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Synovial inflammation and the destruction which results from recurrent and chronic inflammation lead to arthritis and tenosynovitis. Clinical manifestations are bilateral and symmetrical, affecting virtually all joints. The hands and the feet are the main targets. Cervical involvement should be routinely investigated. X-rays demonstrate the erosion and deformation caused by rheumatoid arthritis. Altogether, the manifestations of the disease constitute a distinct and painful handicap. Treatment should be undertaken as early as possible in the course of rheumatoid arthritis in an attempt to avoid evolution toward irreversible destruction.

Diagnosis of microcrystalline arthritis often is based on joint punctures, performed whenever possible. The clinical features of the crises may suggest diagnosis, but is not decisive. The course before or during treatment is not indicative and cannot fully exclude infection when the patient is seen during a crisis; arthritis with one or several microcrystals is possible, as in forms associated with joint infection. For well-oriented management, good knowledge of such diagnostic difficulties is necessary.

Two cases of "yellow-nail syndrome" are reported: in the first, nail changes began eight months after the diagnosis of a breast cancer; in the second, yellow dystrophic nails were associated with hypertrophic osteoarthropathy due to pleuro-pulmonary metastatic lesions. Clinical features are described: characteristic nail changes, lymphoedema, pleural effusions, and, often bronchopulmonary infections and sinusitis. Various combinations are seen, and the time between the development of the different manifestations may vary from several months to many years. Among associated diseases, immunological changes and malignancy are emphasized. The pathogenesis remains obscure. Accurate part taken by lymphoedema, immunological changes, is unknown, and the relationships between "yellow-nail syndrome" and malignancy are still uncertain.

Osteoradionecrosis (ORN) is not exceptional, despite advances in irradiation techniques. Six cases are reported, involving the pelvis, coxofemoral joint, mandible and vertebrae; in this last case, the semiologic value of the lucent intrasomatic image seen on plain films and tomographies of the vertebrae is underscored. The irradiation dose (above 3 000 rad) is the chief factor in osteoradionecrosis, which may be precipitated by adjuvant factors and potentiating events such as trauma and infection. Pathologic study shows several lesions whose association is suggestive: cell lesions, osteoporosis, vascular lesions, and foci of necrosis. The pathogenic significance of lesions of bone cells is demonstrated, while the part played by vascular lesions is controversial. Involvement of the pelvis and hips following irradiation of pelvic carcinoma is the most common. The scapular girdle and ribs may be involved in irradiation for breast cancer. In involvement of the mandible, remarkable features are its frequency following irradiation of carcinoma of the mouth, the significant part played by potentiating factors, i.e. infection and trauma, severity of complications, i.e. fistulae and hemorrhage, and lastly difficulties of management. Among infrequent sites, involvement of the vertebrae is of interest as it may mimic collapse due to osteoporosis or metastasis. Diagnosis rests on an association of criteria, and fortunately bone biopsy is usually unnecessary. The clinical features, topographical characteristics and course of the disease allow differentiation from bone metastasis; it may be more difficult to distinguish postirradiation sarcoma, which is exceptional, or a number of benign conditions, such as aseptic necrosis, infectious osteoarthritis, and destructive coxarthrosis.

The recently described Hardinge approach is currently widely used for implanting total hip prostheses. It is characterized by a dissociation of the fibers of the mid-gluteal, of which the anterior fibers remain continuous with the vastus lateralis. To assess the functional impact, a series of 63 prostheses implanted with the Hardinge approach was compared with an identical series performed with the posterior approach. Results show a lower frequency of dislocation with the Hardinge approach, but also a 33 p. cent residual functional deficiency of the mid-gluteal at one year, compared with 17 p. cent with the posterior approach. A modification of the technique is proposed to limit this phenomenon.

The principal complication of continuous ambulatory peritoneal dialysis (CAPD) is peritonitis in most cases benign and treated effectively by local, specific antibiotic therapy. In some cases, however, the infection fails to respond to medical treatment and surgical exploration occasionally reveals serious lesions such as sclerosing peritonitis or an intestinal perforation. Prognosis is dependent not only on the extent and severity of the lesion but also on the rapidity of operative intervention. The development of an appendicitis, often masked by early antibiotic therapy, represents a particular course of peritoneal infection during CAPD.

In 200 dissections of internal jugular veins, the valves were investigated with regard to their constitution, their macroscopic and their microscopic anatomy. In 88% of the cases, an ostial valve was found. The cusp of each consists of two parts in 77%, of only one part in 16%, and in 7% of three parts. In 12% these valves are not found. The structure, the configuration, the topography of these valves are explained. The stroma of the valve consists of collagen and elastic fibrils. The surface of the luminal and parietal part is covered by endothelial cells with elastic and muscular fibers close to the attachment of the cusp to the vein wall.