Torticollis as a sign of cervico-thoracic epidural haematoma in an infant with severe haemophilia A.

We describe the case of a spinal epidural haematoma in an infant with severe haemophilia A. Initial signs and symptoms were non-specific resulting in delay of the diagnosis and more definitive therapy. The patient eventually developed torticollis, acute flaccid paralysis of the upper extremities, and respiratory distress, prompting radiological examination of the spinal cord. The patient was treated with recombinant FactorVIII and laminectomy. Neurological recovery was complete 3 months following the event. We hypothesize that infants with haemophilia may be at higher risk for this rare complication because of their increasing mobility, frequent falls while cruising furniture, and lack of prophylactic factor replacement. Non-specific signs such as irritability without a focus should alert the clinician to this diagnostic possibility. Torticollis should prompt rapid radiological evaluation of the cervical spine with magnetic resonance imaging to avoid delay in diagnosis.

Subcutaneous Corynebacterium parvum in bladder cancer: a controlled study of its immunological effects.

Fourteen out of 26 patients with invasive bladder cancer were randomly assigned to receive weekly subcutaneous injections of Corynebacterium parvum (CP) in addition to standard treatment. Peripheral blood T lymphocyte percentage, K cell activity, mitogen responsiveness, and monocyte and polymorph leucotaxis were measured at intervals over a period of 1 to 2 years. The only consistent difference between the CP-treatment patients and the controls was a slightly higher level of K cell activity in the former, who, however, fared rather worse than the controls in terms of survival.

Effect of cortisone acetate on effector cells for antibody-mediated cytotoxicity in mouse and rat.

We have looked at the effect of in vivo cortisone acetate treatment on effector cells for antibody-dependent cell-mediated cytotoxicity in mice and rats, using both chicken erythrocytes and the mouse lymphoma cell line AKR.A as target cells, since the AKR.A cell line is susceptible to antibody-dependent cell-mediated cytotoxicity killing only by the lymphoid effector cell, whereas a wide variety of effector cells will lyse chicken erythrocytes in the presence of antibody. The lymphoid K cell, detectable in rat spleen and blood, was unaffected by steroid treatment sufficient to cause lymphopenia, whereas splenic anti-chicken erythrocyte cytotoxicity of whole spleen and of phagocyte-free spleen was depressed in mice and rats. The greatest suppression was seen with nonphagocytic mouse spleen, and may have been in part attributable to steroid-induced redistribution of the effector cell(s), since the cytotoxic capacity of nonphagocytic bone marrow cells was increased by 70% at a time when the activity in spleen was 25% of normal.

Intercellular immunological controls and modulation of cyclic AMP levels. Some doubts.

We have re-examined two sets of observations put forward to support the hypothesis that rises in cAMP levels induced by vasoactive amines and prostaglandins are involved in the intercellular control of immunological and inflammatory processes. (1) This hypothesis is said to be supported by the fact that cholera toxin, which raises cAMP levels in lymphoid tissue in vivo, is immunosuppressive. However, we found that cholera toxin inhibited antibody production only if given in doses causing gross destruction of lymphoid tissue. This sort of evidence, therefore, cannot be used to support a hypothesis about homoeostasis under physiological conditions. (2) The hypothesis is also said to be supported by the claim that vasoactive amines, prostaglandins, cholera toxin and methyl xanthines, which raise cAMP levels in cells in vitro, also inhibit the formation of haemolytic plaques by spleen cells from mice immunized with sheep red cells. However, we were unable to confirm this claim, except when the experimental conditions were such that cells were killed or other artefacts operated.

Mechanisms of specific and non-specific tumour immunity after azathioprine treatment of mice.

The ability of phagocyte-depleted spleen cells to lyse chicken erythrocytes (CRBC) in the presence of antibody was measured in mice which had been treated with the antimetabolite azathioprine. Single doses of the drug had no effect on this ability when measured on the day after administration. A 4-day course of 80 mg/kg/day of the drug markedly reduced splenic antibody-dependent cell-mediated cytotoxicity (ADCMC) although it reduced neither antibody responses nor the development of cytotoxic cells following subsequent immunization with an allogeneic tumour. Splenic phagocytosis and phagocyte-mediated ADCMC were both slightly enhanced following drug treatment. The implications of these findings are that the major antibody-dependent cytotoxic cell in phagocyte-depleted mouse spleen is normally in a state of proliferation, and plays no important role in antigen recognition.