High-titered spontaneous interferon (IFN) antibodies were detected in a patient with pure red cell aplasia (PRCA), a benign mediastinal tumor, and recurrent cutaneous carcinomas. The circulating IFN antibodies reacted broadly with various human IFN-alpha subtypes (20-140 x 10(3) neutralizing units/ml serum) but not with IFN-beta or IFN-gamma, and they neutralized the antiviral activity of the patient's endogenous IFN-alpha. The IFN-alpha-binding activity was restricted to the IgG1 subclass in a nonmonoclonal manner. Whereas the PRCA repeatedly responded to immunosuppression with high-dose cyclosporin A (CSA) and CSA plus plasmapheresis, IFN antibody production continued during treatment with cyclophosphamide and CSA. Serological analysis revealed past infection with parvovirus B19 and persistent B19 IgM titers. Antibody-mediated impairment of the IFN-alpha system might have favored the development of both PRCA and the various cutaneous carcinomas in this patient.

Aged↗

PubMedDate not supplied

Elevated plasma cortisol levels during interferon-gamma treatment.

We investigated plasma levels of cortisol and ACTH in 9 patients with advanced metastatic tumors before and during treatment with interferon-gamma (IFN-gamma), 2-4 h after administration of IFN-gamma there was a sharp rise in plasma cortisol levels. The rise coincided with the onset of fever. Highest cortisol levels were reached 4-6 h after IFN-gamma injections, whereas IFN-gamma serum levels peaked 6-10 h after the IFN-gamma injections. Elevated cortisol levels during IFN-gamma treatment may be part of a homeostatic response of the neuroendocrine system to the immunological stimulus induced by IFN-gamma. On the other hand, the increased plasma levels of cortisol in response to pharmacological doses of IFN-gamma may dampen the in vivo effectiveness of IFN-gamma.

Adrenocorticotropic Hormone↗

PubMedDate not supplied

[Evidence-based medicine in orthopedics - a sensible or unnecessary addition to clinical routine? Part 1: the diagnostics tool].

AIM: The methods of evidence based medicine (EBM) are recommended to solve problems in day-to-day routine. Aim of this article is to demonstrate the practicability of this procedure for the diagnostic module. METHODS: Within a teaching session in our department 20 participants guided by an extern al EBM teacher validated the results of an article according to the EBM criteria concerning the module "diagnosis". We demonstrate what EBM can contribute to solve day-to-day clinical problems and discuss the six formal steps for the implementation of EBM into day-to-day practice. 1) To transform the clinical problem into an answerable 4-part question. 2) To answer this question based on your internal evidence. 3) To search for external evidence to answer this question. 4) To critically appraise the evidence found with respect to its validity, importance and applicability. 5) To integrate the appraised external evidence into your existing internal evidence in order to come to a new decision if the additional new external evidence is convincing. 6) To assess the benefit which was gained for the patient. RESULTS: Statistical tests to evaluate the relevance and validity of the chosen article were performed. The following data were determined: sensitivity, specifity, pretest probability, posttest probability, likelihood ratio, positive predictive value, negative predictive value. CONCLUSION: In conclusion we show that EBM can help to solve day-to-day clinical problems, because the structured analysis of concrete questions can lead to a validation of the literature.

Clinical Competence↗

PubMedDate not supplied

[Evidence-based medicine in orthopaedics - a sensible or unnecessary addition to clinical routine? Part 2: the therapy tool].

AIM: In the second part of our project to implement evidence-based medicine into day-to-day clinical practice the module therapy is presented. METHODS: Within a teaching session in our department 20 participants guided by an extern al EBM teacher validated the results of an article according to the EBM criteria concerning the module therapy. To work with this module formal procedures are necessary, too. RESULTS: Statistical tests to evaluate the relevance and validity of the chosen article were performed. The following data were determined: relative risk reduction, absolute risk reduction, number needed to treat. CONCLUSION: In conclusion we can show, that EBM can help to solve day-to-day clinical problems, because the structured analysis concerning valid answers to concrete clinical problems is possible.

Clinical Competence↗