[Integration of EDP into the crossmatching laboratory and into recipient files].
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Biomedical subjects
Publications and source records attributed to R Eckstein.
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Indicator cells--tanned, surface stabilized sheep erythrocytes--were incubated for 1 h in supernatants of 3 h MLCs. Their electrophoretic mobility was measured by an analytical, carrier free electrophoresis system. The change in their mobility compared with an appropriate control was calculated in per cent and correlated with the conventional measured MLR-cpm. The correlation of the two quantities is statistically highly significant (p less than 0.01). Furthermore, the difference of the electrophoretic mobility values of the group of HLA-D-identical and the groups of HLA-D-haploidentical or -different donors is significant beyond the 1% level (p less than 0.0005). Our method enables, therefore recognition of a positive or negative MLC after only 4 h. Typing for HLA-D-determinants seems to be possible. This could be of great importance for histocompatibility testing and organ transplantation.
Immune function (mitogen and antigen stimulation, suppressor cell activity, T-cell subpopulation distribution) and immunogenetics (HLA-gene determination) were studied in 13 patients with histiocytosis-X and in 88 healthy controls. We found three clusters with significantly different immune responses (F-values greater than 4-20, p less than 0.05-0.001) against mitogenic and antigenic stimulation among the controls which differed, too, in HLA-gene distribution. As suppressor cell activity and T-cell subpopulation distribution are the same in all three control clusters, these reactivity differences should be functional ones and may be genetically determined. Patients with histiocytosis-X show a significantly reduced suppressor cell activity and their helper cells are significantly reduced compared to the controls (p less than 0.01). Furthermore, their lymphocyte reactivity does not correspond with their immunogenetics, but is significantly reduced (p less than 0.05-0.001). Suppressor cell activity, helper cells and lymphocyte reactivity normalized in all eight patients treated systemically with thymostimulin (Tp-1 Serono). It seems to be possible therefore, to influence immunological aberrations in vivo by thymostimulin. In our opinion, the results of this study justify further investigations of the immunoregulatory mechanisms of histiocytosis-X and larger prospective clinical trials with thymic factors to find out, whether such a therapy may be a real alternative to the conventional therapeutic approach in this disease.
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Second episodes of varicella after a definite primary exposure to chicken-pox are well known in immunosuppressed children. We report an outbreak in adult cancer patients. This observation suggests that there is also a higher risk of varicella infection in immunosuppressed adults. As there is a trend for a pronounced severity of chicken-pox in patients receiving anticancer drugs or suffering from immunosuppressive diseases, the prophylactic use of varicella zoster immune globulin in adult patients has to be discussed, especially as positive experiences with children were recently gained. Following manifestation, therapy with systemic aciclovir seems to be effective.
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A primary malignant fibrous histiocytoma of the left atrium was diagnosed in a 27 year old woman. After surgical excision the tumour recurred together with enlargement of the right hilar lymph nodes. The patient was then treated with nine courses of chemotherapy using a combined drug regimen. During the first course the tumour regressed, and after nine courses almost complete remission was achieved. Subsequently, the residual tumour was removed by resection of the right lung, the right hilar, paratracheal, and paraeosophageal lymph nodes and by cardiotomy with partial resection of the right and left atria and atrial septum followed by a reconstruction of the atrias. To date, more than two years after initial presentation, the patient is alive and well.
In vitro treatment of bone marrow grafts with absorbed rabbit-antidog thymocyte globulin (ATG) prevented graft-versus-host disease in a substantial number of the dogs differing by one DLA haplotype. Absorbed ATG has now been used for serological identification of canine lymphocyte populations. Specific labeling of canine T-lymphocytes by absorbed ATG could be demonstrated by (a) a distribution of ATG-positive cells in suspensions of canine lymphoid organs similar to that of T cells observed in other species and by specific staining of paracortical thymus-dependent lymph node areas in immunohistochemistry, (b) complementary labeling of nylon-wool-separated cells by ATG and antiimmunoglobulin sera, and (c) correlation of ATG surface labeling with responder activities in mixed lymphocyte cultures.
Transfusion of frozen blood has become a routine method. As the cost is high, the method is restricted to autologus transfusion and storage of rare blood groups. Transfusion of frozen platelets will become a routine method in near future. Especially large pools of HLA-identical platelets should be of great advantage in many cases.
Eleven adults have been transplanted for various reasons between July 1979 and July 1982: 2 with aplastic anemia (AA), 1 with paroxysmal nocturnal hemoglobinuria (PNH), 8 with acute leukemia (AL). Four patients suffered from acute lymphocytic leukemia (ALL) and four from acute non-lymphocytic leukemia (ANLL). Two of them were transplanted in relapse, 1 in a partial remission, and 5 in complete remission. All patients were in their late stage of disease. The PNH-patient had an identical twin, 8 patients had an HLA- and MLC compatible sib, 1 an unrelated donor, and 1 was transplanted from his father. Four patients are alive, 2 more than 3 years: 1 with AA and 1 with ALL who was transplanted in relapse. Six patients died of infectious complications (4 of interstitial pneumonia, 1 of a candida sepsis, 1 of acute toxoplasmosis). Patients living more than 3 weeks had a take. Acute graft-versus-host (GvH) disease did not present a major problem. All patients received methotrexate for GvH-prophylaxis, in three instances the marrow was additionally pre-incubated with anti-T-cell globulin.
We studied suppressor cell function in 10 patients who had congestive cardiomyopathy, 13 patients who had myocarditis and 98 healthy controls. Myocardial biopsy, coronary arteriography and left ventricular angiography were used to define and differentiate congestive cardiomyopathy and myocarditis. The suppressor component of the immune response was assessed by examining the in vitro responses of peripheral blood lymphoid (PBL) cells under standard conditions. Briefly, PBL cells were incubated with concanavalin A to stimulate suppressor activity. Induced activity was measured by the ability of PBL cells to inhibit 3H-thymidine uptake of nonstimulated autologous cells when subsequently presented with allogenic or mitogenic stimuli.
Two cases of immune haemolytic anaemia and acute renal failure induced by nomifensine are reported. The two female patients had been under continuous nomifensin therapy because of reactive depressions. In both cases nomifensine had been discontinued and the clinical reactions--immune haemolytic anaemia and acute renal failure--started immediately after they had taken again a capsule of nomifensine. In one case the patient's serum contained a potent antibody which agglutinated her red blood cells in presence of nomifensine in the antiglobulin test.
From March 1975 until May 1980 twelve patients with severe aplastic anemia were grafted with bone marrow from HLA-identical siblings by the Munich Cooperative Group for Bone Marrow Transplantation. Six patients are alive between 10 months and more than 5 years after grafting with normal blood values and marrow. One patient is treated as an out patient for chronic localized graft-versus-host disease (GvHD), five patients are well and without treatment. Six patients have died, one patient with a cerebral hemorrhage the day before transplantation, three patients following rejection of grafts 32, 40 and 55 days after grafting, one patient with severe GvHD 85 days after grafting and one patient, probably with interstitial pneumonia, following cerebral hemorrhage. Three of 6 patients who were conditioned with Cyclophosphamide (CY) only died following rejection of the graft. Two adults who were conditioned with CY and "total lymphoid irradiation" and three children, who wer given unirradiated leukocyte concentrates from the marrow donor after grafting, did not reject their grafts. The results of the Munich-Cooperative Group for Bone Marrow Transplantation are comparable to those of large, specialized centers for bone marrow transplantation, they indicate possibilities of cure of severe aplastic anemia by marrow grafts from HLA-identical siblings. They confirm that better results are obtained with earlier transplantation in the course of the disease.
An alternate method for making the long bony cut for a sagittal osteotomy has been presented. By using this method, the sagittal osteotomy can be accomplished in less time and with greater ease, while achieving more predictable splits with fewer complications.
EMT indicator cells were incubated for 1 h in the supernatant of a 3 h MLC. Their electrophoretic mobility was then measured by an analytical, carrier-free electrophoresis system. The alteration of their mobility against a medium-standard was calculated in per cent and correlated with the conventional measured MLR-cpm. According to our results the correlation of the two quantities is statistically highly significant. This method could enable recognition of a positive or negative MLC after only 4 h. This fact could be of great importance for histocompatibility testing and transplantation.
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Endolaryngeal injection of Teflon paste to augment and medialize the paralyzed hemilarynx aims to improve dysphonia and relieve aspiration. After an initial short-lived inflammatory reaction in the laryngeal tissues, a foreign body granuloma forms around the Teflon. In most cases the results are good but it may occasionally be necessary to consider removal of the granuloma if too large a volume has been injected, if it is inappropriately placed, or if the paralyzed vocal cord subsequently recovers. Surgical removal is difficult and the results are unpredictable. This case illustrates, for the first time, that evaluation using both a high-resolution computed tomographic (CT) scan and endoscopy with telescopes permits satisfactory assessment before removal of Teflon.