Cell Mediated Lympholysis in Man. Patterns of Killing Power in Relation to the HL-A System

In general it can be said that the HL-A ( LA and FOUR) antigens seem to be of major qualitative and partly quantitative importance for the degree of destruction in Cell Mediated Lymphoiysis (CML).
This has been established by analyses of 1299 effector/target combinations involving 97 different healthy individuals.
The main observation is that the cytolytic capacity of MLC effectors is positively ranked with the number of HL-A ( LA and FOUR) antigens introduced by the incompatibility between stimulator, effector and target lymphocytes. However, the fact that not all cytolytic situations can be explained by the HL-A system stresses that other specific antigens ( Target Determinants ) may interfere with the Cell Mediated Lympholysis.     

INCREASED EXPRESSION OF IL-15 IN THE SYNOVIUM OF PATIENTS WITH RHEUMATOID ARTHRITIS COMPARED WITH PATIENTS WITH YERSINIA-INDUCED ARTHRITIS AND OSTEOARTHRITIS

Recently, a new player in the cytokine network has been described that is produced by monocytes and can be detected in the rheumatoid synovium: interleukin-15 (IL-15). Since this cytokine may play a role in the accumulation and activation of T-cells, B-cells, and natural killer (NK) cells characteristic of synovial tissue (ST) from patients with rheumatoid arthritis (RA), the expression of IL-15 was studied in ST from RA patients in comparison with ST from patients with reactive arthritis (ReA) and osteoarthritis (OA) and the phenotype of IL-15-positive cells was determined. IL-15 expression was investigated by immunohistochemical analysis of ST from ten patients with RA, ten patients with Yersinia enterocolitica-induced ReA, and nine patients with OA. The immunohistological findings were quantified and the results obtained in the different patient groups were compared. To determine the phenotype of IL-15-expressing cells, double-labelling immunofluorescence was performed. The expression of IL-15 was significantly higher in ST from patients with RA than in ST from patients with ReA or OA. In double-label experiments, co-expression was observed with markers for macrophages, T-cells, and NK cells. The composition of the cellular infiltrate in the synovium of patients with RA might be partly explained by the specific increase in expression of IL-15 in rheumatoid ST. It can be speculated that IL-15 production by inflammatory cells other than macrophages may occur in the rheumatoid synovium. © 1997 by John Wiley & Sons, Ltd.     

THREE CASES OF PEMPHIGUS VEGETANS: INDUCTION BY ENALAPRIL—ASSOCIATION WITH INTERNAL MALIGNANCY

Background. Pemphigus vegetans, a rare form of pemphigus vulgaris, consists of vegetating plaques localized to flexural areas. Two types, the Neumann and the Hallopeau type, are recognized with their own characteristics. Methods. Three patients with pemphigus vegetans were examined, two with Hallopeau type and one with Neumann type. The microscopic and immunofluorescence findings were recorded. Results. Two remarkable features were present. In one case pemphigus vegetans was possibly induced by the use of enalapril. Only in three previous cases has enalapril been described in relation to pemphigus. A second case was associated with a malignant lung tumor, a phenomenon which could not be traced in the literature. Conclusions. Two types of pemphigus vegetans must be distinguished. Induction of pemphigus (also vegetans) is an accepted side effect of captopril. The effect of enalapril on pemphigus is still in debate. To the best of our knowledge, this is the first time that a patient with pemphigus vegetans and a simultaneously occurring internal malignancy is described.     

Testosterone in Chronic Alcoholic Men

Reduced testosterone levels in chronic alcoholic men may be associated with the age, alcohol consumption history, severity of liver injury, and nutritional status of these patients. In this study, total testosterone levels were measured in 163 alcoholic men upon admission to an alcohol treatment program (ATP) and at 3 months follow-up. Values of testosterone below the clinical normal range were found in over 17% of the subjects, a finding significantly predicted by age, alcohol consumption and liver injury tests. Follow-up at 3 months further demonstrated that abnormally low testosterone values significantly increased in men who remained abstinent as compared to those who continued to drink.     

COMPARISON OF THE NEUROMUSCULAR BLOCK INDUCED BY MIVACURIUM, SUXAMETHONIUM OR ATRACURIUM DURING NITROUS OXIDE-FENTANYL ANAESTHESIA

We compared the neuromuscular and cardiovascular changes followingadministration of mivacurium 0.15, 0.20 and 0.25 mg kg^–1,suxamethonium 1.0 mg kg^–1 or atracurium 0.5 mg kg^–1i.v. in 41 (ASA physical status I or II) patients during nitrousoxide—fentanyl anaesthesia. Mean onset times for totalablation of twitch response for mivacurium 0.15, 0.20 and 0.25mg kg^–1, were 2.5, 2.4 and 2.7 min, respectively, similarto that for atracurium (2.5 min), but longer than for suxamethonium(1.1 min) (P < 0.05). Mean times from administration of druguntil twitch response recovered to 10% of control were shorterfor each dose of mivacurium (15.6, 18.0 and 20.6 min, respectively)than for atracurium (40.0 min) and longer than for suxamethonium(7.7 min) (P < 0.05). Mean infusion rate required to maintaintwitch response at 5±4% control was 6.7 µg kg^–1min^–1 for mivacurium and 6.3 µg kg^–1 min^–1for atracurium. Following neostigmine 0.045 mg kg^–1, meantimes for twitch tension to recover from 10% to 90% of controlwere similar for mivacurium (9.7 min) and atracurium (10.5 min).Transient decreases in mean arterial pressure (> 20%) wereobserved in seven of 15 patients who received the two higherdoses of mivacurium. Presented in part at the Annual Scientific Meeting of the AmericanSociety of Anesthesiologists, San Francisco, October 1988.     

Differential Toxicity of 2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) in C57BL/6J Mice Congenic at the Ah Locus

Differential Toxicity of 2,3,7,8-Tetrachlorodibenzo-p-dioxin(TCDD) in C57BL/6J Mice Congenic at the Ah Locus. BIRNBAUM,L. S., MCDONALD, M. M., BLAIR, P.C., CLARK, A. M., AND HARRIS,M. W. (1990). Fundam. Appl. Toxicol 15, 186–200. The acutetoxicity of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) was examinedin male C57BL/6J mice differing only at the Ah locus. Wild typemice (Ah^b/b; "b/b") were treated once with 0, 50, 100, 200,300, and 400 eg TCDD/kg po while congenic mice (Ah^d/d; "d/d")received a single dose of 0, 400, 800, 1600,2400, and 3200µgTCDD/kg. Mice were checked daily, weighed twice a week, andthose that survived, killed 35 days post-treatment. The LD5Ovalues were 159 and 3351 µg/kg for b/b and d/d mice, respectively.Mean time to death was 22 days and was independent of dose andgenotype. Decrease in body weight gain was noted in both strains5 days after treatment and occurred at doses 100 µ/kgin b/b mice and 1600 µg/kg in d/d mice. Dose-related increasesin liver weight (both absolute and relative to body weight)and decreases in thymus, spleen, testes, and epididymal fatpad weights were observed at 8–24–fold higher dosesin d/d than in b/b mice. A dose-related increase in segmentedneutrophils was observed in both strains. Serum chemistry valuesindicated that 8–24x greater doses of TCDD were neededto elevate sorbitol dehydrogenase, alanine aminotransferase,and 5'-nucleotidase and to decrease total and esterifled cholesterolin d/d than in b/b mice. Few effects were seen on total bileacids, serum triglycerides, glucose, or nonesterifled cholesterol.In the liver, hepatocellular cytomegaly, fatty change, and bileduct hyperplasia occurred in both strains in a dose-relatedmanner, as did thymic and splenic atrophy. Necrosis of germinalepithelium in the testes and edema in the stomach submu cosaoccurred at acutely toxic doses. These lesions also occurredat doses 8–24x greater in did than in b/b mice. Thus,the spectrum of toxicity is independent of the allele at theAh locus, but the relative dose needed to bring about variousacute responses is approximately 8–24x greater in congenicmice homozygous for the "d" allele than for the wild type animalscarrying two copies of the "b" gene.     

Subcutaneous Implantable Cardioverter Defibrillator Lead Failure due to Twiddler Syndrome

We present a case of Twiddler syndrome in a patient with a subcutaneous implantable cardioverter defibrillator (S‐ICD). The patient presented herself to the outpatient clinic with pain in the left chest. Chest x‐ray confirmed Twiddler syndrome and ICD read‐out revealed lead failure resulting in absent heart rhythm sensing in one vector. The lead and pulse generator were extracted and a new S‐ICD system was reimplanted submuscular underneath the serratus anterior muscle to prevent reoccurrence. Lead investigation revealed an insulation defect caused by excessive mechanical stress.