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The authors report 8 cases of scleroderma with oedema in the initial stages which could be divided amongst three groups on the basis of their clinical, biological, histological characteristics and course: normal systemic scleroderma, mixed connective tissue disease, Shulmans syndrome. The relationship between one of these cases and Buschke's scleroderma is discussed. These cases of scleroderma are characterized by diagnostic difficulties in the initial phase and by their relatively favourable vital prognosis (one death only). Corticosteroids may be effective to some extent in the presence of mixed connective tissue disease of Shulman's syndrome.

A woman with isolated juvenile Sjögren's syndrome gave birth, at 3 years' interval, to two children with complete atrio-ventricular heart block (AVB). This is the first published case of AVB in children of mothers with Sjögren's syndrome without any clinical and laboratory evidence of connective tissue disease, notably lupus. Ultrasonography showed that the AVB was acquired in utero and occurred during the 23rd week of gestation. In both children the AVB was isolated, without any symptom of congenital malformation of the heart; there were no abnormalities of conduction in the mother. Early corticosteroid treatment of the mother's disease had no beneficial effect on AVB in the foetuses. Attempts to reproduce the condition experimentally met with failure.

The detection of circulating immune complexes by precipitation by polyethylene glycol represents a valuable technique of study in sub-acute bacterial endocarditis. In a series of 13 patients, this measurement was carried out, confirming the quasi-constant presence of circulating immune complexes in active S.B.E. This might be of diagnostic value in forms with negative blood culture and, further, make it possible, subsequently, to find the antigen responsible by dissociation of the circulating immune complexes.

49 unrelated subjects suffering from systemic scleroderma were typed for 28 HL-A antigens, without any particular significant association of an antigen with the disease or one of its manifestations being noted. In addition, 13 patients from the same family were genotyped for HL-A. Transmission of the disease through 4 generations does not seem to be linked to a particular haplotype and no pair of sibling HL-A identical patients were seen in the same generation. By contrast, two pairs of sibling patients were HL-A different. Nevertheless, other cases, and in particular familial, will be necessary before an association between the genes of susceptibility to S.S. and a gene in the chromosomal HL-A region may be definitely eliminated.

Attention has recently been drawn to the association of digestive carcinoma and streptococcus bovis endocarditis. The authors studied 130 records of patients with endocarditis and an association with a digestive tumour (3 neoplasms, one villous tumour) was found in four. Streptococcus bovis was demonstrated in one case, streptococcus faecalis in two and streptococcus durans in one. The association of carcinoma and subacute endocarditis would thus seem to not solely relate to digestive commensual organisms. The question of common factors favourising carcinoma and endocarditis is raised.

Splenectomy was performed in two patients amongst a group of 120 suffering from bacterial endocarditis. In the first case, rupture of the spleen followed rupture of a partially thrombosed splenic vein and bacteriological specimens were negative despite the presence of multiple infarcted areas, certain of which were suppurative. In the second case surgery was possible before rupture of the spleen. The latter was the site of numerous abcesses, one of which was in the process of fissuration, and bacteriological specimens were positive. The course in both cases was favourable. Twenty two other cases have been found in the literature with 15 deaths. Whilst the prevalence of such complications remains low, their severity is such that routine surveillance of the kidney should be the rule in infectious endocarditis. The methods of such surveillance are discussed, the mechanism of such complications not being fully elucidated: the respective role of splenic infarction, splenic abcess and immunological factors remains to be determined.

One hundred and three cases of systemic lupus erythematosus (SLE) were reviewed after a period of up to 10 years. The pericardium was involved in 27%, the endocardium in 23% and the myocardium in 14.5% of the cases. Arrhythmia was rare and usually accompanied pericardial or myocardial lesions. Conduction disorders were present in 14.5% of the patients. Atrioventricular block often occurred long after the acute phase of SLE, and synthetic antimalarial drugs appear to be responsible for their development. Whether or not SLE affects the heart, the prognosis is the same during the first ten years of the disease.