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Kiprov, Dobri; Pfaeffl, Wolfgang; Parry, Gareth; Lippert, Randolph; Lang, William; Miller, Robert
doi: 10.1002/jca.2920040103pmid: 3391987
Peripheral neuropathy is increasingly recognized in patients with AIDS as well as AIDS‐related complex (ARC). Thirty homosexual men with polyneuropathy were evaluated in this study. Twenty‐one had ARC and nine had AIDS. We observed three distinct clinical syndromes: distal sensorimotor polyneuropathy, chronic inflammatory demyelinating polyrediculoneuropathy (CIDP), and mononeuropathy multiplex. Circulating antibodies to peripheral nerve tissues were found in all patients. In six patients, treatment with plasma exchange was undertaken because of severe, progressive weakness. Four patients with clinical, electoophys‐iologic, and histologic evidence of CIDP improved with plasma exchange, three regaining normal function. These results suggest that the peripheral neuropathy associated with ARC and AIDS is immunotogically mediated and that plasma exchange is an effective treatment in a subgroup of patients with this disorder.
doi: 10.1002/jca.2920040104pmid: 3391990
A patient with a hyper‐IgE syndrome was treated with 60 plasmaphereses over a period of 2 years in conjunction with cytotoxic immunosuppressive drug therapy. During this time her severe dermatitis of 8 years' duration became almost completely inactive, and her circulating IgE level was reduced by 73%. An elevated pretreatment ratio of CD4+/CD8+ T lymphocytes fell to subnormal. The beneficial results of treatment may be attributed to the reduction of lymphocyte populations responsible for IgE production by the combined action of plasmapheresis and of cytotoxic drugs as well as the direct effect of removal of circulating IgE and possibly IgE‐potentiating factors.
Andrzejewski, C.; Gault, E.; Briggs, M.; Silberstein, L.
doi: 10.1002/jca.2920040105pmid: 3391986
Plasmapheresis is commonly advocated in cold agglutinin disease with life‐threatening hemolysis. Some clinicians, however, are reluctant to use this therapy because of perceived technical problems and risks attendant with the temperature of the extracorporeal circulation. In this study we report our experience of two patients with severe life‐threatening hemolysis and in whom plasma exchange was not feasible due to red blood cell autoagglutination in the extracorporeal circuit. A method is described involving the use of blood warmers and the Fenwal CS‐3000 blood cell separator with its 37 °C centrifuge compartment. The use of plasma exchange in this manner is a safe and beneficial form of adjunctive therapy and should be considered for patients with cold agglutinin disease at risk for extracorporeal agglutination or hemolysis.
Antwiler, G. Delbert; Dau, Peter C.; Lobdell, Donn D.
doi: 10.1002/jca.2920040106pmid: 2455708
A novel on‐line system for the selective precipitation of low‐density lipoprotein (LDL) using dextran sulfate has been devised and tested in four patients with heterozygous familial hypercholesterolemia (type II). The mean pretreatment serum cholesterol was 410 mg/dl. Plasma was generated by membrane filtration and LDL and VLDL (very‐low‐density lipoprotein) were completely precipitated with 10–35 mg% dextran sulfate (Mr 5,000) in the presence of 55 mM Ca2+. The precipitate was removed by filtration and the excess Ca2+ by dialysis. For 41 procedures the mean reduction of plasma solutes was LDL + VLDL 65%, HDL 23%, fibrinogen 19%, albumin 15%, IgG 20%, IgA 19%, IgM 24%. We conclude that dextran sulfate precipitation is an effective method for selective on‐line removal of LDL from plasma.
Wallace, Daniel J.; Goldfinger, Dennis; Savage, Gail; Nichols, Sherri; Goodman, David; Fichman, Marshal; Stewart, Morgan; Klinenberg, James R.
doi: 10.1002/jca.2920040107pmid: 3391988
Twenty‐seven patients with lupus nephritis and nephrotic syndrome had persistent disease activity despite an adequate trial of corticosteroids and immunosuppressive drugs; 30% were Asians, compared with 7% of our overall SLE population. Two years later, seven had a very good outcome and seven a poor outcome. Thirty clinical, pathological, laboratory, and treatment variables were analyzed in a good versus poor responder subset comparison in an effort to determine which factors were associated with favorable outcome. Administration of pulse steroids (P = .069) and a low biopsy chronicity index (P = .048) were associated with the good responder subset. Serum creatinine, biopsy class, blood pressure, complement, and anti‐DNA values at entry as well as the choice of immunosuppressive drug were not helpful in predicting outcome. All seven good responders were plasmapheresed (P = .026). Patients with refractory lupus nephritis who have a low biopsy chronicity index may benefit from the use of pulse steroids or plasmapheresis, and controlled studies are suggested.
Kottke, Bruce A.; Pineda, Alvaro A.; Case, Marvin T.; Orsuzar, Alyce M.; Brzys, Karen A.
doi: 10.1002/jca.2920040108pmid: 3292517
Atherosclerosis‐induced coronary heart disease remains the major cause of death and disability in industrialized countries. Hypercholesterolemia is recognized as a causative factor in the development of atherosclerosis. While the lowering of cholesterol levels as a treatment goal has met with general agreement and acceptance, the preferred methods for doing so are still open to conjecture. This literature review discusses various factors in the hypercho‐lesierolemia‐atherosclerosis link and surveys a variety of treatment protocols including diet modification, drug therapy, surgical intervention, and plasmapheresis. Evidence is accumulating to prove that the ideal hypercholes‐terolemia therapy is one that reduces LDL levels while maintaining or increasing HDL levels. Because LDL‐apheresis has this potential, this paper also reviews the various LDL‐apheresis methods, including immunoadsorp‐tion, chemical affinity,' and double‐membrane filtration.
Moxey‐Mims, Marva M.; Luban, Naomi L. C.; Bock, Glenn H.; Ruley, Edward J.; Preston, Karen M.
doi: 10.1002/jca.2920040109pmid: 2455709
Therapeutic leukapheresis of a 10‐year‐old girl with adult‐type chronic myelocytic leukemia is described. The efficiency of WBC removal was noted to improve significantly after addition of hydroxyethyl starch to the anticoagulant infusion. In fact, the percentage of white cells removed more than doubled (39% vs. 16%) when comparing procedures of similar duration, with and without the sedimenting agent. Of particular interest was the relief of the patient's respiratory distress concomitant with the decline in her leukocyte count, a finding that has not previously been documented in pediatric patients. The arterial oxygen pressure remained greater than 95 mmHg after the procedure with hydroxyethyl starch compared with 70 tnmHg after the procedures without it la addition, her respiratory rate decreased from 70 on admission to the low 20s after the final procedure. Leukapheresis with hydroxyethyl starch was shown to be a safe procedure, and the use of hydroxyethyl starch was shown to be of particular benefit for prevention of prolonged aphercsis procedures.
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