Efficacy of a 6-month treatment with Daflon 500 mg in patients with venous leg ulcers associated with chronic venous insufficiency.

AIM: Epidemiological data show that standard compression therapy for leg ulceration in chronic venous insufficiency (CVI) often fails to effectively improve patients' condition. This study assesses the contribution of Daflon 500 mg added to conventional therapy in the healing of hypostatic ulcers of CVI patients. METHODS: Patients of about 65 years were included, with ulcers > or = 2 and > or = 10 cm diameter on 1 or 2 limbs, Doppler ankle/arm pressure index > 0.9, and no recent history of skin graft. Controls (n=68) remained on compression alone while the tested group (n=82) also received Daflon 500 mg 2 tablets/day during 6 months. Treatment could be stopped as soon as the reference ulcer appeared fully healed. Primary endpoints were the rate of healed ulcers and the time to complete healing assessed by planimetry/photography and clinical examination. Variations of the ulcer surface, appearance of the skin, and clinical symptoms of CVI were the secondary criteria. RESULTS: Only 7% of Daflon 500 mg patients necessitated the full 6 month therapy. Whatever the lesion size, from W8 significantly more healed ulcers were observed under Daflon 500 mg (p=0.004), and the ulcer surface was more reduced (p=0.012). For large ulcers, the rate of healing was approximately 2-fold higher with Daflon 500 mg, and the percentage of ulcers healed before W24 was significantly higher (p=0.008). Heavy leg sensation was significantly improved by Daflon 500 mg from W4 (p < 0.05). No treatment-related side effects were reported and the acceptability was considered excellent by 85% of Daflon 500 mg patients. CONCLUSION: Six months of Daflon 500 mg in addition to compression significantly improve some clinical symptoms and accelerate the healing process in patients with ulcerous complications of CVI, with a good acceptability.

Cell-mediated immunity in children with Hodgkin's and non-Hodgkin's lymphomas.

Natural killer (NK) cell activity and lymphocyte proliferation to mitogens might to have diagnostic implications that will help to distinguish between benign and malignant lymphadenopathy in children. In addition, we suggest that NK activity and especially the lowering of NK activity after chemotherapy might be of prognostic value in NHL children.

Interleukin-2 activated cells from peripheral blood of patients with systemic lupus erythematosus.

The effect of recombinant interleukin-2 (IL-2) on proliferative and cytotoxic response of peripheral blood mononuclear cells (PBMC) was investigated in a group of 21 patients with systemic lupus erythematosus (SLE). There was a significant decrease in thymidine uptake of peripheral blood mononuclear cells when compared with controls. However, IL-2 induced cytotoxicity was not diminished and minimal frequencies of lymphokine-activated killer (LAK) cells precursors remained in the range of control group. These data provide an evidence about the dissection between proliferative and cytotoxic response of PBMCs to exogenous interleukin-2 in patients with SLE in vitro. The factors contributing to this effect and the clinical significance of these findings remains to be answered.

[Response of peripheral blood lymphocytes to antigenically nonspecific mitogens in systemic erythematosus]. / Odpovídavost lymfocytu periferní krve na antigenne nespecifické mitogeny u systémového erytematodu.

In 24 patients with systemic lupus erythematosus the proliferating response of lymphocytes of the peripheral blood stream to mitogens PHA, ConA and PWM was examined. The spontaneous incorporation of 3H-thymidine was increased in two patients. The mean response to PHA and PWM was reduced, while the response to ConA was within the normal range. In the active stage of the disease the lymphocyte response was in general lower in the stage of low activity. There was no correlation between the number of CD4 and CD8 lymphocytes nor the CD4/CD8 index and the lymphocyte response to mitogens. In systemic lupus erythematosus the response to PWM was lower than in rheumatoid arthritis, while in rheumatoid arthritis the response to PHA and ConA was lower than in systemic lupus erythematosus.

[Various clinical courses of hypersensitivity vasculitis with eosinophilia]. / Rozdílné klinické prubéhy hypersenzitivních vaskulitid s eozinofilií.

The authors present three case-histories of patients who were followed up for prolonged periods and where the diagnosis of hypersensitive vasculitis was made. During the follow up period it was not possible to prove development into a different group of vasculitis or to detect a hitherto latent associated disease. Another common sign of the investigated patients was eosinophilia repeatedly found in peripheral blood, bone marrow and tissues. According to clinical criteria the above patients could not be included in groups of known types of vasculitis which are associated with eosinophilia. The patients differed significantly as to clinical manifestations of the disease, the response to different therapeutic approaches and some laboratory immunological indicators. The authors discuss the possible participation of eosinophilia in the tissue damage.

Natural killer and interleukin-2 induced cytotoxicity in asthmatics. I. Effect of acute antigen-specific challenge.

Natural killer (NK) cell activity and interleukin-2 (IL-2) induced cytotoxicity to NK-resistant targets T24 in a group of patients with grass pollen seasonal asthma were investigated. Acute bronchial provocation with this antigen was also performed and blood samples were taken before and 15 min after the maximal clinical response. NK activity was elevated in this group but there was a significant decrease after acute challenge. IL-2 induced cytotoxicity was also increased and declined after antigen challenge. Limiting dilution analysis for minimal frequencies of precursors of the IL-2 induced killer cells was introduced and showed increased numbers of lymphokine-activated killing precursors in this group of patients. These data might indicate the aberrations of the IL-2 system in immediate type allergy but the clinical significance of these findings remains to be determined.

Natural killer cell activity following thermal injury.

The role of natural killer cell activity in immunosurveillance following thermal injury remains unknown. We utilize a chromium-51-release assay of K562 targets to monitor NK activity. NK activity of peripheral blood mononuclear cells of severely burned patients (BSA greater than 20%) was determined once a week until the convalescence period was completed. From the second week after thermal injury, impairment of NK activity was demonstrated, but the differences did not reach statistical significance. However, a correlation was found between decline of NK activity and incidences of septic complications. Surprisingly, no decline in NK activity was observed in the first week after thermal injury.

Immunoglobulin E (IgE) in patients with severe burns.

The concentrations of immunoglobulin E (IgE) were measured serially in 30 patients with severe burn injury. A characteristic finding was a rapid and dramatic increase of IgE in the serum of all patients, some of whom showed up to 20-fold increases. IgE was also found in considerable amounts in blister fluid and pleural effusions. In some patients raised IgE values were the only indicator of an anamnestic immediate allergic state. No correlation was found between the IgE levels and clinical characteristics of individual patients but significant changes seemed to be present only in patients with a burn covering more than 20 per cent of the body surface area.

Autoantibodies in hypertrophic cardiomyopathy and their clinical significance.

Data concerning autoantibodies in hypertrophic cardiomyopathy are rare and controversial and only the results of indirect immunofluorescence methods are available in the literature. The aim of this study was to determine the frequency and clinical significance of autoantibodies in hypertrophic cardiomyopathy by means of the Western blot which is a highly sensitive immunological technique. Sera from twelve (48.0%) of the whole group of 25 patients with hypertrophic cardiomyopathy reacted with actin from the HeLa extract. The incidence of anti-actin antibodies in sera from 23 ischaemic heart disease patients was 13.0% (P less than 0.025) and in 37 apparently healthy subjects was 8.1% (P less than 0.001). When samples were assayed on the actomyosin prepared from Xenopus laevis muscle, sera of 14 (56.0%) of the patients exhibited actin positivity while the positivity in ischaemic heart disease and in healthy subjects was found to be 13.0 and 13.5%, respectively (P less than 0.001). Presence of anti-actin antibodies was related to the functional and clinical status and the progression of the disease. Anti-actin antibodies were found more frequently in medically treated patients. These data suggest that anti-actin antibodies are probably not directly involved in the pathogenesis of hypertrophic cardiomyopathy, but their detection might be useful as an additional marker of disease severity.

Effect of interleukin-2 on peripheral blood mononuclear cells in severely injured patients.

The effect of human recombinant interleukin-2 (IL-2) on the proliferative and cytotoxic response of peripheral blood mononuclear cells was analyzed in 12 severely injured patients. The in vitro proliferative response (measured from tritiated thymidine uptake) was normal during the first post-injury week, but rapidly decreased from the second week. The cytotoxic response to natural killer cell-resistant target T24 was likewise diminished from the second week. To clarify if the defect in cytotoxic response was due to numerical reduction of precursors or to reduced responsiveness, limiting dilution assay was introduced. No post-trauma reduction in precursor numbers was observed. These data collectively suggest that, in addition to impaired IL-2 production, there is an endogenous defect in IL-2 responsiveness. In the context of high incidence of septic complications, the observations may be clinically important.

Depression in spontaneous cell-mediated cytotoxicity occurs during hemodialysis.

NK activity against K 562 target cells and the percentage of HNK-1+ lymphocytes in peripheral blood were evaluated in 24 patients on maintenance hemodialysis prior to and during post hemodialysis session. No difference was found in the NK activity of these patients before hemodialysis and normal subjects. On the other hand patients had a decreased number of HNK-1+ cells. During hemodialysis, the NK activity as well as the HNK-1+ cell count decreased. No correlation was found between these parameters and either the cause of end-stage renal disease or the duration of dialysis treatment. In addition no correlation was observed between NK activity and the number of HNK-1+ cells.