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The inter- and intra-annual snow cover distribution in the Zackenbergdalen valley, north-east Greenland, was monitored using images from a digital camera. The Digital Camera Images (DCIs) provide-in contrast to satellite images-data with a high temporal and spatial resolution at low cost. The digital camera, positioned on a rock 500 m above sea level (asl), automatically takes oblique photographs of the valley. To obtain the necessary area consistency for mapping purposes, the DCIs are transformed into digital orthophotos. Snow cover mapping is performed using these orthophotos. In order to suppress errors due to illumination effects, a normalized index based on red, green and blue (RGB) values was developed. The index can be used as an analogue to the Normalized Difference Snow Index (NDSI), commonly used in combination with Landsat Thematic Mapper (TM) images. During the melt-off season, a maximum of 10-15 Landsat TM passes occur over the Zackenberg area. For the 1999 meltoff season only three cloud-fre...

The cost of treating venous leg ulcers with pinch grafting was evaluated for 58 consecutive patients: 29 in hospital care and 29 in primary care. The mean age was 76.8 and 74.3 years and the mean ulcer size 15.1 and 13.5 cm2, respectively. The operation technique, pinch grafting, was the same for all patients but primary care patients were not immobilised postoperatively. Healing rate within 12 weeks was the same for patients in hospital care and primary care (31%). Treatment costs for one week pre-operatively and three weeks postoperatively amounted to 5109 Pounds per patient in hospital care and 870 Pounds per patient in primary care (p < 0.001), and the costs for one week pre-operatively and 12 weeks postoperatively were 6738 Pounds and 1806 Pounds, respectively (p < 0.001). Costs for patients whose ulcers healed within 12 weeks were 5552 Pounds for those receiving hospital care and 1676 Pounds for those receiving primary care (p < 0.001). Pinch grafting in primary care was shown to cost 3.3 to 5.9 times less, with the same healing outcome, than pinch grafting in hospital care.

Eddy correlation measurements of methane exchange were conducted during a period of 43 days covering the summer season in high-arctic, NE Greenland. Measurements were carried out over a fen area and showed fluxes ranging from no exchange in the early part of the campaign to 120 mg m(-2) d(-1) during midsummer. The emission showed a clear variation related to soil temperatures and water table level in the late part of the summer, whereas the thickness of the active soil layer was a main controlling parameter in the thaw period, in the early part of the season. A model to assess methane emission dependency on physical parameters is found to give a realistic estimate for the seasonal variations in flux. The proportion of C returned to the atmosphere as CH4 relative to the total C cycling was around 2%, which is similar to ratios often reported in literature. On the basis of these findings, an estimate is given for the total summer season emission of CH4, in which a simple model including both physical parameters and net primary production (NPP) is adapted to reproduce CH4 exchange rates for periods when no measurements were undertaken. In this way the total emission of CH4 during the period June 1 to September 1 1997, is found to equal 3.7 +/- 0.57 g m(-2), which is a relatively high rate given the harsh climate in which the measurements were made. (Less)

Pinch grafting offers an alternative approach to conventional management of chronic leg ulcers, and is particularly well suited for venous and diabetic ulcers. Relevant literature review from 1872–1998 was reviewed. The method of pinch grafting is described here in detail, and is illustrated by two case reports. Since pinch grafting hastens the healing of granulating wounds, is easy to perform and does not require strict immobilisation, a revival of the method, with adaptation for primary care, should be encouraged.

SUMMARY To prospcctively study the prevalence of Lyme arthritis, 100 consecutive patients referred to a rheumatology out-patient clinic and 115 patients with a classified rheumatological disease were included. Individuals seropositive for antibody against the Borrelia burgdorferi sensu la to complex were examined for clinical signs or a history of Lyme borreliosis. Positive titres against B. bwgdorferi s.l. were found in 7/100 and 15/115, respectively. Among the 100 referred patients, Lyme arthritis was diagnosed in five cases. Carpal tunnel syndrome was the presenting clinical feature in two of them. One of the 115 individuals with a previously classified rheumatological disease was re-classified as Lyme arthritis. All cases of Lyme arthritis improved after oral antibiotic treatment. This study revealed Lyme arthritis to be a common disorder in this part of Sweden and the diagnosis should be considered in patients with acute or recurrent episodes of mono- or oligoarthriti s.

Objective: The aim of this study was to compare four measurement methods. Digital planimetry was compared with mechanical planimetry, placing the film over graph paper and counting the squares (grid tracing), and multiplying the two maximal perpendicular diameters of the ulcer (diameter product). Method: Twenty patients with 50 chronic leg ulcers of various aetiology and sizes (20 ulcers were ≤3cm2, 15 ulcers were >3cm2 and ≤10 cm2, and 15 ulcers were >10cm2) were enrolled consecutively into this study. Ulcer area was calculated from film transparency tracings using a digital planimeter, a mechanical planimeter, grid tracing and diameter product. Results: The mean difference of digital planimetry versus mechanical planimetry, grid tracing and diameter product was 0.51cm2, 0.72cm2 and −5.38cm2, respectively. For all methods difference tended to increase with ulcer size. Conclusion: Digital and mechanical planimetry, together with grid tracing, appear to be appropriate means of obtaining accurate surface area measurements. Digital planimetry is a quick and practical method and could therefore be recommended in the clinical setting. Declaration of interest: The digital planimeter was loaned by Mölnlycke Health Care

Objective. To study the aetiology of leg ulcers in patients with rheumatoid arthritis (RA) and to study healing and pain relief after pinch grafting. Methods. Twenty patients with RA and leg ulcers were studied. Diagnosis of the ulcers was founded on the clinical picture and measurements of the ankle-brachial pressure index. To detect vasculitis, skin biopsies were taken for immunohistochemistry and histopathology. Pain severity was assessed pre- and post-operatively using a visual analogue scale. Results. Ten of the 20 patients had ulcers with multifactorial aetiology. Fifteen had signs of venous insufficiency, 11 had histopathological evidence of vasculitis, four had reduced arterial circulation and two patients had diabetes. Healing after pinch grafting was found in eight patients, all of whom had an ulcer area less than 15 cm 2 . Eleven out of 18 patients had pain reduction after pinch grafting. Conclusion. The causation of leg ulcers in patients with RA was found to be multifactorial, with vasculitis and venous insufficiency as the main determinants. Pinch grafting seems to be a good alternative to conservative treatment for minor leg ulcers for these patients, regarding both wound healing and pain relief.

To study the prevalence and the clinical features of Lyme arthritis in a Swedish area highly endemic for Lyme borreliosis.Sera from 480 of 540 individuals living in a tick endemic area on an island in southern Sweden were tested by ELISA for IgG antibodies against Borrelia burgdorferi. A questionnaire was completed at the time serum was obtained. Antibody positive individuals who reported joint pain were examined by the authors one year later.Of 90 seropositive individuals, 34 (38%) reported symptoms of chronic or recurrent arthralgia. Of seronegative individuals from the same area 48/390 (12%) reported such complaints (p0.001). One year later one of the 34 seropositive patients with arthralgia had died and, of the remaining, 32 still had arthralgia. Lyme arthritis was diagnosed in 11/32 (35%) of these individuals corresponding to a prevalence of 2.3% (95% confidence interval: 1.0-3.6) in the population. The prevalence of other rheumatic disorders did not differ from that found in other areas in South Sweden. Clinical and laboratory findings were in agreement with previous reports of Lyme arthritis. Other manifestations of Lyme borreliosis were found in 6 of the 11 patients with Lyme arthritis. After antibiotic treatment 9/11 (82%) remain free of complaints followed for 6 months or more.Our results indicate that arthritis and musculoskeletal symptoms of Lyme borreliosis are as common in highly endemic areas for Lyme borreliosis in Sweden as in similar areas in North America.

The prevalence of primary Sjögren's syndrome (primary SS) among patients with autoimmune thyroiditis (AT), and that of AT among patients with primary SS were studied prospectively. Of 63 patients with AT, one had precipitating antibodies against SS-A/Ro antigen together with objectively verified primary SS, and none had precipitating anti-SS-B/La antibodies; in contrast 17/63 (27%) had above normal values of anti-SS-B/La antibodies, as tested with ELISA. Of 19 AT patients tested objectively for xerostomia and keratoconjunctivitis sicca, six (32%) had keratoconjunctivitis sicca together with xerostomia and four (21%) had autoimmune sialadenitis. The prevalence of AT in patients with primary SS (n = 28) was 18%; of the 28 patients, 64% had an enlarged or abnormal thyroid gland on palpation and four of them (14%) had cytology verified AT. Ten (36%) had anti-thyroglobulin and/or antimicrosomal autoantibodies. Based upon the present investigation we conclude that the prevalence of primary SS is ten times higher among patients with AT, and that of AT is nine times higher among patients with primary SS, compared with the general population.

Inflammation of medium and small sized arteries caused by polyarteritis nodosa (PAN) sometimes causes acute and life threatening ischaemic intestinal complications. We report a case of PAN presenting with severe abdominal pain successfully treated with nitroglycerin.

Borgfeldt C, Hansen B, Manthorpe R. The hypereosinophilic syndrome. Report of a case with successful medical treatment following cardiac biopsy. Scand J Rheumatology 1988; 17:51-54.Together with pronounced blood eosinophilia an endomyocardial biopsy is the method of choice in diagnosing and assessing the severity of the systemic disorder hypereosinophilic syndrome (HES). Eosinophilia is not uncommon in several connective tissue diseases which may share clinical manifestations with HES. We report a case of HES, investigated and followed up with cardiac biopsies. A missing right radial artery pulsation gave rise to several differential diagnostic considerations.

Recherche de l'existence de maladies inflammatoires du tissu conjonctif chez les meres de nouveau-nes atteints de bloc auriculo-ventriculaire complet congenital isole. Etude clinique et paraclinique, en particulier serologique (recherche d'anticorps anti SSA et anti SSB) chez les meres et les nourrissons. A partir d'une observation de mere ayant developpe un syndrome de Sjogren 15 ans apres la naissance d'un tel enfant

Nine pregnant women with false-positive syphilis test results, and 13 matched controls, were screened for autoimmune antibodies to ascertain whether any relationship might exist between their presence and the occurrence of obstetric problems. Investigations included assays for anti-cardiolipin antibodies (ACA), lupus anticoagulant (LAC), anti-nuclear antibodies (ANA) (including antibodies against extractable nuclear antigen), anti-smooth muscle antibodies, anti-mitochondrial antibodies, anti-DNA antibodies, IgM-RF and complement factors. We found no significant difference in the incidence of obstetric problems between the two groups. Except that significantly more women were positive for ACA in the group with false-positive syphilis tests than in the control group, there were no differences between the groups with regard to the antibodies tested for. There was only one case of SLE, a patient positive for LAC, and who had had several miscarriages and no pregnancy resulting in a live birth. Our findings suggest that it would be unwarranted to devote resources to routine screening for these antibodies in healthy women with a false-positive syphilis test result, though the presence of LAC could possibly be used as an indicator of the risk of spontaneous abortion due to SLE.