[The role of plasmapheresis in the treatment of primary and secondary cryoglobulinemia]. / Ruolo della plasmaferesi nel trattamento delle crioglobulinemie primarie e secondarie.

The data on monoclonal or mixed cryoglobulinaemia patients admitted to Pavia University's 1st Medical Division since 1970 were examined. Complications included peripheral microangiopathies caused by immune complexes and especially kidney lesions of varying severity caused by immune complexes precipitated in the basal membrane. Although the course of the condition was ameliorated in all patients given immunosuppressive treatment alone, this could not prevent the appearance of progressively worsening kidney conditions. Terminating in severe renal failure these were often complicated by encephalopathies, disturbed microcirculation in the brain and hypertension patients given plasmapheresis at an early stage, at the first sign of renal or brain circulation problems, responded brilliantly with regression of all clinical symptoms. Where plasmapheresis was not given until an advanced stage of the kidney disease, a satisfactory improvement was obtained and the quality and expectancy of life enhanced, even though a total cure was not achieved. Regular cycles of plasmapheresis indubitably protect the patient from irreversible renal or microvascular conditions so that immunosuppressive treatment can effectively control the cryoglobulinaemia.

Drugs affecting the hormonal receptors of normal and leukaemic peripheral leucocytes.

The authors investigated the behaviour of steroid hormone uptake in leukaemic cells (CML, CLL, AML, ALL), in basal conditions and after incubation with drugs which modify the cellular concentration of cAMP, PGE and PGF. The results demonstrated the presence in leukaemic cells of an alteration in the incorporation of steroid hormones. This alteration was scarcely modified by incubation with theophylline, which increases cellular concentration of cAMP. On the other hand, it was moderately counteracted by thioproline and was evidently inhibited by flurbiprofen, which also reduced cellular concentrations of prostaglandins, particularly PGE2, with the exception of PGF2 which showed a poor response. Differences were observed in the behavior of hormonal uptake of CML, in contrast to that of AML, CLL and ALL peripheral leucocytes.