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Biomedical subjects

H H Euler

Publications and source records attributed to H H Euler.

At least 37 records · Page 2Linked to original sources
PubMed1994

Treatment-free remission in severe systemic lupus erythematosus following synchronization of plasmapheresis with subsequent pulse cyclophosphamide.

OBJECTIVE: To investigate the effect of an intensified treatment protocol synchronizing plasmapheresis with subsequent pulse cyclophosphamide for severe systemic lupus erythematosus (SLE). METHODS: A protocol of plasmapheresis (3 x 60 ml/kg) and subsequent high-dose pulse cyclophosphamide (36 mg/kg) followed by 6 months of peroral immunosuppression was used to treat 14 patients with severe SLE. RESULTS: Rapid improvement was achieved in all patients. Immunosuppressants, including corticosteroids, were withdrawn at month 6 in 12 patients. Eight patients continued without treatment for a mean observation period of 5.6 years (46-91 months). CONCLUSION: The results demonstrate that treatment-free clinical remission can be achieved in some patients with severe SLE.

Adolescent↗
PubMed1994

Disseminated histoplasmosis in a non-immunocompromised host.

Histoplasma infections in Europe are rare, and acute disseminated histoplasmosis has only been observed in immunocompromised persons. We describe a case of acute disseminated histoplasmosis in a young, nonimmunocompromised European woman. The probable source of infection was Sri Lanka or the Maldives. At presentation she was severely ill with fever, lymphadenopathy, anemia, thrombocytopenia, hepatosplenomegaly, and polyserositis. Histologically, myelofibrosis and osteosclerosis were observed with extramedullary hematopoiesis. Histoplasma capsulatum yeasts were detected in bone marrow trephine biopsy by methenamine silver staining. Treatment with conventional and liposomal amphotericin B and subsequent itraconazole led to rapid and complete recovery.

Acute Disease↗
PubMed1994

Plasmapheresis and subsequent pulse cyclophosphamide in severe systemic lupus erythematosus. An interim report of the Lupus Plasmapheresis Study Group.

The rarity with which therapy-free remission is achieved in patients with severe SLE demand the continued search for improved treatment strategies. Possibly, therapeutic results can be improved by means of a "synchronized" combination of plasmaphereses followed by pulse cyclophosphamide (Ctx). If the hypothesis is correct, that plasmapheresis induces a compensatory "rebound" proliferation of pathogenic clones, then pulse Ctx applied immediately after plasmapheresis should attack these activated clones when they are most vulnerable and, ideally, eliminate them. Employing a strict variant of this strategy in a pilot study, treatment-free remission lasting now for up to 7 years were achievable in 8 of 14 SLE patients. The Lupus Plasmapheresis Study Group (LPSG) is currently conducting a randomized international multicenter trial comparing a synchronized procedure with the administration of pulse Ctx alone. The present paper explains the rationale of synchronization and reports on the interim status of the LPSG Study.

Combined Modality Therapy↗
PubMed1993

A method for chronic membrane plasmapheresis in the rat.

Therapeutic apheresis as applied to humans may encompass a single treatment or numerous treatments for disorders ranging from acute poisoning to severe chronic autoimmune disease. However, the mechanisms of beneficial effects of apheresis are not well characterized. Utilizing a miniaturized hollow-fiber membrane system, we have developed a reliable technique for long-term vascular access in the rat that permits repetitive plasmapheresis. We established vascular access in 14 animals, with 8 and 6 rats randomized to 3- and 7-wk experimental periods, respectively. Immunoglobulin levels of blood samples obtained immediately before and after each plasmapheresis were measured to examine membrane filtration characteristics. Overall, 100% of the animals survived and 93% successfully completed their assigned experimental periods. Mean decrease of immunoglobulin G and M levels for 28 plasmapheresis treatments in five rats was 66.9 +/- 8.1 and 61.0 +/- 7.3% (SD), respectively, indicating effective membrane filtration. This model of apheresis can be applied to several disorders in the rat, including, but not limited to, spontaneous insulin-dependent diabetes mellitus and experimental inflammatory bowel disease.

Animals↗
PubMed1993

Effect of antigen-specific immunoadsorption on antibody kinetics in a rat model.

The investigation of antibody kinetics following antigen-specific immunoadsorption in alkaline phosphatase immunized rats revealed significantly lower antibody levels than in untreated controls over a follow-up period of 6 weeks. A rebounding antibody synthesis as a result of specific depletion was not observed. Non-adsorption of specific antiidiotypic antibodies may explain these findings.

Alkaline Phosphatase↗
PubMed1991

[Intensified therapy of severe lupus erythematosus].

14 female patients (mean age 28 [18-56] years) with severe systemic lupus erythematosus (SLE) were treated after discontinuing previous immunosuppressive therapy, according to an intensified protocol, with three plasmaphereses (days 1-3), followed by pulse cyclophosphamide (12 mg/kg i.v. each on days 3-5) and then oral immunosuppression (cyclophosphamide 1-5 mg/kg daily, depending on white blood cell count; prednisone equivalent 2.0 decreasing to 0.1 mg/kg, according to response, for 6 months). The aim of "synchronization" of plasmaphereses with subsequent cyclophosphamide pulse-therapy is to damage pathogenic lymphocyte clones during maximal compensatory activation induced by plasmapheresis. In all patients there was rapid improvement from the nephritis, pneumonitis, cytopenia, CNS abnormalities and polyserositis. The lupus activity index (SLAM) fell clearly, from initially 28.4 (13-37) points to 8.9 (2-13) after 6 months. Treatment was discontinued after this fall in 12 patients. A recurrence was observed in two patients, at 12 and 39 months respectively. Another patient died from liver cirrhosis of unknown aetiology. Nine patients are under observation but without treatment at present, in essential remission after 2 years (5-51 months), with a SLAM of 2.8 (0-7) points. "Synchronization" of plasmaphereses with subsequent pulse cyclophosphamide achieved rapid improvement and it resulted, for the first time, repeatedly in long-term treatment-free clinical remissions.

Adolescent↗
PubMed1991

Plasmapheresis and subsequent pulse cyclophosphamide versus pulse cyclophosphamide alone in severe lupus: design of the LPSG trial. Lupus Plasmapheresis Study Group (LPSG).

A group of clinics are collaborating in the Lupus Plasmapheresis Study Group (LPSG) to investigate whether repeated plasmapheresis prior to pulse cyclophosphamide improves the therapeutical results in severe systemic lupus erythematosus (SLE). The underlying rationale is the hypothesis that plasmapheresis 1) eliminates pathogenic autoantibodies and immune complexes and 2) induces compensatory lymphocyte activation via feedback mechanisms between circulating antibodies and their respective clones ("antibody rebound"). It should be possible to utilize this enhanced activity for increased clonal deletion if pulse cyclophosphamide is applied shortly after plasmapheresis. Accordingly, in a randomized study, the LPSG will be comparing the repeated application of pulse cyclophosphamide alone with a treatment involving repeated plasmapheresis prior to the cyclophosphamide pulses in severe SLE. A third arm of the study will be gathering experience with a more intensified procedure. This overview summarizes the most important details of the planned study.

Combined Modality Therapy↗
PubMed1991

A randomized trial of plasmapheresis and subsequent pulse cyclophosphamide in severe lupus: design of the LPSG trial.

A group of clinics cooperating as the Lupus Plasmapheresis Study Group (LPSG) is starting an international multicenter study of the treatment of severe systemic lupus erythematosus. The primary goal of this randomized and prospective trial is to establish whether treatment with plasmapheresis and subsequent pulse cyclophosphamide improves the outcome compared to treatment with pulse cyclophosphamide alone. The underlying rationale assumes that plasmapheresis: a) eliminates pathogenic autoantibodies and immune complexes and b) induces a compensatory activation of pathogenic lymphocyte clones through a feed-back between circulating antibodies and their respective antibody-producing clones. Synchronization of plasmapheresis with subsequent pulse cyclophosphamide should enhance the deletion of pathogenic clones during the period of greatest vulnerability. This overview reviews the first results of treatment approaches based on this concept and summarizes the design of the LPSG trial.

Combined Modality Therapy↗
PubMed1989

[Induction of remission in severe lupus erythematosus by intensified therapy].

11 patients with severe SLE were treated with plasmapheresis and subsequent pulse cyclophosphamide. In all patients rapid improvement was observed. After another 6 months of immunosuppression any treatment was withdrawn. The remissions remained stable in 6/8 patients during the follow-up period of 7-33 (mean: 21) months.

Cyclophosphamide↗