[Polyarteritis nodosa with ureteric stenosis. Two cases (author's transl)]

In two cases, surgical exploration fully confirmed that ureteric stenosis was related to PAN. There are four cases of this association in the litterature but it is probable that the frequency of such stenosis is underestimated: amongst 75 patients being treated for PAN in our department, only 11 underwent intravenous urography, 10 being abnormal.

[Value of plasma exchange in necrotizing angeitis. 11 cases]

Plasma exchanges proved useful in a series of 11 patients with necrotizing angeitis resistant to conventional treatment (corticosteroids alone in 6 cases and combined with cyclophosphamide in 5 cases). Among the 9 patients alive after 18 months' follow-up, 5 were in remission without treatment. The only disturbing complication of plasma exchanges was hepatitis B in 3 of the 4 survivors who received frozen fresh plasma as substitute. It is suggested that these immuno-compromized patients should receive diluted albumin instead of fresh frozen plasma.

[Proliferative glomerulopathy in pneumococcal septicemia in a patient with lupus (author's transl)]

Acute glomerulopathy due to pneumococcal infection occurred in a patient with chronic discoid lupus. The onset of renal involvement in this context suggested that cutaneous lupus may have developed into systemic lupus erythematosus. Renal biopsy established the correct diagnosis. The physiopathology of glomerular involvement in lupus and infections is discussed. Attention is drawn to the significance of complement activation, either by the classical or the alternative pathways according to the etiology.

[Thrombophlebitis of the superior sagittal sinus in patient with systemic lupus erythematosus (author's transl)]

The case reported here is the first observation of thrombophlebitis of the superior sagittal and left transverse sinuses in a patient with systemic lupus erythematosus. Thrombophlebitis occurred thirty-six years after onset of SLE. The patient had neither nephrotic syndrome nor serum anti-coagulants. Various hypotheses concerning pathogenesis are suggested. The opportunity for heparin therapy is discussed.

[Cardiac involvement in systemic lupus erythematosus. 103 cases (author's transl)]

One hundred and three cases of systemic lupus erythematosus (SLE) were reviewed after a period of up to 10 years. The pericardium was involved in 27%, the endocardium in 23% and the myocardium in 14.5% of the cases. Arrhythmia was rare and usually accompanied pericardial or myocardial lesions. Conduction disorders were present in 14.5% of the patients. Atrioventricular block often occurred long after the acute phase of SLE, and synthetic antimalarial drugs appear to be responsible for their development. Whether or not SLE affects the heart, the prognosis is the same during the first ten years of the disease.

Effects of captopril on blood pressure, electrolytes, and certain hormones in hypertension

Short-term hypertensive and hormonal effects of captopril were studied in 26 hypertensive patients. Blood pressure (BP) and heart rate were recorded in subjects in the supine position 1 hr before and 3 hr after an oral dose of 1 mg/kg. Urinary, plasma electrolytes, plasma renin activity (PRA), and plasma aldosterone (PA) were determined before and after the test. It was verified, in a preliminary investigation involving 5 patients, that a placebo did not alter the measured parameters. Captopril decreased mean arterial pressure (mean ABP +/- SD) from 128 +/- 2.5 to 108.5 +/- 2.6 mm Hg (p less than 0.001); the maximum decrease was between 30 and 180 min. No changes in heart rate or plasma electrolytes were noted. PRA increased after captopril from 2.29 +/- 0.96 to 3.13 +/- 1.25 and to 4.11 +/- 1.87 at 1 hr and 3 hr (p less than 0.05). There was a correlation between PRA in standing subjects before captopril and decrease in mean ABP (r = 0.59, p less than 0.01). The best correlation was between the decrease in mean ABP and the maximum increase in PRA after captopril (r = 0.69). A good correlation was found between mean ABP and PRA 3 hr after captopril (r = 0.62). Correlation coefficients between decrease in mean ABP and either precaptopril PA or decrease in PA were not significant. In 14 patients, captopril (5.1 +/- 0.61 mg/kg/day) for 4 mo induced the same decrease in mean ABP that was observed during the test. After short- and long-term captopril, mean ABP correlated (r = 0.76, p less than 0.01).

[Efficacy of captopril in periarteritis nodosa with arterial hypertension and renal failure (author's transl)]

In a patient with periarteritis nodosa failure of antihypertensive treatment with beta-blockers and diuretics encouraged the authors to use captopril in doses of 150 mg per day. Blood pressure rapidly returned to normal levels. The hypotensive effect of captopril is ascribable to its action on the renin-angiotensin system, since plasma renin activity was particularly high in this patients.

[Periarteritis nodosa associated with hepatitis B virus. 42 cases (author's transl)]

HBs antigen was detected by immunodiffusion or radioimmune assay in the blood of 19 out of 42 patients with periarteritis nodosa examined between 1970 and 1978. Histological or biochemical signs of hepatitis were present in 6% of HBs--positive patients and 1% of HBs-negative patients. The incidence of clinical symptoms was similar in both groups, except for multiple neuritis, which was much more frequent in HBs-positive patients (89%) than in HBs-negative patients (52%; p less than 0.001), suggesting a close relationship between neuritis and HBs and HBs antigen. There was a negative correlation between myalgias and skin lesions and the presence of the antigen. The prognosis of periarteritis nodosa was similar in both groups. The course of the disease seemed to be more prolonged in HBs-positive patients, but there was no significant difference in mortality rate.

[Cardiac localizations of lymphomas. A case report and review of the literature (author's transl)]

A case of malignant lymphoma with cardiovascular manifestations is reported. It is a febrile form with compression of the aortic ring provoking a murmur simulating aortic valve disease with an Osler's graft. An analysis of the various complications due to lymphomas reported in the published literature emphasizes the iatrogenic nature of some of them: cardiac toxicity of chemotherapy, post-radiotherapy pericarditis, and increased incidence of coronaritis after both cobalt and radiotherapy. The diagnosis of lymphomas in the cardiac area is difficult but should be evoked in case of febrile and chronic cardiopathy, no other etiology being detectable.

[Cardiac manifestations of scleroderma. Prospective study of thirty cases (author's transl)]

A prospective study was conducted to evaluate cardiac effects of scleroderma by means of phonomyography (30 patients) and ultrasound cardiography (18 patients). Clinically silent effusions can be detected by ultrasound cardiography, and 50 p. cent of the patients were found to have pericarditis through this investigative technique. Valvular lesions (mitral prolapsus) were present in a more important number than simply a coincidence. Measurement of myocardial relaxation appears to give the best indication of the specific myocardial lesion in this disease, and even may be of some prognostic value.

[Fatal polyarteritis nodosa following Graves' disease (author's transl)]

Polyarteritis nodosa (PAN), with a fatal outcome, developed during the course of a therapeutically controlled Graves'disease. A review of the published literature confirms that two mechanisms may be involved in the onset of PAN in hyperthyroid patients: an immune response, which is probable in the case reported, or a toxic effect related to the treatment of the hyperthyroidism. This case also emphasizes the therapeutical difficulties encountered, in spite of the corticoid and cyclophosphamide associated treatment with plasmapheresis.

[Ureteral manifestations of collagen diseases (author's transl)]

Ureteral lesions are rarely observed during the course of collagen diseases, and when they do occur, are specific localizations of these disorders. Diagnosis is made by intravenous urography. This usually demonstrates uni- or bi-lateral segmentary stenoses that may be calcified, with the lesions being most frequently present in the lumbar region. In rare cases there is dilatation of the "necklace of pearls" type. The stenosis usually increases in severity, especially when corticotherapy is reduced, and resection of the affected ureteral segments may be necessary.

[Horton's disease. Current problems]

Much that has been written in the last few years concerning temporal arteritis has allowed us to better clarify the clinical picture, and for example frequency of hepatic involvement. The atypical forms of the disease such as those that involves large arteries, or those in which sedimentation rate is normal, are better known. It is in such atypical cases, particularly in a young patient, that an external carotid arteriography is most useful. Though the pathophysiology of the disease is not well understood, serologic and histologic arguments exist in favor of an autoimmune etiology, in which the antigen would be the alestin, found in the internal elastic lamina of the artery. Temporal arteritis is theorically well classified amongst the giant cell granulomatous arterities but there are some atypical forms difficult to distinguish from Takayasu's arteritis or even periarteritis nodosa.

[Nodo-ventricular accessory pathway unmasked by a block in the trunk of the bundle of His]

A case is reported in which, contrary to the unusual finding, conduction was slower in an accessory pathway than in the node-His pathway. Only when this latter became blocked (in the trunk of the bundle of His) following on the longest refractory period, was a pre-excitation syndrome unmasked related to the right nodo-ventricular fibres (the fibres of Mahaim).