Cellular and humoral alterations in the cerebrospinal fluid (CSF) of patients with herpes simplex virus (HSV) encephalitis are summarized. At the onset of signs of HSV encephalitis. CSF parameters may appear normal. Lymphoid pleocytosis is usual, and in some cases polymorphonuclear cells may dominate initially. The lymphoid reaction in CSF is prominent for months or even years after infection. Damage to the blood-brain barrier is variable. Total protein level and concentrations of IgG, IgM, and IgA increase in the early phase of the disease. The IgG content usually remains abnormal. Levels of HSV-specific IgG in the CSF increase in correspondence with total IgG content and remain high. A fairly consistent finding is the increased local IgG production in the central nervous system during HSV encephalitis. The ratio of the concentration of HSV antibody in serum to that in CSF is abnormal, usually from the second week of illness. In many cases a fourfold or greater increase in CSF antibody level is observed. The use of enzyme or radioimmunoassay in antibody determinations does not essentially hasten the diagnosis, and isolation of HSV or demonstration of its antigen in brain-biopsy specimens is the only way to achieve a conclusive diagnosis. The persistence of the CSF alterations suggests that HSV encephalitis is a chronic disease.

Albumins↗

PubMedDate not supplied

Inflammatory cells in chronic middle ear disease. Value of lymphocyte subset determination in ear surgery.

Lymphoid cell subsets were studied in biopsy specimens of uninfected and infected ear canal epidermis, tympanic membrane, cholesteatoma epithelium, and middle ear and antrum granulation tissue. All specimens showing uninfected squamous epithelium, including those of cholesteatoma membrane, contained only a few lymphoid cells. Biopsies of infected squamous epithelium showed enhanced Ts/c activity in the subepithelial layer. Granulation tissue showed normal Th/i activity. B-cells and NK cells appeared in small numbers. Lymphoid cell subset analysis is indicated in ears reconstructed with allograft material to detect signs of rejection. It is of little value in cases of chronic inflammatory middle ear disease which have not previously been operated upon.

Cholesteatoma↗

PubMedDate not supplied

Postoperative radiation therapy and adjuvant chemoimmunotherapy in breast cancer. Aspects of timing and immune competence.

The effects of radiation therapy and adjuvant chemoimmunotherapy on the immune competence of patients with breast cancer were investigated. The tests performed included intradermal tuberculin tests, T- and B-lymphocyte counts, and lymphocyte blast transformation tests; phytohemagglutinin (PHA), concanavalin A (ConA) and pokeweed mitogen (PWM) were used as mitogens. Enhancement in lymphocyte proliferative response to mitogenic stimulation by PHA and PWM was seen in patients after 3 courses of chemotherapy + levamisole, whereas irradiation given after chemotherapy caused long-lasting depression in response to PHA (p = 0.039) and PWM (not significant). T-lymphocyte counts were also lower after irradiation than after chemoimmunotherapy (p = 0.007). Clinically, the 16 patients treated with radiation therapy after chemotherapy exhibited a higher recurrence rate than the 24 patients treated first by irradiation. Enhanced reactivity to tuberculin tests occurred generally in patients receiving a planned treatment including irradiation, chemotherapy (5-fluorouracil, doxorubicin, cyclophosphamide) and levamisole. Enhancement of reactivity was seen more often in patients who had not relapsed.

Adult↗

PubMedDate not supplied

Sequential CT in monitoring experimental lung transplant.

The criteria for diagnosis of lung rejection remain controversial. In this study early changes in lung rejection were characterized using sequential CT with the aim of developing a sensitive and safe monitoring method, which would also provide specific information on graft status. Twenty-one experimental single lung transplants (SLTs) in piglets, including unmodified rejections, immunosuppressed recipients, and autogenic reimplants, were scanned using CT on days 3, 5, 7, 10, 14, 22 up to 134 days after operation. In addition to morphological analysis, bilateral densitometric CT measurements of the peripheral lung parenchyma were used to evaluate the intensity of interstitial infiltration of lung grafts. Altogether 67 postoperative CT studies were carried out. Simultaneous transbronchial/thoracic biopsies were undertaken. The mean follow-up time was 28 days (range 0-134 days). The experience obtained was then used in relation to SLT in a male patient for chronic obstructive pulmonary disease. All piglets had a typical hilar reimplantation response, which disappeared in 10-20 days. Two distinct patterns of radiological acute rejection were found. Increasing peripheral alveolar infiltrates reflected early massive rejection in untreated animals. In immunosuppressed animals, after the initial reimplantation response, acute rejection was detected as densitometrically measured diffuse interstitial infiltration over the whole graft. Local findings, like focal infections, were seen later in the lingula and basal portions of the graft. In the SLT patient, density changes preceded clinical rejection episodes, which responded to steroid therapy. In the experimental study, the lung graft was compared to normal contralateral lung. In the SLT patient, however, this was not possible, and, therefore, the subsequent repeated CT studies formed the basis of clinical follow-up. Sequential imaging and densitometric measurements allowed objective estimation of diffuse interstitial infiltration relating to rejection.

Animals↗

PubMedDate not supplied

Bronchoalveolar lavage. Influence of cytologic methods on the cellular picture.

Bronchoalveolar lavage (BAL) was applied to 803 subjects who had various lung diseases or were healthy controls. Combined Millipore (MiPo) filtration of alcohol-fixed cells and cytocentrifugation (CCF) of fresh, air-dried cells was used for the cytologic studies. On the MiPo preparations the proportions (mean +/- SD) of lymphocytes (30.6 +/- 23.7), neutrophils (5.4 +/- 11) and respiratory epithelial cells (2.4 +/- 3.8) were significantly (P less than .001) higher when compared with those on the CCF slides (21.0 +/- 2.3, 3.6 +/- 1.0 and 0.4 +/- 1.5, respectively). The proportions of eosinophils and basophils were nearly the same on the CCF (1.9 +/- 5.3) and MiPo slides (1.6 +/- 6.1). In MiPo filtration the loss and degeneration of cells can be avoided if the cell suspension is fixed prior to filtration. In cellular morphology the two methods complemented each other, and the specificity and sensitivity were the same. In nonparenchymal lung diseases false pathologic cell findings due to bronchial content contamination can be more reliably excluded from MiPo specimens than from CCF ones.

Bronchoalveolar Lavage Fluid↗

PubMedDate not supplied

Single-lung allotransplantation in pigs: effects of two preservation methods on pulmonary gas exchange.

Single left lung allotransplantation was performed in 16 pigs to determine an optimal solution for lung preservation. Modified Euro-Collins and oxygenated fluorocarbon solutions (FC-43) were used as the lung preservative. Donors in both groups were pretreated with intravenous prostaglandin E1 infusions. The effects of the two different preservatives on ventilation and oxygenation were noninvasively monitored with capnometry and pulse oximetry. The functional results were further compared with morphologic findings. After implantation the right pulmonary artery was clamped, and the transplanted lung supported pulmonary circulation and ventilation. Arterial carbon dioxide tension (PaCO2) and arterial oxygen tension (PaO2) were measured from the arterial blood samples. The Euro-Collins group experienced hypercarbia (PaCO2, 54 to 72 mm Hg) and low end-tidal carbon dioxide (EtCO2) values (3.3% to 3.9%) when the donor lung was reimplanted and reperfused. The pigs in the Euro-Collins group were also hypoxemic after reimplantation of the left lung. The saturation (SpO2) values were 85% to 89%, and the PaO2 values were between 61 and 66 mm Hg. The oxygenated fluorocarbon group had normal ventilatory parameters and arterial oxygen saturation after reimplantation of the left lung; no significant gradient between EtCO2 and PaCO2 was detected. Scanning and transmission electron-microscopic studies of the transplanted lungs showed good to moderate preservation after reperfusion in the oxygenated fluorocarbon group, whereas preservation was judged to be moderate in the Euro-Collins group. Oxygenated fluorocarbon (FC-43) donor lung preservation thus resulted in superior functional recovery in pulmonary gas exchange during reperfusion compared with Euro-Collins solution. Electron-microscopic findings supported functional results obtained.

Animals↗

PubMedDate not supplied

Langerhans' cells in chronic otitis media.

Langerhans cells (LCs) were studied in chronic otitis media (COM) by the immunoperoxidase technique and monoclonal antibodies. The LCs were a regular finding in both thin and thick cholesteatoma epithelium, and in open cavity skin. OKT-6 positive cells were also found in smaller numbers in subepithelial connective tissue and lymphoid follicles, and in cuboidal secretory epithelium. LCs form an important part of the immune defence system of the skin, which lacks the humoral secretory IgA defence mechanism of the mucous membranes. There is no proof that LCs are connected with the keratinization process and possible reformation of cholesteatoma.

Antigens, Surface↗