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x Editors: Thiago Devesa Marquez and Davi Urgeiro Neto

Chapter VIII - Pulmonary arterial hypertension (PAH) is defined as a sustained elevation

of pulmonary arterial pressure to more than 25 mm Hg at rest or to more than 30 mm Hg with
exercise, with a mean pulmonary-capillary wedge pressure and left ventricular end-diastolic
pressure of less than 15 mm Hg.
Chapter IX - Pathogenic antibodies in Systemic Lupus Erythematosus (SLE) are known
to play a major role in initiating and exacerbating the disease through the formation of
immune complexes that are deposited in kidney glomeruli. It is apparent that the IgG isotype
and an antibody specificity to nuclear components, particularly double-stranded DNA, is
associated with increased pathogenesis of autoantibodies. The role of autoreactive IgM is less
clear. Through a series of experiments, we have demonstrated that IgM is not only not
pathogenic in mice with a lupus-like syndrome (MRL/lpr) but that it is actually protective.
Passive transfer experiments using anti-dsDNA IgM antibodies prevented development of
lupus nephritis in these mice. The cells secreting protective antibodies displayed a different
repertoire of immunoglobulin heavy chain variable region usage, suggesting the possibility of
a distinct population of B cells that secrete these antibodies. The possibility of IgM therapy or
differential activation of a putative B cell population secreting protective antibodies is
discussed.
Chapter X - Systemic lupus erythematosus (SLE) is an autoimmune disease with a varied
clinic picture, chronic course and exacerbation tendency as well as many complications
resulting from the underlying disease and the immunosuppressive therapy administered.
In case of an insufficient effect of immunosuppressive treatment or its contraindication other
therapeutic processes are searched that would enable mastering the disease activity.
In the paper authors describe two case reports of female patients with SLE with polyorgan
involvement and infectious complications that were successfully treated by administering
intravenous immunoglobulins.
Chapter XI - Diffuse alveolar hemorrhage (DAH), is a rare pulmonary complication of
collagen-vascular diseases, including systemic lupus erythematosus (SLE). As the
pathogenetic mechanism of DAH remains unclear, no established treatment is available.
However, DAH is potentially fatal. Similar to adult respiratory distress syndrome (ARDS),
DAH patients develop severe hypoxemia caused by wide alveolar collapse. Patients may
require management with mechanical ventilation in the intensive care unit. The properties of
the alveolar-capillary barrier are abnormal during acute lung injury, such as DAH. DAH
patients develop severe hypoxemia. It is generally treated with immunosuppressive agents.
However, the effects take several weeks. Therefore, mechanical ventilation is used to support
these patients until the treatments are effective. DAH lungs include healthy tissue, recruitable
tissue, and diseased tissue that are unresponsive to pressure changes. Most of the ventilation
used during conventional management of these patients may be directed at recruitable and
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probably healthier units, resulting in their over-distention, which is thought to be one of the
causes of ventilator-associated lung injury. Airway pressure release ventilation (APRV) is one
mode of ventilation that may achieve recruitment and improve oxygenation while maintaining
acceptable peak airway pressures. APRV applies a continuous airway pressure (Phigh)
identical to continuous positive airway pressure (CPAP) to maintain adequate lung volume
and promote alveolar recruitment. APRV adds a time-cycled release phase to a lower set
pressure (Plow). In addition, spontaneous breathing can be integrated and is independent of the

EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 6/14/2017 3:16 PM via MARYVILLE UNIV
AN: 591939 ; Neto, Davi Urgeiro, Marquez, Thiago Devesa.; Lupus : Symptoms, Treatment and Potential Complications
Account: 096-810