Intermittent claudication complicating beta-blockade Intermittent claudication is an occasional side effect of beta-adrenergic blockade' but clinical details are lacking. Beta-blocking agents may exacerbate intermittent claudication in patients with severe peripheral arterial insufficiency.2 The following cases suggest that they may also provoke claudication in patients with previouslv asymptomatic peripheral arterial disease. Case 1 A man aged 54 without previous cardiovascular symptoms was found to be hypertensive. He was treated with methyldopa and, because of probable paroxysmal nocturnal dyspnoea, with bendrofluazide. After six months propranolol 120 mg daily was substituted for methyldopa. Three weeks later he developed cold extremities and bilateral calf claudication at 150 yards. After eight weeks' treatment, during which the blood pressure fell from 220/125 to 200/120 mm Hg, propranolol was withdrawn. Claudication began to improve after three weeks and resolved within five. Seven weeks after stopping propranolol the patient could play golf. Although both feet were cool, all peripheral pulses were palpable. The

Approximately 35000 hip replacements are performed in Britain annually and about 350000 worldwide. In the recent literature there have been reports of malignancy at or close to the site of a total hip replacement. BagoGranell et al (1984) and Swann (1984) describe a malignant fibrous histiocytoma occurring near the site of a previous hip arthroplasty whilst Penman and Ring (1984) described a high-grade osteosarcoma. The reports of these malignancies are few compared with the number of hip replacements performed and the association may be simply coincidence but the possibility of a definite relationship between these tumours and an arthroplasty should be considered.

Osteoarthritis in human skeletons from archaeological sites is common but there have been very few convincing descriptions of rheumatoid arthritis. We present a case of a near symmetrical erosive polyarthropathy in a medieval skeleton which we believe fulfils the criteria for typical rheumatoid arthritis.

Evidence of pituitary tumours in osteoarchaeological material is rare. In the present case, an enlarged pituitary fossa in the sphenoid bone indicated an expanding lesion. There was no evidence of hormonal abnormality, and a non-secreting adenorna or, less likely, a craniopharyngioma are suggested as probable diagnoses.

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