[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.

[Plasmapheresis and survival of patients with myeloma and secondary renal insufficiency]. / Plasmaferesi e sopravvivenza del paziente mielomatoso con insufficienza renale secondaria.

The mortality rate due to renal insufficiency in patients with myelomas was studied and the results obtained compared with figures on patients given plasmapheresis to correct the insufficiency. The results of the comparison confirm the value of the immediate use of plasmapheresis on patients with myelomas. In a large percentage of cases, the technique either completely cured or significantly improved renal dysfunction, thus normalizing the blood and urine situation and improving the patients' chances of survival.

[Behavior of the principal protein hormones in normal and leukemic leukocytes]. / Comportamento dei principali ormoni proteici nei leucociti normali e leucemici.

GH, LH, insulin and glucagon patterns were studied in the peripheral leukocytes of normal subjects (granulocytes and lymphocytes separated on a Ficoll-Hypaque gradient) and leukaemic patients (CML, AML, CLL, and ALL), using a double antibody RIA on whole cells. The uptake of 125I-labelled insulin and GH by these cells was also assessed. The results showed that in leukaemia, particularly CLL, ALL and AML, though not in CML, there was a constant reduction in hormone values, plus depressed GH and insulin uptake. The only exceptions were glucagon and insulin in CML, and LH in CLL, since their concentrations were normal or clearly enhanced. The data are seen as an expression of a membrane receptor block extending to several hormones with structural differences (protein, steroid, T3 and T4), capable of altering the ability of leukaemic cells to respond to ordinary factors modulating their differentiation, functional activity, and the expansion of the corresponding stem cell compartment.