[Long-term survival and prognostic factors in stage II-III multiple myeloma treated with conventional chemotherapy]. / Survie à long terme et facteurs pronostiques du myélome multiple stade II-III traité par chimiothérapie conventionnelle.

In this retrospective study, survival and prognostic factors were analysed in 65 patients with stage II-III multiple myeloma with osteolytic lesions. Multiple myeloma was diagnosed from 1976 to 1984, and patients were treated with conventional chemotherapy. The response rate to initial chemotherapy was 46%. The median survival time was 31 months. The 10-year survival rate was 10%. Four variables were individually prognostic: response to initial chemotherapy, bone marrow plasma cell percentage, the Durie and Salmon staging system, a biological staging system derived from Durie and Salmon's biological criteria regardless of bone lesions. In the multivariate analysis, only two prognostic variables were retained, namely the response to chemotherapy and the biological staging system. No prognostic value was observed for the extent of osteolytic lesions. This study suggests that, in conventionally treated multiple myeloma, long-term survival has improved compared with the previous decade. It also indicates that the extent of osteolytic lesions has little value for the definition of high-risk myeloma.

[Polyneuropathy and solitary bone plasmacytoma. A new case]. / Polyneuropathie et plasmocytome solitaire osseux. Une nouvelle observation.

The authors report a case of acute polyneuropathy revealing a solitary osseous plasmacytoma with osteo-dense and osteolytic bone lesions. Initially, the rapid progression of the sensory and motor loss led to treatment by plasma exchanges and irradiation of the plasmacytoma. Four months later, despite a significant improvement of the neurological condition, serum protein electrophoresis continued to show a peak of monoclonal immunoglobulin. Chemotherapy with cyclophosphamide and prednisone was administered for one year whilst the neuropathy continued to regress. This case, which presents many classical features of plasma cell dyscrasia (polyneuropathy with albumino-cytological dissociation, radiological osseous condensation, low concentrations of lambda light chain protein), illustrates some unusual features of solitary plasmacytomas associated with peripheral neuropathy: the young age of our patient, an acute progression of the neuropathy in the early stages, tumoral localisation in the diaphysis of a long bone.

[Twenty-three cases of gonococcal arthritis (author's transl)]. / Vingt-trois cas d'arthrites gonococciques.

Twenty-three cases of gonococcal arthritis involving 10 men and 13 women aged from 18-81 years (mean, 32 years) are reported. Seven of the men had developed urethritis 3 to 21 days previously. Seven of the women had no signs or symptoms of genital infection. Twelve patients presented with polyarticular lesions and 7 with monoarticular lesions heralded by migratory arthralgias. The joints most commonly affected were the knees, fingers, wrists and ankles. Ten patients had tenosynovitis of the flexor muscles of fingers, and 10 exhibited a skin rash suggestive of the condition. Haemocultures were positive for N.gonorrhoeae in 4 out of 12 patients. The organism was isolated from synovial fluid in 7/11 cases and from urethral and vaginal secretions in 9/20 cases. All patients were cured rapidly and without sequelae with penicillin or ampicillin.

Peripheral neuropathy and plasma cell neoplasias: a report of 10 cases.

Ten patients with peripheral polyneuropathy associated with plasma cell neoplasias are reported. Progressive sensorimotor polyneuropathy was the presenting complaint in all patients. CSF protein concentration was elevated in most patients. The electrophysiological and pathological changes were consistent with a primary segmentary demyelinating disease. All patients were male and younger than the average patient with myeloma. None presented with high tumour mass or overt multiple myeloma. Six were affected with single or multiple plasmacytomas with osteolytic lesions. Unusual haematological features such as polycythaemia, thrombocytosis and lymphadenopathy were often combined with the polyneuropathy. Skin hyperpigmentation, gynaecomastia and diabetes mellitus were noted in some patients. Complete recovery of the polyneuropathy was observed in some patients after either cyclophosphamide and corticosteroid therapy or radiotherapy of localized plasmacytoma, suggesting a direct relationship between the plasmacytic proliferation and the neuropathy. The nature of the postulated factor produced by the plasma cells and responsible for nerve injury is discussed and the importance of a careful search for plasma cell proliferation in men with obscure polyneuropathies is outlined.

[Gonococcal arthritis]. / Arthrites gonococciques.

Gonococcal arthritis, a rare complication of gonorrhoea, more frequent in women, causes polyarthritis in 75% of cases or monoarthritis. An erythematous skin rash or acute pustular rash (40%), recent signs of genital infection (75% of cases in man, less than 50% in women) suggest the diagnosis. The gonococcal nature of the arthritis is confirmed by isolation of the germ in the joint fluid, the blood and the skin biopsies. In about half the cases, these bacteriological investigations are negative, but the diagnosis remains very probable if the germ is isolated from one or other of the primary foci of the infection: ureter, cervix, vagina, rectum and even pharynx. The rapidly favourable course under antibiotic treatment with penicillin or ampicillin confirms the diagnosis. The pathogenesis of arthritis is a direct toxic action of the gonococcus on the synovial membrane and the periarticular structures. The role of circulating immune complexes recently demonstrated in gonococcemia is probably not relevant.

[Polyradiculoneuritis associated with plasmocytoma. Recovery following radiotherapy (author's transl)]. / Polyradiculonévrite au cours d'un plasmocytome: guérison après radiothérapie.

A new case of extensive subacute polyradiculoneuritis associated with a costal plasmocytoma secreting IgG lambda is reported. Radiotherapy of the rib, resulted in remarkable neurological improvement and haematological cure, which have now persisted for more than 5 years, though treatment was discontinued 3 years ago. By its distinctive haematological features, this case illustrates the lack of clear-cut distinction between "solitary" plasmocytoma and multiple myeloma. It also emphasizes the need for systematic testing for plasma cell proliferation when confronted with a subacute or chronic neuropathy of obscure origin.

[Vascular and obstetrical prognosis after hypertension during pregnancy: value of renal biopsy (author's transl)]. / Pronostic vasculaire et obstétrical après un accident vasculo-rénal de la grossesse. Apport et limites de la biopsie rénale.

Renal biopsy was performed in 125 patients with severe hypertension during pregnancy. Three groups could be defined: I: normal kidney; II: vascular lesions; III: nephropathy. The histological appearance could not be suspected from clinical criteria (age, parity, symptoms, date of appearance). About 70% of the patients in groups I and II had permanent metabolic disorders (mainly hypercholesterolemia) and had a familial history of hypertension. Recurrence of hypertension during subsequent pregnancies occurred in 70% of cases, identical in groups I and II, and therefore impossible to predict by histological findings. Permanent hypertension developed in 47% of group II patients and 8% of group I (p < 0.001). The authors conclude that hypertension during pregnancy affects a sub-population genetically selected and that renal biopsy is of little value for predicting the prognosis in future pregnancies. The indications for renal biopsy are discussed.

[Diagnostic value of synovial membrane immunofluorescence]. / Valeur diagnostique de l'immunofluorescence de la membrane synoviale.

The immunofluorescent study of 93 synovial membranes of persons suffering from various types of arthropathy has shown that the only element sufficiently specific to have real diagnostic value is the presence of cells with a fluorescent cytoplasm. This appearance was in fact found in 63% of the cases of rheumatoid arthritis, irrespective of their being either seropositive or seronegative, in 69% of the cases of probable rheumatoid arthritis, in only 15% of the unclassified cases of arthritis, in 28% of the cases of various types of arthritis (20% with exclusion of a case of mixed connectivitis and of a case of Waldenström's macroglobulinemia with rheumatoid arthritis) and in 0% of the cases of mechanical arthropathy. The results of immunofluorescent examination compare favorably with those of standard histology: the classical histologic appearance of rheumatoid synovitis with a node-forming tendency of the infiltrate was observed in only 36% of the verified cases of rheumatoid arthritis, while immunofluorescence was positive in 63% of the cases in this group. In the category of unclassified arthritis, these percentages were comparable, viz. 19% and 20%, repectively. The presence of cells with fluorescent cytoplasm during immunofluorescent examination of the synovial membrane may be regarded as an additional criterion supporting the diagnosis of rheumatoid arthritis.