRACT FROM AUTHOR]

Objectives: To assess the efficacy and safety of polyethylene glycol 3350 plus electrolytes (PEG+E) for the treatment of chronic constipation in children. Design: Randomised, double blind, placebo controlled crossover trial, with two 2-week treatment periods separated by a 2-week placebo washout. Setting: Six UK paediatric departments. Participants: 51 children (29 girls, 22 boys) aged 24 months to 11 years with chronic constipation (lasting ⩾3 months), defined as ⩽2 complete bowel movements per week and one of the following: pain on defaecation on 25% of days; ⩾25% of bowel movements with straining; ⩾25% of bowel movements with hard/lumpy stools. 47 children completed the double blind treatment. Main outcome measures: Number of complete defaecations per week (primary efficacy variable), total number of complete and incomplete defaecations per week, pain on defaecation, straining on defaecation, faecal incontinence, stool consistency, global assessment of treatment, adverse events and physical examination. Results: The mean number of complete defaecations per week was significantly higher for children on PEG+E than on placebo (3.12 (SD 2.05) v 1.45 (SD 1.20), respectively; p<0.001). Further significant differences in favour of PEG+E were observed for total number of defaecations per week (p = 0.003), pain on defaecation (p = 0.041 ), straining on defaecation (p<0.001), stool consistency (p<0.001) and percentage of hard stools (p=0.001). Treatment related adverse events (all mild or moderate) occurred in similar numbers of children on PEG+E (41%) and placebo during treatment (45%). Conclusions: PEG+E is significantly more effective than placebo, and appears to be safe and well tolerated in the treatment of chronic constipation in children. [ABSTRACT FROM AUTHOR]

Background: Early use of nasal continuous positive airway pressure (nCPAP) may reduce lung damage, but it is not clear how many extremely preterm infants can be cared for without mechanical ventilation on the first days after delivery. Objectives: To describe our experience of nCPAP in infants born at <27 weeks' gestation and to determine the chance of reintubation of this group of extremely preterm infants. Methods: A retrospective, observational study examined the period from November 2002 to October 2003, when efforts were made to extubate infants to nCPAP at the earliest opportunity. Data were collected on all infants born at <27 weeks' and gestation admitted to The Neonatal Intensive Care Unit, Queen Charlotte's and Chelsea Hospital, London, UK. The chance of an individual infant requiring reintubation within 48 h of delivery was estimated, calculating the predictive probability using a Bayesian approach, and oxygen requirements at 36 weeks' postmenstrual age were examined. Results: 60 infants, 34 inborn and 26 ex utero transfers, were admitted; 7 infants admitted 24 h after birth were excluded and 5 died within 48 h. The mean birth weight was 788 g and the gestational age was 25.3 weeks. Extubation was attempted on day 1 in 21 of 52 infants on ventilators and was successful in 14; and on day 2 in 14 of 35 and successful in 10 of infants extubated within 48 h of delivery survived to discharge. 5 of 23 infants on mechanical ventilation at 48 h of age were on air at 36 weeks postmenstrual age, and 12 of 26 of those were on nCPAP at 48 h of age. The probability of an individual baby remaining on nCPAP was 66% (95% CI 46% to 86%) on day 1 and 80% (95% CI 60% to 99%) on day 2. The smallest infant to be successfully extubated was 660 g and the youngest gestational age was 23.8 weeks. Conclusions: Extremely preterm infants can be extubated to nCPAP soon after delivery, with a reasonable probability of not requiring immediate reintubation. [ABSTRACT FROM AUTHOR]

This article offers a critique of the recently revised BMA guidance on routine neonatal male circumcision and seeks to challenge the assumptions underpinning the guidance which construe this procedure as a matter of parental choice. Our aim is to problematise continued professional willingness to tolerate the non-therapeutic, non-consensual excision of healthy tissue, arguing that in this context both professional guidance and law are uncharacteristically tolerant of risks inflicted on young children, given the absence of clear medical benefits. By interrogating historical medical explanations for this practice, which continue to surface in contemporary justifications of non-consensual male circumcision, we demonstrate how circumcision has long existed as a procedure in need of a justification. We conclude that it is ethically inappropriate to subject children--male or female--to the acknowledged risks of circumcision and contend that there is no compelling legal authority for the common view that male circumcision is lawful. [ABSTRACT FROM AUTHOR]

Background: Gaviscon Infant (GI) has been recommended for gastro-oesophageal reflux (GOR) in infants. Its efficacy has not been examined with a physiologically appropriate denominator to define the degree of GOR. Aim: To investigate the influence of Gaviscon Infant on GOR in infants using combined pH and intraluminal impedance measurement. Methods: Twenty infants (mean age 163.5 days, range 34-319 days) exclusively bottle fed, with symptoms clinically suggestive of GOR, underwent 24 hour studies of intra-oesophageal 6 channel impedance and dual channel pH monitoring, during which six random administrations (3+3) of Gaviscon Infant (625 mg in 225 ml milk) or placebo (mannitol and Solvito N, 625 mg in 225 ml milk) were given in a double blind fashion. Impedance/pH reflux data were recorded and analysed blind by one observer. Results: The median number of reflux events/hour (1.58 v 1.68), acid reflux events/hour (0.26 v 0.43), minimum distal or proximal pH, total acid clearance time per hour (time with pH below pH 4), and total reflux duration per hour were not significantly different after GI than after placebo. Reflux height was marginally lower after GI (median 66.6% v 77.3% oesophageal length) compared with placebo. Conclusions: Results showed a marginal but significant difference between Gaviscon Infant and placebo in average reflux height, and raises questions regarding any perceived clinical benefit of its use. [ABSTRACT FROM AUTHOR]

Background: Salmonella enterica serovar typhimurium (S typhimurium) causes invasive gastroenteritis in humans, a disease involving significant penetration of the intestinal mucosa. However, few studies have been undertaken to investigate this interaction directly using differentiated human gut tissue. Aims: To investigate the early interactions of an enteropathogenic strain of S typhimurium with human intestinal mucosa using human intestinal in vitro organ culture (IVOC). Methods: Wild-type and mutant derivatives of S typhimurium TML were used to compare interactions with cultured human epithelial cells, bovine ligated loops, and human intestinal IVOC. Results:S typhimurium TML was shown to attach to cultured Caco-2 brush border expressing cells and cause tissue damage and fluid accumulation in a ligated bovine loop model.S typhimurium TML bound predominantly to the mucus layer of human IVOC explants during the first four hours of IVOC incubation. From four to eight hours of IVOC incubation, small but characteristic foci of attaching and invading S typhimurium TML were detected as clusters of bacteria interacting with enterocytes, although there was no evidence for large scale invasion of explant tissues. Ruffling of enterocyte membranes associated with adherent Salmonella was visualised using electron microscopy. Conclusions:Human IVOC can be used as an alternative model for monitoring the interactions between S typhimurium and human intestinal epithelium, thus potentially offering insight into the early stages of human Salmonella induced gastroenteritis. [ABSTRACT FROM AUTHOR]

Background: Cows' milk sensitive reflux oesophagitis is an emerging clinical entity in children, normally indistinguishable from primary gastro-oesophageal reflux (GOR) apart from the response to dietary antigen exclusion. It is conjectural whether a tendency towards mucosal eosinophilia distinguishes this group from primary GOR.Aims: To determine whether there may be differences in the mucosal lesion within the oesophagus in those children with reflux in association with cows' milk induced small bowel pathology, particularly in relation to the eosinophil chemokine eotaxin.Methods: A total of 29 children underwent endoscopic assessment, including nine with cows' milk sensitive enteropathy (CMSE) and associated GOR, seven histologically normal controls, six with primary GOR, and seven disease controls. Oesophageal biopsy specimens were examined immunohistochemically for the chemokines eotaxin and MCP-2, and T cell lineage and activation markers.Results: Strong upregulation of eotaxin expression, limited to basal and papillary epithelium, occurred in all CMSE patients. By contrast, weak expression was seen in a minority of controls and in 50% of primary GOR patients. Infiltration of CD3, CD4, and CD8 lymphocytes occurred in similar distribution in CMSE patients, significantly increased above controls. Significant upregulation of activation markers (CD25, HLA-DR) was also seen in the CMSE group within basal and papillary epithelium compared to controls and primary GOR.Conclusion: Basal and papillary epithelial eotaxin expression, with focal lymphocyte activation, was seen in infants with CMSE associated GOR. This preliminary study provides early evidence to suggest a pathogenesis distinct from primary GOR, in which specific recruitment of T cells and eosinophils may contribute to oesophageal dysmotility. [ABSTRACT FROM AUTHOR]

During a two year period 48 children admitted to hospitals in the Blackburn district were found to have cryptosporidium in stool samples. Cryptosporidium accounted for 6% of the 742 cases of childhood gastroenteritis, being as common as campylobacter. Altogether, 89% of children with cryptosporidiosis had diarrhoea, which was usually offensive and watery, and 80% vomited, the mean duration of both symptoms being six days. A substantial proportion were moderately ill with dehydration and persistent vomiting. Over half of all cases were aged 2 years or more and 37% were over 5 years. Most of the ill children were over 2 years, in contrast with other cases of gastroenteritis. Eight children were less than the 3rd centile for weight and three of these were investigated for failure to thrive. Only 6% of cases occurred in Asian children, but Asians accounted for 32% of all admissions with gastroenteritis and 59% of admissions with shigella. This unexpected ethnic difference may be due to limited contact with animals among Asians or to differences in diet. [ABSTRACT FROM AUTHOR]

A biochemical and histological study of hepatic lipid in children dying from the sudden infant death syndrome (SIDS) and children of a similar age dying explicably are reported. Contrary to a previous report based on histological assessment of hepatic lipid, no significant increase of total lipid content in livers of children dying from SIDS was found. Analysis of hepatic phospholipid fatty acid esters, however, revealed a significant difference between SIDS and children of similar age dying acutely and explicably. The phospholipid abnormality found in SIDS was similar to that found in children dying subacutely with hypoxia and would be consistent with increased cell membrane fluidity. The implications of these findings in the pathogenesis of SIDS are discussed. [ABSTRACT FROM PUBLISHER]

The method using radioactive tracer particles has been applied to study the effect of the mode of inhalation of aerosols on the depth of deposition in the lungs of 50 patients with airways obstruction. The findings show that the penetration of particles is directly related to: (1) volume inspired per breath (VI); (2) forced expiratory volume in one second (FEV1); and inversely related to (3) flow rate during inhalation (V). In mathematical terms, alveolar deposition (%) = 40-3 (VI)+10-98 (FEV1)--0-75 (V)+40-4; for this regression F = 4-41 and P less than 0-01. [ABSTRACT FROM PUBLISHER]

The mucolytic efficacy of S-carboxymethylcysteine has been assessed in a double-blind crossover trial in 16 patients with chronic obstructive bronchitis. No significant difference was found between drug and placebo after four or seven days' treatment in the rate of clearance of secretions from the lung. This was measured by external counting of previously inhaled polystyrene tracer particles tagged with technetium-99m (99mTc). Lateral scans across the right chest after inhaling the aerosol showed equal penetration of particles towards the periphery of the lung in drug and placebo runs; this indicated that the airways had not been cleared of mucus by the drug. There was no significant difference between drug and placebo runs in the number of coughs or the weight and radioactive content of sputum voided or raised at the end of the run by chest percussion and postural drainage. Ventilatory capacity was not significantly changed nor was there any subjective improvement in the patients as a result of taking the drug. [ABSTRACT FROM PUBLISHER]

, , 742-747. The effect of guaiphenesin (administered as Robitussin) on mucociliary clearance has been assessed in 15 subjects from the rate of removal from the lung of previously inhaled radioactive tracer particles. The guaiphenesin was compared with a positive control preparation consisting of the guaiphenesin vehicle only in two double-blind crossover trials. The first trial examined eight aged `healthy' volunteer subjects and the second trial examined seven chronic bronchitic patients. Sequential gamma counts were made from the whole lung by scintillation counters for 6 hours after inhalation and the chest was also scanned rectilinearly. In the first 5 hours after inhalation the mean rate of removal of particles and therefore of secretions was faster after guaiphenesin than after the control preparation. This difference was not statistically significant in the healthy volunteers but achieved significance (P <0·05) in the chronic bronchitic patients. Lung scans after inhaling the tracer aerosol indicated that on average the initial penetration of the particles into the lung was similar in the guaiphenesin and control runs. The faster clearance after guaiphenesin was unlikely to be due to bulk movements of mucus caused by coughing since the mean frequency of coughing during the experiment was somewhat less after the drug. [ABSTRACT FROM PUBLISHER]

Introduction Iron deficiency is the most common nutritional disorder globally. There is increasing evidence from clinical and population studies for a role of H pylori infection in the aetiology of iron deficiency. Rodent models of infection are needed to investigate causal links to iron deficiency in the host. The aim of this study was to investigate the effects of gastric infection on host iron metabolism gene expression in hypergastrinaemic INS-GAS mice. Methods Male transgenic INS-GAS mice were inoculated with or broth only by oral gavage. Uninfected genetic background FVB/N mice were used as controls. Infected mice and uninfected controls were sacrificed at 9 months post-inoculation. Gastric corpus mucosa was stored for total RNA extraction and analysis by quantitative real time PCR. The level of expression of target genes was assessed as relative abundance compared to control gene by the ΔΔCt method. Serum ferritin protein levels were measured by ELISA. Results H felis-infected INS-GAS mice had a significant reduction in hepcidin transcript levels in the gastric mucosa compared to uninfected INS-GAS mice and FVB/N controls (p < 0.03). The reduction in hepcidin hormone expression in H felis infected mice is likely to result in increased expressions of genes which control the influx and efflux of iron in gastrointestinal cells. Divalent metal transporter 1 (DMT1) which is negatively controlled by hepcidin is expressed on the apical membrane of gastrointestinal cells and absorbs reduced ferrous iron (Fe) from the lumen. There was a significant increase (p < 0.02) in gastric transcript levels in H felis-infected INS-GAS compared to uninfected INS-GAS mice or FVB/N controls. Other iron metabolism gene expression levels were also significantly increased with gastric H felis infection, such as Ferroportin 1 (p < 0.05), Transferrin receptor 1 (p < 0.003) and Lipocalin 2 (p < 0.001). Serum ferritin levels were significantly reduced (p < 0.001) in H felis-infected INS-GAS mice compared to uninfected controls at 9 months. Conclusion This study demonstrates the interplay between hepcidin transcript levels and the expression of host iron metabolism genes. Previous studies have shown that chronic gastric H felis infection in INS-GAS mice results in decreased serum transferrin saturation. This study investigates the molecular basis for previous observations and finds that chronic gastric infection results in a significant reduction in gastric hepcidin gene expression levels which coincides with significant increases in gene expression of several proteins implicated in host iron metabolism. [ABSTRACT FROM PUBLISHER]

The authors present a case of splenic artery aneurysm rupture, which neatly illustrates some of the problems of modern medical practice and the potential detriment of blind adherence to protocol driven care, without adequate reflection on the whole clinical picture and possible alternative diagnoses. [ABSTRACT FROM AUTHOR]

The aim of this work is to assess the medium term efficacy of the BARD Endocinch device for the treatment of gastro-oesophageal reflux disease (GORD) in children and adolescents. 17 males with symptoms of GORD dependent on proton pump inhibitors (PPI) for greater than 12 months or refractory to PPIs underwent endoscopic gastroplication (EG), and follow up occurred bra median of 15 months. Symptom scoring, upper gastrointestinal endoscopy, oesophageal manometry, gastric scintiscan, 24 hour oesophageal pH, and completed reflux quality of life were at 0, 6 and 52 weeks. This is the first study reporting paediatric experience with an endoscopic anti-reflux procedure and demonstrates medium term sustained efficacy in managing GORD in children.

Background: In addition to acid gastro-oesophageal reflux (GOR), non-acid GOR (pH > 4) may be clinically relevant in neurologically impaired children. However, standard pH metry can only detect the former. We have therefore used the pH independant technique of intraluminal electrical impedance to quantify all reflux events. Aim: The aim of this study was to quantify acid and non-acid reflux in a group of these patients using a new catheter related technique. Methods: Ten children (9 cerebral palsy, 1 Trisomy 27) fed intragastrically underwent 12 h studies of intra-oesophageal 6 channel impedance and dual channel pH monitoring. All patients were off medication influencing gastric pH. Recordings were analysed for the frequency of acid and non-acid GOR and the height reached by the refluxate. Results: 369 reflux events were detected with the combined technique. 191 (51.8%) were non-acid events (mean pH 5.6) and of these 138 (72.2%) reached the uppermost (1) impedance channel. Of the 178 acid reflux events (mean pH 3.1), 81.5% reached the uppermost channel. Conclusions: Over half of reflux events in neurologically impaired children are non-acidic and therefore are missed using standard pH merry. Most of these refluxes reached the upper oesophagus. Simultaneous intraoesophageal impedance and pH measurements proves to add valuable information that may improve therapeutic management in this patient group. [ABSTRACT FROM AUTHOR]

Aims: A new form of inflammatory bowel disease (ileocolonic lymphonodular hyperplasia) has been described in a cohort of children with developmental disorder. This study investigates the presence of persistent measles virus in the intestinal tissue of these patients (new variant inflammatory bowel disease) and a series of controls by molecular analysis. Methods: Formalin fixed, paraffin wax embedded and fresh frozen biopsies from the terminal ileum were examined from affected children and histological normal controls. The measles virus Fusion (F) and Haemagglutinin (H) genes were detected by TaqMan reverse transcription polymerase chain reaction (RT-PCR) and the Nucleocapsid (N) gene by RT in situ PCR. Localisation of the mRNA signal was performed using a specific follicular dendritic cell antibody. Results: Seventy five of 91 patients with a histologically confirmed diagnosis of deal lymphonodular hyperplasia and enterocolitis were positive for measles virus in their intestinal tissue compared with five of 70 control patients. Measles virus was identified within the follicular dendritic cells and some lymphocytes in foci of reactive follicular hyperplasia. The copy number of measles virus ranged from one to 300 000 copies/ng total RNA. Conclusions: The data confirm an association between the presence of measles virus and gut pathology in children with developmental disorder. [ABSTRACT FROM AUTHOR]

Background: Treatment-related toxicity and delays in the management of this toxicity can impact the outcomes of patient with cancer. In Scotland, a national cancer helpline was established to provide triage assessment for patients receiving systemic anticancer therapy (SACT) in an attempt to minimise delays in toxicity management. In this article, we describe the use and impact of the helpline in our region over the last 5 years., Methods: Patients who contacted the NHS Tayside cancer helpline between 1 January 2016 and 31 December 2020 were retrospectively identified. Patient demographics as well as the reason and outcome of each call was recorded. A descriptive analysis was performed., Results: 6562 individual patients received SACT and 8385 calls were recorded during the time period. Median age of callers was 63 years (range 17-98) and 59.2% were women. Use of the helpline increased by 83.6% between 2016 and 2020, driven by an increase in in-hours calls. 41% of calls required review by a healthcare professional only, 24% required review and admission and the remaining 35% telephone advice only. The majority of cases (85%) were either assessed or advised solely by oncology. The proportional use of general practitioner services has decreased., Conclusions: The helpline provides a way for patients to report symptoms directly to their clinical team and receive appropriate specialist advice at an early stage. We demonstrate that most of these calls can be managed solely by our oncology team. This system can reduce pressure on other parts of the local health system., Competing Interests: Competing interests: RDP has undertaken speaking, consulting and advisory roles for Eli Lilly, BMS, Pfizer, Sanofi, Servier; and received research funding (not related to the work in this manuscript) from Astra Zeneca, Roche, MSD, Merck serrano, Eli Lilly, Five Prime Therapeutics, Clovis, Boston Biomedical and Janssen. MB, IT, SG and MT have no conflicts of interest to declare., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

In April 2009 a Cochrane review was published assessing the effectiveness of male circumcision in preventing acquisition of HIV. It concluded that there was strong evidence that male circumcision, performed in a medical setting, reduces the acquisition of HIV by men engaging in heterosexual sex. Yet, importantly, the review noted that further research was required to assess the feasibility, desirability and cost-effectiveness of implementation within local contexts. This paper endorses the need for such research and suggests that, in its absence, it is premature to promote circumcision as a reliable strategy for combating HIV. Since articles in leading medical journals as well as the popular press continue to do so, scientific researchers should think carefully about how their conclusions may be translated both to policy makers and to a more general audience. The importance of addressing ethico-legal concerns that such trials may raise is highlighted. The understandable haste to find a solution to the HIV pandemic means that the promise offered by preliminary and specific research studies may be overstated. This may mean that ethical concerns are marginalized. Such haste may also obscure the need to be attentive to local cultural sensitivities, which vary from one African region to another, in formulating policy concerning circumcision.

Background: The effect on clinical safety of dampening articular mechanoreceptor feedback at the ankle is unknown. Injection of the ankle joint for pain control may result in such dampening. Athletes receiving intra-articular local anaesthetic may therefore be at increased risk of sustaining ankle injuries, which are a common reason for missed sporting participation., Objective: To determine the effect of intra-articular local anaesthetic on movement discrimination at the ankle joint., Design: Prospective, randomised, double-blinded, placebo-controlled, cross-over trial., Setting: Australian Institute of Sport Medical Centre, Canberra, Australia., Patients: Twenty two healthy subjects (44 ankles) aged 18-26 were recruited for the three visits of the study., Interventions: Subjects were tested for their initial movement discrimination scores using the active movement extent discrimination apparatus (AMEDA). They then received ultrasound-guided intra-articular injections of local anaesthetic (2% lignocaine hydrochloride) or normal saline, on two separate later occasions, before further AMEDA assessment., Main Outcome Measures: Change in movement discrimination scores after intra-articular injection of local anaesthetic or saline., Results: Movement discrimination scores were not significantly different from control ankles after injection of either local anaesthetic or saline into the ankle joint., Conclusions: The intra-articular injection of neither 2 ml lignocaine nor an equivalent amount of normal saline resulted in significant effects on movement discrimination at the ankle joint. These results suggest that injections of local anaesthetic into the ankle joint are unlikely to significantly affect proprioception and thereby increase injury risk.