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Suniiriary. Skin collagcn conlcnt a~~d skin thickness in a g r o u p of postinenopausal wonicn w h o had been treated with sex h o r m o n c implants were c o m p a r e d with those in a n untreated g r o u p of similar w o m e n . Both skin collagen content and thickness were found t o b e significantly greater in the treated than in the untreated group. In the untreated women skin collagen content declined in re1 a 1' ion to m e n opausal age but not t o chronological age. No correlation was found with menopausal age, chronological age or duration of therapy in t h e trcated group. These data suggest that skin collagen is influenced by t h c sex h o r m o n e status arid declines after t h e menopause. contributing t o t h e increase in urinary liydroxyproline excretion that has been reportcd to occur a t this time.Alhright ct nl. (1940) first postulated that loss of oestrogens leads to bone loss after the menopause. but the effects of oestrogcn deficiency on the skin collagen content and skin thickness have not been reported. Although it has been suygested that there is a link between the quality of the skin and bone mass. (McConkey et ul. 1069; tiordon 19771, the possible effect of sex hormones on skin has not been adequately investigated. Brincat el al. (l983), in a study comparing 29 postmenopausal women with 26 women of similar age, who had been on sex hormone replacement for between 2 and 10 years, showed that the treated group had a higher skin collagen content than the untreated group. thus suggesting that sex hormones have a direct effect on the skin. Shuster et al. (1Y70) wggested'that it is an increase in androgen levels that gives hirsute women their higher skin collagen and skin thickness.In order to investigate the effects of sex hormones on the skin. we have studied the skin collagen content and the skin thickness in a large number of women treated with sex hormones and in untreated women at various stages after the menopause. Patients and methodsThe skin collagen content was measured in 52 postmenopausal women, who had been treated with oestradiol and testosterone implants for 2 to 10 years, and compared with that in a group of 66 postmenopausal women who had never received sex hormone therapy.The two groups were similar in age. the mean age was 50.5 years in the treated group and 50.3 years in the untreated group. The treated group of women were maintained on implants of 50 mg of oestradiol (&,) and 100 mg of testosterone (Tlo,,) (Brincat et al. 1984) administered every 6 nionths. Those women who had a uterus were given 5 mg of norethisterone for 7 days to produce a regular bleed and to prevent endometrial hyperplasia (Thorn et (11. 1979). The mean duration of therapy in the treated group was 5-2 years. The mean number of years since the menopause was 8.8 in the treated group and 8-1

1337amenable to blocking of the local nerves.7 Rectal indomethacin with its systemic effect was shown to be a more efficient analgesic agent, providing a broader degree of pain control. On all the variables we measured rectal indomethacin had a stronger analgesic effect than cryoanalgesia. The combination of rectal indomethacin and cryoanalgesia produced an additive effect. The ease of administration of rectal indomethacin, with its simplicity in use, its absence of noted side effects, and its low cost, has much to commend it in thoracic surgery. Its potential benefit in other branches of surgery is apparent. We should like to add a cautionary note, however, concerning the concurrent administration of subcutaneous heparin: before conducting this trial we saw several cases of persistent bleeding after surgery, but no such cases occurred after we stopped the routine use of subcutaneous heparin.Of the available methods for effectively controlling pain after thoracotomy, the epidural route, although effective, has much against it in terms of possible complications and the need for specialised staff, while a cryoprobe is simple to use provided that the equipment is available. Similarly, continuous intravenous infusions of opiate are effective2 3 but require an infusion pump and trained medical staff to start and supervise treatment, while intramuscular injection of opiate, in sufficient dosage to produce satisfactory analgesia, may produce appreciable respiratory depression. Indomethacin administered rectally has none of these drawbacks. We recommend its use after thoracotomy, both alone and as an adjuvant to other analgesic regimens. We found it singularly efficacious in reducing pain on movement, and it could thus make a considerable contribution to effective physiotherapy and earlier mobilisation.It is difficult to produce useful objective data on the influence of analgesics on changes in respiratory function after thoracotomy. We were impressed with the way in which peak flow values mirrored the other variables and provided useful information.We conclude that rectal indomethacin provides good, safe, simply administered analgesia after thoracotomy and has an additive effect when used as an adjuvant to conventional analgesia such as cryoanalgesia. Sex hormones and skin collagen content in postmenopausal women M BRINCAT, C F MONIZ, J W W STUDD, A J DARBY, A MAGOS, D COOPER Abstract Skin biopsy specimens were taken from 29 postmenopausal women who had not been given hormone replacement therapy and from 26 women who had been treated with oestrogen and testosterone implants for two to 10 years. The mean hydroxyproline content and therefore the mean collagen content in the skin was found to be 48% greater in the treated than the untreated women, who were matched for age. This difference was significant (p < 001).The implication of this finding is that oestrogen or testosterone, or both, prevents the decrease in skin collagen content that occurs with aging and protects skin in the same way as it protects bone in postmeno...

3D = three-dimensional; ACI = autologous chondrocyte implantation; H&E = haematoxylin and eosin; ICC = intraclass correlation; MOD = modified O'Driscoll; MRI = magnetic resonance imaging; TE = echo time; TR = repetition time. (Print ISSN 1478-6354; Online ISSN 1478-6362). This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any non-commercial purpose, provided this notice is preserved along with the article's original URL. Arthritis Research and Therapy AbstractAutologous chondrocyte implantation is being used increasingly for the treatment of cartilage defects. In spite of this, there has been a paucity of objective, standardised assessment of the outcome and quality of repair tissue formed. We have investigated patients treated with autologous chondrocyte implantation (ACI), some in conjunction with mosaicplasty, and developed objective, semiquantitative scoring schemes to monitor the repair tissue using MRI and histology. Results indicate repair tissue to be on average 2.5 mm thick. It was of varying morphology ranging from predominantly hyaline in 22% of biopsy specimens, mixed in 48%, through to predominantly fibrocartilage in 30%, apparently improving with increasing time postgraft. Repair tissue was well integrated with the host tissue in all aspects viewed. MRI scans provide a useful assessment of properties of the whole graft area and adjacent tissue and is a noninvasive technique for long-term follow-up. It correlated with histology (P = 0.02) in patients treated with ACI alone. Keywords: cartilage repair, collagens, glycosaminoglycans histology, MRI Open AccessAvailable online http://arthritis-research.com/content/5/1/R60 R61Cartilage function reflects its biochemical composition [8]. A small biopsy specimen such as is used for histochemical assessment can provide only limited information, as it is from a discrete location. MRI, in contrast, can provide information on the whole area. In addition, it is noninvasive and successive scans can be carried out, so allowing longitudinal monitoring at different time points. MR images have been shown to correlate with biochemical composition in other tissues, in cartilage in vivo, and even in engineered cartilage generated in a bioreactor [9][10][11]. Thus in this study we have used both forms of assessment of articular cartilage and correlated them where they are available at the same time points post-treatment. We have previously reported on the immunohistochemical appearance of such biopsy specimens, but only on two individuals and at 12 months after implantation [12]. Here we report on a much more extensive sample group, obtained up to 3 years after treatment, and compare histological assessments with those obtained by MRI. Materials and methods Tissue biopsiesPatients receiving ACI in our centre undergo arthroscopic assessment and biopsy of the treated region as part of their routine follow-up at approximately 12 months postgraft. The taking of biopsies from grafted regions was given ethical ap...

It is possible that degenerate changes in sacrococcygeal discs and/or intercoccygeal discs are associated with pain. Surgical results are better in those with a severe degree of degenerative change. Coccygectomy remains a successful treatment for a majority of severely disabled patients with coccydynia.

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Chordomas of the lumbar vertebral bodies are rare. We report an unusual case of an entirely intraosseous chordoma of the fifth lumbar vertebra treated by vertebrectomy. Conventional radiographs and scintigraphy were normal. The lesion was well visualised by MR imaging, but showed only slight sclerosis on CT. We give our reasons for making a diagnosis of chordoma rather than giant notochordal rest and discuss the problems of management resulting from this diagnostic dilemma.