Differential B- and T-cell activation in Wegener's granulomatosis

BACKGROUND

Autoimmune mechanisms are postulated to play a role in the development and progression of Wegener's granulomatosis (WG), a form of systemic, idiopathic necrotizing vasculitis.

OBJECTIVE

We investigated the relation between lymphocyte activation and disease activity in patients with WG.

METHODS

B- and T-lymphocyte activation was studied by cytometric assessment of the expression of the activation markers CD38 on B cells and CD25 and HLA-DR on CD4(+) and CD8(+) T-cell subsets, respectively. Activation at the cellular level was related to serum levels of antineutrophil cytoplasmic antibodies and soluble IL-2 receptor, which can be regarded as soluble activation markers of B and T cells.

RESULTS

Percentages of CD38(bright) activated B cells were higher in patients with active WG than in patients experiencing disease remission (P <.05) or in healthy control subjects (P <.05). Percentages of activated CD4(+) and CD8(+) T cells were higher in patients with active WG (CD4 subset, P <.0001; CD8 subset, P <.005) than in healthy individuals. An increased percentage of activated T cells of both subsets was also seen in patients whose condition was in remission, as compared with healthy control subjects (CD4 subset, P <.0005; CD8 subset, P <. 001). Lymphocyte activation at the cellular level did not correlate with plasma levels of antineutrophil cytoplasmic antibodies or soluble IL-2 receptor.

CONCLUSION

In WG, B-cell activation is related to active disease, whereas T-cell activation persists during remission of the disease, which points to an intrinsic disordered immune system in this disease.

The role of superantigens in vasculitis

Multiple risk factors are involved in susceptibility to vasculitis. Inherited determinants may increase the risk but are insufficient to induce the disease. Environmental factors, such as infections, are important modulators and probably trigger the disease in most cases. One of the possible triggers may be a bacterial superantigen (SAg). SAgs may activate autoreactive T cells that mediate autoimmune vessel wall destruction. Furthermore, SAgs may activate autoreactive B cells to produce autoantibodies that are involved in the pathophysiology of vasculitis, such as antineutrophil cytoplasmic autoantibodies or anti-endothelial cell antibodies. In patients with Kawasaki disease, Wegener's granulomatosis, and infection-related forms of vasculitis, SAg-producing microorganisms have regularly been found. Activation of circulating T cells and skewing of the T-cell repertoire have been reported in most forms of vasculitis. In the past year, for the first time, patients were described in which T-cell receptor V beta expansions were documented simultaneously with the typing of the microbial SAgs, providing evidence that the observed changes in the T-cell repertoire could be caused by these bacterial SAgs. In the future, elucidation of the immunologic mechanisms by which SAgs may play a role in the pathophysiology of vasculitis will provide more effective methods for the treatment of vasculitis.

[Immediate and early reinterventions in the surgery of colorectal cancer]

Out of 584 cases submitted to colorectal surgery 461 (78.92%) were performed for cancer. Thirty-three patients (7.16%) necessitated immediate (1) or precocious reinterventions for bleeding, fistulae, peritoneal infections, bowel occlusion, necrosis or stenosis of the iliac anus. We are out the technical procedures chosen for each class of complications asking for reintervention. We registered 4 deaths, in aged patients with hard associated morbidity, with emergency reinterventions. We appreciate that a correct preoperative preparation reduces the rate of reintervention and an early reintervention reduces the post-operative mortality.

[The repair of voluminous postoperative abdominal wall defects with synthetic mesh]

Important postoperative abdominal wall defects, especially recurrent or multirecidivated ones, are raising multiple problems to the surgeon. We are presenting a homogeneous trial of 209 patients with such lesions, in which the abdominal wall repair was made with different kind of synthetic materials, with good results. In a single case the mesh was rejected, because a silent quiescent infection. In three patients undergoing iterative abdominal operations for other diseases we performed optical and electronic microscopical studies showing out that the material integration was done by normal biological reaction. This provides the materials' tolerability and a normal reaction of the organism.

[The effect of a plant mixture on the metabolic equilibrium in patients with type-2 diabetes mellitus]

The present paper analyses the results obtained in 82 patients with diabetes mellitus of the 2nd type: 59 women and 23 men, between 41 and 74 years old (average +/- DS, 58 +/- 9 years), of which 58 had an index of the body weight higher than 26. The diabetes duration ranged between newly discovered and 11 years. Each patient was given, 3 times a day, a 150 ml cup containing an infusion of the following mixture of plants previously cut into small pieces: Phaseolus vulgaris (pod), Morus alba (leaf), and Vaccinum myrtillus (leaves). The approximate dose used was of about 15 g/day. The treatment lasted for two months. Before and after treatment, the following parameters were determined: Hb Al (Bio-Rex method) in 31 cases; the average of 3 consequent glycemias; the value of glycemia and insulinemia recorded after a standard lunch, consisting of about 40 g glucides, 14 g proteins and 6 g lipids (50 g bread, a boiled egg and a boiled apple of 100 g). Analysis of the results obtained enabled the following temporary conclusions (1). In 74 out of the 82 cases studied, the average values of glycemia, after the treatment with plants, were lower than those recorded before the treatment (the average values of the whole lot: 219 +/- 82 mg/dl before treatment and 166 +/- 76 mg/dl after treatment (2). The overall decrease recorded, of 53 mg/dl, represents 24.3% of the initial value (3).(ABSTRACT TRUNCATED AT 250 WORDS)

Measurement of perception threshold to an electric stimulus using a phase-sensitive technique in normal and diabetic subjects

To evaluate the functional state of peripheral sensitivity we measured the perception threshold to an electrical stimulus applied deeply at the level of the lower limbs in both diabetic and nondiabetic patients. The data were obtained using a phase-sensitive technique with a sinusoidal applied voltage at 1592 Hz. The test signal applied through needle electrodes was monitored using a current-to-voltage convertor, the current being considered to have two components, one resistive (IR) in phase with the voltage V across the electrodes, and the other capacitive (IC) 90 degrees out of phase. A significantly (p less than 0.001) higher perception threshold was found in diabetic patients than in nondiabetic subjects with all three electrical variables measured: IR, IC and V.

Disappearance rate of insulin antibodies after discontinuing insulin treatment in 42 type 2 (non-insulin-dependent) diabetic patients

The disappearance rate of insulin antibodies was studied after cessation of insulin treatment which had been given for 3 months to 6 years in 42 Type 2 (non-insulin-dependent) diabetic patients. Insulin antibodies were measured before and 15 days after interruption of insulin treatment, and every 30 days until the disappearance of insulin antibodies. The mean +/- SD value of insulin binding in the entire group before the interruption of insulin treatment was 32 +/- 14%. There was no relationship between the antibody level at that time and the duration of insulin treatment. However, the insulin antibody level was significantly higher in 17 diabetic patients on an insulin dose of greater than 20 U/day (p less than 0.02) than in 25 on an insulin dose of less than 20 U/day (39 +/- 13% versus 28 +/- 12%). A positive correlation was found between initial insulin binding and the time required for it to fall below 10% (r = 0.74). Antibodies were absent 60 days after discontinuing insulin treatment in eight of ten subjects presenting with initial binding of less than 20%. In contrast, in only two of 12 patients with an initial binding of greater than 40% were insulin antibodies detectable 150 days after discontinuation of insulin therapy. Disappearance of insulin antibodies sometimes took up to 1 year and occasionally even more than 2 years.

Characteristics of severe diabetic ketoacidoses occurring before and after 60 years of age

Between 1978 and 1982, 459 cases of severe diabetic ketoacidosis (pH less than or equal to 7.20, total -CO2 less than or equal to 10 mMol/l) were admitted to our Intensive Care Unit. 416 (241 males, 175 females) were under 60 years (41 +/- 7) and 43 (22 males, 21 females) exceeded 60 years of age (67 +/- 7). The precipitating causes were fairly similar, in both groups, with infections foremost (68%). Presenting biochemical parameters, before and after 60 years showed differences in: blood glucose: 32.7 +/- 12 versus 34.8 +/- 8.1 mMol/l; plasma sodium 137 +/- 14 versus 143 +/- 16 mMol/l; plasma potassium 4.2 +/- 0.9 versus 4.9 +/- 0.7 mMol/l; hydrogen ion concentration 95 +/- 17 versus 73 +/- 12 mMol/l, (p less than 0.01); plasma osmolarity 327 +/- 98 versus 379 +/- 96 mOsm/l. The difference was significant (p less than 0.01) in frequency of hypernatremic hyperosmolarity (initial sodium greater than 147 mMol/l): 7.4% of 202 cases before age 60 years versus 24.1% of 29 case after age 60 years. The fluid amounts administered i.v. within the first 24 h was greater before (7516 +/- 2121 ml; p less than 0.01) than after 60 years (5276 +/- 1132 ml); insulin requirements were greater after 60 years (236 +/- 78 U/24 h; p less than 0.01) than before the age of 60 years (182 + 59 U/24 h). The mortality rate in the course of severe diabetic ketoacidoses was significantly lower before 60 years (1.3%, p less than 0.01) as against 6.9% after age 60 years.(ABSTRACT TRUNCATED AT 250 WORDS)

The dynamic of impaired glucose tolerance in women with fetal gigantism

In a group of 51 women who had given birth to giant children, the glucose tolerance test (GTT) was performed at entry in the study and after intervals of 6 to 12 years. The results of the first determination, estimated according to the WHO's criteria (1980), have revealed an impaired glucose tolerance (IGT) in 7 cases (14%); the second determination showed IGT in 10 cases (20%) and diabetes mellitus in 2 (4%). Insulinemia assays, concomitant with the second performance of GTT, showed the highest values in the diabetic subjects, moderate values in those with IGT, and low values in those with normal glucose tolerance. The presence of obesity in some cases could not be considered as fully responsible for the glucose tolerance impairment in the women with fetal gigantism. The dynamics of glucose tolerance disorders showed variations in time, i.e. the initial pathologic changes were no more recorded on the second testing in the same subjects, while women with normal initial GTT showed high insulinemia or IGT on the second determination.

Blood glucose and plasma insulin responses to various carbohydrates in type 2 (non-insulin-dependent) diabetes

The blood glucose and plasma insulin responses to some simple carbohydrates (glucose, fructose, lactose) and some complex ones (apples, potatoes, bread, rice, carrots and honey) were studied in 32 Type 2 (non-insulin-dependent) diabetic patients. Blood glucose and plasma insulin were measured at zero time and then at 15, 30, 60, 90 and 120 min after ingestion of 25 g glucose, fructose or lactose, or 30 g honey, 50 g white bread, 125 g white rice or potatoes, 150 g apples or 260 g carrots. Maximum blood glucose and plasma insulin responses were recorded 60 min after ingestion of each test meal. At this time the increases in blood glucose and in plasma insulin were significantly higher after the more refined carbohydrates (glucose, fructose and lactose) than after the more complex ones (apples, potatoes, rice, carrots and honey, -p less than 0.01). Counting the blood glucose increase after glucose as 100%, the corresponding increases in glycaemia for other carbohydrates were: fructose, 81.3%; lactose, 68.6%; apples, 46.9%; potatoes, 41.4%; bread, 36.3%; rice, 33.8%; honey, 32.4% and carrots, 16.1%.

Effect of the antidiabetic treatment of hyperlipoproteinemia in newly detected diabetes mellitus

A parallel study concerning the influence of antidiabetic treatment of the carbohydrate and lipid disturbances were carried out in 209 patients with newly discovered diabetes mellitus: 120 females and 89 males, ranging in age from 28 to 73 years. The treatment applied in terms of the clinical from of the disease was: insulin in 12 cases, tolbutamide in 25 cases, glurenorm (a sulphenyl urea derivative in 114 cases, biguanide in 45 cases, tolbutamide associated with biguanide in 13 cases. After 60 days of treatment, the incidence of HLP fell from 55.02% to 43.06% (in 90 of 209 cases), with a change in the distribution of the five HLP types. Parallel analysis of blood glucose, triglycerides (Tg) and cholesterol (Ch) revealed appraisable differences in the post-therapeutic evolution of the three biochemical parameters in terms of the treatment applied. A statistically significant, parallel and comparable decrease in glycemia, Tg and Ch was recorded after insulin and glurenorm; biguanides lowered only glycemia and Tg, and tolbutamide only glycemia. The fact that correction of carbohydrate disturbances is accompanied by a significant decrease only of Tg and not of Ch suggests that the pathophysiologic mechanisms by which these lipid fractions are modified in diabetes mellitus, differ and are probably independent on one another. The close relationship between the weight excess and plasma Tg (but not also plasma Ch) levels, likewise lends support to this assumption.

Technique of lung ventilation through an injector

Clinical and experimental evidence that the risks of ventilation through an injector can be diminished if the rate of gas flow in the tracheal probe is kept slow is presented. In practice those inlet devices for oxygen which permit an acceleration of the flow at the end of insufflation give better ventilation. The oxygen and air mixture is more uniform and the distribution is more physiological if there are side holes in the tube; the intake of additional air is then not due to the Bernoulli effect but to the effect of propulsion. Lung ventilation through an injector is worthwhile and is the only possible method in some cases, but it demands skill and care.

The epidemiology of hyperlipoproteinemia in a Rumanian general population sample. Study of 7,085 cases

Using a two stages screening method the prevalence in the general population of hyperlipoproteinemias (HLP), separated in the five types proposed by Fredrickson, Levy and Lees, and adopted by WHO has been studied. The study included 7,085 subjects of both sexes, aged 25-65 years, representing 84,52 % of a population taken at random within a district of Bucarest. HLP was found in 1,013 cases, i.e. 14,29 % of the investigated population. 48.37 % were men and 51.63 % women. The prevalence of HLP was lowest in the first decace of age studied (25-35 years) and highest in the last two decades (45-65 years). Overweight was more frequently encountered in these patients (64.46 %) than in the total population (32.3 %). Of the 1,013 cases with HLP, 42.35 % (6.05 % of the total population) were of type IV, 27.05 % (3.86 % of the total population) of type II-b, 22.80 % (3.26 % of the total population) of type II-a, 4.74 % (0.67 % of the total population) of the type III and 3.06 % (0.43 % of the total population) of the type V. 22.70 % of the HLP patients were considered primary familial HLP, 66.54 % primary non-familial HLP and 10.76 % secondary HLP; IN 109 secondary HLP, the most frequently encountered disease was diabetes mellitus (42.20 %), followed by hypothyroidism (24.77 %), alcoholism (12.84 %), obstructive liver diseases (9.17 %), pancreatitis (5.50 %), nephrotic syndrome (2.75 %) and treatment with estrogens and steroids (2.75 %).

[Comparative clinico-histologic study of metastatic adenopathies in cancer of the lip]

The authors studied the correlation between clinical examination and histological findings in lymph node metastasis in 256 patients suffering from carcinoma of the lip. According to the clinical stage, the following were encountered: a) 84 cases of nodes without any clinical changes (32.8%); b) 140 cases of nodes larger than normal, but mobile (54.6%); c) 32 cases of fixed nodes (12.6%). Lymph node dissection was carried out in 210 patients and histological examination revealed: --in group (a) 61 patients operated): lymph node involvement in 8.9% of cases; --in group (b) (120 cases operated): lymph node involvement in 30% of cases; --in group (c) (29 patients operated): lymph node involvement confirmed in 86.2% of cases. In conclusion, only histological examination provides definite information regarding lymph node involvement, confirming or contradicting pre-operative clinical findings.