Vertebral fractures are increased in rheumatoid arthritis despite recent therapeutic advances: a case-control study.

Prevalence and risk factors of vertebral fractures in postmenopausal RA women were assessed in 323 patients and compared with 660 age-matched women. Of patients, 24.15% had at least one vertebral fracture vs.16.06% of controls. Age, glucocorticoids and falls were the main fracture risks. Vertebral fractures were associated with disease severity. INTRODUCTION: There is little quality data on the updated prevalence of fractures in rheumatoid arthritis (RA) that may have changed due to advances in the therapeutic strategy in recent years. This study was aimed at analysing the prevalence and risk factors of vertebral fractures in postmenopausal women with RA and comparing it with that of the general population. METHODS: We included 323 postmenopausal women diagnosed with RA from 19 Spanish Rheumatology Departments, randomly selected and recruited in 2018. Lateral radiographs of the thoracic and lumbar spine were obtained to evaluate morphometric vertebral fractures and the spinal deformity index. We analysed subject characteristics, factors related to RA, and fracture risk factors. The control group consisted of 660 age-matched Spanish postmenopausal women from the population-based Camargo cohort. RESULTS: Seventy-eight (24.15%) RA patients had at least one vertebral fracture. RA patients had increased fracture risk compared with controls (106 of 660, 16.06%) (p = 0.02). Logistic regression analysis showed that age (OR 2.17; 95% CI 1.27-4.00), glucocorticoids (OR 3.83; 95% CI 1.32-14.09) and falls (OR 3.57; 95% CI 1.91-6.86) were the independent predictors of vertebral fractures in RA patients. The subgroup with vertebral fractures had higher disease activity (DAS28: 3.15 vs. 2.78, p = 0.038) and disability (HAQ: 0.96 vs. 0.63, p = 0.049), as compared with those without vertebral fractures. CONCLUSION: The risk of vertebral fracture in RA is still high in recent years, when compared with the general population. The key determinants of fracture risk are age, glucocorticoids and falls. Patients with vertebral fractures have a more severe RA.

Evaluación de la densidad mineral ósea y de los parámetros de 3D-Shaper en la hipofosfatasia congénita del adulto / Agitated/inattentive children: explanatory models

Objetivo: Evaluar la densidad mineral ósea (DMO) y parámetros de 3D-Shaper a nivel de fémur proximal (FP) en adultos con hipofosfatasia (HPP) confirmada genéticamente y compararlos en aquellos sujetos con y sin fracturas. Material y métodos: Análisis transversal de datos densitométricos y de arquitectura ósea de la visita basal de un estudio longitudinal en el que se incluyeron pacientes con HPP. Se realizó un estudio densitométrico (Lunar Prodigy, GE iDXA) en FP y se empleó el software 3D-Shaper (version 2,7. Galgo Medical). Resultados: Se incluyeron 33 adultos con HPP con mutaciones en heterocigosis. Un 63,6% (21/33) fueron mujeres (42,9% postmenopáusicas), y 8 de los varones (66,6%) fueron mayores de 50 años. La media de edad fue 50,56±15,08 años, el 30,3% (10/33) tuvieron fracturas previas traumáticas, y un 15,2% (5/33), de estrés. La prevalencia de osteoporosis en CF fue del 11,8% (2/17) y de osteopenia, 82,4% (14/17). En premenopáusicas y varones jóvenes se detectó baja masa ósea para la edad en un 12,5% (2/16). Al comparar sujetos con fracturas de estrés y sin ellas, así como con traumáticas, no hubo diferencias en DMO. El 3D-Shaper mostró disminución del grosor cortical (mm) en pacientes con fracturas de estrés [1,8 (1,77-1,89)] frente a sujetos sin ellas [1,94 (1,87-2,03, p=0,03)] y en comparación con los que tuvieron fracturas traumáticas [1,97 (1,88-2,04), p=0,03]. Conclusión: Estos datos reflejan una discreta repercusión densitométrica en formas más leves del adulto. Estudios de arquitectura ósea pudieran resultar de interés para determinar pacientes susceptibles de presentar fracturas de estrés. (AU)

Objetivo: To evaluate bone mineral density (BMD) and 3D-Shaper parameters at the proximal femur (FP) level in adults with genetically confirmed hypophosphatasia (HPP) and to compare them in those subjects with and without fractures. Material and methods: Crosssectional analysis of densitometric data and bone architecture from the baseline visit of a longitudinal study in which patients with HPP were included. A densitometric study (Lunar Prodigy, GE iDXA) was carried out in FP using 3D-Shaper software (version 2.7. Galgo Medical). Results: 33 adults with HPP with heterozygous mutations were included. 63.6% (21/33) were women (42.9% postmenopausal), and 8 of the men (66.6%) were older than 50 years. The mean age was 50.56±15.08 years, 30.3% (10/33) had previous traumatic fractures and 15.2% (5/33) presented stress fractures. The prevalence of osteoporosis in CF was 11.8% (2/17) and of osteopenia, 82.4% (14/17). In premenopausal women and young men, low bone mass was detected for age in 12.5% (2/16). When comparing subjects with and without stress fractures, as well as traumatic ones, there were no differences in BMD. The 3D-Shaper showed a decrease in cortical thickness (mm) in patients with stress fractures [1.8 (1.77-1.89)] compared to subjects without them [1.94 (1.87-2.03, p=0.03)] and compared to those with traumatic fractures [1.97 (1.88-2.04), p=0.03]. Conclusions: These data reflect a discrete densitometric impact in milder forms of the adult. Bone architecture studies could be of interest in determining patients susceptible to stress fractures. (AU)

Estimulación eléctrica invasiva de C2-C3 en el tratamiento del dolor cefálico y facial: Neuralgia occipital. Migraña transformada. Cefalea en racimos. Algias faciales / C2-C3 Invasive electrical stimulation for the treatment of cephalic and facial pain: occipital neuralgia. Transformed migraine. Cluster headache. Facial algias

Introducción: La estimulación eléctrica extraespinal periférica cervico-occipital, llevada a cabo con un sistema implantado, es una técnica quirúrgica poco cruenta que puede proporcionar buenos resultados en pacientes con dolor neuropático refractario localizado en región cefálica y facial. Presentamos treinta y cuatro pacientes con dolor cervico-facial de larga evolución, persitente, severo, no controlado, de diferentes etiologías, en los que se habían agotado otras posibilidades terapéuticas, tratados en la Unidad del Dolor del Hospital Clínico, con estimulación eléctrica y electrodo cervico-occipital uni o bilateral. Material y método: Se trata de 34 pacientes tratados en el período de Junio 2002 a Febrero de 2008. Catorce de estos pacientes cumplían criterios diagnósticos de Migraña Transformada; otros dos casos se trataba de cefalea en racimos y en 18 corresponden a Neuralgia occipital y/o del trigémino. Antes del implante del sistema de estimulación se realizó bloqueo nervioso occipital con anestésico local con el fín dedeterminar el componente cervicogénico del cuadro álgico. El procedimiento quirúrgico se ha realizado en dos tiempos. La valoración de la eficacia está basada en la variación, antes y después del implante del sistema, de los siguientes parámetros: dolor continuo, dolor en las crisis y número de crisis, descanso nocturno, funcionalidad, actividad social y laboral, satisfacción del paciente, reducción del tratamiento farmacológico y estado emocional. Resultados: Los pacientes corresponden a 25 mujeres y 9 hombres, de 51,2 años de edad media (R. 29-80). Presentaban dolor continuo y en 27, además, se manifestaban crisis con agudización sintomática de gran severidad. Todos los pacientes necesitaban tratamiento farmacológico analgésico (media de 4,4fármacos por paciente). En todos los pacientes habían fracasado otras alternativas terapéuticas. El tiempo medio de evolución del dolor era de 98,9 meses (R. 5-360) (...)(AU)

Introduction: The peripheral cervical-occipital extraspinal electrical stimulation with an implanted system, is a little aggressive technique that can achieve good results in patients with refractory neurophatic pain localized in the cephalic and facial region. Thirty four patients with long-evolving, persistent, severe, uncontrolled pain of different ethiologies, localized in the cervical facial region, for whom other therapy options were exhausted, were treated with unilateral or bilateral cervical occipital electrical stimulation in the pain unit of the Zaragoza Clinic Hospital. Material and Method: Thirty four patients were treated from June 2002 to February 2008, fourteen of which were diagnosed with transformed migraine; two suffered from cluster headache and eighteen had occipital and/or trigeminal neuralgia. Before the neurostimulation system was implanted, an occipital nerve block was performed with local anesthetic to establish the cervicogenic component in the pain. The surgical procedure was performed in two stages. The treatment effectiveness assessment was made on the basis of the variation of the following parameters before and after the implant: ongoing pain, pain during the crisis, number of crisis events, overnight rest, functioning, social and laboral activity, patient satisfaction, drug therapy reduction and emotional status. Results: The participants were 25 female patients and 9 male patients with an average age of 51,2 (R. 29-80). They suffered from ongoing pain, and 27 of them also experienced crisis events with a very severe agudization of symptoms. All the patients needed pharmacological treatment with analgesics (average of 4,4 drugs per patient). Other treatment options had failed in all these patients. The mean time of pain evolution was 98,9 months (R. 5-360)...(AU)

Estabilidad de parecoxib en dilución con otros fármacos y administración en perfusión continua IV para el control del dolor postoperatorio / Stability of parecoxib in dilution with other drugs and administered in continuous

Objetivo. Evaluar la estabilidad de parecoxib en un sistema de infusión continua elastomérica portátil IV para 24 horas, en dilución con opiáceos (cloruro mórfico, meperidina ó tramadol), antieméticos y suero fisiológico, durante las 24 horas del postoperatorio; así como, comprobar el resultado analgésico, la aparición de efectos secundarios y el grado de satisfacción de pacientes intervenidos de cirugía mayor susceptibles de tratamiento con dichos fármacos. Material y Métodos. El infusor es un dispositivo desechable y ligero con un depósito elastomérico para administrar medicación. Se realizaron varias pruebas mezclando parecoxib, opiáceos, antieméticos y suero fisiológico y se observó su estabilidad durante 24 horas. Procedimos a observar la mezcla en repetidas ocasiones y la dilución siempre permaneció estable, clara, sin partículas y transparente; por lo que se decidió utilizar dicha mezcla en el infusor IV para el tratamiento del dolor postoperatorio, siempre bajo la supervisión de un anestesiólogo. Se estudiaron un total de 118 pacientes, 46 mujeres (39%) y 72 hombres (61%), ASA I-IV, edad media 59,75 +/- 14,25 (18-89), 92 (78%) fueron intervenidos de cirugía general y 26 (22%) de urología. El llenado del infusor según ASA, edad y tipo de intervención del paciente, se realizó con: parecoxib 80 mg + metoclopramida Cl H 20 ó 30 mg + suero fisiológico en los 118 pacientes, se añadió cloruro mórfico en 65 pacientes, meperidina en 30 y tramadol en 23, a administrar en 24 horas tras la intervención quirúrgica. Se valoró la intensidad del dolor según EAV a la llegada a la Sala de Despertar y a las 24 horas, resultado analgésico, efectos secundarios y grado de satisfacción. Resultados. El resultado analgésico fue muy bueno en 60 pacientes (50,85%); bueno en 40 (33,90%); regular en 12 (10,17%) y suspendido el tratamiento en 6 (5%) por efectos secundarios. Los efectos secundarios aparecieron en 30 casos (25%): 4 con sudoración (3%), 1 con desorientación (0,8%) y 7 con somnolencia y mareo (6%) 3 de ellos con interrupción del tratamiento. En cuanto a las náuseas y/o vómitos: 18 pacientes necesitaron rescate antiemético, y en 3, hubo que suspender el tratamiento. El grado de satisfacción del paciente fue: muy satisfactorio en 56 pacientes (47,5%); satisfactorio en 46 (39%), deficiente en 10 (8,5%) y suspendido el tratamiento en 6 (5%) por efectos secundarios. Conclusiones. La posibilidad de utilizar parecoxib sólo o unido a otros fármacos en perfusión continua IV para el tratamiento del dolor agudo postoperatorio, es una opción a considerar

Objective. To evaluate the stability of parecoxib in a portable elastomeric pump system for IV infusion in dilution with opioids (morphine chloride, pethidine or tramadol), antiemetics and saline solution during 24 hours in the postoperative period; as well as to verify the analgesic result, the incidence of side effects and the degree of satisfaction in patients undergoing major surgery that were eligible for treatment with these drugs. Material and Methods. The infuser pump is a light disposable device with an elastomeric deposit to administer the medication. Several tests combining parecoxib, opioids, antiemetics and saline solution were carried out and its stability was demonstrated during 24 hours. The mixture was then observed in several occasions and was shown that the dilution always remained stable, clear, with no particles and transparent; therefore it was decided to use that combination in the IV infuser for the treatment of postoperative pain, always under the anaesthesiologist supervision. A total of 118 patients were studied, 46 women (39%) and 72 men studied (61%), ASA I-IV, mean age 59.75 +/- 14.25 (18-89); 92 (78%) underwent general surgery procedures and 26 (22%) urologic ones. The filling of infuser according to ASA, age and type of surgery of the patient, was made with: parecoxib 80 mg + metoclopramide CL H 20 or 30 mg + saline solution for the 118 patients, morphine chloride was added in 65 patients, petidine in 30 and tramadol in 23, during 24 hours after surgery. Pain was assessed using a VAS in both at arrival in the PACU and 24 hours after the surgical procedures. Analgesic outcome, side effects and degree of satisfaction were recorded. Results The analgesic outcome was very good in 60 patients (50.85%); good in 40 (33.90%); regular in 12 (10.17%) and the treatment was interrupted 6 (5%) due to side effects. Side effects were present in 30 (25%) cases: 4 with perspiration (3%), 1 with disorientation (0.8%) and 7 with somnolence and dizziness (6%) 3 of them with interruption of the treatment. For nausea and vomiting, 18 patients needed antiemetics rescue, and in 3 cases it was necessary to suspend the treatment. The degree of satisfaction reported by patients was: very satisfactory in 56 patients (47.5%); satisfactory in 46 (39%), inadequate in 10 (8.5%) and the treatment was suspended in 6 (5%) due to side effects. Conclusions. The possibility of using parecoxib alone or in combination with other drugs in continuous IV perfusion for acute postoperative pain is an important option to be considered

Hiponatremia sintomática secundaria a tratamientos con oxcarbacepina / Symptomatic hyponatremia after the use of oxcarbazepine

La oxcarbacepina es un análogo de la carbamacepina utilizada para el tratamiento de la epilepsia y el dolor neuropático. Su espectro de efectos secundarios es sensiblemente inferior a la carbamacepina. Sin embargo, tiene una capacidad mayor de producir hiponatremia. Generalmente esta hiponatremia, que es dosis-dependiente, es asintomática cuando aparece y está favorecida por otras circunstancias concomitantes que pueden disminuir los niveles de sodio, como ocurre con la toma de ciertos fármacos (diuréticos). En raras ocasiones esta hiponatremia inducida por oxcarbacepina puede provocar síntomas que potencialmente pueden llevar al paciente a estados de encefalopatía si no se detectan a tiempo. Presentamos el caso de una paciente con hiponatremia provocada por la asociación de oxcarbacepina e hidroclorotiazida. En este caso se pudo constatar por las circustancias que se dieron que la disminución de los niveles de sodio era debida al efecto de los dos fármacos en conjunto y no por separado (AU)

Oxcarbazepine is a ketoanalogue of carbamazepine used for the treatment of epilepsy and neuropatic pain. However, oxcarbazepine is more likely to cause hyponatremia. Generally, hyponatremia is dose-dependant and asymptomatic, and is favoured by circumstances that cause a decrease in sodium levels, as the use of certain drugs (diuretics). If undetected, hyponatremia might occasionally cause severe symptoms leading to encephalopathy. A case of a patient with hyponatremia caused by the association of oxcarbazepine and hidroclorotiazide is reported. In this instance, the decrease of sodium levels was due to the association both drugs and not to the effect of each one separatedly (AU)

Cefalea cervicogénica. Tratamiento con estimulación eléctrica subcutánea periférica C1-C2-C3 / Cervicogenic headache. Treatment with peripheral C1-C2-C3 subcutaneous electrostimulation

Introducción: Presentamos siete pacientes con dolor cervicogénico (C1-C2-C3) de larga evolución, persitente, severo, no controlado, de diferentes etiologías, en los que se habían agotado otras posibilidades terapéuticas, tratados con una técnica de estimulación eléctrica extraespinal periférica occipital (C1-C2-C3), mediante implante quirúrgico de electrodo cérvico-occipital uni- o bilateral. Material y método: Se trata de siete pacientes, mujeres, edad media de 50,5 años, con los siguientes diagnósticos: en 3 pacientes cefalea cervicogénica (migraña transformada); otros dos casos se tratan de un síndrome de dolor regional complejo, uno localizado cervical tipo 2 post-siringomielia C2-D1 + malformación de Arnold Chiari + cirugía y en otro de hemicara/cuello/occipital y EESS izqda. postcirugía de carótida; un caso de neuralgia postherpética C1-C2-C3 izquierda; y otro caso de cefalea cervicogénica secundaria a artrosis. Resultados: En todos los casos se ha obtenido un buen resultado analgésico. En la mayoría de las pacientes ha desaparecido el dolor continuo, ha disminuido el número de crisis y su severidad. Se ha normalizado su actividad física, y tres pacientes se han reincorporado al trabajo. El descanso nocturno que era malo en todas ha pasado a ser normal. En dos pacientes se ha retirado el tratamiento farmacológico y en el resto se ha reducido de forma considerable. El tiempo medio de seguimiento es de 16 meses, el máximo en el primer caso es de 33. Las complicaciones han sido en dos ocasiones migración del electrodo, una ocurrió a los 7 días del implante definitivo y en otra paciente después de un año. Discusión: La neuromodulación mediada por la estimulación eléctrica invasiva ha demostrado su utilidad terapéutica a lo largo de los últimos años, en pacientes con dolor neuropático refractario e intratable. Los avances recientes en neuroestimulación han permitido ampliar sus posibilidades terapéuticas con la colocación de electrodos extraespinales para estimulación de nervios periféricos. Conclusiones: En todos nuestros pacientes la localización del dolor estaba referida, de forma predominante, en una distribución metamérica C1, C2, C3. En todos los casos la estimulación occipital ha proporcionado un resultado global muy bueno o bueno que se mantiene en el tiempo; desaparición del dolor continuo, disminución de la frecuencia y severidad de las crisis, mejoría funcional, descanso nocturno, actividad de la vida diaria y disminución del tratamiento farmacológico (AU)

Introduction: We present seven patients with long-term, persistent, severe and non-controlled cervicogenic pain (C1-C2-C3) of diverse etiologies and refractory to other therapeutic options, that were treated with occipital peripheral extramedullary electrostimulation (C1-C2-C3) through surgical implantation of a uni- or bilateral cervico-occipital electrode. Material and method: Seven female patients with an average age of 50.5 years had the following diagnoses: cervicogenic headache (transformed migraine) in 3 patients; complex regional pain syndrome in 2 patients, one of them being a type 2 with cervical location secondary to syringomyelia C2-D1 + Arnold Chiari malformation + surgery and the other one with hemiface/neck/occipital location and left EESS secondary to carotid surgery; left postherpetic neuralgia at C1-C2-C3 in 1 patient and cervicogenic headache secondary to osteoarthritis in 1 patient. Results: Satisfactory analgesic result was provided in all the cases. In most patients, continuous pain disappeared and the number and severity of crises decreased. Physical activity returned to normal levels and three patients returned to work. Night rest had been poor in all of them, but returned to normal. Drug therapy was discontinued in two patients and significantly reduced in the remainder. Mean follow-up time was 16 months, with a maximum of 33 in the first case. Electrode displacement was a complication in two cases, one after 7 days of the final implant and the other after one year. Discussion: Neuromodulation mediated by invasive electrostimulation has shown its therapeutic use over the past years in patients with refractory and nontratable neuropathic pain. Recent advances in neurostimulation have provided new therapeutic options with the implantation of extramedullary electrodes for the stimulation of peripheral nerves. Conclusions: In all of our patients, pain location showed preferably a metameric distribution C1, C2 and C3. In all cases, occipital stimulation provided a very satisfactory or good result that was maintained over time, with relief of continuous pain, decreased frequency and severity of pain crises, functional improvement of night rest, normalization of daily life activity and reduced need of pharmacological treatment (AU)

[Primary ciliary dyskinesia, presentation of an atypical case]. / Discinesia ciliar primaria, a propósito de un caso atípico.

Primay ciliary dyskinesia is a rare autosomal recessive disorder, characterized by abnormal ciliary structure and function and chronic lung, sinus and middle ear disease. A 45-year-old man with a history of recurrent respiratory infections, which was developped in the adult age, and was presented with moderate clinical involvement, and spermatic hypomotility in seminogram. Diagnosis and differential diagnosis was based on the typical clinical picture and the electron microscopical demonstration of ultrastructural abnormalities. We found abnormal number of cilia on the bronchial mucosa cells and the ciliary structure was abnormal too. We observed abnormally short dynein arms and defective radial spokes.

Discinesia ciliar primaria, a propósito de un caso atípico / Primary ciliary dyskinesia, about an atypical case

La discinesia ciliar primaria es una rara enfermedad autosómica recesiva, caracterizada por anomalías en la estructura y función ciliar, con infecciones recidivantes de pulmón, senos y oído medio. Presentamos un paciente de 45 años con antecedentes de infecciones respiratorias de repetición desarrolladas en su vida adulta, que cursaron con una afectación clínica moderada, e hipomotilidad espermática en el espermiogra ma. El diagnóstico y el diagnóstico diferencial se efectuaron en base a los aspectos clínicos y a los estudios de microscopía electrónica que mostraron un número anormal de cilios en las células de la mucosa bronquial, con ausencia casi total de los brazos de dineína y de los radios que unen los microtúbulos centrales con la periferia (AU)

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Leucemia neutrofílica crónica: el interés del diagnóstico diferencial / Chronic neutrophilic leukemia: the worth of a complete differential diagnosis

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[Cytogenetic study of 93 myelodysplastic syndromes]. / Estudio citogenético en 93 síndromes mielodisplásicos.

BACKGROUND: We describe the cytogenetic results of 93 patients with myelodysplastic syndromes (MDS). The main object of this report is to analyze the prognostic value of the karyotype in patients with MDS, in relation to the evolution to acute leukemia and the survival time. PATIENTS AND METHODS: Cytogenetic studies were performed in 93 untreated cases of MDS between 1985 and 1994. Overall survival and the evolution to acute leukemia were analyzed. RESULTS: Among 93 patients who were examined at the time of diagnosis, 40 had an abnormal karyotype (43%). The highest frequency of chromosome abnormalities was observed in refractory anaemia with excess of blasts (RAEB) (65.7%) and RAEB in transformation (RAEB-t) (40%) and the lowest in refractory anaemia with ringed sideroblasts (RARS) (10%). The chromosomes most frequently involved were: 5, 7, 8, 11, 12 and 17. No relationship was found between FAB subtypes and the type of chromosomal abnormalities. In respect to the prognosis, an abnormal karyotype, and a complex karyotype were related with a higher frequency of evolution to acute leukemia. A model based on karyotype could divide patients in two groups: poor prognosis (patients with an abnormal karyotype, with involvement of chromosome 7, trisomy 8 or with a complex karyotype), and a good prognosis (patients with normal karyotype). CONCLUSIONS: The cytogenetic studies are very useful in the study of MDS for their clinical implications.

[Treatment of Hodgkin's disease with bulky mediastinal involvement. Study of 28 cases]. / Tratamiento de la enfermedad de Hodgkin con afección mediastínica voluminosa. Estudio de 28 casos.

BACKGROUND: Bulky mediastinal involvement in Hodgkin disease (HD) is usually considered an adverse prognostic factor. Patients treated with radiotherapy alone (RT) or chemotherapy alone (CT) have a high relapse rate. The combined chemotherapy plus radiotherapy is the therapy of choice. The objective of the present study was to report our results and complications in the treatment of 28 patients with HD with bulky mediastinal involvement. MATERIALS AND METHODS: A retrospective analysis was made of a series of 28 patients with bulky mediastinal disease treated in our hospital from 1973-1993, with RT, CT or combined therapy. The overall survival rate and free of disease, the presence of residual mass, as well as therapy toxicity were studied. RESULTS: The overall remission rate was 85.7%. The overall survival rates and free of disease were 76% and 78% at 19 years. Five patients died due to progression of disease, and one due to pulmonary toxicity. Neither heart disease nor secondary neoplasms were documented. CONCLUSION: Our results, in agreement with those reported in literature, support the combined therapy, chemotherapy plus radiotherapy, as the therapy of choice for patients with HD and bulky mediastinal involvement.

Membranous glomerulonephritis in rheumatoid arthritis unrelated to gold, D-penicillamine or other connective tissue disease.

We report a 58-year-old woman with classical rheumatoid arthritis (RA) who developed a membranous glomerulonephritis (MGN). She had never been treated with gold or D-penicillamine; other connective tissue diseases as well as hepatitis B were excluded. We suggest that the responsible cause of MGN is RA.

Cytogenetic abnormalities in 13 patients with multiple myeloma.

Cytogenetic analysis was successfully performed in 45 consecutive multiple myeloma (MM) patients. Cytogenetic abnormalities were observed in 13 of 45 patients (29%). Eleven patients showed numerical changes and 9 showed structural abnormalities in chromosomes 5, 9, 11, 14, 15, and 19 were most frequently gained. Structural abnormalities preferentially involved chromosomes 6, 13, and 14.