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It is a follow-up to Part I of the communication where the authors report on the present possibilities of the diagnostics and therapy of arthrogryposis multiplex congenita. In evaluating the patients with congenital contractures they proceed from the classification of Hall et al. of 1982 and 1983. A 24-member group is made up of patients with classic and distal arthrogryposis. The diagnostics is based on the clinical-genetical examination including dermatoglyphical and electromyographical examination. Electromyographical examination aims at the determination of the prognosis and impairment of mobility. EMG examination has proved neurogenic lesion in 17 children and myogenic lesion which was combined with neurogenic lesion in 3 children. After repeating EMG examination the authors found out in 5 children out of 6 the progression of neurogenic lesion. Dermatoglyphical examination performed in 13 patients (with taking sole prints in four of them) showed considerable changes which are significant for arthrogryposis. In evaluating the clinical findings the verticality of the course of papillary lines correlates with the degree of the clinical impairment as well as the increase of atdangles. The surgical treatment of contractures of lower extremities is indicated on the basis of the authors' own experience as early as in the first year of life. The result of the therapy is to a decisive extent influenced - apart from the severity of congenital contractures - by the timely and longterm comprehensive treatment carried out by an orthopaedic surgeon and rehabilitation specialist closely cooperating together and in case of occurrence of other associated congenital defects also by other specialists. Adequate involvement of parents is a necessary condition for a successful treatment. Key words: arthrogryposis multiplex congenita, amyoplasia, distal arthrogryposis, electromyography, dermatoglyphes, therapy.

By examination of a group of 617 diabetics treated by oral antidiabetics (PAD) and 263 treated with insulin for HBs-antigen carriership (HBsAg) by counter immunoelectrophoresis (CIEP) a total of 34 HBsAg carriers were detected (3.84%). This number comprised 9 treated with PAD (1.5%) and 25 insulin-treated ones (9.5%). Only six were younger than 60 years, the remaining 28 were older. Comparison with results assembled in 1984 revealed that in both groups during the five-year interval a marked decline of the prevalence of carriership had occurred--in the PAD treated group from 4.9% to 1.5% and in the insulin treated group from 29.1% to 9.5%. The decline is above all due to the high mortality of diabetics who are HBsAg carriers. In the course of five years a total of 50% died. Formerly positive patients were, if CIEP was negative, examined also by the ELISA method. On examination by both methods 13 were negative (19.7%). Of the newly detected 14 carriers 7 suffered from cirrhosis of the liver, incl. five where examination of HBsAg revealed the disease. In eight patients the carriership was confirmed only by examination by the ELISA method. Of the latter five had previously alternately positive and negative results when examined by CIEP which indicates variations of the serum concentration of the antigen.

The authors present the method of predicting the body height of patients with achondroplasia in adulthood and the method of predicting shortening of the lower segment of the body as compared to the trunk. They evaluate a group of 12 patients with achondroplasia at the age from 3 to 17 years. They compare the growth curves of patients with normal Czechoslovak population and with a group of American patients suffering with achondroplasia. The application of growth curves of American patients with achondroplasia appears to be the most suitable and simple graphical method for the prediction of the body height of the Czechoslovak patients suffering from achondroplasia. The method of the prediction of dwarfism of the lower segment of the body has been developed for the purpose of the rational indication of the stepwise prolongation therapy by the compression-distraction method. Analogically it will be possible to verify the growth curves for some other bone dysplasiae presented in literature and predict dwarfism of the lower segment of the body in adulthood, e.g. in hypochondroplasia, metaphyseal chondrodysplasia of the type of Schmid, Turner syndromes, etc.

A survey of 26 Czechoslovakian children diagnosed with BCG osteitis during 1981-1986 is presented. Mycobacterial culture was attempted in 19 cases with confirmation of bacillus Calmette-Guerin (BCG) Mycobacterium bovis strain in nine cases. Symptoms appeared approximately 17 months after vaccination; the proximal tibial end, distal femur, and proximal humerus were most affected. Although vaccination has been obligatory since 1953, a different vaccine was introduced in 1980, which led to the diagnosis of BCG osteitis in 1981. The vaccination doses, symptomatology, and methods of treatment are described. The risk of complications and a project for vaccination at later age are discussed.

The authors analyze diagnostic and therapeutic problems in fractures associated with tabes dorsalis. In the foreground of the clinical picture are in the majority neurological symptoms. The first symptoms develop 15 years after the primary infection. The laboratory results are not decisive for the diagnosis. Previously treatment of these fractures was conservative in rare instances arthrodesis of the affected joint was performed. In the case-history the authors submit new therapeutic possibilities in fractures of the neck of the femur associated with tabes dorsalis, using total endoprostheses of the hip joint. The authors mention also possible complications. The subjective evaluation by the patient is, however, very favourable.

A disease in an IgD (lambda) plasmocytoma is described, where after therapy with Alkeran and prednisone a disappearance of all clinical and laboratory findings indicating an activity could be observed. However, there was a progressive development of a picture of encephalomyelitic and polyradicular neuritic syndrome in the female patient with all signs of a recidivous temporary intracranial hypertension which could not be cured. The aetiology of these processes could only be found by the autopsy which revealed an isolated massive infiltration of the meninges and the sheaths of the spinal cord nerves with atypical plasma cells. No signs of the tumour could be identified in other organs. Such localization of the disease, as it is described here, is the first observation of its king. Problems of clinical diagnosis and treatment are discussed.