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de Castro-Afonso LH, Nakiri GS, Moretti Monsignore L, Dias FA, Aléssio-Alves FF, Rezende MT, Trivelato FP, Pontes-Neto OM, Abud DG. Endovascular Reperfusion for Acute Isolated Cervical Carotid Occlusions: The Concept of "Hemodynamic Thrombectomy". Interv Neurol 2018; 8:27-37. [PMID: 32231693 DOI: 10.1159/000493021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/16/2018] [Indexed: 01/08/2023]
Abstract
Background/Aims Endovascular treatment improves the outcomes of patients presenting with acute large vessel occlusions. Isolated proximal carotid occlusions presenting with hemodynamic ischemic stroke may probably also benefit from endovascular treatment. We aimed to assess the clinical and radiological data findings on patients who underwent endovascular treatment for acute ischemic stroke related to an isolated cervical carotid artery occlusion. Methods Of a consecutive series of 223 patients who were admitted with acute ische-mic stroke and were treated by thrombectomy, we included 9 patients with isolated cervical internal carotid occlusions. Results The mean baseline National Institutes of Health Stroke Scale (NIHSS) score was 11.8. Complete carotid recanalization was achieved in 5 of the 9 patients (55.5%). In 2 patients, vertebral angioplasty was performed to improve the collateral flow. All patients had a modified Thrombolysis in Cerebral Infarction (mTICI) score of 3 at the end of the procedures. A good neurological outcome, defined as a modified Rankin Scale score ≤2 at the 3-month follow-up, was observed in 6 patients (66.7%). No symptomatic intracranial hemorrhages or deaths occurred during the 3 months of follow-up. Conclusions The endovascular recanalization of isolated cervical carotid occlusions presenting with acute ischemic stroke symptoms is feasible. Because isolated cervical carotid occlusions are associated with hemodynamic ischemic symptoms, if carotid recanalization cannot be achieved, stenting other cervical arteries' stenoses, with a focus on intracranial flow improvement, appears to be a reasonable strategy. Large controlled studies are necessary to assess the safety and efficacy of recanalization of acute isolated cervical carotid occlusions.
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Affiliation(s)
- Luís Henrique de Castro-Afonso
- Division of Interventional Neuroradiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Guilherme Seizem Nakiri
- Division of Interventional Neuroradiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Lucas Moretti Monsignore
- Division of Interventional Neuroradiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Francisco Antunes Dias
- Division of Neurology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Marco Túlio Rezende
- Division of Interventional Neuroradiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Felipe Padovani Trivelato
- Division of Interventional Neuroradiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Daniel Giansante Abud
- Division of Interventional Neuroradiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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Castro-Afonso LHD, Trivelato FP, Rezende MT, Ulhôa AC, Nakiri GS, Monsignore LM, Abud DG. The routes for embolization of dural carotid cavernous fistulas when the endovascular approach is indicated as a first-line strategy. Interv Neuroradiol 2018; 25:66-70. [PMID: 30165774 DOI: 10.1177/1591019918796493] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Multiple ways to access the dural carotid cavernous fistula have been described. The aim of the present study was to assess the results of embolization of a dural carotid cavernous fistula via different routes using endovascular accesses as a first-line strategy. METHODS A retrospective data analysis of a consecutive series of 63 patients presenting with dural carotid cavernous fistula was performed. RESULTS The dural carotid cavernous fistula was accessed by an endovascular approach in 58 patients (92.1%) and by direct puncture in five patients (7.9%). The inferior petrosal sinus was the main route accessed (65%). A recanalization of an occluded inferior petrosal sinus was obtained in 20.6% of cases. The access via either facial ophthalmic veins or the superior petrosal sinus was obtained in 20.6% and 3.1% of cases, respectively. Complete angiographic occlusion of a dural carotid cavernous fistula immediately after treatment was achieved in 53 patients (84.1%), whereas 10 patients (15.9%) displayed a partial occlusion. Treatment-related complications were observed in two patients (3.2%). CONCLUSIONS In this study, the endovascular approach allowed dural carotid cavernous fistula embolization in most patients. The inferior petrosal sinus, even when thrombosed, was the main route used to access the dural carotid cavernous fistula, followed by the facial vein, direct cavernous sinus puncture, and the superior petrosal sinus.
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Affiliation(s)
| | - Felipe Padovani Trivelato
- 2 Division of Interventional Neuroradiology, Felício Rocho Hospital and Clinics Hospital of Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Marco Túlio Rezende
- 2 Division of Interventional Neuroradiology, Felício Rocho Hospital and Clinics Hospital of Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Alexandre Cordeiro Ulhôa
- 2 Division of Interventional Neuroradiology, Felício Rocho Hospital and Clinics Hospital of Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Daniel G Abud
- 1 Division of Interventional Neuroradiology, University of São Paulo, São Paulo, Brazil
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Tobias AHG, Vitalino AC, Rezende MT, Oliveira RRR, Coura-Vital W, Amaral RG, Carneiro CM. Performance of rapid prescreening and 100% rapid review as internal quality control methods for cervical cytopathology. Cytopathology 2018; 29:428-435. [PMID: 29904955 DOI: 10.1111/cyt.12599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND An objective of quality control for cervical cytopathology is reducing high rates of false-negative results of laboratory tests. Therefore, methods to review smears such as rapid prescreening and 100% rapid review, which have shown better performance detecting false-negative results, have been widely used. The performance of rapid prescreening and the performance of 100% rapid review as internal quality control methods for cervical cytology examinations were evaluated. METHODS For 24 months, 9318 conventional cervical cytology smears underwent rapid prescreening and routine screening. The 100% rapid review method was performed for 8244 smears classified as negative during routine screening. Any discordant results underwent detailed review to define the final diagnosis. This was considered the gold standard for evaluating the performance of rapid prescreening and 100% rapid review. RESULTS Routine screening showed increases of 13.3% and 11.5% in the detection of abnormal smears with rapid prescreening and 100% rapid review, respectively. The relative percentage variation showed a 38.1% increase in the diagnosis of atypical squamous cells of undetermined significance with routine screening and rapid prescreening and a 12.5% increase in the diagnosis of atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion with both rapid prescreening and 100% rapid review. Sensitivity rates of rapid prescreening and routine screening were 48.2% and 83.2%, respectively. Sensitivity rates of rapid prescreening and 100% rapid review were 65.7% and 57.8%, respectively, for detecting false-negative results. CONCLUSIONS Inclusion of rapid prescreening and/or 100% rapid review improved the diagnostic sensitivity of the cervical cytology examination and reduced false-negative results of routine screening and can provide good quality control.
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Affiliation(s)
- A H G Tobias
- Post-Graduate Program in Pharmaceutical Sciences, School of Pharmacy, Universidade Federal de Ouro Preto, Ouro Preto, MG, Brazil.,Clinical Cytology Section, Laboratory of Clinical Analysis, School of Pharmacy, Universidade Federal de Ouro Preto, Ouro Preto, MG, Brazil
| | - A C Vitalino
- Post-Graduate Program in Pharmaceutical Sciences, School of Pharmacy, Universidade Federal de Ouro Preto, Ouro Preto, MG, Brazil
| | - M T Rezende
- Post-Graduate Program in Pharmaceutical Sciences, School of Pharmacy, Universidade Federal de Ouro Preto, Ouro Preto, MG, Brazil.,Clinical Cytology Section, Laboratory of Clinical Analysis, School of Pharmacy, Universidade Federal de Ouro Preto, Ouro Preto, MG, Brazil
| | - R R R Oliveira
- Clinical Cytology Section, Laboratory of Clinical Analysis, School of Pharmacy, Universidade Federal de Ouro Preto, Ouro Preto, MG, Brazil
| | - W Coura-Vital
- Department of Clinical Analysis, School of Pharmacy, Universidade Federal de Ouro Preto, Ouro Preto, MG, Brazil
| | - R G Amaral
- School of Pharmacy, Universidade Federal de Goiás, Goiânia, GO, Brazil
| | - C M Carneiro
- Post-Graduate Program in Pharmaceutical Sciences, School of Pharmacy, Universidade Federal de Ouro Preto, Ouro Preto, MG, Brazil.,Clinical Cytology Section, Laboratory of Clinical Analysis, School of Pharmacy, Universidade Federal de Ouro Preto, Ouro Preto, MG, Brazil.,Department of Clinical Analysis, School of Pharmacy, Universidade Federal de Ouro Preto, Ouro Preto, MG, Brazil
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de Castro-Afonso LH, Trivelato FP, Rezende MT, Ulhôa AC, Nakiri GS, Monsignore LM, Colli BO, Velasco-E-Cruz AA, Abud DG. Transvenous embolization of dural carotid cavernous fistulas: the role of liquid embolic agents in association with coils on patient outcomes. J Neurointerv Surg 2017; 10:461-462. [PMID: 28823989 DOI: 10.1136/neurintsurg-2017-013318] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 07/26/2017] [Accepted: 07/30/2017] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Transvenous embolization is the standard treatment for dural carotid cavernous fistulas (DCCF). Although various embolic materials have been used, the best embolic material for the treatment of DCCF is still unknown. OBJECTIVE To assess the safety and efficacy of different embolic materials used for the endovascular treatment of DCCF. METHODS A retrospective data analysis of a consecutive series of 62 patients presenting DCCF was performed. Clinical and radiological data from patients were assessed, and the embolic material used-coils or liquids-were compared between two groups of patients. RESULTS Complete angiographic occlusion of DCCF after treatment was achieved in 83.9% of the patients (52/62). We found a higher rate of complete occlusion of DCCF when liquids were associated with coils than with coils alone (96.5% vs 71.8%, p=0.01), and no differences in complication rates or clinical outcomes were seen between the two groups. At the 6-month follow-up, we found a higher rate of improvement in ocular symptoms compared with cranial nerve palsy improvement (94.7% vs 77.7%, p=0.02). Two patients (3.2%) had treatment-related complications without clinical symptoms. CONCLUSION In this study, in comparison with the use of coils alone, the association of transvenous embolization with liquid embolic agents for DCCF treatment resulted in higher rates of complete occlusion without increasing complication rates. The clinical outcome at the 6-month follow-up showed significant improvement in ocular symptoms over cranial nerve palsy regression, which was independent of the embolic agent chosen for treatment.
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Affiliation(s)
- Luís Henrique de Castro-Afonso
- Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Felipe Padovani Trivelato
- Department of Interventional Neuroradiology, Instituto Neurovascular, Felício Rocho Hospital, Mater Dei Hospital, University of Minas Gerais, Belo Horizonte, Brazil
| | - Marco Túlio Rezende
- Department of Interventional Neuroradiology, Instituto Neurovascular, Felício Rocho Hospital, Mater Dei Hospital, University of Minas Gerais, Belo Horizonte, Brazil
| | - Alexandre Cordeiro Ulhôa
- Department of Interventional Neuroradiology, Instituto Neurovascular, Felício Rocho Hospital, Mater Dei Hospital, University of Minas Gerais, Belo Horizonte, Brazil
| | - Guilherme Seizem Nakiri
- Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Lucas Moretti Monsignore
- Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Benedicto Oscar Colli
- Division of Neurosurgery, Department of Surgery, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Antônio Augusto Velasco-E-Cruz
- Department of Ophthalmology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Daniel Giansante Abud
- Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Affiliation(s)
- Luciano Manzato
- MD (Fellow - Interventional neuroradiology - Hospital das Clínicas - Federal University of Minas Gerais)
| | - Felipe Padovani Trivelato
- MD (Interventional neuroradiologist - Hospital das Clínicas - Federal University of Minas Gerais)
- Send correspondence to: Felipe Padovani Trivelato. Rua Timbiras, nº 3616. Barro Preto. Belo Horizonte - MG. Brazil. CEP: 30140-062.
| | - Alexandre Yugo Holayama Alvarenga
- MD (Resident - Neurosurgery - Hospital das Clínicas - Federal University of Minas Gerais). Division of Interventional Neuroradiology - Hospital das Clínicas - Federal University of Minas Gerais - Belo Horizonte - Minas Gerais - Brazil
| | - Marco Túlio Rezende
- MD (Interventional neuroradiologist - Hospital das Clínicas - Federal University of Minas Gerais)
| | - Alexandre Cordeiro Ulhôa
- MD (Interventional neuroradiologist - Hospital das Clínicas - Federal University of Minas Gerais)
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Trivelato FP, Manzato LB, Rezende MT, Barroso PMC, Faleiro RM, Ulhôa AC. Preoperative embolization of choroid plexus papilloma with Onyx via the anterior choroidal artery: technical note. Childs Nerv Syst 2012; 28:1955-8. [PMID: 23014951 DOI: 10.1007/s00381-012-1928-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Accepted: 09/08/2012] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Total surgical resection is the treatment of choice for choroid plexus tumors. However, the hypervascular nature of such lesions imposes challenges to the surgical treatment. Preoperative embolization for intracranial tumors has been widely used in an attempt to reduce blood loss, but rarely with choroid plexus tumors. CASE REPORT We describe the first case of preoperative embolization of choroid plexus papilloma with Onyx via the anterior choroidal artery. The procedure underwent without any complications and surgical treatment was possible with minimal blood loss. DISCUSSION Embolization of choroid plexus tumors via anterior choroidal artery is potentially dangerous, but following a meticulous technique, it can be used as a safe and effective preoperative procedure.
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Affiliation(s)
- Felipe Padovani Trivelato
- Division of Interventional Neuroradiology, Hospital Felício Rocho, Rua Timbiras 3616, Barro Preto, Belo Horizonte, Minas Gerais, Brazil CEP 30140-062.
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Wajnberg E, Spilberg G, Rezende MT, Abud DG, Kessler I, Mounayer C. Endovascular treatment of tentorial dural arteriovenous fistulae. Interv Neuroradiol 2012; 18:60-8. [PMID: 22440602 DOI: 10.1177/159101991201800108] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 12/03/2011] [Indexed: 12/17/2022] Open
Abstract
Tentorial dural arteriovenous fistula (DAVF) is a rare vascular disease, which accounts for less than 4% of all cases of intracranial DAVF. Because of the high risk of intracranial hemorrhage, patients with tentorial DAVF need aggressive treatment. Management approaches are still controversial, and endovascular treatment has emerged as an effective alternative. In the current work, we describe our experience with the endovascular approach in the treatment of these deep and complex DAVF of the tentorium. Eight patients were treated between January 2006 and July 2009. Six patients (75%) presented with intracranial hemorrhage related to the DAVF rupture. Four patients (50%) had subarachnoid bleeding and two had intraparenchymal hematoma. Endovascular treatment was performed via the transarterial route alone in five cases (62.5%), by the transvenous approach in two cases (25.0%) and in a combined procedure using both arterial and venous routes in one patient (12.5%). Complete obliteration of the fistula was achieved in all cases. The outcome at 15 months was favorable (modified Rankin scale 0-3) in seven (87.5%) patients. Complete cure of the lesion was confirmed in these cases. This paper reports on the effectiveness of endovascular treatment in tentorial DAVF management. The choice of the venous versus the arterial approach is determined by regarding different anatomical dispositions.
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Affiliation(s)
- E Wajnberg
- Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Brazil.
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Abstract
Background and Purpose—
Hyperperfusion syndrome is a rare but well-described complication after endarterectomy or stenting in the carotid circulation.
Summary of Case—
A 66-year-old man who had vertebrobasilar insufficiency refractory to medical treatment because of an intracranial right side vertebral stenosis was referred to our institution for endovascular treatment. Stenting was performed, and after 24 hours, he became extremely agitated, and this was followed by a period of apathy without focal neurological deficits. MRI showed bilateral thalamic hemorrhage.
Conclusion—
To our knowledge, this is the first report of hyperperfusion syndrome with hemorrhagic presentation after intracranial vertebral artery stenting.
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Affiliation(s)
- Marco Túlio Rezende
- Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France
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Saglie FR, Pertuiset J, Rezende MT, Nestor M, Marfany A, Cheng J. In situ correlative immuno-identification of mononuclear infiltrates and invasive bacteria in diseased gingiva. J Periodontol 1988; 59:688-96. [PMID: 2460612 DOI: 10.1902/jop.1988.59.10.688] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The purpose of this study was to identify and quantify mononuclear cells and invasive bacteria in consecutive histological sections in diseased gingiva. Gingival biopsies were obtained from sites displaying evidences of severe periodontitis (pocket depth greater than 5 mm, bleeding on probing) in six patients. Specimens were frozen and serially sectioned at 8 micron in a cryostat. Monoclonal antibodies (mAb) directed against membrane markers of mononuclear infiltrate cells and rabbit polyclonal sera against specific bacteria shown to be invasive in association with an immunoperoxidase technique and specific point quantification were used. The mAb panel included Leu 1 (Pan T), Leu 2a (T suppressor/cytotoxic), Leu 3a (T helper/inducer), Leu 6 (Langerhans/dendritic), Leu 7 (NK/K), Leu M3 (monocyte/macrophage), and B7 (B cell). This methodology allows for in situ per cent quantification of mononuclear cell subsets along with identification and quantification of invasive bacteria in the same gingival tissue site. This may be a practical approach to establish the relationship between bacterial invasion and cellular immune response by the host. This technique enabled the characterization of the mononuclear infiltrate in relationship to specifically identified invasive bacteria in diseased gingiva.
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Affiliation(s)
- F R Saglie
- School of Dentistry, Center for the Health Sciences, University of California, Los Angeles 90024
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Abstract
Gingival biopsies of the mesial papilla area of the first molar were obtained from each patient at 0-, 14- and 21-day intervals during plaque formation. The biopsies were fixed, serially sectioned, and Gram-stained. The incidence and distribution of the bacteria-like structures were studied by microscopy. In all the specimens the bacterial nature of Gram-stained material was substantiated. In the epithelium the highest number of bacteria was found at the outer layer of marginal oral epithelium, sulcular epithelium and apical oral epithelium along with a decreasing pattern of penetration progressing deeper into the layers of tissue. For junctional epithelium the situation was just the opposite. Each subject had significantly higher counts at Day 21 than at Day 14 for both epithelium and connective tissue. Also significantly higher counts were found in connective tissue compared with epithelium. The higher bacterial density of intragingival bacteria was associated with the higher gingival and plaque indices. This study suggests that early stages of gingival inflammation may be mediated by invasion of bacteria.
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Affiliation(s)
- F R Saglie
- School of Dentistry, Center for the Health Sciences, University of California, Los Angeles 90024
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Saglie FR, Pertuiset JH, Smith CT, Nestor MG, Carranza FA, Newman MG, Rezende MT, Nisengard R. The presence of bacteria in the oral epithelium in periodontal disease. III. Correlation with Langerhans cells. J Periodontol 1987; 58:417-22. [PMID: 2439676 DOI: 10.1902/jop.1987.58.6.417] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Langerhans cells (LC) are cell types found in the skin and gingiva. LC have immunological functions as phagocytic cells and as antigen-presenting cells for T and B lymphocytes. Sections from biopsies of the gingiva in cases of periodontal disease were found to have increased numbers of LC. These biopsies also contained intragingival bacteria. Serial sections of frozen specimens of human gingiva were prepared for staining. Hematoxylin and eosin were used for tissue survey, the Gram stain for assessment of bacterial invasion, anti-Leu-6 monoclonal antibody associated with peroxidase technique (PAP) to identify LC, antibacterial sera to Bacteroides gingivalis and Actinobacillus actinomycetemcomitans associated with peroxidase to specifically identify these two common periodontopathogenic bacteria. Additional positive identification of bacteria was performed by preparing the same histological section containing gram-stained particles for scanning electron microscope and transmission electron microscope LC confirmation. The results suggest that the increased number of LC seen in diseased sites of oral epithelium containing intragingival microorganisms may be one of the host immune mechanisms to penetration by bacteria.
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