Haemodilution with a plasma expander as priming solution in cardiopulmonary

A gelatin plasma expander (Haemaccel) was used as a priming fluid in 10 cases of mitral valve replacement. Measurements of acid-base, coagulation, electrolytes, platelets, urinary output and oxygenation were comparable to those with other priming solutions.S. Afr. Med. J., 48, 1615 (1974

Correction of Fallot's tetralogy in a patient suffering from hereditary spherocytosis

The use of cardiopulmonary bypass in a patient with Fallot's tetralogy and hereditary spherocytosis is described. A method of evaluating the fragility of the red cells is given.S. Afr. Med. J., 48, 1535 (1974)

Book Reviews

Book Review 1Book Title: Clinical Health Psychology: A Behavioural Medicine PerspectiveBook Author: L. Schlebusch (Ed.)pp. xxii + 366. illustrated. Halfway House: Southern Book Publishers. 1990.Book Review 2Book Title: Human Prenatal DiagnosisBook Authors: K. Filkins & J.F. Russo (Eds.)pp. xvii + 601. Geillustreer. New York: Marcel Dekker. 1990.Book Review 3Book Title: Introduction to Respiratory CareBook Authors: Levitzky, Cairo, Hall (Ed.)Pp. x + 589. Kent: Harcourt, Brace, Jovanovich. 1990.Book Review 4Book Title: Clinical Magnetic Resonance imagingBook Authors: R. R. Edelman, J. R. Hesselink, J. Newhouse & D. J. Sartoris (Eds.)Pp. xx +1192. Illustrated.  Kent: Harcourt Brace Jovanovich. 1990Book Review 5Book Title: Basic ToxicologyBook Author: F.C. LuPp. XIV + 361. Illustrated. USA: Hemisphere. 1991Book Review 6Book Title: Controversies in Obstetric Anaesthesia. No. 1Book Author: B. Morgan (Ed.)Pp. vi + 138. Illustrated. Kent: Edward Arnold. 1990.Book Review 7Book Title: Environmental Health Criteria 105: Selected Mycotoxins: Ochratoxins, Trichothecenes, ErgotBook Author: WHOPp. 263. Illustrated. Geneva: WHO. 1990Book Review 8Book Title: Anxiety: Psychobiological and Clinical PerspectivesBook Authors: N. Sartorius, V. Andreoli, G. Cassano, et al. (Eds.)Pp. xv + 292. Illustrated. USA: Hemisphere. 1990Book Review 9Book Title: Current Problems in Epilepsy 7: Focal Epilepsy: Clinical Use of Emission TomographyBook Authors: M. Baldy-Moulinier, N. A. Lassen, J. Engel jun., & S. Askienazy (Eds.)Pp. viii + 216. Illustrated. London: John Libbey & Co. 1990.Book Review 10Book Title: An Otolaryngologist's Guide to AllergyBook Author: H.C. King (Ed.)Pp. xi + 256. Illustrated. Stungan: Georg Thieme Verlag. 1990Book Review 11Book Title: Mainstream Medicine: CardiologyBook Authors: R.G. Charles & A.J. Marshall (Eds.)Pp. ix +449. Illustrated. Durban: Butterworths. 1989.Book Review 12Book Title: Advances if Pineal Research. Vol. 4Book Authors: R.J. Reiter & A Lukaszyk (Eds.)Pp. ix + 278. Illustrated. London: John Libbey & Co. 1990.Book Review 13Book Title: Medico-legal Reportng in Orthopaedic TraumaBook Authors: M.A. Fox & P.S. Fagg (Eds.)Cape Town: Churchill Livinsgtone. 1990.Book Review 14Book Title: Differential Diagnosis in Conventional RadiologyBook Authors: F.A. Burgener & M. Kormano (Eds.)Pp. viii + 866. Illustrated. Stuttgart: Georg Thieme Verlag. 1991.Book Review 15Book Title: Perspectives on Mental Handicap in South AfricaBook Authors: S. Lea & D. Foster (Eds.)Pp. xi + 304. illustrated. Durban: Bunerwonhs. 1990Book Review 16Book Title: Clinical Endocrinology and Metabolism: Water and Salt Homeostasis in Health and DiseaseBook Author: P.H. Bayliss (Ed.)Pp. ix + 578. Illustrated. England: Harcourt Brace Jovanovich. 1989.Book Review 17Book Title: Difficult Medical ManagementBook Author: R.B. Taylor (Ed.)pp. xxvii + 729. illustrated. £47. Kent: Harcourt Brace Jovanovich. 1991Book Review 18Book Title: Introduction to RadiobiologyBook Authors: M. Tubiana, J. Dutreix & A. Wambersie (Eds.) Translated by D.R. Bewley.Pp. 371. Illustrated. London: Taylor & Francis. 1990

Rheumatoid factor isotype switch and somatic mutation variants within rheumatoid arthritis synovium

The presence of clonally-related B-lymphocyte aggregates within synovial lining tisue of rheumatoid arthritis (RA) patients suggests a germinal centre-like reaction, which may hold implications for disease pathogenesis and the causes of chronic inflammation. We studied 250 rheumatoid factor (RF) heavy-chain sequences cloned from the synovium of three patients with RA, to determine whether they undergo both somatic mutation and isotype switching consistent with this hypothesis. Size analysis of immunoglobulin heavy-chain cDNAs from synovial RF+ B cells revealed oligoclonal RF+ populations and identically-sized VH-D-JH transcripts of different immunoglobulin isotypes. Sequencing of individual inserts selected from cloned immunoglobulin heavy-chain cDNAs demonstrated a clonal relationship between immunoglobulin M (IgM) RF and IgA RF, suggesting that this isotype switch occurred in synovium. Furthermore, most somatic mutations were found to have occurred after this isotype switch. This finding suggests that the RA synovial microenvironment sustains somatic mutation and isotype switching in RF-specific B lymphocytes akin to secondary lymphoid organs