[Internal medicine in the last 40 years].

Internal medicine in the last 40 years has known many eminent teachers at universities, such as Hijmans van den Bergh, Van Buchem, Borst, Mulder, Lindeboom, De Langen, Hulst, Jordan, Formijne, Major, Snapper, Groen and Querido, and others outside universities such as Stuyt, Van Hees, Eindhoven, Pannekoek, Schalm, Bruins Slot, Heeres, Stolte and Pompen. The main scientific platform on which the bequeathors assembled in the first few decades after World War II was the Algemene Ziektekundige Vereniging ('General Medical Association'), which met in Utrecht. Important medical steps forward in that period were the virtually complete eradication of tuberculosis in the Netherlands, the developing of vaccines against smallpox and polio, but also against the various types of virus hepatitis, and the progress in intensive care, transplantation and molecular biology.

Soft-tissue uptake of 99mTc-diphosphonate and 99mTc-pyrophosphate in amyloidosis.

This study describes the results of scintigraphy with 99mTc-labeled methylene-diphosphonate (99mTc-MDP) and pyrophosphate (99mTc-PYP) as a noninvasive test for the distribution of organ involvement in five different types of amyloidosis. Scintigraphy with 99mTc-labeled phosphates appeared to be a sensitive noninvasive screening test for the extent and the distribution of organ involvement in systemic AA and systemic AL amyloidosis as well as in local bronchial amyloid, local dermal amyloid, and familial amyloidotic polyneuropathy. Echocardiography, however, was more sensitive for demonstrating cardiac involvement in systemic amyloidosis than 99mTc-MDP or 99mTc-PYP scintigraphy.

Classification of amyloidosis: immunohistochemistry versus the potassium permanganate method in differentiating AA from AL amyloidosis.

As systemic AA and Al amyloidosis differ considerably with regard to prognosis and therapeutic approach, it is of importance to make an accurate histochemical classification with regard to the amyloid protein involved. In the present study the results of the potassium permanganate (KMnO4) method, an indirect histochemical procedure based on differences in cross-beta-potential of different amyloid fibril proteins, were compared with the results of an immunohistochemical method utilizing anti-AA and anti-AP antibodies. Renal biopsy sections of patients with systemic amyloidosis related to inflammatory conditions, systemic amyloidosis associated with plasma cell dyscrasia, idiopathic systemic amyloidosis, and nonamyloidotic controls were studied.

Some effects of combination chemotherapy with cis-platinum on renal function in patients with nonseminomatous testicular carcinoma.

Renal function in 24 patients with disseminated nonseminomatous testicular carcinoma treated with combination chemotherapy including cis-platinum was examined prospectively. Renal function was monitored by several determinations of glomerular filtration rate (GFR), effective renal plasma flow (ERPF) and serum creatinine, and beta-2-microglobulin. A reduction in GFR and ERPF was found at the end of the induction chemotherapy and at six weeks thereafter.

High immune responsiveness in a family with multiple paraproteinaemia and autoimmune thyroid disease.

Immune responsiveness was investigated in a family comprising 12 first- and second-degree relatives, one of whom had kappa-myelomatosis, one IgA-lambda paraproteinaemia, two Graves' disease and a further two thyroid antibodies without disease. Relatives by marriage served as controls. Parameters of immune capacity studied were the humoral and cellular immune response to haemocyanin of Helix pomatia (HPH), dinitrochlorobenzene (DNCB) skin reactivity and in vitro lymphocyte proliferation capacity to phytohaemagglutinin (PHA).

An inherited restriction in the idiotypic variability as a possible explanation of a genetic predisposition for a monoclonal component.

Genetic factors have been proposed to play a role in the aetiology of a monoclonal proliferation of B lymphocytes. As an additional genetic factor we postulate that a restriction in the idiotypic variability of an individual contributes to a genetic predisposition to monoclonal gammopathy. To support our hypothesis, we have examined three families with multiple occurrence of M-components for sharing of idiotypic antigenicity between the related M-components and between the M-components and the sera of unaffected relatives.

Class- and subclass-specific antibody response to hemocyanin in nonmalignant paraproteinemia.

IgM, IgG, and IgA class-specific, as well as IgG subclass-specific antibody titers against the primary immunogen HPH were measured with ELISA in 19 patients with nonmalignant paraproteinemia (eight with IgG1, two with IgG2, two with IgG4, four with IgM, and three with IgA) and in a simultaneously studied age- and sex-matched control group. After primary immunization only IgM and IgA anti-HPH titers were significantly lower in the patient group. Four patients with relatively high IgG or IgA serum paraprotein levels did not produce antibodies in some Ig classes or IgG subclasses, whereas all other patients and all controls developed antibody titers in all classes and IgG subclasses.

A biclonal origin of two monoclonal proteins, IgG3(kappa) and IgA1(lambda), from a single patient.

The cellulose acetate electrophoretic pattern of the serum from patient Sik disclosed two distinct peaks, representing two monoclonal proteins. On immunoelectrophoresis the two M-components were found to differ in heavy chain class as well as in light chain type, IgG3(kappa) and IgA1(lambda). Serum immunoglobulin levels remained relatively constant over a period of 7 years and no clinical symptoms of a malignant deterioration occurred.

Immune complexes in peripheral blood polymorphonuclear leucocytes of patients with Raynaud's phenomenon.

Phagocytosed immune complexes in polymorphonuclear (PMN) leucocytes of sixty-nine patients with Raynaud's phenomenon were studied by scoring the cells for IgG and complement inclusions. The results were compared with the degree of vasospasm, as measured by photoelectric plethysmography of the fingers after cooling. Median IgG and complement scores of PMN cells were significantly elevated in patients with Raynaud's phenomenon when compared with those of the control group (P less than 0.

Class-specific antibody titres (ELISA) against the primary immunogen Helix pomatia haemocyanin (HPH) in man.

Using the indirect ELISA technique, IgM, IgG and IgA antibody titres against the primary test immunogen Helix pomatia haemocyanin (HPH) could be measured. All twenty-seven normal volunteers (age range 26-74 years) developed maximal or high IgM, IgG and IgA antibody titres 2 weeks after primary immunization with 1.0 mg HPH subcutaneously.

Nephroptosis and hypertension.

The degree of renal mobility was measured in patients with and without hypertension to evaluate a suggested causal relation between nephroptosis and hypertension. In contrast to men, women often showed pronounced renal mobility and the degree of renal mobility correlated positively with the blood-pressure. Fibromuscular dysplasia of the renal artery was always accompanied by a considerable degree of renal mobility on the side involved.

Immunoglobulins in families of myeloma patients.

The serum immunoglobulin levels of 200 first-degree relatives and 23 spouses of 32 patients with myelomatosis were compared with those of age- and sex-matched control persons. First-degree relatives of myeloma patients appeared to have higher serum levels of IgG (P less than 0.05), IgA (P less than 0.

Immune response in asymptomatic paraproteinemia. I. Primary and secondary antibody response to Helix pomatia hemocyanin.

In a group of 20 patients with asymptomatic paraproteinemia, as judged after at least 3 years of follow-up, the primary and secondary antibody response to Helix pomatia hemocyanin (HPH) was defective as compared with the response in controls. The class of antibody was assessed by mercaptoethanol (ME) treatment of serum. A lowered response was found not only in the total but also in the ME-resistant (mainly 7S, IgG) antibody titer.