Interval training in men at risk for insulin resistance

We compared 3 months of eucaloric (12 kcal/kg/wk) steady state aerobic training (AER) to interval training (INT) in men at risk for insulin resistance. Primary outcomes included oral glucose tolerance testing (OGTT) and HOMA-IR 24 h and 72 h after each participants last exercise session. Secondary outcomes were VO2max, anthropometry, and metabolic syndrome expressed as a summed z-score (zMS). We also performed a sub-analysis for participants entering the trial above and below the HOMA-IR study median. Mean (95% CI) AER ( - 12.81 mg/dl; - 24.7, - 1.0) and INT ( - 14.26 mg/dl; - 24.9, - 3.6) significantly improved 24 h OGTT. HOMA-IR did not improve for AER, but did for INT 24 h and 72 h post-exercise. VO2max improved similarly for both groups. Changes in body mass for INT ( - 2.29 kg; - 3.51, - 1.14), AER, ( - 1.32 kg; - 2.62, 0.58)] and percent body fat [INT, - 0.83%; - 1.62, - 0.03), AER ( - 0.17%; - 1.07, 0.06)] were only significant for INT. When examined as a full cohort, zMS improved for both groups. Upon HOMA-IR stratification, only high HOMA-IR AER showed significant improvements, while both low and high INT HOMA-IR participants demonstrated significant reductions (P<0.05). Eucaloric AER and INT appear to affect fasting glucose, OGTT and VO2max similarly, while INT may have a greater impact on HOMA-IR and zMS.

On the connection between RNAi and heterochromatin at centromeres

RNA interference (RNAi) is a conserved silencing mechanism whereby double-strand RNA induces specific down-regulation of homologous sequences. In the fission yeast Schizosaccharomyces pombe, centromeric heterochromatin assembly is an RNAi-dependent process. Noncoding RNAs transcribed from pericentromeric repeat sequences are processed into short interfering RNAs (siRNAs) that direct the Argonaute-containing RNA-induced transcriptional silencing (RITS) effector complex to homologous nascent transcripts. RITS is required for H3K9 methylation by the histone methyltransferase (HMT) Clr4; conversely, H3K9 methylation can attract RITS to chromatin via binding of the chromodomain protein Chp1. This codependency has hampered dissection of the order of events and mechanisms of cross talk between the RNAi and chromatin modification machineries. To tackle this problem, we have developed systems that reconstitute heterochromatin at a euchromatic locus, using either hairpin triggers or DNA-tethered chromatin-modifying complexes. These systems reveal that RNAi is sufficient to promote heterochromatin assembly in cis and that direct recruitment of the HMT Clr4 can bypass the role of RNAi in heterochromatin assembly. We have also characterized a new pathway component, Stc1, that translates the RNAi signal into chromatin marks. We discuss the implications of these findings for our understanding of the mechanism and function of RNAi-directed heterochromatin assembly at centromeres.

Subchondral tibial bone mineral density predicts future joint space narrowing at the medial femoro-tibial compartment in patients with knee osteoarthritis

Preliminary studies have shown that dual-energy X-ray absorptiometry (DXA) produces images of sufficient quality for a precise and accurate measurement at density of the subchondral bone. The objective of this study was to investigate the relationship between baseline subchondral tibial bone mineral density (BMD) and joint space narrowing observed after 1 year at the medial femoro-tibial compartment of the knee joint. Fifty-six consecutive patients, from both genders, with knee osteoarthritis diagnosed according to the American College of Rheumatology criteria, were included in the study. Radiographic posteroanterior views were taken, at baseline and after 1 year of follow-up. Minimum joint space width (JSW) measurement, at the medial femoro-tibial joint, was performed with a 0.1-mm graduated magnifying lens. Baseline BMD of the subchondral tibial bone was assessed by DXA. The mean +/- SD age of the patients was 65.3 +/- 8.7 years, with a body mass index of 28.0 +/- 4.9 kg/m(2). The minimum JSW was 3.5 +/- 1.5 mm and the mean BMD of the subchondral bone was 0.848 +/- 0.173 g/cm(2). There was a significant negative correlation between subchondral BMD and 1-year changes in minimum JSW (r = -0.43, p = 0.02). When performing a multiple regression analysis with age, sex, body mass index, and minimum JSW at baseline as concomitant variables, BMD of the subchondral bone as well as JSW at baseline were independent predictors of 1-year changes in JSW (p = 0.02 and p = 0.005, respectively). Patients in the lowest quartile of baseline BMD (<0.73 g/cm(2)) experienced less joint space narrowing than those in the highest BMD quartile (>0.96 g/cm(2)) (+0.61 +/- 0.69 mm versus -0.13 +/- 0.27 mm; p = 0.03). Assessment of BMD of the subchondral tibial bone is significantly correlated with future joint space narrowing and could be used as a predictor of knee osteoarthritis progression.

Influence of daily regimen calcium and vitamin D supplementation on parathyroid hormone secretion

Calcium and vitamin D supplementation has been shown to reduce secondary hyperparathyroidism and play a role in the management of senile osteoporosis. In order to define the optimal regimen of calcium and vitamin D supplementation to produce the maximal inhibition of parathyroid hormone secretion, we have compared the administration of a similar amount of Ca and vitamin D, either as a single morning dose or split in two doses, taken 6 hours apart. Twelve healthy volunteers were assigned to three investigational procedures, at weekly intervals. After a blank control procedure, when they were not exposed to any drug intake, they received two calcium-vitamin D supplement regimens including either two doses of Orocal D3 (500 mg Ca and 400 IU vitamin D) 6 hours apart or one water-soluble effervescent powder pack of Cacit D3 in a single morning dose (1000 mg Ca and 880 IU vitamin D). During the three procedures (control and the two calcium-vitamin D supplementations), venous blood was drawn every 60 minutes for up to 9 hours, for serum Ca and serum PTH measurements. The order of administration of the two Ca and vitamin D supplementation sequences was allocated by randomization. No significant changes in serum Ca were observed during the study. During the 6 hours following Ca and vitamin D supplementation, a statistically significant decrease in serum PTH was observed with both regimens, compared with baseline and with the control procedure. Over this period of time, no differences were observed between the two treatment regimens. However, between the sixth and the ninth hour, serum PTH levels were still significantly decreased compared with baseline with split dose Orocal D3 administration, while they returned to baseline value with the Cacit D3 preparation. During this period, the percentage decrease in serum PTH compared with baseline was significantly more pronounced with Orocal D3 than with Cacit D3 (P = 0.0021). We therefore conclude that the administration of two doses of 500 mg of calcium and 400 IU of vitamin D3 6 hours apart provides a more prolonged decrease in serum PTH levels than the administration of the same total amount of Ca and vitamin D as a single morning dose in young healthy volunteers. This might have implications in terms of protection of the skeleton against secondary hyperparathyroidism and increased bone resorption and turnover in elderly subjects.

Influence of daily calcium and vitamin D supplementation on parathyroid hormone secretion

Calcium and vitamin D supplementation have been shown to reduce secondary hyperparathyroidism and play a role in age-related osteoporosis. In order to define the optimal regimen of calcium and vitamin D supplementation to produce the maximal inhibition of parathyroid hormone secretion, we compared the administration of a calcium-vitamin D supplement as a single morning dose with the administration of two divided doses at 6-hour intervals. Twelve healthy male volunteers were assigned to three investigational procedures, which were alternated at weekly intervals. After a 'blank' control procedure, when they were not exposed to any supplements, they received one of two calcium-vitamin D supplement regimens: either two doses of Orocal D3 (500 mg calcium and 400 IU vitamin D3) with a 6-hour interval between doses, or one water-soluble effervescent powder pack of Cacit vitamin D3, taken in the morning (1000 mg calcium and 880 IU vitamin D3). During the three procedures (control and the two calcium-vitamin D supplementation protocols), veinous blood was drawn every 60 minutes for up to 9 hours, for serum calcium and parathyroid hormone measurements. The order of administration of the two calcium and vitamin D supplementation regimens was allocated by randomization. No significant changes in serum calcium were observed during the study. During the first 6 hours following calcium-vitamin D supplementation, a statistically significant decrease in serum parathyroid hormone was observed with both regimens, compared with baseline and the control procedure. During this first period, no differences were observed between the two treatment regimens. However, between the 6th and the 9th hour, serum parathyroid hormone levels remained significantly decreased compared to baseline with the twice-daily Orocal D3 administration, while they returned to baseline values with the once-daily Cacit D3 preparation. During this period, the percentage decrease in serum parathyroid hormone relative to baseline was significantly greater with Orocal D3 than Cacit D3 (p = 0.0021). We therefore conclude that the twice-daily administration of 500 mg calcium and 400 IU vitamin D3 at 6-hour intervals provides a more prolonged decrease in serum parathyroid hormone levels than the administration of the same total amount of calcium and vitamin D, as a single morning dose in young healthy.

Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial

BACKGROUND

Treatment of osteoarthritis is usually limited to short-term symptom control. We assessed the effects of the specific drug glucosamine sulphate on the long-term progression of osteoarthritis joint structure changes and symptoms.

METHODS

We did a randomised, double-blind placebo controlled trial, in which 212 patients with knee osteoarthritis were randomly assigned 1500 mg sulphate oral glucosamine or placebo once daily for 3 years. Weightbearing, anteroposterior radiographs of each knee in full extension were taken at enrolment and after 1 and 3 years. Mean joint-space width of the medial compartment of the tibiofemoral joint was assessed by digital image analysis, whereas minimum joint-space width--ie, at the narrowest point--was measured by visual inspection with a magnifying lens. Symptoms were scored by the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index.

FINDINGS

The 106 patients on placebo had a progressive joint-space narrowing, with a mean joint-space loss after 3 years of -0.31 mm (95% CI -0.48 to -0.13). There was no significant joint-space loss in the 106 patients on glucosamine sulphate: -0.06 mm (-0.22 to 0.09). Similar results were reported with minimum joint-space narrowing. As assessed by WOMAC scores, symptoms worsened slightly in patients on placebo compared with the improvement observed after treatment with glucosamine sulphate. There were no differences in safety or reasons for early withdrawal between the treatment and placebo groups.

INTERPRETATION

The long-term combined structure-modifying and symptom-modifying effects of gluosamine sulphate suggest that it could be a disease modifying agent in osteoarthritis.

Cerebrospinal fluid dynamics in the tardive cauda equina syndrome of ankylosing spondylitis

Typical cauda equina syndrome secondary to long-standing ankylosing spondylitis is reported in a 63-year-old man. Radionuclide cisternography demonstrated a resorption defect of cerebrospinal fluid in the enlarged lumbosacral dural sac. After transient symptomatic improvement with acetazolamide, a lumboperitoneal shunt was placed. The rate of cerebrospinal fluid, isotope resorption became normal. In the 5 years of follow-up, partial remission has been observed.

[Spinal osteoblastoma. Report of 8 cases]

The authors studied the special features of the vertebral location of this benign tumour of osteoblastic origin in eight cases of spinal osteoblastoma. Clinically, neurological complications are frequently present and scolioses may arise and persist after treatment; radiologically, new imaging techniques enable the limits of the tumour to be assessed with greater accuracy with respect to the neighbouring bone and their relationship to the components of the vertebral canal; surgically, there are difficulties specific to this location raised by the proximity of nervous components, and also by the vertebral destabilization entailed by the considerable bone involvement. Anatomicopathological diagnosis remains difficult, particularly in the case of osteoid osteoma.

Compared effects of isoxicam and indomethacin on the urinary excretion of prostaglandins in degenerative articular diseases

The effects of a 7 day-treatment with isoxicam (200 mg/24 h) on the urinary excretion of prostaglandins (PG) were compared to those of indomethacin (150 mg/24 h) in a double-blind randomized study conducted in 18 patients with degenerative arthritic disease and normal renal function. Indomethacin decreased the urinary excretion of PGF2 alpha by about 70% and 6-keto-PGF1 alpha and thromboxane (Tx)B2, the stable break-down products of prostacyclin and TxA2 respectively, by about 40%. Isoxicam effects on urinary PG did not significantly differ from those of indomethacin. During both treatments, urinary gamma-glutamyl transferase and N- acetyl-glucosaminidase remained stable and none of the changes in the urinary excretion of PGs could be related to either plasma or urinary drug concentrations. In conclusion, chronic administration of isoxicam inhibited the renal PG biosynthesis to a similar extent than indomethacin which suggests that non steroidal anti-inflammatory drugs of the oxicam group ought also be used cautiously in patients with renal impairment.

[Candida spondylodiscitis. Report of 2 personal cases and 28 cases from the literature]

Vertebral osteomyelitis caused by Candida spp. has recently been described and seems to be rare since only 30 cases have been published so far. Its clinical, laboratory and radiological features are identical with those on non-tuberculous bacterial spondylitis. It develops in subjects with poor general condition who underwent multiple surgical operations or received prolonged antibiotic therapy. The finding of Candida at needle biopsy of the since clinches the diagnosis. Serological tests might provide an earlier diagnosis and, above all, enable therapeutic effectiveness to be evaluated. In 27 of the 30 cases reported here, cure was obtained by prolonged infusions of antifungal drugs, chiefly amphotericin B and/or 5-fluorocytosine.

The rheumatoid heel: its relationship to other disorders in the rheumatoid foot

Four-hundred and eight rheumatoid feet are studied. The percentage of talalgia is 3.7%; for inferior exostosis it is 29.6%, and 30.8% for posterior exostosis. Posterior demineralisation is present in 12%, whereas for bony erosion it is 8.1%. Plantar spurs are very closely associated to flattened feet (p less than 0.0001). Likewise a very noticeable statistical association is noted between postero-superior calcaneitis and tarsal arthritis (p less than 0.0001), and calcaneitis was more frequent among marked valgus (p less than 0.001). These results are compared with findings of other works. Therapeutic consequences are evoked.

Deformation of the adult rheumatoid rearfoot. A radiographic study

Three hundred ninety-seven adult rheumatoid feet were examined. Those in whom pain had been present since the onset of the disease were compared radiographically with the painless feet in standing position: examination of the talar angle and of the internal arch showed flattening on the affected feet. The calcaneal angle, on the other hand, showed no difference between the two groups, but this latter parameter is little affected by the valgus pronation deformity of the hindfoot most often seen in patients who had experienced foot pain.

IgM rheumatoid factor (RF), IgA RF, IgE RF, and IgG RF detected by ELISA in rheumatoid arthritis

One hundred patients with rheumatoid arthritis (RA), of whom 73 were seropositive by latex or Waaler-Rose (WR) assays, or both, 100 healthy subjects, and 102 diseased controls (22 patients with systemic lupus erythematosus (SLE) and 80 with bronchial asthma) were evaluated for the presence of IgM rheumatoid factor (RF), IgA RF, IgE RF, and IgG RF by an enzyme linked immunosorbent assay (ELISA). Ninety two per cent, 65%, 68%, and 66% of the patients with RA were found to be positive for IgM, IgA, IgE, and IgG respectively. A positive correlation existed between the levels of IgM RF and IgA RF on the one hand and disease activity on the other, and the levels of IgM RF and IgA RF correlated with the levels of circulating immune complexes as measured by a C1q binding assay. The presence of extra-articular features also correlated positively with the levels of IgA RF and IgE RF. Five out of six patients with Sjögren's syndrome had very high levels of IgA RF. Of 47 patients typed for HLA-DR, DR1 and DR2 were significantly more frequent in those with the highest levels of IgM RF. Conversely, DR3 was associated with low levels or absence of IgA RF and IgE RF. These results suggest that immune response genes may regulate the level of different RF isotypes. The frequencies of IgM, IgA, IgE, and IgG RF were 59%, 36%, 9%, and 27% respectively in SLE and 25%, 2.5%, 70%, and 59% in bronchial asthma.

Flattening of the rheumatoid foot in tarsal arthritis on X-ray

222 consecutive and unselected patients suffering form classical or definite rheumatoid arthritis wee studied. 397 of their feet were examined. Talonavicular arthritis was the commonest finding (31.5% of all patients), followed by sub-talar (23.3%), cuneo-navicular (20.4%) cuneo-metatarsal (14.9%) and tibio-tarsal arthritis (12.6%). Rheumatoid disease of the tarsus becomes commoner as the disease progresses. The incidences of involvement of the talo-navicular and sub-talar joints show a similar pattern, with a leap of 25% between 5 years of duration of the disease and 10 years. The same is seen with involvement of the cuneo-navicular and cuneo-metatarsal joints, between a duration of 10 years of the disease and 15 years. The percentage of flat foot is greater in feet with tarsal arthritis (p less than 0.001). The authors observed a relationship between tarsal arthritis, the length of history of rheumatoid arthritis, and flat foot. The method of investigation is discussed, and theories about evolution of the rheumatoid foot are considered.

[Relation between the cellularity and lactic acid level in 55 synovial fluids and research on concentration profile as a function of the etiology]

The authors investigated 55 determinations of synovial lactic acid in 7 groups of patients: septic arthritis, seropositive rheumatoid arthritis, seronegative rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitic arthritis, reactive arthritis, mechanical fluids of osteoarthritis. Statistical analysis confirmed the diagnostic contribution of this determination in septic arthritis and demonstrated a correlation between the lactic-acid and cell levels within a cell-level range of 5,000-20,000. A significant difference was detected between seronegative and seropositive forms of arthritis. The physiopathologic interpretation of the findings in cases of rheumatoid polyarthritis and in non-rheumatoid inflammatory rheumatism is discussed.

Immunoelectrophoretic investigations in 55 patients with systemic amyloidosis

Among 55 amyloidoses, the detection of a monoclonal protein (MP) led to the selection of 15 primary and 3 myeloma-associated types of amyloidosis. Therefore the presence of a MP gives evidence for an immunocytic amyloidosis. The lambda-light-chain nature of MP and the abundant production of free light-chains are two of the factors predisposing to the production of amyloid deposits (AL) in the course of immunocyte dyscrasias.

[Cytofluorometric study of the cell cycle and various lymphocyte differentiation membrane antigens in the synovial fluid in rheumatoid polyarthritis]

Synovial fluid lymphocytes were studied by cytofluorometry in 11 patients with classical or definite rheumatoid arthritis. This method allowed the study of the cellular cycle after acridine orange staining and of membrane antigens, expressed by normal and/or activated lymphocytes, which were demonstrated by using various monoclonal antibodies (OKT3, OKT4, OKT8, OKIa1, OKT10). The OKT4/OKT8 ratio was decreased in 4 out of 5 cases and the percentage of HLA DR + cells was clearly increased. In 6 out of the 11 patients, the percentage of dividing cells varied from 2.2 to 7.2 and was less than 1 in the others as in normal blood lymphocytes. Increase in cellular RNA content characterized the non dividing cells. The most elevated values of the cellular RNA content were observed in patients who had the smallest percentage of dividing cells, suggesting that the cellular cycle was stopped between the G1 and S phases. Study of the cellular cycle may reveal a lymphocyte activation parameter which could be unrelated to the expression of differentiation membrane antigens.

Increased DNA and/or RNA content of synovial fluid cells in rheumatoid arthritis: a flow-cytometry study

Flow-cytometry studies of DNA and RNA content were carried out in acridine orange-stained synovial fluid lymphocytes from 11 patients presenting with classical or definite rheumatoid arthritis. Monoclonal antibodies were used to detect specific T cell surface antigens (OKT3, OKT4, OKT8) and antigens associated with lymphocyte activation (OKIa 1, OKT10). T3 positive cell percentages were comparable to those of normal blood, although T4/T8 ratios were decreased in 4 out of 5 cases, and HLA-DR positive cells increased. Six out of 11 patients showed percentages of dividing cells varying from 2.2 to 7.2% as compared with less than 1% in the other patients and in normal blood. Nondividing cells were characterised by an increase in their RNA content compared with normal blood. A greater increase of RNA content was observed in patients with lower percentages of dividing cells, suggesting a G1/S block. Changes in cellular DNA and/or RNA contents provide a valuable parameter of lymphocyte activation, not necessarily linked to the expression of differentiation antigens by activated cells.

[Ankylosing spondylarthritis. Pathogenesis of the destructive disco-vertebral lesions. 15 cases]

Fifteen cases of destructive disco-vertebral lesions discovered in patients with ankylosing spondylitis are reported. The incidence of these lesions was 5.5% and they were unrelated to underlying conditions. Radiologically, they fell into five categories: pseudodystrophic, pseudotuberculous, extensive erosions, bone condensation and isolated narrowing of the intervertebral spaces. From an analysis of these 15 cases and of published data, it would appear that these forms result from different pathogenetic processes: an inflammatory process for the pseudodystrophic and pseudotuberculous forms and for early extensive erosions; a mechanical process for bone condensation and perhaps also (though this is more controversial) for late extensive erosions and isolated intervertebral narrowing.

[Treatment of rheumatoid arthritis with isoprinosine. Personal experience]

Twenty patients with classical or proved rheumatoid arthritis were treated with Isoprinosine. 13 patients received a dose of 25 mg/kg/day and 7 received a dose of 50 mg/kg/day, continuously for 2 months and then discontinuously, 5 days every fortnight. The series being treated with 25 mg/kg/day (7 patients) have received treatment for 12 months. No side effects have been observed; the only reason for ceasing treatment was its ineffectiveness (after at least 3 months of administration). The dosage of the associated anti-inflammatory drugs did not need to be increased, but neither was it decreased. The authors conclude that Isoprinosine is largely ineffective clinically, on laboratory tests and in terms of immunology, at least with the therapeutic protocols tested here.

[Humoral and cellular anticollagen autoimmunity in rheumatic pathology]

Using an immuno-enzymatic technique, the authors studied the production of anti-collagen I and II auto-antibodies in 171 cases of rheumatoid arthritis (RA), 40 cases of systemic lupus erythematosus (SLE) and 21 cases of overriding syndrome. Cellular immunity to native collagen II was tested in a group of 26 patients with RA and 27 control subjects, by studying the production of LIF (Leukocyte Inhibitory Factor) in response to this antigen. The anti-collagen I and II antibodies are present in 15.2% and 17.5% of RA patients respectively and also in 15% and 15.5% of the SLE patients studied. Anti-collagen I antibodies are associated with RA with extra-articular signs and anti-collagen II antibodies are associated with early RA, but no association could be found with the clinical or radiological course of the disease. Cellular reactivity to collagen II was found in 30% of the cases of RA studied and was associated with the early forms of the disease. Complementary studies on the association of certain HLA antigens with cellular or humoral reactivity to collagen should allow a better approach to the clinical relationships of certain cases of chronic inflammatory rheumatism with anti-collagen auto-immunization.

[Erbium 169 synoviortheses and infiltrations of triamcinolone hexacetonide in metatarsophalangeal arthritis of chronic inflammatory rheumatism]

The authors report their experience in the treatment of metatarsophalangeal arthritis of chronic inflammatory rheumatism by Erbium 169 synoviortheses (112 joints treated) and by infiltrations of triamcinolone hexacetonide (53 joints treated). The steroid appears to have a marked early superiority as it gives 85% good results compared to 61.6% for Erbium 169 after a period of one to three months. However, its results then deteriorate more rapidly and after 6 months, the proportion of good results is greater with the radioactive treatment (64% compared to 46.7%). The authors consider it reasonable to use triamcinolone hexacetonide as the first line treatment as it is easier to manage and less expensive, reserving the radioactive synoviortheses for later with the prospect of more lasting results.

Chronopharmacokinetic study of a prolonged release form of indomethacin

The chronopharmacokinetics of indomethacin was studied in patients with rheumatoid diseases after a single oral dose of a new prolonged-release form containing indomethacin 75 mg. The drug was given either at 8, 12 or 20 h and its plasma concentrations, as well as those of its main metabolite, O-desmethyl indomethacin, were followed using a new specific gas chromatographic assay. When given at 20 h plasma indomethacin concentrations did not exhibit a sharp peak and remained much more stable than when the drug was given at 8 or 12 h. In addition, plasma O-desmethyl indomethacin was significantly higher after administration of indomethacin at 20 h than at 8 or 12 h. It is concluded that the pharmacokinetics of the oral prolonged-release form of indomethacin exhibited chronobiological variation. The data are in accordance with clinical studies which suggest that it might be worthwhile to administer this formulation of indomethacin at 20 h.

[Distal bone metastases of the upper limb]

This work is based on a review of 120 peripheral bone metastases of the upper limbs found in the literature and 10 others selected from a personal series of 469 cases of bone metastases. The authors stress the scarcity of these lesions (2%), metastases arising in bones of the forearm are usually part of a widespread osseous involvement, generally of mammary or prostatic origin. Metastases to the bones of the hand are more peculiar: 1) Those from bronchogenic carcinoma account for 50%. 2) Resultant soft tissue necrosis creates swelling, redness, heat and pain, which can mimic acute osteomyelitis. 3) X-rays reveal isolated osteolysis affecting metacarpals, phalanges, or more rarely carpal bones. Distal location of those metastases does not modify therapeutic management amputation is the best effective palliative treatment and must be discussed every time there is a concomitant skin ulceration, or if bone metastasis is unique or if the primary tumor is cured or accessible to treatment.

[Mast cells in bone pathology]

The authors have endeavoured to determine the place occupied by mast cells in bone tissue from the mode of action on the bone of their secretion products (metachromatic granules, heparin, prostaglandins), from their proliferation in reaction to some bone diseases (secondary mastocytosis) and from the bone lesions associated with systemic mastocytosis. Metachromatic granules are capable of chelating calcium, and heparin and prostaglandins stimulate bone resorption. However, the role of mast cells in bone remodeling through these mechanisms has not yet been demonstrated. Similarly, the significance of mastocytosis secondary to osteomalacia, renal osteodystrophy and ordinary osteoporosis remains hypothetical. Primary bone mastocytosis produces diffuse or circumscribed osteogenic, osteolytic or mixed lesions. While the pathogenesis of osteolytic forms can readily be explained by the actions of heparin and prostaglandins, that of the osteogenic forms is still mysterious. Finally, the histological profile, and even the nosological profile, of mast cell osteoporosis, a diffuse condition recently individualized, remain undetermined.

[Value of anti hemolysin and anti-gammahemolysin assays for the diagnosis of staphylococcal infections, particularly of osteoarthritis (author's transl)]

The authors report the results of more than twelve years' personal research on the value of anti-alphahemolysin (AASTL) and antigammahemolysin (AGSTL) assays for the diagnosis of staphylococcal infections, and particularly of osteoarthritis. Among 574 controls, AASTL levels exceeded 2 IU in only 14 subjects (11 of these, levels were between 2 and 3 IU). Levels less than, or equal to, 2 IU were therefore considered normal. This is consistent with previously published data. In 144 staphylococcal infections, confirmed by bacteriology, an increase in AASTL was found in 95 of all cases (65.9%) and in 54 of the 76 osteoarthritis' (71%). Similarly, AGSTL titres, which were under 1/160 (upper normal limit) in 138 controls, were increased in 35 patients with unequivocal staphylococcal infections (61.4%), and in 25 of 36 patients with osteoarthritis (69.4%). These results show that AASTL assay is reliable and often abnormal. However, assay of both hemolysins yields even better results. This dual assay was performed in 57 patients with staphylococcal infection. One hemolysin at least was increased in 47 patients (82.4%). This represents additional positivity in 15.7% of patients when compared to AASTL assay alone, and in 21% when compared to AGSTL assay alone. The high level of positive results with dual assay is even more striking when only staphylococcal osteoarthritis is considered: one or both hemolysins were increased in 91.1% of these patients (31/34).