[Apparently isolated plasmacytoma of bone. Clinical and prognostic data. 114 cases and review of literature (author's transl)]. / Plasmocytomes apparemment solitaires des os: aspects cliniques et pronostiques (a propos de 114 cas).

The authors review 114 cases (including 18 personal cases) of apparently isolated plasmacytoma of bone (AIPB) followed-up for periods of a few weeks to 24 years. The number of patients still alive, without recurrence and/or extension to the bone marrow sharply dropped from 77% after 2 years to 15% after 10 years. At the time of diagnosis, AIPB with secondary medullary involvement differed from conventional multiple myeloma of bone on six points: mean age 52,1 versus 63,2 years (p less than 0,001); male prevalence 60,5% vs 38,5% (p less than 0,02); spinal involvement 61,8% vs 88,7% (p less than 0,05); radiological aspect of giant cell tumour 33,3% vs 3% (p less than 0,001); cord involvement 25% vs 5,4% (p less than 0,001); lack of monoclonal component 82,5% vs 4,3% (p less than 0,001). On the other hand, after 10 years there were only three differences between AIPB with and without secondary extension to the bone marrow: mean age 52,1 vs 45,7 years (p less than 0,1); spinal involvement 61,8% vs 26,7% (p less than 0,01); loss of monoclonal component after local treatment 29% vs 100% (p less than 0,05). These data suggest that isolated (i.e. localized) and multiple (i.e. disseminated) myelomas are distinct manifestations of bone marrow malignant plasma cell dyscrasias and that the patient's age, the site of the tumour and the disappearance of the monoclonal component are relevant to the prognosis of the disease.

[Osteoarticular manifestations of brucellosis. Current aspects]. / Manifestations ostéo-articulaires de la brucellose. Aspects actuels.

The authors report 118 cases of brucella osteoarthritis, of which 61 were observed over the last ten years. The most frequent localisations are spinal (53.4%), sacro-iliac (34.5%) and coxofemoral (15.5%). The clinical aspects are not very specific. The general signs, frequent during coxitis and to a lesser degree in spondylodiscitis, are rare during sacro-iliac involvement. The radiological appearance is mainly characteristic in the spine. The diagnosis is usually made in the laboratory, depending on a search for specific antibodies and delayed hypersensitivity tests. Treatment requires the use of intra-tissular and intra-cellular penetrating antibiotics (tetracycline and rifampicin) administered for a long period. The course usually leads to a cure without sequelae.

[Value of successive chemotherapy in multiple myeloma of bone. Prospective study over 4 years]. / Intérêt des chimiothérapies successives dans le myélome multiple des os. Etude prospective sur quatre ans.

In order to study the response of patients with multiple myeloma of the bones (MM) to various anti-cancer drugs (Melphalan M, Cyclophosphamide Cy, Nitrosourea NU, Vincristine V, Adriamycine A and Prednisone P), 70 MM received the following treatment : 1) Induction therapy : a) M and P or b) M and Cy and P ; 2) Levelling with partial or complete response : V Cy P (in case a) or V M Cy P (in case b) ; 3) Relapse : A and NU. The following results were obtained : 1) Only 42.6% of patients respond to induction therapy ; 2) Fewer than 10% of patients showing a response reach a second levelling with Vincristine ; 3) 50% of those not showing a response reach a levelling between --20 and --50 and have prolonged survival ; 4) Only 20% of non responders are improved by Cy P or A and NU. The median actuarial survival is 42 months. Among the responders two poor prognosis factors must be underlined : hypercalcemia and the speed of response.

[Lumbar intraspinal tumors seen in a rheumatological context]. / Tumeurs intrarachidiennes lombaires observées en milieu rhumatologique.

On the basis of a 50 case study, the authors insist on the difficulty of diagnosing lumbar intraspinal tumors seen in a rheumatological context. The increase in pain and spine and spine stiffness at night are the most significant semiological characteristics. A generally slight neurological deficiency is noted in 29 cases (58%) and 21 patients (41%) have a clinical picture identical to that of discal hernias. X-rays of the lumbar spine show signs of bone erosion in 24% of cases. Lumbar puncture furnishes major indications in 85.5% of cases. Contrast testing almost always demonstrates the presence of a tumor. Lumbar intraspinal tumors include a very wide variety of histological types, among which neurinomas, ependymomas and extra-dural malignant tumors are the most frequent.

[Prostatic osteosis. Retrospective study of 110 cases treated with high-dose estrogens]. / L'ostéose prostatique. Etude rétrospective de 110 observations traitées par les oestrogènes a fortes doses.

On the basis of 110 prostatic osteoses that were histologically proven, constantly painful and demonstrated by X-ray, treated by early estrogenotherapy using very high doses, backed up by a high-dose maintenance estrogenotherapy, the authors study the clinical, radiological, histological and biological profile of this metastatic cancer, as well as the response to treatment. The median actuarial survival time of the patients studied is 18.5 months. No statistically significant prognostic correlation was found. Only patients who are clinically estrogen-sensitive, are suffering from bone metastases without a combined visceral conditions, and have a normal initial rate of alcaline phosphates, tend to have a better prognosis (median actuarial survival 31 months versus 18.5 months for the overall population).

[Rheumatoid foot. Practical podiatric problems]. / Le pied rhumatoïde. Problèmes podologiques pratiques.

The rheumatoid foot may obtain relief from practical local measures that prevent the excessive use of drug therapy. These include the decrease in inflammatory phenomena thanks to local injections of corticoids (eventually synoviorthesis), the prevention of deformations through the use of various apparatuses, the protection of the skin of the palms and the nails that are fragile and rapidly altered by local hygiene care. The maintaining of sufficient support and normal walking through the use of plantar prostheses or custommade toe prostheses and by wearing shoes of excellent quality, the maintainance and preservation of articular flexibility and muscular trophicity by adapted kinestherapy and ergo therapy. Major deformations that, while they cannot be modified do not require surgery, can be alleviated with "custom-made shoes" which are at the same time light, adapted and good looking. Whatever the treatment used, local measures are the most effective at any given time.

[Physiopathology of rheumatoid psoriasis]. / Physiopathologie du rhumatisme psoriasique.

The physiopathology of rhumatoid psoriasis (RP) is poorly known. Besides the genetic factors we study immunological disorders from a series of 51 cases. We found mainly an increase of serum IgA, a decrease of IgM, a low level of circulating immune complexes, sometimes IgG type antiglobulin factor (very seldom IgM type, which explains the sero-negativity) seldom antinuclear antibodies; we found also a diminution of T lymphocytes detected by a decrease of E rosette - forming cells and an increase of the lymphocyte subpopulation forming high avidity EA rosettes, whereas the mitogenic response is normal or slightly decreased in the presence of Con A (not significant). A increased frequency of HLA DRW5 and DRW2 was found but too few cases were studied to make possible a definite conclusion. This immunopathologic profile is compared to that of psoriasis with anthropathy. The relevance of immune disorders in the physiopathology of RP is discussed.

[Chemotherapy of multiple bone myeloma. Prognostic features and response criteria (First part) (author's transl)]. / Chimiothérapie du myélome multiple des os. Facteurs pronostiques et critères de réponse (Première partie).

The authors reviewed the recent data about prognostic factors, criteria of response and chemotherapy in multiple myeloma of bone. They insist on the new staging of durie and salmon and on the interest of polychemotherapy.

[Chemotherapy of multiple bone myeloma. Historical and present day aspects. (Second part) (author's transl)]. / Chimiothérapie du myélome multiple des os. Aspects historiques et actuels. (Deuxième partie).

The authors reviewed the recent data about prognostic factors, criteria of response and chemotherapy in multiple myeloma of bone. They insist on the new staging of durie and salmon anf on the interest of poly chemotherapy.

[Immunologic disturbances in psoriatic arthropathy (author's transl)]. / Perturbations immunologiques au cours du rhumatisme psoriasique.

It was observed in 51 cases of psoriatic arthropathy (PA) an increase of blood IgA and a decrease of IgM, a not significant rise of the level of circulating immune complexes, a positive Waaler-Rose reaction in 9.7% of cases and the presence of antigammaglobulin factors (generally of IgG type) in 55,5% of studied patients. Moreover, it was noted a significant decrease of T lymphocytes as detected by E and "active" E rosettes, of EA-gamma rosettes (ox erythrocytes) and an increase of the percentage of high avidity Fc-gamma receptor bearing cells. Lymphocytes responses to mitogens were normal or slightly decreased for Concanavalin A. No correlation was found between the immunological data and the clinical features.

[Suppressor cells of mitogen responses during rheumatoid polyarthritis]. / Cellules suppressives des réponses aux mitogènes au cours de la polyarthrite rhumatoide.

The suppressor activity of mononuclear cells of the peripheral blood (MCPB) during rheumatoid polyarthritis (RP) was studied using experimental protocole. The MCPB stimulated in vitro by concanavaline A (Con A) are capable of suppressing the mitogenis response of autologus cells; moreover, the short-lived spontaneous suppressor cells disappear during 24 hour in vitro incubation that determines an increase in the proliferative response of the incubated cells for 24 hours. In two of the six RP studied, the suppressor activity generated Con A and the spontaneous suppressor activity are nul. Culture experiments with the MCPB of PR and control subjects show that this defect in suppressor activity is more related to a problem in the generation of suppressor cells than to a deficiency in the response to suppressor signals.

[Multiple myeloma of bones. Retrospective study of prognostic factors based on a series of 243 patients]. / Myélome multiple des os. Etude rétrospective des facteurs pronostiques à partir d'une série de 243 malades.

The authors have made a retrospective study of 243 cases of multiple myelomas, most of them treated with alkylating agents. The average age at the time of diagnosis was 65 years (+ 10). The ratio of the sexes was 1 : 1. Seventy two per cent of the patients had a bone rating of 2 or 3 according to the criteria of Durie and Salmon. Fifty-eight per cent of the patients were anemic (Hg 12 g per cent), with less than 15 per cent being leucopenic or thrombopenic. Hypercalcemia (105 mg 0/00) was noted in 27 per cent of cases. The distribution of immunochemical types is as follows : IgG, 51.5 per cent; IgA, 28 per cent; pure Bence Jones, 20.5 per cent. The respective percentages of kappa and lambda light chains were 64.2 per cent and 35.8 per cent. In this series, nearly 80 per cent of the patients were at phase III according to the classification of Durie and Salmon, and 30.8 per cent at phase B. The median survival, including all phases, increased from 8 months without alkylating agent, to 20 months with melphalan and/or cyclophosphamide. The factors influencing the survival of the patients treated were age, the hemoglobin level, calcemia, renal deficiencies, the immunochemical type, the stage of the disease, and the response to alkylating treatment. The value of these different prognostic factors is discussed.