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Biomedical subjects

F Mercuriali

Publications and source records attributed to F Mercuriali.

At least 37 records · Page 2Linked to original sources

Autotransfusion program: integrated use of different techniques.

A successful autologous program should enroll all appropriate patients, conserve homologous blood and minimise the exposure to the risks of donor blood. A program of autotransfusion and proper use of blood has been implemented since 1980 with the objectives to include all eligible patients and to transfuse autologous blood only. The following strategies were adopted: critical review of transfusion indications; control of overtransfusion; avoidance of waste; systematic and integrated use of all autotransfusion techniques currently available. Results in 1992 in elective surgery: 98% enrollment, 75% blood conservation. Exposure to homologous blood was completely avoided in 53% of the cases.

Blood Loss, Surgical↗

[Hashimoto's thyroiditis and HLA in Caucasian Italians].

Sixty cases of goitrous Hashimoto's thyroiditis were observed at the first diagnosis. For 18 of the cases, the diagnosis was made only on the basis of cytological examination since antithyroid antibodies were always negative. To determine if seronegative or seropositive forms constituted a particular genetically determined subgroup, we evaluated whether such peculiarities were related to specific HLA haplotype. Analysis of HLA antigens showed in the seropositive a significant increase in the frequency of HLA-B51 and HLA-A2, a significant decrease in the frequency of HLA-A1 and HLA-DR1. In seronegative cases no increase was found in the frequency of HLA-A-B-DR antigens, but they showed a strong positive association with HLA-DQ3. Our results show that association of Hashimoto's thyroiditis with HLA antigens was different in seronegative and seropositive subgroup. This finding would seem to support the hypothesis that in a few subjects the entire immune process develops exclusively within the involved organ and this process would be genetically determined.

Adult↗

Prevalence of hepatitis C virus antibodies in Italian blood donors. The Italian Cooperative Group.

11,117 blood donors from 24 blood transfusion services evenly distributed throughout the various Italian regions were tested for the presence of hepatitis C virus (HCV) antibodies in the serum and serum alanine aminotransferase (ALT) level. The results are as follows: (1) anti-HCV seroprevalence in Italy was 0.87% with a difference between Northern and Southern regions (0.68 vs. 1.37%) and between younger and older subjects (0.62 vs. 1.21%); (2) prevalence of elevated ALT levels was 4.74% without a North-South effect (except than for markedly elevated ALT levels); (3) anti-HCV seroprevalence was higher in subjects with elevated ALT (5.0%), with a North-South effect (2.2 vs. 9.9%) and particularly high (19.2%) in subjects with markedly elevated ALT; (4) ALT levels were elevated in 26.2% of anti-HCV positive subjects, with a North-South effect (14 vs. 40.5%).

Adult↗

HLA typing in 67 Italian patients with idiopathic hemochromatosis and their relatives.

The frequency of HLA A3 and B7 antigens was significantly higher in 67 unrelated patients with idiopathic hemochromatosis (IH) than in 700 controls (62.7% vs 22.5%, p less than 10(-8) and 26.9% vs 9.3%, p less than 10(-3), respectively). A3 B7, A3 B35 and A3 B5 were significantly more frequent in 72 haplotypes linked to IH gene than in 278 control haplotypes. The prevalence of B35 and A3 B35 was significantly higher in IH patients from North-Eastern Italy than from other regions (60% vs 21%, p less than .05 and 54.5% vs 8.2%, p less than 0.0001, respectively). All 15 siblings HLA identical to the respective proband were homozygous for IH with variable expression of the disease, whereas minor abnormalities of iron-related indexes were present in 23% of heterozygous relatives. Homozygous-heterozygous mating probably occurred in three of 40 families, accounting for the overt disease in three offspring and in one HLA semi-identical sibling; however, in this last case the possibility of a recombination event cannot be excluded.

Adult↗

The cadaver kidney transplant program of North Italy before and after cyclosporine.

NITp is an organization that since 1972 has served an area of approximately 17 million inhabitants through 8 transplant centers, 20 active donor-procuring centers, and 1 coordinating center. The activity of NITp can be divided into three historical periods. In the first period (1972-1977, 408 transplants), collaboration was initiated and protocols implemented. In the second (1978-1982, 592 transplants), a policy was established as follows: three deliberate transfusions of standard packed red cells were given pretransplant to all untransfused patients on the waiting list. Priority was given to immunized patients when an HLA-A, -B-compatible kidney was available and an effort was made to ensure at least two HLA-A, -B matches to nonimmunized patients. All transplanted patients were treated with conventional therapy (corticosteroids and azathioprine). Evaluation of data of this period showed that both graft and patient survival had increased; a center effect was evident; the policy of giving a kidney with at least two HLA-A, -B matches seemed to improve the results; and preformed panel-reacting antibodies had a negative effect on graft survival. The third period began in January 1983 when some centers in the NITp started to use CsA. By December 31, 1985, 589 of 863 transplants performed had been treated with CsA. Data analysis showed that CsA significantly increased the one-year success rate in both first and second transplants; other factors, such as HLA-A, -B and -DR matching, transplant center, old age of the kidney donor (51-60 years), and cold and warm ischemia times seemed less or not important. Preformed panel-reacting lymphocytotoxic antibodies did not influence graft outcome significantly, but a trend was observed in that immunized recipients did worse than non-immunized recipients. The transfusion effect could not be evaluated in our CsA patients since they all are transfused pretransplant; a prospective study is necessary to evaluate if such an effect is still present. Until more data are collected in our setting to allow a sound evaluation of the consequences of CsA treatment, no changes are warranted in the NITp policy.

Cyclosporins↗

Impaired natural killing activity in patients with rheumatoid arthritis. Clinical characteristics and a study of defective mechanisms.

We have studied NK activity against K562 cells of peripheral blood mononuclear cells (PBMC) from 83 patients affected with RA and searched for correlations with some clinical and laboratory parameters. In 65 patients T lymphocyte subsets were investigated by laser flow cytometry using monoclonal antibodies against OKT3, OKT4 and OKT8 antigens and in 25 patients also HNK-1+ cells were enumerated. NK activity in patients with RA resulted significantly decreased compared with controls (relative cytotoxic index = 0.68 +/- 0.74 versus 1.00 +/- 0.60, p less than 0.01). Decreased NK activity was not correlated with sex, age, duration of disease, ESR, haemoglobin, serum alpha-2-globulin, serum gamma-globulin, rheumatoid factor titre. The only clinical parameter correlated with decreased NK activity was the anatomical stage of the disease. NK activity depression resulted to be significantly correlated with OKT3+ cell percentage and at a lesser extent with OKT4+ and OKT8+ cell percentages. HNK-1+ cell percentage resulted only slightly reduced in patients with RA (13.1 +/- 8.7 versus 15.0 +/- 7.0) and there was only a modest correlation (p approximately equal to 0.10) between NK activity and HNK-1+ cell percentage. In order to elucidate the mechanisms of impaired NK activity in RA, experiments in vitro were carried out on PBMC of 23 patients to investigate the effects of the depletion of cells adherent to plastic, incubation with beta-interferon (1000 IU/ml) and incubation with indomethacin (10 -6M). Our data suggest that decreased NK activity in RA is mainly due to functional immaturity of NK cells and sometimes to inhibition by monocytes in some cases probably through prostaglandin release.

Antibodies, Monoclonal↗

Blood transfusion and kidney transplantation: effect of small doses of blood on kidney graft function and survival.

A controlled clinical trial was started to evaluate whether small doses of blood given pretransplant determine a transfusion effect while reducing the risk of antibody production. For this purpose, 65 consecutive never transfused patients suffering from end-stage renal failure were assigned to one of two groups: the first group was transfused with 1 unit of packed red cells (containing a mean of 2350 x 10(6) leukocytes, 900 x 10(6) mononuclear cells) 3 times at 15-day intervals. The second group received one transfusion of about 30 ml of blood adjusted to contain 100 x 10(6) mononuclear cells. While no definitive conclusions are still possible, preliminary data indicate the following: (1) three small transfusions are capable of immunizing the recipient, but lymphocytotoxic antibodies tend to disappear rapidly; (2) in vitro lymphocyte response to lectins of patients receiving small transfusions is not significantly different from that of patients receiving standard transfusions; (3) the two groups of patients differ significantly as far as the T4+ /T8+ cell ratio is concerned: in fact while a decrease of the ratio is observed after standard transfusions, small transfusions determine an increase of the ratio, mainly due to a decrease in the number of T8+ cells; and (4) the clinical course and survival of the graft is worse in patients treated with small transfusions than in those treated with standard transfusions.

Adolescent↗

The cadaver kidney transplantation programme of Milano. Immunological report.

A retrospective investigation was carried out to evaluate the infuence of HLA (A, B) matching, blood transfusions, and preexistence of lymphocytotoxic antibodies on the outcome of the cadaver kidney graft: only non-NIH standard antibodies were considered, since patients with NIH standard antibodies do not undergo transplantation in the programme of Milano. It was found that (1) about one-half the patients with transplants had antibodies in their pretransplant serum. The preexistence of antibodies directed against B lymphocytes had an unfavourable effect on the graft survival; (2) the graft did particularly well in the nonimmunized patients who had been previously transfused; the graft survival was about 80% at 3 years in these patients; and (3) the HLA (A, B) match influenced the graft survival only in patients with antibodies.

Antibodies↗

New groups and segregant series among B-cell alloantigens of the Merrit system. A study of leukemia cells, peripheral B cells, and lymphoblastoid cell lines.

On the basis of reactions with a chronic lymphatic leukemia cell panel, evidence for 6 new specificities of the Merrit B-cell alloantigenic system in man is presented, bringing the number of provisionally defined specificities to 19. These can be roughly divided into two segregant series. The system is well represented on both homozygous and heterozygous B-type lymphoblastoid cell lines. In the cell lines some specificities show a suggestive but inexact correlation with HLA-D locus factors. This correlation is represented also on peripheral blood B cells, on the non-T variety of acute lymphatic leukemia cells, and on acute myeloid leukemia cells. Although great similarities exist, each of the cell populations may manifest differences other than or in addition to mere differences in B-cell antigen frequencies.

B-Lymphocytes↗