Asymptomatic oligoclonal CSF IgG and progressive increase of intrathecal IgG synthesis in a patient with myasthenia gravis treated with thymectomy--a 4-years follow-up

A young woman is described who had myasthenia gravis which was favourably influenced by thymectomy. Although there was no evidence for another neurological disease over 7.5 years of clinical observation and computed tomography as well as visual evoked response were normal, CSF studies over 0.5 years prior to and 3.5 years after thymectomy revealed persistent mononuclear pleocytosis, high CSF IgG index, oligoclonal IgG bands in CSF, and increasing IgG synthesis rate within the CNS, reflecting a continuous local humoral immune response. CSF/serum ratios of antibodies to acetylcholine receptors (AChR) were continuously lower than CSF/serum IgG ratios, contradicting intrathecal AChR antibody production. Proportion of total T cells was slightly higher in CSF than peripheral blood, while active T cells were lower in CSF. CSF lymphocytes did not proliferate on PHA stimulation but responded in allogeneic mixed lymphocyte culture. B cells were 4% in CSF and 4.5% in peripheral blood, but 227 IgG, 0 IgA and 0 IgM producing cells were detected among 20 X 10(3) CSF lymphocytes, compared to 5, 4 and 0 in 20 X 10(3) peripheral blood lymphocytes. This patient represents an in vivo 'experiment' regarding influence of thymectomy on CSF compartment constituents. The present study also shows that an individual can be clinically healthy despite continuous and pronounced intrathecal immune response.     

Effectiveness and nutritional consequences of amino acid-based vs glucose-based dialysis solutions in infants and children receiving CAPD

Excessive glucose absorption and dialysate amino acid and protein losses contribute to malnutrition in children on glucose-based continuous ambulatory peritoneal dialysis (CAPD). We used 2.5 and 4.25% glucose and 1.1 and 2.0% amino acid dialysates to assess short-term effectiveness and nutritional consequences of amino acid-based dialysis solutions. Plasma and effluent urea and creatinine concentrations were similar with amino acid and glucose dialysis although 16% less fluid was removed with amino acid dialysates. Absorption of 77.3 +/- 5.3% of dialysate amino acids exceeded losses of amino acids and protein in glucose effluent. With amino acid dialysates, fasting plasma glucose concentrations were maintained while plasma amino acid levels rose, peaked at 1 h, and, excepting methionine, isoleucine, and phenylalanine with the 2.0% solution, returned to initial levels after 5 h. Compared with glucose, amino acid dialysates provide reduced but satisfactory fluid and waste removal, maintain normoglycemia, and more than compensate for effluent losses of amino acids and protein.     

Computed tomography of acute radiation nephritis

A patient with Hodgkin’s disease received a fractionated 3, 740 rad dosage over 4 weeks to a portal that included both kidneys. Three months later a computed tomographic scan obtained 2 hours after intravenous contrast injection demonstrated sharply demarcated, dense, persistent nephrograms corresponding to the irradiated areas. These changes are ascribed to acute radiation nephritis, reflecting tubular stasis and ischemia.     

Elevated levels of free putrescine and N1-acetylspermidine in cyst fluids of malignant brain tumours.

The contents of free and conjugated polyamines in cyst fluids of brain tumours were analysed. The putrescine and N1-acetylspermidine levels in cyst fluids of malignant brain tumours were significantly higher than those of benign tumours. The free spermidine levels in malignant and benign tumours were about the same, while the total spermidine levels were higher in malignant than those in benign tumours. These results suggest that polyamine levels in cyst fluids reflect the altered polyamine metabolism in brain tumours.