La Nouvelle presse medicale最新文献

Twenty-seven patients aged from 10 to 60 years (mean 34.4 +/- 13 years) in the first perceptible phase of acute myeloid leukemia were subjected to intensive induction chemotherapy consisting of adriamycin (ADM), vincristin (VCR) and cytosine arabinoside (ARA-C). Twenty-four patients (89%) attained complete remission (CR) after 1 to 3 cycles and were then given an early consolidation treatment with one of the previous cycles. This was followed by long-term continuous maintenance chemotherapy with 6-mercaptopurine (6-MP) and methotrexate (MTX) alternatively and 3-monthly reinforcement courses of donaurubicin (DNR) and VCR. Twenty of these 24 patients were splenectomized soon after the consolidation treatment. None of the spleens were enlarged, and histological sections of the spleens, liver biopsies and mesenteric lymph-nodes stained with routine dyes and by the naphthol AS-D chloroacetate esterase method revealed mature granulocytes but no demonstrable leukaemic cells. In the group of splenectomized patients, the probabilities of staying in complete remission at 27 and 44 months were 70 +/- 12.6% and 52 +/- 18.5% respectively, and the probabilities of remaining alive at 32 and 55 months were 79 +/- 11% and 57 +/- 19% respectively. Age over 40 and evidence of extramedullary infiltration at presentation appeared to leave little hope of disease-free survival. The rationale for the present therapeutic study is discussed.

Since plasma is largely involved in autoimmune diseases, plasma exchanges have been used to treat these patients. In the first part of this paper the authors review the indications for plasmapheresis, which they divide into two groups: autoimmune diseases proper, and diseases with autoimmune phenomena. In the second part, the results available in the literature are analyzed. In many cases, it is extremely difficult to form an opinion, since the methods vary from one group of workers to the other. Unquestionably, improvement was observed in bullous pemphigus and pemphigoid, in Goodpasture's syndrome, in glomerulonephritis with autoantibodies and in myasthenia. In other cases, dramatic improvement was sometimes observed (notably in some cases of acute polyradiculoneuritis), but the small number of patients in each series makes it impossible to separate the effects of plasma exchanges and those of the immunosuppressive treatment frequently administered concomitantly.

Abnormally high T3 serum concentrations incompatible with the patients' clinical thyroid status were observed in a case of Graves' disease and in a euthyroid patient with hyperlipaemia. T3 was in the form of immune complexes precipitable by polyethyleneglycol. Specific anti-T3 autoantibodies were detected in the serum gammaglobulin fraction. The T3 affinity constants of these autoantibodies were found to be as high as 1.10(10) and 7.2.10(10)l/mol respectively. The antibodies interfered with radioimmunological T3 determination, resulting in an apparent increase of T3. However, after extraction, true T3 serum levels remained higher than expected. These findings illustrate the importance of hormone concentrations, affinity constants of binding proteins and equilibrium between free and bound forms in the resulting hormonal effect.

A human leucocyte migration inhibition test (HLMT) was performed in 50 healthy subjects and in 23 patients with bacteriologically confirmed listeriosis, using Listeria monocytogenes as antigen. Considerable inhibition was found in most patients, whereas the test was negative in all controls. In view of this consistent relationship between test and disease, it is suggested that the HLMT could be used for the indirect diagnosis of listeriosis, taking into account the delay between the onset of infection and the positivity of the test.