Evidence that treatment of ESRD patients with recombinant human erythropoietin induces immunosuppression without affecting the distribution of peripheral blood mononuclear cell subpopulations.

Fifteen patients with end-stage renal disease (ESRD) were blood sampled before and 1-, 2-, 3-, and 6 months after institution of recombinant human erythropoietin (r-HuEPO) therapy. Subpopulations of immunocompetent peripheral blood mononuclear cells (PBMC) were analyzed by flow cytometry using monoclonal antibodies against various T-lymphocyte antigens, B-lymphocytes, natural killer (NK)-cells, monocytes, and macrophages, and finally bone marrow progenitor cells. Functional properties of peripheral T-lymphocytes were analyzed by proliferation assays with mitogens, alloantigens and microbiological antigens. All patients but 3 responded with sufficient correction of the anaemia. The absolute number of leucocytes and lymphocytes remained unchanged during the study. Likewise, a remarkable intraindividual months to month constancy in the relative distribution of all PBMC subsets analyzed was recorded during the observation period, although some interindividual variability was observed. In contrast, the T-lymphocyte responsiveness decreased significantly except for 2 out of 11. We conclude, that treatment of renal anemia with r-HuEPO seems to induce immunosuppression in ESRD patients without affecting the distribution of various PBMC subsets.

Hyperthyroidism associated with metastatic thyroid carcinoma.

We report a patient with unilateral thyroid carcinoma, who developed hyperfunction of the thyroid gland during the metastatic progression of the thyroid carcinoma. Concurrently with this event, TSI increased and it is suggested that the differentiated aggressive metastatic thyroid neoplasm had initiated the autoimmune disorder leading to TSI production and thus to hyperplasia and hyperfunction of the thyroid resulting in hyperthyroidism.

Does erythropoietin cause hormonal changes in haemodialysis patients?

In 10 female and 10 male haemodialysis patients plasma FSH, LH, testosterone, prolactin, and somatotropin (STH) were estimated during erythropoietin (rHuEpo) treatment for 6 months. All but one patient responded with an increase in haemoglobin. The patients experienced improved sexual function according to the answers given in a self-administered questionnaire. Of the 90% who answered before the study 22% could not perform sexual activities whether they wanted to or not. During and at the end of the study 80 and 60% respectively answered, and none had these problems. In contrast, serum values of the sexual hormones (FSH, LH, testosterone and prolactin) were not significantly changed during rHuEpo therapy, and neither was the basal plasma STH.

Lupus anticoagulant and anticardiolipin antibodies in an obstetric population.

Lupus anticoagulant (LA) and anticardiolipin antibodies (ACA) have been reported to be associated with fetal loss. OBJECTIVE. Our aim was to estimate the incidence of LA and to examine the correlation between LA and ACA in pregnant women. To investigate the clinical significance of LA and ACA in an obstetric population. STUDY DESIGN. A prospective, cross sectional study of 2856 consecutive women admitted to a department of obstetrics and gynecology for delivery or due to pregnancy complications during an 11 month period. METHODS. Activated partial thromboplastin time (APTT) was determined in all patients. LA and ACA were determined if APTT > or = 35 sec. For reference ACA was determined in a group of randomly selected patients with APTT < 35 sec. The results were analyzed in relation to the obstetrical records. RESULTS. Overall incidence of APTT > or = 35 sec.: 7.0%, significantly more frequent in patients with early spontaneous abortion (18.6%) and intrauterine growth retardation (17.5%). Incidence of LA 0.07%. The patients had undetectable ACA and no clinical condition related to LA. Incidence of ACA class IgM (IgM-ACA) in patients with APTT > or = 35: 20.4%, significantly higher than in the reference group (9.6%). Uncomplicated pregnancy in 84% of patients with IgM-ACA. No cases of ACA class IgG (IgG-ACA) in patients with APTT > or = 35 but two cases in the reference group (one normal pregnancy, one spontaneous abortion). CONCLUSION. LA is a rare manifestation with uncertain significance in otherwise healthy pregnant women. IgM-ACA in low titer occurs relatively frequently during normal pregnancy.

Enormous right coronary arterial aneurysm in a patient with type IV Ehlers-Danlos syndrome.

A patient with a giant aneurysm in the right coronary artery combined with dilated and tortuous left descending and circumflex arteries is described. The clinical features and implications are discussed.

Fibrinolytic capacity in hemodialysis patients treated with recombinant human erythropoietin.

A major adverse effect of recombinant human erythropoietin (r-HuEPO) in hemodialyzed patients are thrombotic events. Several reports on platelet function during r-HuEPO treatment have been published but less is known about fibrinolysis. In the present study, the fibrinolytic capacity was studied in 20 patients on maintenance hemodialysis and treated with r-HuEPO. The patients were randomized into two groups and investigated in a crossover design. r-HuEPO was administered intravenously and subcutaneously in each group and was given for 3 months, respectively. Plasma tissue plasminogen activator (t-PA) and released t-PA remained unaffected by r-HuEPO in both groups throughout the study. Tissue plasminogen activator inhibitor (PAI) increased in a cyclic way reaching peak values 4-6 weeks after the start of investigation and again 4-6 weeks after changing therapy. The increase in PAI was significant in the two groups (0.025 > p > 0.01). Tissue plasminogen antigen was low in the uremic patients. The influence of r-HuEPO on this parameter was not investigated. Compensatory changes in plasma levels of factor XII procoagulant activity, activated protein C and of alpha 2-antiplasmin were not observed. Thrombotic events occurred in 4 patients at peak values of PAI. Six patients required an increase in heparin dose simultaneously with the increase in PAI. Thus, r-HuEPO seemed to affect the fibrinolytic capacity of uremic patients.

Hemodialysis does not always protect against recurrence of Wegener's granulomatosis.

Hemodialysis may protect against disease activity in Wegener's granulomatosis. We report here a 41-year-old woman with Wegener's granulomatosis, in whom renal transplantation was performed after a 10-month period of hemodialysis during which no signs of disease activity were detected. Recurrence of disease did, however, take place 2 years after renal allograft transplantation despite immunosuppressive therapy with cyclosporine A and prednisone. Reinstitution of hemodialysis and graftectomy did not improve the patient's condition but plasmapheresis and treatment with cyclophosphamide and prednisone eliminated all signs of disease within a fortnight. A proposal for better maintenance of these patients is made.

The effect of L-glutamine and sodium intake in cystinuric patients.

Four patients with cystinuria were studied to assess the effect of L-glutamine and sodium on the urinary excretion of dibasic amino acids. L-Glutamine 2.1 g/d and sodium about 300 mmol/d were given for three weeks, after which L-glutamine 2.1 g/d and sodium about 150 mmol/d were given for a further three weeks. L-Glutamine reduced the excretion of dibasic amino acids in one patient with both sodium regimens, but not significantly. In the remaining three patients no reduction was observed.

Prolonged Q-T interval and hypokalemia caused by haloperidol.

A patient is described who developed hypokalemia and cardiac arrhythmia after acute intoxication with haloperidol.

1-Deamino-8-D-arginine vasopressin lowers protein C activity in uremics.

The effect of 1-deamino-8-D-arginine vasopressin (DDAVP) on protein C was investigated in 10 uremics and 10 normal subjects. The protein C antigen was higher in the uremic patients than in the normal subjects. DDAVP had no influence on the level of protein C antigen. However, functional protein C in uremics was lower than in normals even before administration of DDAVP. Furthermore, there was a decrease in functional protein C in the uremics after administration of DDAVP. Further studies are needed to clarify the low functional protein C in uremics both before and during administration of DDAVP.

Salmonella bacteremia in renal transplant recipients.

Three cases of salmonella bacteremia in renal transplant recipients are reported. Two patients had prolonged salmonella infections with recurring bacteremia. The longest interval between bacteremic relapses was 15 years. 27 cases from the literature of salmonella bacteremia in renal transplant recipients are reviewed. The courses of salmonellosis in renal transplant recipients are more serious than in other non-compromised patients, being complicated by bacteremia in 70% of the cases. Renal transplant recipients have prolonged carrier states and frequent relapses or recurrences of salmonellosis. 45% of the salmonella bacteremias in renal transplant recipients are seen after a high dose methylprednisolone treatment for graft rejection episodes.

Haemoptysis caused by aneurysm of saphenous bypass graft to a coronary artery.

In a 51-year-old man, coronary artery bypass surgery for severe angina pectoris was followed by protracted mediastinal infection. After recovery the patient had several haemoptyses. Angiography revealed aneurysm of a graft near its distal anastomosis. Upper left lobectomy and ligation of the graft were necessitated by bleeding from the aneurysm into a segmental bronchus. Angina pectoris recurred but was successfully treated with verapamil.

Neuroleptic malignant syndrome during perphenazine treatment.

A 50-year old woman developed symptoms of a neuroleptic malignant syndrome with myoglobinuric renal failure during treatment with perphenazine. After discontinuation of perphenazine and repetitive haemodialysis, the patient recovered. Clinical characteristics of the syndrome, differential diagnosis and various therapeutic possibilities are shortly reviewed.

Toxic hepatitis due to femoxetine.

A 51-year old woman treated with femoxetine--a new serotonin reuptake inhibitor with antidepressive effect--developed toxic hepatitis during the treatment. In spite of that, the elimination half-life of femoxetine in plasma was within normal limits.