High dose subcutaneous immunoglobulin for idiopathic inflammatory myopathies and dysimmune peripheral chronic neuropathies treatment: observational study of quality of life and tolerance.

BACKGROUND: In patients with autoimmune diseases who still derive benefit from high dose intravenous immunoglobulin (IVIg) treatment, some physicians resort to subcutaneous (SC) Ig as a replacement therapy. OBJECTIVE: To collect quality of life (QoL) and tolerance data on SCIg in patients for whom the switch from IVIg to SCIg is essential to maintain treatment. METHODS: This observational study included patients with either idiopathic inflammatory myopathies (IIM) or chronic dysimmune peripheral neuropathies (CDPN) treated with IVIg, who had been switched to SCIg administration for at least three months. The main objective was to describe the impact of SCIg on QoL after six months, using the generic Short-Form 36 questionnaire (SF-36). The secondary objectives were to evaluate SCIg tolerance and clinical efficiency. RESULTS: Eight centres recruited 12 IIM patients and two centres recruited 11 CDPN patients. Neither the physical nor the mental health SF-36 component summaries showed any QoL deterioration during the six-month study period and all IIM and CDPN patients remained clinically stable during the same period. The most frequent adverse effects were injection site reactions (50%), cutaneous tissue disorders (18.2%), and nervous system disorders (13.6%). Two serious adverse events (myocarditis and cerebrovascular accident) occurred in two patients. CONCLUSION: In these rare inflammatory diseases, high dose SCIg administration (which can be home based) has no deleterious effect on patient QoL. It appears to be a safe and efficient alternative to hospital-based IVIg.

Low mitochondrial proton leak due to high membrane cholesterol content and cytosolic creatine kinase as two features of the deviant bioenergetics of Ehrlich and AS30-D tumor cells.

Isolated mitochondria from highly glycolytic Ehrlich and AS30-D tumor cells have a 12.4- and a 2.3-fold higher cholesterol level, respectively, than that of rat liver mitochondria. The passive proton permeability of Ehrlich and AS30-D tumor inner membrane mitochondria is, respectively, 4- and 1.4-fold lower than that of rat liver mitochondrial membrane. This feature is accompanied by a lower proton leak current in tumor mitochondria. A 3.5-fold cholesterol enrichment of rat liver mitochondria decreases their passive proton permeability by a factor of 2, thus establishing a direct relationship between the cholesterol contents of mitochondrial membranes and the passive proton permeability. Creatine kinase activity is present in the cytosol of these cells and is mostly represented by the BB isoform. Since AS30-D tumor cells' treatment with the creatine analogue beta-guanidinopropionic acid decreases their life span and viability, creatinine kinase is an indispensable enzyme entering a main energy distribution pathway starting from mitochondrial ATP, through glycolysis and creatine phosphorylation, to satisfy the large energy demands of tumor cell division.

Neurophysiological explorations in cervicobrachial neuralgia.

The various electrophysiological techniques which can be used in cervicobrachial neuralgia and their respective advantages and limitations are described. Beside the conventional electromyography and electrostimulation techniques, the indications for radicular motor and somesthetic evoked potentials are discussed.

[Myocardial metabolism during coronary perfusion at 10 degrees C with or without cardioplegia associated with potassium]. / Métabolisme myocardique en cours de perfusion coronaire à 10 degrees C avec ou sans cardioplégie associée au potassium.

Myocardial metabolism was studied during coronary perfusion at 10 degrees c with haemodiluted blood by sampling the coronary sinus blood of 20 patients undergoing aortic valve replacement. The patients were divided into four groups : Group 1 with continuous coronary perfusion at 10 degrees c ; Group 2 : continuous perfusion at 10 degrees c with Potassium cardioplegia ; Group 3 : discontinuous coronary perfusion at 10 degrees c ; Group 4 : discontinuous perfusion at 10 degrees c with Potassium cardioplegia. In groups 1 and 2, coronary blood flow remained constant at an average of 200 ml/mn. Cardioplegia did not affect the peripheral coronary resistances at this temperature. During coronary perfusion the average myocardial oxygen consumption was 1.38 vol/mn (Group 1) and 0.18 vol/mn (Group 2), p < 0.01. This reduced oxygen consumption results in a fall in the average amount of oxygen extracted from 4.8 p.100 (Group 1) to 1.2 p.100 (Group 2) p < 0.01. At the end of coronary perfusion lactic acid production was not observed in Groups 1 and 2. Ten minutes after coming off bypass, the percentage of oxygen extraction was nearly the same in both groups (Group 1 : 38.4 p.100 ; Group 2 : 43.2 p.100). Systemic arterial lactic acid levels tended to be higher than those of coronary sinus blood in both groups. With discontinuous coronary perfusion and an average period of myocardial anoxia of 45 mn, metabolic acidosis was observed, greater in Group 3 than in Group 4 (p < 0.05) when the aorta was unclamped. Ten minutes after the end of bypass, despite normal levels of oxygen extraction, myocardial lactate production was observed in both groups. The enzyme levels, in particular the CPK MB isoenzyme, in the coronary sinus blood, remained low throughout operation in all four groups. Deep, stable and constant myocardial hypothermia (10 degrees c) induced by coronary perfusion with haemodiluted blood, affords excellent myocardial protection ; it was not possible to show the complementary benefits of Potassium cardioplegia at such low temperatures.