Autoimmune hemolytic anemia in children. A review of 80 cases

The records of 80 children with autoimmune hemolytic anemia (AHA) followed up in the same department between 1962 and 1971 were reviewed. The peak incidence was in the first 4 years of life. Predominance among males was noted. Two familial cases were observed. Two main clinical patterns were distinguished: an acute transient type and a prolonged chronic type. A statistically significant correlation was found between the presenting clinical, hematologic and immunologic features and the ultimate evolution of the disease into either clinical pattern. High titer cold agglutinins were very rarely observed. In no patient was an underlying malignant disease found. Although the onset was sometimes dramatic, all the patients with acute transient type recovered rapidly. The over-all mortality was 11.2 per cent. Cases were fatal exclusively among patients suffering from prolonged chronic type AHA associated with either thrombocytopenia or other disorders. Corticosteroid therapy was of constant effectiveness in transient cases but its results were variable in chronic cases. Sixteen patients with prolonged chronic type AHA underwent splenectomy. Response was favorable in patients with significant splenic sequestration of ⁵¹Cr-labeled red cells.     

Chemokinetic activity of N-formyl-methionyl-leucyl-phenylalanine on human neutrophils, and its modulation by phenylbutazone

Phenylbutazone (PBZ) is known to inhibit the oriented migration of human polymorphonuclear leukocytes (PMNs) induced by formyl-methionyl-leucyl-phenylalanine (FMLP), and to protect these cells against the deactivation caused by their prior incubation with FMLP. To gain insight into the mechanism of these effects, we measured the oriented PMN migration under agarose induced, in the presence and absence of PBZ, by FMLP, zymosan-activated serum and Klebsiella pneumoniae culture supernatant. The two components of this migration, i.e. the speed (chemokinesis), and direction of locomotion (chemotaxis), were also assessed. At concentrations ranging from 10(-8) to 10(-5) M, FMLP displayed similar chemotactic activity but the speed of PMN locomotion was maximal for 10(-7) M, and lower for concentrations above and below this level. Oriented migration was proportional to the mean cell locomotion speed during the experiments. PBZ inhibited both the oriented migration and locomotion speed induced by 10(-7) M FMLP, but did not affect its chemotactic activity. At concentrations of 10(-6) and 10(-5) M, PBZ increased oriented migration and locomotion speed, again without influencing FMLP chemotactic activity. Oriented migration induced by zymosan-activated serum was not affected by PBZ but the migration induced by Klebsiella pneumoniae culture supernatant diminished slightly. These results demonstrate that PBZ modulates the chemokinetic effect of FMLP on PMNs and thus alters oriented PMN migration.     

Immunofluorescence serology. A tool for prognosis of Q-fever

The indirect immunofluorescence antibody test is currently the method of choice for Q-fever laboratory diagnosis. It permits the detection of IgG-, IgM-, and IgA-specific antibodies against the two phases of Coxiella burnetii. Sera from 20 cases of C. burnetii infection have been examined. Only total IgG against phase II were detected in cryptic infections. In acute Q-fever cases, the appearance of total IgG antibodies against phase I was a sign of aggravation, while IgM titers remained low. In subacute cases of Q-fever, anti-phase-I IgG titers were equal to or higher than anti-phase-II titers, and IgM against both phases were produced over a long time. Particularly high IgM titers were found in cases of granulomatous hepatitis. IgA antibodies against phase I were found in cases of Q-fever endocarditis, although the two cases that died had few or no IgA antibodies, despite very high IgG and IgM titers.     

Electromyographic recording and muscle biopsy in lepromatous leprosy

The aim of this study was to detect early muscular changes in lepromatous leprosy using simultaneously electromyography and muscle biopsy. In 13 subjects a single clinically normal muscle innervated by the popliteal nerve was studied. Three were found to be normal. All the others were electromyographically denervated. Histopathologic findings included only 3 cases of fascicular atrophy. In 8 cases inflammatory nodules were observed in the connective tissue of the muscle and acid-fast bacilli were present in Virchow cells in 5. In only one patient were intact acid-fast bacilli found in muscle cells. It was concluded that electromyography was the better method of detecting early denervation, while muscle biopsy was the better examination to detect “lepromatous myositis”. In practice these techniques are complementary in the study of muscle data in lepromatous leprosy.     

Transient ST segment elevation occurring without anginal pain. Correlations with Prinzmetal's angina.

Two cases presenting with episodes of marked ST segment elevation occurring with, but most often without, anginal pain are reported. The changes were recorded through continuous ECG monitoring during Prinzmetal's angina and in the course of myocardial infarction. Such transient asymptomatic ECG abnormalities reveal silent acute myocardial ischemia and are often unrecognized. However, they may lead to severe arrhythmias or myocardial infarction, and sudden deaths occurring in the course of ischemic heart disease are likely to be explained on this basis. Transient episodes of silent ST segment elevation similar to those occurring in Prinztal's angina have been reported in various circumstances. They bring into discussion the delimitations of variant angina pectoris.     

Rapid and high production of precipitating antibodies in rats.

Rats were inoculated into the foot-pads with 0.2–1 mg antigen mixed with complete Freund's adjuvant or Bordetella pertussis. When DNP-protein conjugates or heterologous immunoglobulins were used as antigen, serum concentrations of 1–2 mg antibody per ml were usually obtained after 11 days. After a booster injection, made in the same way, a few weeks later, much higher titres were frequently observed with most antigens. With microgram doses of antigen, good precipitating antibody production was observed only after booster injections.