Immunological aspects of psoriasis: V. T. cell subsets and suppressor cell functions regulating immune responses in peripheral blood.

T cell subsets bearing Fc-receptors for either IgG (TG) or IgM (TM), and suppressor cell activity of peripheral blood mononuclear cells on in vitro lymphoproliferative responses were studied in patients with untreated psoriasis. The proportions of TG and TM cells were unmodified in 15 patients compared to 15 control subjects studied in parallel experiments. The concanavalin A-induced suppressor cell activity, as well as the spontaneous suppressor cell function of in vitro short-lived adherent cells, were in the normal range for 7 out of 8 psoriatic patients investigated. The data argue against the possibility that a generalized suppressor cell defect occurs in psoriasis.

Increase of class II HLA molecules on the membrane of B lymphocytes from patients with rheumatoid arthritis.

Using a novel cytofluorometric method of cellular antigen quantification, we examined peripheral blood mononuclear cells (PBMC) from patients suffering from rheumatoid arthritis (RA) for quantitative modification of class II human leucocyte antigen (HLA) molecules expressed on the surface. Class II HLA molecules were detected by indirect immunofluorescence with a monomorphic monoclonal antibody. No change was observed in the density of class II HLA molecules at the surface of monocytes of RA patients as compared to that of paired healthy subjects. We confirmed that the percentage of class II HLA-bearing T cells was slightly increased in RA patients versus controls, but the density of class II antigens per cell could not be determined accurately. An increase in the density of class II HLA molecules on RA B cells was shown, suggesting that a chronic activation stage of this population contributes to the disease.

Traumatic brain injury/chronic pain syndrome: a case comparison study.

OBJECTIVE: To identify the pretreatment characteristics and progress in treatment and outcomes of chronic pain patients, with and without concomitant traumatic brain injury (TBI). DESIGN AND PATIENTS: Retrospective cohort study of 12 consecutive patients in a chronic pain treatment program who were discovered to have previously untreated brain injury and a cohort of 12 chronic pain patients from the same program matched for age and sex who did not have brain injury. SETTING: Interdisciplinary university-based outpatient rehabilitation medicine clinic. MAIN OUTCOME MEASURES: Length of time in treatment and vocational outcomes. RESULTS: A surprising number of patients referred for treatment of chronic pain were found to have history and symptoms indicative of previously untreated or undiagnosed mild traumatic brain injury (n = 21 of 65). Of these, 12 received therapy for both their brain injury and chronic pain. The 12 treated, dual diagnosed patients did not differ in terms of education, employment status, or marital status from the chronic pain patients. Those with TBI were more likely to have sustained an automobile injury and less likely to have a work-related injury. On admission, 25% of each group were working, and at discharge, that proportion reached 75% for each group. Those with TBI required significantly longer treatment (459 consecutive days) from intake to discharge compared with the control group (295 days). CONCLUSION: Patients who exhibit memory or concentration problems, who express confusion about their diagnosis, who were injured in an automobile accident, or who complain of pain in the head, neck, or arms should be questioned about the possibility of concurrent TBI. Most of these patients can achieve successful employment outcomes, however, the TBI group may require a longer treatment time.

Arthritis associated with primary agammaglobulinemia: new clues to its immunopathology.

Primary agammaglobulinemia is a rare disorder which is associated with articular symptoms in 11% of patients. Septic arthritis may occur, but often patients complain of chronic oligoarthritis and have a clinical presentation similar to rheumatoid arthritis. We report 2 cases of primary agammaglobulinemia in adults, associated with non-erosive chronic arthritis. Peripheral blood lymphocyte phenotyping showed a predominance of CD8 lymphocytes with a CD4/CD8 ratio < 1. We did not find any abnormalities in cellular immunity. A histological study of the synovium showed chronic synovitis with perivascular CD8 lymphocyte infiltrates. Intravenous infusion of immunoglobulins resulted in a dramatic improvement in the arthritis in both cases. In one patient we noticed a decrease in CD8 lymphocytosis. These results suggest that CD8 lymphocytes are involved in the pathogenesis of the arthritis associated with agammaglobulinemia.

Treatment of infantile spasms with intravenous gamma-globulins.

In a prospective study, 23 children with infantile spasms received intravenous gammaglobulins in high doses. 19 patients present a West syndrome. 4 older patients were included in the study because infantile spasms had preceded their Lennox-Gastaut syndrome. None of the patients had recently undergone corticosteroid therapy. No effect was observed in 15 patients, while transitory clinical and/or electroencephalographic improvement was noted in 3. Complete normalization was obtained in the remaining 5 patients, of whom 4 had severe brain lesions. No correlation existed between the therapeutic results and immunological abnormalities, a deficiency in IgG subclasses in particular. On the whole, the therapeutic results were disappointing. But the existence of some cases in which spectacular electroencephalographic and/or clinical improvement was obtained leads us to suggest that IV gamma-globulins be used as auxiliary treatment in infantile spasms.

Practitioner's guide to industrial back problems.

If return to work is part of the expected outcome, more and more data indicate that medical care alone does not hold the key to providing success. Our modern physical treatments may seem a humane alternative to no treatment, but they have not been proven to significantly alter the natural course of back problems. Even the results of strongly indicated surgical treatment differ little from doing nothing at all after a 4-year period. From the physical standpoint, activation has the best track record for recovery and can be simply provided in a manner that can be used lifelong. The real key to return to work goes beyond the physical treatment by addressing the predicament of what the patient will do until age 65. This humane approach to care has evolved from common frustrations of dealing with patients with back problems, observations in the third world, and information gained from scientific studies. Medical pain, and physical models alone are unsuccessful. To be humane and successful, we can no longer ignore the nonphysical factors that can, and do, influence patients' responses to physical treatment, especially when return to work is part of the expected outcome.

Disability issues with carpal tunnel syndrome. A case discussion.

This article reviews nerve entrapments and cumulative trauma disorders of the upper limbs including a problematic carpal tunnel syndrome (CTS) patient case, idiopathic arm pain, and ulnar neuropathy. Major points of the discourse focus on the problems of treatment, especially as they relate to impairment and disability management.

Sympathetic skin response in fifth lumbar and first sacral radiculopathies.

Skin temperature changes and sympathetic skin response (SSR) changes have previously been reported in lumbosacral radiculopathy patients (6). The SSR was studied in 14 normals and in 8 radiculopathy subjects with unilateral, EMG documented active radiculopathies to assess if the SSR becomes asymmetric when measured across appropriate dermatomes. The SSR was recorded in dermatomal patterns in both feet simultaneously with active electrodes on the plantar surface and reference electrodes on the dorsum. Four wave types were identified and normal values for latency of onset, latency of peak, and amplitude are presented with the normal left/right ratios presented. In all individual subjects the amplitudes of the SSR were extremely variable and asymmetric while latencies were less variable and more symmetric. There were no significant differences in symmetry between radiculopathy and normal subjects. When using this technique the SSR is not significantly altered in L5 and S1 radiculopathies.

Comparison of sensory mid-palm studies to other techniques in carpal tunnel syndrome.

This prospective study was done to assess a technique of comparing Median-Ulnar sensory latency differences across the wrist (Sensory Palm [M-U]) to diagnose carpal tunnel syndrome (CTS) and to compare the relative sensitivities of other previously reported techniques: Median-Radial sensory difference (Sensory Thumb [M-R]), Median-Ulnar mixed palm difference (Mix Palm [M-U]) and Median-Ulnar sensory digit difference (Sensory Digits [M-U]). 90 Hands met the electrodiagnostic (EDX) criteria for mild CTS. The Sensory Thumb (M-R) was abnormal in 90% of the hands followed in order by Mix Palm (M-U) 61%, Sensory Digits (M-U) 42% and Sensory Palm (M-U) 33%. All differences were statistically significant (p < .01). Sensory Palm (M-U) did not significantly add to the diagnosis of CTS. The Sensory Thumb (M-R) was relatively the most sensitive followed by Mix Palm (M-R) was relatively the most sensitive followed by Mix Palm (M-U), Sensory Digits (M-U) and Sensory Palm (M-U).

Effect in vitro of a bacterial extract (OM-89) on interleukin 1 and interleukin 2 production by peripheral blood mononuclear cells from healthy subjects and rheumatoid arthritis patients.

The effect of a lyophilized extract from Escherichia coli strains (OM-89) on interleukin 1 and interleukin 2 production was studied by using peripheral blood mononuclear cells (PBMC) from healthy volunteers and from patients suffering from rheumatoid arthritis (RA) since, in this autoimmune disease, an abnormal cytokine network has been already described. The secretion of interleukin 1 (IL-1) was investigated in supernatants of monocytes purified by adherence, and measured by the C3H/HeJ thymocyte co-mitogenic assay. OM-89 was able to induce the secretion of IL-1 by normal and RA monocytes to about half of the level reached when the same cells were stimulated by lipopolysaccharide. The production of interleukin 2 (IL-2) was investigated in supernatants of PBMC, stimulated or not by phytohaemagglutinin (PHA) and mixed or not with various concentrations of OM-89. The level of IL-2 in supernatants, as measured by the stimulation of the CTLL2 murine cell line, was lower in RA supernatants than in control ones. In the presence of PHA and OM-89, the IL-2 production was enhanced and normalized in supernatants from RA patients. Such data may help to explain the clinical improvement previously reported in RA patients orally treated with OM-89.

[Alteration of IgE production by cefadroxil]. / Altération de la production d'IgE par le céfadroxil.

The effect of two cephalosporins, cefadroxil and cefalexine, was in vitro studied by using two models of regulation of the IgE production in healthy humans, e.g. the induction of CD23-antigens on B-cells and the IgE synthesis in cell culture supernatants after stimulation by recombinant interleukin-4. Cefadroxil clearly inhibited CD23 membrane expression on normal human B-lymphocytes. In the same way, this cephalosporin blocked up to 90% of the in vitro interleukin-4-dependent IgE production by normal peripheral blood mononuclear cells. Cefalexine was unable to do the same. There results suggest that cefadroxil interplays with the regulation processes of the IgE production in humans.

[Cellular immunity during ankylosing spondylitis]. / Aspects de l'immunité cellulaire au cours de la spondylarthrite ankylosante.

A study of cell immunity was carried out in 23 patients with ankylosing spondylitis, 17 HLA B27 +, 6 HLA B27 --, 5 donors of normal blood carrying HLA B27 antigen and 50 controls, 7 methods were used together for a study of the markers of the blood lymphocyte membranes: rosette E, rapid rosette E, anti HTLA + X, surface immunoglobulins, PEA gamma and BEA gamma rosettes, determination of the monocytes after peroxidase staining. Stimulation of lymphocytes with mitogens (PHA, Con A, PWM) were carried out. There exists an increase in blood lymphocytes carrying HTLA + X in patients with ankylosing spondylitis HLA B27 and also in healthy carriers of the same antigen. During ankylosing spondylitis with HLA B27 --, a statistically significant reduction in T lymphocytes forming E and E rapid rosettes was observed; finally, a rise in the levels of circulating immune complexes detected by the PEG --C4 method was noted. The significance of these facts is discussed.

Circulating lymphocyte subpopulations in juvenile insulin-dependent diabetes. Correction of abnormalities by adequate blood glucose control.

Circulating lymphocytes from 39 juvenile insulin dependent diabetics of recent onset were studied by six membrane marker techniques and mitogen stimulation. Well controlled (n = 14) were grouped separately from poorly controlled (n = 25) patients. The total lymphocyte counts were not different from 50 control subjects. The percentage of T-cells detected by erythrocyte rosettes and B-cells detected by erythrocytes--antibody--complement rosettes was significantly decreased only in poorly-controlled diabetics (64.1 +/- 1.3 and 9.7 +/- 1.8, vs 71.0 +/- 1.0 and 15.3 +/- 0.6 in controls). Cells bearing receptors for the Fc fragment of IgG immunoglobulins were decreased in both groups. Mitogen stimulation was not different from controls but was significantly lower in poorly controlled than in well controlled diabetics. Optimal blood glucose control for 5 +/- 2 days using an external artificial pancreas led to a rapid normalisation of membrane marker values and mitogen responsiveness of lymphocytes from previously poorly controlled diabetics. Separate in vitro experiments showed that glucose had an inhibitory effect on mitogen stimulation at concentrations greater than or equal to 8.3 mmol/l and on T- and B-lymphocyte numbers at concentrations greater than or equal to 55.6 mmol/l. DL 3-hydroxybutyrate tested at 17.1 and 34.2 mmol/l only depressed mitogen responsiveness. Such results suggest a rapidly reversible T-cell defect closely linked to the existing metabolic disturbances.

Postinjection vastus lateralis atrophy: 2 case reports.

We report two cases of postsurgical intramuscular meperidine injection with injury to the femoral nerve and subsequent vastus lateralis atrophy. The first case is a patient who had arthroscopic anterior cruciate ligament reconstruction; the second, a patient with a C6-C7 anterior fusion. Photographs, radiography, and electrodiagnostic studies clearly depict the nature of the injuries, and their etiology is discussed. These case reports describe a unique neuropathic injection injury that, to our knowledge, has never before been described in the literature.

Immunological aspects of psoriasis. VI. Impairment of isoprenaline and theophylline-induced inhibition of mitogen responsiveness.

Pharmacological abnormalities occur in the psoriatic epidermis, and if similar abnormalities occur in the peripheral blood mononuclear cells they could impair the immune responses in psoriasis. In a paired control study, we have tested the capacity of histamine, isoprenaline and theophylline (10(-5) and 10(-7) M) to inhibit the mitogen responsiveness of blood mononuclear cells from normal and psoriatic subjects, using phytohaemagglutinin and concanavalin A. In the normal controls, mitogen responsiveness was inhibited by all three pharmacological agents by about 30 to 50%. In cells from psoriatic patients, the response in the presence of histamine was inhibited (as in the controls), but isoprenaline caused no inhibition, and theophylline paradoxically increased the mitogenic responses. These results suggest there is a defect in the pharmacological response of the blood mononuclear cells in psoriasis.