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A brief report is given of an extremely rare case of pericardial constriction in a patient with quiescent sero-negative rheumatoid arthritis. Pericardectomy was only partially completed as it was impossible to divide the bands joining the peri- and epicardium.

The first patient was a 33-year-old woman, diabetic, hypertensive, in whom the haematoma was due to rupture of a Klebsiella abcess of the kidney. The second patient was a 68-year-old woman, who for several months had suffered from renal lithiasis complicated by urinary infections. Spontaneous sub-capsular haematoma of the kidney is rare (21 cases published since 1960, including 2 personal). The diagnosis must be considered in the presence of a characteristic double-contour seen on a plain X-ray of the abdomen, nephrotomographies and intravenous urography. Renal carcinoma is the commonest cause.

A case of lithium poisoning with lithium salts in a man of 66 years is reported. Sinus node dysfunction and conduction-tissue modifications were found. The responsibility of lithium in these disoredrs is discussed. The literature and the cellular mode of action of lithium are reviewed.

Sixteen cases of lactic acidosis are reported: 7 phenformin treated diabetes, 5 cardiovascular diseases (2 myocardial infractions, 2 pulmonary embolisms, 1 heart failure). In 2 patients no etiology was found. Concomittant renal failure or liver diseases were found in respectively 9 and 4 cases. Patients presented the usual criteria of lactic acidosis: clinical, polypnea, severe hypotension (9/16), peripheral symptoms of shock (12/16), hypothermia (9/16), abdominal pain (9/16): biologically, acidosis (pH = 6,99 +/- 0,01, HCO3- = 5,9 +/- 1,5 mmol), hyperlactatemia (14,1 +/- 3,6 mmol/l) with hig lactate/pyruvate ratio (105 +/- 73), and anion gap (24,3 +/- 4,2 mmol/l). Sodium bicarbonate infusion was performed in all cases (2,5 to 42 mmol/kg). Few cases required volhemic expansion or furosemid induced diuresis. One patient was treated with extrarenal dialysis. 13 patients were alkalinised with less than 185% of estimated deficit measured from alkalin reserve: 12 died. 3 patients received 185% more than this deficit, associated with furosemid (1,8 to 12,5 mg/kg): only one patient died ten days after by casual disease, with lactatemia of 3,2 mmol/l. In spite of the small number of patients, these findings suggest that an early and massive alkalinisation, with large doses of furosemid, can improve the severe lactic acidosis prognosis.

The authors report a case of constrictive pericarditis complicating an apparently stable sero-negative rhumatoïd arthritis, a rarely described pathological association. The patient had a serious polyserositis due to an extremely marked and inflammatory pericardial constriction. The rhumatoïd origin was confirmed by pericardial effusion, histological and immunofluorescent studies. The inflammatory pericardial process rendered pericardiectomy virtually impossible and resulted in a fatal outcome.