A muscle mass in a patient with polymyalgia rheumatica.

We report the extremely uncommon case of a 77-year-old woman in whom a tumor found to be a melanotic schwannoma, arising from the right rectus abdominis muscle, was detected during investigation for a rheumatic disorder, finally identified as polymyalgia rheumatica (PMR). Tumors of this type most commonly occur in spinal nerve roots, and their clinical behavior is very difficult to predict. As far as we are aware, this is the first reported case affecting the aforementioned site. The challenging issue in this case concerns the possible link between the 2 clinical conditions, in particular the development of PMR as a paraneoplastic syndrome. Although such an association has not been reported, PMR is included among the rheumatic disorders reported to be associated with malignancies and occasionally with benign tumors. However, given that tumor resection did not result in remission of PMR and symptoms improved rapidly with prednisone, it seems likely that the above disorders might simply coexist.

Pain relief from nasal salmon calcitonin in osteoporotic vertebral crush fractures. A double blind, placebo-controlled clinical study.

We examined the analgesic effect of nasal salmon calcitonin in patients with acute pain due to recent, nontraumatic osteoporotic vertebral crush fractures. 32 men and 68 postmenopausal women were studied using a prospective, double-blind, placebo-controlled clinical design. Men and women taking 200 IU of nasal salmon calcitonin daily for a period of 28 days had a dramatic decrease of spinal pain. This analgesic effect was accompanied by early mobilization and gradual restoration of the locomotor functions, such as sitting, standing and walking. Patients receiving the placebo nasal spray remained in bed for almost the entire period of observation. The consumption of high doses of paracetamol did not help placebo patients to get out of bed during the 4 weeks of hospitalization. Nasal salmon calcitonin and early mobilization also reduced hydroxyproline excretion, thus preventing massive bone loss during the period of bedrest.

Relapsing Wegener's granulomatosis: successful treatment with cyclosporin-A.

We describe the case of a 32-year-old splenectomised man with severe Wegener's granulomatosis which was refractory to conventional treatment with oral cyclophosphamide and prednisolone. Remission was temporarily induced only with plasma exchange or i.v. immunoglobulin. Because of frequent relapses of the disease and cyclophosphamide side effects, he was started on treatment with cyclosporin-A and a long lasting remission was achieved.

Type 1 cryoglobulinaemia associated with a thymic tumour: successful treatment with plasma exchange.

Thymic tumours are associated with a wide range of autoimmune and haematological disorders, notably myasthenia gravis, red cell aplasia, and systemic lupus erythematosus. An association with cryoglobulinaemia has only once been reported previously. In this report we describe a 60-yr-old male patient with a spindle cell thymoma, treated surgically, who also had type 1 cryoglobulinaemia, with severe peripheral circulatory impairment with digital ulceration and a mononeutitis multiplex. The patient has been successfully treated with prednisolone, immunosuppression and plasma exchange.

Change in the epidemiology of Reiter's syndrome (reactive arthritis) in the post-AIDS era? An analysis of cases appearing in the Greek Army.

OBJECTIVE: During the last 5 years we observed a significant decrease in the incidence of newly established cases of Reiter's syndrome (reactive arthritis) in Greek Army personnel. Our study was initiated to validate this observation and to evaluate a possible change in the prevalence of Reiter's syndrome (RS) associated infections. METHODS: The case records of patients with reactive arthritis (ReA) admitted during the periods 1980-83 and 1989-92 at a large Army Hospital were studied retrospectively and the cases of RS were reviewed. In addition, the prevalence of cases with urethritis and dysentery that presented to the hospital in the same periods was studied in retrospect, as these infections are known to participate in the etiopathogenesis of RS. RESULTS: A significant decrease in the overall incidence of the randomly presented RS cases during the second 4 year period was detected (27 versus 4 cases, p < 0.0001, chi 2 test). A similar significant decrease in the number of cases with gonococcal and nongonococcal urethritis was observed while the prevalence of dysentery was not significantly altered during the defined intervals. CONCLUSION: We suggest that the anti-AIDS campaign which began after the years 1984-85 is the principal cause of the observed change of epidemiology of RS cases appearing in the Greek Army.

Tumor induced osteomalacia.

We describe a case of mesenchymal tumor induced osteomalacia. Our patient presented a typical clinical and radiological picture of osteomalacia, with low serum phosphate. With the excision of the tumor, which was located in the right forearm, the serum phosphate concentrations increased to normal values within a week postoperatively and the symptoms improved dramatically.

A case of Adamantiadis-Behçet's syndrome presenting as myocardial infarction.

We report a case of a 27-year-old man who presented with an acute myocardial infarction. When he was hospitalized one month later to evaluate this recent event, he developed clinical findings consistent with the diagnosis of Adamantiadis-Behçet's syndrome. We believe that the myocardial infarction was due to coronary arteritis, because there were no risk factors for coronary disease present.