[Probable coumarin poisoning upon ingestion of an anti-inflammatory agent].

Warfarin overdose leads to hypoprothrombinemia and bleeding diathesis. We report here the case of a 47 year old woman who ingested an overdose of a non-steroidal anti-inflammatory drug, sold in Mexico under the name of Wobenzym (R), and containing, according to the manufacturer: pancreatin, bromelin, papain, lipase, amylase, trypsin, alpha chymotrypsin and rutin. She developed skin, urinary and gastrointestinal bleeding and was found to be apparently under the effect of a coumadin overdose, i.

Serum antibodies to distinct epitopes of the tissue-type plasminogen activator (t-PA) in patients with systemic lupus erythematosus.

Defective fibrinolysis due to decreased tissue-type plasminogen activator (t-PA) activity is a well-established finding in patients with systemic lupus erythematosus (SLE). The possibility that this decrease in t-PA activity may be related to the presence of autoantibodies directed against t-PA, and the possible role of these autoantibodies in the pathophysiology of fibrinolysis in SLE, were investigated. Serum samples from 115 SLE patients and 63 normal volunteers were analyzed for the presence of such antibodies.

Filgrastim-mobilized peripheral-blood stem cells can be stored at 4 degrees and used in autografts to rescue high-dose chemotherapy.

We studied 21 filgrastim (G-CSF)-mobilized peripheral blood stem cells (PBSC) apheresis products obtained from seven patients, and stored at 4 degrees C for periods of up to 96 hr prior to their reinfusion, to rescue high-dose chemotherapy. The apheresis products contained a median of 106 x 10(8)/L mononuclear cells (MNC), 14.6% of them displaying the CD34 antigen; the viability was over 90% in all samples studied at 24, 48, and 72 hr after harvesting.

Laboratory measurement of human cytokines.

Cytokines mediate and modulate different physiological systems. Accurate and sensitive methods for their measurement are being developed using bioassays, immunoassays, measurement of their mRNA, receptor binding assays, and immunochemical procedures. The most clinically significant cytokines and their assay methods are briefly reviewed.

[The immunology laboratory in digestive tract disorders].

Medical laboratory immunology can be useful, for the overall study of patients with gastrointestinal and hepatic diseases, at three different levels. In those diseases where an abnormal immune response has been through to contribute to the pathophysiological process, the specialized laboratory may yield useful information regarding the activation or presence of such mechanisms; in infectious diseases of the liver and/or gastrointestinal tract, the immunology laboratory can contribute- sometimes decisively- to the etiological diagnosis and, finally, in malignant gastrointestinal diseases, immunological studies might provide information that is useful for the diagnosis, and the most importantly, for the follow-up and prognosis of such patients.

Long-term treatment results for acute megakaryoblastic leukaemia patients: a multicentre study.

The prognosis and long-term results of a group of 57 acute megakaryoblastic leukaemia (M7-AML) patients was analysed from a multicentre perspective. Ages ranged from 4 to 83 years, median 49 years; 30 were males and 27 were females. The median follow-up time was 7 months, range 1-24 months.

Disturbances in the tissue plasminogen activator/plasminogen activator inhibitor (TPA/PAI) system in systemic lupus erythematosus.

Increased thrombogenesis observed in systemic lupus erythematosus (SLE) is derived from multiple mechanisms, including: Enhanced coagulation factor VIII:VWf activity, lupus anticoagulants, anti-phospholipid antibodies, acquired deficiencies of natural anti-thrombotic mechanisms (protein C, protein S, anti-thrombin III), and impaired fibrinolytic mechanisms. We studied the fibrinolytic mechanisms of 18 patients with systemic lupus erythematosus, selected carefully to avoid other possible causes of abnormalities in the fibrinolytic activity. Despite the fact that the euglobulin lysis time in steady state was normal in all instances, disturbances in the tissue plasminogen activator/plasminogen activator inhibitor (TPA/PAI) system were found in all SLE patients: TPA activity was undetectable in all cases, whereas it was above 0.

Natural anticoagulants in systemic lupus erythematosus. Deficiency of protein S bound to C4bp associates with recent history of venous thromboses, antiphospholipid antibodies, and the antiphospholipid syndrome.

The association of thrombosis with antiphospholipid antibodies (aPL) in patients with systemic lupus erythematosus (SLE) could be due to their interference with natural phospholipid dependent anticoagulant mechanisms. We studied antigenic protein C (APC), functional protein C (FPC), free protein S (FPS), protein S bound to C4 binding protein (C4bp-S), antithrombin III (ATIII), as well as IgG and IgM anticardiolipin antibodies (aCL) in 38 patients with SLE with a history of thromboses and 70 patients with SLE without such history. We found a high frequency of deficiencies of natural anticoagulants in both groups of patients with SLE but, because of patient selection, we could not determine the actual prevalence of these defects.

[The experimental induction of rheumatoid factors of low affinity and cross reactivity with nonhistone nucleoproteins by means of anti-idiotypes directed at rheumatoid factors of high affinity and cross reactivity with histones H1 and H2b].

The study of the anti-nuclear cross reactivity of rheumatoid factors has shown differences between patients with rheumatoid arthritis and healthy seropositive subjects. This paper describes the finding, of a subpopulation of rheumatoid factor molecules which show a cross reactive idiotype and show high affinity for IgG and cross reactivity against histones in rheumatoid arthritis patients but not in healthy subjects. These molecules, in turn, were able to induce, experimentally, heterogeneous rheumatoid factor molecules that show a low affinity for IgG and cross-reactivity against nucleoproteins other than histones, most likely through idiotypic networks.

[Identification of a focus of beta-thalassemia in Tamiahua, Veracruz].

The prevalence of beta thalassemia (B-thal) in Mexico is largely unknown, and it is thought that the disease is confined to populations with Mediterranean ancestors. Various reports suggest that in certain parts of the coast in the Gulf of Mexico the prevalence of both B-thal and hemoglobin S disease/trait is high. We studied prospectively a town with 11,000 inhabitants named Tamiahua, located along the Gulf Coast, in the State of Veracruz, and very close to the State of Tamaulipas.

Acquired protein C deficiency in a patient with primary antiphospholipid syndrome. Relationship to reactivity of anticardiolipin antibody with thrombomodulin.

A 16-year-old boy had recurrent venous thromboses and pulmonary thromboembolism that caused him pulmonary hypertension. He also had livedo reticularis, thrombocytopenia and high titer IgG antiphospholipid (cardiolipin) antibodies. In the absence of clinical and laboratory evidence of SLE, he was considered to have a primary antiphospholipid syndrome.

Demonstration of a cross-reactive idiotype (IdRQ) in rheumatoid factors from patients with rheumatoid arthritis but not in rheumatoid factors from healthy, aged subjects.

A human monoclonal IgM kappa paraprotein with rheumatoid factor (RF) activity was used to elicit antiidiotypic antibodies in rabbits. The antiidiotypic antiserum thus obtained reacted with samples from 40% of 72 rheumatoid arthritis patients, but not with any of the samples from 22 aged control subjects having serum RF. Our findings suggest that, despite the similarities between RF from rheumatoid arthritis patients and that from healthy individuals, the expression of V region genes may be different in healthy subjects and those with the disease.

The pretreatment DNA labelling index of the blast cells of patients with acute lymphoblastic leukaemia as a prognostic factor in the outcome of treatment: the concept of 'G-0 acute leukaemia'.

A group of 15 patients with acute lymphoblastic leukaemia was studied prospectively to analyse the impact of the pretreatment DNA labelling indices of the blast cells. Patients with labelling indices less than 5% did significantly worse than those with labelling indices greater than 5%: the 60-week disease-free survival of patients with acute lymphoblastic leukaemia and labelling indices greater than 5% was 80%, whereas that for patients with labelling indices less than 5% was 24%, P less than 0.05.

Spontaneous reversal of acquired autoimmune dysfibrinogenemia probably due to an antiidiotypic antibody directed to an interspecies cross-reactive idiotype expressed on antifibrinogen antibodies.

A young man with a long history of abnormal bleeding was seen in January 1985. Coagulation tests showed dysfibrinogenemia and an antifibrinogen autoantibody was demonstrable in his serum. This antibody, when purified, was capable of inhibiting the polymerization of normal fibrin monomers, apparently through binding to the alpha fibrinogen chain.

The incidence of hybrid acute leukaemias.

During a 4-yr period, 292 patients with acute leukaemia were studied using morphology, cytochemistry and immunologic reagents to determine the cell lineage of the leukaemia. One hundred and sixty-three cases were shown to be acute lymphoblastic leukaemia (ALL), 127 acute myeloblastic leukaemia (AML) and two cases (0.6%) were classified as hybrid acute leukaemias.

A prospective trial of the treatment of acute megakaryoblastic leukaemia.

Acute megakaryoblastic leukaemia, the M-7 variant of acute leukaemia according to the French-American-British (FAB) co-operative group, comprises 8.4% of all cases of acute leukaemia in the city of Puebla, Mexico. The malignancy can be identified by means of monoclonal antibodies or electron microscopy.