Clinico-pathological conferences. 2, The case of Joe Bates.

Part 1 is entitled 'Clinical History: a diagnostic problem' (13 mins). John A. Mathews MRCP talks about the problem with accurately diagnosing patients with rheumatoid arthritis. The patient, a middle-aged man, Joe Bates has joint pain in his hands and suffers from the sentation of walking on stones. Despite treatment, his condition worsens. He becomes severly anaemic; his haemoglobin levels fall. In hospital, the consultant tests his grip, strength and they carry out pin prick tests and test the sensitivity of the soles of his feet. Part 2 is entitled 'Clinical History: cause of death'. It is explained that the patient's neurology and anaemia is examined as well as a discussion on iron deficiency. X-rays of the cervical region are seen; there is a notable compression which is considered to be responsible for some of the patient's mobility problems. He is offered surgery or a less conservative option of wearing a cervical collar (neck brace). He opts for the latter and seems to do well until a sudden admission to hospital with paraplegia. He subsequently contracts pneumonia and then dies of a cardiac arrest. Part 3 is entitled 'The Pathology' and is presented by Dr. J. Trevor Hughes. He studies the pathology of the knee joint typical in rheumatoid arthritis; the compression of the spinal cord; the lungs and kidneys are investigated. There is a large tear in the stomach and an ulcer causing peritonitis. Peptic ulcers during steroid treatment can occur.