[Problem-oriented medical record].
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Biomedical subjects
Publications and source records attributed to V Andersen.
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Human venous blood lymphocytes, incubated for 22 h in serum-free culture medium with the plant mitogen concanavalin A (Con-A), elaborated products, which inhibited the migration of human buffy coat cells under agarose. Con-A was removed by applying the supernatants on small Sephadex G-100 columns. The leukocyte migration inhibitory activity (LMIA) was tested in a semi-quantitative modification of the indirect leukocyte migration agarose technique, which is described. Lymphokine activity, demonstrable as early as 9 h after activation of lymphocytes, was most pronounced after 22 h. Significant LMIA was demonstrated in 12 of 17 normal individuals at standard dilution of culture supernatants I/3. In 9 of the 12 experiments, assays of LMIA were carried out on stepwise diluted supernatants with detection of the greatest dilution with significant LMIA. In four experiments LMIA could only be detected after 3- to 12-fold concentrations of supernatants. Considerable individual variation was found, the amounts of LMIA varying by a factor of about 300. The reproducibility appeared to be quite high, but the factor stability of supernatants stored at -20 degrees C was surprisingly low.
14 cases of severe thrombocytopenia in one family are presented. Case histories, clinical examination, analyses of platelets, haemoglobin, reticulocytes, leucocytes, eosinophilocytes, differential counts of leucocytes, serum immunoglobulin IgA, IgM, IgG, IgE concentrations, complement fixing platelet antibodies, isohaemagglutinins, colour perception, determination of red cell and serum groups as well as HL-A types were obtained from a total of 59 members of the family. The in vitro blast transformation response of blood lymphocytes was studied in 6 patients and 45 relatives. The pattern of transmission of the disease was in full agreement with X-linked recessive inheritance. Investigation of the immune system revealed impaired responses to microbial antigens in the 6 patients so studied. All relatives examined had normal haematological status, whereas approximately half showed a subnormal response to one microbial extract. The low responders were evenly distributed within the family, and it was not possible to correlate low response and presumed carrier state.
Fabry's disease is a recessive X-linked inborn error of metabolism due to deficiency of the lysosomal enzyme alpha-galactosidase. The large variety of symptoms may make the diagnosis difficult. A severely afflicted female patient is presented. For several years she had been treated under the diagnosis polyarteritis nodosa until the characteristic cutaneous lesions of Fabry's disease were recognized. Enzymatic studies and electronmicroscopic examinations confirmed the diagnosis. A symptomatic effect of corticosteroid treatment was proven. The grave prognosis, the recent attempts at enzyme substitution therapy and the possibility of preventing new cases by prenatal diagnosis should stimulate the efforts of the clinician to diagnose the disease.
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Lysozyme turnover studies with (125)I-labeled human lysozyme were carried out on 22 patients, viz. nine control patients, seven nephrological patients with varying degrees of renal insufficiency, including three bilaterally nephrectomized patients, and six hematological patients with disturbed turnover of the neutrophilic granulocytes. It was found that plasma lysozyme has a rapid turnover with a fractional catabolic rate of 76%/hr of the plasma content. Lysozyme catabolism varied with the endogenous creatinine clearance; in addition however, extrarenal sites of catabolism were demonstrated since lysozyme could be broken down in the anephric patients, although only at a rate amounting to about 15% of the rate found in persons with intact kidneys. In the uremic patients the increased plasma lysozyme concentration was due to decreased rates of catabolism; in the hematological patients the increased plasma lysozyme level was due to increased rates of synthesis which supports the hypothesis that plasma lysozyme mainly stems from disintegrating neutrophilic granulocytes. Furthermore, it was shown that in the nonhematological patients examined, the rate of synthesis varied with the endogenous creatinine clearance.