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Biomedical subjects

S H Leech

Publications and source records attributed to S H Leech.

At least 37 records · Page 2Linked to original sources
PubMed1985

Accidental administration of hepatitis B immune globulin to a patient positive for hepatitis B surface antigen.

Approximately 24 hours after receiving hepatitis B immune globulin (HBIG), a renal transplant surgeon developed localized urticaria at the site of injection followed by generalized urticaria and angioedema, which resolved after administration of corticosteroids but recurred ten days later. Blood drawn from the surgeon prior to his receiving the HBIG injection was positive for hepatitis B surface antigen (HBsAg). We believe that the adverse reaction may have been caused by HBsAg-HBIG immune complexes. This case illustrates the necessity for knowing the results of hepatitis serology before injection of HBIG is given in high risk individuals. It also re-emphasizes the value of periodic screening for hepatitis B in such persons and the need for hepatitis B vaccine.

Angioedema↗
PubMed1984

Thermostable erythrocyte rosette-forming lymphocytes in hereditary hemochromatosis. I. Identification in peripheral blood.

Although the immunoregulatory role of iron has been demonstrated in vitro, evidence for a similar role in vivo is controversial. We have, therefore, studied certain functional and structural properties of lymphocytes in hereditary (idiopathic) hemochromatosis (HH), a disease characterized by iron overload. T- and B-lymphocyte percentages in peripheral blood, serum immunoglobulin levels, and proliferative responses of peripheral blood mononuclear cells (PBM) to lectins were comparable with those of controls. Furthermore, HH serum with elevated iron concentrations did not significantly alter proliferative responses of normal lymphocytes to mitogens. In contrast to those normal findings was the identification of a subset of T lymphocytes in HH that formed rosettes with sheep red blood cells (SRC) at 37 degrees C in abnormally high numbers. Those lymphocytes that formed thermostable erythrocyte rosettes (TE-R) were not immature thymocytes, activated T lymphocytes, or an artifact of passive attachment of anti-SRC antibodies to the HH lymphocyte surface. Their presence did not correlate with a concentration of iron in the serum, the length of treatment, or the presence of the HLA antigen, A3. We conclude that the cellular expression of HH may be detected not as an immunological abnormality, but rather as an abnormality in receptor expression.

Antibodies, Monoclonal↗
PubMed1984

Insulin receptor autoantibodies in sepsis.

This study was undertaken to investigate possible factors contributing to altered glucose homeostasis in a patient with a history of total pancreatectomy and intermittent sepsis. Blood was drawn when the patient had received no exogenous insulin for the previous 24 hours, had a serum insulin level of 0.3 microU/mL, and gave an inappropriately low glucose response to large amounts of infused glucose. The IgG fraction prepared from this serum stimulated glucose oxidation in vitro and inhibited binding of insulin labeled with I 125 to isolated rat adipocytes, thus fulfilling some of the criteria for autoantibodies to the insulin receptor. The results are compatible with the hypothesis that insulin-receptor autoantibodies may have developed as a result of perturbation of this patient's immune status promoted by intermittent septic episodes and that, preterminally, as these antibodies converted in vivo to their in vitro-type behavior, they may have been partially responsible for the severe disturbances of glucose homeostasis.

Adult↗
PubMed1984

Serum inhibitor in systemic lupus erythematosus associated with aplastic anemia.

Hematologic complications of systemic lupus erythematosus (SLE) usually involve peripheral destruction of blood elements. We report a case of SLE-associated aplastic anemia in which an IgG complement-dependent antibody, obtained from the patient's disease-phase serum but not remission-phase serum, suppressed growth of granulocyte-macrophage progenitor cells from bone marrow of normal donors in vitro. Therapy with plasmapheresis and immunosuppression resulted in lasting remission.

Adolescent↗
PubMed1983

Genetic studies in multiple myeloma. 1. Association with HLA-Cw5.

Human leukocyte antigens (HLA) were identified in 22 black Americans with multiple myeloma. No significant association was observed between antigens at either the A or the B locus. At the C locus, in contrast, HLA-Cw5 was more prevalent in the patient group, four of 22 having it, compared with the control group, in which two of 138 individuals possessed it. All four patients with HLA-Cw5 were males. Those results suggest that genetic factors, perhaps in conjunction with an environmental change, may be responsible for the recent increase in incidence in myeloma in black Americans, especially in males.

Adult↗
PubMed1983

The immunoregulatory nature of iron. I. Lymphocyte proliferation.

An increasing body of evidence suggests that iron may regulate certain immune functions in vitro. Its effects on proliferative responses of human peripheral blood mononuclear lymphocytes (PBM) to various mitogens was therefore investigated. The results showed that it enhanced such responses to pokeweed mitogen (PWM) but suppressed those to phytohemagglutinin (PHA) and to concanavalin A (Con A). Furthermore, the enhancement was mediated by T rather than B cells. In conclusion, those results provide further evidence for the hypothesis that iron has certain immunoregulatory properties in vitro.

Adult↗
PubMed1983

Thermostable erythrocyte rosettes in chronic renal failure and allograft rejection.

Rejection of an allograft usually is preceded by activation of T lymphocytes, in which state such cells may be identified by their ability to form thermostable rosettes with sheep erythrocytes (TE-R). The objective of the present work, therefore, was to determine whether or not enumeration of TE-R in the peripheral blood was of any value in the diagnosis of rejection. The results showed no significant differences between TE-R (mean +/- SEM) in normal subjects (9.9 +/- 1.3; n = 25), renal allograft recipients without rejections (13.5 +/- 1.7; n = 5) and in patients who suffered from acute tubular necrosis in the posttransplant period (12.4 +/- 2.5; n = 8). In contrast, recipients who had rejection episodes showed a marked rise in TE-R levels (43.0 +/- 4.0; n = 11) about two to seven days prior to the diagnosis of rejection by clinical and chemical criteria. Furthermore, TE-R remained high if the rejection episodes turned out to be irreversible after therapy (42.2 +/- 3.7) but fell if the episodes were reversible (19.9 +/- 3.2). TE-R values were elevated in patients with chronic renal failure on maintenance hemodialysis (45.7 +/- 4.9; n = 23). Neither acute dialytic runs or acute infections altered TE-R values. In conclusion, those results show that enumeration of TE-R may be helpful in the early diagnosis of allograft rejection, before clinical and chemical stigmata are apparent.

Erythrocytes↗
PubMed1981

Capping of peripheral blood lymphocyte C3 receptors in chronic lymphocytic leukemia: relationship to chemotherapy.

The data show that in chronic lymphocytic leukemia (CLL) there are elevated numbers of peripheral blood lymphocytes (PBL) capable of rosette formation (complement-rosetting lymphocytes, CRL) with bacteria (B)-antibody-(A)-complement (C) (BAC) complexes. In most of the CLL patients studied, large percentages of CRL were impaired in their ability to undergo BAC-C3R cap formation compared to normal donors. The degree of impairment varied from one patient to the next. A consideration of clinical information suggested that the variation was related to the clinical response of patients to chemotherapy. Four categories of CLL patients could be identified on the basis of clinical data: (1) patients never received therapy for CLL; (2) those whose clinical history indicated a failure to respond to ongoing chemotherapy; (3) patients who had received successful prior chemotherapy and who were asymptomatic or stable and were receiving no therapy at the time of study; and (4) those who were undergoing therapy at the time of study and who subsequently became stable or asymptomatic and were removed from therapy. The first two categories of patients failed to show significant BAC-C3R capping, whereas the last two were able to form C3R caps on significant percentages of CRL. No direct relationship could be discerned between C3R capping and currently accepted classifications on stages (Rai) of CLL. These results suggest that monitoring the percentages of BAC-C3R cap-forming CRL may be useful in determining the success of chemotherapy of CLL patients. The microtubule-disrupting agent colchicine enhanced BAC-C3R capping in all CLL patients to normal levels, whereas the microfilament-disrupting agents cytochalasin B(CB) had no effect on CLL RBL C3R capping. CB totally abolished C3R capping of CRL from normal donors. These results suggest that abnormalities exist in both cytoskeletal and contractile systems of CR from CLL peripheral blood.

Antineoplastic Agents↗
PubMed1981

Instability of immunoglobulins and complement (C3) as predictor of renal allograft rejection.

Ten renal allograft recipients were studied for a period of three months with weekly measurements of serum complement C3 including a baseline value before transplantation. Immunoglobulins (IgG, IgM, IgA) were studied in nine of these patients. Fifteen rejection episodes occurred, three patients losing their graft because of irreversible rejections. The patients were followed for 2.5 years. The degree of of change in serial C3 and immunoglobulin levels from baseline was determined by variability index s. Fourteen out of 15 rejections were preceded by si (C3) greater than .1, one to several weeks in advance. The si (Ig) was useful in week 1 and predicted the rejection missed by si (C3). We conclude that instability of immunoglobulins and complement as measured by s is not only associated with rejections but appears to be a precursor to rejection events. We suggest the following prognostic two-step procedure: (1) Week 1: If either si (C3) or si (Ig) greater than .1, predict rejection. (2) Cases that pass step 1 are monitored by C3 at weekly intervals. As soon as si (C3) greater than .1, predict rejection.

Complement C3↗
PubMed1980

Predictive value of serum complement (C3) in renal allograft rejection.

The purpose of this study was to investigate whether or not changes in serum concentrations of complement component C3 are of value in predicting the long term survival of the transplanted kidney. C3 was quantitated by radial immunodiffusion in fresh sera drawn immediately before transplantation and twice weekly thereafter from 10 recipients. Fourteen episodes of acute rejection occurred during the first 3 months postoperatively. These were diagnosed by the demonstration of graft tenderness, fever without evidence of infection and a rise in serum creatinine of 1 mg/dl in the absence of urinary or vascular obstruction. Five rejection episodes in 3 patients were associated with a fall in C3. In one of these patients, C3 returned to normal levels after the episode was reversed, and the kidney is functioning well 2 years after transplantation. In the other 2 patients, C3 remained at low levels regardless of anti-rejection therapy. Transplant nephrectomy was soon required for irreversible rejection. In contrast, only 1 episode unaccompanied by a fall in C3 was irreversible. Evidence is provided concerning the value of serial C3 complement determinations as a predictor of rejection in renal allografts. Using the variability measure Si, the cumulated standard deviation up to week i, Si > 10 not only predicts rejection but does so rather early, providing more than 90 per cent of the ideal lead time. This suggests that loss of a graft may be predicted, but this needs confirmation in additional cases.

Complement C3↗
PubMed1980

Episodic asthma as a bronchial provocation test.

This study, originally designed to investigate the efficacy of a new inhaled steroid, flunisolide, in New Orleans, demonstrated that episodic asthma (known as "New Orleans Asthma") still occurs in that city. Although its outbreaks are less frequent and severe than reported in previous years, they are still intense enough to affect asthmatics who are on maximal drug therapy. We found in this study that patients who were taking a sympathomimetic, methyl xanthine, and steroids both by inhalation (flunisolide) and by mouth (prednisone) required more prednisone during outbreaks. During such outbreaks the use of flunisolide not only delayed the need for more prednisone but also reduced the dosage needed. Furthermore, flunisolide had over-all prednisone-sparing benefits during the course of the whole 18-week study. Finally, throughout the study, asthma was less frequent in patients on flunisolide therapy, their over-all therapeutic response being significantly better than that of a control group. The authors conclude that New Orleans Asthma provides a natural provocation for extrinsic asthmatics in their normal milieu and thus provides an ideal situation for testing new anti-asthmatic treatments, especially in individuals with severe asthma in whom deliberate challenge may be unethical.

Adult↗