We had the honour to accept at the EmCell clinic Mr.
J.S.M., DOB September 5, 1936. Mr. J.S.M. was attended by his daughter Ms. M. M., and Dr. W.C.R.
Beforehand we were forwarded the file covering the history of the case for recent years, as well as chemistry and serology lab studies. Our own investigation lead us to conclusion quite similar to those of our colleagues.
We established the following
diagnosis: Idiopathic encephalopathy, involution of left frontal and temporal lobe, right cerebellum, initial signs of dementia, aphasia, mild ataxia.
We should note that the patient made an impression of a more severe state than we could conclude from the received reports. He was aphasic, morose, with inattentive not concentrated sight. He replied in single words with poor articulation, with spending a long time thinking the question over. He often turned inside his mind and seemed absent. In the process of treatment procedures he easily fell asleep. His face appeared like a mask void of emotion.
We were troubled a lot by his walk. He had substantial wobbling with sharp tips of the head and body forward while stepping over even a small obstacle (the deterioration of the movement coordination connected with atrophy of the cerebellum). We were not informed about these symptoms in the received reports.
From the internist's point of view Mr. J.S.M. is a man older than his age, of athletic habit, safe in the somatic sense. Pulse regular 64–76 beats per minute, normal blood pressure 75–80 to 115–120 mm Hg. Heart tones were normal including sound and melody. Above the lungs there a clear percussion sound. Palpation of abdomen revealed no particularities. Skin was clear.
Tests:
- Average blood count on the 1st day: Erythrocytes 4.8x1012/l, Hb 138 g/l, color index 0.8, throbocytes 280x109/l, leukocytes 5.2x109/l, stab neutrophils 4%, segmented neutrophils 57%, eosinophiles 4%, lymphocytes 32%, monocytes 2%, ESR 8 mm/hr.
- Average blood count on the 4th day: Erythrocytes 4,2x1012/l, Hb 130 g/l, color index 0.9, thrombocytes 180x109/l, leukocytes 4.0x109/l, stab neutrophils 2%, segmented neutrophils 71%, eosinophiles 3%, lymphocytes 20%, monocytes 4%, sedimentation reaction 3 mm/hr.
- Immune indices on the 1st day: Lymphocytes 1664/mkl, T-lymphocytes (CD3) 965/mkl (58%), T-helper (CD4) 532/mkl (32%), T-suppresser(CD8+) 200/mkl (12%), CD4+/CD8+ 2,6, NK (CD16+CD56) 200/mkl (12%), B-lymphocytes (CD19+) 283/mkl (17%), b2 microglobulin 3.2, IgA 2.8, IgD 8.6, IgM 1.02. Total protein 76.3 g/l, albumin 50%, globulin 50%, alfa1 4.4%, alfa2 9.8%, beta 14.8%, gamma 21%, C-reactive protein ++.
- Blood chemistry on the 1st day: Bilirubin total 12.5 mmol/l, direct – neg., indirect 12.5 mmol/l, ALT 0.30 mmol/l, ACT 0.155 mmol/l, cholesterol 3.4 mmol/l, urea 13.3 mmol/l, creatinine 0.135 mmol/l.
- Blood chemistry on the 4th day: Bilirubin total 14.0 mmol/l, direct – neg., indirect 14.0 mmol/l, thymoltest2.0 units, ALT 0.31 mmol/l, ACT 0.22 mmol/l, cholesterol 3.3 mmol/l, urea 12.5 mmol/l, creatinine 0.135 mmol/l.
- ECG: regular sinus rhythm, signs of mild changes of myocardium.
Examination by ophthalmologist.
Conclusion. Frontal part of the eyes is not changed. Optical media are lucid. In the eye fundus the disks of ophthalmic nerves have normal shape, are pallid-pink. The arteries are narrow and have signs of sclerosis. There are seen circles of peripappilary atrophy of Chorioidea. In the zones of macula nothing pathological was noticed.
Diagnosis: Mild myopia. Angiosclerosis of the retina of both eyes.
Examination by neurologist.
The appearance is older than chronological age. Eye slots are symmetric, pupils s=d, the movements of eye apples in full range. Ny – no, left nasolabial crease is smoothed, tongue in the mid line, swallowing is free. Active movement in full amount, muscular strength is satisfactory, muscle tonus is intact, reflexes s=d are of medium vivid. Strumpfel symptom in both sides. Awkwardness while performing tests for coordination in left side. While performing sensible Romberg test – is falling to the left. Pain sensitivity is intact. Asynergies of Babinsky are absent.
Patient exhibits symptoms of deterioration of the brain in the left side.
Recommendations:
1. differential diagnosis between +process and idiopathic atrophy of the brain;
2. contrast angiography;
3. control of retina condition in time.
Mr. J.S.M. received a course of cell therapy. Action of the cell suspensions was directed to the restitution of nerve connections, normalization of hemato-encephalic barrier functions, removing of immune aggression against brain cells and to the restitution of micro circulation.
The 1st day. Implantation of the cell suspension sample 3038AM284 subcutaneously in the frontal abdomen in two depots in amount 2 ml each.
The 2nd day. Transplantation of the cell suspension sample 3038A284 i/v, amount 3.0 ml.
The 4th day. Transplantation of the cell suspension sample 3038A284 i/v, amount 1.2 ml. Implantation of the cell suspension sample 3038AM284 subcutaneously in the frontal abdomen in two depots in amount 2 ml each.
The 7th day. Transplantation of the cell suspension sample 3038A345 i/v, amount 2.8 ml. Implantation of the cell suspension sample 3038AM345 subcutaneously in the frontal abdomen in two depots in amount 1.4 ml each.
The cell suspension samples 3038AM284, 3038A284, 3038AM345 and 3038A345 possess the mentioned above functional activity and are certified as follow:
| Bacterial sterility test |
Negative |
| Prenatal diagnostic |
| Test with cardiolipid antigen |
Negative |
| Anti-HIV1/HIV2 |
Negative |
| HBsAg |
Negative |
| Fetal diagnostic |
| Enzygnost Anti-HIV1/HIV2 |
Negative |
| HBsAg monoclonal |
Negative |
| Anti-HBc monoclonal |
Negative |
| Anti-CMV/IgG+IgM |
Negative |
| Anti-Rubella Virus/IgG |
Negative |
| Varicella/Zoster |
Negative |
| Toxoplasmosis/IgG |
Negative |
Within the period of treatment there was noticeable reducing of the wobbling while walk and a vanishing of the side tipping. On the next day after the transplantation, Mr. J.S.M. seemed to be more cheerful, but remained aphasic, replying usually with only one word. He appeared emotionally rigid. He became tired very easily. Appetite improved.
In the following days Mr. J.S.M. became more in contact, began to answer questions in a more complete way, there appeared to be a positive emotional attitude to all those around involved in his treatment. He became much more concentrated, attentive and followed the topic of the conversation. There was an obvious improvement of his walk. He became more confident, the ataxia was substantially reduced. The quantity of sleep during the treatment procedures decreased.
On the 7th day Mr. J.S.M. became more vivid with natural emotional reactions, entered into and initiated conversations, followed them with no sings of absence. His facial expression became more animated and his appearance started to become more age appropriate. Mr. J.S.M. first began to verbalize that he felt an improvement in his general state.
Recommendations:
- The observed improvement of the patient's state in the early phase of treatment is a good prognostic sign for the development of the curative effect within the following 2-3 months after the first course of treatment. It is recommended that examination and the next course of treatment by means of cell therapy should be in 6–8 months at the EmCell clinic.
- We recommend a continued course of Pyracetam (Nootropil) – preparation that improves metabolism in the large brain neurons – in total dosage 0.4 (1 capsule 3 times per day) and Cavinton – preparation, that improves brain circulation, opens collateral vessels and restores micro circulation. The course may consist of 5–8 iv injections and then of 4–6 tablets per day during 2–3 months.
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