Ann. rheum. Dis. (1970), 29, 569

Abstracts

This section is published in collaboration with Abstracts of World Medicine and Ophthalmic Literature, published by theBritish Medical Association, and also includes a great many which are specially commissioned for this Journal. Theyare divided into the following sections:

Acute Rheumatism Other Forms of Arthritis Immunology and SerologyRheumatoid Arthritis Bone Diseases Biochemical StudiesStill's Disease Non-articular Rheumatism, including Disk TherapyOsteoarthrosis Syndromes, Sciatica, etc. SurgerySpondylitis Pararheumatic (Collagen) Diseases Other General SubjectsGout Connective Tissue StudiesAt the end of each section is a list of titles of articles noted but not abstracted. Not all sections may be represented inany one issue.

Acute rheumatismA Day Hospital for Children with Rheumatic FeverSPAGNUOLO, M., GAVRIN, J., and RYAN, J. (1970)Pediatrics, 45, 276 1 fig., 11 refs

In the rheumatic disorders of children, as in other ill-nesses, the amount of medical supervision needed de-creases with time, although continued observation re-mains desirable. The need to avoid the overuse of specia-lized and expensive hospital facilities, has led to theestablishment in several places of Day Hospitals, uponan experimental basis. This report is from the IrvingtonHouse Day Hospital, New York, where the patientshave the benefit of whatever medical attention andauxiliary services may be needed and can return homeat night.The authors report on one hundred consecutive chil-

dren with acute rheumatic fever who attended during thelatter part of their illness at a time when they were ableto tolerate near-normal activities. Most of them werefinally discharged shortly after discontinuation of therapy,although a few of the exceptions who are described hadto be readmitted with clinical rebounds and otherresidual disorders.The incidence of permanent heart disease in those

who attended the day hospital did not differ from thatin children who had been subjected to full hospitalizationfor the entire duration of their illness. The authors con-clude that a long period of hospital care and convales-cence is required only in that 5 per cent. of patients whohave chronic rheumatic fever. The others who attendedthe Day Hospital were able to resume normal activitiesincluding schooling much sooner than if they had con-tinued as in-patients. W. S. C. COPEMAN

Acute Rheumatic Fever in Shiraz, Iran GHARIB, R.(1969) Amer. J. Dis. Child., 118, 694 24 refs

Although reports upon the incidence of rheumaticfever in several of the Middle Eastern countries have been

published in the past, this is the first from Iran, and itemanates from the Pahlavi University School of Medical(Paediatric) Cardiology in Shiraz. The prevalence ofrheumatic fever over a 10-year period was found to be0 5 per cent., which is higher than that currently reportedfrom most Western countries. In forty episodes observedamongst patients of an average age of 10 years, 45 hadestablished carditis (64-5 per cent.), but very few de-veloped chorea. Of 55 patients totalling seventy hospitaladmissions, eight died, a case fatality rate of 14-2 percent. No significant difference in socioeconomic statuswas detected between the rheumatic and control groups;contrary to the widely held impression that the diseaseis more frequent in environments in which malnutrition,poverty, and overcrowding are prevalent.

W. S. C. COPEMAN

Role of Tonsils in predisposing to Streptococcal Infectionsand Recurrences of Rheumatic Fever FEINSTEIN, A. R.,and LEvIrr, M. (1970) New Engl. J. Med., 282, 285 1fig., bibl.(see Abstr. Wld Med. (1970), 44, 454).

Indirect Immunofluorescence in the Serological Diagnosisof Streptococcal Diseases L. Application in RheumaticFever (L'immunofluorescenza indiretta nella diagnosisierologica delle affezioni streptococciche. I. Utilizza-zione nella malattia reumatica) CIAMPOLINI, M.,FRANCHINI, F., and TREVISAN, C. (1969). Minervapediat., 21, 2431 4 figs, 43 refs(See Abstr. Wld Med., (1970) 44, 503.)

Decreasing Incidence of a History of Acute RheumaticFever inChronicRheumaticHeart Disease VENDSBORG, P.,FAUERHOLDT-HANSEN, L., and OLESEN, K. H. (1968)Cardiologia, 53, 332 2 figs, 22 refs(See Abstr. Wld Med. (1970), 44, 548).

Some Aspects of Epidemiology and Surveillance ofRheumatic Fever 9rrAj, S., URBANEK, T., and BO§MAN-SKY, K. (1970) Acta rheum. scand., 16, 30 4 figs, 20 refs

570 Annals of the Rheumatic Diseases

Rheumatic Mitral Valvular Disease in the Adolescent.Clinical Evaluation and Surgical Indications in 86 Cases(Valvulopatia mitral reumdtica del adolescent) MATA,M. L. A., SALOM6N, C. A., and ORDONqEZ, M. A. (1969)Arch. Inst. Cardiol. MWx., 39, 612 5 figs, 16 refs

Studies on the Serum Level of Neuraminic Acid in theCourse of Cardiac Failure in Children with RheumaticFever [In Polish] SOWIN'SKA, J., and WOJTECKA, E.(1969) Reumatologia (Warsz.), 7, 341 3 figs, 6 refs

Rheumatic Heart Disease Epidemiology. m. The SanLuis Valley Prevalence Study MORTON, W. E., WARNER,A. L., WEIL, J. V., SHMOCK, C. L., JR., SNYDER, J., andLicHTY, J. A. (1970) Circulation, 41, 773 6 refs

Rheumatic Fever-1970 LUCKSTEAD, E. F., and DIEHL,A. M. (1970) J. Kans. med. Soc., 71, 97 10 refs

Criteria of Rheumatic Fever DAVIS (1970) Lancet, 1,1045

Acute Rheumatic Fever in Virginia-Has it changed in theLast 20 Years? McCuE, C. M., ROBERTSON, L. W.,ELDREDGE, W. J., and NOBLE, A. (1970) Virginia med.Mth., 97, 273 5 figs, 6 refs

Acid-Base Equilibrium in the Treatment of RheumaticFever in Children [In Polish] KORYCHA, A., PRONICKA,E., JACOBSON, E., and KUBALSKA, J. (1970) Pediat. pol.,45, 413 3 figs, 19 refs

Renal Lesions in Rheumatic Heart Disease FAmmy,S. A. (1969) J. Egypt. med. Ass., 52, 524 11 figs, 9 refs

Transient Complete A-V Block in Two Siblings duringAcute Rheumatic Carditis in Childhood STOCKER et al.(1970) Pediatrics, 45, 850

Rheumatoid arthritisHeart Disease in Patients with Sero-positive RheumatoidArthritis BONFIGLIO, T., and ATWATER, E. C. (1969)Arch. intern. Med., 124, 714 44 refs

Pericarditis as an autopsy finding in 30 to 40 per cent. ofcases of chronic rheumatoid arthritis has been reportedin many series since Charcot's paper in 1881 whichrecorded -such a finding in four out of nine examinations.The present authors report detailed post mortem

observations in 47 cases of seropositive rheumatoidarthritis and confirm these findings-in an equal numberof unmatched controls it was uncommon. Such lesions,although almost always benign, are often associatedwith electrocardiographic changes during life. They alsoappear to relate to long duration of the arthritis diseaseand severe musculoskeletal disability. Constrictive peri-carditis and rheumatoid granulomata, however, arerarely found. Myocarditis was found most frequently inpatients with severe osteoporosis. Coronary arteritis,when discovered, seemed to be only doubtfully relevantto the rheumatic condition; functionally importantvalvular disease was rate. Non-specific endocarditis,although found to be quite common, was not more so

than in the control group. The authors conclude thatmost-but not all-heart disease found in rheumatoidarthritis patients is innocuous. W. S. C. COPEMAN

Rheumatoid Arthritis and the Xylose Tolerance TestGAMBLE, W. S., ABBRUZZESE, A., GRAY, S. J., andBAYLES, T. B. (1969) Amer. J. Gastroent., 52, 445 2 figs,36 refs

Among 35 patients with classical or definite rheumatoidarthritis, in whom there was no clinical evidence ofarteritis or amyloidosis and in whom renal function wasgrossly normal, the 5-hour urine zylose was significantlyreduced (below 6-2 g.) in eighteen, and in six of thesethe serum zylose was raised. A low urine zylose wasvirtually restricted to females; it was not related to thetitre of rheumatoid serum factor, nor explicable by theuse of phenacetin. The authors consider these results toindicate renal impairment rather than intestinal malab-sorption and suggest that the former may be commonerthan is generally supposed. J. BALL

Association of Rheumatoid Arthritis with Plasma Cell andLymphocytic Neoplasms GOLDENBERG, G. J., PARAS-KEVAS, F., and IsRAELs, L. G. (1969) Arthr. and Rheum.12, 569-579 6 figs, 36 refs(See Abstr. Wld Med. (1970), 44, 627)

Rheumatoid Arthritis, Dysproteinemic Arthropathy, andParaproteinemia ZAWADZKI, Z. A., and BENEDEK, T. G.(1969) Arthr. and Rheum., 12, 555 2 figs, bibl.(see Abstr. WId Med. (1970), 44, 628)

Association between Rheumatoid Arthritis and Psoriasis inTotal Populations [In English] HELLGREN, L. (1969)Acta rheum. scand., 15, 316 Bibl.(see Abstr. WId Med. (1970), 44, 455)

Disturbance of Pulmonary Diffusing Capacity in Rheuma-toid Arthritis and Systemic Lupus Erythematosus (Diffu-sionsstorungen bei primarchronischer Polyarthritis undLupus erythematodes disseminatus) LODDENKEMPER, R.,BACH, G. L., and CARTON, R. W. (1970) Beitr. Klin.Erforsch. Tuberk., 141, 230 2 figs, 30 refs(see Abstr. Wld Med. (1970), 44, 548)

Studies on the Sicca Syndrome in Patients with Rh toidArthritis ERICSON, S., and SUNDMARK, E. (1970) Actarheum. scand., 16, 60 1 fig., 50 refs(see Abstr. Wld Med. (1970), 44, 772)

Problems of Caplan's Syndrome (Zur Problematik desCaplan-Syndroms) MoRAwErz, F., and ScHNErz, E.(1970) Wien. med. Wschr., 120, 103 4 figs, 17 refs

R atoid Lung Disease (Acute Articular Rh tis)(Pneumopathie rhumatismale (Rhumatisme articulaireaigu)) CARVALHAL, S. S., ATRA, E., SAAD, F. A., andPupo, R. A. (1969) Rev. Rhum., 36, 597 9 figs, 15 refs

Abstracts 571

Chest Roentgenograms in Rheumatoid Arthritis: Hiro-shima-Nagasaki NAKATA, H., and RUSSELL, W. J. (1970)Amer. J. Roentgenol., 108, 819 5 figs, 11 refs

Pleuropulmonary Manifestations in Rheumatoid Arthritis(Manifestaciones pleuropulmonares en la artritis reuma-toidea) PIERoNI, P., LASALA, F., and GAGLIARDI, H.(1970) Pren. med. argent., 57, 73 10 figs, 11 refs

Unusual Pattern of Morphological Changes in RheumatoidArthritis (Eine besondere morphologische Verlaufsformder primer chronischen Polyarthritis) JENTZSCH, K.(1970) Virchows Arch. path. Anat., 349, 244 8 figs, bible.

Microscopic Appearance of Baker's Cyst in Cases ofRheumatoid Arthritis WAGNER, T., and ABGAROWICZ, T.(1970) Reumatologia (Warsz.), 8, 21 3 figs, 9 refs

Rib Lesions in Rheumatoid Disease JOHNSON et al. (1970)Brit. J. Radiol, 43, 269

Severe Subluxation of the Cervical Spine in RheumatoidArthritis CRELLIN, R. Q., MACCABE, J. J., and HAMIL-TON, E. B. D. (1970) J. Bone Jt Surg., 52B, 244 7 figs,14 refs

Changes in the Cervical Vertebrae in Rheumatoid Arthritis(Veranderungen der Halswirbelsaule bei der rheumatoidenArthritis) WEIGL, E., and WRUCK, E. (1969) Radiol.diagn. (Berl.), 10, 655 4 figs, 16 refs

Atlanto-axial Dislocation and Cervical Spondylodiscitisin a Case of Rheumatoid Arthritis (Dislocation atloido-axoidienne et spondylodiscite cervicale au cours d'unepolyarthrite rhumatoide) CABANEL, G., PHELIP, X., andVERDiER, J.-M. (1970) Rev. lyon. Mid., 19, 173 8 figs,24 refs

Types of Presentation of Rheumatoid Arthritis (Die Ers-cheinungsformen der chronischen Polyarthritis) SCHOEN,R. (1970) Med. Welt (Stuttg.), 21, 753 12 refs

Tarsal-Tunnel Syndrome: a Presenting Feature ofRheuma-toid Arthritis LLOYD, K., and AGARWAL, A. (1970)Brit. med. J., 3, 32 8 refs

Involvement of the Manubrio-Sternal Articulation inRheumatoid Arthritis LAITINEN, H., SAKSANEN, S., andSUORANTA, H. (1970) Acta rheum. scand., 16, 40 5 figs,8 refs

Microradiographic and Histological Study of the Manu-brio-Sternal Joint in Rheumatoid Arthritis KORMANO,M. (1970) Acta rheum. scand., 16, 47 21 figs, 18 refs

Positive Elbow Fat Pad Sign in Rheumatoid ArthritisJACKMAN, R. J., and PUGH, D. G. (1970) Amer. J.Roentgenol., 108, 812 7 figs, 11 refs

Terminology of Rheatoid Arthritis (Review) (DieTerminologie der primar chronischen Polyarthritis)MATHIES, H. (1970) KIln. Wschr., 48, 513 7 refs

Prevalence of Rheumatoid Arthritis in Densely and ThinlyPopulated Areas in Sweden HELLGREN, L. (1970) Actarheum. scand., 16, 18 17 refs

Rheumatoid Disease: Rheumatoid Arthritis as a SystemicDisease (La enfermedad reumatoidea. La artritis reuma-toidea como afeccion sist6mica) LASALA, F. G., andPODESTA, H. A. (1970) Pren. mid. argent., 57 149

Clinical Picture of Cases of Rheumatoid Arthritis withRheumatoid Nodules [In Polish] MALDYK, H., andSLOWINSKA, L. (1969) Reumatologia (Warsz.), 7, 3332 figs, 15 refs

Choroidal Nodules and Retinal Detachments in Rheuma-toid Arthritis. Improvement with Fall in ImmunoglobulinLevels following Prednisolone and CyclophosphamideTherapy HURD et al. (1970) Amer. J. Med., 48, 273

Rheumatoid Carditis KRA, S. J., and FAZZONE, P.(1970) Conn. Med., 34, 257 10 refs

Rheumatoid Arthritis in the Aged EHRLICH, G. E.,KATZ, W. A., and COHEN, S. H. (1970) Geriatrics, 25,103 2 figs, 15 refs

Rubella Infection of Synovial Cells and the Resistance ofCells derived from Patients with Rheumatoid ArthritisGRAYZEL, A. I., and BECK, C. (1970) J. exp. Med., 131,367 1 fig., 16 refs

Penicillamine and Rheumatoid Arthritis (Penicillamine etpolyarthrite rhumatolde. (etude de 9 observations))CAMUs et al. (1970) Ann. Med. intern., 121, 237

Ainhum-a Little Known Disease in African Immigrantsto France. Association with Rheumatoid Arthritis in 2Cases (Une maladie peu connue: I'Ainhum. Son associa-tion a une polyarthrite rhumatolde. A propos de 2 cas)ARsov, D., KkivmnE, J.-M., and KAHN, M.-F. (1970)Rhumatologie, 22, 1 4 figs, 11 refs

Systemic Manifestations of Rheumatoid Arthritis andAllied Disorders SALES, L. M. (1970) Sth. med. J. (Bgham,Ala.), 63, 543

Reversible Acute Renal Failure complicating RheumatoidArthritis WEGELIUS, O., and KLocKARS, M. (1970)Acta rheum. scand., 16, 161 4 figs, 12 refs

Rheumatoid Arthritis: Extra-articular Manifestations.H. (Stanley Davidson Lecture, Aberdeen) HART, F.DUDLEY (1970) Brit. med. J., 2, 747

Still's disease'Pseudorheumatoid' Nodules in Children: Report of 10Cases BURRINGTON, J. D. (1970) Pediatrics, 45, 4735 figs, 6 refs

572 Annals of the Rheumatic Diseases

Pituitary and Adrenal Functional Reserve in Childrenwith Rheumatoid Arthritis [In Polish] W6JcIK, T., andBARTKIEWICZ, H. (1969) Reumatologia (Warsz.), 7,347 26 refs

Radiological Diagnosis of Juvenile Rheumatoid Arthritis(Rontgendiagnostik der juvenilen Rheumatoid-Arthritis)LORENZ, K., and BERGER, G. (1969) Radiol. diagn.(Berl.), 10, 647 9 figs, 18 refs

Acid Phosphatase Activity in the Synovial Fluid of Childrenwith Juvenile Rheumatoid Arthritis BECKMAN, G.,BECKMAN, L., GoumFoRs, L., and LEMPERG, R. (1970)Acta paediat. scand., 59, 205 3 refs(see Abstr. Wid Med. (1970), 44, 696)

On the Etiology of Growth Disturbance of the Mandiblein Juvenile Rheumatoid Arthritis SAIRANEN, E. (1970)Acta rheum. scand., 16, 136 5 figs, 28 refs

OsteoarthrosisGeneralized Osteoarthrosis in a Population SampleLAWRENCE, J. S. (1969) Amer. J. Epidemiol., 90, 3812 figs, 1 ref.(see Abstr. WId Med. (1970), 44, 455)

Rapidly Destructive Osteoarthritis of the Hip (La coxar-throse destructrice rapide) LEQuEsNE, M. (1970) Rhuma-tologie, 22, 51 10 figs, 10 refs

Osteoarthritis of the Hip in Rheumatological Practice inLebanon (La coxarthrose en pratique rhumatologique auLiban) BITAR, E. (1970) J. mid. liban., 23, 69 17 refs

Bone Factor in Chronic Disease of the Hip Joint (Le fac-teur osseux dans les coxopathies chroniques) MEUNIER,P., VIGNON, G., and RAVAULT, P.-P. (1970) J. Mid. Lyon,51, 375 9 figs, 13 refs

Significance of the Magnitude of the Medial Hip JointSpace ANDERSON, J., and STEWART, A. M. (1970) Brit.J. Radiol., 43, 238 7 refs

Carpometacarpal Osteo-Arthritis of the Thumb SIMs,C. D., and BENTLEY, G. (1970) Brit. J. Surg., 57, 42213 figs, 6 refs

Subluxation of the Carpal Scaphoid ENGLAND (1970)Proc. roy. Soc. Med., 63, 581

Osteoarthritis and Osteitis with Multiple Foci in theCourse of Septicaemia due to 'Reading' Salmonellacomplicating Sickle-cell Thalassaemia (Ost oarthrite etosteite a foyers multiples au cours d'une septickmie aSalmonella 'Reading' compliquant une thalasso-drepano-cytose) DOURY, P. (1970) Rev. Rhum., 37, 359

Arteriographic Investigation of the Hip in Adult HumanSubjects: A Clinical Study of the Arteries in the HealthyHip, in Neck and Pertrochanteric Fractures, and inNecrosis of the Femoral Head MUSSBICHLER (1970)Acatos cartho p.nd., Suppl. 132

SpondylitisAnkylosing Spondylitis CALABRO and MALTZ (1970)New Engl. J. Med., 282, 606

Ankylosing Spondylitis and Rheumatoid Arthritis Hus-KISSON, E. C. (1970) Proc. roy. Soc. Med., 63, 620

Ankylosis in the Paralysed Patient WHARTON, G. W., andMORGAN, T. H. (1970) J. Bone Jt Surg., 52-A, 105 4figs, 14 refs

Acetabular Labrum in Ankylosing Spondylitis (Le bour-relet cotyloidien dans la spondylarthrite ankylosante)LOUYOT, P., GRAFF, J.-R., JUNG, G., and MONTET, Y.(1969) Rev. Rhum., 36, 569 5 figs

Atypical Forms of Ankylosing Spondylitis [An Analysis of236 Cases] (Les formes atypiques de la spondylarthriteankylosante (A propos de l'analyse de 236 observations))RAVAULT, P.-P., LEJEUNE, E., BOUVIER, M., JEANNERET,J., MEUNIER, P., QUENEAU, P., and ROBILLARD, J. (1970)Rev. Rhum., 37, 197 8 figs, 41 refs

Contribution of Electromyography of the Diaphragm tothe Study of the Dynamic Respiratory Reflexes in Anky-losing Spondylitis (Contribution de l'electromyographiedu diaphragm a l'etude des reflexes respiratoiresdynamiques dans la spondylarthrite ankylosante) DEL-HEZ, L., PIRNAY, F., BARZIN, J., and PETIT, J. M. (1969)J. beige Rhum. Mid. phys., 24, 209 1 fig., 17 refs

GoutUric Acid and Plasma Lipids in Cerebrovascular Disease.Part L. Prevalence of Hyperuricaemia PEARCE, J., andAzIz, H. (1969) Brit. med. J., 4, 78

Of sixty patients with cerebrovascular episodes, fourteenwere found to have sustained hyperuricaemia. It istherefore suggested that hyperuricaemia may be a pre-disposing factor to atheroma.[The definition of hyperuricaemia-values above 7 mg./100 ml. in males and 6 mg./100 ml. in females-wasobtained after reference to an undefined control group of200 subjects. Comparison of the two populations wasnot made by the proper statistical method and interpre-tation of the study is therefore slightly unsatisfactory.]

J. T. SCOTTPart H. Uric Acid-Plasma Lipid Correlations PEARCE, J.,and Azrz, H. (1970) J. Neurol. Neurosurg. Psychiat., 33,88

Blood from sixty patients with cerebrovascular diseasewas examined with reference to uric acid, cholesterol,free fatty acids, triglycerides, and phospholipids. Todetermine whether these results were abnormal, the per-centage of subjects having levels over the estimatednormal 95th percentile was compared with the estimated5 per cent. of normals, normal figures being obtainedfrom published sources. It was concluded that the patientsshowed raised levels of all the lipid fractions, especially inrespect of triglycerides. All the lipid fractions tended to

Abstracts 573

be elevated together, but these changes did not correlatewith hyperuricaemia.[The study and its interpretation would have been facili-tated by the inclusion of a control group.] J. T. SCOTT

Effect of Colchicine on Human Platelet BehaviourSopprrr, G. D., and MITCHELL, J. R. A. (1969) J. Athero-scl. Res., 10, 247 4 figs, 17 refs

Because of the capacity of colchicine to combine withmicrotubules, it has been found to inhibit clot retraction.The present investigation from the Department of Medi-cine, Nottingham University, extends this observation toother aspects of platelet behaviour.The effect of colchicine in various concentrations on

platelet aggregation produced by ADP, by nor-adrena-line, and by a connective tissue preparation ('collagen')was tested in vitro. In each instance, platelet aggregationwas inhibited, the degree of inhibition varying with theconcentration of colchicine. Colchicine was also shownto diminish platelet adhesiveness. By the use of -SHinhibitors it was demonstrated that the action of colchi-cine was probably not due to -SH blockade. By the use ofan acetylated analogue of colchicine it was further shownthat the inhibition of platelet aggregation by colchicinewas not due to the presence of an acetyl group.

It is concluded that, because of its capacity to inhibitplatelet retraction, aggregation, and adhesiveness, col-chicine may modify some fundamental property of plate-lets, perhaps related to their microtubular/contractileprotein system. D. L. GARDNER

Intestinal Malabsorption induced by Oral Colchicine.Comparison with Neomycin and Cathartic Agents RACE,T. F., PAES, 1. C., and FALOON, W. W. (1970) Amer. J.med. Sci., 259, 32 4 figs, 18 refs(See Abstr. Wid Med., (1970) 44, 587)

Treatment of Gout with Thiopurinol (with Reference to50 Cases) (Traitement de la goutte par le Thiopurinol(A propos de 50 observations)) SERRE, H., SIMON, L.,and CLAUSTRE, J. (1969) Rhumatologie, 21, 319 4 figs,4 refs(See Abstr. WId Med. (1970), 44, 456)

Liver Involvement in Gout (Leberbeteiligung bei Gicht)HENNECKE, A., and SiYDHOF, H. (1970) Dtsch. med.Wschr., 95, 59 3 figs, 17 refs(See Abstr. Wid Med. (1970), 44, 456)

Current Problems of Gout (Aktuelle Gichtprobleme)THIELE, P., HEIDELMANN, G., GXRTNER, A., SCHNEIDER,V., and TELLKAMP, F. (1970) Z. ges. inn. Med., 25, 45882 refs

Sacroiliac Gout associated with Hemoglobin E and Hyper-splenism LAMBETH, J. T., BURNS-COX, C. J., andMACLEAN, R. (1970) Radiology, 95, 413 2 figs, 13 refs

Radiological Appearance of the Spine in Gouty Patients[In Polish] KAWENOKI-MINC, E., and ZABOKRZYCKI, J.1969) Reumatologia (Warsz.), 7, 325 2 figs, 15 refs

Gout TALBOTT, J. H. (1970) Med. Clin. N. Amer., 54,431

Manifestations of Gout in the Hip (Manifestations de lagoutte i la hanche) QUEROL, J. R., and GOMEZ, J. M.(1970) Rhumatologie, 22, 77 2 figs, 4 refs

Gout and Myxoedema (Goutte et myxoed me) RUBENS-DUVAL, A., KAPLAN, G., and PANAHI, F. (1970) Rev.Rhum., 37, 333 6 refs

Dynamics of Metabolism in Gout (Dynamik des Stoff-wechsels bei Gichtkranken) MERTZ, D. P., PRASSE, D.,and KLOPFER-ZAAR, M. (1970) Med. Kin., 65, 790 3figs, 49 refs

Circadian Rhythm of Uricaemia (Ritmo circadiano en lauricemia) DE MORO, E. R., and DE DAHINTEN, N. M.(1970) Pren. mid. argent., 57, 241 2 figs, 27 refs

Renal Excretion of Uric Acid in Various Conditionscausing Hyperuricaemia (L'escrezione renale dell'acidourico in diverse condizioni iperuricemizzanti) CAGLI,V., RuOTOLO, V., BOSsINI, A., and BOLOGNA, E. (1970)Policlinico, Sez. prat., 77, 245 7 refs

Renal Function Studies with Radioisotopes in GoutyArthritis (Nierenfunktionsuntersuchungen mit Radio-isotopen bei Arthritis urica) WASCHER, H., KLEIN, G.,EBER, O., HAYN, H., and GOEBEL, R. (1970) Z. Rheuma-forsch., 29, 85 4 figs, 15 refs

Genetics of Gout and Hyperuricemia BAYANI-SIOSON,P. S., ZAFRA, R. G., and BELTRAN, L. (1969) Acta med.philipp., 6, 48 2 figs, 10 refs

Hyperuricemia and Neurologic Deficits: A Family StudyROSENBERG et al. (1970) New Engl. J. Med., 282, 992

Hyperuricaemia in Northern Finland ISOMAKI, H. (1969)Ann. clin. Res., Suppl. 1 to Vol. 1

Calcium Pyrophosphate Crystal Synovitis with ArticularChondrocalcinosis ('Pseudogout' Syndrome) WEBB, J.,CHAMPION, D. G., FRECKER, A. S., and ROBINSON, R. G.(1970) Med. J. Aust., 1, 466 26 figs, 21 refs

Disorder of Purine Metabolism due to Partial Deficiencyof Hypoxanthine-Guanine PhosphoribosyltransferaseKoGUT, M. D., DONNELL, G. N., NYHAN, W. L., andSWEETMAN, L. (1970) Amer. J. Med., 48, 148 10 figs,57 refs

Enzymopathic Types of Gout. Disorders of Purine Meta-bolism due to Deficiency of Hypoxanthine-GuaninePhosphoribosyltransferase. Frequency and Clinical Charac-teristics of the Enzyme Deficiency (Gouttes enzymo-pathiques. Dyspurinies par deficit en hypoxanthine-guanine phosphoribosyltransferase. Frequence et carac-teres cliniques de l'anenzymose) DELBARRE, F., CARTIER,P., AUSCHER, C., GtRY, A. DE, and HAMET, M. (1970)Presse mid., 78, 729 4 figs, 10 refs

574 Annals of the Rheumatic Diseases

Clinical Trial of L2214 in the Treatment of Gout orRheumatological Syndromes associated with Hyperuri-caemia (Essai clinique du L2214 dans le traitement de lagoutte ou des syndromes rhumatologiques associes aune hyperuric6mie) BOGAERT, PH. VAN (1969) J. beigeRhum. Mid. phys., 24, 295 1 fig, 5 refs

Hypouricaemic and Uricosuric Action of Benziodarone(Sull'azione ipouricemizzante ed uricosurica del benzio-darone) TADDEUCCI, E., and TERRENI, F. (1970) Minervamed., 61, 1771 25 refs

Benziodarone in the Treatment of Hyperuricaemis (IIbenziodarone nel trattamento delle iperuricemie)RAVERA, M. (1970) Clin. ter., 52, 407 5 figs, 24 refs

Colchicine Plasma Levels. Implications as to Pharma-cology and Mechanism of Action WALLACE et al. (1970)Amer. J. Med., 48, 443

Prevention of Hyperuricemia by Allopurinol in Hyperten-sive Patients treated with Chlorothiazide NICOTERO etal. (1970) New Engl. J. Med., 282, 133

Significance of the Deficiency State in Lesch-NyhanDisease GHADIMI et al. (1970) Acta paediat. scand., 59,233

Influence of Adenine on the Clinical Features and PurineMetabolism in the Lesch-Nyhan Syndrome VAN DER ZEEet al. (1970) Acta paediat. scand., 59, 259

Dins of Lesch-Nyhan Syndrome by Skin SpecimensFROsT et al. (1970) J. Amer. med. Ass., 212, 316

Other forms of arthritisRhizomelic Pseudopolyarthritis with Temporal Arteritisand Arteritis of the Lower Limbs (Pseudo-polyarthriterhizom6lique de l'art6rite temporale a l'arterite desmembres inf6rieurs) BASTIN, R., GODEAU, P., LAVERNHE,J., LEGER, L., and LEMAIGRE, G. (1969) Presse mid., 77,1649 3 figs, 16 refs

A review of temporal arteritis and its association witharteritis of the lower limbs and with rheumatism, with areport of one case.The patient was a woman aged 60 years, with scapular

and pelvic pain, fever, leucocytosis, anaemia with in-creased sedimentation rate, and changes in the plasmaproteins. She developed gangrene of the legs, requiringbilateral amputation. Histological examination of themain arteries of the legs showed giant-cell arteritis ofthe type seen in temporal arteritis, although biopsy ofthe right temporal artery failed to show any histologicalabnormality. In the affected vessels the media was in-filtrated with lymphocytes and other inflammatory cells:the intima showed fibrous thickening with obliteration ofsmall vessels: the internal elastic lamina was destroyedby granulomatous inflammatory tissue containing giantcells. Atheromatous changes were not present. Treatmentwith corticosteroid hormones was effective.

It is suggested that arteries other than the temporalartery can be involved by a giant-cell arteritis, that thisis more frequent than has been previously supposed, andthat as in the present case the involvement of otherarteries may dominate the clinical picture.

H. A. SISSONS

Chondrocalcinosis and Arthropathy: Studies in Haemo-chromatosis and in Idiopathic Chondrocalcinosis ATKINS,C. J., McIvoR, J., SMITH, P. M., HAMILTON, E., andWILLIAMS, R. (1970) Quart. J. Med., 39, 71 10 figs, 31refs

The arthropathy associated with chondrocalcinosis hasbeen compared in twenty patients with haemochromatosisand forty with idiopathic chondrocalcinosis at King'sCollege Hospital. In the idiopathic group, osteoarthritisaffecting the lumbar spine, hips, and knees was commonlyfound. In the haemochromatosis group, a specific arthro-pathy, mainly affecting the metacarpophalangeal joints,was present in sixteen, superficially resembling rheuma-toid arthritis, but without synovial thickening. X-rayexamination showed small cysts in the matacarpal heads,followed by degenerative changes but without anymarginal erosions of rheumatoid arthritis. Osteoarthriticchanges were also found in the elbows, shoulders, hips,and knees. Acute episodes of crystal synovitis wereequally frequent in either group, most commonly affect-ing the knee. Synovial biopsy revealed calcium pyro-phosphate crystals in six of 24 in the idiopathic group,but in none of seven with haemochromatosis, althoughiron deposits were identified in two of these. Fibrocarti-lage calcification was similar in the two groups, buthyaline cartilage calcification was significantly morecommon with haemochromatosis, and there was acorrelation between the degree of calcification and theseverity of arthropathy in this group, but not in theidiopathic group. A. B. MYLES

Articular Chondrocalcinosis and Rheumatoid Arthritis(Chondrocalcinose articulaire et polyarthrite chroniqueevolutive) SAPORTA, L., AMOR, B., GUIRAUDON, C.,BoNToux, D., HILA, A., MASSIAS, P., and DELBARRE, F.(1969) Rev. Rhum., 36, 647 9 figs, 19 refs(See Abstr. WId Med. (1970), 44, 628)

Primary Chondrocalcinosis Articularis. Its Relation toSex, Age at Onset, and Diabetes (Chondrocalcinosearticulaire primaire. Ses rapports avec le sexe desmalades, l'age des patients au debut de l'affection, lediabete) RADI, I., AMOR, B., BROUILHET, H., DELBARRE,F., and MARTIN, E. (1970) Rev. Rhum., 37, 263 188 refs

Articular Chondrocalcinosis and the Problem of Patho-genesis (La chondrocalcinose articulaire et son myst~repathogenique) SOLNICA (1970) Presse med., 78, 873

Rheumatic Lesions of the Sacroiliac Joint [In Dutch]BLACOURT, J. J. DE, and BLICKMAN, J. R. (1970) Ned. T.Geneesk., 114, 413 9 figs, 2 refs

Abstracts 575

Familial Coexistence of Chronic Rheumatic inflammatoryPolyarthropathies and Involvement of the SacroiliacJoints (Coexistence familiale de polyarthropathiesinflammatoires chroniques rhumatismales avec atteintedes articulations sacro-iliaques) FALLET, G.-H., MEYER,E., Orr, H., and RADI, I. (1970) Rev. Rhum., 37, 213 18figs, 28 refs

Gonorrhoea with Skin and Joint Manifestations WOLFFet al. (1970) Brit. med. J., 1, 271

Diabetic Arthropathy [In Swedish] AMTRUP, F. (1970)Nord. Med., 83, 627 4 figs, 9 refs

Septic Arthritis due to Vibrio fetus KUTNER, L. J., andARNOLD, W. D. (1970) J. BoneJt Surg., 52-A, 161 2 figs,11 refs

Ochronotic Arthropathy DETENBECK, L. C., YOUNG,H. H., and UNDERDAHL, L. 0. (1970) Arch. Surg., 100,215 5 figs, 15 refs

Investigations into the Hereditability of Psoriatic Arthro-pathy (Untersuchungen uber die Vererblichkeit desSyndroms Psoriasis arthropathica) VILAGHY, I., andKREBS, A. (1970) Dermatologica (Basel), 140, 209 8 refs

Intrafamilial Investigations in Psoriatic Arthritis (Intra-familiare Untersuchungen bei Psoriasis-Arthritis)THEIss, B., SCHNYDER, U. W., BONI, A., and WAGEN-HXUSER, F. (1969) Z. Rheumaforsch., 28, 403 2 figs, 103refs

Arthritis complicating Rubella SMITH and GUZOWSKA(1970) Med. J. Aust., 1, 845

Pseudoxanthoma Elasticum [PXE] and Joint Manifesta-tions SAIRANEN, E., ITKONEN, A., and KANGAS, S.(1970) Acta rheum. scand., 16, 130 2 figs, 12 refs

Bone diseaseSecondary Hyperparathyroidism in OsteomalaciaTHALASSINOS, N. C., WicHT, S., and JOPLIN, G. F.(1970) Brit. med. J., 1, 76 3 figs, 29 refs(See Abstr. WId Med. (1970), 44, 603)

Hypocalcaemic Primary Hyperparathyroidism KEYNES,W. M., and CAIRD, F. I. (1970) Brit. med. J., 1, 2081 fig., 45 refs(See Abstr. WId Med. (1970), 44, 449)

Treatment of Paget's Disease of Bone by RadiotherapyLEVISON, V. (1970) Ann. phys. Med., 10, 230 13 refs(See Abstr. WId Med. (1970), 44, 576)

Aseptic Necrosis of the Femoral Head (La necrose asep-tique de la tete femorale) LAGIER, R., MARTIN, E.,and RADI, I. (1970) Schweiz. med. Wschr., 100, 814 4figs, 21 refs

Non-Traumatic Necrosis of the Femoral Head. Part I.Relation of Altered Hemostasis to Etiology BoETrcHER,W. G., BONFIGLIO, M., HAMILTON, H. H., SHEETS, R. F.and SMITH, K. (1970) J. Bone Jt Surg., 52A, 312Part II. Experiences in Treatment BOETrCHER, W. G.,BONFIGLIO, M., and SMITH, K. (1970) J. Bone Jt Surg.,52A, 322

Possible Role of Fat Embolism in the Pathogenesis ofIdiopathic Necrosis of the Femoral Head (Zur moglichenRolle der Fettembolie in der Pathogenese der idio-pathischen Femurkopfnekrose) ScHmID, U., HARTMANNG., MORSCHIER, E., and ELKE, M. (1970) Schweiz. med.Wschr., 100, 820 2 figs, 28 refs

Hydroxyprolinuria in Bone Disease (L'hydroxyprolinurieau cours des affections osseuses) LEJEUNE, E., RUmrION,P., MEUNIER, P., and ORGIAZZI, J. (1970) J. Med. Lyon,51, 385 17 refs

Bilateral Talar Osteochondritis Dissecans with LaxAnkle Ligaments DAVIS, M. W. (1970) J. Bone Jt Surg.,52-A, 168 2 figs, 10 refs

Vertebral Hyperostosis and Diabetes Mellitus (Hyperos-tose vertebrale et diabe'e sucre) LEQuEsNE, M., CASSAN,P., NALLET, J., RYCKEWAERT, A., and StZE, S. DE (1970)Rev. Rhum., 37, 281 3 figs, 14 refs

Non-articular rheumatismAnalysis of Cauda Equina Symptoms in Patients withLumbar Disc Prolapse AHO, A. J., AURANEN, A., andPESONEN, K. (1969) Acta chir. scand., 135, 413 1 fig,36 refs

There have been nineteen cases between 1963 and 1966at the Department of Surgery, Turku University, inwhich a patient with lumbar disc prolapse has also hadurinary symptoms for from 1 to 7 days. This study isprincipally concerned with eighteen such patients treatedby immediate surgery: this group is compared withanother 98 patients operated upon during the sameperiod for uncomplicated lumbar disc prolapse. Mostpatients had a short history of dorsal pain radiating tothe extremities. The straight-leg raising test was positiveand there was some loss of sensation in all patients: theresidual urine exceeded 500 ml. in fifteen patients. Follow-up examinations were made in seventeen cases at from6 mths to 3 yrs after operation. Motor and sensorydisturbances showed little change. Mild urinary symp-toms were present in about 30 per cent. of cases. Urinaryfunction was studied by cystometry: an atonic bladderwas present in about 70 per cent., but the residual urineexceeded 10 ml. in only 25 per cent. and none hadureteral reflux. All patients were at work after 6 months,but some had to change to lighter occupations.

A. J. PALFREY

Predictive Value of Myelography in the Diagnosis ofRuptured Lumbar Discs HUDGINS, W. R. (1970) J.Neurosurg., 32, 152 2 figs, 26 refs(See Abstr. WId Med., (1970) 44, 654)

576 Annals of the Rheumatic Diseases

Effects of Torsion on the Lumbar Intervertebral Joints:The Role ofTorsion in the Production ofDisc DegenerationFARFAN, H. F., CossEITE, J. W., ROBERTSON, G. H.,WELLS, R. V., and KRAUS, H. (1970) J. Bone Jt Surg.,52-A, 468 22 figs, 32 refs

Aetiology of Juvenile Spondylarthritis [Discitis] ALEX-ANDER, C. J. (1970) Clin. Radiol, 21, 178 11 figs, 34refs

Cervical Spondylosis with Radioculopathy JACOBS, B.,KRUEGER, E. G., and LEIWY, D. M. (1970) J. Amer. med.Ass., 211, 2135 3 figs, 14 refs

Lumbo-Sacral Strain Syndrome INGPEN, M. L., andBURRY, H. C. (1970) Ann. phys. Med., 10, 270 8 refs

Effect of Spinal Supports on the Electrical Activity ofMuscles of the Trunk WATERS, R. L., and MORRIS, J. M.(1970) J. Bone Jt Surg., 52-A, 51 5 figs, 13 refs

Low-Frequency Therapy with Interference Current inScapulo-humeral Periarthritis (Niederfrequenztherapiemit Interferenzstrom bei Periarthritis humeroscapularis)NIKOLOVA, L. (1970) Munch. med. Wschr., 112, 472 12refs

Dimethyl Sulphoxide in the Treatment of Scapulo-humeral Periarthrosis [In Danish] RASMUSSEN, G.,ANDERSEN, R. B., and SCHLEDERMANN (1970) Ugeskr.Laeg., 132, 832 5 refs

Electromyography in the Tarsal Tunnel Syndrome (L'6lec-tromyographie du syndrome du tunnel tarsien) SkZE,S. DE, DREYFus, P., DENIS, A., HAMONET, Cl., HEULEU,J.-N., and LEGEAY, A. (1970) Rev. Rhum., 37, 189 2 figs,27 refs

Calcifying Tendinitis (Tendinites calcifiantes) SiZE, S.DE, and WELFLING, J. (1970) Rhumatologie, 22, 45 2 refs

Acute Tendinitis Calcarea HAUPTMAN, H. A. (1970)N. Y. St. J. Med., 70, 955 5 figs, 18 refs

Localization of Calcific Deposits in the Shoulder VIGAROand KEATS (1970) Amer. J. Roentgenol., 108, 806

Connective tissue studies

Collagen Blundle Regulation and Control [Biocybernetics]DE CAMPOS VIDAL, B. (1969) Rev. bras. Pesq. med. biol.,2, 356 1 fig., 12 refs

Regulation of Collagen and Hyaluronate Formation inHuman Synovial Fibroblast Cultures CASTOR, C. W.,RowE, K., DORSEWITZ, E. L., WRIGHT, D., and RrrcHiE,J. C. (1970) J. Lab. clin. Med., 75, 798 6 figs, 23 refs

Studies of Articular Cartilage following Infarction of theCapital Femoral Epiphysis in the Puppy ZAHIR et al.(1970) Proc. roy. Soc. Med., 63, 583

Articular Cartilage Changes in Early Arthritis JANIS, R.,ardd HAMERMAN, D. (1969) Bull. Hosp. Jt Dis. (N. Y.), 30,136 3 figs, 33 refs

Effect of Polysaccharides on the Water-binding Capacityof Collagen (Die Beeinflussung der Wasserbindungs-kapazitat von Kollagen durch Glykosaminoglykane)WEIGEL, W., JASINSKI, B., and IWANGOFF, P. (1969)Z. Rheumaforsch., 28, 429 1 fig., 10 refs

Urinary Polypeptides related to Collagen SynthesisKRANE, S. M., MUfqOZ, A. J., and HARRIS, E. D., JR.(1970) J. clin. Invest., 49, 716 8 figs, 44 refs

Consideration of Pathogenesis of Rheumatoid Arthritis asCollagen Autoimmunity STEFFEN, C. (1970) Z. Immun.-Forsch., 139, 219 1 fig., 37 refs

Histological Observations on Experimentally-inducedDegeneration of Articular Cartilage THOMPSON, R. C.,and BASSETT, C. A. L. (1970) J. Bone Jt Surg., 52-A, 4357 figs, 11 refs

Experimental Study of the Effects of Growth on theRelationship of Tendons and Ligaments to Bone at theSite of Diaphyseal Insertion VIDEMAN (1970) Acta orthop.scand., Suppl. 131

Tendon and Ligament Insertion. A Light and ElectronMicroscopic Study COOPER, R. R., and MISOL, S.(1970) J. Bone Jt Surg., 52 A, 1 13 figs, 76 refs

Periarticular Microscopic Changes in Bones in Rheuma-toid Arthritis [In Polish] MALDYK, E. (1969) Reumato-logia (Warsz.), 7, 281 5 figs, 16 refs

Ultrastructure of Dermal Lesions in Systemic LupusErythematosus GRISHMAN, E., and CHURG, J. (1970)Lab. Invest., 22, 189 11 figs, 21 refs

Arthrography of the Ankle MEHREZ, M., and ELGENEIDY, S. (1970) J. Bone Jt Surg., 52-B, 308 11 figs,16 refs

Microscopic Appearance of Synovia in Cases of Rheuma-toid Arthritis [In Polish] WAGNER, T. (1969) Rheumato-logia (Warsz.), 7, 295 4 figs, 28 refs

Cultures of the Synovial Membrane Lining Cells [InPolish] ABGAROWICZ, T., and KoZIoRowSKA, J. (1969)Reumatologia (Warsz.), 7, 291 1 fig., 6 refs

Characteristic Changes in Esterase and Peroxydase Iso-enzymes in the Synovial Tissue in Rheumatoid Arthritis(Ober charakteristische Unterschiede von Esterase-undPeroxydase-Isoenzymen in synovialem Gewebe beiprogressiv chronischer Polyarthritis) EBERL, R., andALTMANN, H. (1970) Z. Rheumaforsch., 29, 98 3 figs,8 refs

Abstracts 577

P Phenomenon in Synovial Fluid (Das P-Phanomen inder Synovialflissigkeit) KOTZ, R., CHLUD, K., andFRIZA, B. (1969) Z. Rheumaforsch., 28, 425 1 fig., 10refs

Lubrication of Synovial Joints: Possible Significance ofFat FREEMAN et al. (1970) Proc. roy. Soc. Med., 63,579

Malignant Synovioma KOGSTAD, 0. (1970) Acta rheum.scand., 16, 81 7 figs, 16 refs

Studies of the Third Component of Complement in Syno-vial Fluid from Arthritis Patients. II. Conversion and itsRelation to Total Complement HEDBERG et al. (1970)Clin. exp. Immunol., 6, 707

Plasma Kinins in Synovial Exudates EISEN, V. (1970)Brit. J. exp. Path., 51, 322 3 figs, 19 refs

Pararheumatic (collagen) diseasesReserpine in Raynaud's Disease and Phenomenon. Short-term Response to Intra-arterial Injection WILLERSON,J. T., THOMPSON, R. H., HOOKMAN, P., HERDT, J., andDECKER, J. L. (1970) Ann. intern. Med., 72, 17 11 figs,25 refs(See Abstr. WId Med. (1970), 44, 526)

Scleredema and Diabetes Mellitus FLEISCHMAJER, R.,FALUDI, G., and KROL, S. (1970) Arch. Derm., 101,21 3 figs, 16 refs(See Abstr. WId Med. (1970), 44, 559)

'Rheumatoid' Nodules in Systemic Lupus ErythematosusHAHN, B. H., YARDLEY, J. H., and STEVENS, M. B. (1970)Ann. intern. Med., 72, 49 5 figs, 8 refs(See Abstr. WId Med. (1970), 44, 548)

Neurologic Manifestations in Progressive SystemicSclerosis GORDON, R. M., and SILVERSTEIN, A. (1970)Arch. Neurol., 22, 126 44 refs(See Abstr. Wid Med. (1970), 44, 548)

Sjogren's Syndrome in Relation to Pernicious Anaemiaand Idiopathic Addison's Disease WILLIAMSON, J.,PATERSON, R. W. W., MCGAVIN, D. D. M., GREIG, W. R.,and WHALEY, K. (1970) Brit. J. Ophthal., 45, 31 35 refs(See Ophthal. Lit., vol. 24)

Perforating Scleromalacia and Collagenous Disease(Scleromalacia perforante et collagenose) FRANCOIS, J.,VICTORIA-TRONCOSO, V., HASsNENS, M., and BACAKULIN,J. (1969) Ophthalmologica (Baset), 159, 71 13 figs, bibl.(See Ophthal. Lit., vol. 23)

Retinopathy in Polymyositis (Retinopathie bei poly-mYOSitiS) OTRADOVEC, J., STIBOR, V., and SUTA, M.(1970) Klin. Mbt. Augenheilk., 156, 498 7 figs, 12 refs(See Opthal. Lit., vol. 24)

Acute Myositis of the Extraocular Muscles and ErythemaNodosum SACHS, W., MANDEL, D., and COHEN, E.(1969) Harefuah, 77, 239(See Ophthal. Lit., vol. 23)

Myxovirus Antibody Increases in Human ConnectiveTissue Disease PHILLIPS, P. E., and CHRISTIAN, C. L.(1970) Science, 168, 982 22 refs

Skin Involvement in Autoimmune Diseases and Colla-genoses (Hautbeteiligung bei Autoaggressionskrankheitenund Kollagenosen) HOFMANN, N. (1970) Med. Welt(Stuttg.), 21, 415 12 refs

Cardiac Involvement in Collagen Diseases (Herzerkran-kungen bei Kollagenosen) KROScH, H., SCHABITZ, J.,and RIKIRSCH, P. (1970) Z. ges. inn. Med., 25, 424 3figs, 65 refs

Connective Tissue Disease following Anti-Epileptic TherapyDANO, P. (1969) Epilepsia (Amst.), 10, 481 19 refs

Involvement of the Eyes in Collagen Diseases (Augen-beteiligungen bei Kollagenosen) MEYTHALER, H. (1970)Med. Welt (Stuttg.), 21, 1018 9 refs

Double Vision and Temporal Arteritis MARTIN, E. A.(1970) J. Irish med. Ass., 63, 191 6 refs

Takayasu's Syndrome and Lupus Disease (Syndrome deTakayasu et maladie lupique) SIGUIER et al. (1970)Ann. Med. intern., 121, 531

Articular Manifestations of Takayasu's Disease (Lesmanifestations articulaires de la maladie de Takayasu)SERRE, H., SIMON, L., and LAMBOLEY, C. (1970) Sem.H6p. Paris, 46, 1587 5 figs, bibl.

Cytotoxic Serum Factor in Polyarteritis Nodosa andRelated Conditions YUST et al. (1970) Amer. J. Med.,48, 472

Polyarteritis Nodosa of the Gallbladder REMIGIO, P.,and ZAINO, E. (1970) Surgery, 67, 427 6 figs, 8 refs

Proliferative Myositis HEYDEN et al. (1970) Acta path.microbial. scand., 78A, 33

SjOgren's Syndrome and Renal Tubular Acidosis SHioJIet al. (1970) Amer. J. Med., 48, 456

Familial Scleroderma with Sj6gren's Syndrome andLymphocytic and Chromosomal Abnormality (Sclero-dermie familiale avec syndrome de Sjogren et anomalieslymphocytaires et chromosomiques) CAMUS, J.-P.,EMERIT, I., GUILLIEN, R. P., CROUZET, J., and FOUROT, J.(1970) Ann. Med. intern., 121, 149

Radiographic Features of Sj6gren's Syndrome SILBIGER,M. L. (1970) Geriatrics, 25, 114 4 figs, 10 refs

578 Annals of the Rheumatic Diseases

Relationships between Progressive Scleroderma andliant Tumours (Uber die Beziehungen zwischen

progressiver Sklerodermie und malignen Tumoren)HOLZMANN, H., and FRISCH, W. (1970) Arztl. Forsch.,24, 129 2 figs, 89 refs

Progressive Heart Block in a Case of Scleroderma BARR,I. M., ABRAMov, A., DREYFUSS, F., YAHIN, J. H., andNEUFELD, H. N. (1970) IsraelJ. med. Sci., 6, 373 5 figs,14 refs

Treatment of Scleroderma by Rheomacrodex ALANI,M. D. (1970) Acta derm.-venereol. (Stockh.), 50, 13720 refs

Clinical Picture of Articular Chagnes in ProgressiveSystemic Sclerosis in Children [In Polish] SZYMA14SKA-JAGIELLO, W., and RoNDIo, H. (1970) Rheumatologia(Warsz.), 8, 1 4 figs, 37 refs

Systemic Sclerosis associated with Auto-Immune Haemo-lytic Anaemia CHAvEs et al. (1970) Brit. J. Derm., 82,298

Radiological Appearance of Osteoarticular Changes inProgressive Systemic Sclerosis in Children [In Polish]JAKUBOWSKA, K., RoNDio, H., and SZYMAN'SKA-JAGIELLO,W. (1970) Reumatologia (Warsz.), 8, 11 4 figs, 29 refs

Scleroderma as a Systemic Disease in DermatologicalPractice ZIPRKOWSKI, L., and FIENSTEIN, A. (1970)Harefuah, 78, 344 (English summary, p. 366) 16 figs,1 5 refs

Measurement of Creatine Phosphokinase in Patients withScleroderma and Dermatomyositis (Die Bestimmung derKreatin-Phosphokinase bei Sklerodermie und Derma-tomyositis-Kranken) DEBRECZENI, M., and LADANYI,JP. (1970) Hautarzt, 21, 81 7 refs

Clinical Features and Prognosis of Renal Manifestationsof Lupus Erythematosus (Zur Klinik und Prognose derNierenmanifestationen bei Lupus erythematodes)HARTL, W., Roos, R., and GENTH, E. (1970) Klin.Wschr., 48, 711 11 figs, 56 refs

Polymorphous Light Eruption and Lupus ErythematosusFisher et al. (1970) Arch. Derm., 101, 458

Nature of Discoid Lupus Erythematosus HAIM, S., andSHAFRmR, A. (1970) Acta derm.-venereol. (Stockh.), 50,86 2 figs, 16 refs

Liver in Disseminated Lupus Erythematosus; Hepatitisand Cirrhosis with Autoantibodies (Foie du lupus ery-th6mateux dissemin6; h6patites et cirrhoses avec auto-anticorps) FRAssE, H., BEETscHEN, A., DUVERNE, J.,BARIL, A., BRlmzni, C.-P., and tTAIX, J.-P. (1970) J.MMd. Lyon, 51, 1067 1 fig., bible.

Disseminated Lupus Erythematosus as the Rheumatol-gist sees it Today (Le visage actuel pour le rhumato-logue du lupus erythemateux dissemin6) KAHN, M. F.,and SZE, M. DE (1970) Rhumatologie, 22, 65 12 refs

Clinical Picture of Systemic Lupus Erythematosus in theLast Two Decades [In Czech] VACHTENHEIM, J. (1970)Vnitfni Lek., 16, 105 1 fig., 11 refs

Familial Aspects of Systemic Lupus Erythematosus.Report of Three Cases in One Family [In Portuguese]FILHo, A. C. (1969) Rev. Ass. mid. Minas Gerais, 20, 1971 fig., 16 refs

Errors in the Diagnosis of Systemic Lupus Erythematosus(Irrtumer bei der Diagnose des systematisierten Lupuserythematosus) CRuz-FILHo, A., and SCHULER, B.(1970) Z. Rheumaforsch., 29, 102 23 refs

Systemic Lupus Erythematosus BRANDSMA et al. (1970)Angiology, 21, 172

Type 1 Dysgammagiobulinemia, Systemic Lupus Ery-thematosus, and Lymphoma SMTnH et al. (1970) Amer.J. Med., 48, 113

Systemic Lupus Erythematosus. Transmission of ClinicalManifestations and Biological Factors from the Motherto the Newborn Infant (Lupus eryth6mateux systemnique.Transmission de manifestations cliniques et de facteursbiologiques de la mere au nouveau-n6) CRUVEILLER, J.,HARPEY, J.-P., VERON, P., CANNAT, A., DELATTRE, A.,HERVET, E., LAFOURCADE, J., and TuRPIN, R. (1970)Arch. franc. Pjdiat., 27, 195 3 figs, 45 refs

Clinical Observations on Systemic Lupus Erythematosus(Considerazioni cliniche sul lupus eritematodes sistemico)MACCHIONI, P., JUDICA-CORDIGLIA, A., and PANATARO,C. (1970) Minerva med., 61, 908 2 figs, 14 refs

Occurrence of Systemic Lupus Erythematosus in Associa-tion with Ethosuccimide Therapy DABBOUS and IDRISS(1970) J. Pediat., 76, 617

Comparison of the Microangiopathy of Systemic LupusErythematosus, Dermatomyositis, Scleroderma, and Dia-betes Mellitus NORTON, W. L. (1970) Lab. Invest., 22,301 14 figs, 20 refs

SLE-Like Deposition of Immunoglobulins in the Skin inRosacea SALO, P. 0. (1970) Ann. clin. Res., 2, 28 1fig., 9 refs

7S and 19S Isoagglutiins in Systemic Lupus Erythema-tosus BAUM, J. (1970) Acta rheum. scand., 16, 1 1 fig.,10refs

Wegener's Granulomatosis [In Russian] EREMENKO,N. S. (1969) Oftal. Zh., 24, No. 5, p. 386

Clinicopathologic Conference: Wegener's GranulomatosisWASHINGTON UNIvERsrrY SCHOOL OF MEDICINE (1970)Amer. J. Med., 48, 496

Pseudotumor of the Orbit and Limited Wegener's Granu-lomatosis CASSAN et al. (1970) Ann. intern. Med., 72,687

Abstracts 579

Immunology and serology

Immune Complexes in Rheumatoid Synovitis: A MixedStaining Immunofluorescence Study BONOMO, L., TuRsi,A., TRIzio, D., GILLARDi, U., and DAMMAcco, F. (1970)Immunology, 18, 557

This study describes the demonstration of immune com-plexes in rheumatoid synovial tissue. It deals with thedetection, by immunofluorescence microscopy, of invivo formed deposits containing IgG and rheumatoidfactor (RF), and IgG and complement component (,iLc).The presence of such complexes, involving complementRF, and antibody globulin has been suspected from otherobservations, including that of low levels of complementin rheumatoid synovial fluid, but it has hitherto not beendemonstrated.The authors, working at the University of Bari Medical

School in Italy, examined synovial tissue from sevensero-positive and three sero-negative rheumatoid patients,and from two controls. Immunoelectrophoretically pure,specific antisera of human and rabbit origin, conjugatedwith contrasting fluorescent dyes were used to visualizethe components of the immune deposits by mixed directstaining of tissue section.

Sections of synovial tissue from the seven sero-positive patients contained IgG-RF complex, and allten patients had IgG-filc synovial deposits. No specificfluorescence was seen in control sections. The distributionwas similar in all patients and with both types of depositin the interstitial connective tissue, in vessel walls andperivascular areas, and in the cytoplasm of tissue phago-cytes. However, the patterns differed in that IgG-31Lcformed smaller and more numerous connective tissuefoci than IgG-RF, and the latter was present to a greaterextent in vessel walls, while TgG-/3lc stained mainlyperivascular tissue.These findings are discussed in the light of hypotheses

concerning pathogenicity and the role of RF in rheuma-toid arthritis. K. RHODES

Serum Immunogobulin and PlC/IP1A Globulin Levels inRheumatoid Arthritis WASASTJERNA, C., and EKELUND, P.(1969) Acta med. scand., 185, 469 2 figs, 26 refs

Serum total Ig, IgG, IgA, IgM, and 41A globulin (whichis closely correlated with total complement activity)were estimated by a radial immunodiffusion method in55 patients with rheumatoid arthritis and 48 'controls'(blood donors), both groups being divided into approxi-mately equal groups aged < 55 years or > 55 years.

The mean Ig, IgG, IgA, and IgM were higher in thepatients than in the controls, though when age was takeninto consideration the difference with respect to IgA andIgM was not significant. The increase in IgG and Iglevels was greater in patients with a relatively high ESRand low haemoglobin levels. No significant difference in41A values were found between patients and controls.

In controls, total Ig and IgG rose with age whereasIgM fell. In the patients there was no relation with age.In patients but not in normals IgA levels were higher inmales than females. 161A was positively correlated withtotal Ig and with IgG in patients but not in controls.

J. BALL

Elevated IgG Antiglobulins in Patients with Seronegative-Rheumatoid Arthritis TORRIGIANI, G., RoIrr, I. M.,LLOYD, K. N., and CORBETT, M. (1970) Lancet, 1, 144 figs, 12 refs

The authors, working in the departments of immunologyand rheumatology at the Middlesex Hospital, London,have previously reported that a large proportion of so-called sero-negative rheumatoid arthritics possess rheu-matoid factors of the IgG class. These were detected byadsorption upon insoluble cross-linked rabbit gammaglobulin (Cohn fraction II), elution at low pH, andquantitative estimation by radial diffusion on Mancinitype plates.The present study compares the results obtained when

insoluble cross-linked horse y-globulin was used inplace of the rabbit globulin. With very few exceptionshigher values were obtained with the horse globulinadsorbent. By the use of this method many more of theseronegative rheumatoid arthritics gave results well out-side the range found in normal and osteoarthritis subjects.The result also suggest a positive correlation between theamount of IgG antiglobulin and the activity and extentof the disease. L. E. GLYNN

Rheumatoid Anti-Gm Factors with Specificity for thepFc' Subfragment ofHuman Immunoglobulin G NATVIG,J. B., and TuRNER, M. W. (1970) Nature (Lond.), 225,855

Studies on the sites of the determinants on the IgGmolecules reactive with rheumatoid factors have localizedthese to the Fc portion of the heavy chains. Several ofthese determinants are allotypic, i.e. they are present insome individuals but not in others and their presenceis genetically controlled. Amongst these determinantsare those of the Gm system but, although their existencewas first discovered by the use of rheumatoid sera, somedoubt has been thrown upon the specificity of these seraand in consequence studies of the Gm groups are nowusually made using nonrheumatoid anti-Gm reagentschiefly derived from individuals who have received mul-tiple transfusions.The present study from the Rikshospitalet University

Hospital, Oslo, and the Institute of Child Health,London, shows that the anti-Gm activity of rheumatoidsera can indeed be specific, although some four to eighttimesless sensitive than correspondingnon-rheumatoid re-agents. The specificity of these rheumatoid anti-Gmreagents was especially well shown when a fragment ofthe Fc portion referred to as pFc' and carrying the Gm(Xc) grouping was used to inhibit the agglutination systememployed. This pFc' fragment is a dimeric subunit of26,000 mol.wt. derived from the C terminal end of theheavy chains. The other Gm groups studied (x, g, and b)apparently have their determinate sites further towardsthe free amino end of the heavy chains. L. E. GLYNN

Altered Reactivity in Mixed Lymphocyte Culture ofLymphocytes from Patients with Rheumatoid ArthritisASTORGA, G. P., and WnILAM, R. C., JR. (1969) Arthr.and Rheum., 12, 547 3 figs, 17 refs

A series of 22 patients with classical rheumatoid arthritis,six of whom were on small doses of corticosteroid, and

J

580 Annals of the Rheumatic Diseases

controls from among healthy blood-bank volunteers,were investigated using a one-way stimulation mixedlymphocyte culture (MLC). In fourteen of 22 experimentsthe rheumatoid arthritis lymphocytes showed no mutualstimulation, but in another eight cultures pairs the cellsshowed positive responses as much as six times abovebase-line values. When mitomycin-treated lymphocytesfrom normal subjects were cultured with lymphocytesfrom patients with rheumatoid arthritis, the normal cellsproduced marked cell stimulation in sixteen of the 22pairs tested; there was no stimulation in the remainingsix pairs. When control normal lymphocytes were cul-tured with stimulating rheumatoid arthritis lymphocytes,marked blast transformation occurred in nineteen of the22 experiments. The difference in response among variouspairs of rheumatoid arthritis lymphocytes was con-sistent when re-studied on two or three occasions. Ifthere was apparent lack of MLC cell response, the capa-city for lymphocyte stimulation was verified by positivephytohaemagglutinin response.The lack of cross-stimulation could not be correlated

with the presence or absence of serum anti-gammaglobu-lin factors nor with the use of anti-inflammatory drugs.The apparent lack of mutual lymphocyte response ob-served among the rheumatoid pairs studied may berelated to critical ratios of mixed cells. No explanationcould be given for these results; it was suggested thatheterogeneity within the lymphoid system may be alteredin patients with rheumatoid arthritis, so that the cellscapable of responding to histoincompatibility antigensis in some way altered. B. M. ANSELL

Cardioglobulin: Tissue Localization and Plasma Activitywith Special Reference to Cardiovascular Disease andLupus Erythematosus LEONARD, E. J., MAXIMIN, T. J.,and HAJDU, S. (1968) Circulat. Res., 22, 527 4 figs, 8 refs

Mammalian plasma contains a group of proteins, cardio-globulins, which together mediate increased contractilityof isolated frog heart, according to previous reports ofthese authors. Plasma cardioglobulin A is increased inpatients with hypertension and aortic stenosis, and plasmacardioglobulin C is decreased in some patients with con-gestive heart failure. The present report deals with thelocalization of cardioglobulin C in tissues. Frog heartspretreated with human cardioglobulin B and rat cardio-globulin C were purified with guinea-pig antiserumagainst rat cardioglobulin C. This inhibited the effect ofsubsequently purified cardioglobulin A. Fluorescentstaining (by a method inadequately described) showedbinding of anticardioglobulin C antibody on the frogheart muscle. On sections, the same antiserum showedbinding with various rat tissues, including intercellularmaterial in muscle and apparently basement membranein kidney. Further investigations of cardioglobulinlevels in human plasma showed especially low levels in24 cases of systemic lupus erythematosus, but normallevels in seventeen cases of rheumatoid arthritis or otherconnective tissue disease. The authors suggest that plasmaconcentrations of cardioglobulin may vary inversely withtissue activity, and that the low plasma concentrationsin systemic lupus erythematosus may indicate the func-tional significance of cardioglobulins in the tissues.

E. J. HOLBOROW

Removal of Aggregated and Nonaggregated AutologousGamma Globulin from Rheumatoid Joints SLIwINSKI,A. J., and ZVAIFLER, N. J., (1969) Arthr. and Rheum., 12,504 5 figs, 17 refs

The authors, at Georgetown University Hospital, ex-amined the effects of IgG injection into knee joints inthe presence and absence of rheumatoid factor. Reducedand alkylated IgG is a particularly suitable material,since it does not cause inflammation by itself.

Eleven patients with rheumatoid arthritis were studied,and two with degenerative joint disease. Autologous IgGwas produced from serum by DEA cellulose chromato-graphy. This was treated with 2-mercapto-ethanol.Radio-labelling was with 1311 or 1251. Heat-aggregationwas at 630C. for 15 to 30 minutes. Albumin was heatedmore strongly. An external counter was used for body-counting.

It was found that the rate of protein removal, thoughvariable from patient to patient, was faster the greaterthe inflammation of the joint. Although albumin is atfirst removed faster, the rate after the first 2 days issimilar to that of IgG or reduced IgG, which are removedat similar rates. However, heat aggregation of reducedautologous IgG enhanced the rate of removal from thejoint, in both rheumatoid and osteoarthritic patients.Heat-aggregated albumin was also removed morequickly. An inflammatory joint reaction was noted inonly one of the 24 injections in all thirteen patients.During the reaction there was delayed removal of IgGand reduced IgG. G. LOEWI

Agmmamglobulinaemia with Polyarthritis and Subcutane-ous Nodules BARNETr, E. V., WINKELSTEIN, A., andWEINBERGER, H. J. (1970) Amer. J. Med., 48, 40 7 figs,34 refs

This paper from the Department of Medicine, UniversityCollege of Los Angeles, describes a study of a 4-year-oldboy with polyarthritis, no detectable serum immuno-globulin, a normal delayed hypersensitivity response, andsubcutaneous nodules resembling rheumatoid noduleshistologically but in atypical sites.The patient's parents were healthy, but their cultured

blood lymphocytes showed defective uptake of thymidineand only half the expected number of immunoglobulin-producing cells. The patient's lymphocytes transformedin the presence of phytohaemagglutinin but did notproduce immunoglobulins.

Cells containing immunoglobulins were found in thesynovium in which complement was also detected.Synovial fluid complement was depressed; its immuno-globulin content was 2- 5 mg. per cent. for IgG (comparedwith less than 0-019 mg. per cent. in the serum); it con-tained no ragocytes; rheumatoid factor was detectedonly at a titre of 1: 2. The authors conclude that locally-produced complement-fixing antibodies may be respon-sible for the arthritis but that ragocytes cannot be impli-cated.The patient's nodules, which disappeared after treat-

ment with gammaglobulin, contained neither immuno-globulins nor complement. J. BALL

Abstracts 581

Lymphocyte Transformation in Patients with AmyloidosisLEHNER, T., CAMERON, J. S., and WARD, R. G. (1970)Clin. exp. Immunol., 6, 439 20 refs

This paper, from Guy's Hospital Medical School, in-vestigates whether there is any impairment of cellularimmunity, as judged by the lymphocyte transformationtest, in patients with amyloidosis. Seven patients withbiopsy-verified renal amyloidosis were investigated,together with nine controls. The test was carried outaccording to a method previously described, using phyto-haemagglutinin (PHA), purified protein derivative (PPD),extract of Candida albicans, herpes simplex virus, and ahomogenate of foetal liver as antigens. In addition, amy-loid fibrils, prepared by differential centrifugation fromthe liver of a patient with primary amyloidosis, wereused. Only the test involving stimulation with herpessimplex virus revealed any impairment of cell-mediatedimmunity in the amyloid group. Stimulation by theamyloid fibrils caused lymphocyte transformation infive out of seven patients with amyloid, but also in threeout of eight healthy controls. The reaction is thus in-sufficiently specific to be used as a diagnostic test foramyloidosis. J. R. DALY

Rheumatoid Rosette Phenomenon. I. New Technique forDetection of the Rheumatoid Factor at Cell Level. (Lephenomene de la rosette rhumatoide. I. Nouvellemethode de detection du facteur rhumatoide au niveaucellulaire) BACH, J.-F., DELRIEU, F., and DELBARRE, F.(1970) Presse med., 78, 301 17 refs(See Abstr. WId Med. (1970), 44, 577)

Complement in Rheumatoid Inflammation. [Review Articlein English] NATVIG, J. B., and WINCHESTER, R. J. (1969)Acta rheum. scand., 15, 161 Bibl.

Altered Immunoglobulin Metabolism in Systemic LupusErythematosus and Rheumatoid Arthritis LEVY, J.,BARNETT, E. V., MACDONALD, N. S., and KLINENBERG,J. R. (1970) J. clin. Invest., 49, 708

Importance of the Latex Test in Uveitis [In PolishjHORODEN4SKI, J. (1969) Klin. oczna, 39, 855 10 refs(See Ophthal. Lit., vol. 23)

Genetic Studies on the Gc Protein Group System inRheumatoid Arthritis in Adults: Distribution of theCharacteristics of the Gc System and their Heredity inThree Generations [In Polish] BANIOWSKI, A. (1970)Acta med. pol., 11, 59 19 refs

BetalA-(C13)-Globulin Concentration in the Serum inAcute and Chronic Renal Disease, Liver Disease, andRheumatic Diseases (Die Beta-1A-Globulin-(C'3-)Konzentration im Serum bei akuten und chronischenNephropathien, Hepatopathien und rheumatischen Er-krankungen) POGGLITSCH, H., GIESSAUF, W., FELDNER,H., and STOCKL, G. (1970) Wien. med. Wschr., 120,381 4 figs, 17 refs

Rheumatoid Arthritis and the Determination of VariousAntistreptococcal Antibodies (Artrite reumatoide e ladeterminazione di alcuni anticorpi antistreptococcici)RoMITO, S., and FALCHI, A. (1969) Fracastoro, 62, 62620 refs

Applicability of an Increased Antistreptolysin Titre inDifferential Diagnosis (Zur differentialdiagnostischenVerwertbarkeit erhohter Antistreptolysintiter) KLEIN,G., and KLEIN, W. (1970) Wien. Z. inn. Med., 51, 1601 5 refs

Occurrence of Two IgG, Earlier Unknown, in Joint Fluidand Serum from Rheumatoid Arthritis SVARTZ, N. (1970)Acta med. scand., 187, 303 2 figs

Value of the Loose-body Test and of Fluorescence Tech-niques in Rheumatism (Aussagewert des loose-body-Tests und des Fluoreszenzverfahren bei Rheumarkanken)ZABEL, H. (1969) Z. Rheumajorsch., 28, 454 12 refs

Immunologic Study of the Blood Serum and of the SynovialFluid in Patients with Rheumatoid Arthritis STROESCU,O., GHEORGHIU, M., and GHELERTER, L. (1970) Rev.roum. MMd. interne, 7, 31 2 figs, 12 refs

Hypercatabolism of Normal IgG; an Unexplained Im-munoglobulin Abnormality in the Connective TissueDiseases WOCHNER, R. D. (1970) J. clin. Invest., 49,454 6 figs, 39 refs

Impaired Lymphocyte Stimulation by Some StreptococcalAntigens in Patients with Recurrent Aphthous Stomatitisand Rheumatic Heart Disease FRANCIS, T. C., andOPPENHEIM, J. J. (1970) Clin. exp. Immunol., 6, 573 2figs, 30 refs

In vitro Studies on the Pathogenesis of RheumatoidArthritis by Means of the Lymphocyte TransformationTest (In vitro-Studie zur Pathogenese der primer chronis-chen Polyarthritis mittels des Lymphocytentransforma-tionstests) ROTHENBERGER, W., and THIELE, H. G.(1970) Klin. Wschr., 48, 518 45 refs

Lysosomes in Lymphocytes of Peripheral Blood in CertainConnective Tissue Diseases [In Polish] CHWALIINSKA-SADOWSKA, H. (1969) Reumatologia (Wars-.), 7, 305 6figs, 45 refs

Study of Lymphocytic Synthesis of Gammaglobulins inSystemic Lupus Erythematosus (Studio della sintesidelle gammaglobuline da parte dei linfociti in corso dieritematoviscerite luposa) FONTANA, L., and AiUTI, F.(1970) Progr. med. (Roma), 26, 33 2 figs, 15 refs

Rheumatoid Factor as a Functional Protein or an Anomalyof Protein Structure (Gedanken zum Rheumafaktor-Funktionsprotein oder Proteinstrukturanomalie) KOHN,R. A. (1970) Z. Rheumaforsch., 29, 14 2 figs, 14 refs

Chromatography of Rheumatoid Arthritis Serum onSephadex G 200 (Die Chromatographie von Rheumatoid-Arthritis-Seren an Sephadex G 200) GERLACH, D.,KNOLL, H., and OTro, R. (1970) Z. Immun.-Forsch., 139,172 2 figs, 16 refs

582 Annals of the Rheumatic Diseases

Problems of Standardization of Tests for RheumatoidFactor (Probleme der Standardisierung der Nachweis-reaktionen des Rheumafaktors) Orro, R., KNOLL, H.,and TANNER, E. (1970) Z. Rheumaforsch., 29, 1 5 figs,81 refs

Comparative Studies of the Sensitivity, Value, and Depend-ability of Serological Tests in Rheumatic Diseases (Ver-gleichende Untersuchungen zur Empfindlichkeit, Wertig-keit und Zuverlassigkeit serologischer Rheurnatests)ScHMIDT, K., MUELLER-ECKHARDT, CH., and BECKMANN,D. (1970) Z. Rheumaforsch., 29, 20 17 refs

International Reference Preparation of RheumatoidArthritis Serum ANDERSON, S. G., BENTZON, M. W.,HOUBA, V., and KRAG, P. (1970) Bull. Wid HIth Org.,42, 311 1 fig., 6 refs

Serum Antinuclear Antibodies in Rheumatoid ArthritisHUGHES, G. D., and RarHFIELD, N. F. (1970) Conn.Med., 34, 171 2 figs, 23 refs

In vivo and in vitro Anti-Nuclear Reactions in LupusPatients ZWETMAN, B., and HELDRETH, E. A. (1968)Arthr. and Rheum., 11, 660

Proposed Classification of Primary Immunologic De-ficiencies SELIGMANN, M., FUDENBERG, H. H., andGOOD, R. A. (1968) Amer. J. Med., 45, 817

Gm Distribution in Rheumatic Diseases with SpecialReference to Rheumatoid Arthritis. Part I. Gm (a) andGm (x) Factors in Rheumatic Diseases (Gm-Eigenschaftenbei rheumatischen Erkrankungen unter BerUcksichtigungder Polyarthritis chronica progressive. I. Mitteliung:Gm (a)- und Gm (x)- Faktoren bei rheumatischenErkrankungen) NEUMANN, W., BARTHEL, E., TANNER,E., and SEIDEL, K. (1970) Z. ges. inn. Med., 25, 308

Range and Specificity of Antinuclear Antibodies in Sys-temic Lupus Erythematosus ALARC6N-SEGOVIA, D.,FisHBEIN, E., ALCALk, H., OLGUWN-PALACIOS, E., andESRADA-PARRA, S. (1970) Clin. exp. Immunol., 6, 5576 figs, 28 refs

In vitro Assay of Cell-Mediated Immunity: The Inhibitionof Migration of Sensitized Human Lymphocytes by HI-AAntigens FALK et al. (1970) Clin. exp. Immunol., 6, 445

New Slide Test for Reatoid Factor Determination(Neuer agglutinationstest zur Bestimmung desRheumafaktors auf dem Objekttrager) FRoHLIaH, E.(1970) Wien. med. Wschr., 120, 153 10 refs

Importance of Antibody Concentration, Binding Constant,and Heterogeneity in the Suppression of Immunity to theRh Factor POLLACK, W., and KOCESKY, R. J. (1970)Int. Arch. Allergy., 38, 320 4 figs, 16 refs

Immunofluorescent Appearance of Antinuclear Antibodiesand LE Cells in Connective Tissue Diseases [In Polish]KoLARzowsrA, B. (1970) Pol. Tyg. lek., 25, 9 2 figs,17 refs

Comparative Evaluation of Antistreptolysin and Antistrep-todornase Titres. L Acute Rheumatism. H. Acute Glomern-loneporitis (Valutazioni comparative tra titolo ASO e A-DNAsico. I. Malattia reumatica acuta. II. Glomerulone-frite acuta) Romrro, S. (1969) Fracastoro, 62, 614, 6208 figs, 13 refs

Importance of Anti-M Antibody Titration in the Sero-logical Diagnosis of Rheumatic Fever and StreptococcalInfections (Rilievi sull'importanza della ricerca deglianticorpi anti-M nella diagnostic sierologica della malat-tia reumatica e'delle infezioni streptococciche) FANINI,A., VIGNOLA, D., STRAPPARAVA, E., and ZANINI, S.(1969) Quad. Sclavo Diagn., 5, 419 1 fig., 14 refs

Waldenstrom's Macroglobulinaemia with Anti-IgGActivity: A Series of Five Cases BONOMO et al. (1970)Clin. exp. Immunol., 6, 531

Studies on the Possible Presence of the Urate-BindingAlpha-1-Alpha 2 Globulin in Human Erythrocytes ALv-SAKER, J. 0. (1970) Acta rheum. scand., 16, 144 1 fig.,14 refs

Reactions of G-Myeloma Sera with Rheumatoid ArthritisSera KASUKAWA, R., YOSHIDA, H., YOSHIDA, T., andMILGROM, F. (1970) Int. Arch. Allergy., 38, 590 3 figs,12 refs

Experimental studies in animalsChronic Arthritis produced by Streptococcal L-Forms [inRabbits] COOK, J., FINCHAM, W. J., and LACK, C. H.(1969) J. Path., 99, 283 11 figs, 16 refs

This investigation, from the Department of Pathology,Institute of Orthopaedics, Royal National OrthopaedicHospital, Stanmore, Middlesex, describes the arthriticresponse of rabbits to the intra-articular injection of theL-form of the C 203 S strain of group A streptococciused previously for the production of streptolysin S.and of the L-form of the non-haemolytic variant C 203 U.The reactions to these L-forms were compared with thosecaused by the intra-articular injection of the parentorganism C 203 S and by the injection of protoplastmembranes obtained from C 203 S streptococci.A chronic nonarticular arthritis was produced by

injecting the L-forms. Heating at 80'C. for 20 min., atemperature which inactivates the haemolytic lysosome-labilizing fraction of streptolysin S, did not impair theresponse to the organisms, a procedure which, however,caused organismal death. The histological changes pro-duced resembled those of rheumatoid arthritis. Onlytwo of 32 animals given C 203 S L-form developed pre-cipitating antibodies against a suspension of the organ-

Abstracts 583

ism; weak reactions against horse serum (present in themedium in which the L-forms were first cultured) wereoccasionally detected, but there was no association be-tween antihorse serum antibody formation and thedevelopment of arthritis. No evidence of rheumatoidfactor formation was detected in rabbits which developedarthritis.The experiments show that an arthritis similar to that

produced previously by the injection of streptolysin Scan be caused by the injection of the killed L-form of thegroup A streptococcus used to produce the streptolysinS. The nonhaemolytic mutant organism the L-form ofwhich does not contain streptolysin S, was equally effec-tive in causing arthritis.The possibility is suggested, without evidence, that the

L-forms which cause arthritis transform lymphocytes,releasing cytotoxic factors injuring joint tissue. A secondunsubstantiated possibility to which attention is drawnis the presence in the L-form surface of an antigen cross-reacting with a synovial antigen. D. L. GARDNER

Congenital Transmission in Mice of an Active Agent fromHuman Rheumatoid Arthritis WARREN, S. L., MARMOR,L., LIEBES, D. M., and HOLLINS, R. L. (1969) Nature(Lond.), 223, 646

Cell-free extracts of normal and of rheumatoid synovialtissue were injected intraperitoneally into newborn mice.The site and time of injection was found to be unimport-ant. No abnormalities were discovered in the controlanimals or their litters. In some of the animals injectedwith extract from rheumatoid cells changes were notedwhich bore gross and histological similarities to rheuma-toid arthritis. Vertical congenital transmission to thefourth or fifth generation was noted. The results indicatethe presence of an active transmissible agent in humanrheumatoid arthritis tissue. W. C. DICK

Inhibition of Adjuvant Disease in Rats by the Interferon-inducing Agent Pyran Copolymer KAPUSTA, M. A., andMENDELSON, J. (1969) Arthr. and Rheum., 12,463 3 figs,34 refs(See Abstr. WId Med. (1970), 44, 409)

Arthritis induced with Freund's Adjuvant and Its Relation-ship to Changes in the Stomach, Small Intestine, andThymus JULKUNEN, H., and ROKKANEN, P. (1970) Actarheum. scand., 16, 22 4 figs, 12 refs

Influence of Gold on the Survival Time of Skin Homo-grafts in Mice (Die Beeinflussung der Uberlebenszeit vonHauthomotransplantaten der Maus durch Gold) SCHEI-FFARTH, F., BAENKLER, H. W., and ISLINGER, M. (1970)Z. ges. exp. Med., 152, 125 10 refs

Adjuvant Arthritis in the Rat. m. Investigations onPathogenesis (Die Adjuvansarthritis der Ratte. III.Untersuchungen zur Pathogenese) KErrEL, W., andZEIGELER, J. (1979) Z. Rheumaforscb., 28, 434 4 figs,11 refs

Effect and Storage of Gold in Experimental FormalinArthritis of the Rat (Wirkung und Speicherung von Goldbei der experimentellen Formalinarthritis der Ratte)SCHEIFFARTH, F., BAENKLER, H. W., and SCaHRG, G.(1970) Z. Rheumaforsch., 29, 42 12 refs

Depletion of Long-lived Lymphocytes in Old New ZealandBlack Mice DENMAN and DENMAN (1970) Clin. exp.Immunol., 6, 457

Adjuvant-induced Arthritis: An Immunologic Model ofArticular and Connective Tissue Disease PEARSON et al.(1969) Trans. Ass. Amer. Phycns., 82, 253

Effects of Osmium Tetroxide on the Rabbit Knee JointNormal Synovial Membrane MOTroNEN, M., PANTIO,M., and NEVALAINEN, T. (1970) Acta rheum. scand., 16,121 7 figs, 21 refs

Biochemical studies

Arthritogenic Effect of Indole, Skatole, and Other Trypto-phan Metabolites in Rabbits NAKONECZNA, I., FORBES,J. C., and ROGERS, K. S. (1969) Amer. J. Path., 57, 5231 fig., 17 refs

In view of the reports on abnormal tryptophan metabo-lism in RA, it was considered worthwhile to examinemetabolites of this pathway for their ability to inducelesions in rabbit joints. Indole and skatole produced asynovitis consisting of early polymorph infiltrationfollowed by synovial cell hyperplasia and a mono-nuclear cell infiltrate. Subsynovial fat was infiltrated andreplaced by granulation tissue. Multiple prolongedinjections produced chronic disease with pannus andcartilage destruction.

In contrast, the other metabolites, tryptophan, kynu-renine, 3-hydroxykynurenine, kynurenic acid, anthranilicacid, zanthurenic acid, 3-hydroxyanthranilic acid, nico-tinic acid, nicotinamide, oxindole, isatin, and indicaninto rabbit knee joints did not produce any pathologicalchanges.An explanation involving the lipophilic activity of the

arthritogenic compounds is offered, postulating inter-action of such compounds with cell and organelle mem-branes, leading to lysosomal release. G. LOEWI

Comparative Studies on the Activity of LDH, MDH, andCAP in the Synovial Exudates and in the Serum as Supple-mentary Diagnostic Criteria of Rheumatoid Arthritis [InPolish] BANIOWSKI, A., CICHECKA, K., DROZDZ, H.,J5DRYCHOWSKI, A., and ZIELONKA, E. (1969) Reumato-logia (Warsz.), 7, 319 21 refs

Toxicity of Streptolysin 0 for Beating Mammalian HeartCells in Tissue Culture THOMPSON, A., HALBERT, S. P.,and SMrrT, U. (1970) J. exp. Med., 131, 745 10 figs, 30refs

584 Annals of the Rheumatic Diseases

Demonstration of the Therapeutic Effect of AntirheumaticDrugs in Rheumatoid Arthritis by Measurement of Hydro-xyproline Excretion in the Urine (Objektivierung derBehandlungserfolge mit Antirheumatika bei der primar-chronischen Polyarthritis durch die Hydroxyprolin-messung im Urin) HARTMANN, F., ROHDE, J., andSCHMIDT, A. (1969) Z. Rheumaforsch., 28, 447 2 figs,21 refs

Therapeutic Action of Antirheumatic Drugs through theirInfluence on Collagen Metabolism (Beeinflussung desKollagenstoffwechsels durch Antirheumatika als thera-peutisches Prinzip) FEGELER, K., and GERLACH, U.(1970) Z. Rheumaforsch., 29, 107 7 figs, 49 refs

Structural and Morphological Investigation of Poly[Gly-Ala-Pro] SCHWARTZ, A., ANDRIES, J. C., andWALTON, A. G. (1970) Nature (Lond.), 226, 161 2 figs,5 refs

Biochemical and Metabolic Abnormalities in ArticularCartilage from Osteoarthritic Human Hips MANKIN,H. J., and LIPPIELLO, L. (1970) J. Bone Jt Surg., 52-A,424 3 figs, 45 refs

Pathology of the Alpha Chains in a Eurasian (Nouveaucas de maladie des chaines alpha chez un Eurasien)RAMBAUD et al. (1970) Ann. Med. intern., 121, 135

Clearance of 1251-Liabelled Urographin from Knee Jointsin Rheumatoid Arthritis STENSTROM, R., and WEGELIUS,0. (1970) Acta rheum. scand., 16, 151 5 figs, 9 refs

Plasma Cortisol Assay LURIE (1970) J. Amer. med. Ass.,211, 1851

TherapyTreatment of Lupus Nephritis with Azathioprine MAHER,J. F., and SCHREINER, G. E. (1970) Arch. intern. Med.,125, 293 3 figs, 16 refs

This report from the Georgetown University School ofMedicine describes the use of azathioprine (1 *7 to4- 3 mg./kg./day) in eleven patients with nephritis of sys-temic lupus erythematosus. Renal biopsy was performedin six patients before starting therapy. Prednisone hadbeen used in all the patients but had been ineffective inten and the eleventh patient had developed steroidcataracts. Four patients died during or shortly aftertherapy; three of these had renal failure and in two thedisease appeared to increase in severity shortly after theazathioprine was commenced. Two other patients showedno improvement in renal function, but follow-up of 18months and 4 years respectively has shown no progressionof the renal lesion. A further two patients showed tem-porary improvement in urinary abnormalities and intests of renal function, but they died approximately 6months later, having been lost to follow-up. Acute in-fection during azathioprine therapy developed in twopatients. Both recovered and there followed a gradualremission in the renal findings despite reduction in one

and cessation in the other of the immunosuppressivetherapy. The final patient had already partly remittedwith corticosteroid therapy but was changed to azathio-prine when cataracts developed. She went on to achieve afull remission.The authors consider that failure to respond to azathio-

prine usually indicates chronic renal disease with fibrosis.On the other hand, evidence of active disease, as shownby inflammatory glomerular lesions and a low serumcomplement level, and maintenance of normal renalfunction do not always imply a good therapeutic result.Leucopenia occurred in all the patients who respondedto immunosuppressive therapy, but there was no appre-ciable fall in the white blood count in non-responders,indicating that improvement is most likely to occur withdoses that approach or reach levels of toxicity.

D. A. PITKEATHLY

Corticosteroid Crystals in Synovial Fluid KAHN, C. B.,HOLLANDER, J. L., and SCHUMACHER, H. R. (1970) J.Amer. med. Ass., 211, 807 5 figs, 14 refs

Locally-acting corticosteroids, previously injected into ajoint, are a potential source of error in the interpretationof crystals discovered in synovial fluid. The authors, atthe University of Pennsylvania, incubated five commonly-used suspensions of corticosteroids with synovial fluid.This did not alter the morphology of the crystals. Methylprednisolone acetate and triamcinolone acetonide estershad no definable longitudinal axis under polarized light.Birefringence could not be determined and their crystalsleast resembled those of sodium urate or calcium pyro-phosphate. Prednisolone terbutate crystals retained alongitudinal axis and a positive birefringence somewhatlike calcium pyrophosphate. Triamcinolone hexacetonideand betamethasone acetate esters showed strongly nega-tive birefringent rod-shaped crystals which might be in-distinguishable from sodium biurate. Triamcinolonehexacetonide crystals had been detected in joints injectedmore than a month previously. The authors urge thegreatest caution in the interpretation of crystals found insynovial fluids from joints previously injected with sus-pensions of corticosteroids. A. ST. J. DIXON

Response to Treatment of Individual Patients in a DrugTrial SUTHERLAND, S. S., PHILIP, A. E., and SUTHER-LAND, M. S. (1969) Brit. J. Psychiat., 115, 1383 5 refs

In this paper from the Kingseat Hospital, Newmachar,Aberdeenshire, the authors re-analysed their own earlierdata from a comparative trial of 'Prodnol' and Imipraminein the treatment of depression. By using statistical methodsfor the analysis of trends,* more detailed and clinicallyuseful information could be obtained than was revealedby conventional statistical methods. M. J. JEFFREY

Comparative Doubleblind Trial of 16,091 RP and Indo-methacin in Rheumatoid Arthritis (Essai comparatif endouble aveugle du 16 091 RP et de l'indometacine dansles polyarthrites chroniques) VIGNON, G., BOISSEL, J.-P.,and CIBERT, M. (1969) Rev. Rhum., 36, 715(See Abstr. Wid Med. (1970), 44, 628)

Abstracts 585

Results of a Controlled Trial of Methiazinic Acid (16,091RP) in Rheumatic Pelvispondylitis, Osteoarthritis of theHip, and Psoriatic Rheumatism (Resultat d'un essaicontr6le de l'acide metiazinique (16 091 RP) dans lapelvispondylite rhumatismale, la coxarthrose et lerhumatisme psoriasique) StZE, DE, S., KAHN, M.-F.,DREYFUS, P., DRYLL, A., SOLNICA, J., and PIERA, J.-B.(1969) Rev. Rhum., 36, 709 1 fig., 4 refs(See Abstr. WId Med. (1970), 44, 627)

Adrenal Cortical Function in Children on SteroidsKUZEMKO, J. A., and LINES, J. G. (1970) Arch. Dis.Childh., 45, 215 28 refs(See Abstr. Wid Med. (1970), 44, 643)

Cortisone Withdrawal Syndrome in Rheumatoid Arthritisand its Management (Das Cortison-Entzugssyndrom beiprogressiv chronischer Polyarthritis und seine Behand-lung) CHLUD, K. (1970) Wien. Z. inn. Med., 51, 59 8refs(See Abstr. Wid Med. (1970), 44, 550)

Severe Haemolytic Anaemia in Pregnancy in Nigerianstreated with Prednisolone FLEMING, A. F., and ALLAN,N. C. (1969) Brit. med. J., 4, 461 Bibl.(See Abstr. Wid Med. (1970), 44, 445)

A Case of Hypersensitivity to Corticosteroids COMAISH,S. (1969) Brit. J. Derm., 81, 919 2 figs, 18 refs(See Abstr. Wid Med. (1970), 44, 454)

Intra-articular Therapy with a Proteinase Inhibitor (Intra-artikulare Therapie mit einem Proteinasenhemmer)THUMB, N., WEIDINGER, P., and ATEFI, K. (1970) Wien. Z.inn. Med., 51, 7 8 refs(See Abstr. WId Med. (1970), 44, 549)

Treatment of Atrophic Osteopathies with Sodium Fluoride(Traitement des osteopathies atrophiques par le fluorurede sodium) THJEBAUD, M. (1970) Schweiz. med. Wschr.,100, 214 7 figs, bibl.(See Abstr. Wid Med. (1970), 44, 433)

Experience with Injection of Nitrogen Mustard into Jointsof Patients with Rheumatoid Arthritis HENDERSON, E. D.,and NATHAN, F. F. (1969) Sth. med. J. (Bgham. Ala.),62, 1455 6 refs(See Abstr. WId Med. (1970), 44, 550)

Role of Acid Secretion in Aspirin-induced Gastric MucosalInjury JABBARI, M., and VALBERG, L. S. (1970) Canad.med. Ass. J., 102, 178 1 fig., 25 refs(See Abstr. Wid Med. (1970), 44, 605)

Absence of Gastrointestinal Bleeding following Adminis-tration of Salicylsalicylic Acid LEONARDS, J. R. (1969)J. Lab. clin. Med., 74, 911 13 refs(See Abstr. WId Med. (1970), 44, 417)

Genetic Nature of the Hypertensive Ocular Response toLong-term Systemic Steroids GODEL, V., FEILER-OFRY,V., and STEIN, R. (1970) Ann. Ophthal., 1, 426 4 figs,9 refs(See Ophthal. Lit., vol. 24)

Clinical Trial of a New Combination of a Non-SteroidAnti-inflammatory Drug and a Muscle Relaxant: Butaly-seen (Etude clinique d'une nouvelle association d'unanti-inflammatoire non-steroidien et d'un decontracturantmusculaire: le butalyseen) FAMAEY, J. P., and BAUDUIN,M.-P. (1969) J. beige Rhum. Med. phys., 24, 260

Dimethyl Sulphoxide: Review of the Literature [In Danish]RASMUSSEN, G., and ANDERSEN, R. B. (1970) Ugeskr.Laeg., 132, 830 17 refs

Clinical Experience with a rectally administered Anti-rheumatic Antineuritic Preparation (Osservazioni clinichesull'impiego di un preparato antireumatico antinevriticosomministrato per via rettale) CESCATI, A., and VEC-CHINI. L. (1970) Minerva med., 61, 1350 15 refs

Osmium Penetration into the Organism after ChemicalSynovectomy of Knee Joints with Osmic Acid [In Polish]DUBI&SKA-BIELICKA, A., and LUDWICKI, K. (1970)Reumatologia (Warsz.), 8, 27 4 refs

Dynamics of Osmium Elimination after Chemical Syno-vectomy of Knee Joints with Osmic Acid [In Polish]LUDWICKI, K., and DUBI&SKA-BIELICKA, A. (1970)Reumatologia (Warsz.), 8, 31 4 figs, 9 refs

Synoviotherapy by Radioactive Isotopes (Synoviotheses(synoviotherapie par les radioisotopes). Etude de plus de400 traitements et perspectives d'avenir) DELBARRE, F.,et al. (1970) Ann. MMd. intern., 121, 441

Preliminary Observations on the Therapeutic Use of P-Butoxyphenylacethydroxamine [Droxaryl] in PhysicalMedicine (Premieres considerations sur 1'apport thera-peutique de l'acide P-Butoxyphenylackthydroxamique(Droxaryl) en medecine physique) PAQUE, G.-R. (1969)J. beige Rhum. Mid. phys., 24, 273

First Trial of Treatment of Inflammatory Rheumatism byIntra-articular Injection of 224Ra (Thorium) (Premiersessais de traitement des rheumatismes inflammatoires parinjection intra-articulaire de radium 224 (Thorium)LOUYOT, P., MONTET, Y., LEGRAS, J., DIEBOLD, P., andPOUREL, J. J. beige Rhum. Med. phys., 24, 265 6 figs

Treatment of Rheumatoid Arthritis with a CytostaticAgent of the Ethylenimine Group (Behandlung der primar-chronischen Polyarthritis mit einem Zytostatikum derXthylenimin-Gruppe) CRUZ-FILHO, A. (1970) Z.Rheumaforsch., 29, 120 1 fig., 9 refs

Influence of the Plasma Depot-Cortisone Level on thePlasma Cortisol Level (Uber den Einfluss des Fluor-substituierten Depotcortisonplasmaspiegels auf das Plas-macortisol) EBERL, R., and ALTMANN, H. (1970) Z.Rheumaforsch., 29, 94 2 figs, 9 refs

Intrasynovial Corticosteroid Therapy in Arthritis HOL-LANDER, J. L. (1970) Maryland med. J., 19, 62 8 refs

586 Annals of the Rheumatic Diseases

A Comparison of Phenylbutazone and Flufenamic Acid inthe Treatment of Acute Gout DOUGLAS, G., and THOMP-SON, M. (1970) Ann. phys. Med., 10, 275 3 refs

Side-Effects of 6-Azauridine Triacetate in RheumatoidArthritis ELIs, J., SLAVfK, M., and RA§KOVA, H. (1970)Clin. Pharmacol. Ther., 11, 404 1 fig., 12 refs

Double-Blind Clinical Trial of Analgesic Activity ofMefenamic Acid (Sperimentazione clinica a ceciti doppiasull'attivita analgesics dell'acido mefenamico) COL-TORTI, M., and SIMONE, A. Di (1970) Minerva med., 61,1355 24 refs

Observations on the Use ofIndomethacin by the ParenteralRoute (Osservazioni sull'impiego dell'indometacina pervia parenterale) ZEME, D., GUADAGNO, L., and BAR-SACCHI, M. (1970) Gazz. med. ital., 129, 29 11 refs

Disorders of the Eyes due to Parenteral Gold Treatment ofRheumatoid Arthritis (Augenaffektionen bei parenteralerGoldbehandlung der chronischen Polyarthritis) BEH-REND, T., and RODENHXUSER, J. H. (1969) Z. Rheuma-forsch., 28, 441 3 figs, 12 refs

Intra-articular Radiogold Therapy (Intraartikulare Radio-goldtherapie) FELLINGER, K., and THUMB, N. (1970)Z. Rheumaforsch., 29, 36 3 figs, 8 refs

Allergic-Cholestatic Hepatosis after Gold Therapy in aCase of Sero-negative Rheumatoid Arthritis (Allergische-cholestatische Hepatose nach Goldbehandlung einerseronegativen progredient-chronischen Polyarthritis)WIONTZEK, H., and SCHMIDT, J. (1970) Z. Rheumaforsch.,29, 46 9 refs

Drug Therapy of Ankylosing Spondylitis (Part I) (Latherapeutique medicamenteuse de la spondylarthriteankylosante) LOUYOT, P., MOUGIN, G., LEGRAS, B.,MONTET, Y., COMBEBIAS, J.-F., POUREL, J., SIMON, J.-M.,and DIEBOLD, P. (1970) Rev. Rhum., 37, 287 5 figs(Part II) LOUYOT, P., GAUCHER, A., MONTET, Y.,POUREL, J., COMBEBIAS, J.-F., ROLAND, J., and STINES,J. (1970) Rev. Rhum., 37, 296 1 ref.

Treatment of Psychogenic Rheumatism (Behandeling vanpsychogeen reuma) VANSLYPE, J. (1969) J. beige Rhum.Med. phys., 24, 279 9 refs

Pharmacological Analysis of Aspirin COLLIER (1969)Advanc. Pharmacol. Chemother., 7, 333

Ophthalmological Surveillance of Patients treated withSynthetic Antimalarial Drugs: Electroretinographic De-monstration of Toxic Impregnation of the Retina (Surveil-lance ophtalmologique des malades traits par antipalu-deens de synthese: mise en evidence 61ectroretinogra-phique de l'impr6gnation retinienne toxique) RAMPON,S., ROUHER, F., ALFIERI, R., SOLE, P., BUSSIERE, J.-L.,and SAUVEZIE, B. (1970) Rev. Rhum., 37, 233 1 fig.,2 refs

Changes in the Gastric Mucosa induced by Oral Ant-rheumatic Therapy [In Yugoslav] ARSOv, D., DAV6EV,P., VANOvSKI, B., PLAAEVSKI, A., STAVRI6, G., andGU6EVA, I. B. (1969) Acta med. iugosl., 23, 86 7 figs,7 refs

Experimental Study of Chloroquine Retinopathy. (etudeexperimentale de la retinopathie par chloroquine)BABEL, J., and ENGLERT, U. (1969) Bull. Soc. franc.Ophtal., 82, 491 10 figs, 14 refs

Systemic Lupus Erythematosus induced by Procainamide[In Swedish] WAAGSTEIN, F. (1970) Nord. Med., 83,468 17 refs

Drug-induced Lupus Syndromes Leading Article (1970)Brit. med. J., 2, 192 11 refs

Intra-articular Chloroquine in Rheumatology (A proposde la chloroquine intra-articulaire en rhumatologie)BOUwENOT, G., VYKYDAL, M., PEGRIMOVA, E., andVRUBLOVSKY, P. (1970) Rhumatologie, 22, 37 2 figs, 17refs

Management of Foot Problems in Arthritis SEDER, J. I.(1970) Cleveland Clin. Quart., 37, 111 7 figs

Family Expectations and Arthritis Patient Compliance toa Hand Resting Splint Regimen OAKES, T. W., WARD,J. R., GRAY, R. M., KLAUBER, M. R., and MOODY, P. M.(1970) J. chron. Dis., 22, 757 16 refs

Physical, Biological, and Clinical Bases of Pelotherapy(Mud Treatment) (P61otherapie. Ses bases physiques,biologiques et cliniques) GROS, M.-CH., SINGER, S.,ISAAC, J.-P., MATHEVON, G., and WAILLE, Y. (1970)Rhumatologie, 22, 7 29 refs

Investigation of Radioactive Yttrium (90Y) for the Treat-ment of Chronic Knee Effusions PRITCHARD, H. L.,BRIDGMAN, J. F., and BLEEHEN, N. M. (1970) Brit. J.Radiol, 43, 466 1 fig., 10 refs

Gastric Blood Flow and its Distribution during Indo-methacin Administration EDLICH, R. F., NICOLOFF,D. M., BORGEN, L., BUCHIN, R., and WANGENSTEEN,0. H. (1970) Surg. Gynec. Obstet., 130 789, 1 fig., 7 refs

Procainamide-induced Lupus Erythematosus in ManFELLNER, M. J., ROZAN, M., KLAUS, M., and VAN HECKE,E. (1969) Arch. beiges Derm., 25, 417 1 fig., 42 refs

Relationship of the Enterohepatic Cycle to Ulcerogenesisin the Rat Small Bowel with Flufenamic Acid WAX, J.,CLINGER, W. A., VARNFR, P., BASS, P., and WINDER, C. V.(1970) Gastroenterology, 58, 772 4 figs, 33 refs

Abstracts 587

Surgery

Silicone Rubber Implants for Replacement of Arthritic orDestroyed Joints SWANSON, A. B. (1969) Hand. 1, 38

The author has been responsible for the development ofsilicone rubber implants for the replacement of joints.This material has great flexibility, very good forcedampening qualities, and biological inertness. The fingerjoint implant has now been in use for 4 years and hasproved satisfactory. But being a relatively soft material,it does not offer strong lateral stability and thereforecontrol must be exercised over the joint until capsularrepair or replacement has been achieved.A small number of wrist and elbow replacements have

also been tested. K. M. BACKHOUSE

Results of Treatment of Hip Disorders with Cup Arthro-plasty JOHNSTON, R. C., and LARSON, C. B. (1969)J. Bone Jt Surg., 51-A, 1461

This report from the Orthopaedic Surgery Departmentat the University ofIowa analyses data on 543 cup arthro-plasties in 475 patients treated between 1950 and 1963;251 patients (294 hips) were reviewed at least 3 yearsafter the operation. Most of the operations were per-formed for degenerative arthritis or complications oftrauma or congenital hip diseases. The paper sets out toanswer three questions;(1) What is involved in the operation in terms of risks,time in the hospital, time on crutches, and time lost fromwork.(2) What kind of result can be expected in terms of painrelief and functional ability.(3) How much time is required to obtain this result andonce obtained will the result last.The original should be consulted for details, but the

results are incomplete because this is in part a retro-spective survey. P. J. L. HOLT

Double Osteotomy for the Painful Knee in RheumatoidArthritis and Osteoarthritis BENJAMIN, A. (1969) J.Bone Jt Surg., 51-B, 694 3 figs, 4 refs

This paper describes the indications, the operative tech-nique, and results of double osteotomy of the knee, inboth rheumatoid arthritis and osteoarthrosis.The operation was performed for disabling pain that

did not respond to at least one year of conservative treat-ment in patients who had 900 of movement in the absenceof gross deformity.A total of 150 knees were subjected to double osteo-

tomy, and 57 knees (36 with osteoarthrosis and 21with rheumatoid arthritis) operated on between 1961to 1965 are reviewed.

In many, the relief of pain was dramatic, there beingno significant difference between the two groups. Onlyfour rheumatoid patients considered that they had notbenefited. Loss of movement amounting to 200 or morewas noted in twenty knees, only five of which were inthe rheumatoid arthritis group.At operation the femur was divided just distal to the

upper border of the articular cartilage (intra-articularly)and the tibia not more than 2-5 cm. distal to the joint.

The patient was allowed up on the first or second dayin a plaster cylinder, and at 5 weeks the plaster wasremoved, but 6 to 12 months were required to reach afinal state of recovery. A. R. TAYLOR

Arthroplasty of the Knee YAMADA, K., and SmNDo, N.(1969) J. Bone Jt Surg., 51-A, 1480

This paper describes a novel method of arthroplastyspecifically designed to increase the range of painlessknee flexion to allow the use of the squatting positionon tatami mats. 54 patients with stiff knees mainly dueto local fractures had an average range of knee jointmotion of 34.40 before operation and 102.80 afteroperation. Only one patient had decreased function.The operation consists of two parts. A polyethylene

membrane is shaped to make a sack to correspond to theantero-posterior pneumoarthrogram of the contralateralknee. This rests within the potential suprapatellar pouchwith a fringe hanging down to lie in the tibiofemoraljoint space. Within the sack a small polyethylene bagcontaining 1 g. powdered magnetic iron is placed. Anexternal magnetic field is used to move the bag containingmagnetic iron about within the sack and thus preventadhesions developing within the suprapatellar bursa.The quadriceps tendon is lengthened by a Z-plasty

to achieve the required flexion. The authors calculate thata lengthening of 1 cm. is necessary for each 20° of flexion.

Postoperatively the knee is immobilized semiflexed at120 to 1100 for several days. In the fourth or fifth post-operative week the polyethylene bag is removed througha small incision.No loss of stability has been noted, but extensor power

recovers more quickly when the lengthening of thequadriceps tendon is least. P. J. L. HOLT

Recurrent Hemarthrosis after Prosthetic Knee Arthro-plasty: Identification of Metal Particles in the SynovialFluid Kmt ou, R. C., SCHUMACHER, H. R., JR.,SBARBARO, J. L., and HOLLANDER, J. L. (1969) Arthr.and Rheum., 12, 520

Replacement of the tibial plateau by a stainless steelprosthesis and the femoral condyle by a vitallium mouldresulted in a particulate sediment in the synovial fluid.This proved to be due to metallic particles which weremainly extracellular. Similar particles were found in thesynovial tissue. Little inflammatory reaction occurred.X-ray diffraction patterns suggested that the stainlesssteel prosthesis was the source of the metal. This is furtherevidence for the dissolution of metal joints particularlywhen the opposing surfaces are metallic and of dissimilarnature. The long-term effects of this are as yet unknown.

P. J. L. HOLT

Management of the Stiff Proximal Interphalangeal JointCURTIS, R. M. (1969) Hand, 1, 32

Restoration of movement in a stiff digital interphalangealjoint can present somE of the greatest difficulties in handsurgery. The differential diagnosis is wide and often un-certain until surgical exposure is obtained. Limitation in

588 Annals of the Rheumatic Diseases

flexion is often caused by blocking of the collateralligaments. A method of repairing this condition isdescribed, together with suggestions for treatment ofother causes of defective flexion. Among the treatmentsfor repairing fixed-flexion deformity, operations forclearing an adherent volar plate or, if necessary, a volarcapsulectomy are described.

This paper presents, in brief, an excellent review of thepossibilities for mobilization of the joint.

K. M. BACKHOUSE

Excision Arthroplasty of the Metacarpophalangeal JointsHARRISON, S. H. (1969) Hand, 1, 14

Excision arthroplasty is often practised for the treatmentof gross rheumatoid destruction of the metacarpophalan-geal joints and to establish a fibrous but mobile ankylosis.By removing the destroyed joint, pain can be reduced oreliminated and the progress of the disease slowed. Therecan also be a marked improvement in function, but thereis often a tendency for the fingers to drift back into severeulnar deviation. In order to control this tendency, halfthe extensor digiti minimus is divided proximally andthe proximal end is passed around the base of the proximalphalanx of the little finger. It is then passed through thedorsal hoods and sutured to the extensor indicis pro-prius which is itself relocated into the first dorsal inter-osseous muscle.The results in 32 cases are stated to be good for up to

3 years, but the authors also points out that this time istoo short for too definite conclusions. K. M. BACKHOUSE

Correction of the Rheumatoid Boutonniere DeformityHEYWOOD, A. W. B. (1969) J. Bone Jt Surg., 51A, 1309

In this paper from the Department of OrthopaedicSurgery of the University of Cape Town, a small series(9 fingers) is presented in which the treatment was by amethod of tendon reconstruction which, it is suggested,is less likely to produce adhesions. A follow-up of from1 to 3 years showed that this method was successful in ahigh proportion of cases. A Table is included, giving thedetails of progress and the operative findings.The author stresses the scant attention paid to the

methods of tendon reconstruction in the rheumatoidvariety of this condition. He recognizes three stages ofdeformity:(1) Pre-boutonniere synovitis of the proximal interphalan-geal joint, in which he advocates immediate synovectomy.(2) Mobile boutonniere deformity, in which active but notpassive extension is lost; this is treated by reconstructionof tendons.(3) Fixed deformity, in which passive extension is lost;here the treatment advocated consists of arthrodesis ordecompression of the joint.The described method of reconstruction consists of

synovectomy of the joint and anastomosis of the dis-inserted ulnar lateral band to the radial one just distallyto the joint line. The middle slip is repaired by twomattress sutures close to the periosteum. Another suturesecures the transverse fibres connecting the lateral bands.A useful list of references is given to which the following

could be added: a review of 101 cases by Souter (1967)and two papers by Matev (1964, 1969) relevant to thosecases in which the lateral bands show some degree of

shortening and the central slip destruction is well ad-vanced.

[The anastomosis of the lateral bands and suture of theirconnecting fibres tend to restrict flexion of the inter-phalangeal joints and fine judgement is required to leaveenough sideways movement of the lateral bands to allowfor flexion of the distal interphalangeal joint.]

K. KUCZYNSKI

MATEV, 1. (1964) Brit. J. last. Surg., 17, 281-(1969) Hand, 1, 90SOUTER, W. A. (1967) J. Bone Jt Surg., 49B, 710

Role of Splenectomy in Felty's Syndrome O'NEILL, J. A.,JR., Scorr, H. W., JR., BILLINGS, F. T., and FOSTER, J. H.(1968) Ann. Surg., 167, 18

Felty's syndrome of active rheumatoid arthritis, spleno-megaly, and leucopenia is reported in fourteen patientsseen during a period of 30 years at Vanderbilt UniversityHospital.Rheumatoid arthritis had been present for from 21

to 30 years and the total white count was between 500and 4,050 per cu. mm. There was a relative eosinophiliain one patient. Eleven had anaemia and ten hepatomegaly.Half had weight loss and half had susceptibility to infec-tion. Two had lymphadenopathy but none had increasedskin pigmentation. The erythrocyte sedimentation ratewas elevated in all the patients.The seven patients who were tested had a positive latex-

fixation test. There were no L.E.-cells in the five tested.Of the ten with hepatomegaly, four had mild cirrhosis.Ten patients had marrow aspirated and this showederythroid hyperplasia with maturation arrest in eight.The remaining two had marrow hypoplasia and thesedied later.

Six patients, aged between 48 and 74 years, hadsplenectomy and were followed postoperatively for from2 to 6 years. The remainder were aged 45 to 69 yearsand were followed for from 1 month to 13 years. Severerefractory hypersplenism was the sole indication forsplenectomy. In four the white cell count became normaland three had arthritic improvement. One with hypo-plastic marrow showed no blood response but the arthritisbecame inactive. This patient died after 4 years with re-current severe infections. Microscopy of the spleensshowed chronic passive congestion.Of the remaining patients, four died with leucopenia

and thrombocytopenia and with their arthritis unchangedor worse. The six patients who received steroids showedno permanent improvement. C. D. D'A. FEARN

Pituitary Adrenal Responses to Surgical Stress in Patientsreceiving Corticotrophin Treatment CARTER, M. E.,and JAMES, V. H. T. (1970) Lancet, 1, 328 2 figs, 11 refs(See Abstr. WId Med. (1970), 44, 543)

Surgery in Arthritis STEVENS, J. (1970) Geriatrics, 25,153 34 refs

Total Hip Replacement in England ROSENBERG, E. F.(1970) J. Amer. med. Ass., 212, 611 2 figs

Smith-Petersen Mould Arthroplasty of the Hip: Resultsafter 12 to 21 Years LAW and MANZONI (1970) Proc.roy. Soc. Med., 63, 583

Abstracts 589

Spontaneous Subluxation of the First and Second CervicalVertebrae in Rheumatoid Arthritis treated with SpinalFusion SAWMILLER, S. R., and WILDE, A. H. (1970)Cleveland Clin. Quart., 37, 81 3 figs, 19 refs

High Tibial Osteotomy for Osteo-Arthritis of the KneeHARRIS, W. R., and KOSTUIK, J. P. (1970) J. Bone JtSurg., 52A, 330

Proximal Tibial Osteotomy for Compartmental Tibio-femoral Osteoarthritis KYNE, P. J., (1970) N. Y. St. JMed., 70, 1059 2 figs, 8 refs

Synovectomy and Debridement of the Knee in RheumatoidArthritis. Part L. Historical Review GEENS, S. (1969)J. Bone Jt Surg., 51A, 617Part II. Clinical and Roentgenographic Study of 31 CasesGEENS, S., CLAYTON, M. L., LEIDHOLT, J. D., SMYTH,C. J., and BARTHOLOMEW, B. A. (1969) J. Bone Jt Surg.,51A, 626

Synovectomy of the Metatarsophalangeal Joints inRheumatoid Arthritis RAUNIO, P., and LAINE, H. (1970)Acta rheum. scand., 16, 12 1 fig., I ref.

The Injured Hand. Management of the Metacarpophalan-geal Joint: The Key to Hand Function KETCHUM, L. D.,ROBINSON, D. W., and MASTERS, F. W. (1970) J. Kans.med. Soc., 71, 87 6 figs, 4 refs

Synovectomy of the Elbow in Rheumatoid Arthritis.Report of Five Cases TORGERSON, W. R., and LEACH,R. E. (1970) J. Bone Jt Surg., 52A, 371

Arthroplasty of the Elbow Joint using a Vitallium Pros-thesis CHATZIDAKIS, C. (1970) Int. Surg., 53, 119 7 ref,6 figs

Other general subjects

Function of the Knee Joint in Various Activities MORRI-SON, J. B. (1969) Bio-med. Engng., 4, 573 14 figs, 2 refs

In this paper (from the University of Strathclyde,Glasgow), the author takes joint force in the knee asapproximately equal to the total force perpendicular tothe plane of the tibial condyles during knee joint activi-ties. This and the forces in the cruciate ligaments and inthe main muscle groups acting on the knee were pre-viously calculated for men in normal level walking (seeBio-med. Engng., (1968) 3, 164), using a force plate onwhich the subject walks, with cinephotography andelectromyography to correlate attitude of joint, phase ofwalking, and muscle activity with computer analysis.The present study extends the observations

(a) to women walking on the level with either flat- orhigh-heeled shoes (these made little difference to thejoint force patterns in the knee except at heel strikewhen there was an increase up to 24 per cent. (b) to menwalking up and down a ramp or climbing stairs. Thegreatest value for muscle force was 564 lb for men in thequadriceps femoris muscle during resisted muscle exten-sion, i.e. in walking down a ramp. Lesser forces de-veloped in other muscles or during other activities.

[Only positive, compression joint force is treated here.Distraction force, as in the non-weight bearing phase ofknee joint activity, is ignored, although it may havephysiological importance in, e.g. pumping, nutrition ofcartilage.] A. ST. J. DIXON

Occupational Osteoarthropathy and Classical Ballet(Osteo-arthropathies professionnelles et danse classique)NIKOLAEV, I. A., and NAJDENOV, S. (1970) Arch. Mal.prof., 31, 39 8 refs(See Abstr. WId Med. (1970), 44, 479)

Introduction to the Study of the Dynamic Factors of thePersonality in Patients with Rheumatoid Arthritis (Intro-ducton a l'etude des facteurs dynamiques de la person-nalite des polyarthritiques) RUELLE, M., TELLIER, E.,and COUDRON, J. (1969) J. beige Rhum. Mid. phys., 24,255 13 refs

Personality Characteristics of Patients with RheumatoidArthritis POLLEY, H. F., SWENSON, W. M., and STEIN-HILBER, R. M. (1970) Psychosomatics, 11, 45 1 fig., 9refs

Mental Abilities of Rheumatoid Patients and their Suita-bility for Occupational Training under Defined SanatoriumConditions [In Polish] KOZLOWSKA, I., and STACHOWSKA,M. (1969) Reumatologia (Warsz.), 7, 355 6 refs

Economic Aspects of Arthritis and Rheumatism BROOKS,R. G., and BUCHANAN, W. W. (1970) Hlth Bull. (Edinb.),28, 42 4 refs

Fine Needle Biopsy Diagnosis in Nodular PulmonaryAmyloidosis DAHLGREN et al. (1970) Acta path. microbial.scand., 78A, 1

Remission of the Nephrotic Syndrome in Renal AmyloidosisLOWENSTEIN and GALLO (1970) New Engl. J. Med.,282, 128

An Amyloid-forming Nodular SyringocystadenomaJENNINGS and AHMED (1970) Arch. Derm., 101, 224

Osseous and Osteoarticular Manifestations in Walden-strom's Disease (Manifestations osseuses et osteo-articulaires au cours de la maladie de Waldenstrom.Aspect ophtalmologique et 6volutif) MWMIN, Y.,BOUCHAT, J., and PATTIN, S. (1970) Rev. Rhum., 37, 3093 figs, bible.

590 Annals of the Rheumatic Diseases

Osteoarticular Manifestations of Acromegaly (Les mani-festations ost6o-articulaires de l'acrom6galie) SERRE, H.,SImoN, L., and SANY, J. (1970) Sem. Hop. Paris, 46, 16038 figs, 28 refs

Arthroscopy and Endophotography for the Diagnosis andDocumentation of Knee Joint Injuries (Die Arthroskopieund Endophotographie zur Diagnostik und Dokumen-tation von Kniegelenksverletzungen) WRuus, 0. (1970)Wien. med. Wschr., 120, 126 19 figs, 13 refs

Arthrography in the Diagnosis ofCalfPain LAPAYOWKER,M. S., CLIFF, M. M., and TOURTELLOTE, C. D. (1970)Radiology, 95, 319 6 figs, 15 refs

Challenge of the Painful Back-an Industrial and MedicalProblem ROBERTSON, A. M. (1970) Occup. Med., 20,42 1 fig., 18 refs

Pain LIM (1970) Ann. Rev. Physiol., 32, 269

Acute Synovial Rupture of the Knee-a DifferentialDiagnosis from Deep Vein Thrombosis HUGHES andPRIDIE (1970) Proc. roy. Soc. Med., 63, 587

Defect Pseudarthroses BAADSGAARD (1969) Acta orthop.scand., 40, 689

Comparison of the Dynamic Force-transmitting Propertiesof Subchondral Bone and Articular Cartilage RADIN,E. L., PAUL, I. L., and Lowy, M. (1970) J. Bone Jt Surg.,52-A, 444 13 figs, 23 refs

Scintigraphy of Joints with 99mTc-pertecbnetate (DieGelenksszintigraphie mit Tc99m-Pertechnetat) GOEBEL,R., EBER, O., WASCHER, H., HAYN, H., and KLEIN, G.(1970) Z. Rheumaforsch., 29, 75 9 figs, 7 refs

85Strontium Scintimetry of the Spine DEFIORE, J. C.,LINDBERG, L., and RANAWAT, N. S. (1970) J. Bone JtSurg., 52-A, 21 12 figs, 16 refs

Palindromic Rheumatism (Le rhumatisme palindromique(Apport de 16 observations et revue g6n6rale)) RENTER,J.-C., BRiGEON, CH., and BESSON, J. (1969) Rev. Rhum.,36, 583 78 refs

Meningococcal Meningitis complicated by Pericarditis,Panophthalmitis, and Arthritis WILLIAMS, D. N., andGEDDES, A. M. (1970) Brit. med. J., 2, 93 10 refs

Dentated Iner Femoral Condyle SUTRO, C. J. (1969)Bull. Hosp. Jt Dis. (N. Y.), 30, 171 10 figs, 20 refs

Rheumatology as a Specialty in Medicine: A PersonalAppraisal DUTHIE, J. J. R. (1970) Scot. med. J., 15, 1.65