Biomedical subjects
Publications and source records attributed to Y Pennec.
Antiperinuclear factor (APF) and IgG-rheumatoid factor (IgG-RF) has been found in 64% and 48% of cases of rheumatoid arthritis, 36% and 50% of cases of psoriasis and 31% and 45% of cases of primary Sjögren's syndrome. A close relationship between APF and IgG-RF is suggested by statistical and experimental data. Purified IgG-RF has some degree of APF activity.
Serum electrophoresis and immunoelectrophoresis were performed in 67 patients with Sjögren's syndrome. We found a monoclonal gammapathy in 11 cases: IgG (10 cases) and IgM (1 case). 1 monoclonal gammapathy was detected in 2 of 21 patients with primary Sjögren's syndrome. All patients with monoclonal gammapathy were asymptomatic.
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The results of routine antihistone antibody (AHA) assay in a preliminary series of 189 sera are presented. There were 23 positive tests (systemic lupus erythematosus, 8 cases; drug induced SLE, 4 cases; rheumatoid arthritis 7 cases; and multiple sclerosis, 1 case; chronic active hepatitis, 1 case; systemic sclerosis, 1 case and primary biliary cirrhosis 1 case). The results of routine assay in 5 other patients groups are reported: 30 spontaneous SLE (9 positive AHA), 63 rheumatoid arthritis (2 positive AHA), 19 Sjögren syndrome (no AHA), 11 primary biliary cirrhosis (1 positive AHA) and 7 mixed connective tissue disease (no AHA).
Serum immunoglobulins and some complement components (C1q, C3c, C4, factor B, C9) have been evaluated in 99 malnourished patients. The sole abnormality which seems related to protein calorie malnutrition is a C1q decrease significantly correlated to serum albumin, thyroxin binding prealbumin and retinol binding protein. The immunoglobulins modifications seem to be related to pathological conditions associated with malnutrition (sepsis, liver diseases).
Two cases of strokes in the vertebrobasilar territory were observed in patients with Horton's disease during the first week of treatment when the inflammatory process seemed clinically and biologically under control. The mechanisms of arterial ischaemia are discussed: specific localisation of giant cell arteritis, associated atherosclerosis, failure of therapy or a possible inducing role of steroid therapy as the chronology of these cases would suggest.
TwO cases of megaloblastic anaemia, of which one was very severe, occurring in women who had been taking oestrogen-progestogen oral contraception over a long period of time, are reported. The authors take the opportunity, after having reviewed the literature, of pointing out the role of oestro-progestogen products in bringing about vitamin deficiencies. They discuss how and where oestrogen-progestogen products work on folic metabolism and emphasize that there is an associated factor which starts off the deficiencies.
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The nutritional protein status of 260 unselected adult patients admitted to an internal medicine hospital unit and of 60 healthy controls was evaluated by measurement of the brachial muscular perimeter and of the weight--height ratio and by assay of serum albumin, prealbumin, retinol-binding protein and transferrin. The values most frequently low were those of retinol-binding protein (66%), prealbumin (42%) and albumin (25%). The sensitivity of short half-life serum protein assays is underlined. Twenty-eight p.cent of patients were found to have protein malnutrition on admission, most of these being women and patients older than 60 years. In view of the scattering of most values in controls according to age and/or sex, it is suggested that individual reference values should be determined for this type of study and that no comparison should be made with data found in the literature.
Antiperinuclear factor (APF) was detected in 7 out of 38 patients with autoimmune liver disease (AILD) and in 7 out of 83 patients with non-autoimmune liver disease (NAILD). Anti-keratin antibodies were found in 2 out of 18 patients with AILD and in 3 out of 32 patients with NAILD. Neither APF nor antikeratin antibody was significantly more frequent in AILD than in NAILD. The incidence of APF was shown to be greater (p less than 0.02) in patients with rheumatoid factor (RF) and/or antinuclear antibody. This supports the hypothesis that APF is connected with RF rather than with rheumatoid arthritis, although the presence of APF is evidence towards the diagnosis of rheumatoid arthritis.
A prospective nutritional evaluation of 84 unselected patients admitted to a multidisciplinary ICU was performed using anthropometric measurements, creatinine height index (CHI), and serum protein assays. All values tested were significantly lower than those of 40 healthy controls. A matrix of correlation coefficients showed many similarities among the variables studied. Fatal outcome and poor prognosis indices, such as sepsis and renal failure, were analyzed separately. Anthropometric measurements and CHI were not different in the separate groups. Albumin (Alb) and transferrin (Tr) were not different in patients with or without sepsis. Retinol binding prealbumin was significantly higher in patients with renal failure. Thyroxin-binding prealbumin (TBPA) was significantly lower in all the groups. We emphasize the interest of this rapid turnover protein in evaluating nutritional status. We suggest: (1) a systematic nutritional assessment, and (2) an aggressive nutritional support in the ICU patient.
130 patients with multiple myeloma were reviewed for a retrospective study of their classification according to Durie & Salmon. No significant difference was found in survival between patients in stages I, II and III (median survival 24.8, 32.1, and 17.3 months, respectively). Of the classical criteria affecting survival, only the Hb level showed any significant influence (P less than 0.04). In accordance with this finding, the survival time was much shorter (P less than 0.001) in patients with renal failure than in patients without (median survival 7.4 and 24.8 months, respectively); in addition, thrombopenia, fever, old age, and above all, the % of bone-marrow plasmocytes present, were shown to be decisive factors.
Anti-perinuclear antibodies (APN) were studied in 547 subjects, 123 of whom suffered from rheumatoid polyarthritis (RP). They were detected 88 times in the latter group (72 percent). 26 percent of RP were without serological abnormalities when only rheumatoid factors were considered (latex, Waaler-Rose, Waaler-Rose LOR, rheumatoid factors by indirect immunofluorescence). The rate dropped to 10 percent when APN were included. This test is therefore sensitive. It is also specific as APN exists in only 11 percent of non-rheumatoid rheumatological diseases not including psoriasis (42 percent) and in 16 percent of other auto-immune diseases. In addition, there is a correlation (p less than 0.01) between APN level and the evolution of the rheumatoid illness. APN appears early in an illness and is thus of diagnostic and prognostic interest in RP.
Various erythrocyte rosette forming cells (ERFC) were quantified in 111 patients with rheumatoid arthritis (RA): total-ERFC (t-RFC), active-ERFC (act-ERFC), autologous-ERFC (auto-ERFC) and high affinity erythrocyte-antibody rosette forming cells (EA-RFC). B lymphocytes were counted using a direct immunofluorescence method. A decrease in act-ERFC and an increase in high affinity EA-RFC was found, but only the levels of the former correlated with the degree of inflammation and may be regarded as an indicator of clinical activity. Conversely, numbers of t-ERFC, auto-ERFC and B lymphocytes were found to be approximately normal. There was no correlation between the level of act-ERFC and the presence of rheumatoid factor, circulating immune complexes or antinuclear antibodies.
Lysozyme (LZM), immunoglobulins and beta 2-microglobulin concentrations were measured in the saliva of 79 patients with primary (n = 29) or secondary (n = 50) Sjögren's syndrome and in a control population. beta 2-microglobulin and immunoglobulins A, G and M concentrations were higher, and LZM concentrations lower than in controls. A significant correlation was established between LZM and immunoglobulins, but no correlation was found between immunoglobulins and beta 2-microglobulin, nor between the latter and LZM. These results indicate that salivary LZM concentration may be of value in the diagnosis of Sjögren's syndrome.