No abstract

Extramedullary plasmacytomata may arise in any structure containing re-ticulo-endothelial tissue. Such tumors may be either isolated or the initial lesion of a generalized disseminated condition. Ideally, multiple involvement should be diagnosed at the presymptomatic stage; this may be possible by detecting variations in the immunoglobulins. Histologically, electron microscopy is advised to detect the plasma cell in the more undifferentiated case. Nine cases are reported. Two cases showed multiple involvement presenting with extramedullary plasmacytomata. A further case recurred locally many times but is still alive after 22 years. The remaining seven cases showed only isolated extramedullary plasmacytomata; of these, five were benign but in two, the tumor eroded bone locally. Those which subsequently developed multiple myelomata showed changes in the serum proteins, erythrocyte sedimentation rate (ESR) and radiologically, at approximately the same time. Surgical excision and/or radiotherapy was equally successful in those patients with localized disease.

Analysis of middle ear function has for many years been accomplished by acoustic impedance measurements and this has proved of great clinical value. The vectors which contribute to impedance are functions of mass, stiffness and resistance of the system and information about these components may be obtained by use of the otoadmittance meter. The shape of the tympanogram may be altered both by pathologies which change the relative magnitude of the vectors and by variation in the probe tone frequency. Patients with rheumatoid arthritis (55 ears) were compared with a series of controls (50 ears); 38% of 'rheumatoid ears' demonstrated a marked notch on the 660 Hz susceptance curve whilst only 8% of the control group showed this abnormality. The pattern suggests a decrease in the stiffness of the transducer mechanism in rheumatoid arthritis.

We report a case of bilateral sensorineural hearing loss of two years duration which appears to have been due to lateBorrelia burgdorferiinfection. The 39-year-old woman presented with bilateral deafness and multiple other neurological complaints some six months after developing a ‘target’ lesion on the lower leg after walking in the New Forest. Serology forBorrelia burgdorferibecame positive and the patient made a complete recovery from both her deafness and her other neurological problems after a five-week course of oral antibiotic therapy.

SUMMARY Using an otoadmittance meter the function of the middle ear was compared in 38 patients with rheumatoid arthritis (RA) and 30 matched controls with non-articular rheumatism. Patients with pre-existing ear disease were excluded from the study. No subjects in either group showed hearing loss on pure tone audiometry, but otoadmittance abnormalities were recorded in 16 of the RA (42%) and in 2 of the control groups (7 %). The pattern of abnormality was similar in each case and indicated an increased laxity of the conducting system. The reason for this unexpected finding is unknown. There were no significant differences between the RA patients with normal or abnormal recordings as regards clinical or laboratory features or treatment.