PubMed · 5794648
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K Mündnich. 1969. [Mediastinitis].. https://pubmed.ncbi.nlm.nih.gov/5794648/
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In phylogenetically diverse species with the help of T lymphocytes or soluble factors, viral infections induce the Ag-specific B lymphocytes to proliferate and terminally differentiate into IgM, IgG, IgA, IgD, or IgE Ab-secreting cells. Based on previous studies searching for IgD, it was inferred that serum IgD in the mouse is nearly undetectable, although in other species, e.g., humans, IgD is a measurable component of serum Ig. More recently, new information has been obtained indicating that IgD is secreted in minute quantities during normal B cell differentiation. We observed that IgD is secreted in significantly increased quantities in mice undergoing an acute infection with lymphocytic choriomeningitis virus or vesicular stomatitis virus compared with uninfected animals. A substantial fraction of the observed IgD was found to be virus specific. Using a solid-phase immunoenzymatic technique, virus-specific IgD Ab-forming cells were detected in the spleen; their numerical increase correlated with the level of secreted antiviral IgD. In addition, immunohistochemical staining revealed IgD+ plasma cells that occurred with a similar kinetic profile as the virus-specific IgD Ab-forming cells. These findings provide direct evidence that synthesis of IgD is a physiologic event in the mouse. Its precise function in the immune response to pathogens, however, remains to be determined.
BACKGROUND: The role of early endoscopic retrograde cholangiopancreatography (ERCP) and papillotomy in the treatment of patients who have acute biliary pancreatitis without obstructive jaundice is uncertain. METHODS: We conducted a prospective, multicenter study in which 126 patients were randomly assigned to early ERCP (within 72 hours after the onset of symptoms) and endoscopic papillotomy for the removal of stones in the common bile duct, when appropriate, and 112 patients were assigned to conservative treatment. In the conservative-treatment group, ERCP was performed within three weeks if signs of biliary obstruction or sepsis developed. Overall mortality, mortality due to pancreatitis, and complications were compared in the two groups. RESULTS: Early ERCP was successful in 121 of the 126 patients in the invasive-treatment group. Endoscopic papillotomy was performed to remove bile-duct stones in 58 patients; stones were successfully extracted in 57. ERCP was performed in 22 of the 112 patients in the conservative-treatment group; papillotomy for stone removal was successful in 13 patients. Fourteen patients in the invasive-treatment group and 7 in the conservative-treatment group died within three months (P=0.10); 10 patients in the invasive-treatment group and 4 in the conservative-treatment group died from acute biliary pancreatis (P=0.16). The overall rate of complications was similar in the two groups, but patients in the invasive-treatment group had more severe complications. Respiratory failure was more frequent in the invasive-treatment group, and jaundice was more frequent in the conservative-treatment group. CONCLUSIONS: In patients with acute biliary pancreatis but without obstructive jaundice, early ERCP and sphincterotomy were not beneficial.
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