[Infectious osteoarthritis due to Propionibacterium acnes. Two new cases]. / Infections ostéoarticulaires à Propionibacterium acnes. Deux nouveaux cas.

INTRODUCTION: Propionibacterium acnes is an anaerobic germ, usually found as a saprophyte of the skin and the mucosa. It may be responsible for iatrogenic or spontaneous osteoarhritis. EXEGESIS: We report two new cases of septic arthritis induced by P. acnes: a case of iatrogenic spondylodiscitis and a case of spontaneous septic arthritis of the lumbar facet joints. The two patients were immunocompetent, without acne. CONCLUSION: Except for patients with criteria of the SAPHO syndrome (synovitis-acne-pustulosis-hyperostosis-osteomyelitis), osteoarthritis caused by P. acnes is increasingly described. The number of these infections is probably underestimated because of the technical problems involved in isolating P. acnes in the laboratory.

[Limitations of the protein profile for diagnostic orientation in initial internal medicine consultation. Prospective study on 76 patients]. / Limites du profil protéique d'orientation diagnostique en consultation initiale de médecine interne. Etude prospective chez 76 malades.

Determination of the protein profile of orientation (PPO) is now considered by some authors as a means of improving the diagnosis in internal medicine. The feasibility of systematizing this practice was investigated in 76 outpatients (79 included, three excluded secondarily) seen for pathology of undetermined diagnosis. The 79 patients (mean age: 52 years) underwent the classical biological explorations plus PPO. The physicians were divided into two groups (seniors and assistants). Two complete clinical files were established for each patient, with one difference concerning inflammatory and immunologic data: one file included the minimum number of tests considered necessary by the physician and the other the complete PPO (nine proteins). Each file (with or without PPO) was randomly distributed to one of two physicians in the same group. Each physician filled in a diagnostic evaluation sheet indicating whether there was organic pathology or not, the main diagnosis (inflammatory, neoplastic, infectious or other), the secondary diagnosis and the hypothesis of probability. The relevance of the clinical opinion was analyzed by an internal medicine specialist from outside the department with 40 years of clinical experience. The duration of symptoms before the medical visit was from 3 weeks to 5 years (mean 6 months). A diagnosis of organic pathology was reached for three out of four patients. Sixty-seven patients were seen again after a minimum of 6 months, and nine were lost to follow-up. Diagnostic efficiency was no greater for cases with PPO, which appears to be a biological examination of second intention. We suggest that the term "protein profile of orientation" be replaced by "broad protein profile."

[Bilateral traumatic rupture of the renal arteries. Emergency repair. Long-term course]. / Rupture traumatique bilatérale des artères rénales. Réparation en urgence. Evolution à long terme.

The authors present the case of a patient undergoing late surgery following bilateral trauma of the renal hilum. Despite revascularization and a certain urine output the patient remains on hemodialysis. A highly pragmatic study of the literature follows the clinical presentation.

[Anterior thoracic and intervertebral erosive joint diseases associated with palmoplantar pustulosis]. / Arthropathies érosives thoraciques antérieures et intervertébrales associées à la pustulose palmoplantaire.

The authors report three cases of palmo-plantar pustulosis associated with articular signs: erosive arthritis of the right first sternocostal joint in 2 cases (without hypertrophy of the clavicle or the sternum) and atlanto-occipital arthropathy with marked neck stiffness in another case. The HLA phenotype of one case was: A2 - A9 - B14 - X - DR3 - DR4. A surgical sterno-costal biopsy revealed non-specific inflammatory lesions in 2 cases. In one of these cases, a Corynebacterium sp. was isolated. The clinical course was favourable in response to local antibiotic therapy in one case (follow-up of 8 years) and after treatment with non-steroidal anti-inflammatory agents in 2 cases (follow-up of one to two years). The skin biopsy revealed non-spongiform (and therefore non-psoriatic) unilocular pustulosis, distinguishing this non-bacterial pustulosis from pustular palmo-plantar psoriasis with which it is frequently confused. These cases are similar to the cases of "pustulotic arthro-osteitis" reported by Japanese authors (Sonozaki et al.), which appear to be rare in Europe. They seem to be an early form in a vast range of spondylo-arthropathies including rheumatism and acne conglobata. The aetio-pathogenesis of this syndrome is discussed; one of the cases is strongly suggestive of an infectious origin (Corynebacterium). These lesions do not appear to be a form of reactive arthritis, as the presence of HLA B27 is rare in both the European and the Japanese cases.

[Study of blood T-lymphocyte subpopulations in ankylosing spondylarthritis using monoclonal antibodies]. / Etude des sous-populations lymphocytaires T du sang dans la spondylarthrite ankylosante a l'aide des anticorps monoclonaux.

Blood T lymphocyte subpopulations were studied by using various monoclonal antibodies in 20 patients with ankylosing spondylitis (AS) and in 20 age and sex matched controls. A significant decrease in OKT4 (p less than 0.04) and OKT8 (p less than 0.02) lymphocytes was demonstrated in AS patients. OKT4 cells were significantly decreased (p less than 0.02) in patients with a severe ankylosis and in those with the longest disease duration. This decrease was not explained by older ages. Thus there was an negative correlation between OKT4 cell ratio and disease duration. No modification in T cell subpopulations was noted when considering HLA B27 positivity or disease activity.

[Serological profile in so-called seronegative rheumatoid arthritis]. / Profil sérologique des polyarthrites rhumatoïdes dites séronégatives.

89 cases of sero-negative rheumatoid arthritis (RA) were compared to 127 cases of sero-positive RA. Anti-perinuclear and anti-keratin antibodies were detected less frequently in the first group (51 vs 67% and 28 vs 33%, respectively), while the inverse was found for anti-nuclear antibodies (28 vs 24%). "Light" rheumatoid factors (RF)--IgG, IgM, IgE, IgA and IgD--were detected in 23.6, 21.3, 17.5, 11.3 and 0 per cent of cases of sero-negative R.A. The evolutive state of these cases was less severe. RF agglutinins were detected in 5 out of 12 samples of synovial fluid tested in cases of sero-negative RA.

Salmonella-infected subdural haematoma.

Post-traumatic chronic subdural haematoma infected by Salmonella sandiego is reported in a 55-year-old alcoholic man. Treatment involved a four-weeks' course of chloramphenicol and also subdural drainage. The patient ultimately recovered. Only four such cases have been reported in the literature. The mode of infection of the subdural haematoma is presumed to have been haematogenous in the absence of an otorhinological focus, meningitis or previous neurosurgery.

[Rheumatic manifestations in the presence of antibodies to Yersinia pseudotuberculosis. Apropos of 4 cases]. / Manifestations rhumatismales avec preésence d'anticorps anti-Yersinia pseudotuberculosis. A propos de quatre observations.

Rheumatic manifestations due to Yersinia pseudotuberculosis are apparently rare. We report four personal observations, including one of a patient with Reiter disease and significant titres of antibodies to Yersinia pseudotuberculosis. In all four patients a non-specific syndrome, with fever and digestive symptoms, preceded the onset of joint disease. Both peripheral and axial joints were affected. One patient had HLA B27; the brother of another patient had spondyloarthropathy with HLA B27. Stool cultures were negative but they were all done at least three months after the acute episode. These rheumatic manifestations have many features in common with those described in Yersinia enterocolitica infections. Studies of larger series could improve our knowledge of the part played by the patients' constitution and widen the scope of reactive arthritis.

[Spontaneous peritonitis in a cirrhotic patient (author's transl)]. / Péritonite spontanée du cirrhotique.

A case of spontaneous peritonitis in a cirrhotic patient is reported. Because of marked peritoneal and hemodynamic signs, exploratory laparotomy was decided on. Such cases of spontaneous peritonitis, which mimick surgical affections, are very uncommon. Onset is usually insidious with increasing hepatic fluid as the only sign. Bacteriologic examination of the peritoneal fluid is often negative. Diagnosis should be considered if cytology shows more than 75 polynuclear leukocytes per mm. When bacteriology is negative, association of an aminoside with penicillin G and metronidazole seems to be the most satisfactory combination.