Presence of immune complex-like material in sera of patients with paraproteinaemia.

Immunoglobulins of all classes as well as C3 are phagocytosed by normal human granulocytes from sera containing paraproteins. The material that was phagocytosed had the sedimentation properties of immune complexes. Cytostatic treatment did not seem to have a clearcut influence on the presence or absence of these complexes. There was little correlation with two other immune complex detecting tests. The Clq binding test was frequently found positive in paraproteinaemic sera but without apparent correlation to IgG phagocytosis. On the other hand the conglutinin binding test was rarely positive, although C3 was frequently phagocytosed.     

Autoantibodies against Tmu and B lymphocytes in patients with rheumatoid arthritis.

Patients with rheumatoid arthritis have decreased numbers of T mu lymphocytes in their peripheral blood. To find out whether these low number of T mu lymphocytes were associated with the presence of anti-lymphocyte antibodies, the sera of 27 patients with definite or classical rheumatoid arthritis (RA) were investigated for the presence of autoantibodies against subsets of lymphocytes. In addition the numbers of T, T mu, T gamma and B lymphocytes in the peripheral blood of these patients were investigated. Patients with active RA showed lower numbers of T mu lymphocytes in their peripheral blood than patients with inactive RA. However, both groups of RA patients had significantly decreased numbers of T mu lymphocytes in their peripheral blood as compared with 22 age matched healthy donors. Moreover, mainly in patients with active RA cold reactive antibodies were found directed against T mu and B lymphocytes, but never against T gamma lymphocytes of healthy donors. Similar results were found in the indirect immunofluorescence procedure when tested for reactivity against T-cell subsets. This serum reactivity was not caused by rheumatoid factors or antinuclear antibodies. Since RA sera after precipitation with 2.5% polyethyleneglycol, still showed cytotoxicity against T and B lymphocytes, it is suggested that this serum reactivity is not caused by immune complexes but by antibodies.     

Joint distraction in treatment of osteoarthritis: a two-year follow-up of the ankle.

OBJECTIVE: Osteoarthritis (OA) is a degenerative joint disease with an incidence exceeding 10% of the adult population. In end stages, OA can result in severe restriction of activity and consequent disability. For these severe cases of OA, no effective remedy is available yet. Joint distraction is a new experimental approach in treatment of OA. Studied in retrospect it appeared that this treatment results in prolonged clinical improvement in the case of ankle OA. Presently the results of a prospective two-year follow-up are given. METHODS: Patients with severe ankle OA, who were considered for joint fusion (arthrodesis), were treated with distraction, by use of an Ilizarov external ring fixator. Distraction was carried out for 3 months during which full weight bearing (walking) was allowed. Standardized clinical examination was conducted before and at yearly intervals after treatment, including physical examination, functional ability questionnaire, pain scale, joint mobility, and radiographic evaluation. RESULTS: More than two thirds of the patients improved significantly as shown by physical examination, functional ability questionnaires and pain scale; effects were progressive in the second year of follow-up. On average, joint mobility and radiographic joint space were preserved, whilst improvement was observed in a significant number of patients. DISCUSSION : Results of the present prospective study confirm the findings of the previous retrospective study and suggest that Ilizarov joint distraction is a promising treatment for severe ankle OA, at least delaying the need for a joint fusion. Considering the high prevalence of OA and the lack of a remedy for this disorder, Ilizarov joint distraction as a treatment for OA may have great medical, social and economic impact.     

Immature articular cartilage is more susceptible to blood‐induced damage than mature articular cartilage: An in vivo animal study

Objective

Cartilage of young but skeletally mature dogs is more susceptible to blood‐induced damage than that of old dogs. The aim of the present study was to investigate whether cartilage of skeletally immature individuals is even more adversely affected by exposure to blood than that of mature individuals, as suggested by clinical practice experience with humans.

Methods

Right knees of 3 groups of 6 beagle dogs (skeletally immature, young mature, and old animals) were injected with autologous blood on days 0 and 2. On day 4, cartilage matrix proteoglycan turnover (content, synthesis, and release), synovial inflammation, and cartilage‐destructive properties of the synovial tissue were determined and compared with those of the left uninjected control knees.

Results

Subsequent to intraarticular bleeding, cartilage proteoglycan content decreased in an age‐dependent manner, with the largest decrease occurring in cartilage of immature animals. Proteoglycan synthesis per cell also decreased in an age‐dependent manner, with the largest decrease occurring in the immature animals. Cartilage proteoglycan release increased in all 3 groups, but the decrease was not age dependent. Interestingly, immature animals showed a large increase in cartilage DNA content upon exposure to blood, whereas mature animals did not. Histologic analysis showed a mild synovitis in animals of all ages, but catabolic inflammatory activity was found only in immature animals.

Conclusion

Joints of skeletally immature dogs appeared to be more susceptible than joints of mature dogs to the adverse effects of a joint hemorrhage. These data suggest that for humans, specifically young children are at risk for joint damage after a joint hemorrhage.

     

Acute pancreatitis following adder bite in the UK: a case report

Adder bites are common in the UK usually manifesting with localised swelling and gastrointestinal symptoms. We report a rare case of acute pancreatitis secondary to an adder bite in Wales and highlight this serious complication which was managed with standard treatment.     

A prospective study of the factors shaping antibody responses to the AS03-adjuvanted influenza A/H1N1 vaccine in cancer outpatients

Purpose.

To identify the determinants of antibody responses to adjuvanted influenza A/H1N1/09 vaccines in a cohort of cancer outpatients.

Patients and Methods.

Patients with cancer and controls were enrolled in a prospective single-center field study. Two doses of AS03-adjuvanted pandemic influenza vaccine were administered to patients and one dose was administered to controls. Antibody responses were measured using hemagglutination inhibition and confirmed by microneutralization. Geometric mean titers (GMTs) and seroprotection rates (defined as GMTs ≥40) were compared.

Results.

Immunizations were safe and well tolerated in 197 cancer patients (lymphoma, 57; glioma, 26; lung or head and neck, 37; gastrointestinal, 41; breast, 36) and 138 controls. Similar seroprotection rates (82.3% versus 87%) and GMTs (336.9 versus 329.9) were achieved after two doses of adjuvanted vaccine in cancer patients and one dose in controls. Univariate analyses identified older age, prior immunization against seasonal influenza, lymphoma, CD4 count, active chemotherapy, and rituximab and steroid treatments as being associated with weaker antibody responses. However, only age and chemotherapy plus rituximab remained independent determinants of vaccine responses in multivariate analyses.

Conclusions.

Two doses of AS03-adjuvanted influenza vaccine elicited potent antibody responses in most cancer patients despite ongoing chemotherapy, with the exception of rituximab-induced B-cell depletion. Oncology patients treated in an outpatient setting benefit from preventive vaccination against influenza with adjuvanted vaccines.