Successful Treatment of a Therapy-Resistant Severely Pruritic Skin Eruption of Malignancy-Associated Dermatomyositis with High-Dose Intravenous Immunoglobulin

Malignancy-associated dermatomyositis developing in a middle-aged Japanese female was successfully treated by removal of her gastric cancer. However, five years later, concomitant with catching a cold, her severely pruritic skin lesions recurred on exposed areas. Six years after the start of corticosteroid therapy for her annoying skin lesion, we started to treat her with high-dose intravenous immunoglobulin (IVIG) infusion therapy because of the difficulty of reducing the dosage of oral prednisone, that had secondarily induced adverse effects. After five courses of the therapy, her recalcitrant, pruritic, erythematous skin lesions improved dramatically, enabling a satisfactory reduction in the dosage of oral prednisone. There were no significant adverse side effects with IVIG.     

Acute Unidentified Hepatitis in a Hypogammaglobulinaemic Patient on Intravenous Gammaglobulin Successfully Treated with Interferon

ABSTRACT. Lockner D, Bratt G, Lindborg A, TÖrnebohm E (Department of Internal Medicine, Section of Hematology and Oncology, Huddinge University Hospital and Karolinska Institute, Huddinge, Sweden). Acute unidentified hepatitis in a hypogammaglobulinaemic patient on intravenous gammaglobulin successfully treated with interferon. A 59-year-old male with acquired hypogammaglobulinaemia since 1978 developed a fulminant hepatitis. The hepatitis appeared after two years intravenous treatment with Sandoglobu-lin (Sandoz, Switzerland). No virus markers could be detected in the body fluids or liver tissue. Blood transfusions had not been given within one year before development of the liver disease. There was strong suspicion that the patient had acquired non-A non-B hepatitis from the gammaglobulin infusions. Treatment with alpha-interferon ran parallel to a normalization of the pathological liver enzymes and the histology of the liver. This observation suggests a direct antiviral effect of alpha-interferon, despite the anecdotical and non-controlled character of these data.     

Pooled Human Gammaglobulin Modulates Surface Molecule Expression and Induces Apoptosis in Human B Cells

We have previously shown that the pooled human gammaglobulin (IVIG) inhibited mixed lymphocyte reaction (MLR). In this study, we examined (1) if IVIG contains blocking antibodies reactive with cell surface molecules required for alloantigen recognition and (2) if IVIG modulates these surface molecule expressions using flow cytometry. IVIG does not contain significant amounts of blocking antibodies against CD3, CD4, CD8, CD20, CD14, CD40, MHC class I and class II. It reduces the number of intact B cells and monocytes, reduces or modulates CD19, CD20 and CD40 expression on B cells, and induces morphological changes in B cells. This B-cell modulation results primarily because of apoptosis. IVIG also induces apoptosis in T cells and monocytes, but to a lesser degree. Induction of apoptosis requires the intact IgG molecule. Reduction of intact B cell and monocyte cell numbers, modulation of surface molecule expression on B cells, and deletion of B and T cells by apoptosis could result in inhibition of optimal T-cell activation. This likely represents the primary mechanism responsible for IVIG suppression of the MLR, and may account for many of the observed beneficial effects of IVIG seen in the treatment of human autoimmune and alloimmune disorders.     

Monoclonal antibodies specific for kappa chain, lambda chain, and IgG1 of human gammaglobulin

Hybrid cell lines secreting antibodies specific for human gammaglobulin (HGG) were prepared by cell fusion and cloning techniques. The monoclonal antibodies were tested for their antibody reacts with a different antigenic determinant of HGG. One reacts with isolated kappa (kappa) light chains, one with isolated lambda (lambda) light chains, and one with the Fc fragment of IgG1 molecules. The reactivity patterns of two additional monoclonal antibodies are more complex. One reacts with a determinant present on the Fc of all IgG subclasses and the other binds to a determinant on the Fab of IgG molecules. The two monoclonal antibodies reactive with light chains also bind to surface components of human B cells. The murine immunoglobulin (Ig) class of each clone product was identified.     

自拟中药方治疗小儿支原体肺炎40例疗效观察

目的 观察中药治疗小儿支原体肺炎的临床疗效.方法 80例患儿随机分为治疗组和对照组,各40例,2组均采取口服阿奇霉素抗支原体感染,治疗组应用自拟中药汤剂治疗,对照组应用丙种球蛋白治疗.治疗14 d后复查胸片并统计疗效.结果 治疗组在退热时间、咳嗽消失时间、湿啰音及哮呜音消失时间方面均明显短于对照组(P＜0.05),2组总有效率比较,差异无统计意义(P＞0.05).结论 中药治疗小儿支原体肺炎疗效肯定,症状、体征改善较快.     

Reevaluation of the Efficacy of Intravenous Gammaglobulin in the Prevention and Treatment of Coronary Artery Lesion inKawasaki Disease

Kawasaki disease (KD) has received wide con-cernfor its liabilitytoinduce coronary arterylesion(CAL) . Clinical multi-center randomized resear-ches suggest that intravenous gammaglobulin(IVIG) can effectively prevent cardiovascular com-plications of KD[1]. But a number of patients de-veloped coronary artery dilation (CAD) or coro-nary artery aneurysm ( CAA) even after IVIGtreat ment with a varied incidence rate in differentreports . To evaluate the efficacy of IVIGin pre-vention and …     

Do the acute platelet responses of patients with immune thrombocytopenic purpura (ITP) to IV anti‐D and to IV gammaglobulin predict response to subsequent splenectomy?

The acute platelet response to Intravenous Gammaglobulin (IVIG) has been reported to predict response to subsequent splenectomy of patients with ITP. The current study was undertaken to determine if the platelet response to IV anti-D (Winrho-SDF) predicts response to subsequent splenectomy. The 61 HIV-uninfected children and adults in this study had taken part in the pre-licensing studies of IV anti-D and were all those who not only had evaluable platelet responses to IV anti-D but also had undergone splenectomy and had information available describing its 1-year outcome. Results of treatment with IVIG were available in 38 of these 61 patients. Neither response to the initial infusion of IV anti-D, nor response to the initial or last IVIG, predicted the response in either children or adults to subsequent splenectomy. However, response to the last anti-D infusion in adults was strongly correlated (P = 0.003) to response to subsequent splenectomy as was hemolysis >/=2.0 gm/dl after IV anti-D (P = 0.03). There was no overall relationship between response to IV anti-D or IVIG, and response to subsequent splenectomy. However, a good platelet response in adults to the last IV anti-D and a hemoglobin decrease >/=2.0 gm/dl both appeared to predict response to subsequent splenectomy.