Evolution of the structure of amorphous ice: From low-density amorphous through high-density amorphous to very high-density amorphous ice

We report results of molecular dynamics simulations of amorphous ice for pressures up to 22.5 kbar. The high-density amorphous ice (HDA) as prepared by pressure-induced amorphization of I(h) ice at T=80 K is annealed to T=170 K at various pressures to allow for relaxation. Upon increase of pressure, relaxed amorphous ice undergoes a pronounced change of structure, ranging from the low-density amorphous ice at p=0, through a continuum of HDA states to the limiting very high-density amorphous ice (VHDA) regime above 10 kbar. The main part of the overall structural change takes place within the HDA megabasin, which includes a variety of structures with quite different local and medium-range order as well as network topology and spans a broad range of densities. The VHDA represents the limit to densification by adapting the hydrogen-bonded network topology, without creating interpenetrating networks. The connection between structure and metastability of various forms upon decompression and heating is studied and discussed. We also discuss the analogy with amorphous and crystalline silica. Finally, some conclusions concerning the relation between amorphous ice and supercooled water are drawn.

Polyamorphism of ice at low temperatures from constant-pressure simulations

We report results of molecular dynamics simulations of amorphous ice in the pressure range 0-22.5 kbar. The high-density amorphous (HDA) ice prepared by compression of Ih ice at T=80 K is annealed to T=170 K at intermediate pressures in order to generate relaxed states. We confirm the existence of recently observed phenomena, the very high-density amorphous ice, and a continuum of HDA forms. We suggest that both phenomena have their origin in the evolution of the network topology of the annealed HDA phase with decreasing volume, resulting at low temperatures in the metastability of a range of densities.

Long-term and preventive effects of sublingual allergen-specific immunotherapy: a retrospective, multicentric study

There is now an increasing body of evidence to support the practice of allergen-specific sublingual-swallow immunotherapy (SLIT) in the treatment of IgE-mediated respiratory allergies. Recent studies on traditional injection therapy have pointed out that this form of treatment is not only capable to decrease actual allergic symptoms, but may also have long-term clinical and preventive effects and may influence atopy natural history. In the year 2000, our group published a retrospective, multicenter study showing the efficacy and safety of SLIT in a survey of 302 patients. We now carried out a second study on the same patients, with the aim of investigating long-term and preventive effects of SLIT. Beside the well-known safety and efficacy of this treatment (80.8% of patients reported clinical benefits), SLIT proved also to elicit long term clinical effects: over a mean follow-up of 11.6 months after the end of treatment, 80.8% of patients still maintained the previously achieved benefits. During the follow-up period, only 1% of non-asthma patients reported an onset of respiratory symptoms, and only 9.6% of patients undergoing new skin tests showed new sensitizations. All the clinical benefits were strongly linked to the length of treatment: patients with long-lasting benefits were treated for a mean length of 29.1 months, while patients showing a return to pre-SLIT condition were treated for a mean 13.3 months. SLIT can obtain long-term and preventive effects so far attributed to injection immunotherapy.

Nanofriction behavior of cluster-assembled carbon films

We have characterized the frictional properties of nanostructured carbon films grown by supersonic cluster beam deposition via an atomic force-friction force microscope (AFM-FFM). The experimental data are discussed on the basis of a modified Amonton's law for friction, stating a linear dependence of friction on load plus an adhesive offset accounting for a finite friction force in the limit of null total applied load. Molecular dynamics simulations of the interaction of the AFM tip with the nanostructured carbon confirm the validity of the friction model used for this system. Experimental results show that the friction coefficient is not influenced by the nanostructure of the films nor by the relative humidity. On the other hand the adhesion coefficient depends on these parameters.

Ab initio simulations of photoinduced interconversions of oxygen deficient centers in amorphous silica

We have studied by ab initio molecular dynamics the interconversion between oxygen deficient centers (Si-Si bond, dicoordinated silicon =Si:, and E' centers) induced by UV irradiation in a-SiO2. By dynamical simulations in the excited state of a periodic model of a-SiO2 we have identified the reaction path and activation barrier for the Si-Si-->=Si: interconversion. A new competitive transformation of the excited, neutral Si-Si bond into two E' centers has been identified. Our results provide strong theoretical support to the viability of these processes, proposed experimentally on the basis of optical data only.

Safety and efficacy evaluation of sublingual allergen-specific immunotherapy a retrospective, multicenter study

In recent years, several controlled studies have proved the efficacy and safety of sublingual specific immunotherapy, as a possible alternative to the classic subcutaneous route of administration. This alternative option has been officially confirmed by the recent WHO position paper "Allergen Immunotherapy: Therapeutic Vaccines for Allergic Diseases'". Since sublingual immunotherapy has now been widely used for years, we carried out an open, multicentric, retrospective study to investigate the efficacy and safety of this form of treatment in a large number of patients. To this end, we studied 302 subjects undergoing sublingual immunotherapy for at least three months with different allergen compositions. Notwithstanding the obvious limitations due to the study design, this survey has confirmed the high efficacy and safety of this form of treatment, as already reported in previous controlled studies. Sublingual immunotherapy appears to be a simple, well-tolerated and effective method of treatment of allergen-specific diseases.

Transurethral incision of prostate (TUIP) and retrograde ejaculation

OBJECTIVE

Men of any age with bladder outlet obstruction and without measurable enlargement of the prostate constitute ideal candidates for TUIP. Effectiveness of any technique with respect to flow rate improvement is firmly established, indifferently whether unilateral or bilateral. But there is a wide variation in the reported incidence of retrograde ejaculation with unilateral and bilateral incision.

MATERIAL AND METHODS

The retrospective analysis of our 45/57 available patients treated with this technique, between January 1993 and March 1995, does not show a major incidence of this complication for the bilateral incision, with an overall incidence of 6.6% (3/45 patients).

CONCLUSIONS

Although ejaculation may be preserved, it cannot be guaranteed.

Bacillus Calmette-Guerin in the treatment of stage T1 grade 3 transitional cell carcinoma of the bladder: long-term results

PURPOSE

We performed a retrospective long-term study to evaluate the results of immunotherapy in the treatment of high grade superficial bladder tumors.

MATERIALS AND METHODS

Between 1981 and 1993, 593 patients with superficial transitional cell carcinoma of the bladder underwent transurethral resection. Of 64 patients with stage T1 grade 3 disease 50 received intravesical bacillus Calmette-Guerin after transurethral resection of all visible tumor.

RESULTS

At a median followup of 42 months (range 12 to 112) 36 patients (72%) are disease-free and have not required further treatment. Superficial recurrence was noted in 8 patients (16%). Disease progressed in 6 patients (12%), including 5 with locally invasive and 1 with metastatic disease. Cystectomy was performed for progression in 4 patients and for recurrent stage T1 grade 3 disease in 1. There was 1 disease related death (2%). The overall survival rate is 94%.

CONCLUSIONS

Intravesical bacillus Calmette-Guerin appears to be the most effective conservative treatment for patients with stage T1 grade 3 bladder cancer.

Value of autologous bone marrow transplantation in follicular lymphoma: a France Autogreffe retrospective study of 42 patients

The value of high-dose chemotherapy with hematologic stem cell rescue has not been established in the treatment of low-grade non-Hodgkin's lymphoma. We report the results of a retrospective 'France Autogreffe' study of 42 patients grafted in first partial remission (n = 13) or chemosensitive relapse (n = 29) for follicular lymphoma before January 1990. The median age was 38 years (range 26-61 years). Preparative therapy was chemotherapy alone in 22 patients and total body irradiation (TBI)-containing regimens in 20 patients. Thirty-seven patients received hematopoietic marrow stem cells. Bone marrow purging was performed in 15 patients. Five patients received peripheral blood stem cells. Three patients died of bone marrow transplantation toxicity and two others died in complete remission 10 months after autologous bone marrow transplantation. With a median follow-up of 43 months, relapse-free survival is 60%, event-free survival 58% and overall survival 83%. To date no prognostic factors have been shown.

[Cardiotoxicity of anthracyclines]

The only factor limiting the use of anthracyclines (very powerful antimitotic antibiotics) is their cardiotoxicity. The cardiac involvement is irreversible, dose-dependent and may be detected at an early stage by non-invasive (echocardiography, myocardial scintigraphy) or invasive investigations (endomyocardial biopsy). The mechanism of cardiac toxicity involves the oxidative metabolism of the cardiac myocyte and liberation of oxygen free radicals and is different from the antitumoral effect. Protocols of administration over 6 to 24 hours have enabled the use of higher total doses and the reduction of cardiotoxicity without affecting the therapeutic efficacy. The use of "antioxidants" such as ICRF 187 has given promising results in myocardial protection. The strategy of surveillance (screening) of cardiotoxicity, of the mode of administration of the anthracyclines, results from the essential coordination of the efforts of the chemotherapist, taking into account the pathology, the sensitivity of the tumor to anthracyclines therapy, enabling personalization of the prescription and the abandon of the concept of maximal dosage.

A study of 15 cases of primary mediastinal lymphoma of B-cell type

Fifteen cases of pure supradiapragmatic lymphoma with initial prominent antero-superior mediastinal involvement displaying a B-cell pattern of reactivity were studied. These cases occurred in six men and nine women with a median age of 33 years at diagnosis (range, 23 to 75 years). Supradiapragmatic peripheral lymphadenopathies were present in three cases, and intrathoracic extension to the lung, pericardium, or pleura was possible. In five cases a thymic origin was obvious. All cases exhibited a B-cell pattern of differentiation, with a great variety of histopathologic aspects associated with a high frequency of fibrosis and/or necrosis. Hodgkin's disease was initially misdiagnosed in four cases. The evolution was purely local, with extrathoracic extension in five cases, at the ultimate phase of the disease. The prognosis appeared to be poor with only five patients still alive at a median survival time of 16 months. A complete chemoresistance and radio-resistance was observed in seven cases; only two complete remissions were achieved with aggressive chemotherapy. Prolonged remission could be achieved after surgical reduction of the mass. Primary B-cell mediastinal lymphoma appears to be a distinct clinical entity with local evolution and resistance to therapy. A new therapeutic regimen, which could include surgery in some cases, should be found for this disease.

Multicenter randomized study comparing cyclosporine-A alone and antithymocyte globulin with prednisone for treatment of severe aplastic anemia

We report the results of a randomized multicenter study comparing the efficacy of antithymocyte globulin (ATG) with that of cyclosporin A (CsA) as first-line therapy for severe aplastic anemia (SAA). Patients were randomized to receive ATG and prednisone (PDN) or CsA; hematologic response and toxicity were compared. At 3-month evaluation, patients who had no or minimal response received the alternative therapy to assess the value of a sequential immunosuppressive therapy for treatment of severe aplastic anemia. One hundred nineteen patients were randomized; 25 were excluded, of whom 3 were misdiagnosed and 22 did not follow the cross-over protocol. Ninety-four patients were analyzed; 46 received CsA, and 48 received ATG-PDN. The actuarial survival was 66.7%, with a median follow-up time of 19 months. There was no significant difference in survival between the groups with, at 3 months, an actuarial survival of 88% in the CsA group and 75% in the ATG group (NS); at 12 months, it was 70% in the CsA group and 64% in the ATG group (NS). The percentage of complete and partial response was 11.6% and 16%, respectively, at 3 months, and 31.6% and 30%, respectively, at 12 months (NS). The main prognostic factor was the absolute neutrophil count (ANC) at entry: Patients with ANC less than 0.2 x 10(9)/L had a significantly lower survival as compared with patients with more than 0.2 x 10(9)/L ANC (P = .0001). At 12 months, 62 evaluable patients were alive, with a complete or partial response in 36 patients. Patients who had responded to the first treatment had a better recovery of bone marrow failure than those who had sequential immunosuppression. The main complication was infection, which was more often observed and more often lethal during ATG and PDN therapy. In this study, initial treatment of SAA with either CsA or ATG-PDN followed by cross-over therapy for nonresponders produced comparable response and survival rates.

A multicenter randomized study comparing cyclosporin-A alone and antithymocyte globulin with prednisone for treatment of severe aplastic anemia. The cooperative group on the treatment of aplastic anemia

This article reports the results of a randomized multicentric study comparing the efficacy of antithymocyte globulin (ATG) with cyclosporin-A (CsA) as first line therapy for severe aplastic anemia (SAA). Patients were randomized to receive ATG and prednisone (PDN) or CsA; hematological response and toxicity were compared. At 3 months, patients who had no or minimal response received the alternative therapy in order to assess the value of a sequential immunosuppressive therapy for treatment of severe aplastic anemia. One hundred and sixteen patients were analysed, 60 received CsA and 56 received ATG/PDN. The actuarial survival was 55% with a median follow-up time of 19 months. There was no significant difference in survival between the two groups. The main prognostic factor was the absolute neutrophil count (ANC) at entry: patients with ANC less than 0.2 x 10(9)/L had a significantly lower survival when compared with patients with an ANC greater than 0.2 x 10(9)/L (P = 0.0001). At 3 months, 16% of patients had a complete or partial response and a cross-over treatment was given to 68 patients. At 12 months, 77 patients were alive, with a complete or partial response in 47 patients. Patients who had responded to the first treatment had a better recovery of bone marrow failure than those who had a sequential immunosuppression. The main complication was infection which was more often observed and was more often lethal during ATG and PDN. This study demonstrates that CsA is comparable to ATG for primary treatment of SAA, but it is less toxic with fewer infectious deaths.(ABSTRACT TRUNCATED AT 250 WORDS)

Doxorubicin and doxorubicinol plasma concentrations and excretion in parotid saliva

The pharmacokinetics of doxorubicin (DOX) and doxorubicinol (DOXol) was studied in six patients with various advanced neoplastic diseases who received 28-72 mg/m2 DOX (nine courses). Plasma and parotid saliva were collected over a 48-h period, and DOX and DOXol were quantified by high-performance liquid chromatography with fluorescence detection. As reported previously, a wide range of plasma levels were found among our patients. It appears that in addition to being quickly cleared from the plasma, both DOX and DOXol are excreted in detectable amounts in parotid saliva, a route of elimination that has been given little attention, if any. Excretion in the saliva exposes the mucosa of the upper gastrointestinal tract to drug and may play a role in causing stomatitis in patients receiving DOX by the i.v. route. Since huge interindividual and pronounced intraindividual differences were found in S/P ratios that mostly were not systematically related to the plasma drug concentration, the concentration in parotid saliva was not useful in predicting the level of free DOX and DOXol in plasma. For the parent drug and its metabolite, the S/P ratios increased significantly with time during the 48-h period after dosing.

[Prevention of septicemia caused by gastrointestinal tract organisms in patients with granulopenia. Comparison of three gastrointestinal tract decontamination treatments]

Three gastrointestinal tract decontamination regimens were tested in patients with granulopenia: vancomycin 250 mg, tobramycin 75 mg, and colistin 1 million international units (regimen A); vancomycin 125 mg, tobramycin 75 mg, and colistin 1 million IU (regimen B); and colistin 1 million IU (regimen C); nystatin was added to all three regimens. Effectiveness was evaluated by stool organism counts and blood cultures to detect bacterial translocation (passage of bacteria from the intestinal tract to the bloodstream). Regimen C proved insufficiently effective. Regimen A was found to be poorly tolerated by the digestive mucosa. Regimen B was the best treatment since the low dosage of vancomycin proved effective. Nystatin satisfactorily eliminated yeasts.

Bayesian estimation of doxorubicin pharmacokinetic parameters

Doxorubicin was given by brief i.v. infusion (doses ranging from 25 to 72 mg/m2) to 28 patients for 2-7 successive courses of chemotherapy (68 courses studied in all). A Bayesian approach was developed to determine the individual pharmacokinetic parameters of doxorubicin. Statistical characteristics of the population pharmacokinetic parameters were first evaluated for 19 patients and a total of 30 courses, which, when combined with 4 individual plasma concentrations of drug, led to a Bayesian estimation of individual pharmacokinetic parameters for the remaining 38 courses. The estimated parameters for the elimination phase (A3/V1 and t1/2 elimination) and the residual plasma level at 48 h as computed by Bayesian estimation on this reduced sub-optimal sampling protocol were compared with a maximal likelihood estimation of these parameters. No statistically significant differences were found. Performance of the developed methodology was evaluated by computing bias and precision. The mean errors were -0.0315 x 10(-4) l-1 for A3/V1, 0.0839 h for t1/2 elimination, and -0.22 ng/ml for c(48 h). The precision of the prediction of these three parameters (0.304 x 10(-5) l-1, 3.34 h, and 0.659 ng/ml, respectively) remained lower than the interindividual standard deviation (1.42 x 10(-4) l-1, 14.9 h, and 4.54 ng/ml, respectively). This procedure enables the estimation of individual pharmacokinetic parameters for doxorubicin at minimal cost and minimal disturbance of the patient.

[Hereditary protein S deficiency responsible for digestive vascular thrombosis]

Protein S is a physiological inhibitor of coagulation. It intervenes as co-factor of activated protein C and increases the inactivation of factors V and VIII induced by the latter. Patients with protein S deficiency are exposed to recurrent venous and arterial thrombosis. Most of these thromboses affect the lower limbs, but other regions, and notably the digestive tract, may be involved. Deficiencies in physiological inhibitors of coagulation, and in particular protein S, seem to be a new entity in the vascular pathology of the gastrointestinal system. All young patients with thromboembolic accidents affecting the digestive tract should be investigated for protein S deficiency. If such deficiency is found, then all members of the patients' family must also be investigated. Long-term treatment with antivitamin K drugs prevents recurrences of these thromboembolic accidents.

Doxorubicin and doxorubicinol: intra- and inter-individual variations of pharmacokinetic parameters

Doxorubicin was given by short i.v. infusion (dose range 25-72 mg/m2) to 18 patients who underwent three to seven successive courses of chemotherapy (total, 57 courses). Plasma levels of doxorubicin and its major metabolite doxorubicinol were determined by high-performance liquid chromatography over a 48-h period after the infusion. Pharmacokinetic parameters for the parent drug and its metabolite were calculated for each course of treatment. The results show considerable inter- and intraindividual variations for most parameters. The coefficients of variation (CV) ranged from 37% to 93% (inter-individual) and from 6% to 59% (intra-individual). Nevertheless, we observed a good stability over successive courses for terminal half-life in six patients (CV, 6%-25%) and for clearance and AUC in four subjects (CV, 10%-22%). The ratio of the AUCs for doxorubicinol: doxorubicin averaged 0.514. The pharmacokinetic pattern of doxorubicinol was biphasic in plasma of the majority of patients. We propose a model for curve-fitting of these metabolite plasma concentrations that is based on two successive releases of the compound in the plasma compartment, separated by a lag time.

Inaugural intra-atrial neoplastic thrombosis in stage II Hodgkin's disease

We report the first case of intra-atrial neoplastic thrombosis discovered in the initial stage of Hodgkin's disease. Considering the course of the case and the recurrence after 18 months we emphasize the necessity of screening cardiac cavities by CT Scan with a bolus, and of treating such a case as an initial stage IV Hodgkin's disease.

Interest of simultaneous ultrastructural characterization of morphology, cytochemistry and immune phenotype in a case of putative hybrid acute leukaemia

A case of acute leukaemia is reported in which blast cells expressed some B-related antigens (namely the CALLA antigen) and no peroxidase activity at the optical level; however, some mature granular cells contained Auer rods. Simultaneous characterization of ultrastructural morphology, cytochemistry and immune phenotype was performed. There was an apparent mutual exclusion in the expression of myeloperoxidase activity and the CALLA antigen, and a heterogeneity in the CALLA expression among the blastic population. These results disagree with the hypothesis of a true biphenotypic leukaemia and demonstrate a complete heterogeneity between the lymphoblastoid cells and the myeloid ones. The interest of such a simple combined method in a case of putative hybrid acute leukaemia is emphasized.

[Chronic diarrhea caused by Campylobacter jejuni in a patient with AIDS]

We report a case of C. jejuni chronic diarrhea in a homosexual man with AIDS. The antibiotic susceptibility of the bacteria was about normal for the species. Investigating specific immunity, we observed the presence of anti-C. jejuni IgG and the absence of anti-C. jejuni IgA. These findings concord with the hypothesis that specific IgA are necessary for C. jejuni clearance from the digestive tract.

[The role of surgery in primary gastric non-Hodgkin's malignant lymphoma]

A total of 15 cases of primary gastric non-Hodgkin's malignant lymphoma (PGML) seen between 1974 and 1985 were reviewed, and data obtained combined with reports in the literature, to define the place of surgery in this affection becoming the monopoly of chemotherapists. The indication for surgery is indisputable when the diagnosis is in doubt, and justified for ulcerated and preperforating forms and in extirpable tumoral forms of loco malignancy. It should be avoided in high grade PGML unless the operation does not delay chemotherapy. Total gastrectomy should not be performed by principle but by necessity. Abdominal exploration should include lymph node and liver biopsies. An effective total care of these patients requires close cooperation between medical and surgical teams.

Erythrocyte mean corpuscular volume during cytotoxic therapy is a predictive parameter of secondary leukemia in Hodgkin's disease

Mean corpuscular volume (MCV) evolution during cytotoxic therapy was studied in 32 patients with Hodgkin's disease (HD) who developed therapy-related acute nonlymphocytic leukemia (t-ANLL) and in 64 HD controls matched for age, therapy duration, and MOPP (mechlorethamine, vincristine, procarbazine, and prednisone) administration. Maximum MCV during therapy reached 108.3 +/- 8.2 fl in t-ANLL patients and 103.4 +/- 9.1 fl in the controls (P = 0.001). Maximum MCV increase was 26.7 +/- 8.3 fl in t-ANLL patients and 16.6 +/- 8.3 fl in the controls (P = 10(-9). The greatest 3-month increase observed during therapy was 14.8 +/- 6 fl in the t-ANLL patients and 10.1 +/- 4.8 fl in the controls (P = 0.0001). During initial MOPP therapy, the greatest 3-month increase reached 14.1 +/- 5.3 fl in t-ANLL patients and 9.8 +/- 4.5 fl in the controls (P = 0.01). The relative risk of developing t-ANLL was 9 for a MCV maximum increase over 24 fl during therapy, which was observed in 71% of the patients with t-ANLL and in only 22% of the controls. For the greatest 3-month MCV increase over 15 fl observed in 57% of the t-ANLL patients and in 17% of the controls, the relative risk reached 15. This suggests that there is at least one factor, independent from therapy, which predisposes to t-ANLL. MCV evolution during therapy appears useful in determining which HD patients have a high risk of developing t-ANLL.

Preleukemic changes in cases of nonlymphocytic leukemia secondary to cytotoxic therapy. Analysis of 105 cases

Peripheral blood changes preceding therapy-related leukemia were studied in 105 patients who had received cytotoxic therapy, 53 for Hodgkin's disease and 52 for other cancers. Preleukemic anomalies were observed in 74.3% of the cases, appearing after a mean interval of 68.7 months after diagnosis of the initial cancer. This interval was only 57.5 months in patients aged 50 years or older and only 42.3 months in patients with Hodgkin's disease having received cytotoxic therapy for 6 months or less. The first changes most frequently observed were pancytopenia (24.8%) and isolated erythrocyte abnormalities such as anemia or macrocytosis (18.1%). Involvement of two cell lines, isolated thrombocytopenia or leukopenia, circulating immature cells, monocytosis, leukocytosis, or thrombocytosis were also observed. Therapy-related myelodysplastic syndrome was recognized in 19 patients and myelofibrosis in 3. Median duration of the preleukemic phase was 6 months; 9 months in cases of isolated erythrocyte involvement and 5 months in the other cases. Myelomonocytic or monoblastic leukemia appeared less frequently when the first sign involved erythrocytes only. Hematological surveillance thus appears necessary in all patients having received cytotoxic therapy. Bone marrow study with cytogenetic examination should be performed in cases of persistent peripheral blood abnormalities.

Acute leukemia after treatment for ovarian cancer. Report of four cases and review of the literature

Four cases of acute nonlymphocytic leukemia (ANLL) following ovarian cancer are reported. All patients received alkylating agents and had a preleukemic phase. Seventy-nine additional cases of ANLL following therapy found in the literature are also reviewed. All but 2 patients received alkylating or alkylating-related agents alone or in combination. Mean duration of chemotherapy was 31.4 +/- 19.4 months. Eighty-eight percent of the patients presented with preleukemia with a mean duration of 10 +/- 10 months. Mean interval between cancer and ANLL was 57.3 +/- 26 months. Cytogenetic abnormalities were found in 71% among patients who had a karyotype. Long-term alkylating agent therapy seems to have a significant role in the development of ANLL and should be avoided in ovarian cancer.

[Bullous pemphigoid treated by plasma exchange. Open study in 10 patients]

Ten patients with bullous pemphigoid underwent low volume plasma exchange (1/3 to 1/2 of the plasmatic mass) 3 times a week for 2 to 6 weeks followed, in some of them, by maintenance corticosteroid therapy. Eight patients benefited from this treatment. Complete control of the disease was obtained with PE alone in 3: low-dose corticosteroids were sufficient to procure remission in 2, and dosage could be reduced in 3 patients who previously required high doses of corticosteroids. No serious side-effects were recorded. The best results were observed in patients who had been ill for less than 3 months. Thus, low volume plasma exchanges make it possible to obtain clinical improvement while avoiding the rebound phenomena sometimes observed after high volume plasma exchanges. Circulating immune complexes and pemphigoid antibodies usually decreased under treatment, but there was no close correlation between these changes and therapeutic effectiveness.

[Our experince with antiglobulin consumption (Dixon test) in the study of antibodies bound to platelets]

We measured the quantity of IgG bound to platelets (IgGP) by the antiglobulin consumption test (Dixon technic). In controls, the IgG level did not exceed 10 X 10(-15) g for one platelet. The amount of IgGP was often incraeased (more than 10 X 10(-l5) g) in some autoimmune diseases as lupus erythematosus, chronic lymphocytic leukemia and chronic active hepatitis. Among 26 patients presenting an idiopathic thrombocytopenic purpura (ITP) with a low number of platelets, 21 (77%) had a high titer of IgGP. In 6 ITP in remission, the IgGP titer was normal. After a review of the different technics detecting the IgG bound to platelets, we explain why we choose the antiglobulin consumption. This test is excellent for the research of anti-platelets auto-antibodies in ITP. Yet, the reaction remains negative in a minority of ITP. Several explanations are possible: low quantity of IgGP, presence of other anto-antibodies as IgM or IgA, cellular auto-immunity anti-platelets without antibodies, non immunologic ITP.

[Serum beta-2-microglobulin in multiple myeloma. Practical value]

The concentration of serum, beta-2-microglobulin (S beta 2m) and the ratio measured S 2m/theoretical S beta 2m M/TH were evaluated in 69 patients with multiple myeloma (MM) and compared with healthy subjects and with patients with a benign monoclonal gammapathy. The concentration of S beta 2m and the ratio S beta 2m M/TH are higher in multiple myeloma than in controls and are strongly correlated with the plasma cell mass On the other hand, no difference was noted concerning the S beta 2m and the ration S beta 2m M/TH between benign monoclonal gammopathy and multiple myeloma at stage I of Durie and Salmon. Under chemotherapy, the variations in concentrations of S beta 2m and of the ratio S beta 2m M/TH are strongly correlated with those of the tumour mass. Beta 2m is not very useful for the differential diagnosis between benign monoclonal gammapathy and multiple myeloma. Beta 2m is very useful in the prognosis of MM, permitting one to assess accurately the tumour mass and the response to treatment, particularly in cases of deficiency of the usual markers.

[Eosinophilic gastroenteritis in 2 child]

A boy aged 12 years is described who had eosinophilic gastroenteritis, a rare condition in childhood and one that is difficult to diagnose. Eosinophilia in the peripheral blood is a useful diagnostic clue. Although the histological appearances suggest an allergic process, the aetiology is unknown.

[Multiple myeloma of bones. Retrospective study of prognostic factors based on a series of 243 patients]

The authors have made a retrospective study of 243 cases of multiple myelomas, most of them treated with alkylating agents. The average age at the time of diagnosis was 65 years (+ 10). The ratio of the sexes was 1 : 1. Seventy two per cent of the patients had a bone rating of 2 or 3 according to the criteria of Durie and Salmon. Fifty-eight per cent of the patients were anemic (Hg 12 g per cent), with less than 15 per cent being leucopenic or thrombopenic. Hypercalcemia (105 mg 0/00) was noted in 27 per cent of cases. The distribution of immunochemical types is as follows : IgG, 51.5 per cent; IgA, 28 per cent; pure Bence Jones, 20.5 per cent. The respective percentages of kappa and lambda light chains were 64.2 per cent and 35.8 per cent. In this series, nearly 80 per cent of the patients were at phase III according to the classification of Durie and Salmon, and 30.8 per cent at phase B. The median survival, including all phases, increased from 8 months without alkylating agent, to 20 months with melphalan and/or cyclophosphamide. The factors influencing the survival of the patients treated were age, the hemoglobin level, calcemia, renal deficiencies, the immunochemical type, the stage of the disease, and the response to alkylating treatment. The value of these different prognostic factors is discussed.

[Recurrent familial thromboembolic disease due to congenital deficiency in anti-thrombin III. Preliminary study of 3 cases (author's transl)]

The three cases reported, two mesenteric venous infarctions and one asymptomatic carrier, prove the responsibility of the anti-thrombin III deficiency in the development of apparently primary entero-mesenteric venous infarctions. Thus such a deficiency should be sought routibs. Furthermore, these 3 cases confirm the usual characteristics of the 10 familial cases collected since the princeps description of Egeberg: recurrent thromboembolic disease in the young subject involving essentially the lower limbs, relative resistance to heparin, family history of thromboembolic disease confirming the hereditary nature of the disease with dominant transmission, laboratory confirmation of the quantitative deficiency in antithrombin III, the levels and activity of which are reduced by half, and decrease in laboratory sensitivity to heparin contrasting with normal clotting studies. The family history reveals associated conditions within the syndrome: asthma and Biermer's anemia as well as similarities in leucocyte HLA groups.