[Bone and joint Actinomyces meyeri infections. Cervicofacial localizations excluded. Apropos of 3 cases]. / Infections osseuses et articulaires à Actinomyces meyeri. Localisations cervico-faciales exclues. A propos de 3 cas.

The authors report three observations of osseous and/or articular actinomycosis. Osseous localizations, always in contact with abscessed foci of the soft tissues, included the spine and one or several limbs. In one case there was an arthritis of the knee. Culture and typing of the responsible germ: Actinomyces meyeri, were obtained from infectious foci in the three cases. The authors insist on the rare occurrence, at the moment, of osteo-articular actinomycoses outside the maxillo-facial area. Actinomyces meyeri has exceptionally been implicated. The prognosis of osteo-arthritis is similar to that of other localizations. It is usually favorable due to the great sensitivity of the germs to antibiotics, especially penicillin.

[Fabry's disease. Rare etiology of a long-term inflammatory syndrome. Apropos of a case]. / La maladie de Fabry. Etiologie rare de syndrome inflammatoire au long cours. A propos d'une observation.

A man aged 54 years presented multiple symptoms (acroparesthesia, familial deafness, cardiomyopathy, diarrhea, adenopathy with infiltration of frothy macrophages, pancytopenia with a dense marrow, chronic meningitis, renal failure) associated with intermittent fever, with feverish attacks and a temperature of 40 degrees C, and with a severe biologic febrile syndrome. Fabry's disease was diagnosed only after 3 years of fruitless explorations. The reasons for this delay are analysed and it is suggested than Fabry's disease be added to the list of conditions responsible for fever or for a persistent inflammatory syndrome.

[A tricuspid electrophoretic pattern: familial bisalbuminemia with monoclonal immunoglobulin]. / Un tracé électrophorétique tricuspide: bisalbuminémie familiale avec immunoglobuline monoclonale.

An association of a familial bisalbuminemia and a benign M component (IgG Kappa) in a healthy woman is described. Any connection between the two abnormalities is unlikely. However this rare association should be known for a better understanding of the striking features of its electrophoretic pattern.

[Behcet's syndrome and ankylosing spondylarthritis]. / Syndrome de Behçet et spondylarthrite ankylosante.

Signs of ankylosing spondylitis were sought in 11 patients suffering from Behcet's syndrome and followed up in different departments of the Clermont-Ferrand teaching hospital group. Three patients, described in detail, had definite ankylosing spondylitis and 2 had phenotype B27. This prevalence would be greater than that predicted on the basis of data in the literature. This combination is rare but it is felt to be legitimate to seek the other disease when one of these two conditions is diagnosed.

[Diagnosis of the Gougerot-Sjögren syndrome in rheumatology. II--Test strategy]. / Diagnostic du syndrome de Gougerot-Sjögren en rhumatologie. II--Stratégie d'examen.

The diagnostic evaluation of the sicca complex in rheumatology depends, on the one hand, upon performing tests and, on the other hand, upon the specific clinical presentations which lead to these tests. The frequency with which the clinical problem is encountered should be taken into account as well as the probability of whether or not the patient does indeed have the sicca complex, and the necessity of making a precise diagnosis. A labial biopsy should be performed when it is necessary to confirm the diagnosis. Schirmer's test is useful to evaluate the ocular component of the sicca complex, which is the only component requiring therapy. In other cases, one examination can follow another in sequence such as salivary nucleotide scanning followed by biopsy and histological examination.

[The diagnosis of Gougerot-Sjorgen syndrome in rheumatology. I. Evaul ation of the principal complementary examinations]. / Diagnostic du syndrome de Gougerot-Sjögren en rhumatologie. I. Evaluation des principaux examens complémentaires.

The examination of a patient with Sjögren's syndrome includes evaluation of the eye, the buccal cavity, and a search for certain factors in the blood. Schirmer's blotting-paper test is a good test but is not specific. In addition, a decreased amount of tearing is difficult to interpret after the age of 45. Slit-lamp examination (rose bengal and fluorescein) yields lesions which confirm keratoconjunctivitis due to decreased tearing. The buccal component is difficult to evaluate. A biopsy of the buccal mucosa gives the best results with minimum risk and expense. Nucleotide scanning is sensitive, but less specific. Salivary flow decreases with age. After 60 years of age this decrease can not be interpreted. The chemical composition of tears or of saliva is promising, but it is not yet a part of the usual diagnostic work-up. Of the available laboratory tests, anti-SS-A antibodies and/ or anti-SS-B antibodies are of value, but they are not found consistently.