Primary extranodal marginal zone lymphoma of the uvea associated with massive diffuse epibulbar extension and focal infiltration of the optic nerve and meninges, clinically presented as uveitis masquerade syndrome: a case report

To report a clinical, histopathological and immunohistochemical findings in a case of primary extranodal marginal zone lymphoma of the uvea associated with massive diffuse extraocular episcleral extension and focal infiltration of the optic nerve and meninges, clinically presented as longstanding uveitis masquerade syndrome. Interventional case reports with histopathological correlation. We describe a 80-year-old male patient with a 3-year history of chronic recurrent hypertensive (pan) uveitis associated with ocular pain, unresponsive to topical and systemic anti-inflammatory, immunosuppressive, antibiotic/antiviral and antiglaucomatous therapy. Because the eye was not salvageable with conservative treatment, enucleation of blind and painful eye was performed. Findings from histopathological and immunohistochemistry examination of the enucleated eye showed an extranodal marginal zone lymphoma of the uveal tract with massive epibulbar extension and optic nerve and meningeal penetration. During almost 3 years of clinical course and 6 months after the enucleation, there were no systemic manifestations of lymphoma, and patient has not required subsequent treatment. Primary lymphoproliferative lesions of the uvea, comprising the iris, ciliary body and choroid are very rare, associated with epibulbar extension extremely and with optic nerve and menigeal penetration exceptionally. Despite its rarity, primary lymphoma of the uvea should be included in the differential diagnosis particularly in older patients with longstanding recurrent uveitis.

The role of zeolites in wastewater treatment of printing inks

The adsorption of residual organic pollutants from flocculated printing ink wastewater onto several synthetic zeolites was investigated as a finishing method for additional reduction of TOC. The nonselective removal of total organic content was studied. The amount of adsorbed organics was largest for ZSM-5 and NH4-Beta while the other zeolites studied showed lower efficiency, suggesting that adsorption is independent of pore structure. The adsorption rates of organic pollutants were fast. Although the TOC removal increases with increasing amount of zeolite, because of the necessity of additional filtration to lower turbidity to required levels, 5.0 g/L of zeolite was found to be optimum. The 88% reduction of TOC obtained with a single flocculation treatment was improved with the combination of flocculation and adsorption with ZSM-5 which resulted in the overall TOC efficiency of 95%. The addition of zeolites in decantated supernatant water, obtained after flocculation, was also studied in order to assess the effect of floc on zeolite capacity. A decrease in adsorption capacity occurred only if a coagulant concentration less than optimal was applied. Removal efficiency then decreased by around 10%. It was concluded that flocculation followed by adsorption with zeolites is an effective treatment method for this kind of wastewater.

Three-month change in the radiodensity of alveolar bone supporting partial-denture abutment teeth

This study uses the intraoral microdensitometric method to examine the impact of masticatory pressure on the alveolar bone around the abutment teeth clasp. Two retroalveolar radiographs were carried out on all 30 subjects over a period of 3 months using a copper calibration stepwedge. The dental radiographs were digitized and converted into positive. Grey level values on dental radiographs in the alveolar bone area in 7 region of interest (ROI) were measured. They were converted into the equivalent thickness of the calibration stepwedge using mathematical methods and the difference of the bone density between the two radiographs was calculated. The results demonstrated that there were no statistically significant differences between the 1st and 2nd radiographs in any of ROI (p > 0.05).

Complications of pneumatic retinopexy

Twenty-eight patients with rhegmatogenous retinal detachment were treated by pneumatic retinopexy using intravitreal perfluorpropane (C3F8) gas. Reattachment was successfully achieved in 22 eyes (78.6%) after one treatment. Most of the eyes were myopic and had a single retinal break or group of breaks within one o'clock hour. All retinal complications developed in the inferior retinal quadrants with postoperative proliferative vitreoretinopathy (PVR) as one of the most serious complications, occurring in 3 (10.7%) eyes. New retinal breaks developed in 2 (7.1%) eyes.

Syndroma: glaucoma pigmentatum primarium--pigmented glaucoma

In this study pigmented glaucoma was diagnosed in 29 out of 4350 patients suffering from glaucoma. In clinical analysis of those cases main attention was put on Krukenberg spindle with emphasis on the process and reason of its development. In all cases of Krukenberg spindle moderate myopia and myopic astigmatism were present. The main axis of the spindle lies in the principal meridian of corneal astigmatism. The principal meridian of the anterior cornea surface corresponds with the axis of the principal meridian of the posterior corneal surface. The higher degree of astigmatism more pronounced Krukenberg spindle. This corresponds to a number of cases in which the spindle is hardly recognisable in the astigmatism, of only +/- 0.25 to +/- 0.50 Dcyl. The axis of meridian corresponds to direct astigmatism (from 110 degrees to 70 degrees). The authors conclude that there is no pigmented Krukenberg spindle without myopic astigmatism. It is for this reason and because of the inheritance factor that this type of glaucoma should be considered primary glaucoma and a separate clinical entity.

Loss of heterozygosity of DPC4 tumor suppressor gene in human sporadic colon cancer

We investigated the prevalence of DPC4 loss of heterozygosity in sporadic colorectal cancer. Thirty-six cases of human sporadic colon carcinoma and corresponding normal tissue samples were examined to evaluate loss of heterozygosity at the DPC4 tumor suppressor locus using variable nucleotide tandem repeat (VNTR) analysis and three polymorphic markers. From 36 analyzed samples 35 (97%) were heterozygous or informative. Loss of heterozygosity at the DPC4 locus was detected in 18 (51%) of informative tumor DNAs. The DPC4 LOH was more frequent in smaller tumors (<5 cm) than in larger ones. There was no correlation between DPC4 LOH and age or sex of patients. There was a negative correlation between DPC4 LOH and histological grade or Dukes' stage of tumors, but without statistic significance. Observed results are in agreement with the view that malignant progression is consequence of many genetic changes. It can be concluded that inactivation of the DPC4 gene plays a role in a multistep process of outgrowth and progression of colon cancer.

Effect of the nonsteroidal anti-inflammatory drug indomethacin on proliferation and apoptosis of colon carcinoma cells

PURPOSE

Nonsteroidal anti-inflammatory drugs lower the incidence of and mortality from colon cancer. In this paper, we present the effect of indomethacin on growth inhibition and alterations in the expression of several genes involved in cell cycle and apoptosis in CaCo-2 colon adenocarcinoma cells.

METHODS

We used the MTT test to evaluate the effect of indomethacin on the proliferation rate of colon cancer and normal fibroblast cells in vitro. The expression of c-myc oncoprotein and p53 and p27 suppressor proteins was examined using the immunocytochemical method.

RESULTS

We have shown that indomethacin reduces the proliferation rate of CaCo-2 colon cancer cells (up to 60% at the concentration of 4 x 10(-4) M), alters their morphology, and induces cell death by apoptosis. The most pronounced inhibitory effect was observed at the concentration of 6 x 10(-4) M where the growth was completely suppressed. However, the growth of normal fibroblasts (Hef 522) was much less inhibited (about 30% of inhibition at the concentration of 6 x 10(-4) M). Indomethacin reduces the proliferation rate and induces apoptosis in CaCo-2 colon cancer cells through enhanced expression of c-myc, p53, and p27 proteins.

CONCLUSIONS

This is the first report about p27-increased expression in colon carcinoma cells induced by indomethacin treatment. Increased expression of p27 represents a new mechanism of apoptosis in cells treated with NSAIDs (indomethacin). This effect probably contributes to the anti-proliferative effect on colon cancer cells in vitro.

Kineziographic research of patients with cross bite

The paper describes the use of an objective method for the quantitative analysis of the relationship between the posterior cross-bite and the occurrence of occlusive interferences and damages to the mandible muscle elevator. Two groups of subjects were selected for the analysis: 10 patients with unilateral cross-bite and 10 students without any symptoms of temporomandibular disorders (TMD). By means of the Robert Jenkelson K5A kinesiograph we measured maximal opening velocity of the mandible (mm/s), maximal-closing velocity (mm/s), first tooth contact velocity and displacement in the vertical plane at the maximal intercuspidation (mm). The following values were obtained: maximal-opening velocity in the first group was 349 mm/s and 380 mm/s in the control group. This difference was incidental. The maximal closing velocity in the study group was 204.9 and 345.2 in the control group (p < 0.05). The first tooth contact velocity in the study group was 75.93 and 325 in the control group (p < 0.01). Displacements in the vertical plane at the maximal intercuspidation in the investigated group was 0.24 +/- 0.01 mm, while in control group that value was 0.12 +/- 0.012 mm.

[Arrhythmogenic right ventricular dysplasia]

INTRODUCTION

Arrhythmogenic right ventricular dysplasia (ARVD), disease of uncertain etiology, is characterized by fibrofatty collections in the right ventricular myocardium, premature ventricular complexes with left bundle branch block (LBBB) morphology, ventricular tachycardia and fibrillation.

GOALS

To point out diagnostic methods for this progressive disease and to analyze differential diagnosis and significance of arrhythmogenic right ventricular dysplasia in young, active athletes.

RESULTS

Arrhythmogenic right ventricular disease can be asymptomatic or manifested (syncope). It is not uncommon that the first evidence of the disease is ventricular tachycardia/fibrillation or sudden cardiac death. Results of electrocardiography, echocardiography, invasive and other methods can, even after few years, be negative for ARVD. The most significant ECG features are inverese T wave in precordial V1-V3 leads and widened QRS complex (> 120 ms) in V1 lead. Significant echocardiographic features and data obtained by invasive hemodynamic examinations are: dilated right ventricle, left and right ventricular end-diastolic diameter ratio less then 0.5, hypokinetic/akinetic areas involving the wall of the right ventricle, predominantly inferobasal, apical and wall of the left ventricular outflow tract. Findings may also include deep fissures among hypertrophied trabeculae. Biopsy may reveal fibrofatty tissue in hypo/akinetic regions of the right ventricular myocardium.

DISCUSSION AND CONCLUSION

Since arrhythmogenic right ventricular dysplasia is diagnosed in predominantly young population, not uncommonly athletes, and since it may be cause of sudden cardiac death, there must be a high degree of suspicion in cases with activity related VT/VF and positive family history (it is proposed that it is a hereditary disease).

[Magnesium in cardiology]

INTRODUCTION

Magnesium is an oligo-element which has an important effect on the myocardial function and peripheral vascular system.

MATERIAL AND METHODS

The experiences of other authors as well as other papers have been analyzed.

RESULTS

Magnesium participates in over 300 enzymatic reactions in the human organism. It may be found in drinking water and food through which it is substituted. According to WHO, there is a good correlation between Ca++/Mg++ ratio in drinking water and frequency of cardiac events. Higher Mg++ quantity reduces coronary disease. Decreased Mg++ quantity in plasma has been registered in patients with acute myocardial infarction (AMI), coronary patients and patients with heart failure. Various rhythm disturbances, particularly Torsade de points are related to hypomagnesemia. Diuretics and some cytostatics, and antibiotics decrease Mg++ in plasma, erythrocytes and muscles. Decreased Mg++ have been found in alcoholics, diabetics and Crohn disease, which are in certain cases related to existing heart rhythm disturbances. In cardiology it is proved that Mg++ are beneficial in AMI, protection during open heart surgery and treatment and prevention of heart surgery and heart rhythm disturbances. The use of Mg++ in vasospastic angina pectoris, Raynaud's disease and cardiomyopathies due to cytostatics is still in the process of investigation. It is still a matter of discussion whether Mg++ should be administered in these conditions or only when its quantities are reduced. Do Mg++ values in plasma indicate its total presence in the organism? Where should Mg++ be administered as therapy, in which doses and how rapidly? Should preventive addition of Mg++ in drinking water reduce heart disease and prolong life? There are neither many answers nor real conclusions on Mg++ significance in cardiology. However, some encouraging results about its use indicate the significance of further investigations.

DISCUSSION

It has been accepted by the authors all over the world that the role of magnesium is of great importance in prevention and treatment of cardiac patients.

CONCLUSION

Our first experiences are in accordance with other studies.

[Sudden cardiac death]

Sudden death occurs unexpectedly, within 24 hours after the onset of subjective symptoms with or without known preexisting conditions. According to Framingham Heart Study, during a 20-year follow-up, 13% of deceased have died of sudden death. Most frequently it occurs in the first 6 months in infants and in the period 45-75 years of age. In more than 80% of cases sudden death is caused by coronary disease, while in 5% of cases the cause is cerebrovascular insult. The mechanism of sudden death is ventricular fibrillation in 65-85%, ventricular tachycardia in 7-10% and electromechanical dissociation in 20-30%. Sometimes sudden death may be caused iatrogenically, by drug intoxication, catheterization and reflex mechanisms--vasovagal reflex and sinus caroticus reflex. Pathoanatomical finding can be positive on myocardium like fibrosis, edema, individual necrosis, cell infiltration or it can be unchanged. In cases of heart failure, resuscitation is performed: airway maintenance, artificial respiration, artificial circulation, drug therapy and electrotherapy. Prevention of sudden death means detection of high-risk patients and application of medical treatment in order to postpone it. Coronary patients with sustained myocardial infarction and ejection fraction lower than 30% and registered tachycardia represent high-risk patients.

Loss of heterozygosity of APC and DCC tumor suppressor genes in human sporadic colon cancer

We examined 36 cases of human sporadic colon carcinoma and corresponding normal tissue samples to evaluate loss of heterozygosity at the APC and DCC tumor suppressor genes loci using restriction fragment length polymorphism polymerase chain reaction and variable nucleotide tandem repeat analysis. Observed informativity was 83% for APC and 75% for DCC. DNA from 6 (20%) of 30 informative tumors exhibited loss of heterozygosity at the APC locus. Loss of heterozygosity at the DCC locus was observed in 7 (26%) of 27 informative tumor DNAs. Our results support the view that malignant progression is a consequence of more than one genetic change and suggest that inactivation of APC and DCC genes plays a role in a multistep process of colon tumor progression.

[Shock]

Shock is a consequence of disturbed circulation and decreased blood perfusion of tissues which, on the whole, cause functional and morphological impairments of organic systems. Occurrence of shock is not high, but it is significant due to bad prognosis and high mortality rate.

CLASSIFICATION

This is one of the classifications of shock: cardiogenic, extracardiogenic-obstructive, oligentic and distributive shock. PATHOPHYSIOLOGIC MECHANISMS OF SHOCK: Regardless of the cause of shock, the clinical picture is dominated by hypotension mostly caused by decrease of minute volume (septic shock may be an exception--minute volume might be high). Due to hypotension a lot of compensatory mechanisms are activated and in the beginning showing the compensatory phase of disease and if nothing is done decompensatory and in the end irreversible phase of shock occurs with fatal outcome. The clinical picture depends on the etiology of shock, type of shock, but it also has certain specificities.

PROGNOSIS

The prognosis depends on the clinical picture dominated by the following symptoms: hypotension, decreased diuresis, acidosis, consciousness disorders, tachypnea, peripheral cyanosis, cold and damp skin.

MANAGEMENT

These patients are managed in intensive care units, where the following parameters are followed-up: arterial pressure, central venous pressure, minute heart volume, systemic vascular resistance, diuresis, continual follow-up of heart rate, breathing and consciousness. In treatment of shock it is necessary to: normalize the circulatory volume, establish electrolyte balance, regulate glycemia and acid-base status, compensate the volume, calm the patient and alleviate pain.

[Asymptomatic myocardial ischemia before and after surgical revascularization in patients with multivessel occlusive coronary disease]

INTRODUCTION

The objective of this study was to examine the occurrence of asymptomatic myocardial ischemia prior to and after myocardial revascularization in patients with multivessel occlusive coronary disease. Asymptomatic ischemia can be described as real ischemia without anginal pain or other ischemic symptoms in patients with coronary disease or coronary artery spasm. Our study examined silent ischemia after myocardial revascularization. Early detection of silent ischemia is important for prevention of cardiac incidents.

MATERIAL AND METHODS

We have examined patients with multivessel coronary disease with occurrence of continued preoperative silent ischemia. All patients have undergone ECG examination, exercise stress test and Holter-monitoring prior to and after myocardial revascularization.

RESULTS

The investigation comprised 27 patients and their average age was 54.5 years. All patients with silent ischemia had a multivessel occlusive coronary disease and have undergone myocardial revascularization managed with triple or quadruple aortocoronary bypass surgery. Exercise stress test was performed postoperatively in elder patients, as well as ECG and Holter-monitoring. Silent ischemia was established in 21.6% of patients, while in 87.5% untreated diabetes mellitus was diagnosed. Silent ischemia most often occurred in the early morning hours and it was frequently associated with heart rhythm disturbances (VES) whereas these rhythm disturbances depended on the length of the ischemic episode. Intermittent 2nd degree atrioventricular block was found in one patient.

CONCLUSION

Silent myocardial ischemia occurred in 21% of patients after myocardial revascularization. It is most often detected in the early morning hours and is associated with ventricular rhythm disorders. Silent ischemia is easily detected by simple examination procedures providing adequate therapy and prevention of cardiac incidents.

[Vertebrobasilar flow: clinical manifestations and diagnostic approaches]

INTRODUCTION

The role of the damaged function of the brain and brain stem of vascular origin is very important in human pathology, especially today when these lesions are frequent, and prevention and elimination of consequences are complex. In practice vertebrobasilar insufficiency is a very important diagnostic problem. The aim of the paper is to point to the most frequent symptoms of vertebrobasilar dysfunction and to evaluate some diagnostic (electrophysiologic and neuroradiologic) procedures for the detection of a lesion.

PATIENTS AND METHODS

The examination concerned the patients with symptoms and signs of the damaged vertebrobasilar torcular, hospitalized at the Department of Urgent Neurologu of the Clinical Centre of Serbia in Belgrade, from January 1 to December 31, 1990. The diagnosis was made on the basis of the clinical picture and electrophysiologic and neuroradiologic findings. On the basis of these findings the patients were divide in groups 1-5. According to the duration of symptoms and signs of the disease the following damages were observed: transitory ischaemic attack, reversible ischaemic neurologic dificiency and total ischaemic cerebral stroke.

RESULTS

Fifty patients (36 men and 14 women), aged from 18 to 74 years, were examined. According to the localization of the lesion 20 patients belonged to group 2 (vascular area of a cerebelli inferior anterior). Definite infarct lesion was diagnosed in 32 patients (Table 1). The results of electrophysiologic examinations (auditive evoked potentials, somatosensorial evoked potentials, blink reflex, electroencephalographic screenint) were positive in 27-50% of examined patients (Tables 2, 3). The results of neuroradiologic examinations (vertebral angiography-19 patients and computed tomography-40 patients) were statistically significant in comparison to electrophysiologic results.

DISCUSSION

In everyday practice the diagnosis of vertebrobasilar dysfunctions, and especially of transitory attacks of vertebrobasilar insufficiency, may be an important problem because of a large number of symptoms and signs with frequent alterations. The symptoms of this torcular are diverse and they reflect many structures in a limited area which, if minimaly damaged, cause important neurologic deficiency. Instead of a conclusion, we wish to emphasize that, in addition to the clinical picture, the use of different electrophysiologic methods in the diagnosis of vertebrobasilar failure is needed, as with these methods the preservation of function of different nuclei and ways, can be secured. A far as the neuroradiologic methods are concerned, computed tomography of the head must be obligatory when cerebellar or supratentorial elsions of vertebrobasifar torcular are suspected, or when the aetiology of the disease is not clear. Vertebral angiography should only be carried out when all non-invasive methods are exhausted.

Neutrophil and monocyte phagocytic functions in patients with colorectal adenocarcinoma during fluorouracil therapy

Neutrophil and monocyte phagocytic functions, i.e % of phagocytic cells, ingestion and intracellular microbe killing were determined in 51 patients with colorectal adenocarcinoma, 43 with localized disease and 8 with distant metastases. Phagocytic functions were determined at the time of diagnosis, following surgery are before each of 6 cycles of fluorouracil chemotherapy. Four of six phagocytic parameters determined were decreased at diagnosis while all 6 decreased following surgery. During chemotherapy, neutrophil phagocytic activity recovered to normal value while all other neutrophil and monocyte functions remained decreased. Even so, neutrophil ingestion and monocyte phagocytic and bactericidal activities increased reaching from time to time values significantly higher than that found before the start of chemotherapy. The results showed significant alterations of neutrophil and monocyte phagocytosis in colorectal adenocarcinoma patients at the time of diagnosis, with further decrease following surgery. Fluorouracil chemotherapy did not exert suppressive effects on these functions; on the contrary, it seemed to support, or at least not to prevent, their partial recovery.

[Patulous eustachian tube]

Patulous eustachian tube is a pathological condition which exists more often than we make a diagnosis, and a patient is not often aware of his disease. This disease can be manifested with various symptoms: respiratory synchrony noises in the ear, because of the penetration of the air current through the eustachian tube and with the movement of the eardrum outwards and inside, with autophony, reduction of the hearing, the buzzing, dizziness and disturbance of the balance. Two patients are presented. The first one was sick for many years from various chronics exhausted diseases: Jackson's epilepsy, temporary vascular brain disturbances, tuberculosis of lung, stomach ulcer, heart diseases, the patient is from low class, on one side, and also suffers from some local diseases: a paralysis of soft palate and palatal arcs, a chronic catarrhal rhinitis and sinusitis, a deviation of nasal dividing wall and hindered breathing through the nose, on the other side. Many years the patient didn't know for patological condition in the ears and in the eustachian tubes. After improving the hygienic conditions, the physical condition and local therapy, the patient felt much better. The second patient, with considerable shorter evolution of the disease and mild symptomatology, showed the amplified symptoms of the disease of the Eustachian tube in the course of the acute otitis. It is attained a satisfying calming of the manifestative symptoms by remedy therapie. Man must thing about possibility of the appearance of this pathology condition in various disease or conditions, which can take to the fast lost of the weight and physical and moral exhaustion of the patient, i.e. an adult, first as the protection of the appearance of the disease (condition) and afterwards, eventually early and regulary treatment in order to prevent various possible, above mentioned complications.

[Cerebellar ataxia and acute cerebellar insult]

Ataxia, loss of muscle coordination during complex movement, is the most important sign of cerebellar lesion. Acute cerebellar attack of ischaemic and/or haemorrhagic nature is a focal disorder of cerebellar function which occurs rarely considering the prominent collateral net of blood vessels conveying blood to the cerebellum and the brain stem. We examined 12 patients with acute cerebellar attack (9 with ischaemic and 3 with haemorrhagic attack) of 300 patients with symptoms and signs of acute cerebrovascular attacks. We used all available diagnostic methods (EEG, neuro-ophthalmological examination, computed tomography as well as brain scintigraphy and angiography) in the management of these patients.

[Correlation of sonographic and patho-anatomic findings in myomatous changes in the uterus]

In spite of the fact that ultrasound is an accessory diagnostic measure in gynaecology, added to clinical examination, it can help in a more accurate diagnosis and better preparation for surgery. The comparison of data obtained by ultrasonic and macroscopic measurements of uterine leiomyoma in 130 patients did not reveal a statistically significant difference between the two methods. The mean size of all measured leiomyomas was 61.47 mm in longitudinal diameter, 53.00 mm in anteroposterior and 53.95 mm in transversal. Measured by ultrasound the mean dimensions of the same diameters were 62.29 mm, 56.91 mm and 55.11 mm respectively. Differences in the mean values of all measured diameters obtained in some cases can be explained by subjective elements in the use of ultrasound, the examiners experience and postoperative reduction of the removed organ volume, as well as by technical factors which may influence the ultrasonic image. Thus, the accuracy of ultrasonic measurement completes the knowledge about the size of the pelvic mass; it is helpful in preparation for surgery, and decreases the possibility of unexpected situations during the surgery.

[Vascular headache and cerebral edema]

Headache is one of the commonest symptoms in neurology. It can be present among many other somatic illnesses. There are many aetiological factors. Pathogenetic mechanisms are unknown. There is a significant number of patients with headache, especially with vascular headache, (about 15%), and vascular headache associated with cerebrovascular ischaemic stroke. Therefore the new investigations of neurobiochemical and neurophysiological problems are necessary. A group of patients involved in our study with diagnosis of vascular headache was tested. The result of the study (especially neuroradiological results) show that many patients, prevalently young women, had cerebral oedema during the attack of vascular headache.

[Primary carcinoma of the fallopian tube (report on 3 cases)]

Three patients with the primary carcinoma of the fallopian tube, aged 51, 68, and 42, are presented. The disease was diagnosed in the period from 1971 to 1980. In all three patients there was a triad of symptoms: bleeding, adnexal tumour, and pain, but the diagnosis was made only during surgery. The operative therapy with consecutive radiation was applied in all three patients.

Primary hypertrophic osteoarthropathy (PHO) and changes in the joints. Clinical, X-ray, scintigraphic, arteriographic and histologic examination of 19 patients

Nineteen patients with PHO with onset in childhood are presented. In 7 cases the syndrome was found in other family members too. In clinical, X-ray scintigraphic, arteriographic, and plethysmographic investigations, joint affection was found in 14 patients. Clubbing of the fingers and toes was seen in all the patients and a periosteal reaction was found in the long bones in 11 patients. Arteriography was carried out in 5 patients and showed hypervascularization and arteriovenous anastomoses in the clubbed fingers. The gas analysis of the arterial blood did not show any pathological changes. The histological finding showed poorly vascularized and oedematous periarticular tissue and ossification in the periosteal area, while in the synovial membrane, slight, nonspecific inflammatory changes were seen.