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The degree of medullary infiltration by plasmocytes has a prognostic value which completes the clinical classifications proposed in multiple myeloma. Beyond a 50 p. cent medullary infiltration, the mean survival of the patients is significantly shorter (p less than 0.02) than survival of patients presenting less than 50 p. cent medullary infiltration. The degree of medullary infiltration is unrelated to the stage of Durie and Salmon classification, but is correlated to the degree of differentiation of the plasmocytes.

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The effect of bone marrow plasma cell morphology at diagnosis on survival time was evaluated in 66 patients with multiple myeloma. According to the morphologic classification multiple myeloma was categorized as plasmacytic, plasmacytic/plasmablastic, or plasmablastic. The plasmablastic myeloma had an estimated median survival of 9 months compared with 42 months for plasmacytic/plasmablastic myeloma. Median survival of plasmacytic myeloma has not yet been attained. Plasma cell morphology at diagnosis is an important predictor of survival duration in patients with multiple myeloma. These parameters provide information required for decisions on treatment modalities.

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The authors present a study of superoxide dismutase, catalase and glutathione peroxidase in hemolysis product, platelets and serum of 23 patients with rheumatoid polyarthritis and 11 healthy subjects. The nature of the treatment enables to divide the 23 patients into 3 groups: group I (8 cases): no treatment; Group II (7 cases): steroid therapy alone; group III (8 cases): basic treatment associated (3 cases) or not (5 cases) to steroid therapy. Statistical analysis shows no significant difference, whatever the environment and the treatment contemplated. The significance of these results is discussed and compared with literature data concerning only enzymatic activities and not the blood levels as in the present study.

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Several recent studies have identified in multiple myeloma a plasmablastic subgroup characterized by its very sombre prognostic. We report the results of treatment in 10 high risk patients with plasmablastic myeloma stage IIIA in the Durie and Salmon classification, stage III in the Bartl classification (tumoral mass greater than 50%). The median survival of the 10 patients was 8 months. These patients, who were resistant to melphalan-prednisone (M-P) or to VMCP in conventional doses, fell into 2 categories: those who responded to chemotherapy with adriamycin, and those who resisted all types of chemotherapy from the start. The finding of such heterogeneous responses to chemotherapy in the plasmablastic subgroup of multiple myeloma and the usefulness of CALLA+ antigen determination make it necessary to study cell differentiation antigens, which would in the long term alter the therapeutic approach in these patients.

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The authors report a retrospective study of the diagnostic usefulness of synovial biopsy (SB) in 80 cases of unspecified forms of joint disease. SB was able to indicate the diagnosis in 23 (28.7%) of these patients. These 23 cases included 4 of the 15 cases (26.6%) of acute monoarticular arthritis, 5 (31.2%) of the 16 cases of acute oligopolyarthritis. In 6 cases (7.5%) SB was also responsible for the elimination of an initial diagnosis of septic arthritis. Overall, therefore, SB contributed to establishing a diagnosis and guiding therapy in 20 (36.2%) patients. Despite these rather low percentages, SB appears to be an essential examination, particularly in monoarticular arthritis, for the confirmation or exclusion of the diagnosis of conditions which present specific histologic signs and which require appropriate treatment.

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The therapeutic applications of sequential bone marrow biopsy were investigated in 6 patients with myeloma. Our results showed that the response to chemotherapy is modified by data from quantitative bone marrow cytology which separate subgroups of patients (plasmocytes or plasmoblasts) with different prognosis. The selective disappearance of certain bone marrow components (plasmoblasts and/or diffuse infiltration) after chemotherapy results in tumoral growth retardation which is reflected in a higher objective response rate. These preliminary results emphasize the need for pretreatment bone marrow biopsy in order to select the most appropriate drugs. A prospective study involving a large number of patients is in progress; its purpose is to find out whether adding to the already known clinical classifications a classification based on the type of bone marrow infiltration and on the degree of cell differentiation is therapeutically useful.

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The authors report two cases of the articular chondrocalcinosis associated with a laboratory profile compatible with Bartter's syndrome and masked diuretic intoxication in 2 women aged 31 and 59 years. An extensive study of the literature revealed 7 similar cases. The pathogenic relationship between the two conditions could be the hypomagnesemia. 5 other reports concerning young patients presenting the association of chondrocalcinosis and hypomagnesemia, not part of Bartter's syndrome, add further support to this hypothesis. This study suggests that the serum electrolytes and the serum magnesium should be assayed routinely in cases of chondrocalcinosis, especially in young patients.

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The influence of food on the release, absorption and metabolism of metoprolol has been studied after single administration of a 19/190 Oros system to eight healthy volunteers on four occasions, once after an overnight fast, and just before each of three daily meals (breakfast, lunch and dinner). The plasma concentration-time profiles under the four test conditions were virtually identical, and no statistically significant differences in mean areas under the curves between 0 and 32 h, peak concentrations, or times to peak, were detected. The absorption of metoprolol was unaffected by food intake, with 80-90% of the amount absorbed reaching the systemic circulation within 10 h. The ratios of areas under the curve for alpha-hydroxymetoprolol to its parent drug were in the same range for the four treatments, and similar to those reported after conventional tablets. The in vivo release and absorption of drug from the Oros system and its systemic availability, were not influenced by concomitant ingestion of food.

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Two cases of classical rheumatoid arthritis complicated by the development of a glomerulopathy independently of drug treatment are presented. Renal biopsy showed membranous glomerulonephritis in one case and fusion of foot processes in the second. The literature is reviewed and the possible relationships between rheumatoid arthritis and these glomerulopathies are discussed. The authors conclude to the absence of causal relationship between these two diseases.

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