Effect of corticosteroid treatment on hemopoiesis in vivo and in vitro in a patient with Felty's syndrome

We have studied the CFU-GM and BFU-E in vitro growth in a neutropenic and anemic patient with Felty's syndrome, either before or one and three months after steroid therapy when neutrophils and erythrocytes returned to normal. Both CFU-GM growth and CSA production were found to be low before therapy, and prednisone was shown to raise them to normal levels. The in vitro growth of BFU-E and the production of BPA by T lymphocytes of the patient were significantly lower than normal when studied before therapy. However, the T lymphocytes incubated in vitro with hydrocortisone regained their ability to stimulate the BFU-E growth. After prednisone therapy both BFU-E growth and BPA production by T lymphocytes returned to normal. Possible pathogenetic mechanisms of impaired granulo- and erythropoiesis in Felty's syndrome are discussed. The in vitro study with hydrocortisone can help to identify steroid-sensitive patients.

Inhibition of BFU-E in vitro growth and of burst-promoting activity of T lymphocytes by serum of chronic uremic patients receiving hemodialysis

The effects of uremic serum on the in vitro growth of normal BFU-E and on the burst-promoting activity by normal T-lymphocytes were evaluated separately. The effect of hemodialysis on the removal of possible serum inhibitor(s) was also tested. Sera of 12 uremic patients were shown to provoke a 60% inhibition of the in vitro growth of normal BFU-E and almost complete abolition of burst-promoting activity by T lymphocytes. While hemodialysis significantly removed the inhibition of uremic sera on BFU-E growth, it was rather ineffective in removing the inhibitor(s) of T lymphocytes. The different effects of uremic serum on BFU-E and on T lymphocytes are discussed.

Effect of hydrocortisone on BFU-E growth and on burst-promoting activity of T lymphocytes in man

Glucocorticosteroid hormones have been reported either to stimulate or to inhibit human erythropoiesis. We have studied the in vitro effect of hydrocortisone, 10(-6) mol/l, on human BFU-E when stimulated by preconstituted burst-promoting activity (BPA) in a medium conditioned by T lymphocytes. Hydrocortisone was found to stimulate BFU-E growth, even at largely suboptimal concentrations of BPA, through hormone receptors, as the effect was blocked by preincubation of BFU-E with equimolar progesterone. The possibility that glucocorticosteroids may increase the number and/or affinity of erythropoietin receptors on BFU-E is discussed. We have also studied the effect of hydrocortisone on the production of BPA by human T lymphocytes stimulated by phytohemagglutinin. Preincubation of T lymphocytes for 1 h with hydrocortisone, 10(-6) mol/l, significantly reduced the BPA of lymphocyte-conditioned medium. Again the inhibition of BPA production was reversed by incubation of lymphocytes with equimolar doses of progesterone. The conflicting results previously reported on the effect of glucocorticosteroids on erythropoiesis may be due in part to the opposing effects of the hormones on BFU-E growth and BPA production. The role hydrocortisone plays in the physiological regulation of human erythropoiesis is at present largely unknown.

[Transient loss of consciousness: a frequent and difficult problem in emergency service. Retrospective analysis of 391 cases]

The present study was designed to evaluate the patients with transient loss of consciousness who are seen in the emergency room and the ways in which they are currently triaged and evaluated, to determine the risk factors influencing their prognosis, and to analyze the aspects of diagnostic evaluation that are most useful. We made a retrospective study of 391 patients with transient loss of consciousness seen at the emergency room of S. Martino hospital. The causes of loss of consciousness, admission decision, diagnostic tests ordered, initial and final diagnoses and mortality are evaluated. The admission decision was influenced by three factors: cause of loss of consciousness, presence of chronic disease, and patient age. The same factors were shown to influence mortality. Full concordance between initial and final diagnosis was only 50 per cent. In 18.6 per cent of patients the cause of loss of consciousness was not identified at dismissal. The history and physical examination were crucial elements in the evaluation of most patients, and only in selected cases did tests such as electrocardiogram, Holter monitoring, electroencephalogram, computerized tomography scan provide diagnostic information.

Inadequate ability of T-lymphocytes from chronic uremic subjects to stimulate the in vitro growth of committed erythroid progenitors (BFU-E)

The growth of normal burst-forming units (BFU-E) is known to depend on a burst-promoting activity (BPA) produced by T-lymphocytes. Few BFU-E colonies have been observed in cultures of blood mononuclear cells (MNC) of uremic patients. The aim of the present study was to examine the concentration of BFU-E in the blood of uremic patients and to evaluate the ability of uremic T-lymphocytes to produce BPA. We have studied 6 chronic uremic patients treated with maintenance hemodialysis. When 5 X 10(5) blood MNC depleted of T-lymphocytes of uremic subjects were stimulated by 1 X 10(6) normal T-lymphocytes in a methylcellulose culture system we observed the growth of a number of BFU-E colonies that did not differ significantly from normal (29 +/- 11.8 colonies). On the contrary, when 5 X 10(5) blood MNC depleted of T-lymphocytes of normal subjects were stimulated by 1 X 10(6) T-lymphocytes of uremic patients, the number of BFU-E colonies obtained was significantly lower than normal (1.9 +/- 3.1 colonies). These data show that the decreased number of BFU-E colonies obtained from blood MNC of uremic patients is due to a defect of uremic T-lymphocytes. The impairment of T-lymphocytes can be due to inhibitors of T-lymphocyte function or to variations in T cell subsets, leading to a decrease in the OKT4/OKT8 cell ratio. In any case it is a significant pathogenetic mechanism contributing to anemia in chronic uremia.

Alterations of granulopoiesis in chronic uremic patients treated with intermittent hemodialysis

Granulocyte-macrophage progenitor cells (CFU-GM), leukocyte colony-stimulating activity (CSA), granuloblast differentiation and proliferation and the effect of uremic serum on the in vitro growth of normal CFU-GM have been studied in 8 chronic uremic patients treated with intermittent hemodialysis three times a week. The studies were performed in the postabsorptive state twice in each patient, that is at the longest and shortest dialytic interval. CFU-GM growth in agar and leukocyte CSA did not differ significantly from the normal level in uremic subjects. The granulocytic and macrophagic differentiation in a liquid culture system was significantly reduced in uremic patients, notwithstanding the appearance of high numbers of undifferentiated blastic cells. The serum of uremic patients had no effect on normal CFU-GM and leukocyte CSA.

Blood granulocyte-macrophage progenitor cell concentrations and differentiation in vitro in patients with hepatic cirrhosis

Blood granulocyte-macrophage progenitor cells (CFU-GM) and myeloid differentiation were studied in 16 patients with hepatic cirrhosis by culturing blood mononuclear cells in semisolid and in liquid medium. The numbers of CFU-GM from normal and cirrhotic subjects were not significantly different, even when increased numbers of monocyte-macrophagic colonies and decreased numbers of granulocytic colonies were observed in cirrhotic patients. Significantly reduced granulocytic growth and increased monocyte-macrophagic cell growth were found in liquid culture of cirrhotic patients. These data seem to indicate that in hepatic cirrhosis, besides granulocyte sequestration within the spleen, there is a disorder of granulocytic versus monocyte-macrophagic differentiation.

Comparison between diurnal changes and changes induced by hydrocortisone and epinephrine in circulating myeloid progenitor cells (CFU-GM) in man

A significant increase from 8 AM to 3 PM was found in both myeloid progenitor cell (CFU-GM) and polymorphonuclear leukocyte (PMN) blood concentration in 45 normal subjects. Diurnal blood (CFU-GM and PMN changes were significantly correlated. Spontaneous diurnal changes in blood CFU-GM levels and in PMN were compared with the changes induced by i. v. administration of hydrocortisone (16 normal volunteers) and of epinephrine (10 normal volunteers). Diurnal changes in CFU-GM and PMN seem to follow a pattern similar to that induced by epinephrine administration. These findings suggest that diurnal changes in CFU-GM reflect mainly a shift of these cells between different blood compartments.

Disorders of granulopoiesis in patients with untreated Graves' disease

Total and differential leucocyte countings, mobilization of the marrow granulocyte reserve with hydrocortisone and growth of blood colony-forming cells (CFU-C) in agar culture have been evaluated in 17 patients with Graves' disease before therapy. Moreover, the myeloid differentiation of blood CFU-C in liquid culture has been studied in 4 patients. Neutropenia was found in only 1 patient (5.9%), while the marrow granulocyte reserve was reduced in 7 out of 15 patients (46.7%). Blood concentration of CFU-C and myeloid differentiation in liquid culture were normal in all patients studied. These data show an abnormal granulopoiesis in a high percentage of patients with untreated Graves' disease. The mechanisms accounting for the reduction of the marrow granulocyte reserve in patients with Graves' disease are discussed.

Mobilization of colony-forming cells (CFU-C) into the peripheral blood of man by hydrocortisone

The effect of hydrocortisone on blood CFU-C has been studied in six normal subjects through a double layer agar culture system. Increased numbers of CFU-C appeared in the peripheral blood reaching a maximum 366% to 631% increase 5-8 hours after the i.v. administration of the hormone. Contemporary lymphopenia caused a 4 to 10 fold enrichment in the proportion of CFU-C to lymphocytes. Hydrocortisone added in vitro somewhat inhibited the colony growth. The results suggest that the increase of blood CFU-C is due to mobilization from the bone marrow. Hydrocortisone, when compared to other agents, appears to offer some advantages in increasing the blood CFU-C for clinical purposes.

[Surgical treatment of biliary lithiasis associated with acquired valvulopathy]

Personal experience in the treatment of acquired valvulopathies and biliary calculosis in one operating stage is reported. After examination the risk factors determining onset of bile calculosis in valvulopathic patients, the surgical techniques adopted and the special advantages obtained by associating the two operations at the same session are illustrated.

Influence of the spleen on the blood distribution of the colony-forming cells (CFU-C) in man

The incidence of the blood committed granulocyte progenitor cells (CFU-C) before and after epinephrine administration has been studied in 10 normal, 16 splenomegalic and 8 splenectomized subjects through a double-layer agar culture system. A significant increase of the mean values of CFU-C per milliliter of blood has been observed after epinephrine administration in normal and in splenomegalic subjects. In splenectomized patients the baseline mean values of CFU-C per milliliter of blood were higher than those observed in the other groups of subjects, but they did not increase after epinephrine infusion. The concentration of CFU-C per 10(6) total blood leukocytes was the same in all three groups of subjects and it was not modified by epinephrine administration. Our results seem to indicate that the CFU-C are distributed in two blood compartments, the spleen representing an important section of the marginal compartment of the blood CFU-C.

Influence of the spleen on the blood distribution of the leukocytes producing colony-stimulating activity (CSA) in man

The colony-stimulating activity (CSA) produced by the blood leukocytes has been studied before and after epinephrine administration in ten normal, 15 splenomegalic, and seven splenectomized subjects through a double layer agar culture system. A significant increase of mean values of the CSA per milliliter produced by blood monocytes has been observed after epinephrine administration in the groups of normal and of splenomegalic subjects. In the group of splenectomized subjects the baseline mean value of CSA per milliliter of blood was higher than those observed in the other groups, but it did not show any increase after epinephrine infusion. The CSA produced by 10(6) blood leukocytes was similar in all three groups of subjects, and it was not similarly modified by epinephrine administration. Our results seem to indicate that the leukocytes producing CSA are distributed within two rapidly exchangeable blood compartments, the spleen representing an important section of the marginal compartment of blood monocytes.

Normal range of blood colony-forming cells (CFU-C) in humans: influence of experimental conditions, age, sex, and diurnal variations

Blood colony-forming cells (CFU-C) and colony-stimulating activity obtained from feeder layers of peripheral blood leucocytes (leucocyte CSA) have been studies in 69 normal subjects by means of semisolid agar culture system. Groups of normal volunteers were selected according to sex and age (20 to 45 and older than 60 years) and the results compared. The mean number of circulating CFU-C was significantly lower in young women (20-45 years old) than in males over 60 years of age, but no differences were found among the other age and sex groups. Leucocyte CSA did not significantly differ among these groups. In 5 young males the blood CFU-C did not show significant variations at 8 AM and at 4 PM of the same day. When the study was repeated in 18 subjects at longer time intervals, the number of colonies showed a maximum fivefold variation. The amount of plasma and polymorphonuclear granulocytes present in our culture system did not inhibit the colony growth. In most cases, double layer cultures grow a higher number of colonies than single layer, but feeder layers of some normal subject seem to inhibit the colony growth.

Blood colony-forming cells (CFU-C) and leucocyte colony-stimulating activity (CSA) in patients with neutrophilic leucocytosis

The incidence of circulating colony-forming cells (CFU-C) and the ability of peripheral leucocytes to stimulate the colony formation (CSA) have been studied through a double layer agar culture system in 26 patients with neutrophilic leucocytosis and compared to the values obtained in 26 normal subjects. Both mean CFU-C incidence and mean leucocyte CSA of the whole group of patients were found significantly higher than normal, but considerable variation was observed among singular patients. The different patterns of blood CFU-C and leucocyte CSA are discussed. The combined evaluation of blood CFU-C and leucocyte CSA is found a useful tool to investigate the pathogenetic mechanisms of neutrophilic leucocytosis.