Haemolytic uraemic syndrome with prolonged anuria and cortical calcification: a case report

An 18-month-old infant presented with haemolytic uraemic syndrome following a prodrome of colitis. Incomplete recovery of renal function occurred after 4 weeks of anuria and was associated with extensive renal cortical calcification. During the recovery phase he had two relapses of colitis, microangiopathic haemolytic anaemia and thrombocytopenia without any deterioration in renal function.

Effect of bezafibrate on the sequelae of acute experimental focal cerebral ischaemia

The possibility that the ability of bezafibrate to lower the oxygen affinity of haemoglobin might lead to an increased oxygen delivery to ischaemic cerebral tissue was explored in preliminary studies in two animal models. The combined morbidity and mortality of unilateral carotid ligation in the gerbil appeared to be reduced at two hours in bezafibrate treated animals. By four hours and thereafter the outcome was unaffected. Two hours after MCA occlusion bezafibrate-treated rats showed a significantly reduced rise in tissue lactate concentration (p less than 0.01) suggesting less anaerobic metabolism had occurred in the ischaemic tissue.

Do leukocytes have a role in the cerebral no-reflow phenomenon?

The possible role of leukocytes in the cerebral microcirculation following ischaemia was assessed in the gerbil. The no-reflow phenomenon seen after 30 minutes of severe bilateral hemispheric ischaemia during hypotensive reperfusion was compared in control animals and in a group made leukopenic by pretreatment with cyclophosphamide. Neither the incidence nor the severity of the no-reflow phenomenon differed between the two groups. The evidence from this study casts doubt on the hypothesis that leukocyte plugging plays a major role in the cerebral microcirculation's response to ischaemia.

Cytoproteic CSF findings in 33 MS patients: usefulness for diagnosis

Although multiple sclerosis (MS) is mainly defined on clinical grounds, CSF parameters still remain important diagnostic and scoring tools. To demonstrate the usefulness of some easy laboratory techniques, a CSF cytomorphological and agarose gel electrophoresis (AGE) evaluation was undertaken in 33 MS patients: 79% presented a lymphoid cell profile and in 73% the gamma globulin fraction was abnormal. In the great majority of cases (97%) either or both cytological and electrophoretical abnormalities were found.

Autoantibodies and immunogenetics in 30 patients with systemic sclerosis and their families

Clinical and serological evidence of connective tissue disease was found in a high proportion of 132 family members of 30 patients with systemic sclerosis. In 20 probands with the milder CREST form of the disease, 10 had HLA-DR5 and 12 had null alleles at the C4 loci. None of 11 probands with more severe systemic sclerosis had HLA-DR5; all 11 had null alleles at the C4 loci. All but two of the probands had either HLA-DR5 or a C4 null allele, and this was also the case for the majority of the relatives with autoantibodies. Genetic markers of the major histocompatibility complex, including HLA-DR5 and C4 null alleles, appear to be closely associated with markers of disease in these probands and their families.

Genetic susceptibility to scleroderma-like syndrome in symptomatic and asymptomatic workers exposed to vinyl chloride

We have previously reported a genetic susceptibility to a scleroderma-like disorder in a group of workers exposed to polyvinyl chloride and this susceptibility could be mapped to the major histocompatibility complex area of the 6th chromosome. To date no genetic studies have been reported comparing affected with unaffected workers. We report such data and discuss it in the light of our previous findings in vinyl chloride exposed patients and in patients with classical scleroderma. Our results suggest that susceptibility to this disorder is increased in the presence of HLA-DR5 or of a gene in linkage disequilibrium with it and an antigen associated with the haplotype A1 B8, while DR3 favours progression of the disease.

Effects of deoxyadenosine on the activation of ADA inhibited T & B cells

Using an in vitro model of adenosine deaminase deficiency, we have shown that the triggering of T lymphocyte proliferation by PHA is inhibited by concentrations of deoxyadenosine likely to occur in the plasma of ADA deficient children with severe combined immunodeficiency (ADA-SCID). Prostaglandin E1 increases the sensitivity of T cells to this inhibition, suggesting that derangement of cyclic nucleotide metabolism underlies the profound T lymphopaenia seen in ADA-SCID and in patients treated with the ADA inhibitor, deoxycoformycin. The proliferation and Ig synthesis of ADA inhibited B cells stimulated with protein A and EBV is in general less sensitive to the inhibitory effects of deoxyadenosine. However, this sensitivity varies widely between experiments suggesting that other cells present in the cultures may modify the inhibitory effect of deoxyadenosine. This may help explain the variability in B cell numbers and function in patients with ADA-SCID.

Immature B cells in fetal development and immunodeficiency: studies of IgM, IgG, IgA and IgD production in vitro using Epstein-Barr virus activation

Epstein-Barr virus has been used as a B cell mitogen to explore the parallels between the B cells found in patients with hypogammaglobulinemia and the immature B cells in fetal tissues. Peripheral blood lymphocytes from 29 cases of late onset hypogammaglobulinemia (common variable immunodeficiency) and from 10 cases of X-linked hypogammaglobulinemia were depleted of T lymphocytes and stimulated with virus in vitro. Immunoglobulin production was measured over a 4-week culture period using inhibition radioimmunoassays for IgM, IgG, IgA and IgD. The results were compared with those seen with fetal liver cells, cord blood lymphocytes and adult lymphocytes. Virus-stimulated cells from fetal sources produced small amounts of IgG and IgA relative to IgM, the ratio of IgM to IgG in the second week being in all cases greater than 10. Similar patterns were seen in 25/29 cases of late onset hypogammaglobulinemia, and in the eight cases of X-linked hypogammaglobulinemia that responded in vitro. In contrast, the ratio of IgM to IgG was always less than 8 in cultures of normal adult peripheral blood or bone marrow lymphocytes, and also in cultures from four cases of hypogammaglobulinemia known independently to have abnormal circulating suppressor cells. Eight cases of selective IgA deficiency showed reduced IgA production; six of these showed a normal ratio of IgM to IgG production. Thus, the B lymphocytes which circulate in many patients with hypogammaglobulinemia are functionally immature.

Glanzmann's thrombasthenia. A review and report of 42 cases from South India

In the 14 year period from June, 1966 to June, 1980, 42 cases of Glanzmann's thrombasthenia have been diagnosed, all fulfilling the criteria of prolonged bleeding time, with normal venous platelet count, defective clot retraction and decreased platelet aggregation, associated with a lifelong bleeding tendency. Few cases have been reported from India though it is the fourth most common congenital bleeding disorder among the patients seen at the Christian Medical College Hospital, Vellore. The large number of such cases found in South India as compared with reports from other parts of the world may be due to the high degree of consanguinity which is part of the accepted culture in this area. Reliable diagnosis of this condition is possible with fairly simple laboratory procedures.

Essential athrombia. A report on 4 cases from South India

Four cases of essential athrombia have been diagnosed in the 14 year period from June, 1966 to June, 1980 at the Coagulation Laboratory of the Christian Medical College Hospital, Vellore. All cases fit Inceman's description of the original case and fulfill the diagnostic criteria of prolonged bleeding time, decreased platelet aggregation, normal platelet count, normal morphology and normal clot retraction. No cases have been reported from India in the past 15 years.

Axo-dendritic abnormalities in a case of juvenile neuronal storage disease

Axonal enlargements (meganeurites) and dendritic degeneration were found in the pyramidal neurons from the frontal cortex of a patient with juvenile neuronal storage disease studied with the aid of ultrastructural and Golgi methods. Meganeurites appeared as enlargements at the axon hillock-initial segment area and were similar to those described in other neuronal diseases; dendritic degeneration was heavy and appeared throughout the cell domain. These neuropile changes can be related to the precocious mental abnormalities observed in this group of diseases which depend on a storage phenomenon due to a lysosomal enzyme deficiency.

Two cases of rapidly progressive subacute sclerosing panencephalitis. Neuropathological findings

Two cases of rapidly progressive subacute sclerosing panencephalitis that brought about coma in less than three weeks and death in less than two months are reported. The ultrastructural observations of brain biopsy specimens from these patients found unusual neuropathological findings. These uncommon features are discussed on a cliniconeuropathological basis.

Oligoclonal gamma-globulin of cerebrospinal fluid in neurobrucellosis

The clinical manifestations and laboratory findings of two cases of neurobrucellosis are described. The cerebrospinal fluid (CSF) protein electrophoresis showed increased gamma-globulins and decreased relative values of pre-albumin and albumin, associated to high values of total CSF protein. The evidence of oligoclonal morphology of CSF gamma-globulins suggests that part of them had an intrathecal origin, in addition to an increased crossing of the damaged blood-CSF barrier. Similar oligoclonal appearance of CSF gamma-globulins was observed in two additional cases of neurobrucellosis previously reported.