[Chronic illness in adolescence: ten pertinent questions]. / Maladie chronique à l'adolescence: dix questions pertinentes.

Among adolescents with chronic illness or disability, some are survivors of a severe disease in childhood, some have a long-standing yet less severe condition and some have been ill since adolescence only. Owing to the considerable progress of pediatrics, the number of these adolescents and young adults has been regularly increasing. For all, the major question is that of their future and for many, that of the transition from pediatric to adult medical care. This work of follow-up and guidance requires, beyond a strong medical knowledge of each condition, a good understanding of the specific global needs at that age as well as of the multiple and reciprocal impacts between chronic illness and the progression of adolescence. In order to increase pediatricians' awareness and skills in that field, the authors propose a clinical guide composed of ten relevant questions to be addressed when dealing with any chronically ill or disabled adolescent.

Analysis of the V genes coding for a monospecific human antibody to myosin and functional expression of single chain Fv fragments.

A monospecific human IgM monoclonal antibody (mAb), reactive with myosin from human heart, has been obtained by EBV transformation. This mAb may have a diagnostic potential in the imaging of myocardial necrosis. However, owing to the fact that the molecular mass of an IgM is 900 kDa, a poor diffusion and a slow penetration inside necrotic myocytes could reduce its capacity for scintigraphic detection. In order to alleviate these problems, we constructed the scFv by cloning the VH and VL domains into the pHOG21 vector. Analysis of the V genes proved an unmutated configuration showing that the immortalized B cell issued from the primary IgM repertoire. The expression product in Escherichia coli was a 35 kDa scFv fragment with the antigen-binding specificity of the parental mAb.

Salivary IgE in allergic patients and normal donors.

A prospective study was conducted on 73 allergic patients and 14 normal volunteers in order to measure the IgE concentration in both serum and saliva, and analyze salivary IgE according to the characteristics of the allergic disease. IgE was more frequently detected in saliva from allergic patients than from normal subjects, but its concentration was not significantly higher in the allergic group. The IgE concentration in saliva was not related to serum IgE or to the type of syndromes of the allergic disease, but increased with the symptoms during the pollen season in patients suffering from pollen-induced rhinitis and conjunctivitis.

Radioimmunodetection of rat and rabbit cartilage using a monoclonal antibody specific to link proteins.

Biodistribution analysis using [125I]Fab-6F3 specific to link proteins from human articular cartilage performed in rats by autoradiography showed a high concentration of radioactivity in all cartilaginous tissues. Preliminary immunoscintigraphic assays were performed in rabbits. Front and side view images of whole animals exhibited high uptake in cartilage tissue of the knee articulation, in the invertebral disk and the humeral head. This fixation was still detected 24 h post-injection, although high washout of radioactivity was observed.

The effect of sodium cromoglycate on platelets: an in vivo and in vitro approach.

Platelet functions are altered in patients suffering from atopic diseases, including asthma. Such alterations might be related to IgE since platelets bear a specific IgE receptor termed Fc epsilon receptor II, and there is some evidence that IgE alone, that is, in the absence of antigen, could modify platelet functions, such as monoamine uptake. Although disodium cromoglycate (DSCG) has been demonstrated to interfere with IgE-mediated activation of human platelets, its effect in the absence of antigen remains unknown. We examined the DSCG effect on IgE-induced alterations both in vivo and in vitro. The effect, in vivo, of a daily intake of 40 mg of DSCG for 4 weeks was assessed on platelet kinetics, studied by a labeling technique on four patients with stable asthma. The effect, in vitro, of DSCG was assessed on IgE-induced alteration in monoamine uptake in platelets from 12 healthy subjects. DSCG significantly increased, in vivo, the mean time constant of platelet-survival curves from 234 +/- 40 to 463 +/- 150 hours (p less than 0.01). The amplitude of this effect increased with the patient's serum IgE concentration. DSCG, in vitro, reduced the inhibitory effect of IgE on monoamine uptake by 82%. This effect was concentration dependent and not related to IgE binding. It is concluded that DSCG alters both the survival time of platelets from allergic patients in vivo and the IgE-dependent monoamine uptake in platelets from normal subjects in vitro. These effects are likely to be related to the direct action of DSCG on cells bearing the Fc epsilon receptor II and might be independent of the specific trigger.

Biodistribution study of a monoclonal antibody specific to link proteins from human cartilage.

We report the use of monoclonal antibody 6F3 prepared against link proteins from human articular cartilage to elucidate the distribution of these glycoproteins within connective and other tissues. By immunohistochemical analysis, we showed that only the Fab fragment could reach the antigenic site in human articular sections. Cross-reactivity of the antibody 6F3 with link proteins purified from rat articular cartilage allowed us to carry out a biodistribution analysis in vivo in the rat. The time course of whole blood and plasma showed maximal activity 6 h after the 20 micrograms i.v. injection of [125I]Fab-6F3. Urinary excretion seems to be a high route of elimination. Moreover, we noticed no radioactive uptake across the blood-brain barrier. A significant fixation of labeled antibody Fab-6F3 was observed in noncartilaginous connective tissues such as aorta, skin and lung. As expected, specific and increased radioactivity was observed in all cartilage tissues, this increase was significantly higher 6 h after the [125I]Fab-6F3 injection than in the other connective tissues.

The inhibitory effect of immunoglobulin E on monoamine uptake in human platelets.

The uptake of the monoamine radiolabelled tracer 125I-meta-iodo-benzyl-guanidine (MIBG) was studied in vitro in platelets from 15 healthy volunteers and five allergic patients whose serum IgE concentration was 37 +/- 33 and 650 +/- 200 IU/ml, respectively. The MIBG uptake was determined by means of a gamma counter after incubation in a buffer. Binding of IgE to platelets significantly reduced MIBG uptake both in healthy subjects and in allergic patients. This reduction was significantly related to the action of IgE as it did not occur after binding of IgG. Moreover, MIBG uptake plotted versus increasing concentration of IgE (ranging from 10 to 3000 IU/ml) was fitted by a classical sigmoidal curve which was not significantly different between healthy subjects and allergic patients. Lastly, the effect of IgE on MIBG uptake was due to the binding of the sole IgE as it was not modified by subsequent addition of anti-IgE. It is concluded that the binding of the sole IgE to its specific receptor on platelets alters the transport of monoamines.

Control and isotopic quantification of affinity of antithrombin III for heparin-like surfaces.

Heparin-like materials, characterized by a defined superficial density of functional groups which activate antithrombin III (AT III), when in contact with blood specifically inhibit thrombin as soon as it appears. This paper describes an isotopic method to estimate this density and to visualize the distribution of the affinity sites concerned, both directly with AT III labelled with 125Iodine and indirectly with an anti AT III monoclonal antibody labelled with 111Indium.

Conditions for radioiodination of antithrombin III retaining its biological properties.

In order to obtain a radioiodinated antithrombin III (AT III) with a good labelling yield and optimal biological properties towards heparin, thrombin and its anti-AT III monoclonal antibodies, we compared the classical labelling methods and found them wanting. Thus, we perfected a new labelling procedure which fulfils the above requirements.

Platelet kinetics in stable atopic asthmatic patients.

The kinetics of platelets labeled with indium-111 were investigated in 13 healthy subjects as well as in 9 patients in the asymptomatic interattack stage of asthma. The survival times of platelets in healthy subjects was 8.9 +/- 1 days; in asthmatic subjects it was 4.7 +/- 1.3 days (p less than 0.001). The survival curve is of a biexponential form in asthmatics, thus suggesting the presence of 2 populations: one with a short life span (23 +/- 7 h), representing a third of the total population (33 +/- 9%), and the other with a normal life span. No single preferred site of platelet sequestration was found. These results suggest the presence of functional or anatomic lesions of platelets in asthmatic patients, which can be explained only hypothetically at the present time.

Intraperitoneal injection of technetium-99m sulfur colloid in visualization of a peritoneo-vaginalis connection.

Ten minutes after an intraperitoneal infusion of Tc-99m sulfur colloid, a gamma camera was used to obtain anterior abdominal views. This visualized a peritoneoscrotal communication in an 80-yr-old patient. He had developed extensive edema of the genitals and lower limbs after about 6 wk of continuous ambulatory peritoneal dialysis. At operation the communication was confirmed and closed. A repeat test verified the success of operation.

[Kinetic study of indium-111 labelled platelets in idiopathic thrombocytopenic purpura (author's transl)]. / Etude cinétique des plaquettes marquées à l'indium au cours des purpuras thrombopéniques idiopathiques.

Labelling platelets with 111 Indium-oxine has advantages over the conventional 51 Chromium method: labelling is more efficient and the radiations emitted almost exclusively consist of gamma-rays. Owing to these advantages, autologous platelets can be used for kinetic studies in patients with idiopathic thrombocytopenic purpura, even when thrombocytopenia is severe. 111 Indium labelling also provides accurate information on the sites of platelet destruction, which may help to predict the patient's response to splenectomy.

[Comparison of platelets frozen with different cryoprotective agents]. / Etude comparative des plaquettes congelées avec différents cryoprotecteurs.

A comparative study was performed on platelets frozen with dimethyl-sulfoxide (D.M.S.O.), glycérol and dimethyl-acetamide (D.M.A.C.). The results of tests realized in vitro (platelet yields after thawing platelet aggregation, hypotonic stress, release of enzymes and ultrastructure), and in vivo (life span and recoveries after transfusion) have clearly shown that D.M.S.O. is the best cryoprotective agent. The results obtained with glycerol were less interesting and more clinical data are needed in order to study the hemostatic effectiveness of platelets preserved with this agent. Dimethyl-acetamide gave the worse results and in our opinion, must not be used for the cryopreservation of platelets.