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Pigmented villonodular synovitis (PVNS) is rare in the foot; however, it developed in the subtalar joint extending around the ankle of a 24-year-old man. The diagnosis was made by a combination of clinical findings, most notably the aspiration of the synovial fluid. Magnetic resonance imaging was most useful in showing the extent of the soft-tissue mass before surgery. Low-signal intensity of the mass, featured on both T1- and T2-weighted images, was suggestive of PVNS.

A 20-year-old male developed both coccygeal and leg pain and followed by rectocystic disturbance. Disc herniation between L5 and S was suspected and laminectomy was performed. At surgery, an easily curretable tumor occupied the epidural space from L5 to the end of the sacrum. In part, the tumor spread out of the vertebral canal and invaded the surrounding muscle tissue. This muscle tissue and part of the lamina were checked histologically. Initial blood analysis revealed 5% blast-like cells, but failed to confirm them as leukemic cells. Histologically, the tumor cells had round or oval nuclei with large nucleoli and scanty cytoplasm without granulocytic differentiation. Malignant lymphoma or Ewing's sarcoma was initially suspected, but the definite diagnosis was uncertain. Immunohistochemical staining with the PAP method and enzyme histochemistry revealed that the tumor cells were positive for lysozyme and naphthol ASD chloracetate esterase. Thus, granulocytic sarcoma was finally diagnosed. Electron microscopic findings supported this diagnosis. Subsequent karyotyping of bone marrow cells revealed 8; 21 translocation, thus the final diagnosis of this patient was myelodysplastic syndrome, refractory anemia with excess blast cells in transformation or acute myelogenous leukemia, M2, by the FAB classification.

We describe 2 patients with pigmented villonodular synovitis. In both patients, synovial fluids (SF) were characterized by the presence of abundant, strongly birefringent lipid microspherules, which appeared as Maltese crosses and were found both inside foam cells and free in the SF. Histologically, the synovial membranes showed pigmented villonodular synovitis, with aggregation of foam cells containing abundant lipid microspherules in their cytoplasm. Observation of numerous birefringent lipid microspherules and foam cells in SF may be a clue to the diagnosis of pigmented villonodular synovitis.

The proportion of T lymphocytes with receptors for the Fc portion of IgG (T gamma cells), revealed by mixed rosette assay, was determined in the synovial membrane and peripheral blood of 11 patients with rheumatoid arthritis. The percentage of T gamma cells in the lymphocytic infiltration of rheumatoid synovium was significantly lower than that found in peripheral blood (p less than 0.005). There was no significant difference between the percentage of T lymphocytes in the synovial tissue and that in peripheral blood. Depressed supressor activity of T lymphocytes in rheumatoid synovial membrane might lead B-lymphocytes to blastic transformation to the plasma cell series with consequent production of large amounts of immunoglobulins in the joint.

Left ventricular performance, survival rate and subjective symptoms were analyzed in 243 cases of angina pectoris (147 cases of A-C bypass and 96 cases of medical treatment) and 58 cases of left ventricular aneurysm (21 cases of surgical treatment and 37 cases of medical treatment). Left ventricular performance of angina pectoris were improved in surgical group 6 months after A-C bypass with the significance of p less than 0.02-0.05. However, in the medical group, it showed unchanged or aggravated tendency during average 18 months. Similar results were obtained in the patients with left ventricular aneurysm and furthermore, aggravation of EF and Max dp/dt/p in some medically treated cases was observed. Operative death by A-C bypass was seen in 4 cases (2.7%) and 5 years cumulative survival rate was 92.6% including late death cases died during average 30.1 months in the medical group and its 5 years survival rate was 77.3%. For left ventricular aneurysm, no operative death was recognized and the 5 years cumulative survival rate was 95%. Whereas during average 32.7 months in the medical group, 8 cases died and 5 years cumulative survival rate was 78.6%. Improvement of subjective symptoms after treatment for both ischemic heart diseases was also conspicuous in the surgical group.

The capacity of gold compounds to induce morphologic changes and alterations in the functional activity of human mononuclear phagocytes (M phi) in vitro was examined. Human peripheral blood mononuclear cells were incubated with gold sodium thiomalate (25 microgram/ml) for 96 hours. As a result, M phi developed electron dense precipitates within phagolysosomes, as well as marked dilatation of these organelles. Gold incubation also altered a number of M phi functions. While viability and adherence were unaffected, the capacity to spread on surfaces was diminished. Pinocytosis of soluble proteins and phagocytosis of opsonized sheep erythrocytes were impaired, but Fc mediated particle binding was not. These data indicate that gold can alter certain functional activities of M phi and support the idea that the major action of gold in rheumatoid arthritis results from its capacity to alter M phi function.

When rheumatoid articular cartilage samples were incubated with normal polymorphonuclear leukocytes (PMN) in vitro, large numbers of PMN were seen attached to the articular surface. As observed by electron microscopy, significant numbers of these cells invaded the cartilage tissue and phagocytosed amorphous material which presumably contained immune complexes. In control cartilage from osteoarthritic, pyogenic, and normal subjects, only a few PMN were attached to the articular surface after incubation with PMN. These results demonstrate that immune complexes trapped in the superficial region of the rheumatoid articular cartilage may play an important role in the destruction of cartilage by the release of lysosomal enzymes from PMN.

Nineteen cases of exostoses located on part of the pes anserinus were studied clinically and histologically. All lesions were resected during surgery between 1965 and 1985. In these 19 cases, 14 had involvement of the tibia only at the insertion of the pes anserinus. Five had multiple exostoses with pes anserinus involvement. All exostoses occurring only in pes anserinus showed an icicle appearance in roentgenography and had no detectable cartilage cap. On the other hand, exostoses in patients with multiple exostoses (osteochondromas) showed varying appearances in roentgenography and had cartilage caps on their surfaces. Exostoses occurring only in the pes anserinus may or may not be osteochondromata and could be classified as pes anserinus bony spurs.

The effect of in vitro indubation with gold sodium thiomalate (GST) on the morphology and functional activity of human mononuclear phagocytes (Mphi) was examined. Human peripheral blood Mphi that had been incubated with GST (25 micrograms/ml) for 4 days developed large intracytoplasmic vacuoles. Similar vacuolization developed after incubation with gold chloride but not with thiomalic acid. GST pre-incubation also induced a number of functional alterations in Mphi. GST incubation had little effect on glass adherence or FC receptor-mediated particle binding but markedly diminished pinocytosis of horseradish peroxidase and phagocytosis of IgG opsonized erythrocytes. These data indicate that the action of GST in rheumatoid arthritis may result from its capacity to alter the functional capability of Mphi.

The present experiments were designed to investigate in vitro interactions between polymorphonuclear leukocytes (PMN) and rabbit joint collagenous tissues containing trapped immune complexes. Articular cartilages and menisci from antigen-injected and control joints were incubated with normal PMN isolated from rabbit peritoneal exudates or blood. After incubation of cartilage and menisci from antigen-injected joints with PMN, large numbers of PMN became attached to the articular surface. In areas of superficial erosion, the PMN invaded the tissue several cell diameters below the articular surface. Through immunoelectron microscopy, degranulated PMN were observed in scattered areas to phagocytose amorphous material containing rabbit Ig. Following addition of PMN to control tissues, only a few PMN became attached to the articular surface. When tissues from monosodium urate-injected joints were incubated with PMN, these cells were found attached to the surface in moderate numbers, but invasion into the tissues was not seen. These studies indicate that immune complexes trapped in joint collagenous tissues may lead to enhanced release of lysosomal hydrolases.

These experiments investigated the in vitro interaction of macrophages and rheumatoid articular cartilage. When rheumatoid articular cartilage samples were incubated with normal peripheral blood mononuclear cells (PBM) for 1 hour or 12 hours in vitro, there were large numbers of PBM attached to the articular surface, and some PBM invaded the cartilage during the 12 hour incubation period. Conversely, in cartilage from osteoarthritic and normal subjects in the control, only a few PBM were attached to the articular surface after incubation with PBM. Under electron microscopic observation, macrophages were tightly attached to the surface and within the eroded cartilage. Light and electron microscopic observation with immuno-peroxidase staining of the rheumatoid cartilage surfaces showed the deposition of immunoglublins adjacent to the attached macrophages, suggesting the presence of immune-complexes as chemoattractants. These results suggest that macrophages in a rheumatoid joint may play an important role in the formation of pannus, resulting in the destruction of cartilage to interact with immune-complexes trapped in the superficial region of the rheumatoid articular cartilage.

Since NZB mice manifest evidence of intense B cell activation, the state of activation of their T cells was explored. Electron microscopic examination and automated laser light scatter analysis demonstrated the presence of many blast lymphocytes in the spleens of aging NZB mice but not in controls. Only 45% of these large cells were B cells by the criterion of stainable surface IgM. NZB T and B cells were separated using the fluorescence-activated cell sorter; cytographic analysis revealed that both T and B cell populations contained substantial numbers of blast cells. The data thus indicated that T cells, as well as B cells, undergo activation as autoimmunity develops in NZB mice.