International Journal of Clinical and Laboratory Research

The cost of long-term plasma-exchange is comparable with that of chronic hemodialysis and less than long-term residential care. If it could be shown that it saved lives or enabled patients to live in the community when they would otherwise be disabled, then the cost would not matter. At present, however, although there are suggestions that it may save lives in such diseases as myeloma and macroglobulinemia and reduce disability in the connective tissue disorders, these benefits are not weil enough documented to justify its routine introduction.

We have studied the effect of Synchrodyn® 1–17 (100 μg/day/15 days, intramuscularly) on 12 patients with intrinsic asthma, presenting a circadian pattern in several functional parameters related to the bronchial patency (and/or with bouts of nocturnal asthma). Treatment with ACTH 1–17 had two main effects: the pathological rhythms of the bronchial tone disappeared and there was a clear general improvement in the indices of bronchial patency. The drug was well tolerated. Euphoria and water retention were the side effects: they were noticed in a variable number of subjects and disappeared after discontinuation of treatment.

Nel corso del presente esperimento abbiamo studiato gli effetti di un’unica somministrazione intraperitoneale di particelle di carbone colloidale, vale a dire di un agente ingolfante i macrofagi, sul quadro istologico e sulla reattività immunitaria primaria ai G.R.M., nel topo di ceppo BALB/c. Il carbone colloidale è stato iniettato a diversi intervalli di tempo prima, contemporaneamente o dopo l’immunizzazione. I risultati indicano che il trattamento con carbone deprime la risposta immunitaria primaria solo se questo è stato somministrato a brevi intervalli prima dell’antigene. Di conseguenza i macrofagi sembrano giocare un ruolo molto importante negli eventi cellulari associati alla risposta immunitaria primaria ai G.R.M. Appare anche evidente dalle riportate osservazioni che l’interazione macrofago-antigene avviene effettivamente e precede l’interazione fra T-linfocita ed antigene. Inoltre si ritiene di poter suggerire che i macrofagi peritoneali costituiscano un terzo tipo cellulare necessario per l’instaurarsi della risposta immunitaria primaria ad alcuni antigeni particolati somministrati per via peritoneale.

Approximately 40–45% of insulin-dependent diabetic (IDD) patients will develop, with time, clinical proteinuria, a forerunner of certain renal failure. Before this, however, up to 45% of IDD patients excrete supranormal amounts of protein in the urine, though still undetectable by dipstix test. This microproteinuria appears to be glomerular in origin, consists mainly of albumin and IgG, and is associated with poor glycemic control and marginal elevation of arterial pressure. Glomerular hemodynamic disturbances, and loss of charge selectivity of the glomerular membrane, are probably responsible for this microproteinuria, which appears reversible by correction of hyperglycemia and raised blood pressure. Once the dipstix test becomes positive (i.e. total urinary protein excretion exceeds 0.5 g/24h) and blood pressure rises into the hypertensive range, glomerular filtration rate (GFR) falls relentlessly. By the time GFR is as low as 20 ml/min/1.73 m2, more IgG relative to albumin is being filtered, giving rise to a low selectivity proteinuria, a condition consistent with changes in the size selectivity properties of the glomerular filtre. Glycemic control does not affect the decline in GFR, although blood pressure control and low protein diet can slow it, presumably by altering the self-perpetuating hemodynamic disturbances that occur in surviving glomeruli. The recent demonstration that IDD patients with microalbuminuria in excess of 30 µg/min have approximatley a 20-fold increase in risk of developing persistent detectable proteinuria has provided a link between these two phases of diabetic nephropathy. The reversibility of the early microalbuminuria heralds a real chance of preventing the later irreversible phase of end-stage renal failure.

In the early twentieth century, acute myocardial infarction secondary to acute thrombotic coronary occlusion was considered a rare, fatal condition. Acute myocardial infarction is now one of the most-common serious illnesses in the industrialized world. Laboratory medicine now plays a crucial role in identifying risk factors, early events, and conditions triggering plaque rupture in coronary ischemic disease. However, the greatest progress in laboratory research has resulted from the discovery of new and more-promising biochemical markers of myocardial damage. The discovery of cardiac troponins, in particular, has heralded a new age in the diagnosis and treatment or management of a broad spectrum of diseases, grouped together under the heading ofacute coronary syndrome, and including stable and unstable angina, and non-Q wave infarction to Q-wave infarction. Cardiac troponins, which are selectively released by damaged myocardiocytes, have a specificity that has not only allowed an improvement in the diagnosis of acute cardiac ischemic disorders, but has also enabled us to make a more-reliable stratification of risk and prediction of outcome. It is generally agreed that two biochemical markers should be used: an early marker (and we recommed myoglobin for this) and a definitive marker, which is cardiac troponin (I or T). Future research is likely to include the standardization of methods for measuring current markers, troponin I in particular, the assessment of rapid bedside tests, and the investigation of the relationship between cardiac markers and emerging immunological and coagulation parameters. Thrombogenesis is now recognized as important in the final process of coronary atherosclerosis, and new markers of thrombogenesis should be used to evaluate the risk of plaque rupture and to monitor the outcome of thrombolytic therapy. Moreover, recent vascular biology studies have provided information on the developmental stages of atherosclerosis and emphasized the importance of the endothelium as a modulator of vascular reactivity, atherogenesis, and plaque stability. The different types of laboratory test (biochemical, immunological, and coagulative) now available, should soon allow improvement in the diagnosis and therapy of ischemic coronary diseases.

Bifunctional antibodies are monovalent, bispecific, antibody-derived molecules. They have been produced by both chemical and biological means. They are thought to have several advantages over monoclonal antibodies in both immunotherapy and immunodiagnosis. Bifunctional antibodies have been shown to be efficient in the targeting of drugs, toxins, radiolabelled haptens and effector cells on to diseased tissues, primarily cancer cells. In addition, bifunctional antibodies have been used to develop novel immunoassays. The full potential of bifunctional antibodies has yet to be realised.

Impiegando l’adesivo fibrinico in caso di rottura precoce delie membrane al 2° e 3° trimestre di gravidanza è possibile ridurre il numero degli aborti F. dei parti prematuri; occludendo con un coagulo di fibrina la fessura formatasi nella membrana ovulare si evita così anche l’insorgenza di infezioni amniotiche ascendenti.