Ex vivo removal of IgE in atopic asthma by extracorporeal plasmoimmunoadsorption (EPIA): development of a clinical adsorbent

We have developed an immunoadsorbent (IA) for ex vivo removal of IgE after in vitro screening of matrix (Sepharose and tresyl-activated Toyopearl) and ligand (monospecific rabbit polyclonal anti-IgE antiserum and monoclonal antibodies (Abs) or their Fab fragments). Specific adsorptive capacity (SAC) for IgE was maximal in Sepharose-based IA with both types of Abs. Fab-containing IA on Sepharose retained 70-90% of the SAC of native Ab-containing IA. Toyopearl-based IA showed comparable SAC under static conditions but worked unsatisfactorily under continuous flow conditions. To assess the complement-activating capacity (CAC) of IA in vitro anaphylatoxin (C3a, C4a, C5a) generation was applied. CAC was directly related with the amount of immobilized Ab ligand, without depending on Ab specific activity. Fab-containing IA showed more CAC than native Ab-containing IA, and polyclonal IA more than monoclonal IA. Therefore, IA for IgE apheresis were prepared from native monoclonal Abs and CNBr-activated Sepharose CL 4B under aseptic conditions and packed into a glass column. This IA was used in 17 clinical IgE apheresis treatments of five atopic asthma patients. No substantial side effects were observed; in vivo IA effectively removed IgE from plasma (83 to 98%).     

The resistance of cutaneous feline polymodal C-fiber units to tetrodotoxin as revealed by mechanical and thermal stimulation

Mechanical and thermal excitability of cutaneous feline polymodal C-fiber units is maintained under the action of subcutaneous tetrodotoxin injected in concentrations suppressing the mechanosensitivy of A_β-units. A number of features of inhibition and excitation of C-fiber polymodal sensory units can be explained by existence of tetrodotoxinresistant Na channels in their termination. Translated fromByulleten' Eksperimental'noi Biologii i Meditsiny, Vol. 124, No. 10, pp. 369–371, October, 1997     

CHILDREN'S CONSENT TO PSYCHIATRIC TREATMENT: ALL OR NOTHING?

An adolescent with a history of attempted suicide who refused to involve his father in the treatment plan is presented. Issues surrounding consent to psychiatric treatment in childhood are discussed and the assessment process outlined. Contributions by primary healthcare professionals are emphasised.     

Retrograde cardioplegia through the right atrium

The results of retrograde cardioplegia through the right atrium in 50 patients are analysed. The uniform cooling of the myocardium, frequent restoration of the sinus rhythm, and the low hospital mortality rate are evidence of the high efficacy of this method of myocardial protection. Electronmicroscopy showed marked intactness of the myocardial ultrastructure and moderately manifested and reparable reperfusion changes. It is concluded that the method must be employed in coronary disease, combination of ischemic heart disease with heart valvular disease, as well as in mild forms of aortic insufficiency which cannot be corrected.     

The incidence of myopia in the children of myopic parents and the outlook for the primary prevention of this type of refraction

The paper analyses results after investigation of free selection of families, parents myopia selected by signs and a definite minimum age of their first-order offsprings, including 108 matrimonial couples with the total number of 209 children. It was found that myopia is a hereditary sign manifesting itself in children at the age above 15 years and more in 90% of families of the first-order offsprings of the couples in whom one of the parents has this kind of refraction, and in 100% of families in whom both parents suffer from this kind of refraction. The incidence of myopic children in families in whom one or both parents have myopia ranges from 68% to 86%, and depends on the type of refraction.     

Traumatic rupture of the corpus cavernosum: evaluation and management

Rupture of the corpus cavernosum is a rare but probably under-reported entity. It truly represents a urological emergency and current recommendations are for early surgical intervention. We review 5 cases with evaluation, treatment and followup. Delays in treatment lead to long-term complications, such as erectile dysfunction and penile curvature.     

Arteriovenous fistula in the reconstructive surgery of the femoral-popliteal-tibial segments

Reconstructive operations were carried out in 75 patients with occlusive lesions of the femoropopliteal-tibial segment and poor condition of the outflow tract. In group I consisting of 35 patients, a typical autovenous shunt was formed. A similar operation was conducted in 40 patients of group II with additional creation of an arteriovenous fistula. A method for creation of the fistula suggested by the author is described. Regional hemodynamics was studied in both groups of patients by arteriography, ultrasonic and electromagnetic flow measurement. The positive role of the fistula in increasing the volumetric rate of blood flow in the shunt is shown. The immediate and late-term postoperative results are discussed. Three years later patency was maintained by 26.1% of shunts in group I and by 62.2% in group II.