Evans syndrome in a pediatric liver transplant recipient with an autoantibody with apparent specificity for the KEL4 (Kpb) antigen.

Although most warm red blood cell (RBC) autoantibodies react broadly with panel cells in addition to the patient's own RBCs, occasionally an autoantibody with specificity for a specific blood group antigen is encountered. Rare cases of warm autoantibodies with specificity for the Kpb antigen of the Kell blood group system have been described. We report a pediatric transplant recipient with anemia, immune-mediated hemolysis, thrombocytopenia, and a warm autoantibody with apparent anti-Kpb specificity. The patient's autoimmune anemia and thrombocytopenia responded well to discontinuing the immunosuppressant tacrolimus, trans- fusions with Kp(b-) RBCs, and intravenous immunoglobulin therapy, with disappearance of the pathologic antibody. During the autoimmune hemolysis, the patient's RBCs did not react with antisera specific for Kpb. However, repeat testing of the patient's RBCs with Kpb-specific antisera 15 months after the resolution of hemolysis showed reactivity, indicating that the RBC autoantibody was associated with a transient disappearance of the Kpb antigen.

Reconstitution of human hematopoietic function with autologous cryopreserved circulating stem cells.

Complete hematopoietic reconstitution using nonleukemic peripheral blood mononuclear cells has been achieved in animal models but not in humans. We treated two patients who had metastatic breast carcinoma involving the bone marrow and who had failed conventional therapy with high-dose chemotherapy and total body radiation. Cryopreserved autologous peripheral blood mononuclear cells (6.3-8.4 X 10(8)/kg patient weight) obtained by leukapheresis before high-dose therapy were returned to the patients intravenously. In one patient, evidence of bone marrow engraftment was present, but the patient died before full reconstitution of the peripheral blood cells occurred. Bone marrow engraftment and return of all cell lines to the peripheral blood occurred in the second patient. These findings demonstrate that human hematopoietic reconstitution can be achieved with autologous, peripheral blood, mononuclear cell transfusions following high-dose therapy. This approach may be useful to patients who have contraindications for a bone marrow harvest but who are otherwise candidates for autologous bone marrow transplantation.

Specific IgA antibody increases in schizophrenia.

IgA antibody levels in serum were examined in two groups of schizophrenic patients. All were diagnosed according to DSM-III-R criteria. One group of 36 males and 12 females were compared to historical controls. The other group consisted of 13 males off drugs for at least 3 months; these were compared with age- and sex-matched controls. An increase in specific IgA antibodies was found. More schizophrenics than controls showed IgA antibody levels above the upper normal limit to gliadin, beta-lactoglobulin, and casein.

Humoral graft-versus-host disease after pancreas transplantation with an ABO-compatible and Rh-nonidentical donor. Case report and a rationale for preoperative screening.

Severe hemolysis and graft ischemia complicating solitary pancreas transplantation with an ABO-compatible, Rh-negative, anti-D-positive donor to Rh-positive recipient is described in this article. A brief review of the literature is presented. A rationale for preoperative screening for red cell antibodies during solid organ transplantation in this special setting is discussed.

Combined liver/small bowel transplantation using a blood group compatible but nonidentical donor.

A successful liver/small intestinal transplantation with a blood group O donor to a blood type A recipient is described. Mild graft versus host disease developed, manifested by hemolysis, but did not result in graft loss or patient mortality. This suggests that minor ABO incompatibility may be tolerated with intestinal transplantation, despite the transplantation of large amounts of lymphoid tissue.

Addition of peripheral blood stem cells collected without mobilization techniques to transplanted autologous bone marrow did not hasten marrow recovery following myeloablative therapy.

A randomized prospective trial was conducted to determine if the addition of cryopreserved autologous peripheral blood stem cells (PBSC) collected without mobilization techniques to autologous cryopreserved bone marrow for patients receiving an autologous bone marrow transplant (ABMT) affected the time to marrow function recovery. Thirty-five evaluable patients with various malignancies were studied. Sixteen received PBSC + ABMT and 19 received ABMT alone. The PBSC were collected with 4 h leukapheresis procedures on 3 consecutive days. No manipulations to increase the number of circulating stem cells were used during the collections. The median time to recover 0.5 x 10(9)/l circulating granulocytes was 20 days after transplantation in the ABMT group and 27 days in the PBSC + ABMT group (p = 0.12). The median time to recover 20 x 10(9)/l platelets was 22 days after transplantation in the ABMT group and more than 27 days in the PBSC + ABMT group (p = 0.29). The day of discharge from the hospital was earlier for the ABMT group (median 29 days) than the PBSC + ABMT group (median 35 days, p = 0.03). We did not find that the addition of non-mobilized PBSC to infused autologous marrow accelerates marrow recovery.

Allogeneic transplantation of blood-derived, T cell-depleted hemopoietic stem cells after myeloablative treatment in a patient with acute lymphoblastic leukemia.

This report describes an allogeneic peripheral blood stem cell transplant in a patient who had received marrow ablative therapy. The patient was an 18-year-old white male with acute lymphocytic leukemia in third remission for whom an allogeneic bone marrow transplant was recommended. His HLA-identical sibling preferred to donate peripheral blood stem cells rather than marrow. The donor cells were collected with 10 apheresis procedures and depleted of T lymphocytes to prevent excessive graft-versus-host disease. Nine collections were cryopreserved. The patient received high-dose cytosine arabinoside and 12 Gy of total body irradiation, followed by infusion of all cryopreserved donor cells. A portion of the tenth apheresis product collected on the day of transplant containing 1.8 x 10(9) T lymphocytes was infused without further processing to approximate the number of T lymphocytes given in an allogeneic bone marrow transplant; the remainder was T lymphocyte depleted and infused. More than 1 x 10(9)/l granulocytes were present on day +11. A bone marrow biopsy on day +27 showed trilineage engraftment. Cytogenetic studies demonstrated that the recipient's marrow and peripheral blood were populated exclusively with donor cells. Allogeneic peripheral stem cell transplantation produced an early hematopoietic engraftment. Since the patient died on day +32, sustained engraftment could not be evaluated.

Correlates of hysterical symptoms in schizophrenic patients.

The correlations of symptoms of hysteria with 87 symptoms relevant for diagnosing schizophrenia were examined in a sample of 112 patients (70 women and 42 men whose mean age was 38.1 yr., SD = 9.8) with DSM-III diagnosis of schizophrenia. Hysterical symptoms were recorded in 37.5% of the schizophrenics. No significant relationships (phi coefficients) were found to key symptoms of schizophrenia.

Are schizophrenic symptoms different in patients with higher education?

Ratings of 87 symptoms on a Canadian sample of 108 DSM-III schizophrenics (41 men, 67 women) were unrelated (point biserial coefficients) to their education. The only exceptions to this trend were weak correlations with ratings of apathy, insight, and of premorbid adjustment. Patients with higher education were less frequently labelled as apathetic (r = .28) or as lacking insight (r = .26) and their premorbid adjustment was better (r = .25). None of the symptoms traditionally considered as markers specific for schizophrenia was significantly related to education.

Symptom patterns in schizophrenia for men and women.

Differences on symptoms and anamnestic variables were studied in a sample of 112 Canadian patients (42 men and 70 women) who met DSM-III criteria for schizophrenia. Men were more often rated as providing unreliable information than were women. A smaller proportion of men than women showed spontaneous remissions (a return to premorbid level), and fewer men also displayed phasic changes in appetite, weight, or sexual activity. It is noteworthy that men and women did not differ on general indices of severity of illness such as the number of past hospitalizations or length of hospital stay. In contrast to numerous past studies, an earlier age of onset of the illness for men was nonsignificant.

Characteristics of schizophrenic patients and the outcome of fluphenazine and of electroconvulsive treatments.

We examined the outcome with fluphenazine treatment and ECT in a group of 120 patients according to the incidence of psychopathological symptoms, the patients' status on a variety of sociodemographic and anamnestic variables, and their diagnoses according to 13 systems for diagnosing schizophrenia. All had previously been considered to be schizophrenic patients at least once in hospital settings. The outcome with fluphenazine was better in patients with passivity feelings, auditory hallucinations and other hallucinations and delusions. The outcome with patients who had ECT, as judged from the hospital files, was better in those who were preoccupied with delusions or hallucinations and less successful in those who had been diagnosed as having schizophrenia on the first previous occasion when they had been discharged from the hospital.

Social and anamnestic correlates of consensus in diagnosing schizophrenia.

One hundred and twenty patients with a clinical diagnosis of schizophrenia (mean age 38.2 years; 73 women, 47 men) were evaluated by means of 13 systems for diagnosing schizophrenia. The sample included only patients classified as schizophrenic by at least one system. Data analyses indicated that the number of systems that diagnosed patients as schizophrenic (i.e., a variable that ranged from one to 13 points) was larger for persons who suffered from their symptoms in a more chronic manner (r = .47), were more frequently diagnosed as schizophrenic in hospitals in the past (r = .44), were more frequently hospitalized before (r = .31), and whose last hospitalization was more recent (r = .24). They were also less likely to be presently employed in higher-ranking positions (r = .32) and to own a house (r = .32).

A double-blind comparison of fluspirilene and fluphenazine decanoate in schizophrenia.

A double-blind comparison of fluspirilene and fluphenazine decanoate in 28 schizophrenic patients over six months showed equal improvement and the same incidence of side-effects in each group of patients. It would be expected from the literature that a better ratio of therapeutic to side-effects would appear with fluspirilene than with fluphenazine. The absence of such an effect in this study may be attributable to an initial lack of familiarity by the investigators with the use of fluspirilene, indicating an important potential variable in the comparison of a new drug with an established one.

The Whitaker Index of Schizophrenic Thinking (WIST) and thirteen systems for diagnosing schizophrenia.

Developed the present study in conjunction with a project that evaluated the psychiatric diagnosis of schizophrenia (Landmark, 1982; Landmark & Leslie, 1982). This design, which included 13 different interview systems for diagnosing schizophrenic disorders, allowed for an in-depth analysis of the Whitaker Index of Schizophrenic Thinking (WIST). Eighty-five outpatients who were receiving long-term chemotherapy for schizophrenia at the Moditen Clinic of London Psychiatric Hospital were reassessed individually using each of the 13 systems, following a clinical interview format, and the WIST. Major statistical analysis evaluated the concurrent validity and discriminatory efficiency of the WIST in comparison to the 13 systems. The WIST was found to show a consistently high agreement with each of the 13 systems for an average WIST discriminatory efficiency of 70%. The WIST is suggested as a practical, easily administered, diagnostic tool that performs well in comparison to the interview systems.

Inter-rater reliability of twelve diagnostic systems of schizophrenia.

The present and past symptomatology of 31 chronic schizophrenics was rated by four independent judges, two experienced clinical psychiatrists and two psychiatric residents, in a context more representative of actual clinical practice than most research studies. Ratings were made on 64 symptoms derived from 12 diagnostic systems, based on either live or videotaped interviews for present symptomatology and case records for past symptomatology. Inter-rater reliabilities were higher for present than for past symptoms, and in general did not approach those reported for highly trained raters. There were no differences between live and videotaped interviews. Diagnostic systems differed widely in rater agreement. The most consistent across both past and present symptomatology were the systems of Langfeldt, Schneider, and DSM-III, for which the level of reliability was consistent with other studies.

Correlates of suicide attempts and ideation in schizophrenia.

A group of 118 patients with a hospital diagnosis of schizophrenia was reviewed. The incidence of suicide attempts was significantly correlated with more frequent past psychiatric admissions, more frequent past diagnoses of schizophrenia, and poor work function. The apparent relationships could be spurious or based on a reversed causal sequence; for example, suicide attempts are likely to be followed by psychiatric admissions.

Fluphenazine treatment of DSM-III-R male schizophrenic patients among the Xhosa.

A comparison of fluphenazine decanoate depot injection used alone and fluphenazine decanoate with fluphenazine HCl i.m. was undertaken in South African Xhosa patients with schizophrenia diagnosed according to DSM-III-R. The combined treatment significantly shortened the length of hospital stay to a mean of 30.5 days from a mean of 40.7 days for the single therapy group. The combined treatment group also obtained significantly higher improvement ratings one week after the start of treatment than the single treatment patients.

The positive triad of schizophrenic symptoms. Its statistical properties and its relationship to 13 traditional diagnostic systems.

Using data from the WHO International Pilot Study of Schizophrenia and from our own previously reported series of 120 patients receiving treatment for schizophrenia, we ascertained the degree of agreement between 13 different systems for diagnosing schizophrenia. We identified a triad of symptoms similar to that from the International Pilot Study: auditory hallucinations, passivity feelings, and disturbances of affect. This triad correlated very strongly with the diagnosis of schizophrenia as determined by the 13 diagnostic systems, as well as with response to fluphenazine in our series. The triad should serve as a core set of symptoms in the study of schizophrenic illness. It represents the leading phenomena in a group of patients having what is generally considered to be schizophrenia, although it does not provide a definitive diagnosis. Evidence is needed on its specificity.

Autologous peripheral hematopoietic stem cell transplantation restores hematopoietic function following marrow ablative therapy.

From ten patients with advanced malignant disease involving the bone marrow, autologous hematopoietic stem cells were collected from the peripheral blood during eight four-hour pheresis procedures and cryopreserved. No manipulations to increase the number of stem cells circulating in the blood were used during the collections. Following marrow ablative chemotherapy or chemoradiotherapy, the autologous cells were thawed and infused intravenously (IV). WBCs reappeared in the circulation at a median of eight days (range seven to 11 days) after stem cell infusion. Two patients died early, whereas the other eight reached normal numbers of circulating granulocytes that have persisted for up to greater than 20 months. These eight patients became independent of RBC transfusions (hemoglobin concentration greater than 10 g/dL) at a median of 27 days (range 11 to 58 days) after transplantation. One patient received platelet transfusions for counts less than 50 x 109)/L, one patient developed a clinical picture of idiopathic thrombocytopenic purpura, and six patients maintained a platelet count greater than 20 x 10(9)/L at a median of 23 days (range 14 to 25 days) following stem cell infusion. This technique allows patients ineligible for autologous bone marrow transplantation due to unacceptable anesthetic risks, prior pelvic irradiation, or bone marrow metastases to receive marrow ablative therapy.