Striatal infarcts mimicking frontotemporal dementia: a case report

We described a patient with bilateral striatal infarcts, in whom stereotyped and disinhibited behaviors were insidiously emerged over 2 years mimicking frontotemporal dementia (FTD). A positron emission tomography with 18-fluorodeoxy glucose showed a hypometabolism in the frontal lobes, basal ganglia, and thalami. The peculiar behavioral alterations remained unchanged for the following 7 years, suggesting that the disease is not degenerative but of vascular origin. A disruption of the fronto-subcortical circuits at the level of the striatum or the anterior thalamic peduncle is attributable to the FTD-like behavioral and cognitive syndrome.

Evaluation of alveolar macrophage function after experimental infection with equine herpesvirus-1 in horses

The role of the pulmonary alveolar macrophages (PAM) in the lung defense mechanism was evaluated in horses infected with equine hespesvirus-1 (EHV-1). Five adult horses were exposed to 10(6.6) TCID50 EHV-1 by intranasal instillation. Cytology of bronchoalveolar lavage (BAL) was performed using cytocentrifugation of samples and slides stained by Rosenfeld. Cell concentration was adjusted to 2<FONT FACE=Symbol>´</FONT>10(6) cells/ml, for the measurement of macrophage activity - spreading, phagocytosis of zymosan particles and release of hydrogen peroxide (H2O2). All animals were positive in virus isolation on the second, third and fifth days post-inoculation (DPI). Seroconversion was observed on the 14th DPI. Lymphocytosis was observed by BAL cytology on the 16th DPI. Measurement of macrophage activity demonstrated a marked increase in the spreading rate, on the 23rd and 30th DPI. Phagocytosis was decreased on the second DPI, and returned to levels similar to those observed before inoculation on the 23rd DPI. The amount of H2O2 released by PAM declined on day 2, but, by day 16, they returned to values similar to those observed before inoculation. The decline in PAM activity in the acute phase of disease is indirect evidence that these cells have an important role in lung defense mechanisms against this agent.

MR angiographic evaluation of carotid and intracranial arteries in Japanese patients scheduled for coronary artery bypass grafting

BACKGROUND AND PURPOSE

Stroke is a serious complication of coronary artery bypass grafting (CABG). Preoperative evaluation of the cerebral arteries to identify patients at increased risk of stroke after CABG is important. In a prospective study, we evaluated cerebral artery occlusive lesions with MR angiography in Japanese patients scheduled to undergo CABG to determine the prevalence of occlusive diseases in the extracranial carotid and intracranial arteries in this population and to identify preoperative risk factors for these patients.

METHODS

The subjects were 151 consecutive patients (115 men and 36 women ranging in age from 41 to 82 years) who were scheduled for CABG under nonemergency conditions between October 1995 and February 1998. Carotid and intracranial arteries were examined for occlusive lesions with MR angiography. Patient demographics and risk factors including age, sex, hypertension, diabetes mellitus, hyperlipidemia, smoking habit, history of stroke, peripheral vascular disease and preoperative thromboembolic infarcts revealed by MR imaging were recorded and analyzed.

RESULTS

Cervical carotid artery stenoses of more than 50% narrowing were detected in 16.6% of the subjects, and intracranial artery stenoses of more than 50% narrowing were detected in 21.2% of the subjects. Multiple logistic regression analyses identified peripheral vascular disease and lacunar infarcts in the basal ganglia as significant and independent predictors of cervical carotid arterial stenoses. No significant predictor for intracranial arterial stenoses was identified.

CONCLUSIONS

The prevalence of extracranial carotid and intracranial artery stenosis in Japanese patients scheduled for CABG is considerably high. MR angiography is of value of identifying these patients. Preoperative evaluation of cranial arteries is recommended, particularly in patients with peripheral vascular disease and infarcts in the basal ganglia.

Alternative approach to endoluminal treatment of an anastomotic aneurysm

Conventional surgical treatment of patients with an anastomotic aneurysm can be a surgical challenge if severe adhesions are present. We report here effective treatment of an anastomotic aneurysm using an endoluminal stent graft. A 71-year-old man had undergone an aorto-bifemoral bypass for Leriche's syndrome in 1989 and partial gastrectomy for cancer in 1996. He was admitted to our department with a pseudoaneurysm of a proximal anastomosis located at the aorta below both renal arteries. Based on his medico-surgical history, we considered that an endovascular stent should be placed. This graft composed of an UBE(UBE-WOVEN GRAFT) graft and self-expandable Z stents were introduced through the right limb of the bifurcated graft previously implanted, then were placed using the delivery system while advancing under fluoroscopic control, using a pusher rod. Endoleakage was not evident and the postoperative course was uneventful. An endovascular graft is one alternative approach for treating patients with an anastomotic aneurysm as it is less invasive. This procedure proved satisfactory for this patient.

The effect of APOE epsilon4 allele on cerebral glucose metabolism in AD is a function of age at onset

BACKGROUND

Although the APOE epsilon4 allele is a well-known risk factor for developing AD, the impact of the epsilon4 allele on clinical manifestations in patients with AD is still controversial. One possible reason for this controversy is that previous studies did not consider the effect of patient age at symptom onset.

OBJECTIVE

To investigate the possible impact of patient age at onset of AD on the effect of APOE genotype on regional cerebral glucose metabolism (rCMRglc).

METHODS

The authors compared rCMRglc between probable AD patients (based on criteria of the National Institute of Neurologic Disease and Stroke/AD and Related Disorders Association) with APOE epsilon4/4 and APOE epsilon3/3 alleles in early-onset (< or =65 years old) and late-onset (>65 years old) groups. In each group, the patients with APOE epsilon4/4 and APOE epsilon3/3 alleles were comparable for age at onset, age at examination, sex, disease duration, education level, and severity of dementia.

RESULTS

In the early-onset group, the patients with the APOE epsilon4/4 genotype showed a significant decrease of rCMRglc in the medial temporal lobe and a significant increase of rCMRglc in the inferior parietal and posterior temporal cortices as compared with those patients with the APOE epsilon3/3 genotype. In the late-onset group, there were no significant differences in the rCMRglc pattern between the patients with APOE epsilon4/4 and APOE epsilon3/3 alleles.

CONCLUSIONS

The current findings indicate that the impact of the APOE epsilon4 genotype on cerebral glucose metabolism of patients with AD may be a function of age at symptom onset.

Transient global amnesia: increased signal intensity in the right hippocampus on diffusion-weighted magnetic resonance imaging

We report on a patient with pure transient global amnesia (TGA) whose magnetic resonance imaging (MRI) demonstrated a small region of increased signal intensity in the right hippocampus on diffusion-weighted imaging (DWI). DWI was sensitive and useful for evaluating the early stage of TGA and might help to explain the pathophysiology of TGA.

Human esophageal cancer cell death mediated by apoptosis-inducing nucleosides from CD57+HLA-DRbright natural suppressor cell line

We approached the induction of apoptosis in human esophageal cancer cells (T.Tn) by apoptosis-inducing nucleosides (AINs) from CD57+HLA-DRbright-natural suppressor (57.DR-NS) cell line originated in decidua. The 57.DR-NS cells generated apoptosis in T.Tn cells by AINs released into the cultures. We isolated a series of AINs by high performance liquid chromatography (HPLC) from 57.DR-NS cell culture fluids. Each AIN and its mixture induced apoptotic cell death in T.Tn cells, detected by DNA fragmentation in agarose gels, terminal deoxynucleotide transferase mediated dUTP-nick end labeling (TUNEL) method and accumulation of sub-G1 DNA content with flow cytometry. Furthermore, we found the occurrence of DNA strand breaks followed by the activation of caspase-3 during AINs-induced apoptosis in T.Tn cells. Thus, we validated that AINs could induce apoptosis in T.Tn cells mediated through DNA strand breaks and activation of caspase-3.

Inhibitory effect of prostaglandin E 1 on intimal thickening caused by poor runoff conditions in the canine autologous vein grafts

The efficacy of ONO-1608, a newly developed liposomal formulation of prostaglandin E 1 prodrug, was evaluated on intimal hyperplasia of experimental canine autologous vein grafts under distal poor runoff conditions. The femoral vein was implanted into the femoral artery, preparing a distal poor runoff canine model. After 4 weeks of preparing the poor runoff model, the femoral vein was implanted into the femoral artery. They were then divided into two groups consisting of the control group and the ONO-1608 group. At 4 weeks, the grafts were harvested and intimal hyperplasia of the graft was measured with an ocular cytometer. Intimal cell proliferation was determined by bromodeoxyuridine incorporation 2 weeks after surgery. In addition, the effect of ONO-1608 on the proliferation of platelet-derived growth factor (PDGF)-stimulated human aortic smooth muscle cells (HASMCs) in culture was also investigated. At 4 weeks, the degree of intimal hyperplasia of the graft in the ONO-1608 group was significantly less than that of the control group. The bromodeoxyuridine labeling index 2 weeks after grafting was significantly lower in the ONO-1608 group compared with that in the control group. In addition, ONO-1608 significantly inhibited the proliferation of PDGF-stimulated HASMCs in culture. These results demonstrate the efficacy of ONO-1608 in reducing the degree of intimal hyperplasia of canine autogenous vein grafts under poor runoff conditions. The mechanism of reducing the intimal hyperplasia may be that ONO-1608 inhibited PDGF-stimulated proliferation of the smooth muscle cell. These results suggest that the administration of ONO-1608 may be beneficial in patients who have undergone gone arterial reconstruction.

Apolipoprotein E epsilon 4 and the pattern of regional brain atrophy in Alzheimer's disease

BACKGROUND

Although the APOE epsilon 4 allele increases the risk of developing AD, the effects of the epsilon 4 allele on brain atrophy in clinical AD patients are controversial.

OBJECTIVE

To investigate a possible relationship between the genetic variants of APOE and brain atrophy in patients with AD.

METHODS

Using MRI-based volumetry techniques, the authors compared the volumes of the hippocampal formation, amygdaloid complex, and whole brain in probable AD patients (based on criteria of the National Institute for Neurological and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association) with different APOE alleles. One group (n = 46) had the epsilon 3/3 allele, one group (n = 46) had the epsilon 3/4 allele, and one group (n = 46) had the epsilon 4/4 allele. The three groups were matched for age, sex, disease duration, education level, and severity of dementia represented by their score of the Mini-Mental State Examination. A possible difference in pattern of cognitive deficits with dose of the APOE epsilon 4 allele was also examined.

RESULTS

The normalized hippocampal volume was correlated with the number of APOE epsilon 4 alleles (r = -0.285, p = 0.0007). The amygdalar volume was also correlated with the number of APOE epsilon 4 alleles (r = -0.178, p = 0.037). The number of APOE epsilon 4 alleles was positively correlated with the whole-brain volume (r = 0.185, p = 0.030). It was also correlated with Wechsler Adult Intelligence Scale-Revised performance IQ (r = 0.203, p = 0.017) and with Wechsler Memory Scale-Revised attention/concentration score (r = 0.191, p = 0.025).

CONCLUSIONS

Different patterns of regional brain atrophy were found among patients of different APOE genotypes. The effect of APOE epsilon 4 allele on the brains of AD patients may have regional specificity.

Referral and care for acute ischemic stroke in a Japanese tertiary emergency hospital

To examine the current emergency referral and care for acute stroke at a Japanese tertiary emergency hospital with a 24-h stroke team and care unit, we surveyed the presentations of patients with acute ischemic stroke or transient ischemic attack (TIA) seen within 7 days of onset. Delay from symptom onset to arrival at our hospital, from arrival to initial diagnostic brain computed tomography (CT), and the type of anti-thrombotic treatments were evaluated. During the 18-month period, there were 254 ischemic events in 244 patients; 239 (94%) had an ischemic stroke and 15 (6%) TIA. Eighty-two (32%) events presented within 3 h of onset, and 102 (40%) and 179 (70%) within the first 6 and 24 h, respectively. The median delay from hospital arrival to CT was 32 min, ranging 10 min to 22 h. Two hundred (79%) events underwent CT within 1 h of arrival (n=172) or at the referral hospitals before transfer (n=28). Direct ambulance transportation and more severe neurological deficits were independent predictors both for early arrival and short in-hospital delay to CT. Anti-thrombotic therapies including anticoagulant and/or antiplatelet medications were given in 237 (93%) episodes. Two (1%) patients received thrombolysis, although 18 (7%) patients fulfilled the National Institute of Neurological Disorders and Stroke guidelines for intravenous thrombolysis with tissue plasminogen activator. As in western communities, our pre-hospital emergency referral systems for acute stroke require substantial improvements including the wider use of ambulance calling. Although our in-hospital stroke management is functioning relatively well, further efforts are necessary in reducing the diagnostic delay.

Successful and optimized in vivo gene transfer to rabbit carotid artery mediated by electronic pulse

Several gene transfer methods, including viral or nonviral vehicles have been developed, however, efficacy, safety or handling continue to present problems. We developed a nonviral and plasmid-based method for arterial gene transfer by in vivo electronic pulse, using a newly designed T-shaped electrode. Using rabbit carotid arteries, we first optimized gene transfer efficiency, and firefly luciferase gene transfer via electronic pulse under 20 voltage (the pulse length: P(on)time 20 ms, the pulse interval: P(off) time 80 ms, number of pulse: 10 times) showed the highest gene expression. Exogenous gene expression was detectable for at least up to 14 days. Electroporation-mediated gene transfer of E. coli lacZ with nuclear localizing signal revealed successful gene transfer to luminal endothelial cells and to medial cells. Histological damage was recognized as the voltage was increased but neointima formation 4 weeks after gene transfer was not induced. In vivo electroporation-mediated arterial gene transfer is readily facilitated, is safe and may prove to be an alternative form of gene transfer to the vasculature.

The processing of global and local visual information in Alzheimer's disease

We examined the quantitative and qualitative difference of the pattern with visuo-cognitive processing impairment in patients with early onset AD (EOAD) and late onset AD (LOAD). We use a visual attention task introduced by Navon (1977) to examine the function to integrate local visual stimuli into global image. Although the ability to identify solid digits ether of large and small size presented at the same exposure duration, EOAD performance was poor in the global perception especially at the short duration (20~msec). We provide evidence that this dysfunction is attribute to the AD pathology specific to early onset type.

Natural course of the functional and morphological changes in canine autogenous arterial graft

BACKGROUND

We examined the time course of endothelium-dependent and -independent responses in reversed autogenous arterial grafts during regeneration and tissue repair processes after arterial grafting in dogs.

MATERIALS AND METHODS

Autogenous arterial grafts implanted in the canine femoral artery were removed, cut into rings and suspended in organ chambers for isometric tension recording on the 1st, 3rd, 7th, 14th and 28th days after implantation. Electron-microscopic examination on the 1st, 3rd,7th, 14th and 28th days after transplantation was also performed. Control arteries were taken from nonsurgically treated femoral arteries.

RESULTS

Acetylcholine (ACh) and A23187 caused endothelium-dependent relaxations in arterial grafts throughout the study. Although endothelium-dependent relaxations to ACh and A23187 on the 3rd day after transplantation were only significantly impaired compared to those of control, they were similar to the control within 1 week after grafting. Smooth muscle relaxations in response to sodium nitroprusside in arterial grafts throughout the study were comparable with those of control arteries. No apparent intimal thickening of the arterial grafts was observed. Electron microscopy scanning revealed mild endothelial cell damage in implanted autogenous arterial grafts on the 1st or 3rd day after grafting. Seven to 14 days after grafting, the endothelial cell layer appeared to be normal.

CONCLUSIONS

It was observed that the endothelial function remained intact and there was an absence of intimal thickening in the arterial grafts. These observations may explain the improved patency of autogenous arterial grafts compared to the vein grafts in aortocoronary revascularization.

Efficacy of targeted screening for childhood hypercholesterolemia in Japan

The aim of this study is to evaluate the efficacy of targeted screening on the basis of the results from the universal screening of Japanese children. A total of 698 children consisting of 348 in the 3rd grade of elementary school (third graders) and 350 in the 3rd grade of junior high school (ninth graders) were enrolled in one local school district, during the period 1985 to 1998. When body mass index was used as the sole indicator, the sensitivity in detecting hypercholesterolemia was 14.3% in the case of third graders, and 14.7% in that of ninth graders. Family history was investigated through a questionnaire inquiring about the history of 6 atherosclerosis-related diseases in 6 relatives. The sensitivity on the basis of family history was calculated as 0% to 54.5%. According to the atherosclerotic index calculated from the measured levels of total and HDL cholesterol, sensitivity of abnormal levels of atherosclerotic index in children was almost the same as those of hypercholesterolemia. Using targeted screening, it was possible to detect only around half or less of the subjects with hypercholesterolemia. With respect to the sensitivity of the screening, universal screening is recommended for detecting hypercholesterolemia in Japanese children.

Occipital glucose metabolism in dementia with lewy bodies with and without Parkinsonism: a study using positron emission tomography

Reduction of glucose metabolism in the occipital lobe is reported in dementia with Lewy bodies (DLB) and Parkinson's disease. If dysfunction of the nigrostriatal system is responsible for occipital hypometabolism, (1) DLB patients with parkinsonism would show a lower occipital metabolism than do patients without parkinsonism, and (2) DLB patients without parkinsonism would show an occipital metabolism comparable to those of normal subjects and patients with Alzheimer's disease (AD). To examine these hypotheses, we studied the regional cerebral metabolic rate of glucose (rCMRglc) in patients with a clinical diagnosis of DLB or AD, using (18)F-fluorodeoxyglucose and positron emission tomography. The subjects consisted of 15 DLB patients with parkinsonism, 7 DLB patients without parkinsonism and 7 AD patients without parkinsonism. The medial and lateral occipital rCMRglc was significantly lower in the DLB patients without parkinsonism than in the AD patients. There were no significant differences in occipital metabolic rates between the DLB groups with and without parkinsonism. DLB patients without parkinsonism showed a significant reduction of occipital glucose metabolism which is comparable with that of DLB patients with parkinsonism. The neurobiological bases of occipital hypometabolism in DLB may be pathological processes in the brainstem or basal forebrain structures other than the nigrostriatal system.

Active roles of caspase-3 in human gastric carcinoma cell death by apoptosis inducing nucleosides from CD57+HLA-DRbright natural suppressor cell line

The six apoptosis inducing nucleosides (AINs), which were isolated by high performance liquid chromatography from CD57+HLA-DRbright natural suppressor (57.DR-NS) cell cultures, induced apoptosis in human gastric carcinoma (GCIY) cells demonstrating the accumulation of sub-G1 DNA content and morphological changes. By means of DNA unwinding assay, it has been revealed that DNA strand breaks were initially involved in the apoptotic cell death of GCIY cells treated with AINs followed by activation of caspase cascades, especially caspase-3. Actually, the cleavage of fluorogenic substrate for caspase-3 was identified in the reaction. Whereas, the addition of caspase-3 inhibitor into the reaction prevented the cleavage of fluorogenic substrate for caspase-3 and resulted in the blockage of the sub-G1 DNA accumulation and DNA fragmentation as apoptotic signals. Thus, it was definitely elucidated that the activation of caspase-3 displayed a key feature during AIN-induced apoptosis in GCIY cells.

Detection of carbohydrate recognition molecules on the plasma membrane of boar sperm by dextran-based multivalent oligosaccharide probes

Two kinds of molecules, one recognizing the sialo-/asialo-N-acetyllactosamine structures and the other recognizing the Lewis X structure in a divalent cation-independent manner, were detected on the head of boar sperm prepared from cauda epididymis by fluorescence-labeled or biotinylated dextran-based multivalent oligosaccharide probes. The N-acetyllactosamine recognition molecule(s) is weakly detected on uncapacitated sperm and becomes strongly detectable on capacitated sperm. On the other hand, the Lewis X recognition molecule is detected at a moderate level before capacitation and at a high level after capacitation. Both molecules disappear from the sperm head after induction of acrosome reaction and also by mild detergent treatment. Thus, the two kinds of carbohydrate molecules are expressed on the plasma membrane of boar sperm depending on their physiological state. Inhibition study of the oligosaccharide-dextran probe binding to isolated sperm plasma membrane by various glycoproteins, oligosaccharides, and sulfated polysaccharides also supported the occurrence of the two distinct kinds of molecules.

Avaliação da função de macrófagos alveolares em cavalos clinicamente sadios

Devido à importância dos macrófagos alveolares (MA) nos mecanismos de defesa pulmonar, foram realizados estudos para avaliar a atividade desses fagócitos em cavalos hígidos. Foram realizados lavados broncoalveolares (LBA) em cinco cavalos clinicamente sadios. A citologia foi realizada pela citocentrifugação das amostras e posterior confecção de lâminas coradas pelo método de Rosenfeld. Todas as amostras do LBA foram centrifugadas e a concentração celular foi ajustada para 2×10(6) células/ml, para a mensuração da atividade macrofágica (testes de espraiamento, fagocitose e liberação de peróxido de hidrogênio). A contagem diferencial das células presentes no LBA demonstrou a predominância de macrófagos (59,0± 6,9%). Os resultados obtidos nos testes de mensuração da atividade macrofágica foram: índice de espraiamento 25,1± 19,7%, índice de fagocitose 89,4± 6,2% e liberação de peróxido de hidrogênio 1,6± 0,3nmoles/2×10(5) células (sem PMA - phorbol 12-myristate 13-acetate) e 1,8± 0,4nmoles/2×10(5) células (com PMA). Os resultados demonstraram um padrão de atividade para MA de cavalos hígidos, os quais apresentaram índices de ativação mesmo sem elicitação prévia, indicando que as técnicas utilizadas foram adequadas para tal propósito.

Non-penetrating Vascular Clips Anastomosis Inhibited Intimal Thickening Under Poor Runoff Conditions in Canine Autogenous Vein Grafts

OBJECTIVE

Late graft failure is still a significant problem, particularly in cases with poor runoff vessels. The main cause of late graft failure is intimal thickening of the anastomotic region. Vascular closure system (VCS) clips may provide ideal anastomosis, since they do not penetrate the wall. Therefore, we examined whether the VCS clips affect intimal thickening under poor runoff conditions in the canine autogenous vein grafts.

METHODS

A canine poor runoff model was prepared at both femoral veins. Four weeks after the first surgical procedure, two groups were established according to the two different methods of anastomosis employed. The right femoral vein graft was performed using polypropylene sutures, conventional surgical anastomosis (control group), while the left femoral vein graft was performed using VCS clips anastomosis (VCS group). Four weeks after grafting, the vein grafts were removed and the intimal thickening of proximal, distal anastomosis and midportion of the vein grafts were examined histologically.

RESULTS

In the control group, flow rate and variation were 26+/-8 ml/min and 51+/-10 dynes/cm(2), respectively. In the VCS group, the flow rate and variation were 23+/-11 ml/min and 44+/-14 dynes/cm(2), respectively. There were no significant differences between the two groups. The average value of intimal thickening of both the anastomotic region and the midportion of the vein graft in the VCS group was significantly inhibited compared to that of the control group. The number of positive cells of masson trichrome stain in the VCS group was significantly less than that of the control group.

CONCLUSIONS

These experiments indicate that VCS clips significantly inhibit intimal thickening under poor runoff conditions in canine autogenous vein grafts to a greater extent compared to suture-constructed anastomosis. One mechanism that may account for the decreased intimal thickening is the inhibition of the expression of transforming growth factor-beta (TGF-beta), because the number of positive cells of masson trichrome stain in the VCS group was significantly less than that of the control group.

Adenosquamous carcinoma of the remnant stomach: report of a case

We report herein the case of a 59-year-old man found to have adenosquamous carcinoma of the remnant stomach which demonstrated rapid progression. The patient was admitted to our hospital to undergo surgery for a papillary tumor of the remnant stomach. Total resection of the remnant stomach with lymph node dissection was performed, and pathological examination confirmed a diagnosis of adenosquamous carcinoma with invasion into the muscularis propria and lymph node metastasis around the perigastric areas. Multiple liver metastases were found 6 months after the operation, for which a right hepatectomy was performed with curative intent; however, he died 2 months later due to lymphangitis carcinomatosa of the lung.

Neuronal substrates for semantic memory: a positron emission tomography study in Alzheimer's disease

We examined 57 patients with mild Alzheimer's disease by using three kinds of verbal semantic memory tests (category fluency, confrontation naming and generation of verbal definition) and correlated each score with regional cerebral glucose metabolism determined by (18)F-fluorodeoxyglucose and positron emission tomography. The scores of all three verbal semantic memory tests correlated significantly with regional cerebral glucose metabolism in the left inferior temporal gyrus, even after controlling for the effects of age, sex and educational attainment. In contrast, the scores of the word recall test did not correlate significantly with regional cerebral glucose metaboliosm in the left inferior temporal gyrus, neither before nor after controlling for these confounders. Our results suggested that the left inferior temporal lobe contributes to verbal semantic memory.

Avaliação citológica de lavados traqueobrônquico e broncoalveolar em cavalos clinicamente sadios pelo método de coloração de Rosenfeld

Foram realizados estudos comparativos dos exames citológicos obtidos a partir de amostras dos lavados traqueobrônquico (LTB) e broncoalveolar (LBA) de cavalos clinicamente sadios. Foram colhidas 25 amostras pela técnica do LTB (25 animais) e 25 amostras pela técnica do LBA (5 animais). A suspensão celular dos lavados foi centrifugada, confeccionando-se lâminas coradas pelo método de Rosenfeld. A contagem diferencial mostrou predominância de macrófagos em ambas as técnicas de colheita, confirmando a possibilidade de sua utilização para obter amostras celulares das vias aéreas distais. Observou-se diferença na proporção de macrófagos e linfócitos entre as técnicas dos lavados traqueobrônquico e broncoalveolar. As porcentagens de macrófagos e linfócitos observadas foram de 81,51±11,06% e 2,91±3,44% no LTB e de 54,78±15,92% e 33,70±14,41% no LBA, respectivamente. Também notou-se ausência de células epiteliais cilíndricas e produtoras de muco em LBA, indicando que essas amostras são provenientes da população alveolar e que esta técnica não traumatizou as vias aéreas proximais. Os demais tipos celulares foram identificados em proporções semelhantes e em pequenas quantidades em ambas as técnicas. As características morfológicas dos tipos celulares foram semelhantes nas duas técnicas.

[Thrombolytic therapy for acute ischemic stroke]

In this paper, results of the recent clinical trials were reviewed, and problems in treating patients with thrombolysis were discussed. Data generated from randomized controlled trials over the past few years have shown that acute intervention can improve neurological outcome in patients with ischemic stroke. Intravenous recombinant tissue plasminogen activator has become established as an acute treatment for stroke. Intra-arterial thrombolysis is a developing modality for the treatment of the acute stroke that shows promise in restoring cerebral arterial supply. However, thrombolysis have not approved yet in any forms in Japan. Under this circumstance, thrombolysis should be carried out in GCP-compatible clinical trials, so far. The overall results of a clinical trial cannot necessarily generalized to all patients in the trial and all similar future patients. A difference between settings of a clinical trial and of general practice should be also noted. Early recognition of stroke symptoms and immediate transfer to a suitable treatment facility should bring thrombolysis to a larger number of stroke victims. Finally, successful treatment is due in part to selecting patients who are not at increased risk for intracranial hemorrhage based on clinical and imaging features, and therefore rapid in-hospital triage protocols are mandatory.