Non-secretory multiple myeloma with multinucleated giant plasma cells.

We report a case of non-secretory multiple myeloma with unusual cytological features. The plasma cells were multinucleated and contained up to forty nuclei. All nuclei had regular outlines without multilobulated and convoluted slopes. DNA content measurement demonstrated that all nuclei of uni- and multinucleated cells were diploid. All plasma cells contained cytoplasmic alpha chain but light chains and their corresponding transcripts were absent. There is no clear explanation concerning multinuclearity. In addition, hypotheses regarding non-secretion of immunoglobulin in non-secretory multiple myeloma and in other B-cell neoplasias are discussed.

Treatment of multiple myeloma with etidronate: results of a multicentre double-blind study. Groupe d'Etudes et de Recherches sur le Myélome (GERM).

OBJECTIVES: Because osteoclastic bone resorption is stimulated in multiple myeloma, we evaluated the efficacy of etidronate in this disease, in a multicentre controlled study. METHODS: Ninety-four previously untreated patients with stage II or III multiple myeloma received, in addition to the same chemotherapy, 10 mg/kg/day etidronate per os (n = 49) or placebo (n = 45) for 4 months. The evaluation was clinical (pain, Karnofsky, survival), biological and radiological. Forty-one patients had iliac bone biopsy before the treatment and 34 patients also at the end of the study. Histologic bone parameters were compared with 49 normal controls. RESULTS: No statistical difference was found between etidronate and placebo treated patients for clinical, biological and radiological parameters. Compared with controls, pretreatment biopsies showed markedly increased bone resorption and decreased trabecular bone volume. Bone resorption decreased significantly in patients with etidronate compared with those with placebo (p < 0.05). CONCLUSION: Though we found no clinical, biological and radiological difference with placebo, etidronate inhibited the increased bone resorption in multiple myeloma.

[Importance of the study of the cytology and proteins of the spinal fluid in lumbago]. / Intérêt de l'étude de la cytorachie et de la protéinorachie dans les lombalgies.

In the cerebrospinal fluid (C.S.F.) of hundred patients suffering from lumbago we have studied the existence of cytobiochemical and cytoradiological correlations in order to confirm the demonstration of cytologic and biochemical signs of organicisty or seriousness of this frequent pathology. We have realized cytorachia, that is to say differential cells counts and formulas on C.S.F. samples after cytocentrifugation and staining associated with biochemical determinations. Cytologically 96% of C.S.F. samples had normal count but 67% of them had a disturbed formula often associated with hyperproteinorachia. We have found lymphocytes and histiomonocytes the normal cells of C.S.F. but also neutrophilic, eosinophilic and basophilic polymorphonuclears and above all leptomeningeal cells. A disturbed cytorachia is often related with a pathological radiological picture (68% of cases). A cytologic anomaly with hyperproteinorachia in the same C.S.F. sample seems to be a sign of seriousness and to reveal a resistance to medical treatment. A technical presentation of cytorachia and an attempt of physiopathological explanation of observed cytologic abnormalities are proposed.

Current aspects of osteoarticular pathology in patients undergoing hemodialysis: study of 80 patients. Part 1. Clinical and radiological analysis.

Eighty patients undergoing longterm hemodialysis were evaluated for joint function and radiographic abnormalities. Mean age of the population was 53 years, and mean duration of dialysis was 76 months (24 patients underwent dialysis for more than 10 years). Fifty-eight patients (72%) had joint symptoms; nonspecific arthralgia was the most frequent. Fifteen patients had morning stiffness and interrupted sleep due to arthralgias (shoulders 9, fingers 3) and 10 patients had diminished finger mobility. Radiographic evaluation showed 7 classes of lesions which are not characteristic of renal osteodystrophy or degenerative lesions, including erosive arthropathies of the fingers (8%), multiple carpal bone cysts (10%), cysts of the humeral head (9%), cysts of the hip (11%), erosive spondyloarthropathies (9%), cervical spondylolisthesis (5%) and multiple diaphyseal lacunae (1%). Overall, 42 distinct radiological lesions were observed in a total population of 23 patients. Twenty-nine of these lesions occurred in patients undergoing dialysis for at least 10 years. Certain clinical and radiological patterns were frequently combined after dialysis for more than 10 years: carpal tunnel syndrome, inflammatory joint pain, bone cysts and spondyloarthropathies.

[Acute systemic lupus erythematosus after thymectomy for myasthenia. Sequential study of lymphocyte subpopulations]. / Lupus érythémateux aigu disséminé survenu après thymectomie pour myasthénie. Etude séquentielle des sous-populations lymphocytaires.

A 35 year-old woman developed severe systemic lupus erythematosus 9 years after thymectomy for myasthenia gravis. "Seric Thymic Factor" (STF) was low; T helpers subset, T helpers/T suppressors ratio and to a lesser extent T suppressors subset were decreased. Suppressor cell function investigated by Concanavaline A lymphocyte reactivity was low. Under cyclophosphamide, plasmapheresis and steroids all clinical and biological symptoms improved but STF remained low; T helpers, T suppressors subsets and T helpers/T suppressors ratio increased but did not reach the normal range. Statistical and immunological arguments suggest that the association between systemic lupus erythematosus and myasthenia gravis did not occur only by chance. Moreover, thymectomy might have played a role by decreasing the number and function of some subpopulations of lymphocytes.

[Erosive disk diseases of chronic hemodialysis patients. 3 cases of cervical localization]. / Les discopathies érosives des hémodialysés chroniques. Trois cas de localisation cervicale.

The authors report three new cases of erosive disk disease in chronically hemodialysed patients. The cases included one man and two women, who were diagnosed, on the basis of cervical or shoulder pain, as having spinal injuries involving pinched disks, punched-out lesions and incipient condensation. Discal puncture was carried out in only one patient, and proved futile. All three patients were followed-up for periods of at least one year. These three cases raise the problem of erosive disk disease in long-term dialysis patients; several other cases have been reported recently. The etiology remains obscure, but the part played by amylosis, by apatite microcrystals and by the duration of dialysis treatment are all discussed. It would appear that a novel disease entity is indeed involved, one for which, although several etiologic factors can be suggested, it has not been possible to definitely identify any single cause as the exclusive origin of the lesions detected.

[A new case of rheumatoid nodulitis]. / A propos d'un nouveau cas de nodulite rhumatoïde.

A new case of rhumatoid nodulitis is reported in à 28 year old man presenting with rapidly regressive arthralgia, numerous rhumatoid nodules and metatarsal lesions without signs of associated arthritis. The biochemical profile was non-specific; serology was weakly positive for rhumatoid factor; there was no obvious immunological disorder (no circulating immune complexes, total complement and its various fractions within normal limits). The clinical findings, treatment and classification of this condition are discussed with reference to six other published cases with a similar clinical and paraclinical features.

[Treatment of algodystrophies]. / Traitement des algodystrophies.

The first part of the article is a general review of the various drug treatments available for algodystrophy : purely symptomatic, analgesic treatment, vaso-active drugs, calcitonin. The major advance over the last few years has been the use of beta-blockers and calcitonin but, to date, only one double blind trial has been published. This study demonstrated the value of calcitonin after one month of treatment. The authors undertook a retrospective study of 651 cases and a prospective study of 91 cases and based their work on the evaluation of various treatments prescribed separately examining each therapeutic sequence rather than each individual case. Three treatments stood out by their frequent use : griseofulvin, calcitonin and beta-blockers. Each of these drugs was effective in more than 60 p. cent of cases. It is impossible, in such a study, to formulate a hierarchy of the various treatments. Only controlled studies will be able to establish their order of effectiveness. The results vary somewhat according to the site of the algodystrophy. The best therapeutic response is obtained in lesions involving the hip leading to a very favourable prognosis.