Downgrading of non-Hodgkin's lymphoma following chemotherapy

A case of high-grade non-Hodgkin's lymphoma (malignant lymphoma centroblastic) is presented which, following chemotherapy, manifested low-grade histology. The importance of repeated biopsies in cases of persistent or recurrent disease following therapy for lymphoma is emphasized.

LPS-activated CBA/N mouse B cells respond to anti-Ig and a BSF-1-like factor

Highly purified small splenic CBA/N B cells show little or no proliferative response to LPS, soluble anti-Ig, LPS plus anti-Ig, or anti-Ig plus the B cell stimulatory factor BSF-1. An excellent proliferative response is obtained, however, if CBA/N B cells are cultured concurrently with LPS, anti-Ig, and a supernatant rich in T cell-derived lymphokines. The pertinent T cell-derived CBA/N B cell co-stimulating factor has the same m.w., isoelectric point range, and hydrophobicity as BSF-1, and co-migrates with BSF-1 throughout a two-step biochemical scheme developed for BSF-1 purification. These data therefore suggest that CBA/N B cells respond to a BSF-1-like lymphokine under appropriate activation conditions. In support of this conclusion, separate experiments demonstrated that unstimulated small CBA/N B cells respond to HPLC-purified BSF-1 by increased expression of membrane-bound class II major histocompatibility antigens. Taken together, these findings indicate that small CBA/N B cells express the receptor for a factor resembling BSF-1, and acquire the capacity to proliferate in response to anti-Ig and this BSF-1-like factor when co-stimulated with LPS.

LPS-activated CBA/N mouse B cells respond to anti-Ig and a BSF-1-like factor

Highly purified small splenic CBA/N B cells show little or no proliferative response to LPS, soluble anti-Ig, LPS plus anti-Ig, or anti-Ig plus the B cell stimulatory factor BSF-1. An excellent proliferative response is obtained, however, if CBA/N B cells are cultured concurrently with LPS, anti-Ig, and a supernatant rich in T cell-derived lymphokines. The pertinent T cell-derived CBA/N B cell co-stimulating factor has the same m.w., isoelectric point range, and hydrophobicity as BSF-1, and co-migrates with BSF-1 throughout a two-step biochemical scheme developed for BSF-1 purification. These data therefore suggest that CBA/N B cells respond to a BSF-1-like lymphokine under appropriate activation conditions. In support of this conclusion, separate experiments demonstrated that unstimulated small CBA/N B cells respond to HPLC-purified BSF-1 by increased expression of membrane-bound class II major histocompatibility antigens. Taken together, these findings indicate that small CBA/N B cells express the receptor for a factor resembling BSF-1, and acquire the capacity to proliferate in response to anti-Ig and this BSF-1-like factor when co-stimulated with LPS.

Differential proliferative responses of B cells from BALB/c and autoimmune NZB mice to B-cell growth factor(s)

Highly purified B cells from NZB mice have altered responses to various stimuli which require additional costimulatory signals supplied by factors present in EL-4 supernatants when compared to age-matched control nonautoimmune strains. Both crude preparations of EL-4 supernatants as well as partially purified BSF-p1 induced peak proliferation in B cells from normal strains of mice only in the presence of another stimulatory signal, anti-mu. In contrast, B cells from autoimmune-prone NZB mice proliferated in response to B-cell growth factors, with an age-dependent variation. Splenic B cells from 16- to 22-week-old NZB mice, an age where pronounced autoimmune disease is not observed, demonstrated a near maximum proliferative response with B-cell growth factors alone. While normal B cells responded maximally to BSF-p1 in the presence of anti-mu, B cells from young adult NZB mice (16-22 weeks of age) were not further stimulated to proliferate upon the addition of anti-mu. Such NZB B cells appeared to lack the requirement for a stimulation signal delivered by anti-mu in order to respond to B-cell growth factors. These results suggested that NZB cells were partially activated in vivo in the preautoimmune state so that subliminal triggers lead to full activation.

Retention of knowledge and self-care skills after an intensive in-patient diabetes education program

Diabetes knowledge and self-care skills were studied in 35 adults with IDDM and NIDDM before and after an intensive in-patient education program and 6-12 months after discharge. Knowledge and skills were compared to fasting serum glucose levels and percent ideal body weight (%IBW). Although knowledge improved during hospitalization and knowledge and skills were maintained at follow-up, there was not a significant relationship between fasting serum glucose levels and knowledge or self-care skills or %IBW.

Induction of antigen-specific proliferation in affinity-purified small B lymphocytes: requirement for BSF-1 by type 2 but not type 1 thymus-independent antigens

We report here the role of B cell stimulatory factors in the induction of antigen-specific proliferation of affinity-purified small B lymphocytes. TI-1 antigens such as TNP-LPS and TNP-BA induced proliferation of hapten-binding B cells in the absence of exogenous B cell stimulatory factors. TI-2 antigens such as TNP-Ficoll required the co-stimulator BSF-1 to induce antigen-specific proliferation, and this response could be augmented by IL 1. TD antigens such as TNP-OVA were unable to induce antigen-specific proliferation either in the absence or presence of B cell stimulatory factors, and showed an absolute activation requirement for carrier-specific helper T cells. No role for IL 2 or BCGF II could be found in the factor-dependent proliferative response of hapten-binding B cells to TI-2 antigens, either as primary co-stimulators or as modulators of the response obtained with TNP-Ficoll, BSF-1, and IL 1. In contrast, concentrations of IFN-gamma that were nontoxic for normal B cells and B cell hybrids effectively abrogated the proliferative response of affinity-purified cells to TNP-Ficoll, BSF-1, and IL 1. By all of these criteria, the B cell activation requirements of TI-2 antigens appear to be identical to those previously published for soluble anti-IgM antibodies.

Induction of antigen-specific proliferation in affinity-purified small B lymphocytes: requirement for BSF-1 by type 2 but not type 1 thymus-independent antigens

We report here the role of B cell stimulatory factors in the induction of antigen-specific proliferation of affinity-purified small B lymphocytes. TI-1 antigens such as TNP-LPS and TNP-BA induced proliferation of hapten-binding B cells in the absence of exogenous B cell stimulatory factors. TI-2 antigens such as TNP-Ficoll required the co-stimulator BSF-1 to induce antigen-specific proliferation, and this response could be augmented by IL 1. TD antigens such as TNP-OVA were unable to induce antigen-specific proliferation either in the absence or presence of B cell stimulatory factors, and showed an absolute activation requirement for carrier-specific helper T cells. No role for IL 2 or BCGF II could be found in the factor-dependent proliferative response of hapten-binding B cells to TI-2 antigens, either as primary co-stimulators or as modulators of the response obtained with TNP-Ficoll, BSF-1, and IL 1. In contrast, concentrations of IFN-gamma that were nontoxic for normal B cells and B cell hybrids effectively abrogated the proliferative response of affinity-purified cells to TNP-Ficoll, BSF-1, and IL 1. By all of these criteria, the B cell activation requirements of TI-2 antigens appear to be identical to those previously published for soluble anti-IgM antibodies.

Postponing sexual involvement among adolescents. An alternative approach to prevention of sexually transmitted diseases

Over 1,000 teenagers participated in the field test of an educational series designed to help them resist the social and peer pressures that can lead to early sexual involvement. A companion program for parents was designed to help adults better understand the pressures experienced by adolescents and aid the parents in reinforcing the information given to their children. Initial findings indicate skill building may be an important addition to the knowledge-based curriculum commonly used to prevent the spread of sexually transmitted disease among teenagers today.

Management of Acanthamoeba keratitis. A case report and review of the literature

A recalcitrant corneal ulcer resulted in an extensive corneal opacity requiring penetrating keratoplasty. Histopathologic studies and subsequent cultures established the diagnosis of Acanthamoeba keratitis. A second transplant was performed due to a culture-proven recurrence of the keratitis in both the recipient and the graft, with progressive thinning. This has remained clear for six months on systemic ketoconazole and topical miconazole drops. This case demonstrates the difficulty in initial diagnosis of Acanthamoeba keratitis and the apparent successful medical control of the infection despite transplantation into an infected recipient bed.

B cell growth and differentiation factors

The role of T lymphocytes in regulation of B cell responsiveness has been recognized for over a decade. Early studies assigned part of this regulation to a soluble product, initially designated T cell-replacing factor or TRF. Recently, investigators have discovered a level of factor complexity skillfully camouflaged by this simple term. Accordingly, the concept has now matured to encompass a battery of antigen non-specific, genetically unrestricted soluble factors which govern all aspects of B cell immunity: activation, proliferation, and differentiation. Here, we review our developing knowledge of this area. While many questions remain unresolved, there seems cause for optimism and a hope that increased understanding of these factors and their mode of action will eventually reveal the basis of B cell immunoregulation.

Cardiac function in alcoholics with cirrhosis: absence of overt cardiomyopathy--myth or fact?

Cardiomyopathy in alcoholics is considered to be associated with a low incidence of hepatic cirrhosis. To evaluate cardiac hemodynamics in alcoholic liver disease, left ventricular function in 37 patients with hepatic cirrhosis (group II) was compared with that in 13 normal subjects (group I) matched for age, sex and cardiac size. These groups were contrasted with group III, comprising 32 alcoholics without cirrhosis who had cardiac symptoms but no cardiomegaly or heart failure. Patients with cirrhosis as a group did not differ from normal subjects (group I) in terms of left ventricular filling pressure and cardiac muscle and pump function (cardiac index). However, subgroup IIA (n = 21) had a stroke index significantly less than normal, while subgroup IIB had a significantly increased stroke index and myocardial cardial contractility with a diminished systemic arterial resistance. Similar hepatic abnormalities were present in both subgroups. In group III, left ventricular end-diastolic and aortic mean pressures were significantly elevated compared with values in normal subjects, while cardiac index and indexes of ventricular contraction and relaxation were abnormal. Further examination of patients with cirrhosis indicated that the responses to volume or pressure increments in terms of the level of stroke work for a given filling pressure were most abnormal in group IIA, approximating those of group III. Thus, although overt cardiomyopathy is infrequent in patients with cirrhosis, asymptomatic myocardial disease may assume clinical importance during volume or pressure overload.

Interleukin 2 induces antigen-reactive T cell lines to secrete BCGF-I

Antigen-activated T lymphocytes produce within 24 h of stimulation a factor that is indistinguishable biochemically and functionally from the B cell co-stimulating growth factor, BCGF-I, originally identified in induced EL4 supernatants: Supernatants from antigen-stimulated T cell lines are not directly mitogenic for resting B cells, but synergize in an H-2-unrestricted manner with anti-Ig activated B cells to produce polyclonal proliferation but not antibody-forming-cell development; biochemical studies reveal the B cell co-stimulating factor present in antigen-stimulated T cell line supernatants is identical by phenyl Sepharose chromatography and isoelectric focusing (IEF) to EL4 supernatant BCGF-I. We thus conclude that normal T cells produce BCGF-I in response to antigenic stimulation. Analysis of the mechanism of BCGF-I production by antigen-stimulated T cells showed that optimum amounts of BCGF-I were obtained as quickly as 24 h post-stimulation, and that the factor producing cells in the T cell line investigated bore the Lyt-1+2- phenotype. As few as 10(4) T cells produced sufficient BCGF-I to support the proliferation of 5 X 10(4) purified anti-Ig activated B cells. Finally, the activation of normal T cell lines to produce BCGF-I required either antigen presented in the context of syngeneic antigen-presenting cells (APC) or interleukin 2 (IL-2).

Biochemical and physicochemical characterization of mouse B cell growth factor: a lymphokine distinct from interleukin 2

A subline of the C57BL/6 mouse EL-4 thymoma produces upon stimulation with phorbol myristate acetate (PMA) a B cell growth factor (BCGF) that co-stimulates anti-IgM-stimulated splenic B cells. The BCGF present in the EL-4 thymoma culture supernatants is shown to be distinct from IL 2 by a variety of chromatographic criteria. Untreated BCGF exhibits a heterogeneity of isoelectric points (pH 6.4 to 6.6, 7.4 to 7.6, 8.5 to 8.7) all of which are more alkaline than that of IL 2 (pl 3.5 to 4.8). Neuraminidase-treated BCGF exhibits a single major pl of 9.3 that is also distinct from similarly treated IL 2. Moreover, IL 2 and BCGF exhibit distinct monomeric m.w. by SDS gel electrophoresis under nonreducing conditions (IL 2 is 21,000; BCGF is 11,000 and 15,000). The biologic activity of IL 2 is sensitive to trypsin inactivation as is BCGF activity. Thus, BCGF and IL 2 appear to be biologically and biochemically distinct glycoproteins.

Biochemical and physicochemical characterization of mouse B cell growth factor: a lymphokine distinct from interleukin 2

A subline of the C57BL/6 mouse EL-4 thymoma produces upon stimulation with phorbol myristate acetate (PMA) a B cell growth factor (BCGF) that co-stimulates anti-IgM-stimulated splenic B cells. The BCGF present in the EL-4 thymoma culture supernatants is shown to be distinct from IL 2 by a variety of chromatographic criteria. Untreated BCGF exhibits a heterogeneity of isoelectric points (pH 6.4 to 6.6, 7.4 to 7.6, 8.5 to 8.7) all of which are more alkaline than that of IL 2 (pl 3.5 to 4.8). Neuraminidase-treated BCGF exhibits a single major pl of 9.3 that is also distinct from similarly treated IL 2. Moreover, IL 2 and BCGF exhibit distinct monomeric m.w. by SDS gel electrophoresis under nonreducing conditions (IL 2 is 21,000; BCGF is 11,000 and 15,000). The biologic activity of IL 2 is sensitive to trypsin inactivation as is BCGF activity. Thus, BCGF and IL 2 appear to be biologically and biochemically distinct glycoproteins.

Evidence for two distinct classes of murine B cell growth factors with activities in different functional assays

Several previously described B cell growth factor (BCGF) activities from a number of mouse monoclonal T cell sources were compared in different functional assays. The results indicate that there are two distinct classes of BCGF defined by functional activity and source. BCGF I, whose prototype is (EL4)BCGF, synergized with anti-Ig in the proliferation of normal splenic B cells but had no activity when dextran sulfate (DXS), rather than anti-Ig, was used to costimulate the same source of B cells. BCGF I also failed to directly stimulate BCL1 tumor B cells. In contrast, BCGF II, whose prototype is (DL)BCGF, showed a reciprocal pattern of activity. BCGF II failed to synergize with anti-Ig-costimulated normal B cells to give good proliferative responses. Sources of BCGF II also directly stimulated (no anti-Ig or DXS added) B cells of the BCL1 tumor-carrying mice. These results suggest that the two BCGF may have activity on two subsets of B cells that respond differentially to induction with the two polyclonal B cell activators, anti-Ig and DXS. The possibilities that these different patterns of response occur in separate lineages of B cells and/or in B cells in different states of differentiation is discussed.

T cell dependence and factor reconstitution of in vitro antibody responses to TNP-B. Abortus and TNP-Ficoll: restoration of depleted responses with chromatographed fractions of a T cell-derived factor

In vitro anti-trinitrophenyl (TNP) antibody responses to TNP conjugates of killed Brucella abortus organisms (TNP-BA), an antigen previously designated as a type 1 thymus-independent (TI-1) antigen, are markedly diminished after vigorous depletion of T cells, as are the responses to the type 2 TI (TI-2) antigen, TNP-Ficoll. We, therefore, propose that these antigens be redesignated as type 1 and type 2, respectively, to reflect their T cell dependence but to differentiate them from classical T cell-dependent (TD) antigens. T cell-depleted responses to type 1 and type 2 antigens can be restored by the addition of a) EL4 supernatant, b) phenyl-sepharose-purified fractions of EL4 supernatant that are rich in interleukin 2(IL2), and c) pl 4.5-5.5 isoelectric focused (IEF) fractions of EL4 supernatant which are also rich in IL2 activity. Removal of IL2 activity from EL4 supernatant by absorption on IL2-dependent T cells substantially reduced its restorative ability. Whether the active principle in EL4 supernatant activity responsible for restoring responses to type 1 and type 2 antigens is IL2, and whether it acts directly on B cells or by acting on contaminating T cells, is unresolved.

T cell dependence and factor reconstitution of in vitro antibody responses to TNP-B. Abortus and TNP-Ficoll: restoration of depleted responses with chromatographed fractions of a T cell-derived factor

In vitro anti-trinitrophenyl (TNP) antibody responses to TNP conjugates of killed Brucella abortus organisms (TNP-BA), an antigen previously designated as a type 1 thymus-independent (TI-1) antigen, are markedly diminished after vigorous depletion of T cells, as are the responses to the type 2 TI (TI-2) antigen, TNP-Ficoll. We, therefore, propose that these antigens be redesignated as type 1 and type 2, respectively, to reflect their T cell dependence but to differentiate them from classical T cell-dependent (TD) antigens. T cell-depleted responses to type 1 and type 2 antigens can be restored by the addition of a) EL4 supernatant, b) phenyl-sepharose-purified fractions of EL4 supernatant that are rich in interleukin 2(IL2), and c) pl 4.5-5.5 isoelectric focused (IEF) fractions of EL4 supernatant which are also rich in IL2 activity. Removal of IL2 activity from EL4 supernatant by absorption on IL2-dependent T cells substantially reduced its restorative ability. Whether the active principle in EL4 supernatant activity responsible for restoring responses to type 1 and type 2 antigens is IL2, and whether it acts directly on B cells or by acting on contaminating T cells, is unresolved.

Resuscitation in hypovolemia and shock: a prospective study of hydroxyethyl starch and albumin

In a prospective study comprising 50 patients, we evaluated the hemodynamic, pulmonary, renal and coagulation changes after resuscitation with 2 colloidal fluids, 6% hydroxyethyl starch (HES) and 5% albumin (ALB). Twenty-five patients studied in each group were well matched for age, clinical presentation, presence of shock and type of surgical procedures. A standard fluid challenge with 500 ml of either solution significantly (p less than 0.01) increased pulmonary artery wedge pressure (WP), mean arterial pressure (MAP) and left ventricular stroke work index (LVSWI) and decreased systemic vascular resistance index (SVRI). Increases in LVSWI of 43% to 68% over baseline in HES patients compared favorably to 15-22% increases in ALB patients. The cardiopulmonary variables at 12 and 24 h were comparable in both groups. Improvement in cardiac function was also reflected by better tissue perfusion as judged by reduction in arterial lactate from 2.9 to 1.5 mM/L (ALB) and 2.6 to 1.4 mM/L (HES). Increased O2 delivery and reduced O2 extraction without significant deterioration of PaO2 or alveolar-arterial O2 gradient were observed with stabilization of circulation. Clinical bleeding due to colloid resuscitation was not documented and renal function was not affected significantly by either fluid. It seems that HES may offer a cost-effective alternative to ALB for patients requiring colloid resuscitation.