IgM antibody response in acute hepatitis C viral infection.
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IgM antibody against hepatitis C virus (IgM anti-HCV) was measured in serial samples from 15 transfusion recipients in whom posttransfusion chronic non-A, non-B hepatitis (NANBH) developed and three plasmapheresis donors during acute HCV infection using recombinant proteins derived from three immunodominant regions: core, NS-3, and NS-4 (c100). IgM anti-HCV core was detected in 13 of 15 posttransfusion patients. Nine of these patients had transient, acute-phase IgM anti-HCV core detected coincidentally or earlier than active IgG anti-HCV core response. The average duration of IgM anti-HCV core reactivity was 8.1 +/- 3.7 weeks. One patient lacking an IgM anti-HCV core response had detectable IgM anti-HCV NS-3 during the acute phase. Passive transfer of IgM anti-HCV was not observed in these posttransfusion cases, in contrast to the high frequency observed for IgG anti-HCV. Late IgM anti-HCV was detectable against core, c100, and NS-3 in three, two, and one posttransfusion patients, respectively. These data indicate that IgM anti-HCV core is a useful acute-phase marker in HCV infection. (+info)
Systemic lupus erythematosus with sensorineural hearing loss and improvement after plasmapheresis using the double filtration method.
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A 32-year-old female was diagnosed as having systemic lupus erythematosus based on her laboratory tests. In 1985 she began to complain of hearing difficulty. Her hearing ability deteriorated to the extent that her audiogram revealed a hearing loss of 90 db to 110 db in both ears in September 1989. She received two series of plasmapheresis treatments using the double filtration method. After two series of plasmapheresis treatments, her hearing improved dramatically. This improvement suggests that circulating immune complexes and anti-phospholipid antibodies might play a pathological role in the hearing impairment in SLE patient. (+info)
Thrombotic thrombocytopenic purpura-like syndrome associated with systemic lupus erythematosus--combined treatment with plasmapheresis and fresh frozen plasma infusion.
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We report on a patient with systemic lupus erythematosus, who, during the course of the illness, developed thrombotic thrombocytopenic purpura. In this case, the coexistence of these two conditions was confirmed by laboratory and pathologic findings. The infusion of fresh frozen plasma with plasmapheresis reversed the course of thrombotic thrombocytopenic purpura. (+info)
Multiple myeloma complicated by congestive heart failure following first administration of recombinant alpha-interferon.
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A 59-year-old female was admitted to Tsukuba University Hospital and diagnosed as IgA-lambda multiple myeloma (stage IIIA). No cardiovascular disorder with the exception of minor ischemic changes in ECG was revealed before treatment. Recombinant human alpha-interferon (IFN) at a dose of 3 million units combined with melphalan and prednisolone was administrated. Sixteen hours after the first administration of IFN, IFN was suspended by the symptoms of congestive heart failure (CHF). Treatment with diuretics and catecholamine products showed almost complete recovery from CHF in 3 weeks. An adverse reaction to IFN was strongly suspected as the cause of CHF. (+info)
Plasmapheresis in radioimmunotherapy of micrometastases: a mathematical modeling and dosimetrical analysis.
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The feasibility of combining plasmapheresis with a large administration of radiolabeled antibody in order to overcome the "binding-site" barrier to antibody penetration in targeting hematologically distributed micrometastases is examined. In such a strategy, intravenous administration of excess radiolabeled antibody, to saturate antigen sites on the cell cluster periphery, is followed by removal of unbound antibody from the plasma, by plasmapheresis, to reduce the absorbed dose to the red marrow. Plasma antibody kinetics are simulated by a non-linear compartmental model representing free and antigen-bound antibody. This provides the boundary condition for a model of antibody diffusion, saturable binding to and dissociation from antigen sites within a 200 microns diameter cluster of tumor cells. Using these models, the absorbed dose to the red marrow and the absorbed dose profile across the cell cluster are calculated. Changes in marrow and cell cluster absorbed dose from alterations in the onset time and rate of plasmapheresis are illustrated for antibody labeled with 123I, 125I and 131I. The results demonstrate that the "binding site" barrier may be overcome, yielding a 2- to 100-fold improvement in the cell cluster absorbed dose for a given bone marrow absorbed dose. (+info)
Platelet-rich plasma: a promising innovation in dentistry.
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The goal of periodontal therapy is to protect and maintain the patient's natural dentition for his or her lifetime. More specifically, after periodontal regenerative surgery, the aim is to achieve complete wound healing and regeneration of the periodontal unit. A recent innovation in dentistry is the preparation and use of platelet-rich plasma (PRP), a concentrated suspension of the growth factors found in platelets. These growth factors are involved in wound healing and are postulated as promoters of tissue regeneration. This clinical update outlines the specific effects of these growth factors, both in vitro and in vivo, on periodontal wound healing. The review focuses on current animal and human trials using PRP to promote tissue regeneration and alveolar bone repair. The article goes on to describe the clinical benefits of PRP and the step-by-step preparation of PRP in the dental office. (+info)
Successful simultaneous pancreas kidney transplantation from living-related donor against positive cross-match.
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A positive pretransplant flow cytometry cross-match (FC-XM) allows precise identification of high-risk recipients vulnerable to hyperacute or accelerated rejection after transplantation. Living donor kidney transplant recipient candidates with positive cross-match have been successfully treated with a combination of plasmapheresis (therapeutic plasma exchange, TPEX) and intravenous immunoglobulin (IVIG), achieving conversion to negative cross-match and successful transplant. We report the first successful case of simultaneous pancreas kidney transplant (SPKT) from a living donor (LD) performed against an initially positive FC-XM, converted to negative using a protocol based on TPEX and IVIG in combination with antiCD20 monoclonal antibody. This strategy of overcoming the cross-match barriers in living donation may offer a chance of successful transplantation to highly sensitized candidates for SPKT, for whom cadaveric transplant is difficult to achieve. (+info)
Sudomotor function in familial dysautonomia.
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BACKGROUND: Patients with familial dysautonomia (FD) manifest episodic hyperhidrosis despite the reduction of sudomotor fibres and sweat glands associated with this autonomic neuropathy. We assessed peripheral sudomotor nerve fibre and sweat gland function to determine if this symptom was due to peripheral denervation hypersensitivity. METHODS: In 14 FD patients and 11 healthy controls, direct and axon reflex mediated sweat responses were determined by measuring transepidermal water loss (TEWL) after application of acetylcholine via a microdialysis membrane, a novel method to evaluate sudomotor function in neuropathy patients. Results were compared with data from conventional quantitative sudomotor axon reflex testing (QSART). Using microdialysis, interstitial fluid was analysed for plasma proteins to evaluate protein extravasation induced by acetylcholine as an additional parameter of C-fibre function. RESULTS: Although reduced axon reflex sweating was expected in FD patients, neither direct or axon reflex mediated sweat responses, nor acetylcholine induced protein extravasation differed between control and patient groups. However, the baseline resting sweat rate was higher in FD patients than controls (p<0.05). TEWL and QSART test results correlated (r = 0.64, p = 0.01), proving the reliability of TEWL methodology in evaluating sudomotor function. CONCLUSION: The finding of normal direct and axon reflex mediated sweat output in FD patients supports our hypothesis that, in a disorder with severe sympathetic nerve fibre reduction, sudomotor fibres, but not the sweat gland itself, exhibit chemical hypersensitivity. This might explain excessive episodic hyperhidrosis in situations with increased central sympathetic outflow. (+info)