摘要:

Oral anticoagulant therapy has been practiced for 40 years but we still do not have definitive evidence of its value. Early clinical trials are now discounted due to the varying quality and lack of standardisation of the thromboplastins then available. There was also no statistical evidence that therapy was adequately maintained. We now have sensitive and reliable thromboplastins and there is an international standardisation of calibration and of reporting prothrombin time. With therapeutic quality control of oral anticoagulation and the so treated patients clinical assessed, we might hope that definitive evidence of the value of this therapy would result.

ISSN:0001-5792    

DOI:10.1159/000206023

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

Clinical immunology, already a subspecialty within internal medicine, is achieving increasing importance within the field of reproductive medicine. The recent recognition that subclinical autoimmune processes may be causally related to repeated early-pregnancy loss has allowed for the conceptional connection between the fields of infertility and obstetrics. While the immunology of infertility has been in mainstream clinical practice for years, clinical application of immunologic knowledge in obstretrics has somewhat lagged behind. The review presented here is an attempt to summarize recently recognized immune processes which affect pregnancy. Pregnancy seems particularly susceptible to immunologic interference during the very early and very late stages of gestation. During early pregnancy subclinical autoimmune processes seem capable of causing both pregnancy loss as well as congenital fetal abnormalities such as congenital heart block. Very acutely occurring immune processes in late pregnancy can endanger both maternal and fetal life and need therefore to be clinically recognized as such. The considerable progress in the clinical immunology of pregnancy made over the last few years needs to be continued by defining the clinically observed processes immunologically and biochemically in more detail. The thus obtained knowledge will not only benefit the clinical management of immunologically affected pregnancy, but will also enhance the general understanding of many far wider-reaching immunological processes. After all, pregnancy represents an unique model of nature.

ISSN:0001-5792    

DOI:10.1159/000206024

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

The frequency of clinic attendance of long-term anticoagulant patients varies considerably between centres. At this hospital, patients with a record of good anticoagulant control are seen every 3 months, which is double the currently recommended period. To assess this policy, the British ratio of 461 patients on long-term anticoagulants was examined at each visit over the last year. 46% of patients had been seen only at 3-month intervals over the last 5 visits and their anticoagulant control was excellent, 88% of visits falling in the British ratio range 2.0-4.0. It is concluded that amongst chronic anticoagulant patients a significant subgroup may be identified who can safely be monitored at 3-monthly intervals, and this has considerable cost implications.

ISSN:0001-5792    

DOI:10.1159/000206025

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

Since intravascular and endoparietal fibrin deposition is thought to be involved in the development of atherosclerosis, we measured factor XIII activity and its subunit ‘a’ and ‘b’ concentrations against a background of other haemostasis parameters in diabetics with angiopathy and in 2 control groups (healthy subjects and diabetics without vascular complications). Diabetics with angiopathy revealed a significant increase of factor XIII activity as well as its subunit concentrations. They also had significantly elevated antithrombin III, α2 macroglobulin, α1 antitrypsin, C\ inhibitor, fibrinogen, FDP concentrations and prolongation of euglobulin lysis time. The highest factor XIII levels were found in diabetics with renal failure. We suppose that increased factor XIII level and other observed changes of haemostasis in patients with diabetic angiopathy might promote intravascular and endoparietal fibrin deposition and contribute to the development of atherosclerotic complications of

ISSN:0001-5792    

DOI:10.1159/000206026

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

The lupus anticoagulant (LA) is an acquired autoantibody of the IgG or IgM type that acts on platelet factor III, inhibiting the generation of the prothrombin activator complex. It is prevalent in 5–10% of SLE cases and, in contradistinction to the name anticoagulant, it may be associated with thrombotic events, recurrent abortion or intrauterine death. Anti-cardiolipin antibody like LA, is an anti-phospholipid antibody and also causes recurrent thrombotic events. Mention has been made of a possible cross-reactivity between anti-phospholipid antibodies and anti-DNA antibodies. The optimal treatment for this problem is at present unknow

ISSN:0001-5792    

DOI:10.1159/000206027

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

The correlation between the presence of lupus circulating anticoagulant (LCA) and the incidence of thromboembolic phenomena was evaluated in 66 systemic lupus erythematosus (SLE) patients. Our criteria for the presence of LCA included an elevated LCA index and a prolonged recalcification time. Thirty-two patients (48%) fulfilled these criteria (group A). The incidence of thromboembolic phenomena, recurrent abortions and involvement of the nervous system was higher in group A patients than in SLE patients without LCA (group B). Moreover, 16 patients of group A who exhibited also a positive thromboplastin inhibition test associated with a markedly elevated LCA index, manifested higher incidence of severe thromboembolic phenomena. Early detection of LCA has important therapeutic implications. We suggest that the presence of LCA should be recognized as one of the criteria for the diagnosis of SLE.

ISSN:0001-5792    

DOI:10.1159/000206028

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

The establishment of mouse and human monoclonal anti-DNA antibodies is described. Common idiotypes were identified on these antibodies employing monoclonal (mouse) and polyclonal anti-idiotypic antibodies. The significance of the presence and titer of the common idiotypes as clinical activity marker was examined in patients with systemic lupus erythematosus. Based on Jerne’s network theory [Ann. Immunol. 125c: 373–389, 1974], naturally occurring anti-idiotypic antibodies to anti-DNA antibodies were reported. The utilization of this information to understand autoimmunity is discus

ISSN:0001-5792    

DOI:10.1159/000206029

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

The development of the hybridoma technology and the recent advances in molecular biology have opened new directions in the study of autoimmune mechanisms. Monoclonal autoantibodies can now be isolated and their structural elements may be studied in detail. In addition, the immunoglobulin genes which code for the production of antiself antibodies may now be cloned and analyzed for their structure and regulation in normal and autoimmune individuals. Initial results in this new field of molecular immunology are reviewed in this article, and their implications for the understanding of autoimmune phenomena are discussed.

ISSN:0001-5792    

DOI:10.1159/000206030

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

Six out of 8 healthy first-degree relatives of a patient with systemic lupus erythematosus (SLE) had very high serum levels of a common anti-DNA idiotype (16/6). In this family an additional sister developed SLE, and all members were heterozygous for C4 deficiency. Measurements of common autoantibody idiotypes may contribute to the understanding of the genetics of autoimmune diseases. They might be found useful in detecting healthy subjects prone to the development of an overt clinical state.

ISSN:0001-5792    

DOI:10.1159/000206031

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

Thirty-three patients with idiopathic thrombocytopenic purpura (ITP) were tested for HLA-A, B and C antigens, platelet antibodies, immunoglobulin levels and ABO blood groups. With one exception, ITP proved not to be significantly associated with the HLA antigens studied; an increased frequency of HLA-A28 was found in chronic ITP patients (50 vs. 18.7% in the control population). An increased incidence of blood group A was found in ITP patients (64 vs. 37.98% in the control population), especially in those with acute ITP (84.7%). A significant reduction of IgG levels was noted in patients with chronic ITP, while below-normal levels of IgA were found in both chronic and acute ITP patients. There was no difference in levels of IgM. Circulating platelet isoantibodies were demonstrated in 67.6% of the ITP patients. No correlation was demonstrated between the presence of platelet antibodies, immunoglobulin levels or HLA antigens.

ISSN:0001-5792    

DOI:10.1159/000206032

出版商:S. Karger AG    

年代:1986

数据来源: Karger