Treatment of chronic autoimmune thrombocytopenic purpura with monoclonal anti-D.

BACKGROUND: The platelet count increases transiently after treatment with polyclonal anti-D in about 50 percent of D+ patients with autoimmune thrombocytopenic purpura (AITP). The effect is usually attributed to macrophage Fc-receptor blockade by antibody-coated red cells. As polyclonal anti-D is in limited supply, prospective testing was performed on a monoclonal anti-D (MoAb D) in such patients. STUDY DESIGN AND METHODS: Seven D+ patients with chronic AITP received MoAb D intravenously at doses of 47 to 95 microg per kg of body weight. Response was assessed by studying platelet count increment. Hemolysis and red cell-bound MoAb D were measured before and after MoAb D administration. RESULTS: MoAb D red cell binding was demonstrated in all patients at a ratio higher than that observed in AITP patients successfully treated with polyclonal anti-D. However, little or no platelet count increment was observed in six patients, while a transient response was observed in only one (platelet count 97 x 10(9)/L before MoAb D infusion and 163 x 10(9)/L 4 days later). Furthermore, because five patients showed signs of hemolysis and two became anemic, higher doses of MoAb D should be used only with caution in patients with AITP. CONCLUSION: The MoAb D used in this study cannot be proposed as an alternative treatment for patients with AITP.

Complete remission following recombinant interferon alpha-2a in a patient with diffuse large B cell cutaneous lymphoma.

Recombinant interferon alpha (r IFN alpha) has shown significant antitumor activity in patients with follicular small cleaved cell (low-grade non-Hodgkin's lymphomas) and cutaneous T-cell lymphomas. However, IFN alpha seems to be less effective in patients with intermediate or high-grade lymphomas. This case report describes a patient with an initial diagnosis of low grade B-cell lymphoma with histologic conversion to diffuse large B-cell (B1+, Kappa+) cutaneous lymphoma. This tumor proved refractory to chemotherapy but a complete and durable remission was induced with R IFN alpha 2a treatment.

[The drug combination amoxicillin-clavulanic acid compared to the triple combination ampicillin-gentamicin-metronidazole in the treatment of severe adnexal infections]. / L'association amoxicilline-acide clavulanique comparée à la triple association ampicilline-gentamicine-métronidazole dans le traitement des infections utéro-annexielles sévères.

Forty-four patients with severe pelvic inflammatory disease were randomly divided into two groups. Single drug therapy with the amoxicillin-clavulanic acid was used in 22 patients (group A). The other 22 patients (group B) were given a combination of ampicillin, gentamicin and metronidazole. Clinical results were comparable in both groups with 91% successes and 9% improvements in group A, against 86% successes, 9% failures, and 5% non-interpretable results in group B. The difference between the two groups was not statistically significant (p = 11.6%). 30% of patients in each group had positive serologic tests for Chlamydiae. This had no influence on therapeutic results but led to secondary prescription of a cycline. Because amoxicillin-clavulanic acid is active against aerobic and anaerobic pathogens, including beta-lactamase-producing microorganisms, it is a satisfactory alternative to the ampicillin-gentamicin-metronidazole combination, especially as it is simpler to use, less toxic and less expensive.

Timentin (ticarcillin and clavulanic acid) in combination with aminoglycosides in the treatment of febrile episodes in neutropenic children.

Timentin (ticarcillin + clavulanic acid) combined with an aminoglycoside usually netilmicin, was given to 33 children with neutropenic haematological malignancies. The combination of Timentin and aminoglycoside was effective treatment in 27 (87%) of 31 febrile episodes. There were four failures and three results which could not be interpreted. Bacteriological investigations were positive in 13 patients, three strains were resistant to ticarcillin but all were sensitive to Timentin. Clinical success, based upon reduction of fever within 48 h of treatment, was identical whether an organism was isolated or not. The combination of Timentin plus aminoglycoside was very successful and represents one of the best combinations available for empirical treatment for febrile neutropenic children.

Temocillin treatment of serious infections due to gram-negative bacilli in an intensive care unit.

In a group of 27 severely ill patients in an intensive care unit, 40 infections caused by Gram-negative bacilli were treated with temocillin 2g twice daily by the direct intravenous route. The patients (17 men and 10 women) were aged from 35 to 93 years (mean 65.7 years) and 22 had severe underlying diseases. In addition, 10 of the patients were admitted to the intensive care unit following surgery; 6 had acute renal insufficiency, 5 had acute respiratory insufficiency, and 12 were suffering from infectious shock. The infections included septicaemia (19), urinary tract infection (10), respiratory tract infection (4) and biliary tract infection (4). The most frequent bacterial isolate was Escherichia coli (14), followed by Enterobacter cloacae (5), Proteus spp. (5) and Klebsiella pneumoniae (4). The initial pathogens were eliminated in 34/40 infections (85%) and the corresponding clinical cure rate was 60%, with a further 27.5% of patients being improved. In the septicaemic patients, 17/19 pathogens were eradicated from the blood, while clinically, 12 patients were cured and 5 were improved. Eight of the 10 urinary tract pathogens were eliminated, with 6 patients being clinically cured and a further 3 being improved. All of the initial pathogens in both biliary tract and respiratory tract infections were eradicated, accompanied by clinical success in 3 and 2 patients, respectively; the remaining patients were improved. Superinfection with streptococcus group D, Pseudomonas aeruginosa and Staphylococcus aureus was seen in 3 patients. The emergence of resistance to temocillin occurred in an isolate of E. coli, and also possibly in an isolate of K. pneumoniae. No adverse reactions nor abnormal laboratory values related to temocillin administration were observed and, although 7 patients died, none of the deaths were attributable to uncontrolled Gram-negative infection.

Use of the enzyme-linked immunosorbent assay for detection of antibodies to Chlamydia trachomatis.

An enzyme-linked immunosorbent assay (ELISA) using a soluble antigen prepared from the D strain of Chlamydia trachomatis was used for titration of IgG antibodies to Chlamydia trachomatis in 153 sera from 126 patients with non-specific genital infection and from 27 healthy subjects. The results were compared to those obtained with the micro-immunofluorescence method and were in complete agreement in 143 of the 153 sera. The ELISA proved to be reproducible and as sensitive as the micro-immunofluorescence method.

[The enzyme-linked-immunosorbent assay and its application to toxoplasmosis immunity (author's transl)]. / Application de la méthode immunoenzymatique à la détection de l'immunité antitoxoplasmique.

The enzyme-linked-immunosorbent assay (ELISA) was used for the serodiagnosis of toxoplasmosis. 238 sera were tested, and the results compared with those of agglutination and immunofluorescent test. ELISA gives a good correlation (p < 0.001).

Contribution to the early diagnosis of congenital toxoplasmosis.

A method based on a single serological test enabling the diagnosis of congenital toxoplasmosis immediately after birth is described. The concentration of anti-toxoplasmosis antibody from the CSF is compared to that of rubeola used as reference. It is thus possible to distinguish between the passive passage of antibodies in the CSF and their in situ synthesis. When concentration of antibody in the CSF is higher for toxoplasmosis than for rubeola, the existence of a congenital infection of toxoplasmosis can be suggested.

Mode of action of acid pH values on the development of vesicular stomatitis virus.

The effect of low pH's on the development of vesicular stomatitis virus (VSV) was studied. L cells infected with VSV were incubated at pH 6.6. A 99% inhibition in the yield of infectious particles was observed by comparison with the yield at pH 7.4. Such inhibition was not due to inhibition of viral RNA synthesis, since at pH 6.6 all the known species of VSV RNA molecules were synthesized. Furthermore, all the known species of VSV proteins were also synthesized. However, no viral particles nor nucleocapsids were detected. Raising the pH to 6.9 resulted in the appearance of nucleocapsids and viral particles, although the yield of infectious virus was still inhibited by 90%. The lack of infectivity of these pH 6.9 viral particles was correlated with their inability to promote primary transcription. The hypothesis that low pH's alter the correct positioning of the viral proteins into the cell membrane is presented.