Distribution of HLA antigens in patients with hypertension

An immunogenetic study of 71 patients with essential hypertension associated with no signs of heart or renal failure, and 276 normal Russian male residents of Moscow demonstrated a significantly increased frequency of antigens HLA-B13 (p less than 0.01) and HLA-B22 (p less than 0.05), as well as HLA-A11 (p less than 0.05), in the hypertensive sample. Aggravated heredity (familial hypertension) was established in 64% of hypertensive carriers of antigens HLA-B13 and HLA-B22.     

Humoral and cellular immunity in meningitis of various etiology

The parameters of humoral and cellular immunity were studied in patients with meningitis due to tuberculosis and other diseases. Peripheral blood and spinal fluid were measured in 91 and 76 patients with tuberculous meningitis, in 75 and 59 with purulent meningitis, and in 54 and 33 with serous meningitis, respectively. Comparing assessment of the findings revealed profound changes in the content of T lymphocytes and their subpopulations. With this, impaired cellular immunity appeared not only as changes in the relative count of immuno-complement cells, but in their different functional activity detectable by blast cell formation. Thus, in tuberculous meningitis, 18.11 +/- 0.95% of peripheral lymphocytes and 15.1 +/- 1.2% spinal fluid were exposed to the specific blast cell transformation antigen PPD whereas they were 1.94 +/- 0.3 and 2.4 +/- 0.9% (p < 0.001) and 1.86 +/- 0.28 and 3.1 +/- 0.8% (p < 0.001), respectively. Elevated spinal fluid levels of beta 2-microglobulin and IgE in patients are shown to be a differential diagnostic sign typical of tuberculous meningitis.     

HLA antigens and atopy in children with coeliac disease

HLA antigens and various aspects of atopy were studied in 42 Finnish children and adolescents with coeliac disease, and the results were compared with findings of recent population studies. The HLA associations were as expected: relative risks for coeliac disease in individuals with HLA-B8, DR3, and DR7 were 8 . 0, 18 . 6, and 15 . 0, respectively. Children with coeliac disease were significantly more often atopic than unselected schoolchildren. Atopy was significantly more frequent and the onset of coeliac disease later for B8/DR3- patients than B8/DR3+ patients. There was no obvious relation between DR7 and atopy. It is concluded that atopy predisposes to coeliac disease partly independently of the HLA-DR3 associated disease susceptibility gene(s), and that different mechanisms may operate in the pathogenesis in coeliac disease patients with and without atopy.     

Distribution of HLA antigens in ischemic heart disease patients with stenocardia

HLA antigens were typed by A, B, and C loci in 162 male residents of Moscow with coronary heart disease (CHD) and angina pectoris, aged 27 to 69 years. Coronary patients showed significantly increased incidence of HLA antigens B13, B15, B17, B22 and Cw3, as compared to control population samples. The rates of some histocompatibility antigens carriage were different in different patients, showing a dependence on the duration of disease, the hyperlipoproteinemic type, serum apoprotein level and some clinical characteristics (the severity of CHD, the number of affected coronary arteries).     

HLA antigens in patients with various courses after hepatitis B virus infection

The course after hepatitis B virus infection seems to be determined by the host's immune response, which in turn may be regulated by the major histocompatibility complex. In order to find a possible relationship between the course of disease and the phenotype frequency of HLA determinants, we studied 396 Dutch subjects of northern European local race. Six groups of individuals with various courses after hepatitis B virus infection were compared to healthy controls. The hepatitis B patients were grouped according to standard criteria: 47 had recovered from acute symptomatic hepatitis B virus infection; 60 had recovered from asymptomatic hepatitis B virus infection; 26 were asymptomatic hepatitis B surface antigen carriers; 16 had chronic persistent hepatitis B; 37 had chronic active hepatitis B, and 10 had chronic active hepatitis after elimination of hepatitis B antigens. Twenty-nine Class I and 13 Class II HLA antigens were assayed by standard microlymphocytotoxicity tests. The phenotype frequency of the Class II antigen DQw1 appeared to be significantly lower in patients with chronic active hepatitis B virus infection. Some other HLA specificities showed deviations from control values, but they were not statistically significant after correction for the number of antigens tested. In conclusion, we have found no evidence that the elimination of hepatitis B virus is related to HLA phenotype. DQw1, however, may affect the morphologic type of chronic hepatitis B infection, since its presence may protect against chronic active hepatitis.     

Tuberculous meningitis in children]

Tuberculous meningitis in children is a rare disease and develops in the absence of the current complex of measures aimed at tuberculosis prophylaxis. In 62.7% of children the disease had a gradual course beginning with a prodromal period with infectious-toxic symptoms being predominant over meningeal and encephalitic ones. Basal localization of the process with cranial nerves involvement was diagnosed in 59% of patients. In 31.8% of children the disease took the course of diffuse meningoencephalitis, 9% has signs of leptomeningitis combined with thromboarteritis of the middle cerebral artery. In 63% of patients the course of meningitis proceeded as a progressive undetected and untreated tuberculosis. Five years later 18% of children died and 9% had nervous system affection.     

HLA antigens in patients with osteoarticular tuberculosis with different disease course]

Examination included 93 Uzbek patients with osteoarticular tuberculosis: 37 had localized and 56 disseminated tuberculosis process. All the patients were typified according to the HLA antigen locuses-A, B, C and DR by the standardized microlymphocytotoxic test. As a control, 135 healthy Uzbeks were typified by antigens of the same HLA locuses (105 subjects were typified by antigens of the HLA-DR locus). The patients with osteoarticular tuberculosis were found to have genetically controlled susceptibility to tuberculosis infection. The frequency of HLA, B7, B27 and DR2 antigens occurrence in tuberculosis patients is increased as compared to that in healthy subjects. In patients with a disseminated tuberculosis process, the frequency of HLA-Cw4 and HLA-DR4 antigens was increased to 33.9% and 44.6%, respectively, as compared to that in patients with a localized process (5.4% and 21.6%, respectively).     

Pancreatic insufficiency in chronic pancreatitis of various etiology]

The goal of this study was to examine the severity of exocrinous and endocrinous pancreatic incompetence, composition of bile acids (BA) and hemostasis state depending on the etiologic form of chronic pancreatitis (CP). The study comprised 76 patients with CP at the age of 33-74 (46 females and 30 males), 20 of them having alcoholic pancreatitis (AP), 26 --biliary pancreatitis (BP), and 30--involutional pancreatitis (IP); 15 people (without any signs of gastrointestinal tract lesions) made up the control group. CP was diagnosed based on clinical data, laboratory and instrumental assessments. Various degrees of severity of exocrinous and endocrinous pancreatic incompetence were revealed depending on the CP etiology. AP patients had more marked alterations of this type depending on the severity and presence of complications. The study revealed changes in the quantitative and qualitative BA composition, which can cause reduced absorption of exogenous cholesterol in the CP patients' bowels and be one of the reasons affecting the exocrinous function of the pancreas. IP patients had more marked alterations of this type. All CP patients had blood hypercoagulation accompanied by a reduction of the public constant of blood coagulation, increase of the coagulation index and clot elasticity. Patients with the complicated course of the disease had more marked alteration of this type.     

Association of different HLA antigens with various toxic effects of gold salts in rheumatoid arthritis.

An association of gold induced proteinuria with HLA-D(R)3 has been reported. To investigate other possible relationships between gold toxicity and HLA antigens we studied 85 patients with rheumatoid arthritis (RA) divided into four subgroups: patients with gold induced interstitial pneumonitis, mucocutaneous lesions, proteinuria, and patients without gold toxicity. The HLA frequencies in patient groups and 283 healthy controls were compared in different pairwise combinations. Gold induced pneumonitis was associated with HLA-B40 and Dw1. An association between gold induced proteinuria and HLA-Dw3 was also seen. The increased prevalence of Dw4 in RA was observed only in the control patient group without gold induced side effects. The frequencies of HLA-B7 and Dw2 were decreased in all patient groups compared with the control population. These results further support the view of the heterogeneity of RA as manifested by the unique HLA associations with resistance and susceptibility to gold induced side effects characterising different subgroups.     

Distribution of HLA histocompatibility antigens, ABO blood groups and Rh antigens in alcoholic liver disease.

The distribution of 16 antigens of the HLA-A and 15 antigens of the HLA-B series of HLA system, the blood groups ABO, and Rh antigens were studied in 40 alcoholics with cirrhosis, 18 alcoholics without cirrhosis, and in normal control subjects. The group of alcoholics with cirrhosis showed a significantly high frequency of HLA-B13 (corrected P less than 0.01) when compared with normal subjects, while the frequency of HLA-B13 was similar to normal in alcoholics without cirrhosis. On the basis of these findings, its seems that the carriers of HLA-B13 are more susceptible to liver damage caused by alcohol. Both groups of alcoholics and the normal controls had a similar distribution of ABO blood groups and Rh antigens.     

Vasorenal hypertension in children and adolescents]

From among child-patients examined by the authors 41 were found to suffer from hypertension of vaso-renal genesis (58.5%). Major diagnostic tests were: functional intravenous urography, radioisotope renography, scintigraphy, angiography of the kidneys and also determination of the renin activity in the venous renal blood. The sole effective method of treating patients with vaso-renal hypertension is surgery.     

Metabolic acidosis in chronic renal insufficiency of various etiology]

The renal acidosis may appear by a decrease of the number of nephrons able to function (decrease of the filtrate of the glomerulum) as well as by a selective alteration of the tubular acidification mechanism. In 66 patients with chronic renal insufficiency of different degrees of severity (32 patients with diabetic glomerulosclerosis, 18 patients with chronic glomerulonephritis and 16 patients with chronic pyelonephritis) studies of the parameters of the acid-base-state and the renal insufficiency were carried out. 53 of these patients had a pathologically changed acid-base-state which was most expressed in patients with chronic pyelonephritis. A characteristic relation between the renal function (creatinine clearance) and the change of the pH-values was observed. The regression curve of the pH-values was descending so that in clearance values below 25 ml/min in nearly all patients a pronounced acidosis was present. This could be proved in the patients with pyelonephritis already when higher clearance values were present. The forms of the development of the metabolic acidosis in chronic renal insufficiency are discussed.     

Hemodynamics changes in children and adolescents with mitral valve replacement]

The authors analyze the pre and post-operative hemodynamic picture of 30 children and adolescents with mitral valve replacement, which corresponds to a group of 106 patients operated on from 1964 to 1974. At variable time periods, between 9 days and 48 months (average 28 months) from the valve replacement, a new catheterization was done. The majority of the studies were done in the period between 13 and 36 months. Of the 30 cases, 21 were carriers of the Starr-Edwards valve, and the rest of different types. The Starr-Edwards valves produced a lawering of the CVP from 23.0 to 11.0 mm. Hg (average values) whereas with the other types the average pre-operative figure was 21.0 and in the post-operative period it fell to 11.0 mm. Hg. In the group with SE valves, pre-operative SPP was an average of 64.3 and in the post-operative period it was 32.0 mm. Hg. In the cases of SE valves the pre-operative total pulmonary resistances were 12.3 units and post-operatively they fell to 3.7 units. With the other types of valves the pre-opeative average was 10.9 units and post-operatively it was 5.3 units. The hemodynamic results obtained over a period of time with valvular substitution were similar in the distinct types of valves. However in the SE the benefits resulted more constant. The value of radiological and electrocardiographic study in order to predict the early post-operative hemodynamic changes is discussed. These studies serve essentially for a long range evaluation, whereas the hemodynamic, and clinical improvement maintained a strict relationship. This work shows that, in children and adolescents, the presence of severe venous-capillary and arterial pulmonary hypertension, and the elevated pulmonary resistences, are not contraindications for surgical treatment. It equally proves the eficacy of the valvular replacement, when the surgical indication and the control of the patients are handled in the proper way.