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The authors present a study of the incidence of HLA-DR antigens in 113 controls and in a Breton population suffering from chronic inflammatory rheumatism. They found 80 cases of rheumatoid arthritis and found a significant increase incidence of the DR4 antigen in rheumatoid arthritis (54% compared with 19.5%; pc less than 10(-4); RR = 4.8) and a decreased incidence of the DR2 antigen (12.5% compared with 35%; pc less than 10(-2); RR = 0.27). The increased incidence of DR4 does not seem to be related to the presence of rheumatoid factor. Out of the 95 cases of chronic inflammatory rheumatism treated, 33 cases of drug intolerance (cutaneous and/or renal to gold salts or D-penicillamine) were reported. The authors found a decreased incidence of the DR2 antigen in the patients who presented a drug intolerance, which was partially significant in the group of patients with rheumatoid arthritis (p less than 0.04; pc less than 0.3). This is an important argument in favour of the supposed protective role of this antigen.

Computer-assisted instruction permits a student to work individually and at his own pace. His learning occurs by interactive dialogue with a conversational type terminal. The system comprises the following programs: tutorial, conversational and simulation. The study describes the objectives and the characteristics of a system based on a simulation program using the file of the data-base from the Rennes Hospital. Furthermore it describes in detail the steps that the student must take and discusses the programming of the system. The recording of the various lessons is subjected to statistical analyses to make the teaching exercises better and to adapt the conversation to the behaviour of the students facing the system.

Twelve patients who had a subsequent lumbar sciatica after surgery were evaluated with computerized tomography (C.T.) and magnetic resonance imaging (M.R.I.). The M.R.I. was performed with a 0.35 T whole body superconducting unit using spin echo technique. Two pulse sequences were realized varying the repetition time (TR) from 500 to 2,000 ms and the echo time (TE) from 28 to 60 ms. For the longer pulse, the twice echo were interpreted. The slide obtained with a surface-coil were performed in sagittal plane for the twice pulse sequences and in transaxial plane for the shorter pulse sequence. In seven cases, the results obtained with C.T. and M.R.I. were correlated. In two cases, the C.T. showed a scar formation, the M.R.I. showed a recurrent disk herniation. In three times, C.T. was unable to differentiate clearly between recurrent disk herniation and scar formation, the M.R.I. showed unequivocally on one case a scar formation and on two cases a recurrent disk herniation.

Twenty four patients who were hospitalized for a suspicion of spondylodiscitis were prospectively evaluated with magnetic resonance imaging (MRI), radiology and radionuclide studies. Fifteen patients had an infectious spondylodiscitis, four had a vertebral degenerative disease, four had a rheumaticus spondylodiscitis, one had a chemical spondylodiscitis. The microbiological examinations and the clinical development bore the diagnosis out. Seven patients underwent Indium 111 scanning. The results of this scanning were correlated with MRI results. The MRI was performed with a 0.35 T whole body superconducting unit using spin echo technique. All patients were studied in the sagittal plane with two pulse sequences and more often with a surface-coil: TR 500 msec./TE 28 msec. and TR 2,000 msec./TE 60 msec. In all cases of true infectious spondylodiscitis the MRI results finding were characteristics. On the image obtained with the TR 500 msec./TE 28 msec., there was a confluent decreased signal intensity from the vertebral bodies and the intervertebral disk space. On the image obtained with TR 2,000 msec./TE 60 msec. there was an increased signal intensity from the vertebral bodies and the intervertebral disk space. The other spondylodiscitis have given a different MRI imaging, it was a confluent decreased signal intensity from the vertebral bodies and the intervertebral disk space on the twice pulse sequences. different images were obtained during the evolution of the infectious: first we observed a modification of the vertebral signal then the typical image that we described then a normal signal of the vertebral bodies with a pathological signal from the intervertebral disk space at last a degenerative intervertebral disk.(ABSTRACT TRUNCATED AT 250 WORDS)

In the majority of the medical disciplines the diagnosis still constitutes the corner-stone of medicine. Every year this function becomes increasingly difficult and time-consuming and it is felt that the doctor should be able to benefit easily and rapidly from the most recent findings. A simple analysis of the natural process of decision-making, followed by a critical inventory of the various methods used to diagnose, has led us to develop our method for computer-assisted diagnosis (ADM). In our presentation of the methodology of diagnostic decision-making we examine the natural process, the analytical and synthetic methods as well as the difficulties and errors liable to occur. Four methods used in arriving at a diagnosis are analysed and criticized: those based on probability, those based on pattern recognition, those based on logic, and those based on classification methods. Finally a case is made for a computer-assisted diagnostic system based on a logical method of the documentation type.

The creation of the data-base for our ADM system begun in 1972, tests on a high productivity type of procedure which we consider should be explained. In organizing and creating our data-bank our routine procedures are: first, the capture of signs, symptoms and pathological data after the text editing of the description of diseases as prepared by medical students under the direction of the Medical Computing Service; second, the control and coding of the data by the personnel of the Medical Computing Service: third, the machine storage of the data and the automated logical controls by the Medical Computing Service; and fourth, the semantic control of the data as well as the availability of each new version. Other related procedures based on the individual theses and various studies are described as examples. From 1972 to 1980 an impressive data-bank was created holding descriptions of 2200 diseases with 22000 signs and symptoms and 3500 bibliographies. It is now foreseen that between 1980 and 1983, the prototype will be placed in service and adapted. The creation and maintenance of such a data-bank with all the problems that it entails, and developed under such economical conditions justifies our presentation.

The manubrio-sternal joint was studied in 168 subjects divided up into two groups : one group of 80 control subjects and one group of 88 patients with chronic inflammatory rheumatism divided up into 3 sub-groups (rheumatoid arthritis 54 ; ankylosing spondylitis 25 ; peripheral psoriatic rheumatism 9). This was a clinical study (search for spontaneous and induced pain) and a radiological study (A.P. and lateral views) with classification in 5 groups : 0 normal appearance, 1 hazy appearance of the joint space, slight narrowing of the joint space, slight osteoporosis and/or subchondral bony condensation ; 2 irregularity of the margins of the joint space, increased osteoporosis and/or condensation, narrowing of the joint space ; 3 increase in the previous signs, erosion, vacuole formation ; 4 partial or total fusion. The results show that only spontaneous pain and the radiological appearances of class II and class III permit one to differentiate in a statistically significant way the control group from the rheumatism group. considering these data one may note a greater frequency of the clinical and radiological signs, together with greater clinical and radiological agreement in ankylosing spondylitis than in rheumatoid arthritis. The interest of a study of the manubrio-sternal joint in the early diagnosis of ankylosing spondylitis is recalled although the involvement of this joint is usually later than the sacro-iliac joint.

Fifty-three patients with suspected infection of prosthetic joints had Indium-111 granulocyte scintigraphy. Twenty-nine of them had associated technetium-99m phosphate scans. Labelled granulocyte sensitivity was 82% and specificity 100% for the group of 47 patients with suspected late infection. Technetium phosphate sensitivity was 92% and specificity 25%. The main quality of labelled granulocyte scintigraphy is its high specificity: there were no false positives in our series. Its main limitation seems to be that sensitivity is sometimes only moderate: we had 4 false negatives. The probable explanation is the histological characteristics of bone infection: vascular thromboses occur frequently and at an early stage, the inflammatory infiltrate is not very abundant and often has a low granulocyte content. The method is therefore reliable and can be used in situations where diagnosis of periprosthetic infection is difficult with conventional techniques.