Alterations in interleukin secretion (IL-2 and IL-4) by CD4 and CD4 CD45RO cells from common variable immunodeficiency (CVI) patients

The failure of B cells from CVI patients to secrete normal amounts of antibodies has been attributed either to an intrinsic B cell defect or to a lack of cooperation from T cells. In an attempt to improve the definition of the origin of this defect in one of the main cellular compartments, we studied the ability of helper CD4 cells and their CD4 CD45RO subpopulation from CVI patients to secrete interleukins (IL-2 and IL-4) in response to mitogen stimulation. We found that CD4 and CD4 CD45RO cells from some patients secrete abnormal amounts of interleukins (in general low levels of IL-2 and high levels of IL-4) upon stimulation with pokeweed mitogen (PWM). These irregularities may contribute to the defective differentiation of B cells in these patients.

A simplified method for cryopreservation of hematopoietic stem cells with -80 degrees C mechanical freezer with dimethyl sulfoxide as the sole cryoprotectant

A simplified method for cryopreservation was developed with 10% dimethylsulfoxide (DMSO) as the sole cryoprotectant without rate-controlled freezing. This method produced high recovery rate for mononucleated cells (87%) and elevated trypan blue viability (90%). Autologous peripheral blood stem cells (PBSCs) and bone marrow cells with plasma and 10% DMSO were frozen and stored in a -80 degrees C mechanical freezer. Eleven patients with solid and hematological malignancies were transplanted with autologous bone marrow or PBSCs. The median number of infused mononuclear cells (MNC) and CD34+ cells were 3.63 x 10(8)/Kg and 4.80 x 10(6)/Kg, respectively. The median number of infused post-thawing CFU-GM was 20 x 10(4)/Kg. All patients showed a rapid and sustained engraftment. The mean times to reach a neutrophil count of 0.5 x 10(9)/L and a platelet count of 50 x 10(9)/L were 11 and 13 days, respectively. All patients are alive and 10 in unmaintained complete remission for 3-9 months after transplantation. These results show the efficacy of this simplified cryopreservation technique that will be useful for institutions without rate-controlled freezing facilities.

Neonatal mixed lineage acute leukaemia

We report here an uncommon case of neonatal acute leukaemia that presented concomitant with serological evidence of rubella infection. The clinical course was aggressive and the patient died 5 days after diagnosis from septicaemia. Leukaemic blasts had a mixed lineage immunophenotype co-expressing a constellation of B-lymphoid (CD19, cytCD22, TdT) and myeloid (CD13, CD33, CD14, anti-MPO) markers, as well as multiple adhesion molecules and markers associated with early lympho-myeloid progenitor cells (CD34, CD7, HLA-DR). A previously unrecorded discordant expression of different CD10 and CD34 epitopes was identified using different monoclonal antibodies. The karyotype was 46,XX t(4;11)(q21;q23) and molecular analysis confirmed rearrangement of the trithorax-related oncogene HRX at 11q23. There was a clonal biallelic rearrangement of the immunoglobulin heavy-chain gene. The features of this rare case have implications for possible aetiological events leading to leukaemia.

Treatment of vernal keratoconjunctivitis a double-masked study

Thirty-one children aged five to 14 years with severe vernal keratoconjunctivitis (VKC) were enrolled in a double-masked study evaluating the efficacy of three ophthalmic preparations: cromolyn sodium (Opticrom) 2%, artificial tears and fluorometholone 0.1% (FML). These drugs were coded respectively as A, B, C, and dispensed in similar bottles. Both eyes were treated, and drug assignment was made at random. Objective assessment of the disease activity was done under slit lamp by two ophthalmologists according to a five-point scale. The results were tabulated and the chi-square test performed. Decoding of the drugs was done only after completion of the statistical analysis. FML was found effective with a statistically significant difference from the other two drugs, both after the first week on the initially assigned treatment (p = 0.05) and on completion of the treatment period according to protocol (p = 0.005). Although several patients improved under cromolyn sodium, there was no statistically significant difference between cromolyn sodium 2% and artificial tears. All the preparations were well tolerated. One patient developed bilateral allergic blepharitis when treated with FML during the study. Another patient who responded well to FML developed posterior subcapsular cataract while continuing treatment with corticosteroids a few months after completion of the study.

A functional vagotomy induced by unilateral forced right nostril breathing decreases intraocular pressure in open and closed angle glaucoma

There is evidence of the central regulation of intraocular pressure, and it has been suggested that vagal tone might be increased in glaucoma simplex. The nasal cycle, the simultaneous congestion-decongestion response in the nasal cavities, reflects the dynamic lateralisation of the autonomic nervous system. Since this lateralisation presents with sympathetic activity induced by left brain hemisphere stimulation and parasympathetic activity induced by right hemisphere stimulation, it was subsequently demonstrated that forced unilateral nostril breathing induces selective contralateral hemispheric stimulation as measured by relative increases in the electroencephalographic amplitude in the contralateral hemisphere as well as alternating lateralisation of plasma catecholamines. Using this functional vagotomy, we report that left hemispheric stimulation by 20 minutes of forced unilateral right nostril breathing led to a significant bilateral decrease of 4.6 mmHg (25%) in intraocular pressure in 46 patients with open and closed angle glaucoma. However, it significantly increased the IOP in three patients with neovascular, one with juvenile onset, and one with closed angle glaucoma.

Evaluation of several tests in screening for chloroquine maculopathy

Patients receiving antimalarial therapy, specifically hydroxychloroquine, for different periods were evaluated using contrast sensitivity test (CST) and results were compared with those of electro-retinography (EOG), and pattern visual evoked potential (PVEP), and a matching age control group. The results indicated CST to be most sensitive of the evaluated techniques particularly in patients under 40 years old. In 44.4% of the cases CST revealed macular dysfunction of which the other two methods of examination were not capable. Our findings suggest the CST is a reliable and practical method which could be used as an additional screening test for chloroquine maculopathy.

Changes in intraocular pressure induced by differential forced unilateral nostril breathing, a technique that affects both brain hemisphericity and autonomic activity. A pilot study

There is evidence of the central regulation of intraocular pressure, and it has been suggested that vagal tone might be elevated in glaucoma simplex. The nasal cycle, the simultaneous congestion-decongestion response in the nasal cavities, reflects the dynamic lateralization of the autonomic nervous system. Since this lateralization presents with sympathetic activity induced by left brain hemisphere stimulation and parasympathetic activity induced by right hemisphere stimulation, forced unilateral nostril breathing (FUNB) has recently been demonstrated to induce selective contralateral hemispheric stimulation as measured by relative increases in EEG amplitude in the contralateral hemisphere as well as alternating lateralization of plasma catecholamines. Using this functional vagotomy/sympathectomy, we report the novel finding that right hemispheric activation via left FUNB increases intraocular pressure (IOP) by an average of 4.5%, whereas left hemispheric stimulation via right FUNB leads to a significant (25%) decrease in IOP.

Bilateral retinopathy and encephalopathy

A 22-year-old woman presenting with recurrent transient episodes of vertebro-basilar artery syndrome and blurred vision was initially diagnosed as suffering from a collagen disease affecting the retina and CNS. Treatment with systemic steroids induced an apparent remission. However, a rapid deterioration of her condition prompted a reevaluation of the diagnosis and treatment. Ophthalmoscopic examination disclosed numerous ischemic foci in both eyes, scattered superficial hemorrhages, and neovascular tufts on the optic nerves. The possibility that both the cerebral and ocular phenomena were the results of systemic showering of emboli was raised. Careful two-dimensional echo cardiography revealed a mitral mass compatible with myxoma of the left atrium. The difficult differential diagnosis of combined encephalopathy and retinopathy is discussed.

Treatment of endogenous uveitis with cyclosporine A

Thirty patients suffering from severe sight-threatening bilateral chronic endogenous uveitis were treated with initial dosages of 10 mg/kg/d of CsA. After 1 month of therapy, all patients but one demonstrated a rapid decrease of the intraocular inflammatory processes along with an arrest of the deterioration of vision. After 1 year (or more) of treatment, most patients still show the same visual acuity achieved after 1 month. During the 3-year span of this study, attempts at tapering off the CsA dosage to less than 5 mg/kg/d induced a temporary flare-up in 20 of the 24 patients followed without interruption for more than 6 months. Nonetheless, control of the intraocular inflammation was finally achieved by 5 mg CsA/kg/d or less in 14 of the 25 patients. In six of these 14 patients the CsA dosage was further tapered to total discontinuation. Two of the six patients showed a rapid reactivation of the intraocular inflammatory processes with a profound decrease in vision within 1 and 3 weeks, respectively. In four patients, control of the intraocular inflammation and preservation of good visual acuity have been observed for a period of up to 18 months.

Treatment of severe vernal keratoconjunctivitis with cyclosporine A eyedrops

Twenty-one children (4 to 12 years old) with severe vernal keratoconjunctivitis refractive to treatment with corticosteroid eyedrops and/or 2% disodium cromoglycate (Optic-rom, Fisons) were treated with CsA 2% eyedrops in oil solution. Eighteen patients (86%) experienced a rapid relief of their subjective symptoms three to four days after initiation of treatment. This was accompanied by objective improvement of ocular manifestations and visual acuity within a week. Sixteen of the children (76%) remained controlled during the 6-week period of treatment. However, only five patients (24%) did not need any additional therapy 2 months after discontinuation of the CsA eyedrops. These findings can be interpreted as an indication for the possible involvement of interleukin secretion in the clinical manifestations of vernal keratoconjunctivitis. Alternatively, the beneficial effects of CsA in this disease may be due to a direct effect on the mast cells preventing the release of their mediators.

[Pediatric AIDS through vertical transmission]

We report here the first paediatric immunodeficiency acquired syndrome (AIDS) in Spain, acquired by vertical-transmission and a second infant case with the same transmission and classified as AIDS related complex. We also mention the incidence and characteristics, of the neonatal population born in the last eighteen months to HIV positive mothers in our geographic area. The AIDS patients, was a female drug addicted parents born to who died at 22 month. Her parents are HIV positive and have ARC. The second patient was a boy, born to a sexual HIV positive partner of a member of a high risk group who died pat 17 month. Review of the literature until September 1986, revealed 369 AIDS paediatric patients, the number is lower 265 (7 Spanish), if only vertical transmitted AIDS is considered. For this reason, we considered pertinent to provide some information about clinical manifestations and laboratory, radiologic and necropsy findings in our patients.

LDH isoenzymes in the T lymphocytes of patients with primary hypogammaglobulinaemia

A fetal lactate dehydrogenase (LDH) isoenzyme pattern, with relative deficiency of LDH1, was found in enriched T cell preparations from patients with late onset and X-linked hypogammaglobulinaemia. This provides further evidence that such T cells are 'immature'.

Histochemical studies for 5'-nucleotidase and alpha-naphthyl (non-specific) esterase in lymphocytes from patients with primary immunoglobulin deficiencies

Lymphocytes from patients with primary immunodeficiency were tested histochemically for ecto 5'-nucleotidase (5'N) and alpha-naphthyl (non-specific) esterase. More than half the patients with 'common variable' hypogammaglobulinaemia, all those with X-linked hypogammaglobulinaemia and some of those with selective IgA deficiency had a very low percentage of lymphocytes staining for 5'N as compared to controls. A lack of B cells probably explains the finding in X-linked hypogammaglobulinaemia, but does not fully explain the results in the other groups. Most patients with 'common variable' hypogammaglobulinaemia had a very low percentage of lymphocytes with granular staining for alpha-naphthyl (non-specific) esterase in contrast to normal numbers in those with X-linked hypogammaglobulinaemia and most of those with selective IgA deficiency. Granules containing non-specific esterase are characteristically found in 'mature' T lymphocytes. The enzyme abnormalities in the T and B cells of 'common variable' hypogammaglobulinaemic patients could be explained by 'immature' cell types.