The protective effect of high-titer anti-lipid A hyperimmune globulin with respect to the course of the disease and the mortality rate was studied in patients with septicemia verified by positive blood cultures. Six patients were treated with anti-lipid A in an open study. Dramatic improvement in fever curves and clinical condition in some of the patients encouraged us to start a randomized double blind study. So far, 17 patients have entered the study, 16 of whom were evaluable. Immediately after a positive blood culture was found, patients received either high doses of anti-lipid A or placebo (saline solution) on two subsequent days. Before and after each infusion blood samples were taken in order to assess serum bactericidal activity and anti-lipid A titers. Because of the still small numbers of patients the results of both studies were summarized. In all patients treated with anti-lipid A clear-cut increases in anti-lipid A titers were shown. Patients with repeated gram-negative infections showed higher median anti-lipid A titers than patients without such a history. The patients treated with anti-lipid A immune globulin ran a significantly milder course than the placebo group. The severe signs of septic shock were reversed in seven of 15 patients on anti-lipid A compared to two of seven patients treated with placebo. In the anti-lipid A-treated group, three of 15 patients died, and in the placebo group two of seven. This difference is not statistically significant.

Aged↗

PubMedDate not supplied

Detection of class II antigens on human nasal cartilage.

The presence and distribution of class II antigens on human nasal cartilage was investigated using monoclonal antibodies directed against HLA-DR, HLA-DP, and HLA-DQ molecules. Tissue sections and chondrocytes in suspension were prepared for immunoperoxidase staining and flow cytometric analysis. Class II antigens were detected primarily on the perichondrium. In contrast, chondrocytes, either isolated or in tissue sections, were completely negative, suggesting that cells of the perichondrium, may, by themselves, be capable of initiating a rejection process.

Antibodies, Monoclonal↗

PubMedDate not supplied

Immunologically activated cells in aural cholesteatoma.

In this immunohistochemical study, we characterized the cells infiltrating the stroma of acquired aural cholesteatomas in detail, using a panel of monoclonal antibodies directed against immune cell type-specific antigens, HLA class II antigens, and interleukin-2 receptor. For all antibodies used, normal ear skin was stained for comparison. The vast majority of the infiltrating cells was CD45-positive, ie, derived from bone marrow. Reactivity with anti-CD3 and anti-CD6 antibodies revealed an abundant infiltration of T lymphocytes beneath the squamous epithelium of cholesteatoma. The B lymphocyte-specific anti-CD19 and anti-CD22 antibodies detected only occasional positive cells. Hence, the cellular infiltrate in the stroma of aural cholesteatoma is made up primarily of T cells with macrophages scattered between them. Expression of HLA-DR was almost as high as that of CD45, whereas CD25-positive cells were detected in lower amounts. We infer that the majority of T cells and macrophages in the stroma of cholesteatoma are in an immunologically activated state. The characteristics of the infiltrating cell population suggest an antigen-driven process in cholesteatoma.

Antibodies, Monoclonal↗

PubMedDate not supplied

Possible autocrine growth stimulation of cholesteatoma epithelium by transforming growth factor alpha.

INTRODUCTION: Transforming growth factor alpha (TGF-alpha) is known to be produced by normal human keratinocytes and to stimulate their proliferation. The squamous epithelium of middle ear cholesteatoma is believed to exhibit hyperproliferative characteristics. This study was undertaken to determine if growth factors can be identified in cholesteatoma. MATERIALS AND METHODS: Cholesteatoma samples (n = 6) and retroauricular skin (n = 9) were obtained during surgery. Monoclonal antibody against epidermal growth factor (EGF) and TGF-alpha were evaluated in these specimens using immunohistochemical techniques. RESULTS: Epidermal growth factor receptor (EGF-R) was highly expressed in the basal layer of the epidermis, hair follicles, eccrine sweat glands, and the capillary system of normal skin. In the majority of cholesteatoma samples, expression of EGF-R was not confined to the basal layer but persisted in suprabasal cells of the stratum spinosum and stratum granulosum. In two cases, heterogenous standing was found in different parts of the same cryosection. Staining for TGF-alpha was consistently stronger in cholesteatoma than in normal skin, and encompassed all epithelial cell layers. Immune cells infiltrating the stroma of cholesteatoma stained positively for TGF-alpha. CONCLUSION: These data are consistent with autocrine stimulation of the squamous epithelium of cholesteatoma by TGF-alpha contributing to its unrestrained growth in the middle ear cavity.

Antibodies, Monoclonal↗

PubMedDate not supplied

Expression of human intercellular adhesion molecules in middle ear cholesteatoma.

INTRODUCTION: Cell adhesion molecules are cell surface proteins that allow specific cell-cell interactions among leukocytes, as well as between leukocytes and other cells. Because middle ear cholesteatoma is characterized by the presence of leukocyte infiltrates, the presence of the two molecule types of intercellular adhesion molecules (ICAM-1 and ICAM-2) was investigated on cholesteatoma using monoclonal antibodies. METHODS: Tissue sections from 10 patients with cholesteatoma, and normal skin from 5 patients were prepared for alkaline-phosphatase--anti-alkaline-phosphatase (APAAP) staining. RESULTS: ICAM-1 and ICAM-2 were present in normal skin in microvascular endothelial cells and in intersticial cells of the dermis. Cholesteatoma showed a very important increase of the ICAM-1 expression with comparison to human skin. All infiltrating immune cells showed positive reactions for the antibody. Furthermore, the intensity of the staining of vessels cells was higher than in normal skin. Keratinocytes were only positive if a very heavy infiltrate was present subepidermally. ICAM-2 was present in endothelial and intersticial cells in normal skin and in cholesteatoma. Most of the infiltrating cells in the cholesteatoma stroma showed positive reactions for the anti-ICAM-2 antibody. CONCLUSION: Our results suggest that both ICAM-1 and ICAM-2 play a central role in the regulation of the inflammatory disorders observed in cholesteatoma.

Antibodies, Monoclonal↗

PubMedDate not supplied

High levels of fibronectin in the stroma of aural cholesteatoma.

PURPOSE: Because abundant fibronectin deposition is a hallmark of healing cutaneous wounds and provides a matrix for hyperproliferative and migratory epidermal cells, the distribution of fibronectin in aural cholesteatoma was investigated immunohistochemically. MATERIALS AND METHODS: A monoclonal antibody against the major cell binding domain of human fibronectin was used to stain 4-micron cryosections of cholesteatoma tissue by the alkaline phospatase-antialkaline phosphatase method. Section of normal retroauricular skin served as control. RESULTS: When processed in parallel, fibronectin staining was much stronger in the stroma of cholesteatoma than in normal dermis. The squamous epithelium of both tissues did not show any staining for fibronectin. CONCLUSIONS: These observations lend support to the view that the growth of cholesteatoma epithelium reflects an aberrant regenerative process.

Antibodies, Monoclonal↗

PubMedDate not supplied

Comparison of the TEMPO+ ear-level speech processor and the cis pro+ body-worn processor in adult MED-EL cochlear implant users.

A study was conducted to compare the new MED-EL TEMPO+ ear-level speech processor with the CIS PRO+ body-worn processor in the COMBI 40/COMBI 40+ implant system. Speech tests were performed in 46 experienced subjects in two test sessions approximately 4 weeks apart. Subjects were switched over from the CIS PRO+ to the TEMPO+ in the first session and used only the TEMPO+ in the time between the two sessions. Speech tests included monosyllabic word tests and sentence tests via the telephone. An adaptive noise method was used to adjust each subject's scores to approximately 50%. Additionally, subjects had to complete a questionnaire based on their 4 weeks of experience with the TEMPO+. The speech test results showed a statistically significant improvement in the monosyllabic word scores with the TEMPO+. In addition, in the second session, subjects showed a significant improvement when using the telephone with the TEMPO+, indicating some learning in this task. In the questionnaire, the vast majority of subjects found that the TEMPO+ allows equal or better speech understanding and rated the sound quality of the TEMPO+ higher. All these objective and subjective results indicate the superiority of the TEMPO+ and are mainly attributed to a new coding strategy called CIS+ and its implementation in the TEMPO+. In other words, based on the results of this study, it appears that after switching over from the CIS PRO+ to the TEMPO+, subjects are able to maintain or even improve their own speech understanding capability.

Adult↗