[Hereditary angioneurotic edema: therapeutic aspects].
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Serum levels of complement components(cc), whole complement activity (CH 50), and circulating immune complexes (IC) were measured in 41 patients with neoplastic diseases. The level of cc was higher than in healthy controls; the levels of C1q, C1INA, C4, C3c, C3ACT, C5, and C9 were statistically higher. In patients with lung cancer, the levels of cc were correlated with the clinical stage as well as the performance status. Both the IC serum level and the incidence of high serum IC levels in lung cancer were higher in stage III and IV than in stage I and II. Serum CH 50 was higher than in healthy controls, but not correlated with the clinical stage.
Seven patients with systemic lupus erythematosus (SLE) were treated with Danazol in a controlled study. Phenomena observed in some patients treated with Danazol were: 1) decrease in immunoglobulins and antibodies to native DNA; 2) increases in serum complement and platelets; and 3) clinical improvement. Ineffective drug trials were associated with increasing disease activity. Drug side effects were minimal. It appears that the drug may have an ameliorative effect on mildly active SLE patients and sometimes a marked effect on thrombocytopenia. Further evaluation of Danazol appears to be warranted for these types of patients but not for treatment of acute or severe forms of the disease.
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In one family two genetic diseases were transmitted as autosomal dominant traits; hereditary angioneurotic edema was inherited from the paternal side and Charcot-Marie Tooth disease from the maternal side of the family. The conditions occurred separately in 8 and 11 members respectively and together (an exceedingly rare occurrence) in 3. Of six siblings, two girls and four boys, all had Charcot-Marie-Tooth disease, and three, the two girls and one of the boys, also had hereditary angioneurotic edema.
The author studied human complement system, especially alternative pathway as a primitive biological defense system, in maternal serum during normal pregnancy, delivery and puerperium. The results obtained were as follows. 1. The mean value of hemolytic activity of alternative pathway (AlCH50) in healthy women was 18.3 +/- 1.1. This value was increased gradually in progress of gestational stages up to 26.6 +/- 2.3 of the average in the last trimester. Stochastically, significant differences about this value was noted between in the first trimester and in the last. This AlCH50 is decreased temporarily at delivery, and it was increased again rapidly, then went down to normal range about one month after delivery. 2. The average of immunochemical C3PA by SRID method during pregnancy was 22.5 +/- 0.4 mg/dl. It was significantly higher than the average 18.1 +/- 0.4 mg/dl of 59 healthy women. C3PA was noted to remain high level constantly during pregnancy. This C3PA level after delivery was observed to take a similar pattern as AlCH50. 3. beta 1C/1A globulin (C3) in 19 healthy women was 60.7 +/- 2.1 mg/dl. This C3 was also increased gradually during pregnancy up to maximum level of 87.5 +/- 2.8 mg/dl at the 3rd trimester. 4. Classical pathway (CH50, C4 and Cl INA) and fetal complement level were investigated at the same time and discussed here.
Report on a newly recognized sibship with hereditary angioedema (HAE). The 27 persons investigated include 8 with decreased concentrations of C-1INH and C4 in the Serum. Three of these are children without symptoms of HAE. Five patients have characteristic attacks of HAE, some of which are predominantly abdominal. The effects of treatment with danazol in 4 patients are described. HAE is briefly reviewed with special reference to pathogenesis and treatment.
A total increase of blood complement components, particularly C4, is found in subjects with familial Mediterranean fever both before and after colchicine therapy. This effect differs from the serum haptoglobin and orosomucoïd concentration decreases detected after identical therapy, confering diagnostic value to this inflammatory syndrome. This could be of both hepatic and extrahepatic origin. For the latter, it is possible that up take of circulating monocytes, macrophage precursors, by the connective tissue of the serum sub-mesothelial layer is responsible for the lesion.
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Genetic deficiencies of complement proteins are now more often recognized and analysed more precisely because the structure of the different complement proteins is better known. Partial defects may be detected in some components by the combined utilization of titration techniques, polymorphism studies and linkage analyses. The partial deficiency in C4 seems to be the most frequent protein deficiency in the human. The complement markers on the short arm of the sixth chromosome in man (BF, C2, C4A and C4B) are located in close proximity to the HLA-D/DR region. The combined study of the complement and HLA markers will probably allow the fine structure of the HLA region to be better defined. The association of some diseases with HLA types will probably also be better specified by the definition of associations not only with HLA-B or HLA-D types but also with the BF, C2 and C4 types.
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