home
***
CD-ROM
|
disk
|
FTP
|
other
***
search
/
Shareware Overload Trio 2
/
Shareware Overload Trio Volume 2 (Chestnut CD-ROM).ISO
/
dir26
/
med9406d.zip
/
M9460554.TXT
< prev
next >
Wrap
Text File
|
1994-06-25
|
4KB
|
53 lines
Document 0554
DOCN M9460554
TI [Immunoglobulins or plasma exchange? Synchronization of plasma exchange
and intravenous polyvalent immunoglobulins. A consecutive study of 11
patients]
DT 9408
AU Bussel A; Boulechfar H; Naim R; Unite d'Hemapherese Therapeutique,
Secteur; d'Hemobiologie-Transfusion de Paris-Est, Hopital Saint-Louis.
SO Ann Med Interne (Paris). 1993;144(8):532-8. Unique Identifier : AIDSLINE
MED/94234622
AB Synchronization is defined as a prescription sequence aimed at obtaining
synergic response or potentialization. THEORETICAL BASIS--The concept of
synchronization is based on clinical and biological observations such as
similar indications and transient effectiveness. Certain mechanisms of
action such as reduction of pathological autoantibodies and accelerated
elimination of immune complexes are common to both methods. Inversely,
long-term effects differ. Plasma exchange cannot control the synthesis
(or could aggravate) of autoantibodies while gammaglobulins have a
suppressor effect on autoreactive clones. The aim is to obtain a
summation effect by eliminating immediately cytotoxic factors. The
potentializing effect of gammaglobulin anti-idiotypes on the
modification of the immunologic repertory is favoured by prior reduction
in the level of circulating pathogenic antibodies. RESULTS--It is
difficult to evaluate the efficacy of this therapeutic association. Only
a few trials have been conducted in refractory autoimmune thrombopenic
purpura (n = 8), in intra-uterine Rhesus disease (n = 3), and HIV
associated pathologies. We report our experience in 11 patients in a
situation of therapeutic failure including three cases of renal
transplantation, two cases each of chronic polyradiculoneuritis and
neurological paraneoplastic syndromes, and one case each of Wegener's
syndrome, polymyositis, sclerokeratitis, and antiphospholipid antibodies
during pregnancy. Immunoglobulins were injected at an initial dose of 2
g/kg following at least 3 plasma exchanges. Consolidation cures were
then administered every 3 weeks at a dose of 1 g/kg. Two major
complications occurred and required interruption of the treatment: acute
regressive oligo-anuric renal failure (Wegener) and exacerbation of
sclerokeratitis inflammatory lesions. The disease process was controlled
in 7 patients. CONCLUSIONS--Despite these promising preliminary results,
the proposed combination therapy is not devoid of complications and its
cost is high (cost of PE for 500 mg/kg Ig is about 5,000 FF). The next
step should be the study of experimental models and prospective trials
on pathologies with well characterized immunological features.
DE Adult Aged Antibodies/ANALYSIS Autoantibodies/ANALYSIS Autoimmune
Diseases/THERAPY Combined Modality Therapy English Abstract Female
Human Immunoglobulins, Intravenous/*THERAPEUTIC USE Immunologic
Diseases/*THERAPY Male Middle Age *Plasma Exchange Pregnancy
Pregnancy Complications/IMMUNOLOGY/THERAPY Retrospective Studies Time
Factors JOURNAL ARTICLE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).