The relationship between hemolytic and immunodiffusion methods for measurement of C4 in patients with immunologic disorders

A comparison of radial immunodiffusion and functional (hemolytic) assays for C4 revealed a highly significant correlation between the two methods in patients with a variety of immunologic disorders. Immunodiffusion technics are more convenient than hemolytic assays for most clinical laboratories. C4 assays are useful for the presumptive diagnosis of hereditary angioneurotic edema, whereas C3 is usually normal in such patients. C4 is usually more sensitive than C3 in a variety of immunologic disorders, although in some patients the opposite is true, especially in hypocomplementemic nephritis.     

Sarcoidosis in a patient with autoimmune hemolytic anemia

A 65-year-old woman was admitted to our hospital because of severe anemia. A skin biopsy was done in January 1994 and sarcoidosis was diagnosed. Diffuse reticular shadows were seen in both lung fields on a chest X-ray film and mediastinal lymph node swelling was seen on a chest CT scan. She was followed as an outpatient and was not treated. She suddenly experienced vertigo and general fatigue in March 1995. Laboratory findings on admission were as follows: Hb 6.2 g/dl, MCV 115.9 fl, Ret 198%, LDH 732 IU/L, I-Bil 1.9 mg/dl, and Coombs' test was positive. Autoimmune hemolytic anemia was diagnosed, and she was treated with prednisolone (1 mg/kg). As of the time of this writing, she has no relapse of hemolytic anemia though prednisolone was discontinued 6 months ago.     

In vitro evaluation of the cytotoxic, hemolytic and clastogenic activities of Rhizostoma pulmo toxin(s)

A 36-year-old woman with early recurrence of uterine cervical cancer had received radiotherapy and a CDDP-containing chemotherapy regimen. She was treated with oral etoposide by administration of 50 mg/day for 21 consecutive days at 14-day intervals. After two courses, complete remission was demonstrated by disappearance of the cervical tumor mass and pelvic lymph node enlargement on MRI. Leukopenia (grade 3) occurred after five courses, as well as alopecia (grade 2) and gastrointestinal discomfort (grade 1) after two courses. The patient has shown no sign of recurrence for 1.5 years. This method might be quite effective for patients with recurrent cervical cancer as well as allowing outpatient treatment and improving the quality of life.     

Activation and cytotoxic activity of macrophages: a short review

Interaction of sensitized T-lymphocytes with specific antigen, as well as several other nonimmunological stimuli, will induce the appearance of new properties in macrophages collectively referred to as "activation". The importance of macrophage activation in various physiological processes is only just beginning to be understood. A growing body of evidence strongly suggests that activated macrophages may play a dual role: firstly in protecting the host against certain interacellular pathogens, and secondly in modulating cell proliferation and adversely affecting cells with abnormal growth properties. It is expected that the ability of activated macrophages to discriminate between normal and tumor cells will receive increasing attention. If confirmed, this property may be of major importance with regard to immunotherapy of tumors.     

Cytotoxicity of hemolytic, cytotoxic necrotizing factor 1-positive and -negative Escherichia coli to human T24 bladder cells

Approximately one-half of Escherichia coli isolates from patients with cystitis or pyelonephritis produce the pore-forming cytotoxin hemolysin, a molecule with the capacity to lyse erythrocytes and a range of nucleated cell types. A second toxin, cytotoxic necrotizing factor 1 (CNF1), is found in approximately 70% of hemolytic, but rarely in nonhemolytic, isolates. To evaluate the potential interplay of these two toxins, we used epidemiological and molecular biologic techniques to compare the cytotoxicity of hemolytic, CNF1(+), and CNF1(-) cystitis strains toward human T24 bladder epithelial cells in vitro. A total of 29 isolates from two collections of cystitis-associated E. coli were evaluated by using methylene blue staining of bladder monolayers at 1-h intervals after inoculation with each strain. Most (20 of 29) isolates damaged or destroyed the T24 monolayer (less than 50% remaining) within 4 h after inoculation. As a group, CNF1(+) isolates from one collection (11 strains) were less cytotoxic at 4 h than the CNF1(-) strains in that collection (P = 0.009), but this pattern was not observed among isolates from the second collection (18 strains). To directly evaluate the role of CNF1 in cytotoxicity of hemolytic E. coli without the variables present in multiple clinical isolates, we constructed mutants defective in production of CNF1. Compared to the CNF1(+) parental isolates, no change in cytotoxicity was detected in these cnf1 mutants. Our results indicate that CNF1 does not have a detectable effect on the ability of hemolytic E. coli to damage human bladder cell monolayers in vitro.     

Characterization of cytotoxic factors of Yersinia pseudotuberculosis using the MDBK cell line

The cytotoxin of four strains of Yersinia pseudotuberculosis was characterized using the MDBK cell line and by application of the MTT colorimetric test. The highest cytotoxin yield was obtained in tryptic soy broth medium after 24 h. It was detected in the cell-free culture filtrate, and treatment of the cells with CHAPS as a membrane detergent did not decrease significantly their cytotoxic activity. The cytotoxin was inhibited by trypsinization and by increasing values of either acidity or alkalinity. The cytotoxin was inactivated partially by heating at 70 degrees C for 20 min and totally at 90 degrees C for 10 min. The results obtained indicate that the cytotoxin is protein in nature and produced mainly as free exotoxin.     

Microangiopathic hemolytic anemia with metastatic adenocarcinoma: response to chemotherapy

Microangiopathic hemolytic anemia developed in two patients with metastatic malignancy, one with primary carcinoma of the colon and the other with ovarian carcinoma. There was no evidence of consumptive coagulopathy except severe thrombocytolysis in one patient. Both patients improved remarkably after chemotherapy. The colonic carcinoma responded to 5-fluorouracil delivered into the hepatic artery, and the ovarian tumor to multiagent systemic therapy.     

Case report of a female patient with autoimmune hemolytic anemia and cold agglutinin antibodies

We report a case of acute transient cold agglutinin disease, the etiology of which we could not determine with the available methods. Cold autoagglutinins had anti I specificity, high titers of the autoantibody (> 1:1,000) and the thermal range was relative wide. Our patient had severe haemolysis and immunosuppressive therapy with methylprednisolone and cyclophosphamide was administered. It is a question how much these immunosuppresive agents influenced the recovery, and in what extent it was a self limited disease with spontaneous recovery.     

Immuno-allergic hemolytic anemia connected with streptomycin

The distribution volume of 125l-diatrizoate in rat tissues was studied 5 seconds to 5 minutes after intravenous injection and 5 seconds to 2 minutes after intra-arterial injection. Immediately after injection, diatrizoate was distributed into a larger volume than plasma. Marked temporal changes in the distribution volume of individual tissues occurred during the first 2 minutes. At 5 minutes, the diatrizoate space approached the total extracellular fluid volume, with more than 80% of the contrast agent remaining outside the blood vessels. Thus the relative magnitude of contrast enhancement of a tissue appears to be related to the volume of the rapidly equilibrating extracellular space. Intra-arterial administration can significantly overload muscle with contrast material for about 2 minutes. This and other temporal changes in contrast distribution may prove useful in contrast-enhanced computed tomography using short scanning times.     

Isolated limb infusion with cytotoxic agents: a simple alternative to isolated limb perfusion

We use population genetics theory and computer simulations to demonstrate that population bottlenecks cause a characteristic mode-shift distortion in the distribution of allele frequencies at selectively neutral loci. Bottlenecks cause alleles at low frequency (< 0.1) to become less abundant than alleles in one or more intermediate allele frequency class (e.g., 0.1-0.2). This distortion is transient and likely to be detectable for only a few dozen generations. Consequently only recent bottlenecks are likely to be detected by tests for distortions in distributions of allele frequencies. We illustrate and evaluate a qualitative graphical method for detecting a bottleneck-induced distortion of allele frequency distributions. The simple novel method requires no information on historical population sizes or levels of genetic variation; it requires only samples of 5 to 20 polymorphic loci and approximately 30 individuals. The graphical method often differentiates between empirical datasets from bottlenecked and nonbottlenecked natural populations. Computer simulations show that the graphical method is likely (P > .80) to detect an allele frequency distortion after a bottleneck of < or = 20 breeding individuals when 8 to 10 polymorphic microsatellite loci are analyzed.     

Multiprofessional relationship with children and family: a challenge for the staff

This work focus the importance of the relationship existent between the multiprofessional staff, the hospitalized child and the responsible. The authors identify and comment about the positive and negative points of the pediatric units studied, as well as the orientations given by the staff and assimilated by the children and responsibles. Multiprofessional relationship X child X responsible: challenge to the staff.     

Streptococcus pneumoniae-induced hemolytic uremic syndrome: a case for early diagnosis

The Mitek Mini GII anchor is showcased as a relatively new device that provides a rapid, simple method for bony reattachment; here, it is introduced for the fixation of flexor or extensor tendons at their insertion. Transosseous tunnels with limited visualization, pull-out sutures, and external devices can now be avoided if desired. Applications for soft-tissue fixation should in no way be limited to the small bones of the hand. Expense of the apparatus remains its only major drawback.     

Characterization of a new breast cancer-associated antigen and its relationship to MUC1 and TAG-72 antigens

We have characterized a new tumor-associated antigen defined by monoclonal antibody (MAb) generated against HMA-1 breast cancer cell line. MAb AM-1 was selected based on its preferential reactivity to breast cancer cells versus to normal or benign epithelial cells by immunofluorescence and immunohistochemical assays of cultured, or fresh specimens. AM-1 demonstrated strong reactivity to breast cancer cell lines including HMA-1, YMB-1-E, YMB-1 and MDA-MB-231 in flow cytometry. In immunoprecipitation, AM-1 recognized high molecular weight components of 160-210 kDa and > 370 kDa. Reactivity with HMA-1 cells was diminished markedly when treated by heat, protease or periodate, suggesting that the antigenic epitope is composed with carbohydrates and peptides. Enzyme digestion of precipitated antigens demonstrated that the antigen contains O-linked and N-linked carbohydrates with neuraminic acid structures. Furthermore, binding inhibition and sandwich ELISA assays using MAbs reactive with known breast cancer-associated antigens and synthetic MUC1 core peptide (PDTRPAPGSTAPPAHGVTSAPDTR) demonstrated that the antigen is distinct from CEA, TAG-72 or MUC1, while the antigen conjoins with MUC1 and TAG-72 as a trimmer form in HMA-1 cells. These results suggest that AM-1 recognizes a novel glycoprotein which is abundant in breast cancer, and may be utilized in the management of breast cancer patients.     

Microangiopathic hemolytic anemia and thrombocytopenia in a child with atrial septal defect and pulmonary hypertension

We found that exposure to room temperature (RT/21 degrees C) causes apoptosis in HL-60 cells. Here we characterized RT-induced apoptosis in HL-60. After exposure to RT, apoptosis starts within 6 h and more than 80% of the cells underwent apoptosis within 20 h. All cells, however, were committed to apoptosis after 16 h and no viable cells could be recovered. The caspase-1 inhibitor (YVAD-CHO) effectively blocked apoptosis, whereas the caspase-3 inhibitor (DEVD-CHO) did not. About 20% of newly obtained early passage HL-60 cells (passage 10) also underwent apoptosis by RT treatment. These data suggest that some population in HL-60 which responds to RT with apoptosis became dominant during passaging.     

Primary biliary cirrhosis associated with mixed type autoimmune hemolytic anemia and sicca syndrome: a case report and review of literature

A case presenting with an unusual association of primary biliary cirrhosis and mixed type autoimmune hemolytic anemia plus sicca syndrome is described. The 49-yr-old female primary biliary cirrhosis patient had a confirmed sicca syndrome and presented with jaundice and life-threatening anemia. Laboratory tests revealed positive Coombs' test with coexisting cold and warm autoantibodies. She was successfully treated by blood transfusion with packed red cells lacking any red cell antigens corresponding to serum alloantibodies and pulse methylprednisolone therapy. The patient remained stable under maintenance treatment using oral steroids and ursodeoxycholic acid. This case is probably the first reported showing an association between primary biliary cirrhosis and mixed type autoimmune hemolytic anemia plus sicca syndrome and was probably induced by heterogenous and complicated autoimmune reactions.