Palmar fasciitis and polyarthritis, a rare paraneoplastic syndrome related to ovarian cancer.

Palmar fasciitis and polyarthritis syndrome (PFPAS) is an uncommon disorder characterized by diffuse inflammation of the palmar fascia, tendon sheaths, and joints of the fingers and wrists, which rapidly progresses to flexion contracture of the hands. This paraneoplastic syndrome, originally linked to ovarian carcinoma, has also been associated with multiple different malignancies. As PFPAS usually precedes the detection of cancer, its symptoms should raise the suspicion of an underlying malignancy and should be thoroughly investigated.

Hypothyroidism and arthritis during interferon therapy.

The development of autoantibodies during interferon therapy is frequent, but clinical symptoms of autoimmune disease are uncommon. We report on a female patient who developed arthritis with strongly positive antinuclear factor (ANA) and autoimmune thyroiditis while being treated with alpha 2b interferon (IFN) for chronic myelocytic leukaemia (CML). The arthritis subsided promptly after discontinuation of IFN and initiation of nonsteroidal anti-inflammatory drugs.

[Physio-pathology of pseudohypoparathyroidism (author's transl)]. / Physio-pathologie du pseudohypoparathyroïdisme.

A case of pseudohypoparathyroidism has been investigated. Indirect evidence allows to eliminate a defect of renal 1 alpha-hydroxylase as the determining factor of this condition. Similarly, the increased size of the mean surface area of the cross-section of periosteocytic lacunae, as determined on decalcified sections of bone obtained by transiliac biopsy, shows the osteocytes to be sensitive to the endogenous PTH, discarding cAMP response to PTH in bone as a prerequisite for PTH action on bone. The authors conclude from these data and from previous experiments that the defect of parathyroid function in this condition probably relates to the existence of an abnormal PTH molecule and/or metabolism and/or interaction with the receptors sites. The endocrine function was studied as well. Prediabetes was demonstrated, as well as primary latent hypothyroidism (TRH test). Prolactin release could not be stimulated by TRH, levodopa, metoclopramide, chlorpromazine and insulin hypoglycemia. The latter produced a normal release of ACTH (as ascertained by plasma cortisol levels) and GH, and possibly a sluggish response of glucagon and gastrin. There was a deficiency of urinary concentration upon restriction of fluid intake. This was only partially corrected by ADH administration.

Pyrophosphate arthropathy in the carpal and metacarpophalangeal joints.

The hand x-rays of group of patients with generalised osteoarthrosis alone were compared with those patients with generalised osteoarthrosis and chondrocalcinosis (CC). An arthropathy seemingly specific for CC could be identified in the metacarpophalangeal (MCP) and carpal joints. In the MCP joints it was characterised by subchondral rarefactions, deviation of the joint axis, joint space narrowing, and osteophytosis. Usually only the second and/or third MCP joints are affected. In the carpal joints similar subchondral cysts, sometimes associated with joint space narrowing, were found much more frequently in the group with CC. There was no direct relation with the presence of calcification.

[Incidence and specificity of circulating immune complexes in infectious mononucleosis (proceedings)]. / Incidence et spécificité des complexes immuns circulants dans la mononucléose infectieuse.

Occurrence of immune complexes in infectious mononucleosis has been investigated by the 125I Clq binding assay. Increased serum Clq-binding activity was found in 87% of the 23 patients studied during the acute stage of the disease. The serum Clq-binding material detected has properties identical to those of immune complexes. IgG antibodies dissociated from the complexes at acid pH and F (ab)'2 fragments obtained after treatment by pepsin appeared to be directed against the viral capsid antigen of Epstein-Barr virus.

[Immunologic study of pleural neoplastic effusions: Detection of immune complexes and complement activation]. / Etude immunologique des épanchements pleuraux néoplasiques: détection de complexes immuns et activation du complément.

Occurrence of immune complexes in malignant pleural effusions has been investigated by the 125I-c1q binding test. 55% of the pleural effusions had C1q binding activity levels higher than those found in transudates used as controls. The levels of C1q binding activity in effusions were significantly higher than those found in the serum of the same cancer patients. High levels of C1q binding activity were found in malignant effusion independently of type or differentiation of the tumors involved. The C1q binding material had properties of immune complexes. The levels of CH50 and C3d, i.e. the degradation product of C3, in malignant effusion were similar to those of transudates. These observations show a high incidence of immune complexes in malignant effusions and a slight activation of complement inadequate for its local consumption. The persistence in major quantity of immune complexes in malignant effusion suggests local formation or decreased clearance.