[Anaphylactoid accidents during general anesthesia. Apropos of 55 cases]. / Les accidents de type anaphylactoïde au cours de l'anesthésie générale. A propos de cinquante-cinq cas.

Analysis of fifty-five anaphylactoid accidents during general anesthesia (GA) in fifty patients shows significant female predominance (70%), relatively frequent allergic predisposition (34% as compared to 14.3% in a normal population) and fairly frequent responsibility of suxamethonium and succinylcholine. One or more, even recent, previous GAs do not seem to enhance the risk. 50% of intradermal skin tests to different anesthetics were negative, 40% were positive and consistent with clinical history, and 10% were positive but inconsistent clinically. Biological tests (basophil degranulation, lymphoblast rosettes, in vitro consumption of complement) were negative. Physiopathological mechanisms remain uncertain, whether they involve IgE allergy or complement activation. The frequency and severity of these unpredictable accidents must stimulate clinical and biological research in this field.

[Hypereosinophilia in cancer and cirrhosis : utility of total eosinophil count (author's transl)]. / Hyperéosinophilie au cours des cancers et des cirrhoses : intérét du compte absolu des éosinophiles.

A total eosinophil count (TEC) and a white blood cell count (WBCC) were performed simultaneously in 213 patients. Discrepancies were found between TEC and WBCC. WBCC did not allow detection of hypereosinophilia (TEC exceeding 300 eosinophils/microliter) in 45 patients. Patients were classified in three groups : controls (n = 27), benign disease (n = 65), and apparently cured cancer (n = 36). There was no significant difference between total eosinophil counts for these three groups (Wilcoxon non-parametric test). The incidence of hypereosinophilia (TEC exceeding 300) was similar in the three groups (11%, 14% and 6%). Average TEC levels were determined in 20 patients with decompensated hepatic cirrhosis, in 31 patients with active cancer, and in 14 patients with infection. These levels were significantly different from those found in each of the three previous groups. (Wilcoxon test). The incidence of hypereosinophilia (greater than 300/microliter) was significantly higher among patients with cirrhosis (50%) or active cancer (58%). The possible mechanisms of this hypereosinophilia and it's eventual prognostic utility are considered.

Automated measurement of human basophil degranulation.

Basophils disappear after challenge with specific antigen. A human basophil degranulation test has been carried out on a slide using an enriched cell suspension. On each slide, the same volume of cell suspension was deposited in wells with antigen diluted in buffer or with buffer only (control). The basophil count was made on an equal number of randomly distributed microscopic fields either by eye (optical) or by image analyser (automatic). In 33 subjects, the correlation coefficient between the numbers of non-degranulated basophils counted by eye and by image-analyser on control wells was found to be r-0.91, p less than 10-8. In 12 patients (6 with hydatidosis and 6 with schistosomiasis), the percentage of degranulation with three antigen dilutions was measured. The correlation between the results obtained by eye and by image-analyser reached 0.76 (p less than 10-7). The authors now use the automated measurement of human basophil degranulation routinely.

Haemoglobin content of multilayer E rosettes is a parameter of activated human T lymphocytes.

In stimulated cultures, a proportion of human T lymphocytes form multilayer rosettes with sheep red blood cells (SRBC) and they can be easily separated from common E rosettes by velocity sedimentation. We have developed a simplified method for harvesting multilayer rosettes and quantifying them. Practical applications of this technique are discussed.

Human basophil degranulation in dermatophagoides allergies: 93 cases.

In tests conducted on 93 subjects human basophil degranulation (HBD) with Dermatophagoides pteronyssinus (DP) and Dermatophagoïdes farinae (DF), often involved in house dust allergy, were studied. The human basophil degranulation technique involves the enrichment of the circulating basophils of the patient allowing readings in the microscope on a fixed and colored slide and a count of at least 100 basophils, the minimum number necessary to give an adequate interpretation of the results. For each allergen dilution ratios of 100 microgram/ml, 10 microgram/ml and I microgram/ml were used. The degranulation was significant (p less than 0.001) for values higher than 35% (HBD positive). Out of 30 subjects with a positive skin test with DP, 27 had a positive HBD; no HBD was obtained in subjects with negative skin test (95% of concordance). With DF, out of 30 subjects the concordance reached the level of 86.6%. Contrary to previous work conducted on grass pollen extracts, no significant correlation was found between the skin test diameter and HBD. This might be due to the variable allergenic potency of the dermatophagoïdes extracts used for the skin tests. The HBD has now been confirmed as a simple and reliable technique for studying reaginic allergies.

[Human basophil degranulation in pollinosis: correlation with skin-test diameter (author's transl)]. / Corrélation entre test de dégranulation des basophiles humains et tests cutanés au cours de la pollinose (95 sujets)

A human basophil degranulation (HBD) performed on an enriched basophil suspension (by gradient density) was applied in 95 subjects with 3 dilutions of grass pollen extract. Concordance with intradermal skin-test (ST) results reached 90% for wheal and 94% for flare. In 45 positive ST subjects, mean (+/- s.e.m.) of degranulation index was 54,1 +/- 4,2, 54,9 +/- 4,7 and 35,7 +/- 4,9 respectively for dilutions of 10(-4), 10(-6) and 10(-8) of grass pollen. Mean was 6,1 +/- 1,6, 8,2 +/- 1,7 and 8,5 +/- 1,6 in 50 negative ST subjects. In positive ST patients, a significant correlation (r = 0,53 p less than 0,001) appeared between ST diameter (flare) and degranulation index. HBD appears as reliable as RAST or automated histamine analysis but more easy to perform. It permits pharmacological studies of drugs inhibiting human basophil degranulation.

[Eosinophilia and respiratory function in the asthmatic (author's transl)]. / Eosinophilie et fonction respiratoire chez l'asthmatique.

Total eosinophil count (TEC) was done in 13 normal subjects, in 8 subjects before and 90 mn after a "French" breakfast and in 29 asthmatic patients. The geometric mean is higher (p less than 0,001) in asthmatic than in normal subjects: 304 (231--391) versus 144 (101--197). The breakfast does not interfer with the result of the TEC. In asthmatic subjects, a significant inverse correlation appears (r = 0,57, p less than 0,01) between the logarithm of TEC and the quotient: formula; see text. This correlation persists whatever may be the subject's age, the duration of the asthma or age at which he first contracted the illness. Asthma appeared after 40 years in 4 of the subjects: their TEC was higher (p less than 0,01) than in subjects who had become asthmatic before the age of forty. The respiratory function was lowered more in these 4 patients than in others who had been ill for the same time (p less than 0,001). The TEC is not related to results of skin testine with usuel inhalant allergens (grass pollen, house dust, cat's or dog's dander) or by result of a provocation test (by inhalation of allergen). Eosinophilia and bronchial obstruction are connected by one (or more) factors that may be inhalant allergens in extrinsec asthma and circulating immune complexes in intrinsec asthma.

[Correlation of skin test to grass pollen with basophil degranulation test results in 72 patients (author's transl)]. / Le test de dégranulation des basophiles humains: comparaison avec les tests cutanés aux pollens de graminées chez 72 sujets.

Seventy-two subjects have been tested by skin-test (ST) and human basophil degranulation test (HBDT) with grass pollen extract (GPE). HBDT was done, using a suspension enriched in basophils, by a technic on slide. Results are expressed by an index (DI) which is percentage of basophils having apparently disappeared (i. e. degranulated) in presence of GPE. No less than 100 intact basophils (and often many more) were always counted in absence of GPE (control) for each subject, so that DI higher than 35% are significant (p less than 0,001). DI were higher than 35% in 28 positive ST subjects for at less one of three dilutions of GPE (10(-4), 10(-6), 10(-8)); in the 5 subjects with false-negative result, 3 had a weak ST response. In 39 subjects with negative ST, DI were higher than 35% in two subjects and only for one dilution (10(-4)). So, concordance of results of HBDT and obviously positive ST reaches 94%. In 33 positive ST subjects, a significant correlation appears between DI (at 10(-4) and 10(-6)) and flare diameter and between DI (at 10(-4)) and wheals diameter. HBDT appears to be a suitable and simple technic for routinely study of reaginic allergies.

[Eosinophilia and respiratory function in the asthmatic subject (author's transl)]. / Eosinophilie et fonction respiratoire chez l'asthmatique.

Total eosinophil count (TEC) was done in 13 normal subjects, in 8 subjects before and 90 mn after a "French" breakfast and in 29 asthmatic patients. The geometric mean is higher (p less than 0,001) in asthmatic than in normal subjects : 304 (231-391) versus 144 (101-197). The breakfast does not interfer with the result of the TEC. In asthmatic subjects, a significant inverse correlation appears (r = 0,57, p less than 0,01) between the logarithm of TEC forced expiratory volume in one second and the quotient : vital capacity. This correlation persists whatever may be the subject's age, the duration of the asthma or age at which he first contracted the illness. Asthma appeared after 40 years in 4 of the subjects : their TEC was higher (p less than 0,01) than in subjects who had become asthmatic before the age of forty. The respiratory function was lowered more in these 4 patients than in others who had been ill for the same time (p less than 0,001). The TEC is not related to results of skin testing with usual inhalant allergens (grass pollen, house dust, cat's or dog's dander) or by result of a provocation test (by inhalation of allergen). Eosinophilia and bronchial obstruction are connected by one (or more) factors that may be inhalant allergens in extrinsec asthma and circulating immune complexes in intrinsec asthma.

[Effects in man of a total adrenal cortical extract on delayed immunity and lymphocyte sub-populations]. / Effets d'un extrait cortico-surrénal total (ECST) sur l'immunité retardée et les sous-populations lymphocytaires chez l'Homme.

After a 10 day treatment with total adreno-cortical extract, administered to 11 subjects, the following results were obtained: increase of delayed cutaneous responses to various antigens, increase in the number of null lymphocytes, decrease in the number of B lymphocytes. These changes did not occur in 16 control patients who were not treated.