Psychologie und Psychiatrie

International Journal of Legal Medicine -     

Vasospasm after SAH due to aneurysm rupture of the anterior circle of Willis: value of TCD monitoring

OBJECTIVE: The aim of this study was to verify the presence of angiographic vasospasm in patients with transcranial Doppler (TCD) of high velocities after subarachnoid hemorrhage (SAH). METHODS: Seven hundred and eighty-six cases admitted within 48 hours after SAH due to the rupture of anterior circulation aneurysm, were prospectively studied with TCD. In cases of TCD velocities higher than 120 cm/s (TCD vasospasm), the patient underwent a control angiography. Hunt-Hess and Fisher's grade on admission CT and location of the aneurysm were related to occurrence of TCD vasospasm. The increase in TCD velocities within 24 hours was calculated and related to the presence of cerebral ischemia on discharge CT, considering three groups of patients: Group A with an increase in velocities higher than 60%, Group B with an increase in velocities between 30 and 60%, and Group C with an increase in velocities lower than 30%. RESULTS: TCD vasospasm was observed in 216 patients (27%). In 97% of patients with TCD vasospasm on middle cerebral artery (MCA) and in 71% with TCD vasospasm on anterior cerebral artery (ACA), control angiography confirmed the vasospasm, with a significant lower diagnostic TCD predictivity of ACA spasm (chi2=28.204, p=0.000). The overall positive predictive value of TCD was 89%. There was no significant correlation of TCD vasospasm with clinical status on admission and location of the aneurysm, but a significant correlation between occurrence of TCD vasospasm and Fisher's grade (chi2=15.470, p=0.002) and between the increase rate in TCD velocities and cerebral ischemia (chi2=56.564, p=0.000). CONCLUSION: Our study shows a good correlation between TCD and angiography to detect vasospasm on MCA, but the correlation is low for ACA. TCD alone cannot discriminate different hemodynamic pathways after SAH.     

Psychologie und Psychiatrie

International Journal of Legal Medicine -     

Gehirn,Nerven

Ohne Zusammenfassung     

Serologie,Blutgruppen, Endokrinologie,Bakteriologie, Immunitätslehre

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Intrathymic lymphoid cell differentiation in myasthenia gravis: An immunophenotypic study

Thymocytes express multiple different surface antigens according to their stage of maturation. We studied lymphocyte surface differentiation antigens using direct immunofluorescence technique in the thymus of 20 patients with myasthenia gravis (MG) and 10 controls undergoing cardiac surgery. Fluorescein isothiocyanateconjugated monoclonal antibodies were used to stain thymic cell surface antigens. We found a decrease in the percent expression of CD1, CD5, and CD7 surface antigens and a significant increase of CD20+ cells in myasthenic thymus compared with the controls. The changes in the percent expression of CD3, CD4, and CD8 antigens were not significant. These data suggest both the decrease in the imunophenotypes corresponding to cortical thymocytes (probably reflecting the cortical atrophy of the MG thymus) and the increase of mature B Cells (CD20+), which may participate in an active immune response.

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Sommario Nel timo i timociti esprimono diversi antigeni di superficie in accordo con il loro stadio di maturazione. In questo lavoro, sono stati studiati gli antigeni di differenziazione timica nel timo di 20 pazienti con miastenia gravis (MG) e di 10 soggetti sottoposti a intervento cardiochirurgo. Per evidenziare gli antigeni di superficie delle cellule timiche sono stati utilizzati anticorpi monoclonati coniugati con isotiocianato di fluorescina. Rispetto al timo normale, nel timo miastenico si è rilevata una riduzione della percentuale di espressione degli antigeni CD1, CD5 e CD7, un significativo aumento dei linfociti CD20+ e nessuna differenza significativa nell'espressione degli antigeni, CD3, CD4 e CD8. Questi risultati suggeriscono da una parte la riduzione degli immunofenotipi corrispondenti a timociti corticali (che probabilmente riflettono l'atrofia della corticale timica già dimostrata nella MG), dall'altra suggeriscono l'incremento di cellule B mature (CD20+) in grado di intervenire in una attiva risposta immunitaria.

     

Psychiatrie und gerichtliche Psychologie

Ohne Zusammenfassung