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The authors have studied the advantage of CT scans in muscular pathology. The scan, in addition to the diagnosis of tumors and muscular abscesses, permits to differentiate primary myopathies from neurogenic atrophies: in the course of myopathies, the muscle volume is preserved and they appear as a hypodensity; in neurogenic atrophies, the muscle volume is reduced with preserved density. The CT scan permits to determine the extension of these lesions. In the course of polymyositis, certain forms of rheumatoid arthritis, the scan discloses a trabecular and "worm-eaten" aspect of the muscles. This is also observed after long-term steroid therapy and other endocrine diseases (hyperthyroidism, osteomalacia) indicating an infra-clinical myopathy. In vertebral osteoporosis with fractures and patients with chronic lumbalgia, very often, an atrophy of the spinal muscle is observed. Finally, in the course of acquired kyphosis of the adult patient (camptocormia), the CT scan suggest an isolated myopathy, with late manifestations, of the paravertebral muscles.

The authors present 12 cases of symptomatic acquired narrowing of the lumbar canal (with multiple nerve root involvement) in patients suffering from typical vertebral hyperostosis. In each case, the lesion was transverse stenosis due to hypertrophy of the articular apophyses of the last three lumbar vertebrae (posteromedial apophyses). Amongst the radiological abnormalities detected, especially with the aid of the C.T. scan in 6 cases, the authors stress the frequency of irregular bony proliferations on the non-articular surface of the articular apophyses and the ossification of the ligamenta flava, which has already been observed in the thoracic region in cases of vertebral hyperostosis.

Monoclonal antibodies and flow cytometry techniques were used to analyze and compare the distribution of lymphocyte subpopulations of peripheral blood and synovial fluid (SF) from 70 patients, 43 with rheumatoid arthritis (RA), 10 with ankylosing spondylitis (AS) or reactive synovitis, 10 with psoriatic arthritis and 7 with other inflammatory arthritic diseases. Patients with RA had significantly reduced number of CD8+ T cells and greater CD4/CD8 ratios in peripheral blood, a greater number of CD4+ T cells and lower CD4/CD8 ratio in SF. No significant difference was found between the groups with AS, reactive synovitis and psoriatic arthritis. The simultaneous analysis of peripheral blood and SF lymphocyte subpopulations allowed us to establish a transsynovial lymphocytic ratio which reflects CD4/CD8 variations on both peripheral blood and SF, 2 easily accessible compartments for physicians. This new ratio may distinguish RA from other inflammatory arthritic diseases.

A combined study organised by the French Society of Rheumatology was devoted to the investigation of bone and phosphoro-calcium metabolism in cases of reflex sympathetic dystrophy. The following observations were made: the usual phosphoro-calcium parameters are not altered, apart from a slight elevation of the urinary calcium in multifocal forms of the disease, during the 3rd and 4th months; the level of PTH, studied in 11 patients, was normal in each case; the examination of 8 bone biopsies, one performed in the 7th week and six others performed during the 3rd and 4th months of the disease, showed, initially, invasion of the spongy tissue by oedema, signs of marrow stress and bone stress, with a reduction in the number of osteoblasts, without any marked alteration of bone remodelling. At a later stage, the biopsy shows intense bone remodelling with hyperosteoclastosis and hyperosteoblastosis and the formation of irregular bone tissue which later becomes lamellar. Electron microscopic study of two biopsies revealed signs of acellular demineralisation with normal appearance of the osteoblasts and osteoclasts.

We report a case of septic arthritis of the knee due to Neisseria mucosa. a widespread commensal of the oropharynx following an infiltration of the joint. Evolution was favorable in ten weeks, with antibiotics (amoxicillin then erythromycin), and without surgery.

The viscosity of total venous blood was studied in 21 patients with osteonecrosis (ON) of the femoral head, and compared with the viscosity of 43 control patients, blood donors of the same mean age, and with the viscosity of 17 patients suffering from hip arthrosis. Measurements were carried out on a rotary resistance meter with coaxial cylinders. Along with the viscosity, certain biological, hematological and biochemical parameters, making up the main macro-rheological parameters, were measured in the same blood samples. Statistical analysis of the results confirms the hyperviscosity of total venous blood in patients with ON of the femoral head. This hyperviscosity does not seem correlated with the biological parameters studied, contrary to the viscosity of the blood in the control group. It is likely secondary to other factors, intrinsic to ON, and especially microrheological factors.

Three observations of patients with algodystrophia of the foot are reported. Biologic disorders suggestive of osteomalacia were found in two patients who recovered after receiving vitamin D. Cushing disease was diagnosed in the remaining patient ; again algodystrophia disappeared after specific therapy was given. The few similar cases published in the medical literature are reviewed. Attention is drawn to their misleading nature. Most published cases occurred with osteomalacia or endocrinic osteopathy. Such conditions should be looked for in all patients with apparently primary algodystrophia of a lower limb.

It has been shown in radioisotope scans made three hours after injection of 99mTc MDP that a significant hyperfixation in bone extremities is present in causalgias, probably due to accelerated osteogenesis. However, this gives no information concerning blood circulation inside bone. Nevertheless, the kinetic activity of tracer in areas of lesion for the initial seconds after injection depends upon the vascularity of this region. The computerized recording of isotope activity forms an early activity curb (isotope transit) which can be compared to the activity curb of the corresponding healthy articulatory region of the other limb or side. This curb breaks down into two parts: first, a rapidly ascending slope that corresponds to infiltration of the periarticular arterial network; second, a slowly ascending slope that corresponds to the tracer diffusion space in bony extremities. Among the 27 cases of causalgia in our series 19 evolved into thermalgias in less than three months. Furthermore, in 18 of these 19 cases the lesion-side activity curb was significantly different from the aspect of the healthy side's curb in that both portions showed a hyperactivity. The initial "arterial" hyperactivity slope probably corresponds to an increase in arterial blood flow (and sometimes circulatory speed) in soft tissues around joints; subsequent hyperactivity, gradually increasing, probably corresponds to an increase in the vascular bed volume and diffusion surface due to functional entry of usually silent intraosseous capillaries. Thus, the causalgia which has become thermalgic has a typical initial isotopic tracing curb: this hyperfixation explains the anatomic and pathophysiologic disorders evidenced by other procedures in this disease.

Infection of the joint with pyogenic organisms usually causes purulent arthritis the prognosis of which is linked to the severity of the bone, cartilage and ligamentous destruction. The tissue response to infection is moreover influenced by a certain number of factors such as the nature of the bacteria and, above all, the circumstances of onset of the infections. Considering the difficulties in diagnosis, special mention should be made of bone and joint infections with a torpid course.

Sixty-six patients managed in an outpatient clinic for various inflammatory or degenerative conditions were given 300 mg per day of Bi-Profenid in two daily doses of one 150 mg tablet each, for 20 days. At completion of the trial, patients with degenerative disease showed a statistically significant improvement in pain upon mobilization, nocturnal pain and pain index as evaluated by the pain scale. Similarly, in patients with inflammatory conditions, significant effectiveness was recorded upon nocturnal pain, overall pain as assessed by the pain scale and articular index. Tolerance was considered satisfactory in more than 65% of cases. The most common undesirable side-effect was gastric pain (22.7%). Bi-Profenid thus confirms its effectiveness in pain due to arthrosis as well as in inflammatory conditions.

The authors report 7 anatomo-clinical cases of osteonecrosis of the femoral head, the clinical onset of which occurred during pregnancy or in the fortnight after delivery. On the basis of histological data obtained through core-biopsy in these 7 cases they discuss the relationship between osteonecrosis and reflex sympathetic dystrophy of the hip.

Ankylosing vertebral hyperostosis and internal frontal hyperostosis have a frequency of 5% and 8% respectively. In Paget's disease, these two disorders are found with a frequency of 40% and 19.1% respectively. This frequency is not due to chance. There exists a link between the 3 diseases. Ankylosing vertebral hyperostosis is thusa new pathological association in Paget's disease. It is even the most frequent of these associations. It seems Paget's disease induces hyperostosis and not the contrary. The authors suggest the theory that cortical and periostal hypervascularisation in pagetoid bone favour the development of these hyperostoses.

The authors analysed the case histories of 40 patients with cervical myelopathy and were struck by the frequency of associated vertebral hyperostosis (Forestier and Rotès-Quérol disease). They found 17 cases in which dorsal vertebral hyperostosis was indiscutable and in which there was acquired stenosis of the cervical canal related to the bony proliferations that had developed on the anterior face of the cervical canal and to the type of cells described by Forestier and Rotes-Querol on the anterior and lateral faces of the vertebral column. According to the present authors these posterior growths occurred in a site that has not previously been described for hyperostosis. These growths are likened to those observed by Japanese neurosurgeons since 1960. Their particular interest concerns their role in pathology.

A nosological classification of arthrosis is proposed, consisting of two groups depending on whether the cartilage is intact (mechanical chondrosis) or altered (structural chondrosis). For both categories the principal aetiologies are mentioned. This aetiological differentiation has the aim of counteracting the facile diagnosis of primary arthrosis and is based on more elaborate diagnostic methods concerning the condition of the bone and cartilage.

In 16 cases of reflex sympathetic dystrophy of the knee, the authors obtained by drill biopsy 29 bone samples from the epiphyseal and metaphyseal regions of the femur and tibia and 8 cartilagenous samples (including 6 by arthrotomy and 2 after patellectomy). They noted thinning of the cortical bone, lacunae of cortical reabsorption, rarefaction of the trabeculae, of which some were dead, stasis and fibrosis of the bone marrow. The 8 cartilage samples were pathological, with, in particular, fibrosis of the surface cartilage (vascular pannus formation). The association of chondromalacia of the patella with an S.R.D. syndrome of the knee is frequent.

The authors have shown that the initial phase of coxarthrosis consists purely of cartilaginous lesions, not visible in radiographs. They have studied 200 arthrograms of the hip using a precise technique which is described. They have found cartilaginous lesions both in cases of insufficiency of the lateral wall of the acetabulum, and in cases of insufficiency of the medial wall of the acetabulum. Cartilaginous lesions may range between a simple decrease of articular cartilage height and complete ulceration either on the cephalic or acetabular sides. These lesions may be present at a time when the radiograph is still normal, especially in cases of hip dysplasia. It is concluded that the articular cartilage of the hip may chondromalacic in the same way as in the patello-femoral joint, and that arthrosis may be secondary to this chondromalacia. Arthrography makes early diagnosis possible.

We studied the mineral phase of two cases of subdeltoid calcification by thermogravimetry, infrared spectometry and X ray diffraction. We have shown that these were phosphates deficient in calcium ions with an apatite structure. They contained both carbonate ions and HPO4 ions in variable proportions from one sample to another. These phosphates are very similar both by their structure and their composition to phosphates in bony tissue. They differ by the fact that they are better crystallised than the latter.

Effect of section of sino-aortic nerves on intramedullary bone marrow pressure in the dog. In the dog, after section of sino aortic nerves, the intramedullary bone marrow pressure decreases immediately by vasoconstriction. Injection of propranolol decreases further this pressure possibly by action on beta receptors in the bone.

Sixty patients with Paget's disease underwent bone scintigraphy and a radiological and biological exam. The use of scintigraphy in this disease is of double importance: it allows the spread of the disease to be diagnosed without doing X-rays of the entire skeleton. In twenty per cent of cases this disease cannot be located using X-rays and is detected by scintigraphy. It also supplies an additional objective criteria for judging the development of this disease, especially under treatment. The authors study the different hypotheses concerning the fixation to the bone of the isotope tracer in the Paget zone.

The joint fluid in cases of algodystrophy was studied in 17 samples. It is poor in cells (275/mm3 with a mean of 15% polymorphs). The protein level was studied 4 times and was equal to or greater than 40 g/l, i.e. double the normal value. A detailed histological examination of 33 biopsies of synovial tissue reveals a typical appearance of the synovium in algodystrophy, defined by 6 features, 2 negative and 4 positive: absence of hyperplasia of the synovial lining, absence of any real inflammatory cell infiltrate, presence of a marked hypervascularity, an oedema of the chorion, especially marked in the first weeks of the disease, hyperplasia of the walls of some arterioles, and fibrosis of the chorion which becomes more marked as the disease progresses and which is predominantly in the deeper layers. The authors recall that articular cartilage can show superficial alterations of structure with areas of fibrosis.

Infusions of corticosteroids in massive doses (methylprednisolone 1 g/day for 1 to 3 days) are used by nephrologists against acute episodes of rejection of transplanted kidneys and in acute glomeruloneppritis , especially lupic , with threatening renal failure. During the last few years this method has been tried in collagen diseases, notably in acute episodes of systemic lupus erythematosus without renal insufficiency, in rheumatoid arthritis and in ankylosing spondylitis. Published controlled studies concerning these three diseases are too few for firm conclusions to be drawn. The improvement obtained during 3 months on average after 3 g (1 g/day for 3 days) is not observed in all patients and it is not certain that such high doses are innocuous: they do not seem to have been responsible for deaths, as reported in patients with renal transplantation, but undesirable side-effects are observed in one-half of the cases. Close supervision with repeated measurement of blood electrolytes and electrocardiograms is mandatory during and immediately after treatment.

Using radio-labelled microspheres, the authors studied bone blood flows in various segments of goose femurs (femoral head, trochanter, condyles). Experiments were conducted on three groups of geese: control, fatty liver induced and corticosteroid-treated animals. The preliminary results suggest that hyperlipemia and fatty liver conditions do not seem to obviously disturb intra osseous blood circulation in fatty geese, although corticosteroids might affect bone blood flows in condyles.

The authors studied the karyotype in blood and marrow of 34 patients with Paget's disease and compared the results with those of a control group of the same age. Structural abnormalities are more frequent in the blood than in the marrow, but there is no significant difference in comparison with the abnormalities in the control group. Ionizing radiations and drugs do not seem to be responsible for the abnormalities encountered. The numerical abnormalities are characterized by an increase in the number of hypodiploidies, particularly involving the chromosome groups A, B and D, whereas chromosomal damage affecting the C and G groups is less than normal. These abnormalities were encountered in a limited number of patients. The authors discuss the significance of these chromosomal abnormalities in the more general context of the genetics of Paget's disease.

Marrow scintigraphy using 99mTc colloids was performed in 20 patients with Paget's disease of bone and compared with skeletal scanning in each of them. As long as the regions explored were haematopoietically active, despite the advanced age of the patients, there was decreased marrow uptake in regions of increased uptake on the skeletal scan. Whilst increased uptake of pyrophosphate reflects bone hyperosteogenesis, decreased uptake of colloids reflects marrow fibrosis, and early histological sign of the disease. This scanning technique could be a new criterion in the surveillance of the therapeutic effectiveness of calcitonins or of diphosphonates.

The authors report on 4 cases of condensating prostatic osteosis, whose biological picture and histomorphometric lesions in the involved area indicate osteomalacia. They discuss the individual nature of such a syndrome, the links between vitamin D deficiency and hyperosteoidosis at a very slow noted speed of calcification, and the usefulness of investigating and treating the syndrome.