[Tolerability and pharmacokinetics of an intravenous immunoglobulin preparation in immunologically normal subjects and tolerability in patients with hypogammaglobulinemia resulting from chronic lymphatic leukemia]. / Verträglichkeit und Verweildauer eines intravenösen Immunglobulinpräparates bei immunologisch gesunden Personen und Verträglichkeit bei Patienten mit Hypogammaglobulinämie infolge chronischer lymphatischer Leukämie.

Tolerance, clinical effects and kinetics of an unmodified immunoglobulin preparation for intravenous use were investigated in 4 patients with advanced chronic lymphocytic leukemia. Previously, good tolerance of the preparation had been found in 49 immunologically normal patients. The four patients with secondary humoral immunodeficiency received doses of 140-360 mg IgG/kg per infusion as outpatients at monthly intervals. With one exception, no acute infections (pneumonitis), as commonly seen before, were observed during the observation time of 24 to 68 weeks, and the pre-existing chronic infections (bronchitis, sinusitis etc.) remained compensated without antibiotics. In all four patients tolerance of the preparation was good. In all cases of hypogammaglobulinemia a dose-dependent increase in the serum IgG concentration was observed immediately after the infusion. However, persistence of the serum IgG increase showed considerable interindividual differences. The half life of the tetanus and HBs antibodies (21.7 to 34.4 and 19.7 to 25.7 days respectively) found in 4 healthy volunteers is within the biological range. This indicates an unmodified structure of the antibodies of the IgG class contained in the preparation used.

[Lymphoproliferative diseases with small molecular (monomere) IgM paraproteinemia (proceedings)]. / Lymphoproliferative Erkrankungen mit kleinmolekularer (monomerer) 2gM-Paraproteinämie.

Phytohemagglutinin P, when used like an antiserum in immunoelectrophoresis, precipitates with pentameric IgM but not with monomeric IgM subunits. In a retrospective study this simple screening method was applied to 180 sera containing monoclonal IgM. Five cases were found to be of the monomeric type of IgM paraproteinemia. Four of these patients had lymphoproliferative diseases with lymphocytic infiltration of the bone marrow. The last case was complicated by acute myelomonocytic leukemia.

Cytoplasmic immunoglobulins in bone marrow cells of polyclonal and of monoclonal origin.

Cytoplasmic immunoglobulins in human bone marrow plasma cells and lymphoid cells were characterized by direct immunofluorescence with fluorochrome-labelled reagents specific for immunoglobulin heavy and light chains. The percentage distribution of cells containing IgA, IgG or IgM and kappa- or lambda-immunoglobulins was determined in bone marrow samples from 168 immunologically normal individuals, in 11 patients with polyclonal increase of bone marrow plasma cells and in 80 patients with benign or malignant monoclonal gammopathies. A clear differentiation between monoclonal and polyclonal cell populations could be obtained in all cases.

[Frequent and rare forms of vitamin B 12 and folic acid deficiency anemias]. / Häufige und seltene Formen von Vitamin-B12-und Folsäuremangelanämien

The common and rarer causes of vitamin B12 and folic acid deficiency are discussed with special reference to pathophysiological aspects and conditions in Switzerland. The overall incidence of Addisonian pernicious anemia was found to be 80 per 100,000 patients, whereas the incidence of other B12 deficiency states was 18 per 100,000 patients. Folic acid deficiency was found in 23 of 100,000 patients, though this figure appears to be an underestimate. Nutritional (latent) folate deficiency seems to be the most frequent vitamin deficiency in Switzerland.

Absorption of hemoglobin iron: the role of a heme-splitting substance in the intestinal mucosa.

The dog behaves like man in his ability to utilize dietary hemoglobin iron and, therefore, is an excellent model in which to study the mechanisms of absorption. Heme is taken up intact into the epithelial cell of the small intestine but the iron appears in the plasma in a nonheme form. A substance is present in mucosal homogenates which is capable of releasing iron from a hemoglobin substrate in vitro. This has a molecular weight greater than 64,000, and appears to behave as an enzyme. There is no difference in the in vitro, effective concentration of the hemesplitting substance in the mucosa of iron-loaded and iron-deficient dogs to explain in vivo changes in iron absorption. However, the rate at which the heme-splitting substance works in vivo appears to be increased by the removal of the nonheme-iron-end product from the epithelial cell to the plasma. Reduction of the heme-iron content within the epithelial cell may then enhance uptake from the lumen. These studies suggest that the labile nonheme-iron content of the intestinal epithelial cell determines its ability to accept heme as well as ionized iron from the lumen.