The use of intravenous immunoglobulin in recurrent pregnancy loss associated with combined alloimmune and autoimmune abnormalities.

PROBLEM: Several studies have evaluated the effect of intravenous gammaglobulin (IVIG) in women with unexplained recurrent spontaneous abortions (RSA). Data regarding the underlying immunologic abnormalities in these patients is scant. This study reports the pregnancy outcome and immunologic changes observed in a large group of women with RSA associated with well-defined alloimmune and autoimmune abnormalities treated with IVIG. METHODS: Thirty-five patients with three or more recurrent miscarriages were studied. None of the patients had identifiable alloimmune response to paternal lymphocytes. Twenty-four patients had anti-thyroid antibodies, ten patients had high levels of circulating immune complexes, and six patients had anti-cardiolipin antibodies. Five patients had Hashimoto's disease, one had immune thrombocytopenic purpura, and one had Crohn's disease. Twenty-three patients had more than one autoimmune abnormality. All patients received IVIG infusions (200-250 mg/kg) every 3 weeks during the first 8 months of pregnancy. RESULTS: Twenty-eight patients (80%) had a successful pregnancy. Decrease of the level of autoantibodies and circulating immune complexes was observed in all patients who had a successful pregnancy. Only three of these patients developed measurable alloimmune response to paternal antigens. CONCLUSIONS: This preliminary study suggests that IVIG may be of benefit to patients with recurrent pregnancy associated with combined alloimmune and autoimmune abnormalities. This benefit was seen in spite of lack of detectable correction of the alloimmune abnormality in the majority of patients.

A gandhian model of health: Looking at Alzheimer's disease.

Mahatma Gandhi was often criticized for mixing religion, politics, economics, and health. However, it was his very insistence on the fundamental interrelationship of all aspects of life that gives his ideas such relevance for today's problems. This paper focuses on his views on health and attempts to develop a Gandhian model of health that has relevance for us today. This model is then specifically applied to the vexing problem of Alzheimer's disease, and an ongoing therapeutic trial that is based on this model is described.

Type A behavior: clinical significance, evaluation, and management.

Throughout recorded medical history a relationship has been postulated between the emotions and heart disease. Type A behavior is, in part, a contemporary restatement of this relationship. It is a clustering of behaviors characterized by a profound sense of time urgency, hostility, competitiveness, and a chronic struggle to obtain more and more poorly defined goals. Originally described in white urban men, it has now been shown to characterize many men and women in a variety of western industrialized societies. Type A behavior has been clearly established as a risk factor for coronary heart disease equal in magnitude to the other standard risk factors. The definitive identification of this behavior pattern is done either through a standardized interview or through one of several written tests. A simplified checklist is presented for use by the family physician in the office setting. Modification of this behavior pattern is best done using a multifaceted approach that addresses the behavioral, cognitive, physiologic, and environmental aspects. The discipline of meditation has potential as a therapeutic tool that fits in with this multifaceted approach.

A rapid method for the isolation of ribonuclease from yeast (Saccharomyces carlsbergensis).

A ribonuclease (RNAase; EC 3.1.14.1) from brewer's yeast was purified 90-fold. Crude RNAase was initially separated from other proteins by precipitation at pH 4.0 after incubation of the mechanically disrupted yeast cells at pH 6.0 and 52 degrees C for 30 min. The RNAase was purified from the supernatant by ultrafiltration with a PM-30 membrane and adsorption chromatography on hydroxyapatite. RNAase preparation was free of phosphatase, deoxyribonuclease and phosphodiesterase activities. It showed maximum activity at pH 6.0 and a temperature optimum of 52 degrees C with yeast RNA as substrate. This RNAase hydrolysed yeast RNA to nucleoside 3'-phosphates and showed no evidence of base specificity.

Social aspects of urbanization.

PIP: In slightly less than a century the world has gone from a predominantly rural to a largely urban society. Unlike Western Europe which industrialized slowly with labor-intensive industries, the developing world is industrializing rapidly with capital intensive industries which provide insufficient employment for the millions coming into the cities from the countryside. 2 factors responsible for growth of cities are rural push combined with urban pull, a lack of opportunity in the country combined with hopes and aspirations represented by the city. In addition, large population growth is a factor in both the increase in numbers of city-born dwellers and in the increase of young people leaving the countryside. Problems of health, sanitation, and public welfare are compounded by this rapid population growth. The social implications of these migrations are awesome. Already people are crowding together into cities without sufficient industrial base to provide employment; 1/5 to 1/4 of adult males are unemployed; as many as 4 out of 5 families live in a single room; as many as a 1/3 or more are without water. The tensions and social unrest caused by such conditions are the seedbed for serious political unrest. Resources and knowledge must quickly be brought to bear on the urban problem so that the now-disadvantaged will be able to realize their dream of a better life.^ieng