Production of Leukocyte Migration Inhibition Factor by Lymphocytes of Larynx Cancer Patients Stimulated by Laryngeal Carcinoma Solubilized Membrane Antigens

The production of leukocyte migration inhibition factor (LIF) from lymphocytes after stimulation with 3 M KCl soluble tumor and normal mucosa extracts was investigated in 30 patients with laryngeal carcinoma at different development stages and in 30 normal donors. The experiments were performed in heterologous and autologous systems. In heterologous systems 3 M KCl tumor extracts induced LIF production by heterologous lymphocytes from patients in 91 % of the cases, and normal mucosa extracts induced LIF production by heterologous lymphocytes from patients in 73 % of the cases and from normal donors in 90 % of the cases. In autologous systems 3 M KCl tumor extracts induced LIF production by autologous lymphocytes from the same patients in 65 % of the cases, whereas the normal laryngeal mucosa extracts induced LIF production by the same autologous lymphocytes in the 6 % of the cases. The high positivity percentage of the test in heterologous systems could be related to differences in the major histocompatibility complex. The 65 % test positivity in autologous systems using tumor extracts could be related to the presence of tumor associated antigens.

Specific Lif Production in Laryngeal Cancer Patients: Evidence of Suppressor Activity Exerted by Adherent Cells

The specific tumor-induced LIF production in 30 laryngeal cancer patients has been investigated before and after the removal of adherent cells to evaluate the existence of a suppressor activity. LIF production, after challenging lymphocytes with 3 M KCl autologous tumor extracts, was significant in 16 patients and showed a further significant increase after removal of adherent cells. A conversion to significance when the adherent cells were removed was shown in 6 patients, with no previous significant LIF production. These data suggest the existence of a suppressor activity exerted by adherent cells on LIF production in laryngeal cancer patients.

Primary Graft Dysfunction After Zero-Mismatch Kidney Transplantation Secondary to Early Biopsy-Proven Acute Cell-Mediated Rejection: Case Report

We report a case of primary renal allograft dysfunction and early acute cell-mediated rejection after a 12/12 HLA antigen zero-mismatch (0MM) transplant. The recipient was a 40-year-old white man who was highly allosensitized, with a calculated panel reactive antibody score of 100%. In posteroperative day 1 the recipient remained anuric and underwent dialysis because of hyperkalemia. Graft biopsy showed early acute cellular rejection, Banff grade 2B. No evidence of antibody-mediated rejection was observed. To our knowledge, this case is the 1st to report early cell-mediated rejection after 12/12 HLA antigen 0MM kidney transplantation. This case suggests that highly sensitized candidates are at high immunologic risk even in the context of 0MM kidney transplantation.

Recipient outcomes for expanded criteria living kidney donors: the disconnect between current evidence and practice

Older individuals or those with medical complexities are undergoing living donor nephrectomy more than ever before. Transplant outcomes for recipients of kidneys from these living expanded criteria donors are largely uncertain. We systematically reviewed studies from 1980 to June 2008 that described transplant outcomes for recipients of kidneys from expanded criteria living donors. Results were organized by the following criteria: older age, obesity, hypertension, reduced glomerular filtration rate (GFR), proteinuria and hematuria. Pairs of reviewers independently evaluated each citation and abstracted data on study and donor characteristics, recipient survival, graft survival, serum creatinine and GFR. Transplant outcomes for recipients of kidneys from older donors (> or =60 years) were described in 31 studies. Recipients of kidneys from older donors had poorer 5-year patient and graft survival than recipients of kidneys from younger donors [meta-analysis of 12 studies, 72% vs. 80%, unadjusted relative risk (RR) of survival 0.89, 95% confidence interval (CI) 0.83-0.95]. In meta-regression, this association diminished over time (1980s RR 0.79, 95% CI 0.65-0.96 vs. 1990s RR 0.91, 95% CI 0.85-0.99). Few transplant outcomes were described for other expanded criteria. This disconnect between donor selection and a lack of knowledge of recipient outcomes should give transplant decision-makers pause and sets an agenda for future research.

Prevalence and clinical course of BK virus nephropathy in pancreas after kidney transplant patients

The influence of BK virus nephropathy (BKVN) in pancreas after kidney (PAK) transplantation is unclear. A retrospective analysis of PAK transplants performed at our center was conducted to determine the impact of BKVN. Among 40 PAK transplants performed using sequential immunosuppression, four patients developed BKVN, as defined by a >20% rise in serum creatinine and BK viremia (BK plasma load >4 log copies/mL), at a median of 19 months following PAK. In all four patients, treatment of BKVN consisted of reduction in tacrolimus, cessation of mycophenolate mofetil, and introduction of leflunomide. With this approach, two patients experienced improvement or stabilization of renal function. The remaining two patients progressed to dialysis dependence despite treatment. Plasma BK load < or =5 log copies/mL was associated with graft preservation. Gender, age, delay between transplants, cumulative Thymoglobulin dose, and type of kidney donor were not associated with BK virus infection. Pancreas graft rejection or dysfunction was not observed with the above immunosuppression modification. Mean amylase and lipase > or =6 months following BKVN treatment remained normal. BKVN is an important cause of kidney allograft loss in PAK patients. Screening and early treatment of BKVN may enable preservation of kidney and pancreas grafts.

Medicare elective surgery outcomes and state prospective reimbursement programs

This article examines the relationship between the introduction of State prospective reimbursement (PR) programs and mortality rates for elective surgery. We study 15 such programs using a sample of about 40 percent of U.S. hospitals. We examine mortality data for 1974 to 1983 for these hospitals, selecting a 20-percent sample of all Medicare admissions for eight elective procedures. Indirect standardization (age, sex, procedure) was used to define mortality outcomes, and regression procedures were used to estimate PR effects that controlled for hospital, community, and other regulatory influences. Introduction of PR is found to be occasionally and inconsistently associated with increases in relative mortality.

Specific lymphokine responses in cervical nodes of patients with laryngeal cancer

The role of lymphokines in modulating the immune response in patients suffering from neoplastic disease is still controversial. Recent studies indicate that in patients with head and neck cancer, a decrease in LIF (leukocyte migration inhibiting factor) production is usually present in advanced disease. In this study, the authors investigate: the LIF production in lymphocytes derived from the peripheral blood and cervical nodes of patients with laryngeal carcinoma by using an autologous pattern (i.e., for each patient, the specific LIF production was challenged by means of an autologous cell extract derived from his own tumor); the influence of histologically confirmed cervical node metastases on LIF production. Our results indicate that: There is a significant decrease in LIF production in patients with histologically proven cervical node metastases as compared to patients with no metastatic foci. The decrease of LIF production is related to the presence of mononuclear adherent cells. When the latter are removed, there is a significant reversal of specific LIF suppression. The possible meaning of the data is discussed.

Evaluation of blocking mechanisms against immunological responses in patients with laryngeal carcinoma

The specific tumor-induced leukocyte inhibition factor (LIF) production in laryngeal cancer patients has been investigated before and after the removal of adherent cells in order to evaluate the existence of a suppressor activity; 20 patients served as subject. The LIF production, after challenging the lymphocytes with 3MKC1 autologous tumor extracts, was significant in 12 patients and showed a further significant increase after the removal of adherent cells. In 3 patients with no previous significant LIF production, there was a conversion to significance when the adherent cells were removed. The other patients did not show any significant variation. These data seem to suggest the existence of a suppressor activity exerted by adherent cells in laryngeal cancer patients on LIF production.

Natural killer-mediated cytotoxicity in patients with laryngeal carcinoma

Natural killer (NK)-mediated cytotoxicity against the K562 cell line was evaluated in normal subjects and in patients with laryngeal cancer. Results showed reduced lymphocyte cytotoxicity in patients with neoplastic disease and further reduction in NK activity following postoperative radiation therapy. The authors discuss the possibility of using this test in the immunological monitoring of patients with laryngeal carcinoma.

Evaluation of the immune responsiveness in laryngeal cancer patients with specific and aspecific tests: first results of follow-up in 80 cases

We have evaluated in 80 patients suffering with laryngeal carcinoma their specific and aspecific immune responsiveness. We used the E rosette-test, the PHA-induced in vitro stimulation and the in vitro specific LIF production. We chose to use the LIF production test both for its marked sensitivity and because the lymphokines--which are soluble mediators--act as a "bridge" between the different fields of the immune response. Furthermore in our previous research, we observed that the specific LIF production was influenced in a negative way by adherent cells of the peripheral blood that could behave as blocking factors. For what attains the autologous LIF production, before and after the removal of adherent cells, our results show that the patients suffering with a cancer staged as T3T4N1N2N3 exhibit much more marked blocking phenomena than the patients with a cancer staged as T1T2T3N0. In fact the results demonstrate that in this second group only 62% of the cases, after the removal of the adherent cells, showed an increase of LIF production, while this percentage rose to 83% for the patients with a more advanced disease. A similar pattern was found in those patients who showed a recurrence two of three years after the primary disease.

Evidence of suppressor activity mediated by concanavalin-A stimulated cells towards aspecific LIF production

Since the T-suppressor subpopulation is known to have a peculiar sensitivity to the mitogenic activity of Concanavalin-A we decided to verify whether in normal subjects it was possible to induce, by using the Con-A as a mitogenic factor, the proliferation of cells--possibly T-suppressor--which: a) had the property of adherence and b) show inhibitory activity toward LIF production. The statistical analysis of the results of our experimental patterns show that even if a difference between the suppression exerted on LIF production by Con-A stimulated versus not stimulated cells is present at any dilution, the level of significance rises from P less than 0.005 to P less than 0.0001 for the range of dilution 1:1/4 to 1:132, thus revealing that these experimental conditions are optimal for eliciting the blocking effect. The researches that are currently in progress in our laboratory seem to suggest that this experimental approach is of some value in characterizing the immunity pattern of laryngeal cancer patients and its evolution through the course of disease.

Effect of the cryopreservation on the production of leukocyte migration inhibition factor (LIF) by lymphocytes from normal volunteers and patients with laryngeal carcinomas

The present paper reports the results of an investigation on the influence of cryopreservation methods of human lymphocytes on the leukocyte migration inhibition factor (LIF) production following PHA stimulation. The optimal freezing and thawing procedures, fetal calf serum and dimethyl sulphoxide concentrations are reported.

Primary gastric lymphoid proliferations: immunological criteria to distinguish gastric lymphoma from reactive hyperplasia

A group of six patients with a marked gastric lymphoid "hyperplasia", two of these with generalised lymphoma and the others suspected for primary gastric lymphoma, were investigated to discriminate between simple reactive hyperplasias and lymphomatous proliferations. Microscopical and ultrastructural examinations were not useful for this purpose but immunological data can give evidence of a two-fold nature of gastric lymphoid hyperplasia. Some cases are without immunological disorders, others are met with peripheral blood signs of immunological alterations similar to those observed in malignant lymphomas and in chronic lymphocytic leukemia. Only these latter cases should, in our opinion, be regarded as primitive gastric lymphomas.

Waldenström-like immunocytic lymphoma with IgG serum M component

A case of immunoproliferative disorder with clinical features of Waldenström's disease but with an IgG-k instead of IgM serum M component is described. The lymphocyte population in the bone marrow, blood and lymph nodes was studied by rosette test, culture with PHA and immunofluorescence staining. Most of the bone marrow lymphocytes had membrane IgG. This case represents an intermediate form between myeloma and Waldenström's disease, thus supporting the unitarian concept of all the immunoproliferative disorders.

In Vitro Development of Macrophages from PHA-stimulated Blood Cultures in Hodgkin's Disease and in Chronic Lymphocytic Leukaemia

Blood was cultured from 17 normal subjects, 28 cases of untreated chronic lymphocytic leukaemia (CLL) and 41 cases of Hodgkin's disease. Macrophages were not observed in PHA-stimulated cultures of normal subjects, of CLL or of 18 cases of Hodgkin's disease. The latter had an almost normal rate of lymphocyte blast transformation (70,2 ± 7,2%). On the other hand, macrophages were numerous in PHA-stimulated cultures of 23 cases of Hodgkin's disease with a low blast transformation (28,4 ± 13,7%). In Hodgkin's disease the development of macrophages in PHA cultures may be related to the lower blast transformation and cytotoxic activity of lymphocytes. In CLL the dilution of lymphocytes and monocytes by leukaemic B cells may account both for PHA unresponsiveness and low yield of macrophages in culture.