Forensic Neuropathological Studies on Alzheimer - Type Dementia

用免疫组织化学方法检测整个大脑皮质的尸检结果。这些大脑在神户大学医学院法医学系和兵库县法医办公室进行了尸检，其中包括10例急性死亡病例，其中包括5例非痴呆病例，3例阿尔茨海默型痴呆(ATD)病例和2例痴呆或非痴呆不明病例。至于ATD患者，他们的一生都是在一些医疗机构被临床诊断的。每次尸检时，取全脑称重，右侧大脑半球即刻用4%甲醛溶液固定，左侧大脑半球冠状切片，厚度5~10 mm，用4%多聚甲醛0.01M缓冲液(pH 7.4)固定数天后，用15%蔗糖0.01M缓冲液(pH 7.4)固定。大脑半球两侧、海马体、杏仁核、额叶联合皮质(额叶上回)、颞叶联合皮质…获得较多的Tex(颞上回)、视觉联想皮质和顶颞叶联合皮质(角回)作为组织块和标本。分别对右侧标本进行经典染色和淀粉样蛋白染色，左侧标本进行GFAP、乳转铁蛋白(LF)和人类白细胞抗原-DR免疫组织化学染色。关于SP和NFT的偏好区，它们的得分也是不同的。此外，在某些区域可见大量的SP，而在另一些区域则以NFT为主。因此，SP或NFT的出现在病例和区域的分布也有很大的差异。ATD组和对照组均可检测到反应性星形胶质细胞和反应性小胶质细胞。但总体而言，ATD组的阳性细胞数明显多于正常对照组，尤其是在SP或NFT明显的区域。2例未确诊的ATD患者各区的SP、NFT、反应性星形胶质细胞和反应性小胶质细胞均有不同程度的变化。本组病例均可综合诊断为ATD，但部分区域无明显变化，提示法医尸检病例诊断为ATD，需对整个联合皮质进行检查。较少

Autopsied human brain tissues of whole association cortex were examined immunohistochemically. The brains, autopsied at the Department of Legal Medicine, Kobe University School of Medicine and the Medical Examiners Office of Hyogo Prefecture, included 10 cases of acute death consisting of 5 cases of non-demented, 3 cases of Alzheimer-type dementia (ATD) and 2 cases of demented or non-demented unknown. As for patients of ATD,they were clinically diagnosed at some medical facilities in their life time. At the time of each autopsy, whole brain was weighed and right side hemisphere was fixed in 4% formaldehyde solution instantly, and left side hemisphere was sliced with 5 to 10 mm thickness in coronal sections and after fixation for several days in 4% paraformaldehyde 0.01M buffer solution (pH7.4) , fixed by 15% sucrose 0.01M buffer solution (pH7.4). From each side of hemisphere, hippocampus, amygdaloid nucleus, frontal association cortex (superior frontal gyrus) , temporal association cor … More tex (superior temporal gyrus) , visual association cortex and parietotemporal association cortex (angular gyrus) were obtained as tissue blocks and specimens. Each specimen from right side was stained by classical methods and amyloid staining methods, and specimens from left side were stained immunohistochemically with GFAP,lactotransferrin (LF) and HLA-DR.In some ATD cases, senile plaques (SP) were significantly numerous, and in others, neurofibrillary tangles (NFT) were marked strongly. Concerning with predilectional areas of SP and NFT,their scores were also variable. Furthermore, in some areas, SP were numerous and in other ares, NFT were marked dominantly in a case. So, distributions of appearance of SP or NFT were awfully variable in cases and also in areas. Reactive astrocytes and reactive microglias were detected in ATD cases as well as in controls. However, on the whole, they were more detected in ATD cases than in controls and particularly they were detected numerously in areas with marked SP or NFT.Two cases undiagnosed as ATD marked variable scores of SP,NFT,reactive astrocytes and reactive microglias in each area. These cases were synthetically able to be diagnosed as ATD.However, they had some areas without remarkable changes, it was suggested that for the purpose of diagnosing as ATD in the medicolegal autopsy cases, examinations in whole association cortex were needed. Less