Previous studies on the relationship between activated BAL T lymphocytes and clinical features in sarcoidosis revealed controversial results. We determined lavage lymphocytes, T lymphocytes, activated T lymphocytes, helper, suppressor and natural killer cells in 50 patients with pulmonary sarcoidosis and compared the results with clinical findings, serum angiotensin converting enzyme (ACE), the radiological pattern and lung function data (vital capacity [VC], total lung capacity [TLC], FEV1, transfer coefficient KCO and arterial-alveolar oxygen difference [AaDO2] during exercise). Patients with erythema nodosum (n = 7) showed a lower proportion of activated T lymphocytes (p < 0.05) and lymphocytes (p < 0.01) than the other patients. There was a significant correlation between activated T lymphocytes and AaDO2 during exercise (r = 0.49, p < 0.001), and an inverse correlation was seen between activated T lymphocytes and VC or TLC (r = -0.35 and r = -0.36, p < 0.01). We conclude that the percentage of activated BAL T cells may be related to the degree of parenchymal involvement as expressed by functional disturbance.

39 peripartal hysterectomies from 1983 to 1993 were divided into three groups. Indication, post-operative development and complications were analysed. The first group contains the planned Caesarean section hysterectomies. The patients (n = 18) in this group hat the smallest blood loss and fewest complications. The second group includes the hysterectomies after Caesarean section without emergency (n = 8). The main reason was the rupture of the uterus without clinical signs during delivery. The complication rate of this group was also low. In the third group all operations were performed for vital risk of the patient (n = 13). Complications as placenta accreta (n = 8) or atonal bleeding of the uterus (n = 5) ended up in hysterectomy (eight after vaginal deliveries, five after Caesarean section). In this group we could observe a high blood loss as well as a high rate of complications. The prognosis of the patient depends on blood loss per time period, the dynamic of the bleeding. The mortality was higher in the group where patients needed a relaparotomy because of bleeding partially as a cause of clotting disorders. The most important task is to prevent shock situations by early sufficient blood transfusion. Because of the higher mortality of relaparatomy selective angiographic arterial embolisation should be considered.

BACKGROUND--Circulating immune complexes can be elevated in serum samples of patients with sarcoidosis and are associated with disease activity, but their diagnostic significance is not understood. METHODS--The different classes of circulating immune complexes containing immunoglobulin A, G, or M, and the content of complement in circulating immune complexes (polyethylene glycol precipitation) as well as levels of complement binding circulating immune complexes (complement binding assay) were determined in 19 patients with active, untreated pulmonary sarcoidosis. The results were compared with other parameters in the serum (soluble interleukin 2 receptor, angiotensin converting enzyme, immunoglobulin A, G, and M) and the bronchoalveolar lavage fluid (lymphocytes, helper cells, suppressor cells, activated T cells), and with radiological stage and functional parameters (FEV1, vital capacity, total lung capacity, transfer coefficient (KCO), and the alveolar-arterial oxygen difference during exercise). RESULTS--In all patients circulating immune complexes could be detected by polyethylene glycol precipitation and were similar to control subjects. The content of C1q in circulating immune complexes was higher than in controls, yet in all but one of the cases was still within normal limits. In contrast, elevated levels of complement binding circulating immune complexes were found in 67% of the patients. No correlation was seen between circulating immune complexes and any of the other parameters in the serum, bronchoalveolar lavage fluid, or lung function values. No differences were found between radiological type I and II presentations of sarcoidosis. CONCLUSIONS--The complement binding assay showed a much higher sensitivity for the detection of circulating immune complexes in active pulmonary sarcoidosis than the polyethylene glycol precipitation method. As there was no correlation between levels of circulating immune complexes and other parameters of the disease they are probably not useful for the assessment of disease activity.

: 39 peripartal hysterectomies from 1983 to 1993 were divided into three groups. Indication, post-operative development and complications were analysed. The first group contains the planned Caesarean section hysterectomies. The patients (n = 18) in this group hat the smallest blood loss and fewest complications. The second group includes the hysterectomies after Caesarean section without emergency (n = 8). The main reason was the rupture of the uterus without clinical signs during delivery. The complication rate of this group was also low. In the third group all operations were performed for vital risk of the patient (n = 13). Complications as placenta accreta (n = 8) or atonal bleeding of the uterus (n = 5) ended up in hysterectomy (eight after vaginal deliveries, five after Caesarean section). In this group we could observe a high blood loss as well as a high rate of complications. The prognosis of the patient depends on blood loss per time period, the dynamic of the bleeding. The mortality was higher in the group where patients needed a relaparotomy because of bleeding partially as a cause of clotting disorders. The most important task is to prevent shock situations by early sufficient blood transfusion. Because of the higher mortality of relaparatomy selective angiographic arterial embolisation should be considered.

39 peripartal hysterectomies from 1983 to 1993 were divided into three groups. Indication, post-operative development and complications were analysed. The first group contains the planned Caesarean section hysterectomies. The patients (n = 18) in this group hat the smallest blood loss and fewest complications. The second group includes the hysterectomies after Caesarean section without emergency (n = 8). The main reason was the rupture of the uterus without clinical signs during delivery. The complication rate of this group was also low. In the third group all operations were performed for vital risk of the patient (n = 13). Complications as placenta accreta (n = 8) or atonal bleeding of the uterus (n = 5) ended up in hysterectomy (eight after vaginal deliveries, five after Caesarean section). In this group we could observe a high blood loss as well as a high rate of complications. The prognosis of the patient depends on blood loss per time period, the dynamic of the bleeding. The mortality was higher in the group where patients needed a relaparotomy because of bleeding partially as a cause of clotting disorders. The most important task is to prevent shock situations by early sufficient blood transfusion. Because of the higher mortality of relaparatomy selective angiographic arterial embolisation should be considered.

We report on 28 surgical procedures performed between 1978 and 1992 performed on patients aged 90 years or older. 18 of them had a malignant tumour (11 mamma, 2 corpus, 3 vulva and 2 ovarian cancer), one had an ovarian cystoma. Three patients suffered from pelvic relaxation, four had postmenopausal bleeding, one vulvar dystrophy and one patient suffered from pyometra. Four laparotomies, three vaginal hysterectomies with colporrhaphy, four minor operations of the vulva, six curettages and eleven mammary operations were performed. During the surgical procedures, none of the patients died, whereas two patients died some time after the operation: so-called hospital mortality. The survival of the other patients was comparable to that of their age group. Two patients died of gynaecological diseases. After the surgical procedure, 21 patients reattained their preoperative level of health. 23 were satisfied with the result of the operation because of improvement of their complaints. If surgery in the aged allows the patients to lead a comfortable life, the operational risks can be justified.

Background -Circulating immunecomplexes canbeelevated inserumsamples ofpatients withsarcoidosis andareassociated withdisease activity, buttheir diagnostic significance isnotunderstood. Methods-Thedifferent classes ofcirculating immunecomplexes containing immunoglobulin A,G,orM,andthecontent ofcomplementincirculating immune complexes (polyethylene glycol precipitation) aswellaslevels ofcomplement binding circulating immune complexes (complement binding assay) weredetermined in 19 patientswith active, untreated pulmonarysarcoidosis. The results werecomparedwithotherparametersintheserum(soluble interleukin 2 receptor, angiotensin converting enzyme,immunoglobulin A,G,andM)and thebronchoalveolar lavagefluid (lymphocytes, helpercells, suppressor cells, activated T cells), andwithradiological stageandfunctional parameters (FEV1, vitalcapacity, totallung capacity, transfercoefficient (Kco),and the alveolar-arterial oxygendifference dur

We report on 28 surgical procedures performed between 1978 and 1992 performed on patients aged 90 years or older. 18 of them had a malignant tumour (11 mamma, 2 corpus, 3 vulva and 2 ovarian cancer), one had an ovarian cystoma. Three patients suffered from pelvic relaxation, four had postmenopausal bleeding, one vulvar dystrophy and one patient suffered from pyometra. Four laparotomies, three vaginal hysterectomies with colporrhaphy, four minor operations of the vulva, six curettages and eleven mammary operations were performed. During the surgical procedures, none of the patients died, whereas two patients died some time after the operation; so-called hospital mortality. The survival of the other patients was comparable to that of their age group. Two patients died of gynaecological diseases. After the surgical procedure, 21 patients reattained their preoperative level of health. 23 were satisfied with the result of the operation because of improvement of their complaints. If surgery in the aged allows the patients to lead a comfortable life, the operational risks can be justified.

We report on 28 surgical procedures performed between 1978 and 1992 performed on patients aged 90 years or older. 18 of them had a malignant tumour (11 mamma, 2 corpus, 3 vulva and 2 ovarian cancer), one had an ovarian cystoma. Three patients suffered from pelvic relaxation, four had postmenopausal bleeding, one vulvar dystrophy and one patient suffered from pyometra. Four laparotomies, three vaginal hysterectomies with colporrhaphy, four minor operations of the vulva, six curettages and eleven mammary operations were performed. During the surgical procedures, none of the patients died, whereas two patients died some time after the operation: so-called hospital mortality. The survival of the other patients was comparable to that of their age group. Two patients died of gynaecological diseases. After the surgical procedure, 21 patients reattained their preoperative level of health. 23 were satisfied with the result of the operation because of improvement of their complaints. If surgery in the aged allows the patients to lead a comfortable life, the operational risks can be justified.

Alpha 1-proteinase inhibitor (alpha 1-PI) has been demonstrated to suppress mitogen-induced lymphocyte response in vitro. To evaluate the effect of intravenous application of human alpha 1-PI (Prolastin HS) on cellular immunity, we determined total lymphocyte count, lymphocyte subsets and lymphocyte response to concanavalin A, before and 24 h after infusion of 60 mg.kg-1 body weight alpha 1-PI in eight patients with homozygous alpha 1-PI deficiency (PiZ phenotype). The results were compared with two blood samples from seven healthy controls. After infusion, serum alpha 1-PI levels were increased from 0.98 +/- 0.24 to 2.68 +/- 0.51 g.l-1. No significant differences were found for total lymphocyte count, lymphocyte subsets and lymphocyte response between both groups in both samples. Maximum 3H-thymidine incorporation before and after infusion showed no significant difference; the same was true for the two control samples. However, additional incubation in vitro with alpha 1-PI 5 g.l-1 led to a significant (p < 0.03) decrease of lymphocyte proliferation in samples after infusion. Our data indicate that alpha 1-PI substitution therapy does not lead to a major suppression of lymphocyte response to concanavalin A in PiZ individuals in vivo, although a suppressive effect was found after additional in vitro incubation with alpha 1-PI.

From 1975 till 1989 246 621 deliveries were registered in West-Berlin, 29,257 of which were caesarean sections. 41 cases of maternal death appeared. 19 women succumbed after vaginal delivery, 22 after caesarean section. Thus, during the 15 years of observation, mortality after caesarean section was 0.75% (1 case of maternal death on 1330 caesarean sections), whereas lethality--death due to surgical or anesthetical complications--was 0.41% (1:2438). At the end of the 80ies lethality of caesarean section was three-fold higher than of vaginal delivery.

In 29 patients with chronic bronchitis, 17 of whom were receiving systemic prednisolone, parameters of cellular and humoral immunity from the blood were evaluated and compared with a control group. Serum concentrations of immunoglobulins IgG, A and M, IgG subclasses, lymphocyte subsets and lymphocyte response to mitogenes (PHA, ConA, PWM), antibodies (anti-CD3) and tetanus antigen were determined. Whereas T cell subsets did not show any difference between all groups, the relative proportion of B lymphocytes was lower in the patient group without corticosteroids. Both patient groups showed a decreased lymphocyte response. As expected, serum IgG was lower in the steroid group, which could not be explained by additional cellular findings. Our data indicate that patients suffering from chronic bronchitis may show signs of a decreased cellular immunity.

The determination of lymphocyte subsets utilizing monoclonal antibodies and flow cytometry has become essential in the evaluation of immunological status. Using a standardized method it was found that in healthy children the percentage of CD 8 + (Leu 2 +) positive cells increases significantly (P < 0.01) during infancy, whereas the percentage of CD 4 + (Leu 3 +) positive cells decreases with age (P < 0.01). The percentage of CD 3 + (Leu 4 +) cells remains constant. The ratio of CD 4/CD 8 positive cells is significantly (P < 0.001) higher in infants than in older children. Other subpopulations (HLA DR +, Leu 7) were found to be constant in all age groups. For the comparison of data on lymphocyte subsets obtained by flow cytometry a standardized test procedure is important.

The spectrum of opportunistic infections seen in HIV disease in children resembles that in adults. Most striking, however, is the role of bacterial infections in pediatric AIDS. Although defective humoral immunity seems to play a significant role in predisposing to bacterial infections, there is no direct correlation between the risk for bacterial infections and poor B cell mitogenic responses or hypergammaglobulinemia (Rubinstein 85), suggesting additional predisposing factors. We therefore examined polymorphonuclear leukocytes (PMNL) functions and complement activity (CH 50) in 17 HIV-infected children (P2A-D) in comparison with 37 children born to HIV infected mothers (PO). Lymphocyte subsets and functions (PWM and tetanus toxoid [TT] induced proliferation) as well as global and specific [7T-Ab] IgG levels were studied in parallel. Our results confirm the well known quantitative (CD 3, HLA-DR normal; CD 4 decreased; CD 8, act. T-ceils increased) and functional (PWM, TT induced stimulation decreased; IgG increased; TT-Ab decreased) disturbances of lymphocytes in HIV-infected children. In addition, PMNL of the P2A-D group show a reduced chemiluminescence to zymosan (p<0,05). No significant differences were observed in PMA induced chemiluminescence or CH 50 in the two groups. From our data we conclude, that in HIV-infected children a reduced PMNL responsivness might contribute to a increased risk for bacterial infections.

Recent findings indicate a defective mitogenesis of cord Wood lymphocytes as demonstrated by stimulation with the monoclonal antibodies anti-CD 2/2a (alternative pathway) and anti-CD 3 (T-cetl-rezeptor-complex) (Gerli 89). In order to investigate the age dependency of this antibody induced transformation and a possible association with changes of lymphocyte subsets, blood was obtained from healthy subjects: cord Wood samples, 5 day old neonates, 4 month old infants, 2-4 year old children as well as adults (n=10 in each group). Lymphocytes were incubated for 96 h with optimal concentrations of anti CD-2/2a and anti-CD 3. In addition lymphocyte subsets CD 2 and CD 3 were determined by flow cytometry. Only cord Wood samples were found to have a significantly (p<0,001) reduced percentage of CD 2 and CD 3 positive lymphocytes, wheras from day 5 on percentages were within the range of adults. In contrast, proliferative responses of lymphocytes induced by anti-CD 2/2a and anti-CD 3 were significantly reduced in all pediatric groups (p<0,001) compare to adults. Within the pediatric groups there were no differences in lymphocyte responses. From our data we conclude that in infancy and early childhood there is a functional defect of lymphocytes detectable by stimulation with monoclonal antibodies, which is not related to differences in lymphocyte subsets.