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The tarsal tunnel syndrome is a complex entity. The condition results from a compression of the posterior tibial nerve, either at its terminal or collateral branches, at the tibio-astragalo-calcaneal canal of Richet. A retrospective study of 27 consecutive cases, treated by epi- or perineural neurolysis, illustrates the variability of the clinical picture but fails to confirm the complete and immediate success of the intervention, as reported by the majority of authors. However, the long-term follow-up shows a significant improvement in the terminal latencies of the posterior tibial nerve at 2 years post-surgery. A pathological study of 20 cadaveric feet discloses microscopic anomalies in 22 of the 120 nerve biopsy specimens.

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The introduction of an automated flow cytofluorograph has facilitated the detection of T lymphocyte subsets because it enables a larger number of cells to be analyzed. Many authors have reported a decrease of cytotoxic/suppressor T lymphocytes in rheumatoid arthritis (RA), in contrast to the results of other workers. We believe that the discrepancy between the various studies is due to the fact that different methods and different criteria for patient selection were used. Our study comprised a larger number of patients which makes the results suitable for statistical inference. Disease activity is clearly defined and all drugs that could alter the results were excluded. The use of a flow cytometer enhances the reliability of T lymphocyte subset determination by monoclonal antibodies (OKT series). Our study confirms the reports, which suggested that the number of suppressor/cytotoxic T lymphocytes (OKT8+ cells/mm3) is decreased in patients with active RA, resulting in a high T helper/inducer lymphocyte/T suppressor/cytotoxic lymphocyte ratio (OKT4+:OKT8+). This immune balance represents an interesting feature of the disease, since several active antirheumatic drugs share a common immunomodulatory action, which normalizes the OKT4+:OKT8+ ratio. Finally, we found a good correlation between the OKT4+ cells and OKT8+ cells in the normal control population. This observation enabled us to isolate a subgroup of active patients with RA not responding to slow acting antirheumatic drugs and characterized by a low OKT4+:OKT8+ ratio.

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A family study of 2 probands, suffering from seronegative spondyloarthritis with ileocolonoscopic evidence of chronic inflammation of the ileum, is presented. On the father's side 2 brothers carry the HLA-Bw62 antigen. One developed typical Crohn's disease, the other showed chronic inflammatory signs of the ileum on biopsy. These lesions have frequently been demonstrated in reactive arthritis and ankylosing spondylitis (AS) with peripheral arthritis, in the absence of gastrointestinal symptoms. On the mother's side there were no clinical or histological signs of ileum inflammation, or spondyloarthritic features, although the mother carries the HLA-B27 antigen. The 4 children are all HLA-Bw62 and B27 positive, but only 2 of them have developed seronegative spondyloarthritis associated with histological evidence of chronic ileum inflammation. The familial aggregation of the seronegative spondyloarthritides is demonstrated. The lesions found on ileal biopsy in reactive synovitis and AS with peripheral arthritis may be related to Crohn's disease.

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Patients with active rheumatoid arthritis are characterized by a decrease in the number of circulating T-suppressor lymphocytes (identified by OKT8), resulting in an imbalance between helper (identified by OKT4) and suppressor cells. Piroxicam is a non-steroidal anti-inflammatory agent which modulates lymphocytic functions, especially by reducing the concentration of the rheumatoid factor in vitro and in vivo. A double-blind placebo-controlled study was performed in 20 patients suffering from active RA to investigate the acute effect of a single administration of piroxicam 40 mg on the number of circulating OKT3, T4, T8 and IA1 positive cells. Blood samples were obtained 16 hours before and 0, 2, 6, 8, 24, 48, and 72 h after administration of piroxicam or placebo. There was a significant decrease (P less than 0.05) in T4/T8 cell ratio 48 and 72 h after piroxicam, whereas placebo had no effect. There were no significant changes in absolute numbers of total T-lymphocyte (OKT3 positive cells), T-helper-inducer (OKT4 positive cells) and T-suppressor cytotoxic lymphocytes (OKT8 positive cells). The number of IA1 positive cells (B-cells and activated T-lymphocytes) was significantly higher in the afternoon samples (at 14.00 and 16.00 hours) than in the morning samples (at 08.00 and 10.00 hours) after both placebo and piroxicam administration (P less than 0.05). These data show that piroxicam decreases the T4/T8 cell ratio in active RA, but only 48 h after the first administration.(ABSTRACT TRUNCATED AT 250 WORDS)

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