Long-lasting and complete remission was obtained in a 48-year-old patient with refractory pemphigus vulgaris by an experimental treatment protocol that tries to synchronize plasmapheresis with ...subsequent pulse cyclophosphamide therapy. The rationale of the approach tries to utilize the plasmapheresis-induced increased proliferation of pathogenic cell clones for partial deletion of these clones through application of maximum pulse immunosuppression treatment during the period of assumed maximum proliferation and, thus, maximum vulnerability of the antibody-producing cells. The treatment schedule consisted of initial withdrawal of immunosuppressive drug therapy, repeated large-volume plasmaphereses substituted with immunoglobulin-free albumin solutions, subsequent application of high-dose (36 mg/kg of body weight) cyclophosphamide therapy, and low-dose maintenance immunosuppression for several months. As a result, our patient remained disease free over a follow-up period of 40 months without any further immunosuppressive treatment. Stimulation of postexchange antibody production and subsequent application of high-dose cytotoxic drugs might be a valuable tool in the management of refractory pemphigus vulgaris and, possibly, in the management of other autoantibody-mediated diseases.
Monoclonal cryo‐antifibrinogenemia Euler, Hans H.; Zeuner, Rainald A.; Béress, Rosemarie ...
Arthritis and rheumatism,
June 1996, Letnik:
39, Številka:
6
Journal Article
Odprti dostop
We report on a 54‐year‐old female patient with arthritis and a severe cold‐induced leukocytoclastic vasculitis of the skin caused by a rare form of cryofibrinogenemia (“type II” cryofibrinogen). ...Affinity chromatography of cryoprecipitates from the patient's plasma revealed reversible cryoprecipitability of complexes composed of fibrinogen and a monoclonal antifibrinogen antibody (IgG3k). Conventional serum and plasma electrophoresis did not detect the paraprotein. Control of symptoms was achieved by long‐term plasmapheresis.
The number of mast cells is increased in psoriatic lesions and this is particularly prominent in their early phase. Mediators released by mast cells may interfere with various aspects of cutaneous ...inflammation and epidermal proliferation. Therefore, the aim of the present investigation was to find out whether a 4-week treatment period with Tiacrilast, a highly potent inhibitor of mast cell degranulation, might have antipsoriatic potential. A total of 31 patients with plaque-type psoriasis were evaluated after treatment with a 3% Tiacrilast hydrogel and hydrogel alone, in a double-blind, placebo-controlled, within-patient comparative study. No statistically significant improvement of the Tiacrilast-treated plaques compared to the hydrogel-treated sites could be demonstrated. Therefore, the present study does not provide evidence of a potential role of mast cell degranulation in the treatment of psoriasis.
Intravenous lorazepam is preferable to intravenous diazepam as first line treatment of status epilepticus. 1 It has a longer redistribution half life, which lessens the chance of seizure recurrence. ...1 Lorazepam may also bind more tightly to receptors in the brain, so, although it has a similar onset of action to diazepam, its anticonvulsant effects last longer. 2 Intravenous lorazepam is as effective as intravenous diazepam and phenytoin but causes fewer adverse events and is easier to use. 1 2 3 4 5 National UK guidelines recommend intravenous lorazepam for convulsive status epilepticus (ongoing generalised tonic-clonic seizures) in secondary care. 3 However, our hospitals have been without intravenous lorazepam since May 2010, which is causing great difficulty in treating patients with status epilepticus and those with agitation. www.nice.org.uk/nicemedia/live/12108/50164/50164.pdf. 4 Appleton R, Macleod S, Martland T. Drug management for acute tonic-clonic convulsions including convulsive status epilepticus in children.
