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Biomedical subjects

J C Jennette

Publications and source records attributed to J C Jennette.

At least 145 records · Page 8Linked to original sources

Immunologic and ultrastructural characterization of the small cell population in malignant thymoma.

A case of malignant thymoma is presented. The electron microscopic (EM) findings of the lymphocyte-epithelial relationships were similar to these previously described. Utilizing specific monoclonal antibodies to differentiate thymocytes from T-lymphocytes, the small cell population with ultrastructural features of lymphoid cells consisted of true thymocytes rather than peripheral T-lymphocytes. The latter finding may prove to be of importance in differentiating thymomas from reactive or most neoplastic lymphocytic processes involving the thymus gland.

Female↗

Pathologic differentiation between lupus and nonlupus membranous glomerulopathy.

The following clinical and pathologic features were evaluated in 170 patients with electron microscopically documented membranous glomerulopathy: age, sex, race, American Rheumatism Association lupus criteria, serum ANA, serum complement, glomerular hypercellularity, stage of subepithelial dense deposits, endothelial tubuloreticular inclusions, tubular basement membrane deposits, tissue ANA, glomerular deposition of IgG, IgM, IgA, C3, C4, and Clq. At the time of biopsy 148 patients had no clinical evidence for lupus, and 22 had a clinical diagnosis of lupus. Six additional patients eventually developed overt lupus after an average of 12 months. Incidences of serologic and pathologic features in lupus as compared with nonlupus membranous glomerulopathy were determined. These data were used to calculate sensitivity, specificity, positive and negative predictive values, and overall efficiency of each parameter in differentiating between lupus and nonlupus membranous glomerulopathy. In general, serologic, morphologic and immunohistopathologic features are more accurate at ruling out lupus than making the diagnosis of lupus. However, a number of features are significantly more frequent in lupus membranous glomerulopathy. Therefore, identification of these features, especially more than one, warrants a high suspicion of lupus rather than nonlupus membranous glomerulopathy even in patients without clinically overt systemic lupus erythematosus. The positive/negative predictive values of some of the pathologic features studied are as follows: mesangial dense deposits 63/99, subendothelial dense deposits 77/93, tubuloreticular inclusions 61/96, intense C1q deposition 47/95, tubular basement membrane deposits 100/87, and glomerular hypercelularity 26/86.

Antibodies, Antinuclear↗

Chronic hyperamylasemia and chronic pelvic inflammatory disease.

A 54-year-old woman with chronic pelvic inflammatory disease and pyelonephritis developed persistent hyperamylasemia with transient increases in the amylase-creatinine clearance ratio. Even though chronic pancreatitis was suspected clinically, at postmortem examination the pancreas was found to be normal. We suggest that the hyperamylasemia resulted from entry into the circulation of amylase produced within sequestered endosalpingeal epithelial cysts, possibly amplified by impaired renal clearance. Thus, the potential of the serum amylase assay as a sign of serous ovarian tumors is further indicated.

Amylases↗

Influence of antibody avidity on glomerular immune complex localization.

Immune-complex-mediated glomerulonephritis (IC-GN) was induced with daily intraperitoneal injections of horse apoferritin (HAF) for varying intervals in Swiss albino and BALB/c mice. Anti-HAF antibody avidity in plasma pools from mice with predominantly mesangial immune deposits was compared with avidity in plasma pools from mice with predominantly capillary wall deposits. Plasma from Swiss mice having predominantly mesangial deposits after 7 or 14 days of HAF had higher avidities than plasma from Swiss mice with predominantly capillary wall deposits after 14 days or more than 28 days of HAF. Plasma from BALB/c mice with exclusively mesangial deposits after 7 days of HAF had higher avidity than plasma from BALB/c mice with predominantly capillary wall deposits after 14 or more days of HAF. Therefore, there was a correlation between glomerular site of immune deposition and avidity of circulating anti-HAF antibodies, with higher avidity antibodies associated with mesangial immune deposits and lower avidity antibodies with capillary wall deposits.

Animals↗

Interaction of antigen load and antibody response in determining heterologous protein nephritogenicity in inbred mice.

Genetically disparate inbred mouse strains mounting quantitatively different immune responses to a potentially nephritogenic heterologous protein had varied development of glomerulonephritis (GN) dependent upon the interaction between level of antibody response and antigen dose. High responder BALB/c mice given high doses of horse apoferritin developed a severe necrotizing GN. BALB/c mice given low dose horse apoferritin developed less severe GN, or when antibodies were in extreme excess, no GN. Low responder C3H mice given high dose horse apoferritin were in extreme antigen excess and developed no GN. C3H mice given low dose horse apoferritin developed a glomerulopathy characterized by capillary loop immune deposits. Interstrain differences in immune clearance and avidity did not account for this varied nephritogenicity, although avidity did relate to glomerular site of immune deposits in the BALB/c model. In the models under consideration susceptibility to heterologous antigen-induced glomerular injury was a function of the magnitudes of both the antibody response and the antigenic challenge.

Animals↗

Fatal herpetic hepatitis in pregnancy.

Disseminated herpetic infections are becoming more commonly reported during pregnancy. Such infections almost always occur in the third trimester and are usually associated with a primary infection, which serves as a portal of entry. Because of the high fetal and maternal mortality associated with this condition, early diagnosis and treatment are essential. Disseminated herpesvirus infection must be considered whenever a pregnant patient has herpetic mucocutaneous lesions, vague systemic symptoms, or evidence of massive hepatic dysfunction.

Adult↗

IgA nephropathy associated with seronegative spondylarthropathies.

Three patients with a seronegative spondylarthropathy were found to have IgA nephropathy. Two patients had ankylosing spondylitis (one with psoriasis), and one had incomplete Reiter's syndrome. All three had a focal proliferative glomerulonephritis with IgA-dominant mesangial immune deposits. One patient had a leukocytoclastic vasculitis. This association of IgA nephropathy with seronegative spondylarthropathies raises the possibility of a common or related pathogenesis. There is evidence to suggest that both diseases are mediated by genetically controlled immune responses to mucosal contact with etiologic antigens.

Adult↗

The inflammatory response to secondary methylmethacrylate challenge in lens-implanted rabbits.

Polymethylmethacrylate intraocular-lens-implanted rabbits were challenged with subcutaneous polymeric or monomeric methylmethacrylate. The inflammatory response to this secondary challenge was compared to that at the site of sham procedures and to that in control rabbits never exposed to methylmethacrylate. There was a definite granulomatous inflammatory response to both polymeric and monomeric methylmethacrylate. There was, however, no secondary enhancement of this inflammatory response at the site of subcutaneous challenge or exacerbation of intraocular inflammation in lens-implanted rabbits, thus substantiating the nonimmunogenicity of methylmethacrylate.

Animals↗

Diffuse T-cell lymphoma preceded by nodular lymphoma.

A patient with a nodular lymphoma morphologically indistinguishable from follicular B-cell lymphoma subsequently developed a diffuse T-cell lymphoma. This T-cell lymphoma displayed characteristics analogous to mature T-lymphocytes, and typed as a suppressor/cytotoxic T-cell with the monoclonal antibodies. The light and electron microscopy morphology of the T-cell lymphoma was similar to that reported for node-based T-cell lymphomas. There was a polymorphous proliferation of variably transformed lymphocytes including immunoblasts. This case could represent either a nodular form of T-cell lymphoma converting to a diffuse T-cell lymphoma, or a follicular B-cell lymphoma preceding, and possibly inducing, a suppressor T-cell lymphoma.

Adult↗

Concurrent antiglomerular basement membrane antibody and immune complex mediated glomerulonephritis.

A teenage male, with Goodpasture's syndrome and serum antiglomerular basement membrane (anti-GBM) antibodies, had a focal proliferative glomerulonephritis with crescents. Immunofluorescence microscopy of his glomeruli using anti-IgG antibodies demonstrated both intense linear GBM staining, and granular subepithelial staining. Electron microscopy revealed numerous subepithelial electron-dense deposits. Identical IgG subclass restriction (dominance of IgG1 and IgG4) of both types of glomerular deposits in this patient supports, but does not prove, a postulate that the linear staining was due to anti-GBM antibodies bound to intact GBM, and that the granular staining was due to anti-GBM antibodies complexed with freed GBM antigens.

Adolescent↗

Interstrain variations in nephritogenicity of heterologous protein in mice.

Swiss albino, BALB/c, and eight substrains of C3H mice were given daily intraperitoneal injections of horse apoferritin (HAF) for up to 56 days. At varying intervals, renal tissue was examined by light, immunofluorescence, and electron microscopy. Swiss mice developed proliferative glomerulonephritis after 7 to 14 days of HAF, and 45 per cent progressed to severe crescentic glomerulonephritis after from 21 to 56 days of HAF. In Swiss mice, glomerular immune deposits evolved from predominantly IgM mesangial deposits at 7 days to mesangial IgG at 14 days to capillary wall IgG after 21 or more days of HAF injections. BALB/c mice given identical HAF doses never developed severe crescentic glomerulonephritis but rather an extensive global necrotizing glomerulonephritis most prevalent after from 9 to 18 days of HAF. The distinct evolution of glomerular immune deposits observed in Swiss mice was less clear-cut in BALB/c mice, with greater persistence of mesangial deposits and IgM over time. Only 11 per cent of C3H mice (confined to two substrains) developed glomerular lesions by light microscopy after 2 to 3 weeks of HAF administration. No C3H/HeN mice developed glomerulonephritis even after up to 47 days of HAF injection. From 7 days on, 45 per cent of HAF-injected C3H mice had low level IgM mesangial immune deposits but did not manifest the evolution from mesangial to capillary deposition observed in BALB/c and Swiss albino mice. F1 hybrid and congenic mice carrying BALB/c H-2 genetic information developed glomerular lesions similar to those produced in BALB/c mice. These data (1) indicate an interrelated morphologic and immunohistologic evolution of heterologous protein induced glomerular lesions in mice, (2) demonstrate morphologic and immunohistologic differences in glomerular lesions development between genetically disparate mouse strains given identical antigen exposures, and (3) support the genetic control of heterologous protein-induced glomerulonephritis and suggest a role for the major histocompatibility region in this genetic regulation.

Animals↗

Exclusively vascular systemic amyloidosis with visceral ischemia.

A patient with multiple myeloma had systemic amyloidosis exclusively confined to the vascular system. These vascular deposits had the typical tinctorial and ultrastructural characteristics of amyloid. At first, the patient clinically had ischemic heart disease, and at postmortem examination was seen to have had acute and chronic ischemic injury of the heart and kidneys due to vascular narrowing by massive amyloid deposits. Exclusively vascular systemic amyloidosis represents a morphologically and clinically distinctive, but uncommon, variant of amyloidosis.

Aged↗

Insulin receptor autoantibody-induced pancreatic islet beta (B) cell hyperplasia.

A patient with progressive systemic sclerosis (scleroderma) and anti-insulin receptor autoantibody-induced diabetes mellitus was found to have pancreatic islet beta (B) cell hyperplasia by computerized morphometry and immunohistochemistry. Unlike most previously reported cases of islet cell hyperplasia, where the islet cell hyperactivity produced disturbed glucose metabolism (hypoglycemia, this case illustrates compensatory islet cell hyperplasia in response to a perturbation in glucose metabolism by insulin-receptor blockade with resultant hyperglycemia.

Adult↗

IgD myeloma with intracytoplasmic crystalline inclusions.

Plasma cells from an IgD myeloma contained intracytoplasmic crystals. By electron microscopy, these crystals had 13-nm periodicity and were contained within vacuoles formed of smooth membranes. Immunofluorescence microscopy of the neoplastic plasma cells demonstrated diffuse cytoplasmic staining with accentuated Golgi region staining specific for immunoglobulin delta heavy and lambda light chains. The observations support an association between the crystal-containing vacuoles and the Golgi apparatus. Previously reported plasma cell and lymphocyte crystalline inclusions are reviewed, and compared with the crystals described in this report.

Aged↗