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The mortality pattern occurring 3 to 6 years after recovery from myocardial infarction is described in a group of 349 patients. Mortality in this group had been previously related to prognostic factors recorded prospectively at the time of adnission to hospitals, and separate coronary prognostic indicesfor hospital and three-year survival had been formulated. The present follow-up shows that mortality between 3 and 6 years can still be related to factors dependent on the degree of myocardial damage sustained, and can be predicted by the coronary prognostic indexfor 3-year survival. Hypertension also had an adverse effect on survival, but the effect which emerges over the 3-to 6-year follow-up is apparent only in patients with an otherwise good prognosis.We have previously reported on clinical factors, present on admission to hospital, which were associated with mortality in a group of 757 patients with myocardial infarction admitted to three hospitals in Auckland during one year (I966-67) (Norris et al., i969, 1970). We incorporated numerical weightings for these factors into coronary prognostic indices for survival in hospital (Norris et al., i969), and for 3 years after discharge from hospital (Norris et al., I970). The present paper reports progress of the 3-year survivors of this same group of patients at a median period of 6 years after discharge. It shows that the chances of survival between 3 and 6 years after recovery were, as in our shorter term surveys, associated with age and factors dependent on the severity of myocardial damage. These factors were radiological evidence of pulmonary venous congestion, pulmonary oedema, and cardiac enlargement at the time of the infarct. vival was correlated with risk factors (hypertension, diabetes, and obesity), recorded at the time of infarction, and with the coronary prognostic index for 3-year survival. The diagnosis of hypertension was based either on a positive history from the patient or his referring practitioner, or the finding of high blood pressure requiring treatment during hospital admission.Of 530 patients followed after discharge from hospital (Norris et al., I970), 357 were known to be alive at 3 years. Of these, 349 (98%) were traced at 6 years, comprising 66 per cent of those who were originally discharged from the hospitals in I966-67.Results Seventy-eight patients had died between the 3-and 6-year follow-ups, this number being 22 per cent of the 357 three-year survivors, and I5 per cent of the original group of 530. Mortality at 3 years had been 33 per cent, so that the total 6-year mortality rate was 48 per cent of hospital survivors.Mortality rates were related to the presence of the previously described clinical prognostic factors which had been present at the time of infarction 6 years before.

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This study was undertaken to determine pressure changes within the knee joint under various experimental conditions. All the knees studied were the seat of chronic effusions secondary to rheumatoid arthritis, psoriatic arthritis, or degenerative joint disease. Aspirations were performed because of persistent pain and limitation of movement of the joint.Material 21 patients were studied, one of them on two occasions. In the majority, arthritis had been present for a number of years. MethodWith sterile precautions and after infiltration with local anaesthetic, a special type of needle was introduced into the lateral aspect of the knee near the upper border of the patella. This needle (S.W.G. 18, Down Bros., with a short bevel and perforations made in the sides 0 5 cm. from the point to prevent blockage) had a tap and a side-arm. A manometer filled with normal saline was attached to the side-arm and the tap was opened. The manometer level fell rapidly and the pressure equalized with the atmospheric pressure with a minimal loss of joint fluid ( Fig. 1 The procedure took 45 to 60 minutes, and afterwards joint fluid was taken for culture and 40 mg. depot methyl prednisolone was introduced. No growth of organisms was recorded in the 22 joints examined. ResultsOf the 22 joints, six were excluded from the series because of blockage of the needle with large fibrin clots, other technical difficulties, or inability of the patient to relax adequately. Apprehension, or anything leading to a slight bracing of the knee and, with it, quadriceps contraction, produced considerable elevation of pressure.Each reading was estimated three times except for a few which were estimated twice. The data from each patient are arranged in the Table (

1. A case of glomus tumour of the subcutaneous tissues of the knee which presented with extreme pain is described. Successful removal of the tumour led to complete relief of pain and return to normal function. 2. The histological features are given. 3. The literature is briefly reviewed.

To investigate the importance of body image concerns relating to hand appearance in rheumatoid arthritis, a questionnaire was devised and administered to 80 female out-patients. Subjective judgements of hand attractiveness, feelings about hands, and behaviours relating to hand adornment and concealment were sought. Objective ratings of hand attractiveness were obtained from photographs taken at this time of the women's hands. Factor analysis indicated four principal orthogonal factors describe these body image items. Evaluative and affective elements were found to be independent of each other. The hypothesis that body image, thus rated, is relevant to desire for reparative hand surgery was tested using a two-stage general linear modelling procedure. Body image concerns, particularly negative feelings about hands, emerged as significant predictors of desire for surgery, and remained significant after the removal of variance accounted for by duration of arthritis, age, grip strength and objectively rated hand attractiveness. It is suggested that in rheumatoid arthritis, self-perception of hands and the associated emotional response, may be a covert agenda in women's decision to have surgery, and need specific clinical consideration.