Rescue therapy with local intra-arterial urokinase after poor clinical response with intravenous recombinant tissue plasminogen activator in acute ischaemic stroke.

We report a case of combined intravenous and intra-arterial thrombolysis in a patient presenting with acute ischaemic stroke. Progression to intra-arterial thrombolysis in patients who fail to show clinical improvement within 6 h of symptom onset might be a safe treatment option at centres with access to stroke specialist and endovascular services. The purpose of this report is to demonstrate the efficacy and potential benefits of this rescue therapy.

Use of routine computed tomography brain scanning of psychiatry patients.

The aim of this study was to evaluate the usefulness of CT of the brain in patients presenting with a psychiatric condition without focal neurological signs. The reports of 397 consecutive CT brain scans of patients presenting to two acute tertiary hospital psychiatric services over a 2-year period were assessed retrospectively. Of the 397 patients, 241 had psychosis, 87 had depression, 44 had bipolar affective disorder, seven had alcohol dependence, five had dementia, and the remaining 13 had a variety of diagnoses including personality disorder and transient ischaemic attack. Findings on 377 (95%) of the CT scans showed no abnormality. Specific abnormalities were described in 20 (5%) of the CT scans. Three scans showed non-specific minor abnormalities, which, when followed up by MRI, showed no relevant abnormality. All the abnormalities shown on CT were considered to be clinically unrelated to the patient's psychiatric condition. In conclusion, the pretest probability of finding a space-occupying lesion or other pertinent abnormality in patients presenting with psychiatric illnesses in this retrospective study appears not to be greater than that of the general population. The outcome of this study could be implemented to develop a clinical pathway for limiting assessment by CT for possible organic pathology in acute psychiatric illness.

Gadolinium-enhanced computed tomographic aortography.

Radiographic contrast agents using gadolinium have a better safety profile and photoelectric effect than iodinated contrast, allowing use where iodinated contrast is contraindicated. A case of gadolinium-enhanced computed tomographic aortography (CTA) for suspected thoracic dissection is reported. Aortic enhancement was sufficient for confident exclusion of an intimal flap. The findings were later confirmed by MRI. Vascular enhancement diminished below the diaphragm and tissue enhancement was minimal. Gadolinium diethylenetriamine penta-acetic acid (Gd-DTPA) may be used for CTA of the thoracic aorta, where the use of iodinated contrast is contraindicated. Multi-slice CT may expand the role of gadolinium enhancement in the future.

Identification and isolation of CD1a positive putative tumour infiltrating dendritic cells in human breast cancer.

Identification of dendritic cells (DC) in human tissues has been technically problematic due to the lack of truly specific immunohistochemical markers for DC's. Human dendritic cells express CD1a glycoprotein at certain points in their life cycle. CD1a positive cells are present in many human tumours and have been associated with improved survival. However, little information exists concerning the separation of DC from human tumours. The current study reports that human breast carcinomas have low densities of CD1a positive cells with dendritic morphology, and details are shown of a technique for successful separation of these cells from tumour tissues.