Background and Purpose: Though there have been many reports on poststroke seizures, there is still much we do not know about them. Using a large cohort of stroke patients we analyzed the characteristics of the seizure(s) and the rate and factors involved in seizure recurrence. Methods: Out of the 3,205 patients admitted for a first-ever stroke to our department between 1984 and 1994, we retrospectively studied the data of all patients with a first-ever seizure and analyzed their evolution. Two types of seizure(s) were defined: ‘early-onset’ seizures (occurring within the 14 days following the stroke) and ‘late-onset’ ones (after the 14th day). Results: 159 patients were included in the study, i.e. 4.96%. There were 116 ischemic strokes and 43 primary hematomas. Cortical involvement was found in 87% of the patients. Early-onset seizures occurred in 57 patients and late-onset ones in 102 patients, 76% of which were observed within 2 years. Follow-up was performed in 135 patients with a mean follow-up period of 47 months; 68 of them presented a seizure recurrence. A 2nd seizure occurred more often in the patients with late-onset seizures (p < 0.01); recurrence was either single (24 patients) or multiple (44 patients). Univariate analysis demonstrated 3 factors for multiple recurrences: hemorrhagic component, low Rankin scale after the initial seizure and occipital involvement. Multivariate analysis determined 2 factors: occipital involvement and late onset of the 1st seizure as a predictive model of multiple recurrences. Conclusions: This study confirms that poststroke seizures are frequent and must be divided into 2 types: early-onset (≤14 days) and late-onset seizures. It demonstrates that a significantly lower rate of patients with early-onset seizures develop another seizure, i.e. epilepsy, than do patients with late-onset seizures. Other factors are involved in recurrence suggesting that poststroke epilepsy probably occurs in a chronically injured brain. The problem of treatment remain unanswered.
Abstract. Several animal studies suggest that T cell-mediated immunodeficiency may play a role in the progression of atherosclerosis. This study examined the association between lymphocyte subsets and atherosclerotic events in renal transplant recipients. A total of 302 consecutive renal transplant recipients were enrolled in this prospective study. Peripheral blood lymphocyte subsets were quantified and analyzed with respect to other known cardiovascular risk factors. The patients were followed for a mean duration of 23.5 Ϯ 4.5 mo. Mean CD4, CD8, and CD19 cell levels were 511 Ϯ 290/mm 3 , 553 Ϯ 596/mm 3 , and 66 Ϯ 62/mm 3 , respectively. CD4 levels were positively related to transplant duration (r ϭ 0.32; P ϭ 0.02) and inversely related to age (r ϭ 0.35; P ϭ 0.01). Twenty-five atherosclerotic events (AE) occurred in 25 patients (8.3%). CD4 levels were lower in patients who experienced CVE (288 Ϯ 170/mm 3 versus 531 Ϯ 290/mm 3 ; P Ͻ 0.0001). Cox regression analysis showed that patients in the three upper quartiles of CD4 cell count had a decreased risk of CVE compared with those in the lowest quartile. There was a linear increase in risk of CVE with decreasing CD4 cell count (P Ͻ 0.0001). A CD4 cell count in the highest quartile (Ͼ663/mm 3 ) divided the risk of CVE by 10 as compared with the lowest quartile. In conclusion, CD4 lymphocytopenia is an independent risk factor for the development of cardiovascular complications in renal transplant recipients, suggesting that impaired immune response promotes accelerated atherogenesis in this population.Stable renal transplant recipients (RTR) have disproportionately high rates of arteriosclerotic outcomes (1). An increased prevalence of traditional cardiovascular risk factors cannot fully explain this increased incidence of CVE in the transplant population (2), and our group has recently emphasized the role of nontraditional cardiovascular risk factors, such as hyperhomocysteinemia (3). A recent study from the USRDS registry showed an increased cardiovascular mortality in RTR having received polyclonal antilymphocyte globulins (4), suggesting either that intense immunosuppression may accelerate native atherosclerosis or that polyclonal antithymocyte globulins exerts specific longterm detrimental effects on the course of atherosclerosis. Nevertheless, interpretation of this finding is challenged by the fact that the atherosclerotic lesion contains large number of immune cells, particularly macrophages and T cells. Furthermore, atherosclerosis is associated with systemic immune responses, including inflammation.On the other hand, several animal studies have shown that immunosuppression may accelerate native atherosclerosis (5-8).Moreover, an increased incidence of cardiovascular events has been reported in AIDS patients (9), and recent reports suggest a correlation between intensity of immunodeficiency and presence of atherosclerotic plaques (10). Lastly, a significant decrease in CD4 cells has been described in the blood of atomic bomb survivors, and an increased inci...
SummaryThe World Health Organization Classification of Lymphoid Neoplasms identifies Burkitt's lymphoma/leukaemia (BL) as a single entity, characterized by unique clinical and genetic features that require specific high intensity chemotherapy regimens. Although remarkable successes in the treatment of the disease have been observed, when compared with paediatric patients, adults are less likely to reach stable complete remission. We investigated 32 BL cases, composed in equal part by adults and children that were treated with the French LMB regimen, for factors that may be implicated in chemoresistance. Immunohistochemical detection of procaspase-8, caspase3a, survivin, p53, CD95, c-Flip and Phospho-RelA (Ser536) was investigated on paraffin-embedded tissues. The expression of c-Flip was found highly related to a poor prognosis, mostly characterized by adults with a chemoresistant disease, resulting in a high death rate within the first year of diagnosis. The 2-year overall survival with c-Flip expression was 24% compared with 93% in the absence of this marker (P ¼ 0AE04). All c-Flippositive BL cases presented a nuclear Phospho-RelA (Ser536) localization, suggesting the presence of an active nuclear factor (NF)-jB transcription pathway. These findings show that c-Flip could be a reliable prognostic factor in BL, suggesting new therapeutic approaches that target the NF-jB pathway.
Although emissions from incinerators are usually not regarded as an important source of exposure to dioxins compared with other background sources, our findings support the hypothesis that environmental dioxins increase the risk of non-Hodgkin lymphoma among the population living in the vicinity of a municipal solid waste incinerator.
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