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HLA class II antigens were determined in 65 patients with biopsy-proven giant cell arteritis (GCA). An increase in DR4 antigen frequency was found in the patients (40%) compared with that in 200 healthy controls (20%) (Pcorr less than 0.05). DR4 was significantly more frequent in GCA patients with polymyalgia rheumatica (PMR) than in those without PMR (58.8% versus 19.3%) (P less than 0.005). HLA-DR4 frequency in GCA patients without PMR was similar to that in the control population (20%). Patients with severe, disabling PMR had DR4 more frequently (90%) than did those with moderate symptoms who required medical care because of cranial arteritis manifestations (41.6%) (P less than 0.05). We conclude that, in GCA patients, association with DR4 is mainly related to the manifestation of the disease as PMR. We discuss clinical and immunogenetic similarities between PMR and other DR4-associated rheumatic disorders. Common immunopathogenic mechanisms leading to clinical overlap among them are suggested.

Two cases of transitory IgM monoclonal gammopathy associated with infectious disease are presented. One patient was a 29 year-old woman with acute brucellosis; electrophoresis showed a homogeneous spike of slow gamma mobility constituted of IgM lambda. The second case was a 52 year-old male with milliary tuberculosis, in whom a homogenous spike of rapid gamma mobility constituted of IgM kappa was found. The monoclonal component disappeared in both cases after treatment of the infections; at 2 and 21/2 months respectively. The fact that the association of transitory IgM paraprotein and infection is not common, especially with brucellosis, is commented upon and a direct relationship between the infection and the monoclonal component is suggested.

The serum catalytic concentration of alpha-L-fucosidase (AFU) was measured to evaluate its usefulness for the diagnosis of hepatocarcinoma (HPC). Fifty-one patients with hepatocarcinoma, 30 with hepatic metastases, 40 with hepatic cirrhosis, 22 with other hepatic diseases and 48 healthy individuals were evaluated. The values of serum AFU were significantly higher in all groups (p less than 0.001), than in the reference group; there were also significant differences between those with HPC and hepatic cirrhosis (p less than 0.01), and between HPC and other hepatic diseases (p less than 0.05). The highest effectiveness of the test was achieved with a catalytic concentration of serum AFU of 210 nKat/l, with a 37% sensitivity and a 91% specificity. When the AFU measurement was used concomitantly with that of alpha-fetoprotein (AFP) for the diagnosis of HPC, sensitivity increased to 72% when AFI or AFP were elevated, and specificity reached 99% when both were increased. We think that the measurement of serum AFU may be helpful for the diagnosis of hepatocarcinoma.

Serum activity of glutathione reductase (GR), glucose phosphate isomerase (GPI), aspartate aminotransferase (AST), alanine aminotransferase (ALT) phosphate alkaline (PAL), and gamma-glutamyl transferase (GGT) was studied in 142 patients, in all serum bilirubin was more than 2 mg/dl. Distribution was as follows; 68 cirrhosis of the liver; 27 acute hepatitis; 31 benign extra-hepatic biliary obstruction; and 16 neoplastic obstruction of the biliary tract without liver metastasis. Fifty-three healthy volunteer blood donors were used as the control group. Mean values for GR activity in our patients were significantly higher than those for the control group, although less so in benign obstruction (p less than 0.01) than in those with acute hepatitis (p less than 0.001), cirrhosis (p less than 0.01) and neoplasic biliary obstruction (p less than 0.001). The GPI values were higher than the control groups in patients with acute hepatitis (p less than 0.001) and obstructive neoplastic jaundice (p less than 0.02). In cases with cirrhosis, 87% presented slightly higher values of GR, while GPI was within normal levels in 93 % of all cases. In patients with acute hepatitis, 92% showed a definite increase in GPI and GR values. In 71% of those with benign biliary obstruction levels for both enzymes were normal, as they were in only 6% of those with obstructive neoplastic jaundice. These findings are statistically significant in all cases and of diagnostic value in establishing a differential enzymatic diagnosis in patients presenting with clinical and biological patterns of cholestasis.

Hypertrophic osteoarthropathy (HOA) may be an idiopathic condition or may be secondary to other diseases, the most common of which is bronchogenic carcinoma. Among non neoplastic etiologies, it is commonly associated with chronic liver disease, usually cirrhosis and chronic active hepatitis. The concomitant occurrence of HOA and hepatic steatosis is another association that has recently been reported. We report here a 70-year-old male with periostitis, clubbing of the fingers and alcoholic hepatitis stenosis. We emphasize the need to perform observational studies to validate this association.

A cross-sectional study was carried out in the Baix Ebre region about the prevalence of alcohol use, within a wider study of hypertension and other risk factors. The following characteristics were considered for the elaboration of the present study: non drinker, moderate drinker and heavy drinker, as well as the amount of alcohol intake related with demographic, socioeconomical and cultural variables such as: age, sex, urban or rural medium, marital status, place of origin, working status, social and professional level, and educational status. 64.2% of the whole population greater than or equal to 20 years were usual alcohol users, and so were 79.4% of males and 48.2% of females. According to the definition of heavy or excessive drinker, such were 21.8% of males and 2.6% of females. Males drank a higher alcohol amount, with a mean and standard deviation of 47.1 +/- 35.5. In females, these figures were 19.4 +/- 12.4 g per day. The rate of alcohol drinkers was higher in young individuals, in those with active working status, in those with medium social and professional level, and in those with medium and high educational status.

The clinical and bacteriological characteristics of eight cases with purulent pericarditis observed over the last five years are studied. The route of the infection and dissemination in the majority of the cases (75 percent) was through pleuropulmonary lesions in the form of pneumonia and/or empyema, attributing the remaining cases to a subhepatic abscess and a pericardial infection after a thoracic surgical operation. In seven patients the diagnosis of the disease was established while they were alive. The more orientative clinical data were the pericardial pain (50 percent), pericardial friction murmur (25 percent), and signs of cardiac tamponade (62.5 percent). The observation of the above mentioned clinical signs together with the presence of cardiomegaly and electrocardiographic alterations suggestive of pericarditis, obliged the practice of a pericardial puncture, which confirmed the diagnosis of a purulent pericarditis by the macro and microscopic characteristics of the fluid. Staphylococcus and pneumoncoccus were isolated in two cases, respectively; other Gram-negative bacillus (E. coli and Pseudomonas aeruginosa) were isolated in the remaining cases. All patients were treated with the appropriate antibiotic according to the isolated germ; surgical drainage was carried out in six cases, and a pericardiectomy in one. Two patients died, one as a consequence of a septic myocardiopathy and the other in which the diagnosis of purulent pericarditis was not clinically suspected. During the follow-up period one case presented a constrictive pericarditis, which was corrected by a pericardiectomy.