James H. Knepshield

Goodpasture's Syndrome: Recovery from Severe Pulmonary Hemorrhage After Bilateral Nephrectomy

Abstract A case of Goodpastures syndrome is presented wherein life-threatening pulmonary hemorrhage, refractory to immunosuppressive drug therapy, rapidly resolved after bilateral nephrectomy. Thi...

Synergism In Immunosuppression: Iii. Allograft Rejection And Humoeal Antibody Production In Intact And Splenectomized Mice

SUMMARY Intact and splenectomized mice were given full thickness skin allografts and tetanus toxoid and then treated with several immunosuppressive agents singly and in combination. Both allograft rejection and humoral antibody production were suppressed in a similar proportion of animals by similar treatment protocols. Splenectomy potentiated depression of the cellular and humoral response in mice treated with one agent. A radiosensitive cell essential to humoral and cellular immunocompetence may have been the common target affected in both types of immunosuppression.

413 HEMOCARBOPERFUSION IN CHILDHOOD HEPATIC COMA

Fulminant hepatic failure and coma in children has a mortality rate of 60 to 70%. Hemocarboperfusion (HCP) employing an acrylic hydrogel polymer coated charcoal column was used in three children ages 8,11, and 13 years presenting with acute encephalopathy and hepatic failure. Two children were in stage IV hepatic coma and one in stage V Reye syndrome. Following HCP all patients showed significant improvements in deranged serum chemistries. Serum ammonia and amino acid concentrations decreased dramatically. Serial examinations revealed no evidence of hemolysis, thrombocytopenia, or microembolization secondary to HCP. One of three patients survived and had no evidence of cerebral edema. The other two patients developed posturing and pupillary changes suggestive of severe cerebral edema prior to HCP. Continuous intracranial pressure monitoring (employing Richmond screw) in one patient showed > 50mmHg (N:0-10) which transiently diminished with mannitol infusion but failed to respond to HCP. The patients who expired had nearly isoelectric EEGs which showed no improvement following HCP.The patient who responded to HCP and had no evidence of cerebral edema is well without complications after a two year period. It is concluded that for effective HCP in children with hepatic encephalopathy, the therapy should be initiated before the onset of cerebral edema.

Synergism in immunosuppression. II. Effect of splenectomy on suppression of tetanus antitoxin production induced by methylprednisolone, azathioprine, chlorambucil, and radiation.

SUMMARY An in vivo assay of tetanus antitoxin production in the mouse was utilized to evaluate the effect of splenectomy on treatment with immunosuppressive drugs and/or whole body radiation. Methylprednisolone, azathioprine, chlorambucil, and 100 rads of 60Co radiation were administered as single, double, triple, or quadruple agents to splenectomized and intact mice. For both intact and splenectomized mice, the administration of two agents produced greater immunosuppression than one agent and three agents greater than two agents. Treatment with all four agents resulted in the highest percentage of animals with depressed antibody synthesis. Splenectomy reduced antitoxin production and significantly potentiated the immunosuppressive effect of each agent when administered alone. Splenectomy did not increase significantly the immunosuppressive effect of two, three, or four agents in combination therapy.