Circulating intercellular adhesion molecules-1 and autoantibodies including anti-endothelial cell, anti-cardiolipin, and anti-neutrophil cytoplasma antibodies in patients with vasculitis

Circulating intercellular adhesion molecule-1 (ICAM-1) and 3 types of autoantibodies were measured in 30 patients with angiographical or pathological proved vasculitis. There were 18 patients with systemic vasculitis and 12 patients with cutaneous vasculitis. The measured antibodies included anti-endothelial cell antibodies (AECA), anti-cardiolipin (ACL) antibodies of 3 isotypes and anti-neutrophil cytoplasma antibodies (ANCA). The results showed that patients with systemic vasculitis had elevated levels of ICAM-1, AECA and IgG isotype antibody as compared with none or lower in patients with cutaneous vasculitis. Levels of ICAM-1 and IgG isotype ACL antibodies also decreased significantly after disease activity subsided in patients with systemic vasculitis. Measurement of ICAM-1 and autoantibodies may be useful in evaluating the extent of involvement and in following the disease activity of patients with vasculitis.

Salbutamol in treatment of bronchial asthma--comparison of controlled release tablet with standard tablet

Salbutamol in controlled release tablet form was compared to salbutamol in standard tablet form for the management of patients with bronchial asthma. A total of twenty asthmatic patients enrolled in the study were classified into two groups, ten patients each, for a cross-over study. Group 1 received controlled release tablets for a 2 to 3 week period, and were then shifted to standard tablets for another similar period. Group 2 received standard tablets first and was then shifted to controlled release tablets. Patients were required to record symptom scores during therapy, including sleep disturbance, chest tightness, wheezing, cough, sputum production and inhalational bronchodilator use. Measurements of peak expiratory flow rate (PEFR) were also done, as well as record made of side effects experienced. The result showed that a lower symptom score was found in patients receiving controlled release tablets than in patients receiving standard tablets (p < 0.001 for sleep disturbance, p < 0.005 for sputum formation and p < 0.001 for total score). There was a higher PEFR in patients receiving controlled-release tablets than in patients receiving standard tablets (p < 0.001). Side effects with tremor were observed in 30% of both groups of patients with a slightly higher degree in the patients receiving standard tablets (statistically not significant). In conclusion, salbutamol of controlled release tablet form obtains a better therapeutic response than standard tablets in the management of patients with bronchial asthma.

Analysis of a new subtype of HIV-1 gag sequence from a case of vertical transmission in Taiwan

A Taiwanese woman who lived with a presumably bisexual man of German nationality, and her infant daughter were found to be seropositive for HIV-1. From DNA preparations of peripheral blood mononuclear cells of the mother-infant pair, we amplified a segment, about 560 base pairs (bp), of gag portion of HIV-1 provirus by using polymerase chain reaction (PCR). The high degree of homology (94.7-97.5%) among clones (TM-1 and TM-2 from the mother, and TC-1 and TC-2 from the infant) of gag sequence provided a molecular epidemiological evidence for vertical transmission. However, these sequences exhibited lower degrees of homology (85.1-87.0%) with the corresponding gag segment of a North American HIV-1 subtype (HXB2), and that of a Zairean HIV-1 subtype (Z2Z6). The disparity of sequences between these Taiwanese clones and those of HXB2 and Z2Z6 was particularly prominent in the first (5' proximal) 200 bp, as shown by the low degree of homology (74.8-79.6%) when sequences of TM and TC clones which represented the first 200 bp were compared with those of HXB2 and Z2Z6. The sequence dissimilarity of these clones as compared with HXB2 manifested as transitions more frequently than transversions. Transitions involving G/A to A/G changes were more frequent than those involving T/C to C/T. Transversions involving G/A to T/C changes were slightly more frequent than those involving T/C to G/A changes for all clones except for TM-2 which showed an equal frequency. Presence of stop codons in each of the reading frames of these clones suggests that these may represent defective viral quasispecies. The deduced amino acid sequences from available open reading frames of these clones showed also distinct dissimilarities to HXB2 or Z2Z6. These findings indicate the presence of a gag subtype of HIV-1 which, according to the phylogenetic tree analysis, would represent a new subtype distinct from other known subtypes.

Measurement of anti-endothelial and anti-cardiolipin autoantibodies and intercellular adhesion molecules-1 in patients with systemic and cutaneous vasculitis

Two types of autoantibodies and intercellular adhesion molecule-1 (ICAM-1) were measured in patients with vasculitis. There were 13 patients with systemic vasculitis, and 12 with cutaneous vasculitis. The measured antibodies included antiendothelial cell antibodies (AECA) and anti-cardiolipin (ACL) antibodies of three isotypes. Results showed that patients with systemic vasculitis had elevated levels of ICAM-1 and IgG isotype ACL antibodies. Higher levels of ICAM-1 and IgG isotype ACL antibody were found in patients with systemic vasculitis than in those with cutaneous vasculitis. Levels of ICAM-1 and IgG isotype ACL antibodies also decreased after disease activity subsided in patients with systemic vasculitis. Measurement of ICAM-1 and autoantibodies may be useful in evaluating the extent of involvement, and for following the disease course.

Acute pancreatitis related to anticardiolipin antibodies in lupus patients visiting an emergency department

Four patients with systemic lupus erythematosus visiting an emergency department were reported with clinical presentation of acute pancreatitis. All had high levels of anticardiolipin antibodies (aCL); at autopsy, one had multiple thrombi within the blood vessels of the pancreas. The aCL antibody might play an important role in the pathogenesis of acute pancreatitis. Three patients had multiple organ involvement, especially the central nervous system, concomitant with an acute attack of pancreatitis; all died from these complications. Thus it was suggested that initial acute pancreatitis is an omnious prognostic factor in lupus patients visiting an emergency department. When evaluating lupus patients visiting an emergency department, clinicians should be alert to the status of aCL and the possibility of pancreatitis in these patients.

Thyroid disorders in Chinese patients with systemic lupus erythematosus

To clarify the prevalence of thyroid disorders in Chinese patients with systemic lupus erythematosus (SLE), 45 SLE patients not receiving corticosteroid therapy for at least 6 months were selected over a period of 1 year. They were investigated by utilizing thyroid ultrasonography and by determinations of thyroid antibodies and thyroid function. Of these patients, 24 (53.3%) showed abnormal sonographic findings. Thyroid antibodies (microsomal and/or thyroglobulin) were detected in 21 patients (46.7%), but a low index of thyrotropin-binding inhibitory immunoglobulin (TBII) was found in only one euthyroid patients with a normal echogram. Ten patients (22.2%) had abnormal thyroid function. The mean disease duration was longer in patients with thyroid anomalies (p < 0.05). Hashimoto's thyroiditis was found in four patients (8.8%), two of whom had hypothyroidism. We concluded that thyroid anomalies are frequently found in patients with SLE in the area of this study. The possibility of the coexistence of thyroid disorders in systemic lupus erythematosus should be carefully considered throughout the course of patients' follow-up, especially in those with a long disease duration.

Plasminogen activation activity of urokinase determined via a cascade enzymatic reaction system

A method for determining the plasminogen activation rate by urokinase via a cascade enzymatic reaction system is presented. A procedure of parameter estimation has been proposed for the determination of the activity of urokinase and the kinetic constants. Urokinase from urine has been successfully assayed through use of a plasminogen concentration lower than its saturating level. The methodology presented in this work may be adopted for the analysis of other cascade enzymatic reaction systems.

Myopathy associated with human immunodeficiency virus infection: report of a case

Neuromuscular manifestations, including a variety of peripheral neuropathies and myopathies, can occur either as isolated clinical phenomena or concurrently with other clinical manifestations, and are common in acquired immunodeficiency syndrome (AIDS). A 33-year-old male patient had a four-year history of increasing proximal muscle weakness of the extremities. Elevated muscle enzymes, a muscle biopsy and interstitial lung disease all suggested a diagnosis of polymyositis with lung involvement. However, a transbronchial lung biopsy revealed Pneumocystis carinii pneumonia, and serology for HIV infection disclosed positive results. Zidovudine and cotrimoxazole were instituted and the patient improved. HIV-associated myopathy should be considered by practicing clinicians in cases presenting with myopathy, since the number of patients with HIV infection is increasing in Taiwan.

Non-excretory myeloma with diffuse osteolytic lesions caused by tumor necrosis factor: report of a case

A 63-year-old male patient was admitted to the hospital after a six-month complaint of low back pain. Anemia, hypercalcemia and 5 to 18% giant abnormal binucleated plasma cells infiltrations in the bone marrow suggested a diagnosis of multiple myeloma. However, repeated serum and urine immunofixation electrophoresis failed to demonstrate any abnormal monoclonal band. Diagnosis of non-excretory myeloma was verified by immunocytochemical stains demonstrating intracellular kappa chain in these neoplastic cells. Some authors have claimed that there were fewer bone lytic changes, less bone marrow infiltration, more preservation of normal immunoglobulin but with more neurological presentations among non-excretors. However, this patient had severely generalized bone lytic lesions and high serum level of tumor necrosis factor. The former might be attributed to the latter. Literatures about multiple myeloma and the tumor necrosis factor are also reviewed.

Circulating intercellular adhesion molecule-1 and lymphocyte subsets involved in immune response of breast cancer

To understand the immune responses of patients with breast cancer, circulating intercellular adhesion molecules-1 (ICAM-1) and lymphocyte subsets were measured in patients with breast cancer and in healthy persons. There were 10 patients of with metastasis, 11 patients breast cancer without metastasis and 9 age-and-sex matched healthy persons. Their serum samples were counted for circulating ICAM-1 levels, and blood cells were calculated for lymphocyte subpopulation including CD3, CD4, CD8 and CD19 by using flow cytometry. Higher levels of circulating ICAM-1 were noted in patients with breast cancer and metastasis than those without metastasis (p < 0.01). Lower percentage of CD8 lymphocyte subset were found ih patients with breast cancer and metastasis than those without metastasis (p < 0.05). Shedding of ICAM-1 antigens from the tumor may block the attachment of cytotoxic T cells, and decreased numbers of cytotoxic T cells may be unable to inhibit the spread of cancer cells. Immune responses of patients with breast cancer may be different between metastatic status and limited status. Further investigations should correlate the results of tissue stains of breast cancer with ICAM-1 and lymphocyte markers with those from peripheral blood.

Successful treatment of Kaposi's sarcoma with interferon-alpha in a patient with acquired immunodeficiency syndrome

Although combined therapy with interferon-alpha and zidovudine may be safely administered to some patients with the acquired immunodeficiency syndrome (AIDS) and Kaposi sarcoma, no ethnic Chinese patient has been successfully treated before in this area. This case report concerns a 47-year-old male with a history of bisexuality who had suffered from oral ulcers for half a year, Human immunodeficiency virus (HIV) serology was positive, and pathology of the oral ulcers disclosed Kaposi sarcoma. Combination therapy with zidovudine and interferon-alpha was initiated. The patient received a low-dose regimen of 5.0 million U interferon-alpha s.c. per day for 8 weeks and 5 million U twice a week for another 8 weeks. The oral ulcers faded away without recurrence. This report also reviews the literatures on treatment of AIDS-related Kaposi sarcoma with interferon.

Monoclonal gammopathies and the related autoimmune manifestations in Taiwan

A total of 50,000 patients were surveyed for the presence of monoclonal immunoglobulins during the past two decades. There were 411 cases of monoclonal gammopathies including 243 cases of plasma cell neoplasms and 168 cases of secondary plasma-cell dyscrasia. Among the 227 cases of multiple myeloma and Waldenström's macroglobulinemia, there were 49.3% IgG class, 22.9% IgA class, 9.7% IgM class and 13.2% light chain type. In addition, there were 1.3% of nonexcretory myeloma including an IgM type. A relatively high frequency (4.8%) of IgD M-proteins was detected but heavy chain disease was not encountered in the present series. Purified M-components from patients with possible autoimmune manifestations were subjected to immunofluorescence studies. Autoimmune activity of M-proteins was found in a patient of Waldenström's macroglobulinemia with peripheral neuropathy, and another patient of cryofibrinogenemia with recurrent purpura and gangrene. In conclusion, a high frequency of IgD myeloma is found in Chinese patients of this area. M-components may have autoimmune activity resulting in unusual clinical manifestations.

Anticardiolipin antibodies and interleukin-6 in cerebrospinal fluid and blood of Chinese patients with neuro-Behçet's syndrome

Anticardiolipin antibodies of the IgG, IgM and IgA isotypes and soluble IL-6 were measured in paired serum and cerebrospinal fluid samples from five patients with neuro-Behçet's syndrome. Another five patients with non-inflammatory neurological diseases were also studied as a control group. Anticardiolipin antibodies, especially the IgM isotype, and IL-6 were highly elevated in the cerebrospinal fluid of patients with neuro-Behçet's. Levels of both IgM isotype anticardiolipin antibodies and IL-6 in the cerebrospinal fluid dropped after disease activity subsided. These results suggest that the increase in IgM isotype anticardiolipin antibodies and IL-6 in cerebrospinal fluid may be involved in the immune response of neuro-Behçet's within the central nervous system. Serial measurements of IgM isotype anticardiolipin antibodies and IL-6 in the cerebrospinal fluid may be useful in evaluating disease activity in neuro-Behçet's.

Autoantibodies and related immunity of leprosy patients from leprosarium in Taiwan

Autoantibodies and related immunological examinations were measured in 60 leprosy patients from a leprosarium in Taiwan. Thirty-one lepromatous type, 24 tuberculoid type and 5 borderline type patients were identified. The measured autoantibodies included antinuclear antibodies, anti-nDNA, anti-cardiolipin and rheumatoid factor. Serum protein electrophoresis and immunofixation were also performed to detect the monoclonal and polyclonal status of immunoglobulins. Circulating immune complex and complements were also quantitated. Delayed type skin tests were performed during patients' visits. A higher frequency of autoantibodies, especially the antinuclear antibodies and anticardiolipin antibodies, were detected in lepromatous type patients. Higher levels of circulating immune complex and frequency of polyclonal and monoclonal gammopathy were also noted in lepromatous type patients. Anergy skin tests were only noted in lepromatous type patients. It was concluded that the more impared cell-mediated immunity in leprosy patients, with lepromatous type in particular, the greater the production of autoantibodies.

Increased production of interleukin-6 and autoantibodies in patients with Sjögren's syndrome

The occurrence of autoantibodies including antinuclear antibody, anti-nDNA, anti-Sm, anti-RNP, anti-SSA, anti-SSB, anticardiolipin (aCL) antibody, M-Proteins, and interleukin-6 (IL-6) and circulating immune complex (CIC) were studied in 18 patients with primary Sjögren's syndrome (SS) and 20 patients with secondary SS. Another 15 healthy individuals were served as a control group. The differences between primary and secondary SS in these autoantibodies, IL-6 and M-protein were also compared. The result showed a high incidence of autoantibodies and CIC in patients with SS. Higher frequencies of anti-nDNA and anti-Sm antibodies were noted in patients with secondary SS. There were also elevated levels of IL-6, much higher in primary than in secondary SS. In addition, higher frequencies of M-protein were detected in patients with primary SS. In conclusion, through immune dysregulations, higher levels of IL-6 were found in patients with SS. Autoantibodies produced in these patients might be derived from IL-6 stimulated B cells.

Pancreatitis related to antiphospholipid antibody syndrome in a patient with systemic lupus erythematosus

A 39-year-old woman was admitted with abdominal pain and dyspnea, and a diagnosis of systemic lupus erythematosus with renal involvement was established. Laboratory tests revealed highly elevated anticardiolipin antibody, thrombocytopenia and false positive VDRL. Generalized thrombus formation and Libman-Sacks endocarditis were found at postmortem examination. The pancreas showed chronic inflammation with thrombi in pancreatic arteries, but no vasculitic change was observed. Lowering of pancreatic blood flow because of arterial thrombi was a possible cause of pancreatitis in this patient. The spectrum of antiphospholipid antibody associated diseases may be extended to include pancreatitis as a thrombotic complication.

Status and trend of HIV-1 infection and AIDS in Taiwan, December, 1991

From May 1, 1985 to December 31, 1991, a total of 4,962,707 serum samples from 8 population groups in Taiwan were tested for anti-human immunodeficiency virus type 1 (anti-HIV-1). In total, 256 samples were seropositive; of these individuals, 43 developed acquired immunodeficiency syndrome (AIDS): 29 were homosexuals; 5 were hemophiliacs; 8 were heterosexuals and 1 was of unknown risk. Although the prevalence of HIV-1 infection and AIDS remains low compared with other countries, since 1988 the increase has been rapid. Before 1977 the majority were homosexuals and hemophiliacs; thereafter the risk groups diversified, with a trend away from homosexuals and hemophiliacs towards heterosexuals and intravenous drug abusers (IVDAs). A few patients have caused serious social problems for the public, health care workers and families. Active community efforts are needed to achieve future success in the control of HIV-1 infection and AIDS in Taiwan.

Immunochemical characterization and therapeutic effect of house dust extract in bronchial asthma

The immunochemical characteristics of house dust extract used in hyposensitization were studied by SDS-polyacrylamide gel, isoelectrofocusing, counterimmunoelectrophoresis and Western blot. The gel electrophoregram and isoelectrofocusing plate demonstrated a complex mixture of acid proteins with molecular weights ranging from 56 to 12 KD and isoelectric point distributing from 4.6 to 5.6. The counterimmunoelectrophoresis revealed as many as five precipitating bands in sera from 60% asthmatic patients after hyposensitization. The Western blot showed heterogeneous IgE reaction bands varied from 45 to 22 KD, including a strong 27 KD reaction band found in 40% of the asthmatic patients not receiving hyposensitization. The efficacy of house dust extract hyposensitization was evaluated in 102 asthmatic patients, followed up at the Allergic Clinic since 1980. There were 42 malea and 60 females with a mean age of 30.8 (16 to 60), and the total follow-up patient-year was 512.6 with a mean of 5.0 year per patient (1 to 11). Complete remission of asthmatic symptoms and medication was found in 5% patients, and 12% patients had little or no improvement. The majority of patients (83%) had improvement in asthmatic symptoms and medication dosage. The average serum IgE levels and total eosinophil count dropped significantly after hyposensitization (p < 0.001). In conclusion, the immunochemical characteristics of house dust extract were analyzed and mite allergens, especially Group I antigens, may be the important constituents. Good therapeutic effect, both clinically and with laboratory evaluation, was obtained with more than 80% of the asthmatic patients achieving improvement under house dust hyposensitization.

Biclonal gammopathy--report of a case with primary gastrointestinal lymphoma

A 61-year-old female patient had had abdominal pain for two months; primary gastrointestinal lymphoma of diffuse, large cell type histology was diagnosed. Bone marrow study was negative. Bimodal gamma globulin was found on serum protein electrophoresis. Immunoelectrophoresis and immunofixation confirmed the nature of biclonal gammopathy with a fast-migrating IgM-kappa band and a slow-migrating IgG-kappa band. Biclonal gammopathy is unusual, and only rarely have cases been reported. The immunologic and molecular implications of biclonal gammopathy are discussed.

The diagnostic value of IgM to natural trisaccharide phenylpropionyl bovine serum albumin in leprosy patients: a preliminary report from Taiwan

An evaluation was made of the serum anti-phenolic-glycolipid-I (PGL-I) IgM levels of leprosy patients in the Taiwan area by enzyme-linked immunosorbent assay (ELISA) with a specific synthetic PGL-I antigen and natural trisaccharide phenylpropionyl bovine serum albumin (NT-P-BSA). Fifty-five blood samples were collected from 24 tuberculoid and 31 lepromatous leprosy patients and 21 healthy age- and sex-matched subjects. Among these groups, lepromatous patients had the highest levels of IgM and anti-NT-P-BSA IgM with a good correlation between these two levels (p less than 0.01). Tuberculoid patients also had higher levels than normal subjects. Wide variation in the standard deviation and decreased levels within the cutoff value of some lepromatous patients may be due to various periods of anti-leprosy treatment. Serial anti-NT-P-BSA IgM assessments in response to anti-leprosy treatment may provide more information and serve as a guideline for therapy.

Anticardiolipin antibodies in patients with acute myocardial infarction

Fifty-six consecutive patients, 53 males and 3 females aged from 36 to 83 with a mean age of 61.0, all with acute myocardial infarction (AMI), were screened for anticardiolipin antibodies (ACA) by single sampling at time of admission to the medical intensive care unit; results were compared with those for age-matched, healthy controls. IgM and IgG-ACA were measured by an enzyme-linked immunosorbant assay technique. IgG-ACA were detected in 9 patients (16.1%); IgM-ACA were detected in 9 patients (16.1%). Only one of the patients had raised ACA of both isotypes. There was on difference in either ACA levels or frequency of ACA elevation between patients and controls. Risk factors of coronary artery disease showed no significant difference between patients with and without ACA. Low titer of IgG-ACA was found in one of ten patients with reinfarction and/or previous cerebral infarction. In conclusion, single measurements of anticardiolipin antibodies in general AMI patients are unlikely to yield diagnostically important information. The implication of occasional significant elevation of such antibodies in a general AMI population remains to be speculated.

Changes in T-lymphocyte subpopulations in patients splenectomized for trauma

Surface markers of peripheral mononuclear cells, using a monoclonal antibody, were characterized, and the serum immunoglobulins (IgG, IgM, IgA) as well as complement proteins (C3, C4) were determined in 20 adult patients with splenectomy because of trauma. A similar analysis was performed on 20 healthy individuals and the results compared. The average interval from splenectomy to testing was two years. The percentages of total T-cells (CD3), T-helper cells (CD4), and T-suppressor cells (CD8) were reduced in all subjects the splenectomized, but the results were statistically significant only for the CD4 cells (p less than 0.01). The proportion of B-cells (OKB7) showed no difference in either group. However, the ratio of CD4/CD8 cells was significantly decreased in splenectomized subjects (p less than 0.05). Measurement of serum immunoglobulins (IgG, IgA, IgM) and complement proteins (C3, C4) revealed no significant differences between the two groups. These data suggest that healthy adults undergoing splenectomy for trauma have a specific and persistent immunological deficit. Our results suggest that a more cautious and conservative attitude toward the splenic trauma should be adopted.

Diagnostic value of measuring BCG sonicate antigen and anti-BCG antibodies in the cerebrospinal fluid and blood of patients with tuberculous meningitis

Fourteen cerebrospinal fluid (CSF) and paired blood samples were obtained from patients with tuberculous meningitis, seven with positive culture and seven clinical/laboratory diagnosis. Another 14 paired specimens served as control, including 7 infectious meningitis and 7 non-inflammatory neurological diseases. Four groups were thus classified, including confirmed and suspected patients, and controls with infectious meningitis and neurological diseases. Measurements of Bacillus Calmette-Guérin (BCG) sonicate antigen and IgG antibody were performed using enzyme-linked immunosorbent assay. Generally, CSF BCG sonicate antigen level and anti-BCG sonicate antibody of patients with tuberculosis meningitis were higher than in control groups; greater antigen levels were found in confirmed patients than in non-inflammatory subjects (p less than 0.05), and in suspected patients than in infectious and non-inflammatory subjects (p less than 0.05 and p less than 0.01). For serum anti-BCG sonicate levels, confirmed patients had higher antibody value than non-inflammatory subjects (p less than 0.05). To conclude, detection of high levels of both BCG sonicate antigen and antibody in CSF and blood samples shows great value in the diagnosis of tuberculous meningitis. However, given the limited samples of the current research, more data are needed to elucidate the sensitivity and specificity of such tests.

Intrathecal anti-myelin basic protein antibody production in Chinese patients with multiple sclerosis

Cerebrospinal fluids and paired serums from 23 patients with multiple sclerosis (MS) were studied for intrathecal synthesis of oligoclonal band and antimyelin basic protein (MBP) antibody. Three parameters for anti-MBP antibody were designed to represent three different pathophysiological meanings, including value, index and ratio of anti-MBP antibody. Oligoclonal band was detected by agarose gel electrophoresis in 23 MS patients, and anti-MBP was assayed by enzyme-linked immunosorbent assay in 11 MS patients to investigate these anti-MBP parameters in MS group and non-inflammatory control group. The anti-MBP assay revealed that intrathecal anti-MBP antibody production was increased during active stage of MS. However, anti-MBP antibody production correlated poorly with the IgG index, nor was it conspicuously higher than IgG production. This might imply that, except for MBP, still other protein components are involved in this immune process.

Continuous methacholine inhalation provocation with resistance monitoring in asthmatic patients

Continuous methacholine inhalation with simultaneous bronchial resistance monitoring was performed in 15 controls and 26 asthmatic patients. The subjects were in quiet tidal breathing, and the airway resistance measured by forced oscillation method were continuously recorded with X-Y recorder. The mean airway resistance of the asthmatic patients was higher than that of the control group, so was the conductance of the asthmatics lower than that of the control. All the asthmatics were responsive to the methacholine test, while only two controls had the response. No correlation could be obtained between bronchial reactivity and sensitivity, but the bronchial sensitivity was correlated with serum total IgE (r = 0.448; p less than 0.05), and suggest that the higher the IgE is, the more sensitive the asthmatic patients respond to methacholine. Continuous methacholine provocation is useful in the diagnosis of bronchial asthma and is more safe and time-saving compared with conventional intermittent method.

Evaluation of host defense in critically ill patients in medical intensive care unit

Thirty three patients, 24 male and 9 female, aged from 19 to 90 with an average of 58.8, were admitted to the medical intensive care unit (ICU) from 1988 December to 1989 December. Their host defenses were evaluated. Cell-mediated immunity (CMI) included delayed type skin test (MULTITEST CMI), total lymphocyte count and lymphocyte subpopulations (CD3, CD4 and CD8) were determined. Investigation of humoral immunity (HI) included use of serum levels of immunoglobulins (IgG, IgA and IgM) and complements (C3 and C4). Episodes of nosocomial infection were documented by patients' clinical and laboratory data, including positive culture. The CMI, especially for total lymphocyte count, T lymphocyte count and skin test, was impaired by underlying diabetes mellitus and such associated conditions as malnutrition, steroid administration and surgical procedures. The longer the admission period, the lower was the CMI including total lymphocyte count, CD3 percentage, CD4 percentage and skin test response. The HI was less impaired by underlying conditions and not influenced by admission duration. More infection episodes were found in patients with longer admission duration. In conclusion, the host defense was impaired in patients hospitalized longer in medical ICU, and the combination of compromised immunity and impaired mucocutaneous barriers made them more susceptible to infections.

Low oxygenation index and pulmonary artery hypertension in predicting early death from adult respiratory distress syndrome (ARDS)

Hemodynamic and respiratory parameters were continuously monitored in 45 septic shock patients, 15 of whom developed adult respiratory distress syndrome (ARDS). Low oxygenation index (OI = PaO2/FIO2), pulmonary artery hypertension (high mean pulmonary artery pressure, MPAP) and elevated pulmonary vascular resistance (PVR) were observed in all ARDS, as well as in non-ARDS septic patients, as a baseline. These same pulmonary factors were compared between those who survived and those who died during the first few days (early fatalities) in both the ARDS group (5 patients) and the non-ARDS group (8 patients). The results showed that the early fatalities in the ARDS group had a significantly lower (p less than 0.001) OI than the survivors, as well as a lower MPAP (p less than 0.01). In the non-ARDS group, the MPAP of the early fatalities was significantly lower (p less than 0.01) than that of survivors, but their OI was not significantly lower. PVR, when compared between groups (ARDS versus non-ARDS) or between subgroups within each group, was elevated concurrently with the elevation of MPAP. It is concluded that patients with septic shock and ARDS who show a severely depressed OI and a modestly elevated MPAP and PVR during the first few days can be predicted to have a poor outcome.

Improvement of systemic absorption of insulin through eyes with absorption enhancers

A painless, simple, and practical method has been developed for systemic delivery of peptide drugs through eyes. In order to increase the amount of peptides absorbed into systemic circulation, effects of enhancers on insulin absorption into systemic circulation and reduction of blood glucose concentration have been studied. Saponin showed the highest potency to enhance insulin absorption, while Tween 20 was the least effective. The efficacy order of seven compounds studied can be arranged as follows: saponin greater than fusidic acid greater than BL-9 = EDTA greater than glycocholate = decamethonium greater than Tween 20. Since 1% of saponin reached the maximum effect to enhance insulin absorption and decrease blood glucose concentration, not more than 1% of saponin should be used for enhancing peptide absorption through eyes.

Evaluation of humoral immunity on leprosy patients in Taiwan: a preliminary report

Twenty-four tuberculoid (T)-type and 31 lepromatous (L)-type leprosy patients from Taiwan Provincial Lo-Sheng Leprosarium were enrolled in this study. Twenty-six age- and sex- matched normal subjects were also studied as a control group. The evaluation of their general and specific humoral immunity included B-cell subpopulations, 3 major classes of immunoglobulin (G, A and M) and antibodies in the IgG class against lepromin suspension and Bacillus Calmette-Guerin (BCG) sonicate. T-type patients showed a larger B-cell percentage than L-type patients (p less than 0.01). In general, patients with leprosy, both T and L types, had higher serum immunoglobulin levels than the control group. T-type patients showed greater antibody levels than the control group (p less than 0.05 for anti-lepromin and p less than 0.0001 for anti-BCG). L-type patients demonstrated a higher anti-BCG IgG level than the control group (p less than 0.0001). The level of anti-BCG IgG was more frequently above the cutoff level than that of anti-lepromin IgG in leprosy patients (p less than 0.01 for T, p less than 0.005 for L). In conclusion, humoral immunity is not impaired in leprosy patients. Discrepancies for T- and L-type patients among B-cell subpopulation, serum immunoglobulin levels and specific antibody levels reflect different aspects of cell-mediated immunity impairment. Though leprosy patients had elevated anti-BCG IgG levels, it is impossible to differentiate L- and T-type patients; specific antigens are needed for serodiagnosis of leprosy patients in Taiwan.

Enzyme-linked immunosorbent assay with BCG sonicate antigen for diagnostic potential of mycobacterial infection in Taiwan

The diagnostic potential of enzyme-linked immunosorbent assay (ELISA) with Bacillus Calmette-Guerin (BCG) sonicate antigen for detection of mycobacterial infections, including pulmonary tuberculosis and leprosy, has been evaluated in Taiwan area. One hundred blood samples were collected from 74 active and 26 inactive pulmonary tuberculosis patients of the Taiwan Provincial Tuberculosis Control Bureau. Another 50 samples were collected from 24 lepromatous, 23 tuberculoid and 3 borderline leprosy patients at the Taiwan Provincial Lo-Sheng Leprosarium. The IgG anti-BCG sonicate levels were compared among patients with tuberculosis, active or inactive, patients with leprosy, and healthy individuals. Patients with tuberculosis, both active and inactive, and those with leprosy had higher BCG sonicate antibody levels and frequencies above cutoff value than healthy subjects (for BCG-sonicate antibody, p less than 0.05 for inactive tuberculosis, p less than 0.0001 for others; for frequency above cutoff, p less than 0.001 for inactive tuberculosis, p less than 0.0001 for others). Among the three groups of patients, significant differences were noted in anti-BCG sonicate antibody level, and there was no difference of frequency above the cutoff value (i.e. inactive tuberculosis had lower level than active tuberculosis and leprosy, p less than 0.005). In conclusion, ELISA with BCG sonicate antigen could serve as a diagnostic aid for mycobacterial infection in Taiwan. However, it was not possible to differentiate disease activity in tuberculosis, or to discriminate infectious species of mycobacteria. Purified mycobacterial antigens should be tried in further research to improve the specificity and sensitivity in serodiagnosis with ELISA.

[AIDS and the oral cavity]

The oral cavity is the site for a number of diseases associated with an infection of the human immunodeficiency virus. Often the oral lesions may appear before the establishment of an AIDS diagnosis; and occasionally, the diagnosis may depend solely on the oral manifestations. The most commonly reported oral infections are those caused by Candida albicans and the herpes simplex virus. Hairy leukoplakia, a newly described lesion, may also be of viral origin. Kaposi's sarcoma is the most frequently reported oral malignancy in patients with AIDS. Oral squamous cell carcinoma and non-Hodgkin's lymphomas have also been reported.

Systemic delivery of insulin through eyes to lower the glucose concentration

An attempt has been made in this study to develop a simple, economical and painless method for the delivery of insulin systemically without using parenteral routes. Insulin was shown to be absorbed effectively into systemic circulation through the eyes. With 0.125% (0.031 mg/25 microliters), 1% (0.25 mg/25 mg/25 microliters) insulin instilled topically into the eyes, systemic blood concentrations of 1.3 ng/ml, 9 ng/ml, and 24 ng/ml, respectively, could be attained. When 25 microliters of 1%, 2% and 5% insulin plus 1% saponin solution were instilled into eyes they reached 63 ng/ml, 89 ng/ml and 195 ng/ml, respectively in the systemic circulation. These results indicate that the systemic absorption of 1% insulin through the eyes can be enhanced at least 7-fold when 1% of the surfactant, saponin, was added to the solution. However, the insulin absorption was not affected by aminopeptidase inhibition nor by the change of pH in the range of 5 to 8. Most importantly, the blood glucose was reduced concomitantly with the increase of blood insulin when 50 microliters of 1% insulin in 1% saponin solution was instilled in the eyes. The blood glucose of alloxan-treated diabetic animals reduced drastically from 370 mg % to 185 mg % in 90 min and further to 75 mg % in another 150 min. In normal animals, 25 microliters of 1% insulin in 1% saponin reduced blood glucose from 102 mg % to 50 mg % in an hour and blood glucose remained low for at least 3 hrs. These results indicate that insulin can be delivered systemically through the eyes, particularly with the surfactant enhancers, such as saponin. This new method is economical and simple as compared with parenteral administration and/or minipump implantation. It is hoped that this new method would improve patients' compliancy in using insulin for diabetes treatment.

Serum interleukin-2 receptor in systemic lupus erythematosus and rheumatoid arthritis

Interleukin-2 receptor (IL-2R) is expressed on activated lymphocyte after stimulation with antigen or interleukin-2 (IL-2), meanwhile soluble form of the receptor is released. Using enzyme-linked immunosorbent assay, serum IL-2R levels were determined in 34 healthy controls, 61 patients with systemic lupus erythematosus (SLE) and 32 patients with rheumatoid arthritis (RA), yielding mean +/- SD values of 355 +/- 89, 807 +/- 453 and 567 +/- 210 U/ml respectively. In both SLE and RA patients, the active disease group had more markedly elevated serum IL-2R levels compared with those of the inactive group. In patients with SLE, elevated serum IL-2R is associated with lymphopenia, renal disorders, decreased C3 level and increased anti-DNA, thus make it a good parameter to monitor disease activity in SLE.

Waldenstróm's macroglobulinemia with peripheral neuropathy--the role of IgM M-protein in autoimmune mechanism

A total of 11 cases of Waldenstróm's Macroglobulinemia (WM) have been investigated to study the association of the disease with neuropathy. A 53-year-old female patient (Wu) had a pronounced peripheral neuropathy, in which the role of IgM M-protein could be observed. Sections of Wu's biopsied sural nerve were subjected to light and electron microscopy and direct immunofluorescence (IF). Myelin degeneration with axonal change was found, while fluorescence reaction occurred in epineurium only. Sections of a healthy dog's sciatic nerve were submitted to purified IgM M-proteins from Wu and another WM patient (Kon) without neuropathy, respectively. Indirect IF showed a deposit of fluorescence on the myelin sheath by Wu's, but not by Kon's, M-proteins. It is proposed that an autoimmune mechanism underlies the peripheral neuropathy in the WM patient.

Treatment of hypoglycemia with glucagon eye drops

Glucagon is useful in the treatment of insulin-induced hypoglycemia when dextrose tablet, paste, or solution is not available. A prolonged hypoglycemia might lead to irreversible coma. Although injection of glucose or glucagon will correct the hypoglycemia, the patients are usually unable to handle it by themselves in such an occasion. A new method has been developed in this study to administer glucagon through the eyes as eye drops. Glucagon at 0.2% raised the blood glucose effectively to 204 mg % from 104 mg % in 30 min, came down to 116 mg % in 2 hrs, and remained at the same level for the rest of the experiments. In contrast, a therapeutic dose of glucagon (50 micrograms/3 kg i.v.) increased the blood glucose concentration rapidly to reach 235 mg % from 125 mg % at 30 min then reached the bottom at 120 min after the injection. At 1%, glucagon raised the blood glucose concentration to 248 mg % from 103 mg % in 30 min and remained high for another 60 min. It declined gradually to reach 120 mg % in 6 hrs. At 5%, glucagon raised the blood glucose concentration quickly to 276 mg % from 130 mg % in 60 min and remained high for the next 90 min and then declined gradually to reach 160 mg % at the end of 6 hr experiment period. These results suggest that a sufficient amount of glucagon can be absorbed rapidly into systemic circulation to raise blood glucose concentrations.

Systemic delivery of enkephalin peptide through eyes

Leu-enkephalin is one of the important peptides which could become useful drugs in the clinics because of its analgesic action and its availability in mass quantity through biotechnology production. It is found in this study that enkephalin can be effectively absorbed systemically through eyes without using a surfactant as absorption enhancer. Enkephalin at 0.125% (31.25 micrograms/25 microliter) reached a plateau of blood concentration at 11.5 ng/ml in 3-4 hrs and stayed high for 8-9 hrs. In contrast, the blood concentration of enkephalin declined rapidly after i.v. administration with a T1/2 of less than 30 min and reached the lowest point at 22 ng/ml in 5 hrs. With higher concentrations at 1% (.25 mg/25 microliter) and 5% (1.25 mg/25 microliter) similar absorption kinetics was observed except that they reached higher plateau of blood concentration at 72 ng/ml and 233 ng/ml, respectively.

Systemic delivery of polypeptides with molecular weights of between 300 and 3500 through the eyes

Systemic absorption of polypeptides through eyes has been demonstrated in this study to provide an effective route of peptide administration as an alternate to parenteral administration. TRH at 0.0025% reached a plateau of blood concentration at 0.05 ng/ml in 60 min. and stayed high for at least 4 hrs, thereafter. In contrast, a therapeutic dose of TRH (15 micrograms/70 kg i.v.) could maintain a blood concentration of 0.07 ng/ml. At 1%, TRH reached a plateau of 26 ng/ml in 2 hrs. and persisted in the plateau for 10 hrs. thereafter. At 5%, TRH peaked at 138 ng/ml in 60 min. and then fell gradually to a steady state of 60 ng/ml in 9 hrs from the peak. Addition of peptidase inhibitors (Leu-Leu, 4 mM; Bestatin, 60 microM; and DL-Thiorphan 0.6 microM) did not affect the uptake of TRH into systemic circulation. LHRH showed entirely different kinetic of systemic absorption through eyes. The blood concentration never reached peak or plateau during 12 hrs. of experimental period. The blood concentration of LHRH increased steadily during experiments. With 0.0025%, 1% and 5% of LHRH, they reached final highest blood concentrations of 0.13 ng/ml, 45 ng/ml and 95 ng/ml, respectively. The therapeutic dose of LHRH (15 micrograms/70 kg i.v.) could maintain a blood concentration at 0.25-0.3 ng/ml which was slightly higher than that reached with 0.0025% of LHRH instilled into the eye. Addition of peptidase inhibitor (Leu-Leu, 5 mM) enhanced the absorption of LHRH into systemic circulation slightly but significantly. Glucagon behaved similarly as TRH except that the blood concentration remained high without falling at 5% dose level. These results suggest that topical instillation of peptide drugs into eyes is a workable method for administration of these peptide drugs.

Ocular anti-inflammatory actions of matrine

Matrine is an alkaloid isolated from the root of Sophora subprostrata (Leguminosae) which has been used as a Chinese medicine for the treatment of inflammation. Instillation of 50 microliter of 1% matrine showed significant inhibition of ocular inflammation induced by lens proteins. Unlike corticosteroids, matrine did not facilitate the IOP recovery in rabbit eyes nor did it change the electrical potential difference across rabbit iris-ciliary body. These results indicate that matrine could become a safer ocular antiinflammatory agent than corticosteroids. Further, matrine was found to markedly increase the reaction time of a mouse placed on a hot plate. These results indicate that matrine could be used as an analgesic as well.

Cardiovascular effects of matrine isolated from the Chinese herb Shan-dou-gen

Matrine, a pure compound isolated from the Chinese herb Shan-don-Gen (Sophora subprostrata), was studied for its effects on the cardiovascular system of the rat. Intravenous injections of matrine at doses from 5 mg to 20 mg/kg body weight exhibited dose-dependent hypotensive and bradycardiac effects. These effects lasted only 1 to 3 min. In the isolated atria and ventricle preparations, matrine at doses from 50 micrograms to 200 micrograms/ml increased the amplitudes of spontaneous contraction of the atria and electrically induced contraction of the ventricle, whereas the frequency of the spontaneous beating of the atria was reduced. The dose-dependent effects of matrine on the isolated preparations persisted as long as the compound was present. Tachyphylaxis was not observed with repeated applications of this compound to the isolated preparations. The positive inotropic effects on both atria and ventricle and the negative chronotropic effect on spontaneous beating of the atria by matrine were not blocked by diphenhydramine, atropine, phenoxybenzamine, propranolol, trifluoperazine, or methysergide. In contrast, verapamil significantly reduced the positive inotropic effect of matrine on the ventricle. In the isolated aortic strip preparation, matrine at a dose of 200 micrograms/ml led to a slight increase in muscle tone. The same dose of matrine induced a 35% increase of perfusion pressure in the hindleg perfusion model. These results suggest that the in vivo transient hypotensive effect of matrine is likely associated with a decrease in heart rate itself, since positive inotropic effects on both the atria and the ventricle, and vasoconstriction of some vascular beds could not be the cause of hypotension.(ABSTRACT TRUNCATED AT 250 WORDS)

Epstein-Barr virus-associated antibodies and serum biochemistry in nasopharyngeal carcinoma

Nasopharyngeal carcinoma is difficult to diagnose in its early stages. It also has frequent recurrences and/or distant metastases after radiotherapy. Extensive clinical, serological and biochemical studies were done during 1980-1982 on 351 patients to aid in the diagnosis of the disease, especially with recurrence or metastasis. Seropositive rates of the antibody titers against viral capsid antigens (VCA) and early antigens (EA) of Epstein-Barr virus (EBV) in IgG and IgA classes were 41.7%-100%. They ranked, in order of frequency: anti-VCA/IgA, anti-VCA/IgG, anti-EA/IgG, and anti-EA/IgA. Mean total serum IgG and IgA levels were moderately increased in all patients. Serum GOT, GPT, alkaline phosphatase, lactate dehydrogenase and mucoprotein were elevated either alone or in combination in a few patients before treatment, in many patients with recurrence or metastases, and in all patients with liver metastasis.

Changes of serum protein and immunoglobulins in ovarian agenesis

The levels of serum proteins and immunoglobulins were determined in five cases of Turner's syndrome, in five secondary amenorrheic patients who responded to progesterone, and in five healthy women as controls. Compared with the controls, the patients with secondary amenorrhea showed significantly lower albumin, but higher alpha 1- and beta-globulins; IgG was also lower. In the Turner's syndrome group, gamma globulin, IgG and IgM levels were significantly lower. These results support the suggestion that at least some of the serum proteins and immunoglobulins are related to estrogen.

[Serological and biochemical studies in late stage of nasopharyngeal carcinoma]

Serological and biochemical studies were done at the National Taiwan University Hospital, on 243 patients with biopsy-proved anaplastic nasopharyngeal carcinoma (NPC) in various clinical conditions. The remarkable elevation of both IgG and IgA antibody titers against EB virus was specific for NPC patients. The seropositive rates ranged from 75% to 100% in various stages of NPC patients. Serum IgG and IgA levels were also increased moderately and nonspecifically in stages II-IV and recurrent patients. Peripheral white blood cell count was also slightly increased in these patients. Peripheral lymphocyte counts were slightly decreased in patients with neck recurrence or distant metastasis. Serum IgM, C3, C4 and Acid phosphatase levels were within normal range in all the patients. Serum GOT, GPT, alkaline phosphatase, and lactate dehydrogenase were elevated in some of patients with distant metastasis and in most of those with liver metastasis. Mucoprotein was elevated in about 10% of stage II-IV patients but in about 50% of patients with recurrent neck metastasis or distant metastasis. in conclusion, serological and biochemical examinations are important in the diagnosis of late stages and recurrence or metastasis of NPC.

Immunopathological diagnosis of plasma-cell dyscrasia. Part I. "Primary" monoclonal gammopathy

Two patients with "primary" plasma-cell dyscrasia, one with IgG kappa multiple myeloma and another with delta type light chain disease, are reported. Both of them presented extraosseous tumor mass on the forehead as an initial problem. They had moderate to severe anemia, accelerated ESR and multiple osteolytic lesions in the x-ray bone survey. They did not show prominent monoclonal spikes in serum electrophoregram and physiological immunoglobulins were not decreased. Repeated bone marrow aspirates on these two cases did not reveal definite plasmacytosis and pathological diagnosis was established by tumor biopsy. Immunopathological correlations were made, with an emphasis on rational analysis and interpretation of monoclonal proteins.