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Aim:  This study is a clinician's perspective of the association of bilateral ankle arthritis with mediastinal lymphadenopathy. Method:  Forty‐three patients with bilateral ankle arthritis with mediastinal lymphadenopathy were included in a 14‐month prospective follow‐up study in our hospital. Complete history, examination and investigations were carried out. Result:  There were 27 female and 16 male patients. Ankle arthritis with tuberculous mediastinal lymphadenopathy was associated in 58.13%, sarcoidosis in 32.5% and 9.3% were non‐specific. The patients were clustered in the spring‐summer months. Erythema nodosum was found in 14.3%, polyarticular presentation in 25%. Thirteen out of 43 patients (28.2%) had biopsy/fine needle aspiration (FNA), of which 69.23% had histopathological evidence of tuberculosis. Conclusion:  The aetiology of bilateral ankle arthritis associated with mediastinal lymphadenopathy may be tuberculosis as opposed to sarcoidosis. There is a seasonal clustering of these cases. FNA of mediastinal lymphadenopathy is a fairly safe procedure and should be carried out when feasible, for confirmation of diagnosis.

The present experimental study was planned to evaluate the effect of intrathecal administration of L-glutamic acid upon antinociception produced by intrathecal morphine in a prospective-controlled manner in conscious freely (P < 0,01). Chez les rats pr6trait$s ~ la naloxone, on remarque la restauration et l'exag~ration de l'antinociception induite par la morphine avec une augmentation du TFL (9,0 -t-0,4 sec; P < 0,0001 L-glutamic acid, a precursor of GABA is an excitatory amino acid (EAA) present in the brain. In addition to its anabclic and catabolic effects it serves as the main mediator of fast excitatory neurotransmission in the mammalian spinal cord ~ and vertebrate neurons. ~ At least three EAA receptor subtypes coexist including those activated by the agonists-N-methyl-D-aspartate (NMDA), (RS)-a-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid HBR (AMPA) and kainate. ~,3 Glutamate, an NMDA-reeeptor agonist 4 has been implicated in hypoxic ischaemic brain damage which can be attenuated by morphinan derivatives s and naloxone. 6 CAN J ANAESTH 1995 / 42:6 / pp541-6

A 55-year-old woman with rheumatoid arthritis having 4 months previously received two doses of infliximab, presented with fever, hypotension and swelling of right thigh posterolaterally. CT-guided aspiration was performed from the right thigh and revealed acid-fast bacilli (AFB) +++ and mycobacterial culture grew Mycobacterium tuberculosis. The patient improved on anti-tubercular treatment.