[Long-term results of chymopapain nucleolysis].

The retrospective study of the first 67 patients treated by chemonucleolysis, since December 1980, shows a good overall result, in 69 p. cent of the cases (40 patients) and a failure in 31 p. cent of the cases (18 patients), with a 42 months follow-up.

[Rheumatologic manifestations of Lyme disease].

The characteristics of 15 patients with Lyme disease have been retrospectively reviewed; 12 patients had lymphocytic meningitis with mono or polyradiculitis including facial neuritis; 5 patients had mono or oligo-arthritis; 4 patients had inflammatory enthesopathy-like complaints which were the only expression of the disease in 2 of them. All the patients received antibiotic treatment. A dramatic clinical improvement was noted in all patients within four days.

[Failure of chemonucleolysis and its surgical treatment. Apropos of 268 cases].

The authors have reviewed 268 cases of herniated lumbar discs treated by chemonucleolysis between 1980 and 1984. 52 patients had a laminectomy (19,40 p. 100) and 18 of theses failures were due to a large disc herniation (34,61 p.

[Oligo-arthritis associated with type IV hyperlipoproteinemia].

A case of chronic, corticosteroid-responsive arthritis affecting particularly one ankle in a patient with type IV hyperlipoproteinaemia is reported. After gout or inflammatory rheumatism of another nature had been excluded, and following synovial fluid examination and synovial membrane biopsy, a diagnosis of type IV hyperlipoproteinaemia rheumatism was made. At electron microscopy, the synovial membrane showed numerous large spumous cells and a peculiar appearance of the capillary vessels.

[Monocytic arthritis. Study of their clinical significance apropos of 43 cases].

The clinical significance of synovial monocytosis (greater than 50 p. cent) of inflammatory fluids (greater than 1,000 elements per mm3) was studied retrospectively in 43 patients. An accurate diagnosis was made 35 times: rheumatoid polyarthritis (13 cases), lupus disease (1 case), Gougerot-Sjögren syndrome (1 case), isolated infantile monoarthritis (1 case), sarcoidosis (1 case), seronegative spondylo-arthropathy (3 cases), microcrystalline arthritis (5 cases) arthritis revealing a blood disease (2 cases), idiopathic "lymphocytic" arthritis (3 cases), eosinophilic pseudo-allergenic arthritis (2 cases), aseptic osteonecrosis of the medial condyle (1 case), femoro-patellar arthrosis (1 case).

[Nicardipine in the treatment of Raynaud's phenomenon].

The efficacy of the calcium-channel blocker nicardipine in the treatment of Raynaud's phenomenon was assessed in a double-blind, randomised, crossover trial in 20 patients. Each patient received 2 weeks of nicardipine 20 mg three times daily and 2 weeks of placebo. Nicardipine significantly improved the frequency and severity of Raynaud's phenomenon.

[Specific antibodies of soluble nuclear antigens in autoimmune vasculitis].

In order to assess the clinical value of antinuclear antibody (ANA) assays in classifying vasculitis, 136 sera from 28 patients with cutaneous vasculitis alone, and 80 patients with vasculitis associated with a connective tissue disease or an unclassified arthritis were tested. ANAs were assayed by indirect immunofluorescence, anti-ENA and anti-histone antibodies were tested by immunodiffusion. ANAs are seldom in patients with cutaneous vasculitis alone (1 positive serum/28 = 3.

[Skin tests and chymopapain-specific immunoglobulins E after chemonucleolysis].

Skin tests (prick tests) with chymopapain were performed on 3 groups of patients: 75 patients awaiting chemonucleolysis with chymopapain (group I), 42 of these 75 patients 2-3 weeks after chemonucleolysis (group II), and 60 atopic patients suffering from asthma and/or rhinitis with positive skin tests to at least one of the airborne allergens (group III). A positive skin test was found in one patient of group I (1.33%), one patient of group III (1.

[Treatment of Felty's syndrome accompanied by agranulocytosis using high-dose corticoids. 3 cases].

Three cases of severe Felty's syndrome (neutrophils 80/mm3 in 2 cases and 800/mm3 in one) with enlarged spleen (1 case) and leg ulcer (2 cases) were treated with high doses of corticosteroids (methylprednisolone 1 g by intravenous infusion over 3 hours, on 3 consecutive days). In all 3 patients a dramatic result was obtained, the granulocytes returning to normal values in 24 to 48 hours. In 2 cases, an early relapse (1 month) required a second course in high dosage; after a follow-up of 36 and 8 months respectively, the number of granulocytes remains stable under prednisone 5 to 10 mg/day.

Nicardipine in the treatment of Raynaud's phenomenon: a randomized double-blind trial.

The efficacy of the calcium-channel blocker nicardipine in the treatment of Raynaud's phenomenon was assessed in a prospective, double-blind, randomized, crossover trial in 20 patients. Each patient received nicardipine 20 mg or placebo three times a day for two weeks and then was crossed over for two weeks. Nicardipine significantly decreased the frequency and severity of Raynaud's phenomenon as compared with placebo.

[Sciatica caused by synovial cysts and lumbar articular diverticula with intraspinal development. Saccoradiculographic, computed tomographic and arthrographic study].

The authors report 8 cases of patients with synovial cysts (3 cases) or diverticuli (5 cases) of the lumbar joints, compressing the sciatic roots. They describe the radiological aspects of the two sides of the degenerative pathology of the posterior articular processes, which are relatively unrecognized (14 cases in the literature). They insist on the advantage of saccoradiculography which is the only test to be able to demonstrate dynamic alterations in relation with diverticuli, if performed in a standing position.

[Ankylosing spondylitis with juvenile onset. Study of 62 cases].

The study of 338 files of patients hospitalized for ankylosing spondylarthritis between 1977 and 1985, has enabled to select 52 cases (15 p. cent) of juvenile forms (onset before the age of 16). An additional 10 cases followed in pediatric clinic are included.

[Treatment of sarcoid dactylitis with brief intravenous perfusion of high-dose methylprednisolone].

Sarcoid phalangeal involvement is a rare complication of a chronic disease process. Some forms pose difficult therapeutic problems, as steroids, even at high doses, do not always arrest the destructive changes. We report 3 cases of sarcoid phalangeal disease treated by intravenous infusion of 1 g of Methylprednisolone given in 3 hours on 3 consecutive days at monthly intervals for 4, 5, 7 and 8 months, respectively.

[Value of dapsone in the treatment of rhizomelic pseudopolyarthritis and Horton's disease].

In 11 patients suffering from polymyalgia rheumatica or Horton's disease, dapsone was associated with corticotherapy because of corticosteroid side effects (11 cases) and/or progression of the disease despite relatively high dose steroid therapy (6 cases). This treatment had to be discontinued in 4 patients because of side effects and in 3 patients because of a recurrence of the disease. Despite these numerous withdrawals, dapsone seems to be of clinical benefit in these patients because of 1) the mildness of the side effects observed in this study, 2) its efficacy evaluated on the improvement of clinical signs of the disease and, overall, on the decrease in the corticosteroid consumption.

Increased expression of Epstein-Barr virus receptor on lymphoblastoid cell lines from subsets of patients with rheumatoid arthritis.

We studied the expression of Epstein-Barr virus receptor (EBVR/CR2) on lymphoblastoid cell (LCL) lines established from 23 patients with rheumatoid arthritis and the T cell suppression of IgM secretion by EBV activated B cells. Ten patients had normal T cell suppression of IgM secretion, whereas 13 patients had defective suppressor T cell function. EBVR expression on LCL was assessed using a rabbit anti-gp 140 IgG; Raji cells, used as reference cell line expressed 50,000 EBVR, a 140 k glycoprotein (gp 140).

Pharmacodynamic effect of dipyridamole on thallium-201 myocardial perfusion in progressive systemic sclerosis with diffuse scleroderma.

We evaluated the effect of dipyridamole on thallium-201 myocardial perfusion in 23 patients with progressive systemic sclerosis (PSS) with diffuse scleroderma. Thallium-201 single photon emission computed tomography (SPECT) was performed at rest and after coronary artery vasodilatation with intravenous dipyridamole (0.14 mg/kg/min for four minutes).