SUMMARY Arthro-osteitis at the anterior chest wall was found in 12 (9*4 %) out of 128 consecutive patients with pustulosis palmaris et plantaris. This finding indicates that the concomitance of arthro-osteitis with PPP is not incidental but is based on some common aetiological factor. We propose a term 'pustulotic arthro-osteitis' for this condition.Intersterno-costoclavicular ossification is a newly described rheumatic condition which shows unique ossifications between the clavicle and the first rib.
Stimulation of sensitized lymphocytes by specific antigen in vitro leads to the production of migration inhibition factor (MIF). In the case of the pure soluble protein, or hapten-protein antigens used in the present studies, this MIF production was a property of the T lymphocytes in the cell suspensions. When PPD was used, B cells, as well as T cells, produced MIF. Similarly, PPD could stimulate B cells to mediate the macrophage disappearance reaction, a reaction which is known to be a T cell-dependent in vivo manifestation of cell-mediated immunity. Suspensions of lymphocytes from nonimmune donors could also be stimulated by PPD; in this case, B cells, but not T cells, produced MIF. The factors produced by the two lymphocyte subpopulations appeared to be similar, if not identical, on the basis of physico-chemical criteria. It is suggested that PPD stimulates B cells for MIF production because of its role as a B cell mitogen. The ability of endotoxin lipopolysaccharide, another B cell mitogen, to also induce MIF production by B cells supports this contention. Thus, although activation of lymphocytes for MIF production by specific antigen is a property of T cells, B cells as well as T cells may be so activated by agents which act nonspecifically. This may prove to have implications for in vivo events involved in immunization. In addition, these observations lend further support to the concept that lymphokine production represents a general biologic phenomenon in addition to playing a role in the effector mechanisms for reactions of cell-mediated immunity.
We present 22 cases with inter-sterno-costoclavicular ossification. Clinical and pathological findings show that abnormal ossification observed in this situation is due to non-suppurative chronic inflammation of the soft tissues around the sterno-costo-clavicular region such as the costo-clavicular ligament. We have classified X-ray findings into three stages according to the extent of the ossification; localized, generalized, and hyperostotic, and show that the disease progressed in this sequence. A considerable number of the patients showed abnormal X-ray findings in the spine or the sacro-iliac joint. Frequent association of pustulosis palmaris et plantaris was noted in this disease. Most of the cases were treated effectively with anti-inflammatory drugs, but a few cases required surgical resection of the ossified mass with the clavicle or the first rib in order to relieve the severe pain.
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