Biomedical subjects
Publications and source records attributed to D G Scott.
Chronic synovitis is a rare complication of sarcoidosis, virtually confined to the black population. Synovial histology may be nonspecific or show typical sarcoid granulomata. We report 2 cases of chronic sarcoid synovitis in Caucasians. Histology showed typical granulomata in one patient, whose distinctive arthroscopic appearance is discussed.
A radioimmunoassay has been developed for measuring IgG antiglobulins using baboon IgG as antigen. Raised levels were virtually confined to the sera of patients with rheumatoid arthritis (RA) and not found in other seronegative arthritides. High levels were found in both seropositive and seronegative (as judged by latex slide and sheep cell differential agglutination for IgM antiglobulins) patients with RA and were associated with systemic disease but not synovitis. Very high levels (more than twice the upper limit of normal) showed a strong association with vasculitis.
Vasculitis has been seen in rectal biopsies from 22 patients over a six year period. The most common finding was a necrotising vasculitis of small arteries, indistinguishable from that seen in polyarteritis nodosa (PAN). Sub-acute, chronic ("burnt out") and leucocytoclastic changes were also seen. Sixteen patients had vasculitis complicating rheumatoid arthritis (RA), 3 PAN and 3 overlap syndromes. Patients with RA and rectal vasculitis had a higher mortality, and a greater incidence of neuropathy than those with negative biopsies. An adequate biopsy is positive in 40% of patients with clinical vasculitis and RA but was only positive in one of a control series of 46 RA patients with no clinical vasculitis. Rectal biopsy in experienced hands is a safe, and repeatable procedure. It is useful as a "blind" biopsy site in the diagnosis of systemic vasculitis, especially that complicating RA. It can also be used for serial studies of the evolution of vasculitis. Serial sections of the entire biopsy may be required to reveal the vasculitis which is often focal in nature.
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IgG and IgM rheumatoid factors (IgG-RF and IgM-RF), complement and three assays for immune complexes were measured in 22 patients with rheumatoid arthritis (RA) complicated by either chronic active synovitis or vasculitis. Patients with vasculitis had relatively inactive arthritis but had higher titres of rheumatoid factors, especially IgG-RF, anticomplementary activity (ACA) and lower levels of C4 than those with synovitis. Clq-binding and platelet aggregation (PA) levels were similar in both groups. Serial measurements during cytotoxic therapy showed a close temporal relationship between the clinical features of vasculitis and levels of IgG-RF, ACA and C4 both with remission and with relapse. We suggest that immune complexes containing IgG-RF which activate complement and are detected by ACA are useful markers of rheumatoid vasculitis and may be important in its pathogenesis.
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The buccal mucosa in both coeliac disease and dermatitis herpetiformis behaves in the same manner as the skin with regard to immunofluorescence. The simple technique of buccal punch biopsy can be used to give further confirmation of the diagnosis of dermatitis herpetiformis and, especially in patients with an equivocal diagnosis, may prove easier than carrying out repeated skin biopsies.
Methotrexate by intermittent intramuscular injection was used to treat three patients with fibrosing alveolitis complicating connective tissue diseases. All three patients had improvement of symptoms, two had radiological improvement, and one had significant improvement of pulmonary function. Two patients whose pulmonary symptoms, function, and chest radiographs had deteriorated on penicillamine improved when treated with methotrexate. Methotrexate may be a useful treatment for fibrosing alveolitis complicating connective tissue diseases.
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An immunofluorescence investigation of thirty-six non-inflamed and thirty-four inflamed acne lesions has been carried out. Fluorescence for C3, unaccompanied by fluorescence for immunoglobulins, was found in the walls of dermal blood vessels or at the basement membrane zone of the comedo or at both these sites in fifty-seven lesions. Fluorescence for C3 accompanied by fluorescence for immunoglobulins was found in nine lesions. In two papules and three nodules the comedo was surrounded or replaced by a mononuclear cell infiltrate. These findings have been taken to indicate that cellular immune mechanisms are a late event and activation of complement is an early event in the pathogenesis of inflammation in acne. The mechanism of complement activation remains uncertain.
A case of hypereosinophilic syndrome is reported. Investigation failed to reveal any precipitating cause or evidence of leukaemia. Death was due to intractable cardiac failure, and post-mortem examination showed infiltration of the myocardium with sheets of immature cells. The relevance of these cells is discussed and further investigation such as cardiac biopsy is suggested for similar cases.
Life table analysis of early entry to this randomised blind trial of 318 patients has shown a significantly poorer survival for resected lung cancer patients treated with levamisole for three days before operation and three days a fortnight thereafter than for placebo-treated controls. This excess was largely due to deaths that had been attributed to operation or other causes (non-cancer deaths), most occurring in the six weeks after operation. In the 99 resected patients treated with levamisole there was a 15% excess of deaths in this category, compared with the placebo-treated controls. Extensive analysis excluded maldistribution of patients between the groups as a cause of this difference. Many more died in respiratory distress, mostly without clear cause, in the levamisole group. Antibody (lgG) reacting with myocardial sarcolemma or sarcoplasm was found in the only serum samples available for testing which were drawn from patients during the syndrome. The findings are in keeping with a primary effect on the heart, possibly involving an autoimmune mechanism. The effect has not been noted in other trials.
Testicular biopsies from 6 oligozoospermic and 12 azoospermic patients were examined histologically and immunohistologically. Evidence of maturation arrest and of Type II allergic reactions involving tubular basement membranes was found in all oligozoospermic patients. No evidence of an immune reaction was found in 9 azoospermic patients with maturation arrest. Unilateral or bilateral germ cell aplasia with evidence of mixed Type II and III or Type III and IV reactions was present in 2 oligozoospermic and 2 azoospermic patients. The findings have been interpreted to indicate that maturation arrest and germ cell aplasia may occasionally be linked in a chain of immunological events, initiated possibly by damage to tubular basement membranes. No correlation was demonstrable between the histological and immunohistological findings and indirect immunofluorescent tests for sperm antibodies. It is suggested that testicular biopsy is a potentially hazardous procedure in the investigation of infertility, and that prepubertal testicular tissues as well as sperm be used as antigens in the immunological investigation of infertility.
Jejunal immunofluorescence studies have shown that there is a significantly increased incidence of extracellular IgA and complement in the basement membrane zone and lamina propria of untreated adult coeliac patients compared to coeliac patients on a gluten-free diet. IgG was also demonstrated with complement, particularly in the untreated patients. These findings, taken together with those of other studies, suggest that a local antibody-antigen reaction involving IgA and complement may be responsible for the ongoing mucosal damage in untreated coeliac disease as well as for the acute damage following gluten challenge of the treated patient. Furthermore, consequent upon this damage there may be a secondary IgG antibody response, possibly reticulin antibody, contributing to the mucosal damage.
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Immunofluorescence studies have been carried out on rashes from 36 patients with rheumatoid arthritis receiving gold therapy. 24 of the rashes were clinically attributed to gold and 12 were diagnosed as coincidental rashes. IgE was found in 6 of the gold rashes and in 4 of the coincidental rashes. Immunofluorescence changes of immune complex vasculitis, lichen planus, or pemphigoid were found in 9 gold rashes while 2 coincidental rashes showed vascular fluorescence for immunoglobulins but nor for complement. Two definite gold rashes showing no changes on immunofluorescence showed perivascular infiltration with lymphocytes on light microscopy. Thus, while immunofluorescence is only marginally helpful in the diagnoses of gold rashes, evidence of an immunological reaction tends to favour a diagnosis of a gold-induced rash.
Skin lesions from six patients with systemic lupus erythematosus, five patients with discoid lupus erythematosus, twelve patients with systemic sclerosis, five patients with localized morphoea and twenty controls were examined by immunohistological techniques using fluorescein-labelled anti-human IgG, anti-human C3 and anti-human renal glomerulus antisera. The major immunohistological changes in systemic sclerosis and in localized morphoea consisted of foci of intercollagenous staining for connective tissue antigens in the reticular layer of the dermis. It is suggested that these findings indicate collagen neogenesis. In lupus erythematosus the major changes occur in the dermo-epidermal junction and consist of deposits of IgG and C3 and thickening and disruption of the membrane as demonstrated by the use of heterologous sera containing antibasement membrane antibodies. Immunohistological techniques are useful in the diagnostic differentiation between scleroderma and lupus erythematosus.
Cardiomyopathy of pregnancy developed in a healthy primigravida at 34 weeks gestation and was followed two weeks later by the spontaneous delivery of a fresh stillbirth. An immunological basis underlying both the mother's condition and the fetal death was suggested by the presence of myocardial antibodies in maternal and cord blood. Reference is made to two other cases in which a similar pathological process may have occurred.