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Biomedical subjects

J E Balow

Publications and source records attributed to J E Balow.

At least 127 records · Page 7Linked to original sources
PubMed1983

Henoch-Schönlein nephritis: prognostic features and the challenge of therapy.

Henoch-Schönlein purpura is an intriguing entity of uncertain etiology associated with circulating IaA immune complexes, enhanced spontaneous immunoglobulin production, and an apparent imbalance in T cell regulatory functions. The associated glomerulonephritis is highly variable in nature and may profoundly influence clinical outcome. Prognostic features are reviewed in an effort to identify high-risk patients. Age, non-renal manifestations, non-selectivity of proteinuria, and evidence of preceding streptococcal infection are relatively weak predictors of end-stage renal disease. The presenting clinical and histologic expressions of nephritis are more useful prognosticators, but neither are completely reliable. Patients with greater than 50% crescents, and those with nephrotic syndrome complicated by various combinations of hypertension, azotemia, oliguria, and/or hypoproteinemia, are at increased risk of renal failure and might benefit from therapeutic interventions. Experience with various modalities is reviewed. Faced with uncontrolled clinical data, it is unclear whether immunosuppressive agents or plasmapheresis offer a therapeutic advantage over oral corticosteroids alone.

Adolescent↗
PubMed1983

Steroids in immunologically mediated renal disease.

Pulse steroid regimens, early tapering to alternate-day treatment, and careful use of supplemental immunosuppression with cytotoxic drugs offer strategies for improving the therapeutic index of corticosteroid management.

Adrenal Cortex Hormones↗
PubMed1983

Failure of hemodialysis to diminish psychotic behavior in schizophrenia: behavioral and psychophysiological evaluation.

In a double-blind sham replacement study, eight drug-free schizophrenic patients underwent 10 active and 10 sham hemodialysis for 20 weeks. At the end of the 10 active dialyses, none of the patients appeared to be improved in psychotic, affective, or social symptoms. Active dialysis was associated with a "startle" response in heart rate and skin conductance to auditory stimuli, while sham dialysis was associated with an "orienting" response. Night-recorded sleep electroencephalography was unaffected by active dialysis. Spinal fluid beta-endorphin-like immunoreactivity levels were unchanged after active treatment. The behavioral improvements reported in other studies may be related to "stress," psychotherapeutic support, spontaneous remissions, neuroleptic withdrawal, denial of symptoms, or diagnostic differences. This study did not confirm the claims for hemodialysis as a specific therapeutic intervention in schizophrenia.

Adult↗
PubMed1983

Double-blind evaluation of plasmapheresis in schizophrenic patients: a pilot study.

Interest in the effects and possible mechanisms of hemodialysis on schizophrenic patients has led to a double-blind evaluation of the effects of plasmapheresis on symptoms of schizophrenia. Also, plasmapheresis was felt to be an invaluable tool for investigating the autoimmune theory of schizophrenia. Patients (n = 10) in the study fulfilled Research Diagnostic Criteria for schizophrenia and were randomly assigned to either sham or active plasmapheresis. They were blindly assessed by staff psychiatrists and nurses. Evaluation of the behavioral ratings revealed no significant decrease in psychosis for either the active or sham group. Also, no individual responding patient was identified. This finding complements our group's early negative results of a hemodialysis experiment and casts doubt on a simple autoimmune hypothesis of schizophrenia.

Adolescent↗
PubMed1983

Unresponsiveness of Legionella bozemanii pneumonia to erythromycin administration despite in vitro sensitivity.

We report a case of Legionella bozemanii pneumonia that failed to respond clinically and microbiologically to erythromycin administration. The organism was recovered from bronchial brushings and washings and was demonstrated to be sensitive in vitro to erythromycin as well as to rifampin and sulfamethoxazole-trimethoprim. The patient received a 9-day course of erythromycin before she died. Nonetheless, postmortem lung tissue yielded Legionella bozemanii. In treating Legionella pneumonia unresponsive to erythromycin, addition of another antibiotic, based on sensitivity testing, should be considered.

Erythromycin↗
PubMed1983

Controlled studies of oral immunosuppressive drugs in lupus nephritis. A long-term follow-up.

From 1969 to 1975, 53 patients with lupus nephritis took part in randomized trials comparing prednisone, oral azathioprine plus low-dose prednisone, and oral cyclophosphamide plus low-dose prednisone. After a mean follow-up of 85 months, cyclophosphamide appears marginally superior to prednisone for maintaining renal function (p = 0.03) and preventing end-stage renal failure (p = 0.07). Chronic change shown by renal biopsy assessed by a chronicity index was found useful in predicting renal function outcomes and response to immunosuppressive therapy. Three of 21 patients with a low chronicity index and 9 of 10 patients with a high chronicity index doubled their serum creatinine (p less than 0.00003). The probability of renal functional deterioration was not different among the treatments studied. However, in 14 patients with an intermediate chronicity index, 1 of 11 patients treated with azathioprine or cyclophosphamide doubled the serum creatinine level whereas all 3 patients treated with prednisone have progressed to end-stage renal failure (p = 0.005). The study suggests that single-drug oral immunosuppressive treatment combined with prednisone is most beneficial in lupus patients with intermediate chronic change shown by renal biopsy.

Administration, Oral↗
PubMed1983

Epstein-Barr virus induces normal B cell responses but defective suppressor T cell responses in patients with systemic lupus erythematosus.

Epstein-Barr virus (EBV) is a polyclonal B cell activator, independent of helper T cells, which induces the generation of suppressor T cells in vivo and in vitro. Given the complexity of the immunologic abnormalities in patients with systemic lupus erythematosus (SLE), we used EBV as a tool to examine the following questions: a). Are SLE B cells primarily defective? and b). Does EBV stimulate the generation of suppressor activity from SLE T cells? It was found that B cells from SLE patients infected with EBV in vitro generate plaque-forming cell (PFC) responses that are similar to those raised by normal B cells infected with EBV within the first 14 days of culture. T cells from SLE patients, in contrast to T cells from normal individuals, cultured with autologous B cells plus EBV fail to develop the expected normal decrement of PFC during the late phase of the in vitro culture (day 14). However, B cells from SLE patients are susceptible to suppression as mixed cultures of SLE B cells and normal allogeneic T cells showed a pattern of PFC response to EBV similar to that of the co-culture of normal B cells with normal T cells. T cells from SLE patients, in analogous mixed cell cultures, failed to suppress either normal B cells or allogeneic SLE B cells. The above experiments indicate that the B cells are not intrinsically defective in SLE patients; rather, a specific T cell abnormality contributes to the lack of normal immunoregulation of certain B cell responses in SLE.

Antibody-Producing Cells↗
PubMed1982

Alternative modes of cyclophosphamide and azathioprine therapy in lupus nephritis.

Forty-one patients with systemic lupus erythematosus and glomerulonephritis were studied in a randomized drug trial. Thirteen patients received prednisone only (Group 1), 16 received oral cyclophosphamide and oral azathioprine (1 mg/kg body weight . d of each initially) (Group 2), and 12 were given boluses of intravenous cyclophosphamide (0.5 to 1.0 g/m2 body surface area every 3 months) (Group 3). The mean observation period was 42 months (range 1 to 6.5 years). Renal function deteriorated in four of 12 patients in Group 1 and three of 27 patients in Groups 2 and 3 (p = 0.114). By life-table analysis, 86% of the entire group survived 5 years after entry to the study. Marked hypertension, fluctuating changes in serum creatinine, erratic changes in levels of antibody to DNA, reduced C3 levels, increasing proteinuria or sustained hematuria, and flares of extrarenal disease activity occurred more commonly in Group 1. Infectious complications were not commoner in Groups 2 and 3. We conclude that any marginal benefits produced by the programs tested cannot be shown in this class of patients without markedly increasing the sample size. Our current studies involve more vigorous treatment of patients with more acute disease and less treatment during prolonged periods of relatively good health.

Administration, Oral↗
PubMed1982

Effect of plasmapheresis on T anc B lymphocyte functions in patients with systemic lupus erythematosus: a double blind study.

Nine patients with active systemic lupus erythematosus entered a double-blind randomized trial to study the therapeutic effect of vigorous versus sham reinfusion plasmapheresis. Four of them received real plasmapheresis while five received sham reinfusion plasmapheresis. In the present communication we report the effects of these procedures on T lymphocytes in peripheral mononuclear cells, proliferative response to mitogens, allogeneic mixed lymphocyte reaction and cell-mediated lympholysis, as well as the effect of plasmapheresis on the spontaneous and pokeweed mitogen induced immunoglobulin secreting cells in peripheral blood. Several mononuclear cell functions were abnormal at the beginning of the study but no significant changes related to plasmaphersis occurred in any of the parameters studied.

B-Lymphocytes↗
PubMed1982

Concanavalin-induced suppressor cells: characterization on the basis of corticosteroid and radiation sensitivity.

Experiments were performed to examine whether the concanavalin A (Con A)- induced suppressor cells of several in vitro T- and B-lymphocyte functions constitute a functionally unique cell population. This study included simultaneous studies of three different assays of suppression of T- and B-lymphocyte functions. We found that Con-A-induced suppressor cells which inhibit the allogeneic mixed lymphocyte reaction (MLR) and the pokeweed mitogen-induced, plaque-forming cell (PEC) response are radiation sensitive at doses greater than 1000 rad, but corticosteroid resistant, while those suppressing allogeneic cell-mediated lympholysis (CML) are both radiation and corticosteroid resistant. These studies indicate either that Con-A-induced suppressor cells include heterogeneous populations which are differentially sensitive to corticosteroids and radiation, or that functionally distinct suppressor mechanisms are variably sensitive to these agents.

Adult↗
PubMed1982

Natural killer cells and interferon responses in patients with systemic lupus erythematosus.

Natural killer (NK) cell activity was studied in 23 patients with systemic lupus erythematosus (SLE). The overall NK activity was lower in patients with SLE than in normal female individuals. Patients with clinically active SLE disease had slightly lower NK activity than the patients with inactive disease. Other clinical parameters as well as treatment status did not correlate with NK activity. Interferon (IFN) enhanced the NK activity of normal individuals and of 11 SLE patients, while it did not enhance in the remaining 12 patients. The patients whose NK activity was enhanced by beta-IFN had significantly higher initial activity than those who did not respond to beta-IFN. Furthermore, peripheral mononuclear cells (MNC) from IFN responders produced gamma-IFN after stimulation with concanavalin A (Con A) in titres comparable to those of normals. In contrast, peripheral MNC from beta-IFN non-responders failed to produce significant titres of gamma-IFN after stimulation with Con A. These results indicate that certain patients with SLE have low NK activity, which is generally paralleled by an inability to respond to exogenous beta-IFN and by blunted production of gamma-IFN after stimulation with Con A.

Cells, Cultured↗
PubMed1981

Dialysis in schizophrenia: a double-blind evaluation.

Eight chronic schizophrenia patients completed a research program consisting of ten weekly sessions of active hemodialysis and ten weekly sessions of sham dialysis in a double-blind design. Previous reports of therapeutic efficacy were not substantiated. None of the patients improved during active dialysis; four patients worsened.

Adult↗
PubMed1981

Amyloidosis in systemic lupus erythematosus.

Amyloidosis occurs in a significant proportion of patients with rheumatologic diseases. The fibrillar amyloid proteins in such patients are composed predominantly of amyloid A protein, which is characteristic of the amyloid deposits associated with chronic inflammatory diseases. Only four patients with amyloidosis associated with systemic lupus erythematosus (SLE) have been described previously; analyses of their fibrillar amyloid proteins were not reported. We present herein, a patient with SLE and amyloidosis. Histochemical staining of our patient's renal tissue with Congo red demonstrated that the amyloid deposits contained amyloid A protein, as defined by permanganate sensitivity. In addition, the patient's serum contained increased concentrations of serum amyloid A proteins. In review, each of the previously described patients with amyloidosis associated with SLE had renal amyloid deposits, with diagnosis in three during evaluation of proteinuria. Thus, although rare, amyloidosis should be considered in the differential diagnosis of proteinuria in patients with SLE.

Adult↗
PubMed1981

EEG sleep patterns in schizophrenic patients undergoing hemodialysis.

All-night electroencephalographic (EEG) sleep studies were obtained before and during a double-blind clinical trial of hemodialysis in six schizophrenic patients with normal renal functioning. No significant changes were observed in either clinical status or sleep, except for a significant reduction in rapid eye movement (REM) density, a measure of the number of eye movements per minute of REM sleep.

Adult↗