Rheumatic manifestations at presentation of Hodgkin's disease and non-Hodgkin's malignant lymphoma. A national survey of one hundred forty-six patients

The authors report the findings of a national survey conducted at the request of the French Society for Rheumatology to list the rheumatic manifestations that can be inaugural in Hodgkin's disease or non-Hodgkin's malignant lymphoma. This was an exploratory, retrospective, descriptive study of 146 patients from 22 rheumatology departments. A number of clinical features (young male, nocturnal sweats, generalized pruritus, protracted fever, central or peripheral lymphadenopathy) and laboratory test abnormalities (evidence of severe inflammation) considerably increased the likelihood of Hodgkin's disease rather than malignant lymphoma. The diagnosis of bony involvement requires multidisciplinary studies of tumor specimens.

Highly conserved aspartate 68, tryptophane 73 and glycine 109 in the N-terminal extracellular domain of the human VIP receptor are essential for its ability to bind VIP

The human VIP receptor belongs to a subfamily of G protein-coupled receptors that includes secretin, glucagon and several other receptors. We have used site-directed mutagenesis to investigate the requirement of highly conserved aspartate 68 (mutant D68G), tryptophane 73 (mutant W73G), proline 87 (mutant P87G), glycine 109 (mutant delta 109) and tryptophane 110 (mutant W110G) for the ability of the human VIP receptor to bind VIP. After transfection of mutated cDNAs in Cos-7 cells, it appeared that mutants G87P and W110G bound VIP with the same dissociation constant as the wild type receptor whereas mutants W73G, P87G and delta 109 did not bind VIP. Since all mutated receptor proteins were synthesized by Cos-7 cells (Western blot) and expressed at the plasma membrane level (immunofluorescence studies), it is concluded that the N-terminal extracellular domain of the human VIP receptor contains highly conserved amino acid residues which are essential for its intrinsic binding activity.

[Osteo-medullary metastases from cerebral glioblastoma]

A 55 year old female with a history of three different malignancies including a cerebral glioblastoma developed two bone metastases (in the spine and iliac crest). Histologic and immunohistochemical studies of biopsy specimens demonstrated the presence of glial fibrillary acidic protein, establishing that the bone tumors were metastases from the glioblastoma. Specific features of these rare metastases are discussed.

[Tibial hyperostosis and Propionibacterium acnes]

In a 39-year-old patient with tibial productive osteitis, Propionibacterium acnes was identified in a surgical specimen of the bone lesion. Similar cases have been reported by others. The possibility that P. acnes may play in a pathogenic role in the SAPHO syndrome by causing inflammatory or infectious changes is discussed.

Skeletal involvement as the initial disease manifestation in Hodgkin's disease: a review of 6 cases

Initial signs of malignant lymphoma are rarely due to bone lesions. We reviewed 6 cases with early skeletal involvement, recently observed in the rheumatology and hematology departments. In 3 patients, magnetic resonance imaging (MRI) was added to traditional investigations, including radiography, radionuclide bone scan and computerized tomography. We stress the possibility of bone involvement in the clinical onset of malignant lymphoma and the usefulness of early bone assessment using MRI.

[Paraplegia after epidural anesthesia for vascular surgery]

A case is reported of a 67-year-old man who underwent major vascular surgery (iliobifemoral bypass with unilateral sympathectomy) under epidural anaesthesia and resulting in permanent neurological damage. Lumbar epidural anaesthesia was carried out using a mixture of bupivacaine, lidocaine with adrenaline, and alfentanil. The surgical course was uneventful, except for a 30 minute period of relative hypotension (90 vs. 110 mmHg preoperatively). Continuous epidural analgesia (12 ml.h-1 of 0.125% bupivacaine without adrenaline) was started after the end of surgery. Twelve hours later, flaccid lower limb paralysis was noted, but thought to be due to the bupivacaine. At the 24th hour, the epidural analgesia was discontinued and the catheter removed. There were a motor paralysis and a partial sensory block, raising to the level of T10 (temperature and pain). A CT scan and myelography of the thoracolumbar spine revealed no anomaly. The sensory loss ended within ten days, but the motor deficit regressed only slightly. Unfortunately, the patient died on the 16th day after an episode of severe chest pain. The probable cause of the neurological damage was an anterior spinal infarct. It was not possible to determine the degree of responsibility of the peripheral vascular disease, the anaesthetic or the surgery.

[Arthropathy of the fingers in hemodialyzed patients with chronic renal failure. Apropos of a study of 44 patients]

Arthropathy affecting the small joints of the hand are one of the osteo-articular complications of chronic renal failure treated by hemodialysis. Amongst the 44 patients studied, there were 9 cases of arthropathy of the fingers. The clinical characteristics (age, duration of hemodialysis) and paraclinical characteristics (oxygenated free radical activity indicators, serum levels of aluminium and beta-2-microglobulins) appear to be specific to this population and may help us to understand the pathogenesis of the joint lesions.

Diel pattern of emergence in grayling (Thymallus thymallus Linnaeus, 1758)

The emergence rhythm of grayling fry (Thymallus thymallus) was studied under semi-natural rearing conditions, using special traps buried in the gravel. The diel pattern of emergence proved to be mainly diurnal, with a maximum just after sunrise. The discussion emphasizes the fact that this distinguishes the grayling from other salmonids, and since eggs are buried at a reduced depth, proposes the hypothesis that light conditions during development influence the daily pattern of emergence.

[Bone manifestations disclosing Hodgkin's disease and non-Hodgkin's malignant lymphoma. Analysis of 11 cases]

Bone localizations revealing Hodgkin's disease or non-Hodgkin's malignant lymphoma, are unusual. We are reporting 11 recent cases collected in rheumatology and haematology departments, including 4 where a comprehensive study of X-rays, scintigrams, axial tomograms and nuclear magnetic resonance imaging was performed. Review of the literature as well as our experience concerning the type of onset of the bone involvement, the clinical correlation, the imaging techniques, have led us to consider nuclear magnetic resonance as a decisive factor which should be offered at an early stage in the diagnostic approach.

Fracture and embolization of a Lillehei-Kaster mitral valve prosthesis disc: one case successfully operated

We report the fracture of the poppet of a Lillehei-Kaster prosthesis. A 40 years old man was operated upon for endocarditis of the mitral valve. A Lillehei-Kaster tilting disc valve was implanted. Three years later the disc fractured and the two parts escaped in the aorto-iliac axis. Emergency surgical procedure permitted implantation of a Wessex bioprosthesis and removal of the fragments with good results.