Juvenile dermatitis herpetiformis and chronic acquired bullous disease in children

Eight children with chronic acquired bullous disease were studied by direct immunofluorescence. Multiple jejunal biopsies were examined as well as tissue antigens (HLA-andthcDRw₃ B cell allo-antigen). Juvenile dermatitis herpetiformis (JDH) was diagnosed in seven patients and chronic bullous disease of childhood (CBDC) in one. The use of these different laboratory techniques may make it possible to differentiate more clearly between the different chronic acquired bullous diseases seen in childhood.     

Cardiac index in ambulatory patients estimated by precordial dilution curves

1. 1. Four hundred and twenty-nine radiocardiograms were obtained in 240 ambulatory patients with and without heart disease by means of wide angle external counting over the precordium after the injection of radioactive iodinated human serum albumin into an antecubital vein. Cardiac index was calculated from the radiocardiogram and the blood volume. Only seven patients were encountered in whom a tracing adequate for calculation of cardiac index was not obtained.

2. 2. A mean cardiac index of 3.51 L. per minute per square meter surface area with a standard deviation of 0.97 was derived from forty-eight persons without known cardiac or vascular disease. Cardiac indices were slightly but significantly lower when derived from radiocardiograms taken twenty minutes after the initial tests. By contrast, cardiac indices did not differ significantly when calculated from tracings made weeks to months apart in patients with stable cardiovascular systems.

3. 3. A significant decrease in cardiac index was observed in patients with all types of heart disease who had congestive heart failure, whether overt or controlled.

4. 4. In the absence of congestive heart failure, mean cardiac index was increased in patients with borderline hypertension, normal in those with systolic hypertension, and frequently reduced in those with sustained diastolic hypertension, especially when evidence of myocardial involvement also was present.

5. 5. Cardiac index was usually normal in patients with coronary artery disease in the absence of congestive heart failure. Occasional reduction was seen in patients with old myocardial infarctions.

6. 6. A probably significant decrease of cardiac index as measured by the external counting technic was observed in patients with valvular heart disease without congestive heart failure. Also, cardiac index in congestive heart failure due to valvular heart disease was lower than that due to other types of heart disease. Valvular insufficiency apparently leads to erroneously low values of cardiac index estimated by the external counting technic.

7. 7. Classification of radiocardiograms according to qualitative features showed some correlation with cardiovascular status. Prominent fluctuations on the downslope were recognized most often in radiocardiograms of patients with valvular insufficiency. The appearance of the radiocardiogram maintained a constancy over considerable periods of time in the absence of marked change in cardiovascular status.

     

Measurement of plasminogen activator inhibitor 1 in biologic fluids with a murine monoclonal antibody-based enzyme-linked immunosorbent assay

An enzyme-linked immunosorbent assay for plasminogen activator inhibitor-1 (PAI-1) in biologic fluids was developed on the basis of two murine monoclonal antibodies raised against PAI-1 purified from HT- 1080 fibrosarcoma cells. The lower limit of sensitivity of the assay in plasma is 2 ng/mL. The assay is 12 times less sensitive toward the PAI- 1/human tissue-type plasminogen activator (t-PA) complex as compared with free PAI-1. The intraassay, interassay, and interdilution coefficients of variation are 5.2%, 8.0%, and 7.1%, respectively. The level of PAI-1 in platelet-poor plasma of healthy subjects is 18 +/- 10 ng/mL (mean +/- SD, n = 45). In platelet-rich plasma after freezing and thawing, 92% of PAI-1 antigen is released from platelets, whereas only 8% is found in the corresponding platelet-poor plasma. In platelet-poor plasma from healthy subjects, a linear correlation (r = 0.80) was found between PAI activity and PAI-1 antigen. In plasma approximately two thirds of the PAI-1 antigen was functionally active, whereas only 5% of the PAI-1 antigen released from platelets was active. During pregnancy a progressive increase of PAI-1 antigen levels up to three- to sixfold the control value was observed. In plasma of patients with recurrent deep vein thrombosis, PAI-1 levels were 44 +/- 20 ng/mL (mean +/- SD, n = 7), during a clinically silent phase. Four of these patients had a level above 38 ng/mL (mean +/- 2 SD of normal). The present assay, based on stable and reproducible reagents, allows the specific determination of PAI-1 antigen in biologic fluids. It may facilitate interlaboratory comparisons and be useful for further investigations of the role of PAI-1 in clinical conditions associated with impaired fibrinolysis and/or a tendency to thrombosis and investigations of the role of PAI-1 in platelets.