Biomedical subjects
Publications and source records attributed to P Reusser.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
One hundred patients with severe aplastic anemia were treated and evaluated in a prospective study at our hospital between January 1976 and October 1983. 28 patients had a HLA-identical sibling donor and were treated with bone marrow transplantation. 72 patients without a HLA-identical sibling donor were given antilymphocyte globulin followed by oral low dose androgen therapy. One and a half years to nine years after treatment 13 patients (46%) survive in the transplant group and 53 patients (74%) survive in the second group. All except one in the second group have self-sustaining hematopoiesis without need for transfusions. There is one major difference between the two therapies. Marrow transplantation restores bone marrow function completely and no late hematological complications have been seen in this group. The majority of patients treated with antilymphocyte globulin in contrast have residual abnormalities of hemopoiesis: macrocytosis, mild granulocytopenia and mild thrombocytopenia. Relapse (11 of 72 patients) and clonal hematological disorders, such as paroxysmal nocturnal hemoglobinuria (4 patients) and leukemia (one patient) can occur years after complete bone marrow reconstitution with antilymphocyte globulin. These late disorders are of concern. In spite of this we conclude that antilymphocyte globulin treatment is an effective therapy with low early mortality and morbidity and a high chance for a long sustained remission. Results are better or at least equivalent to bone marrow transplantation and patients with donors should be given the option of transplantation or antilymphocyte globulin.
A 51-year-old woman presented with superficial thrombophlebitis and severe hemolytic anemia. The initial direct antiglobulin test using a broad-spectrum antiserum for screening was negative. Later testing with monospecific antisera revealed the rare finding of an autoimmune hemolytic anemia (AIHA) associated with IgA autoantibody. In IgA-AIHA the direct antiglobulin test with a broad-spectrum antiserum may be falsely negative, because a standardized anti-IgA level is not compulsory. This case illustrates the diagnostic significance of monospecific antisera in IgA-AIHA. Our patient responded well to high-dose steroids, but due to repeated exacerbations this treatment could not be tapered. Splenectomy was performed 19 months later. Since then the AIHA remained in remission, even after steroids were stopped, and although the direct antiglobulin test continued to be positive for IgA and became positive again for C3d. Available data about pathogenesis and therapy of IgA-AIHA are reviewed.
Pseudothrombocytopenia, a term used to define a spuriously low platelet count produced by automatic cell counters, is most often due to platelet clumping induced by EDTA. In a period of two years we have observed 8 patients with a mean platelet count of 46,000/mm3 in the presence of EDTA. When samples of capillary blood (without EDTA) were tested, the mean platelet count was 202,000/mm3. A further patient had platelet adherence to neutrophils with normal platelet counts. This rare finding can also lead to pseudothrombocytopenia. In the event of unexpected thrombocytopenia a smear from EDTA-blood samples reveals the presence of platelet clumping or adherence to neutrophils. Counts of capillary blood samples reveal the true platelet number.
A total of 100 patients with severe aplastic anemia were treated and evaluated in a prospective study at our hospital between January 1976 and October 1983: 28 patients had an HLA-identical sibling donor and were treated with bone marrow transplantation, and 72 patients without an HLA-identical sibling donor were given antilymphocyte globulin followed by oral low-dose androgen therapy. At 1 1/2-9 years after treatment, 13 patients (46%) survive in the transplant group and 45 patients (75%) survive in the second group. All except one in the second group have self-sustaining hematopoiesis without need for transfusions. There is one major difference between the two therapies. Marrow transplantation restores bone marrow function completely and no late hematologic complications have been seen in this group. The majority of patients treated with antilymphocyte globulin in contrast have residual abnormalities of hematopoiesis: macrocytosis, mild granulocytopenia, and mild thrombopenia. Relapse (11 of 72 patients) and clonal hematologic disorders, such as paroxysmal nocturnal hemoglobinuria (four patients) and leukemia (one patient) can occur years after complete bone marrow reconstitution with antilymphocyte globulin. These late disorders are of concern. Despite this, we conclude that antilymphocyte globulin treatment is an effective therapy with low early mortality and morbidity and a high chance for a long, sustained remission. Results are better or at least equivalent to bone marrow transplantation and patients with donors should be given the option of transplant or antilymphocyte globulin.
Explore the source record for details and available documents.
Bone marrow transplants were carried out in 18 patients with chronic myelogenous leukemia (CML) in the chronic phase (CP). 12 (67%) are still alive, 11 without evidence of leukemia after a mean observation period of 24 (3-44) months, 1 relapsed and 6 died. The most frequent cause of death was GvHD and interstitial pneumonia (5). 1 patient died of septicemia. 2 grafts were performed in patients with CML in the accelerated phase (AP); both died, one from leukemic relapse and one from GvHD. The authors also participated in an international study in which 117 patients were evaluated. In CP there was a survival plateau at 63%, in AP at 36% and in blastic crisis at 12%. In CP mortality was primarily age-dependent and relapses occurred in only 7%. It is concluded that bone marrow transplantation (BMT) is a highly successful treatment for CML, with the CP the optimum moment for grafting. Longlasting cytogenetic and clinical remissions with potential for cure are possible in a high percentage of patients. The incidence of transplant-related mortality is acceptable. The incidence of leukemic relapse is low in CP. Patients under age 40 with HLA-identical siblings should be transplanted in CP. At present BMT is the only treatment with curative potential for CML.
In 55 patients undergoing elective surgery (general or urological) the colloid osmotic pressure (COP) of serum was followed up until the sixth postoperative day. The patients were divided into two groups, one receiving intra- and postoperative administration of dextran 70 and the other as a control group with no dextran. COP was measured at an artificial membrane (M = 10000) by a transducer; at the same time the concentrations of total protein, albumin and globulin were determined in order to calculate the COP by the formula of Keys. The dextran group and control group showed no difference in the measured COP. This variable reached the lowest value (which was not below 20 mm Hg) on the first postoperative day. The control patients showed close agreement of measured and calculated COP, while the calculated COP of dextran patients was significantly lower than the measured COP until the sixth postoperative day; the artificial membrane thus registered the action of dextran for this length of time. After each dextran infusion the serum proteins fell to a lower level than in the control group. Three possible explanations are discussed: an increase in intravascular volume, accelerated passage of macromolecules through the capillary wall, and a decrease in albumin synthesis.
In 26 patients undergoing elective surgery (general or urological) the colloid osmotic pressure (COP) of serum was followed up until the sixth postoperative day. COP was measured at an artificial membrane by a transducer as described by Weil et al. Simultaneous measurements of the concentrations of total protein and albumin were used to calculate COP by the formula of Keys. Measured COP and calculated COP were in close agreement; to eliminate the systematic (although small) difference, a correction of the Keys formula was developed. COP decreased postoperatively, but never below 20 mm Hg. While no circulatory or pulmonary dysfunction can be found, it seems superfluous to substitute COP if not below 20 mm Hg. The possible value of protein substitution is discussed.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The occurrence of life-threatening infections, including cytomegalovirus (CMV) infection, in recipients of allogeneic bone marrow transplants is related to the severe and prolonged immunodeficiency that is present after transplantation. Studies performed in our laboratory of the recovery of CMV-specific T cell responses after bone marrow transplantation have demonstrated that CMV disease occurs exclusively in those patients with no reconstitution of CD8+ CMV-specific T cell responses. Methods of isolating class I major histocompatibility complex-restricted CD8+ CMV-specific T cell clones from healthy CMV-seropositive individuals with protective immunity have been developed. The majority of cytotoxic T cell clones isolated from several individuals recognize structural proteins of the virion that are presented by infected cells without requiring the expression of the viral gene. These results suggest this immunodominant response may be essential for maintaining the virus in a latent state in healthy CMV-seropositive individuals. Clinical trials have been initiated at our institution to investigate the potential for selective reconstitution of CMV-specific immunity in bone marrow transplant recipients by the adoptive transfer of CMV-specific T cell clones generated from the respective bone marrow donor.