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Biomedical subjects

G Busnach

Publications and source records attributed to G Busnach.

At least 55 records · Page 3Linked to original sources
PubMed1986

Efficacy of a combined treatment with plasma exchange and cytostatics in macroglobulinemia.

Monthly plasma exchange (PE) sessions have been carried out in 3 patients with advanced Waldenström macroglobulinemia, in order to reduce electrophoretic M band under 2g/100 ml. When PE was combined to low doses of cytostatics (n = 18), 3 procedures per session were required to obtain a mean 57.4 +/- 12.3% IgM reduction, from 4.2 +/- 1.2 to 1.7 +/- 0.5 g/100 ml. A mean 61.5 +/- 13.1% IgM reduction, from 5.5 +/- 1.3 to 2.1 +/- 1 g/100 ml, was obtained in 64 procedures carried out as the only therapy in 12 sessions, with 5.3 procedures requirement per monthly session. IgM percent reduction 24 hours after PE was greater with combined treatment (45 +/- 9.7 vs. 28.9 +/- 15.4%; p = 0.001). The advantage of a combined treatment is therefore either a lowered PE requirement or a tapered maintenance cytostatic dosage.

Chlorambucil↗
PubMed1983

T-suppressor cell abnormalities in type I membranoproliferative glomerulonephritis.

Twelve patients with type I membranoproliferative glomerulonephritis (MPGN) have been studied. All had normal renal function, none a nephrotic syndrome, and none was on therapy. In 7/12 serum C3 and/or C4 were low. T cell subsets were analysed with OKT monoclonal antibodies and Ts function (TsF) was studied by the Concanavalin-A Enhancement test (Con-A E) and with a new assay where native OKT8+ cell function only is explored (OKT8-DEP PWM test). OKT4/OKT8 ratio was lower than controls (p less than 0.025). TsF, as studied by the Con-A E was unchanged, while OKT8-DEP PWM test showed a marked decrease (p less than 0.005). Hypocomplementaemic patients (H), as compared with normo-complementaemic patients (N), had lower OKT4/OKT8 ratio (p less than 0.01) while TsF was unchanged in both groups. These results are consistent with a functional defect of Ts activity in type I MPGN. Increased OKT8+ cells may be a compensatory response, and hypocomplementaemia may be a marker of this defect.

Adult↗
PubMed1983

Immunological monitoring of viral infections in renal transplant recipients.

Twelve viral episodes occurred in 54 antilymphocyte globulin-treated renal transplant recipients (two primary cytomegalovirus, seven cytomegalovirus reactivations, one chickenpox, two influenza). In 11 of 12 cases the ratio between peripheral T4 and T8 subsets fell (from 1.698 to 0.986, p less than 0.01) due both to a reduction of T4+ and to an increase of T8+ cells. T10+ and 5/9 subsets also increased. Suppressor T-cell function, as measured by two simultaneous assays, was enhanced. In antibody-negative CMV patients the reversal of T4/T8 ratio preceded the appearance of specific IgM. T4/T8 ratios rapidly returned to normal in mild episodes, but remained reverted in symptomatic CMV patients for several months, despite a reduction in the immunosuppressive regimen. Symptomatic viral episodes displayed marked imbalances in T cell subset numbers and function, while in asymptomatic cases the changes were less evident.

Chickenpox↗
PubMed1983

Plasma exchange in acute renal failure by cortinarius speciosissimus.

Mushroom poisoning by Cortinarius speciosissimus (C. spec.) leading to irreversible renal failure has been described; in a recent report, an expected bad prognosis has probably been overcome as a result of the very early use of hemoperfusion. In Sep. '81, a healthy couple of wife and husband, both aged 38, had gastrointestinal symptoms 2 days after ingestion of C. spec. On day 8 an acute renal failure developed and the same day, before dialysis, plasma exchange (PE) was undertaken. Renal biopsies disclosed a common pattern of tubular necrosis, scattered infiltrates and interstitial edema. Diuresis and partial recovery started in the man on day 10, while failure persisted over six months in the woman. Further to individual sensitivity to C. spec. toxins, renal damage, once established, may be irreversible, irrespectively of early treatment. Limited usefulness of PE in C. spec. poisoning is probably related to the long latency between ingestion and occurrence of the first renal symptoms.

Acute Kidney Injury↗
PubMed1983

Renal abnormalities reverted by plasma exchange in thrombotic thrombocytopenic purpura.

Thrombotic thrombocytopenic purpura (TTP) is usually accompanied by renal disfunction presumable due to diffuse thrombotic occlusions in the microcirculation. Two patients with TTP and slight renal failure with proteinuria and microscopic hematuria, were treated by repeated plasma exchanges with fresh frozen plasma, associated with prednisone and cyclophosphamide in one case, and prednisone alone in the other one. Platelet count, hematocrit and lactic dehydrogenase reverted to normal values within the fourth exchange; circulating immune complexes were never detected. Plasma factor stimulating prostacyclin activity lacked in only one patient and returned to normal levels after plasma exchange without being affected during a hematologic relapse. Renal function and urinary abnormalities reverted to normal by the end of plasma exchange and nine and six months renal and hematologic follow-up is still negative. Renal abnormalities in TTP seem to take advantage of early treatment by plasma exchange, which further to replacement of missing plasma factors, can account for the removal of toxic substances to be further investigated on.

Adult↗
PubMed1982

[Necrotizing angiitis with glomerular and arterial deposits of IgA ].

A 68 year old woman presented a rapidly progressive renal failure associated with manifestation of a systemic disease and showed, at renal biopsy, a picture of severe necrotizing angiitis with a proliferative glomerulonephritis with 80% crescents. Renal function improved after a treatment with high doses of steroids, heparin and immunosuppressive drugs. Immunofluorescence study showed diffuse predominant deposits of IgA and C3 both along capillary walls and in the majority of vessels. Skin and muscle biopsies failed to show lesions of vasculitis. The nosological definition of this condition is discussed, the patient presenting with some aspects suggestive of a Schönlein-Henoch syndrome, and others of polyarteritis nodosa.

Aged↗
PubMed1981

Monocyte infiltration and glomerular hypercellularity in human acute and persistent glomerulonephritis. Light and electron microscopic, immunofluorescence, and histochemical investigation on twenty-eight cases.

Glomerular monocyte infiltration was searched for using staining for nonspecific esterase and/or electron microscopy in 28 patients with acute glomerulonephritis submitted to biopsy at different intervals from the beginning of the disease. Significant monocyte infiltration was detected in 12 cases displaying prominent intracapillary hypercellularity and granulocyte exudation. All cases but one were submitted to biopsy in the first 6 weeks of the disease. Negative cases, submitted to biopsy in the same period or in the later phases of the disease, displayed more or less evident mesangial hypercellularity as the prevailing feature. Most positive cases showed glomerular deposits of IgG. Phagocytosis of IgG by mononuclear cells was investigated in all cases positive for monocytes and in 10 negative ones, using an immunofluorescence technique on paraffin-embedded material. Only in the former group were a few or scanty IgG-phagocytosing monocytes detected in six cases. Our results only partially confirm the role of monocytes in causing glomerular hypercellularity in human acute glomerulonephritis. In fact, the relevance of this phenomenon appears much less important than in several well-known experimental models and in some cases of human chronic glomerulonephritis. Moreover, macrophage infiltration is present in cases with greater immunologic involvement and tends to decline with time. Therefore, it seems that, in human acute glomerulonephritis, glomerular hypercellularity results mainly from intrinsic cell proliferation.

Acute Disease↗
PubMed1981

Renal disease in essential mixed cryoglobulinaemia. Long-term follow-up of 44 patients.

The mode of presentation of renal disease in 44 patients with essential mixed cryoglobulinaemia (EMC) was: acute renal failure (two patients), acute nephritic syndrome (six patients), nephrotic syndrome (eight patients), proteinuria and/or haematuria (28 patients). Renal biopsy, performed in 35 patients showed proliferative lesions in 33, while only minimal glomerular changes were seen in the remaining two. Immunofluorescence studies showed: IgG (85 per cent), IgA (36 per cent), IgM (90 per cent), C3 (90 per cent), C1q (47 per cent), and C4 (33 per cent) deposits, mainly located in subendothelial position. On electron microscopy, crystalloid structure of deposits and monocyte infiltration of capillary loops were the outstanding feature. The survival rate was 75 per cent at 10 years from the onset of clinical symptoms. Thirty-nine patients were followed for three to 146 months (mean 53.8). Twelve patients died, cardiovascular disease and infection being the commonest cause of death. Thirteen patients showed acute renal failure of acute nephritis syndrome: nine recovered completely, whereas the remaining four died during the acute renal episode. Three patients developed chronic renal failure, but only one period required chronic dialysis. The ominous significance of renal impairment in EMC should therefore be revaluated. The high prevalence of hypertension (28/44 patients) which was refractory to treatment in six, may be important to the clinical outcome.

Adult↗
PubMed1979

Morphological, immunohistological and clinical findings in renal amyloidosis: correlations with prognosis in 16 patients.

Sixteen patients affected by renal amyloidosis (A.) and submitted to renal biopsy have been studied by light microscopy and immunofluorescence. Clinical manifestations at observation and follow up have been reviewed. Survival was 32% at ten years, lower than all other nephropathies except rapidly-progressive glomerulonephritis. Primary A. had a significantly worse survival rate than secondary A. An observation up to 6 years after biopsy allowed us to isolate a group of patients with a steady good renal function: this group is characterized by: a longer mean duration of nephropathy before observation, a lower incidence of nephrotic syndrome (NS), absence of renal failure at time of biopsy, a higher incidence of increased mesangial areas at light microscopy, a lower percentage of glomerular capillary walls thickening, a higher incidence of amyloid deposits on vessels but not on glomerular capillaries, a definite more elevated presence of Ig and C3 over mesangium and glomerular capillary walls. The possible role of the last findings is discussed.

Adolescent↗
PubMed1979

The presence and possible role of monocyte infiltration in human chronic proliferative glomerulonephritides. Light microscopic, immunofluorescence, and histochemical correlations.

Twenty-seven cases of chronic glomerulonephritis with proliferative pattern (11 cases of primary mixed IgG-IgM cryoglobulinemia, 8 cases of SLE, and 8 cases of primary membranoproliferative glomerulonephritis) were studied with particular attention to the glomerular monocyte infiltration. The latter, detected by means of nonspecific esterase technique, was compared with the presence of hyaline thrombi and intraluminal immunoglobulin lumps. Monocyte infiltration was heavy and almost constant in cryoglobulinemia, less important in SLE, and practically absent in membranoproliferative glomerulonephritis. By means of immunofluorescence technique on paraffin embedded material, monocytes are shown to contain IgG and IgM, suggesting a phagocytic activity on some types of immune complexes. Since monocytes are migrant cells, and therefore easily removable from the glomeruli by the bloodstream, it seems that they could be responsible for regression of glomerular hypercellularity as reported in some patients with cryoglobulinemia showing clinical improvement.

Chronic Disease↗
PubMed1978

[Treatment with antilymphocyte globulin (ALG) and evolution of renal transplant: observations of 42 cases].

42 necrokidney transplants, performed in Renal Unit of "Niguarda - Ca' Granda" Hospital in Milan, since 1972, have been examined. Hystocompatibility score and previous transfusions and/or pregnancies apparently did not correlate with three months transplants survival. Our patients have been separated into two groups according to treatment with or without ALG: the group treated with ALG showed a better percentage survival of the kidney at three months a lower incidence of rejection episodes during the same period. The usefulness of ALG treatment is reaffirmed; we consider that a better prognosis at three months probably means a more favorable clinical course.

Adolescent↗
PubMed1978

Immunohistological diagnosis of drug-induced hypersensitivity nephritis.

The immunohistological findings in 10 cases of DIHN and in 6 cases of R-ARF were compared with the patterns of experimental models and human examples of immunological nephritis. In most cases the simultaneous involvement of glomerular and extraglomerular structures was observed. A linear pattern on tubules together with a granular pattern on glomeruli and other structures was more frequently seen in Rifampicin adverse reactions. Direct and indirect immunofluorescence techniques performed in these last cases gave no evidence of the presence of the antigen and specific antibodies in the kidneys.

Adult↗
PubMed1977

[Immunohistological aspects of nephropathy with minimal lesions].

Renal biopsies from 32 patients, whose light microscopy showed a pattern of minimal changes nephropathy, have been submitted to immunohistological examination. On the basis of immunofluorescence pattern we separated the cases into three groups: the first group (12 cases) was characterized by absence of any glomerular deposit. The second group (9 cases) showed focal and segmental deposits of IgM and sometimes C3 on capillary walls. In the third group (11 cases) we observed slight deposits of IgM and sometimes C3 "comma like" over glomerular structures in all glomeruli. The site of these last deposits was sometimes mesangium and sometimes the capillary walls. The results of immunohistological examinations gave no information about the pathogenetic mechanisms of minimal changes nephropathy. We observed that the patients enclosed in the second group had a worse clinical prognosis, compared with the other two groups.

Capillaries↗
PubMed1977

[A contribution to ergometric tests in the definition of gravity of mitral stenosis. The importance of the behavior of the left ventricular function, not always correlation to hemodynamic alterations above the valve (author's transl)].

An attempt to evaluate the severity of the valvulopathy was performed in 50 patients with pure mitral stenosis, 36 females and 14 males, by a haemodynamic study and by an exercise test. In 76% of the cases, electrocardiographic "ischemic" abnormalities were observed during the exercise test; after the exclusion of patients over 45, and patients with atrial fibrillation and/or digitalis treatment, a high frequency (63,15%) of electrocardiographic ischemic changes with effort is still observed. No correlations between the result of the exercise test either with pulmonary pressure values, or with other haemodynamic data (cardiac index and pulmonary vascular resistances) were demonstrated. The electrocardiographic abnormalities induced by exercise in these patients are discussed; the authors conclude that this behaviour under effort is significant for the importance of the impairment of the left ventricle function in mitral stenosis.

Adult↗