The aim of this study is to assess the accuracy of MRI alone in the differentiation of soft cervical disc protrusion from osteophytic compression in cervical disc disease. In a retrospective study, the MRI scans of 41 patients with cervical disc disease, who had previously undergone surgery, were presented to three independent observers, randomly on two different occasions, to identify the accuracy of the diagnosis of the presence of hard or soft disc or both as a cause of compression. The observers (two neurosurgeons and one neuroradiologist) were not involved with the treatment of the cases at any stage and were unaware of the surgical findings. Their observations were compared with those of the surgeon recorded at operation. The intra-observer agreement was poor for diagnosis into three categories as hard or soft disc or both. In distinguishing between the presence or absence of hard disc, there was moderate to good (Kappa = 0.6) intra observer and fair to moderate (Kappa = 0.4) interobserver agreement. The sensitivity of diagnosis of a hard disc was high (87%) but specificity was low (44%), due to the overestimation of the presence of hard disc. There was a significantly higher incidence of hard disc in the elderly age group (76% over the fifth decade, P = 0.0073). It is concluded that MRI alone is not a very efficient diagnostic tool in distinguishing between hard and soft disc in the cervical disc disease.

Objective: Assessment of outcome after varicose vein surgeryDesign: Prospective study using the Health Assessment Questionnaire (SF36) which considers different aspects of overall health.Setting: University Hospital and Community.Materials: 150 patients undergoing varicose vein surgery.Chief outcome measures: SF36 questionnaires were sent pre-operatively and at 1 and 6 months post surgery.Main results: Eighty-nine (59%) patients answered all three questionnaires. Pre-operatively their overall health was similar to that of the general population. The ''cost'' to the patient of the operation was demonstrated by an increased pain and reduced role function at 1 month post-operation (p<0.01). By 6 months post-operation, when compared with preoperative values, all dimensions except social function and health perception were improved (p<0.01). Overall symptoms improved (p<0.01) by 1 month and were further improved at 6 months.Conclusions: The general good health of varicose vein patients may justify the low priority given to their treatment, but the improvement in symptoms and general health that relatively simple surgery provides should ensure its continued provision as a health care service.

osteoarthritis, their most common indication in our studies, they can accelerate joint destruction'. The existence of site-specific differences in individual NSAID activity3 influencing their adverse effects profiles4 is now appreciated. Perhaps a more critical attitude towards NSAID prescription is required rather than acceptance of the status quo. Non-steroidal anti-inflammatory drugs and appendicitis in patients aged over 50 years