Imaging of the brain in acute ischaemic stroke: comparison of computed tomography and magnetic resonance diffusion-weighted imaging.

BACKGROUND AND OBJECTIVES: Controversy exists about the optimal imaging technique in acute stroke. It was hypothesised that CT is comparable with DWI, when both are read systematically using quantitative scoring. METHODS: Ischaemic stroke patients who had CT within six hours and DWI within seven hours of onset were included. Five readers used a quantitative scoring system (ASPECTS) to read the baseline (b) and follow up CT and DWI. Use of MRI in acute stroke was also assessed in patients treated with tissue plasminogen activator (tPA) by prospectively recording reasons for exclusion. Patients were followed clinically at three months. RESULTS: bDWI and bCT were available for 100 consecutive patients (admission median NIHSS = 9). The mean bDWI and bCT ASPECTS were positively related (p<0.001). The level of interrater agreement ranged from good to excellent across all modalities and time periods. Bland-Altman plots showed more variability between bCT and bDWI than at 24 hours. The difference between bCT and bDWI was < or =2 ASPECTS points. Of bCT scans with ASPECTS 8-10, 81% had DWI ASPECTS 8-10. Patients with bCT ASPECTS of 8-10 were 1.9 times more likely to have a favourable outcome at 90 days than those with a score of 0-7 (95% CI 1.1 to 3.1, p = 0.002). The relative likelihood of favourable outcome with a bDWI ASPECTS 8-10 was 1.4 (95% CI 1.0 to 1.9, p = 0.10). Of patients receiving tPA 45% had contraindications to urgent MRI. CONCLUSION: The differences between CT and DWI in visualising early infarction are small when using ASPECTS. CT is faster and more accessible than MRI, and therefore is the better neuroimaging modality for the treatment of acute stroke.

Ultrastructure of bronchial epithelium in children with chronic or recurrent respiratory diseases.

The ultrastructure of the bronchial epithelium in three children with recurrent bronchopneumonia, four patients with cystic fibrosis and two with Kartagener's syndrome was studied. The children with recurrent bronchopneumonia and those with Kartagener's syndrome had mostly changes in the pseudostratified ciliated epithelium, and two of them had ultrastructural signs of developing squamous metaplasia. Developed stratified squamous epithelium was found in three of four patients with cystic fibrosis and in one patient with recurrent bronchopneumonia. The squamous epithelium showed striking pathological changes, but, only the oldest patient with cystic fibrosis showed signs of onset of keratinization. Both patients with Kartagener's syndrome had the defect of dynein arms typical of the immotile-cilia syndrome. In the youngest patient the partial absence of dynein arms was combined with a defect in the radial structures of the axonemes.

The influence of endobronchial fluid on the ventilation.

We evaluated the influence of 2 0ml contrast substance Dionosil aq. on the ventilatory function of lung 21 patients who suffered from relapsing bronchial inflammations. The spirographic examination before the local anaesthesia was accomplished with Vitalograph apparatus, the same examination after local anaesthesia of 3 ml 3% cocaine and 60 mg lidocaine and after the bronchoscopy and bronchography and simultaneously was made the bronchocinematographic recording. We verified that the presence of 20 ml contrast substance decreased significantly the values of VC, FVC, FEV1,0 and FEF25--75 and a little even the values of FEV%. The local anaesthesia of the bronchial three did not influence the ventilation values. The bronchocinematography indicated even in contour bronchographs of great bronchi that the intial lumina of peripheral bronchial branches were dispersely fullfilled with contrast media. Because of small flow speed in his section the contrast substance has stopped and it did not move neither at forced breathing nor at coughing. The ventilation secured probably only minor nonfilled branches. Our discoveries contribute to the clearance of failure causes of inhalatory medical treatment with patients having a mild higher viscosity of bronchial secretions.

[Pathological ultrastructural findings in the epithelium of the respiratory passages in children and adults with repeated and chronic respiratory diseases (author's transl)]. / Pathologische ultrastrukturelle Befunde im Epithel der Luftwege bei Kindern und Erwachsenen mit wiederholten und chronischen respiratorischen Erkrankungen.

The ultrastructure of the respiratory passages epithelium of children, adolescents and older adults suffering from repeated or chronic respiratory disease was studied in the material obtained as a small excision during bronchoscopy. The findings were classified into 4 groups according to the character of the ultrastructural changes found in the epithelium. In large bronchi was found: I--a completely unaltered pseudostratified columnar ciliated epithelium, II--a pseudostratified columnar epithelium with various signs of pathological alteration, III--an altered pseudostratified columnar epithelium with first ultrastructural signs of the development of squamous metaplasia, IV--a developed stratified squamous epithelium. In our opinion, in the respiratory passages of children and adolescents, even if they suffer from repeated respiratory diseases, the pseudostratiified ciliated epithelium persists however damaged to various degree. These patients were classified into the second or at most into the third group. The observation of fully developed squamous metaplasia is reserved to older patients with longer history of chronic respiratory disease.