Systemic lupus erythematosus triggered by adult thymectomy in myasthenia gravis patient: report of a case.
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Biomedical subjects
Publications and source records attributed to G Delespesse.
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The influence of age and sex has been evaluated in 326 allergic patients on the following parameters: total serum IgE concentration, serum concentration of specific IgE antibodies against seventeen common allergens, mean number of positive allergens, absolute numbers of circulating eosinophils, corticosteroid dependence and response to sodium cromoglycate (DSCG). The results indicate that age and sex significantly influence the IgE antibody production in these patients. The data strongly suggests the appearance during ageing of a progressive natural desensitization. This contrasts with the increased frequency of corticosteroid-dependent cases during ageing. There is an inverse relation between age and response to DSCG therapy.
The sensitivity to methylmethacrylate monomer in 25 patients undergoing orthopaedic surgery was studied. No relation could be found between the cardiovascular reactions observed during the cementation of the femoral prosthesis and the complement system, investigated by measuring the serum concentration of the haemolytic complement, components 3 and 4.
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Twenty-four patients with chronic utricaria resistant to conventional therapy were treated orally with terbutaline, a specific beta2 stimulant. This therapy was much more effective than antihistamines. At the dose of 1-25 mg three times a day, there were few side effects. The efficacy was independent of the IgE levels; it seemed greater in idiopathic cases than in cholinergic or pressure induced urticaria.
The serum IgE concentration is significantly lower in aged as compared with young people. This is more pronounced in males than in females (P less than 0-05). In fifteen aged (greater than 70 years) compared with fifteen young subjects (less than 40) the specific IgE antibody response to an injection of diphtheria toxoid was significantly reduced (P less than 0-01). The minimum concentration of anti-IgE antibody able to induce a weal and flare reaction when injected intradermally, was comparable in the two age groups. However, the diameter of the weal reaction was significantly reduced in the aged. It is concluded that the reduced incidence of atopic symptoms in old people might be secondary to an anomaly of both the immune system and the mast cells.
Fifteen healthy people, over 70 years old, have been treated during 1 month with Levamisole at the dose of 150 mg a day, twice a week. They have been compared to 15 controls matched for age and sex. At the start of the study, each subject was injected with 0.2 ml of a diphtheria-tetanus vaccine. Levamisole had no effect on the following immune parameters known to be altered in old age: serum IgE concentration, specific IgE and IgG antibody response to diphtheria toxin, lymphocyte response to phytohemagglutinin (PHA). There was a slight and transitory effect of Levamisole on the isohemagglutinin titer. In vitro, Levamisole was weakly mitogenic for the peripheral blood lymphocytes from old and young control subjects but there was no influence on the response to PHA.
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Human tonsil lymphocytes have been separated into three subpopulations of cells: purified B cells and two subsets of purified T cells (F1 and F2). B cells were obtained by rosetting with neuraminidase treated SRBC. F1 and F2 were separated by filtration on a nylon wool column using different speeds of elution. Purified B cells contained less than 5% T cells, the T cells preparations contained less than 5% B cells for F1 and 10 to 15% for F2, respectively. A significant contamination in cells not identified by any B or T marker was observed in purified B cells and in F1. Adherent cells enhanced the response of each lymphochte population to PHA and Con A. This explained the paradoxically low responsiveness of the purified T cells. Purified B cells did not respond to these mitogens in different culture conditions. However, a small B cell response was observed when they were cultured in the presence of mitomycin-treated T cells. Striking was the enhancing effect of B cells on the T cell response to PHA and Con A. This enhancing effect was observed even when B cells were treated with mitomycin or depleted in adherent cells. The comparison of the F1 and F2 response suggested that they contained distinct types of T cells.
A significant and constant increase in DNA synthesis was observed in human lymphocytes cultured in the presence of purified anti-immunoglobulin antibodies specific for human IgG, IgA, and IgM. This has been found in cultures of lymphocytes isolated from blood, tonsils, spleen, and lymph nodes. The optimal culture conditions for blood and tonsil lymphocytes were determined. As a rule 6-day cultures containing 2 x 10(6) cells/ml and 100 mug/ml of antibody yielded the highest 3H-thymidine uptake. Purified T cell cultures could not be stimulated, whereas a low response could be observed in most of the purified B cell cultures. Optimal culture conditions were the same for the B and total tonsil lymphocytes. However, when the purified B cells were totally depleted of T cells, no response was observed. A T and B cell synergy has been demonstrated by supplementing B cell cultures with purified T cells, whether treated or not with mitomycin. These experiments indicated a permissive and potentiating effect of T cells on the B cell response. Cultures containing mitomycin-treated B cells and purified T cells (mB + T) could be stimulated by a-Ig, thus indicating a T cell proliferation. In keeping with this finding was the observation of an increased response of total lymphocytes supplemented with T cells but not with B cells. Adherent cells are necessary for an optimal response to a-Ig; they enhanced the B cell proliferation observed in (Tm + B) cultures and suppressed the response of T cells in (T + Bm) cultures.
Five patients with no detectable serum IgA (less than 20 mug/ml) and one patient with low serum IgA were compared to normal subjects. The number of circulating E-RFC was normal as was the lymphocyte DNA synthesis induced by PHA, Con A, and streptokinase-streptodornase. The patients had normal numbers of IgA-bearing lymphocytes and normal or increased numbers of B cells. Purified anti-immunoglobulin antibodies specific for IgG, IgA and IgM induced a normal lymphocyte DNA synthesis as did PWM. The patients' lymphocytes were able in vitro to transform into actively secreting IgA plasmocytes. This transformation was determined by counting the IgA and immunoglobulin-containing cells and then measuring the IgA and IgG secretion in the cultures. In some patients PWM was selectively suppressive in IgA B-cell transformation into IgA secreting cells; in the other patients PWM had no effect on the IgA B-cell differentiation. PWM enhanced the IgG secretion in the patients' cultures as well as IgA and IgG secretion in the normal controls.
Peripheral blood lymphocytes (PBL) from old subjects were less responsive to PHA than those from young controls, in both groups the PBL content of macrophages, T and B cells were comparable. Macrophages were identified as peroxydase containing cells, rosette formation with sheep red blood cell was used as a T cell marker and immunoglobulin bearing lymphocytes were considered to be B cells. PBL were separated in two subpopulations of purified T cells (F1 and F2) differing in their responsiveness to PHA and in their ability to cooperate with B cells. Purified B cells had a synergistic effect on the F1 response to PHA whereas they were often suppressive for the corresponding F2 response. Peroxydase containing cells enhanced the response of unfractionated total PBL and of purified T cells in the young subjects. The depressed response of the old age group could be related mainly to a suppressive effect of monocytes and a decreased circulating pool of F1 T cells.
A 24-hr preincubation of human peripheral blood lymphocytes in the presence of Con A renders them suppressive for the response of untreated cells to soluble antigens, allogeneic cells and Con A.