[Unilateral acneiform rash in facial palsy]

BACKGROUND

Cetuximab is a chimeric monoclonal antibody selective for epidermal growth factor receptor (EGFR). It is increasingly used in epithelial cancer, often in combination with radiotherapy or chemotherapeutic agents, since it induces a broad range of cellular responses that enhance tumour sensitivity to these therapies. However, it can cause numerous adverse effects, the most common being acneiform eruption on the face and trunk, which is generally bilateral and symmetric.

PATIENTS AND METHODS

Herein we present the first case of unilateral cetuximab-induced acneiform eruption in facial palsy.

DISCUSSION

To our knowledge the medical literature contains no other such cases. Our hypothesis is that lymphoedema associated with facial palsy reduces lymphatic drainage, promoting the deposition of cetuximab on EGFR and persistence of local signs.

A prospective multicentre study on the safety of long-term intensive plasmapheresis in donors (SIPLA)

BACKGROUND AND OBJECTIVES

The safety of chronic intensive donor plasmapheresis has not been determined in large prospective studies examining dropout rates, dropout reasons and predictors of withdrawals.

MATERIALS AND METHODS

Twenty-one plasma centres recruited 3783 donors who were switched from a moderate to an intensive plasmapheresis programme and observed over a 3-year period. Individuals weighing < 70 kg and > or = 70 kg donated 750 ml and 850 ml of plasma per session, respectively. The maximum of annual donations was limited to 60. Total serum protein (TSP) and haemoglobin (Hb) or haematocrit (Hct) were determined at each donation, and immunoglobulin G (IgG) at every fifth donation. Dropout rates, dropout reasons and potential predictors of withdrawal were analysed.

RESULTS

Dropouts were predominantly due to socioeconomic (49.2% of all donors) or medical reasons not related to plasma donations (10.4% of all donors). Sixteen per cent of donors dropped out when IgG, TSP or Hb levels fell below threshold values. Severe clinical adverse events related to plasmapheresis were observed in five subjects. The incidence in severe cardiovascular diseases was lower in donors than in the general population. The risk factors that led to dropping out as a result of low IgG, TSP or Hb levels included younger age, female gender, low initial IgG levels and a high donation frequency. Neither body weight nor the amounts of plasma donated per kilogram of body weight per session were associated with ceasing due to medical reasons, whether related or unrelated to plasma donations. Females and males within the respective lowest body weight category were not at higher risk of dropping out.

CONCLUSION

Long-term intensive donor plasmapheresis under conditions investigated in this study is safe. All donors weighing > or = 70 kg are safely able to donate 850 ml of plasma in each session up to 60 times per year, provided that they are carefully monitored.

[Adenocarcinomas of the ethmoid sinuses. Epidemiological data]

OBJECTIVE

The relationship between adenocarcinomas of the ethmoid (ADKE) and wood-dust exposure has been well established. Sino-nasal cancer in wood-workers has been added to the list of occupational disorders in France, as prescribed disease number 47-Bq.

PATIENTS AND METHODS

Our data set consisted of 207 cases with sino-nasal cancer (from January 1985 to January 2001). Among these cases, 67.1% were adenocarcinoma. A wood dust exposure has been reported in 96.4% cases. The mean duration of wood dust exposure was 30 years. The mean latency between the end of the exposure and the diagnostic was 10.6 years.

RESULTS

Our epidemiological data confirmed those from the biomedical literature. The occupations at greatest risk are furniture workers, sawmill workers, carpentry workers, and other wood product workers. Two components of exposure - duration and average level - contributed independently to the overall elevated risk. The risk is greater among men who were employed in jobs with the highest wood dust exposure and increases with the duration of exposure.

CONCLUSIONS

The preinvasive stages of ADKE (mucostasis/cuboïd metaplasia/dysplasia) are still an unverified hypothesis. ADKE were observed in workers who use "hard" woods. The chemical nature of the carcinogenic factor(s) in wood dust is not known. The factors responsible for induction of ADKE in hard wood-workers probably exist in the wood-dust itself. Tannins were suggested as possible contributing agents to induction of ADKE. In addition to wood dust, exposures may include formaldehyde. Given these facts, it should be possible to define preventive measures, so that incidence of ADKE in professional wood and leather workers should decrease.

DNA-coated carbon adsorbents experimental assessment and results of severe psoriasis treatment

Newly developed combined adsorbents, containing from 1 to 8 mg of thymic DNA per 1 g of the granulated or the fibrous carbonic matrix, demonstrated good biocompatibility and selectivity for DNA- and DNP-binding substances. In a group of 14 patients with severe psoriasis (uncontrol trial) a single hemoperfusion procedure through DNA-coated granulated synthetic carbons (perfusion volume was 2.5-3.1 L, sorbent quantity was 30 g) resulted in complete remission in 6 patients and in substantial improvement of clinical status in 6 other patients. A positive effect was observed in 4 patients during 7-11 months; in 8 patients it is being observed for more than 29-33 months. The double-blind tests in the group of patients subjected to hemoperfusion through the DNA-coated charcoal (27 people) and uncoated charcoal (9 people) showed the full-scale remission in 55.5% and 11.2% respectively. The authors believe that the DNA-coated activated carbons can be an effective therapeutic procedure for treatment of numerous immuno-dependent diseases and states associated with disorders in the kinetics of cell division.

Immunoadsorption and plasma exchange in multiple sclerosis: complement and plasma protein behaviour

Three groups of patients suffering from acute attacks or progressive multiple sclerosis (MS) are under investigation. First results revealed remarkable clinical improvements of patients with acute attacks in the groups treated by therapeutic plasma exchange (TPE) and immunoadsorption (IA). Only slight or no improvements were seen in the patients of the control group treated only with steroids. Plasma protein levels (IgG, IgM, IgA, fibrinogen) were considerably reduced in patients of the TPE group after each treatment procedure as expected. The same holds true concerning the total hemolytic capacities (THC) of the complement of the classic (CP) and the alternative (AP) pathway. On the other hand in the IA group only slight decreases of plasma proteins (about 20%) were observed, but the behaviour of THC's were quite similar than those seen in the patients of the TPE group. The THC decreases in both groups can be explained by removal of all complement factors (TPE group) or by the adsorption of single factors (IA group) of both complement pathways according to earlier in vitro investigations. The THC decreases in patients of both groups suffering from acute MS attacks could mean an "antiinflammatory" effect and could--at least partially--contribute to the clinical improvements of these patients.

A newly developed LDL-binding material

Results of in vitro and ex vivo experiments with a newly developed LDL-binding material are presented. This material consists of macroporous bead cellulose which is capable to bind selectively LDL. LDL-cholesterol is considerably decreased after contacts of plasma or serum samples with this bead cellulose. On the other hand high density lipoproteins (HDL) and other plasma components (proteins, enzymes, electrolytes, and metabolic substances) remained high or unchanged. Triglycerides (TG)--transported by very low density lipoproteins--are also bound up to a certain degree. 1 g of the adsorbent wet mass binds at least 20 mg cholesterol. The capacity suffices to decrease two- to threefold increased cholesterol and LDL plasma levels to the low normal range following passage of the sevenfold plasma volume' through two the three LDL adsorbent columns (results of perfusion experiments). In vitro and dog experiments revealed only slight drops of the hemolytic capacities of the classic complement pathway and moderate decreases of the alternative one. But no detectable side effects were noticed in the dog experiments.

Adsorption of immunologically relevant molecules--its present and future

The development of numerous adsorbents of various types oblige us to define the used terms. Adsorbents functioning on the same principle as that of the binding between antigen and antibody should be designated as specific adsorbents or immunoadsorbents. All other kinds of adsorbing materials act more or less selectively. A review is given concerning investigations about selective adsorbents. The removal of IgG antibodies is possible with adsorbents of the protein A type. Synthetic materials with IgE and IgM binding properties are presented and are under development. The blocking of the complement system by binding certain components and breakdown products can be a worthwhile feature in view of the biocompatibility of adsorbing materials.

In vitro investigations with selective adsorbents for IgE and IgM

In vitro studies were carried out with IM-T. This adsorbent consists of polyvinyl alcohol joined with tryptophan side chains and was delivered by ASAHI Medical Co., Ltd., Tokyo/Japan. It was found that IM-T binds immunoglobulins G and M and also immune complexes only moderately but IgE was adsorbed in remarkable amounts. A clear dose-dependent was adsorbed in remarkable amounts. A clear dose-dependent manner of the IgE adsorption could be stated. Kinetic studies revealed that the binding was only slow and gradual.

Electrophoretic mobilities and levels of T and B lymphocytes in human pregnancy

Automatic cell electrophoresis has been used to investigate electrokinetic properties and the levels of T and B lymphocytes in peripheral blood of 124 pregnant women at different stages of gestation, and in 44 healthy controls. The electrophoretic mobilities (EPM) of T and B lymphocytes in maternal peripheral blood vary only slightly throughout pregnancy. In the pregnant subjects, there is a small but significant reduction in the percentage of circulating T lymphocytes. It is concluded that an increased electrostatic repulsion between maternal lymphocytes and trophoblast cells by alterations in the surface charge of lymphocytes plays an unimportant role in protecting the allogenic fetus from maternal immune attack.

Cell electrophoretic characterization of lymphoid cells from various sources in patients with malignant non-Hodgkin lymphomas

Lymphocytes of 36 patients with malignant Non-Hodgkin lymphomas (NHL) were characterized by electrophoretic mobility (EPM) and EAC-rosette and E-rosette formation. Unimodal cytopherograms found in patients with low-grade malignant NHL are compatible with a monoclonal origin of the proliferating lymphoid cells. Within the CLL subgroup, deviations from the general mean EPM value in the intermediumrange were not unequivocally related to the B- or T-cell origin of the lymphocytes and remain to be explained. Comparing distinct entities of low-grade malignant NHL characterized by lymphocyte arrest at a certain stage of differentiation (Kiel Classification) we found an increase of the mean EPM in the direction of CLL----lymphoplasmacytoid immunocytoma----polymorphic immunocytoma. This arrest of leukemic cells at a certain EPM level may support a cytogenetically oriented subclassification of NHL. The Limitations of the diagnostic value of cytopherograms and rosette formation in malignant NHL--especially in those of high malignancy--are outlined.

[Immunoadsorption using Staphylococcus aureus, COWAN I strain]

Immunoadsorbents bind immunoglobulins, immunocomplexes or immunocytes. Their clinical use could become a new therapeutic principle for diseases in the pathogenesis of which antibodies or immunocomplexes play an important part. Immunoadsorbents are also being tested in the hope that they can at least partially replace the plasmapheresis-plasma exchange therapy at present practised. A report is given on in-vitro studies using protein-A-bearing staphylococci, strain COWAN I. The bacteria bind IgG selectively, IgM to a small extent, IgA, IgD and IgE hardly. The majority of the other plasma proteins tested (e.g. albumin, transferrin, ceruloplasmin, alpha-2-macroglobulin, beta-lipoprotein, alpha-2-glycoprotein, alpha-1-antitrypsin) are bound only non-specifically and in small quantities. The staphylococci can react with acid solutions (glycin-HCl buffer, acetic acid) in several ways. The activation of the complement system by IgG binding to protein A is one of the problems to be solved before immunoadsorbents an be used clinically.

[Circulating immune complexes in kidney diseases: pathogenic significance, methods of proof, problems, tendencies]

The tendency to recognize immune complexes already before their deposition in the tissue led in the seventies to the development of numerous methods of estimation for immune complexes in the serum and to the proof of these complexes in many diseases. The author enters these methods and their problems, the results got up to now for renal diseases, i. e. above all for glomerulonephritides, are cited in form of theses. Among others belong to this the establishments that the proof of circulating immune complexes cannot contribute to the diagnosis, but to the control of the activity of the diseases and of the therapeutic effect. Recently, research concerning immune complexes yielded remarkable results as to their role as regulating factors of the unspecific as well as of the specific defense mechanisms of the organism. This promises that further clarifications on etiology and genesis particularly of diseases of the immune complex type are to be expected, among them also for glomerulonephritides.