Soroterapia intratecal no tétano. Revisão

Levin, Anna Sara Shafferman; Barone, Antonio Alci; Shiroma, Mario

doi:10.1590/S0036-46651987000500001

Resumos

Devido à importância do tétano nos países em desenvolvimento, foi feita uma revisão da literatura recente abordando aspectos históricos e bases fisio-patológicas do uso da soroterapia intratecal no tratamento do tétano. Discute-se principalmente a eficácia dessa terapêutica envolvendo o uso da antitoxina heteróloga e homóloga, associada ou não à antitoxina e a corticosteróides por via sistêmica. São abordadas também as complicações do uso da antitoxina por via intrarraquideana que são, em geral, leves e transitórias. As tentativas de introduzir definitivamente a administração intratecal da antitoxina tetânica, na terapêutica do tétano, são precoces, uma vez que estudos existentes até o momento tem resultados contraditórios e muitas variáveis envolvidas.

Tétano; Antitoxina tetânica; Uso terapêutico

Tetanus is an important disease in underdeveloped countries. We present a review of literature concerning the use of intrathecal antitoxin in the treatment of tetanus. Historical aspects and the physiopathologic basis for this route of administration of antitoxin are brought up and the efficacy of the uses of heterologous and homologous antitoxin associated or not to systemic antitoxin and steroids is discussed. A great number of clinical studies have been done and many aren't well controlled or conclusive. Others have conflicting results. Homologous antitoxin (TIG) was used by GUPTA 14, in slight cases of tetanus; DIOP-MAR et al5, in Senegal; and LIST22, in Austria, with a reduction of the mortality by the disease when of its intrathecal use. However, BOLOT et al34, in France; SEDAGHATIAN35, and VALKI et al 44,45,46, don't obtain favorable results with intrathecal TIG. The same controversy arises with the use of intrathecal heterologous antitoxin (SAT). GALLAIS et al 10,11,12; SINGH et al38; KESWANI et al21; SANDERS et al32, obtain significantly better results when compared to their control groups, NEEQUAYE et al23; THOMAS et al43; and BHANDARI et al², find no advantages to the use of this route. There are a number of factors possibly responsible for these differences in results: the intrathecal or systemic use of steroids; the use of homologous or heterologous antitoxin; their dosage and route of administration. The adverse effects due to intrathecal antitoxin are in general slight, however this route of administration should be considered experimental until there is further evidence of its benefit.

REVISÃO

Soroterapia intratecal no tétano. Revisão

Intrathecal antitoxin in the treatment of tetanus

Anna Sara Shafferman Levin; Antonio Alci Barone; Mario Shiroma

Trabalho realizado no Departamento de Doenças Infecciosas e Parasitárias, da Faculdade de Medicina da Universidade de São Paulo, Brasil

^{Endereço para correspondência} Endereço para correspondência: Dra. Anna Sara Shafferman Levin Rua Harmonia, 564 - apto. 52 05435 São Paulo, SP - Brasil

RESUMO

Devido à importância do tétano nos países em desenvolvimento, foi feita uma revisão da literatura recente abordando aspectos históricos e bases fisio-patológicas do uso da soroterapia intratecal no tratamento do tétano. Discute-se principalmente a eficácia dessa terapêutica envolvendo o uso da antitoxina heteróloga e homóloga, associada ou não à antitoxina e a corticosteróides por via sistêmica. São abordadas também as complicações do uso da antitoxina por via intrarraquideana que são, em geral, leves e transitórias. As tentativas de introduzir definitivamente a administração intratecal da antitoxina tetânica, na terapêutica do tétano, são precoces, uma vez que estudos existentes até o momento tem resultados contraditórios e muitas variáveis envolvidas.

Unitermos: Tétano - terapêutica; Antitoxina tetânica - Administração intratecal; Uso terapêutico - Administração e dosagem.

SUMMARY

Tetanus is an important disease in underdeveloped countries. We present a review of literature concerning the use of intrathecal antitoxin in the treatment of tetanus. Historical aspects and the physiopathologic basis for this route of administration of antitoxin are brought up and the efficacy of the uses of heterologous and homologous antitoxin associated or not to systemic antitoxin and steroids is discussed.

A great number of clinical studies have been done and many aren't well controlled or conclusive. Others have conflicting results. Homologous antitoxin (TIG) was used by GUPTA ¹⁴, in slight cases of tetanus; DIOP-MAR et al⁵, in Senegal; and LIST²², in Austria, with a reduction of the mortality by the disease when of its intrathecal use. However, BOLOT et al³⁴, in France; SEDAGHATIAN³⁵, and VALKI et al 44,45,46, don't obtain favorable results with intrathecal TIG. The same controversy arises with the use of intrathecal heterologous antitoxin (SAT). GALLAIS et al 10,11,12; SINGH et al³⁸; KESWANI et al²¹; SANDERS et al³², obtain significantly better results when compared to their control groups, NEEQUAYE et al²³; THOMAS et al⁴³; and BHANDARI et al², find no advantages to the use of this route.

There are a number of factors possibly responsible for these differences in results: the intrathecal or systemic use of steroids; the use of homologous or heterologous antitoxin; their dosage and route of administration.

The adverse effects due to intrathecal antitoxin are in general slight, however this route of administration should be considered experimental until there is further evidence of its benefit.

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Full text available only in PDF format.

REFERÊNCIAS BIBLIOGRÁFICAS

1. ARNAUD, P. H.; CHARMEAU, A.; BOLOT, J. F. & FOURNIER, G. - Exploration de la sérothérapie intra -thécale dans le tétanos par la méthode des traceurs nucléaires. In: INTERNATIONAL CONFERENCE ON TETANUS, 4., Dakar, 1975. Proceedings. Lyon, Fondation Merieux, 1975. p. 427-453.

2. BHANDARI, B.; AJMERA, N. K. & JAGETIYA, P. R - Intratecal anti-tetanus serum in management of tetanus neonatorum. Indian J. med. Res., 72: 685-687, 1980.

3. BOLOT, J. F.; CANTON, P. H.; CARDINAUD, J. P.; STELLMANN, C. & TRIAU, R. - Sérothérapie intrathecal par gammaglobulins antitétaniques humaines. étude randomisée de 87 cas. In INTERNATIONAL CONFERENCE ON TETANUS, 4., Dakar, 1975. Proceedings. Lyon, Fondation Merieux, 1975. p. 455-460. DIOP-MAR, I.; BADIANE, S.; DIAGNE, S.; STEL-LMANN, C. & REY, M. - Confirmation de l'efficacite de la sérothérapie intrathécale par une étude randomiseé de 245 cas. In: INTERNATIONAL CONFERENCE ON TETANUS, 4., Dakar, 1975. Proceedings. Lyon, Fondation Merieux, 1975. p. 461-465.

6. DIOP-MAR, I.; BADIANE, S. & BA, A. - Traitment du tétanos par le sérum antitétanique hetérologue intrathecal. Bull. Soc. méd. Afr. noire Langue franc., 23: 393-401, 1978.

7. DIOP-MAR, I.; BADIANE, S.; SOW, A. & BA, A. - Treatment of tetanus by intrathecal heterologous antitoxim (Abstract). In: INTERNATIONAL CONFERENCE ON TETANUS, 5., Ronneby, Sweden, 1978. Summaries of the presentations. Ronneby, 1978. p. 71.

8. DUREUX, J. B., modérateur - Table ronde: Progrès dans la sérothérapie du tétanos declare. In INTERNATIONAL CONFERENCE ON TETANUS, 4., Dakar, 1975. Proceedings. Lyon, Fondation Merieux, 1975. p. 467-484.

9. FLOREY, H. & FILDES, P. - Tetanus VIII. The treatment of tetanus in rabbits by large intrathecal doses of antitoxin. Brit. J. exp. Path., 8: 393-397, 1927.

10. GALLAIS, H. - Intérêt de l'administration intrathécale de sérum antitétanique et de corticóides pour le traiment du tétanos declare. Nouv Presse méd, 6: 1571, 1977.

11. GALLAIS, H.; MOREAU, J.; CORNET, C; ODEHOURT, K.; ABISSE, A. & ECHIMANE, A. - Therapeutic evaluation of 404 cases of tetanus - Advantages of intrathecal serotherapy (Abstract). In: INTERNATIONAL CONFERENCE ON TETANUS, 5., Ronneby, Sweden, 1978. Summaries of the presentations. Ronneby, 1978. p. 73.

12. GALLAIS, H.; ADAMA, S. & CASANOVA, P. - Our practical experience of intrathecal serotherapy obtained from a series of 727 cases of tetanus (Abstract). In: NISTICÒ, G. & STRONGOLI, M. C, ed. - International Conference on Tetanus, 7., Copanello, Italy, 1984. Abstracts. Copanello, 1984. p. 130.

13. GRECCO, J. B. - Antitetanus serum and prednisolone in the intrathecal treatment of puerperal and umbilical tetanus. In: INTERNATIONAL CONFERENCE ON TETANUS, 4., Dakar, 1975. Proceedings. Lyon, Fondation Merieux, 1975. p. 415-421.

14. GUPTA, P. S.; GOYAL, S.; KAPOR, R.; BATRA, V. K. & JAIN, B. K. - Intrathecal human tetanus immunoglobulin in early tetanus. Lancet, 2: 439-440, 1980.

15. HANAUSHE, A.; ERDMANN, G. & WELLHÕNER, H. H. - F(ab')₂- Tetanus - antiserum: distribution after intrathecal injection and further purification by affinity chromatography. In: INTERNATIONAL CONFERENCE ON TETANUS, 5., Ronneby, Sweden, 1978. Summaries of the presentations. Ronneby, 1978. p. 52.

16. HENDERSON, A.; GUY, P. & KNIGHT, J. R. - Severe tetanus complicating an open femoral fracture successfully managed using intrathecal human tetanus immunoglobulin and external fixation. J. roy Army med. Cps., 130: 185-187, 1984.

17. HUGUES-DAVIES, T. H. - Intrathecal immunoglobulin for tetanus (letter). Med. J. Aust., 2: 308, 1979.

18. ILDIRIM, I.; MEIRA, A. R. & FURCOLOW, M. L. - Tetanus (letter). New Engl. J. Med., 280: 1243, 1969.

19. ILDIRIM, I. - Intrathecal treatment of tetanus with antitetanus serum and prednisolone mixture. (In: EDSALL, G., ed. - INTERNATIONAL CONFERENCE ON TETANUS, 3., São Paulo, 1970. Proceedings. Washington, PAHO; WHO, 1972. p. 119-127.

20. ILDIRIM, I. - General and intrathecal serotherapy. In: INTERNATIONAL CONFERENCE ON TETANUS, 4., Dakar, 1975. Proceedings. Lyon, Fondation, Merieux, 1975. p. 371-382.

21. KESWANI, N. K.; SINGH, A. K. & UPADHYAYA, K. D. - Intrathecal tetanus antitoxin in moderate and severe tetanus. J. Indian med. Ass., 75: 67-69, 1980.

22. LIST, W. F. - Tetanus treatment with high doses of tetanus antitoxin (Abstract). In: INTERNATIONAL CONFERENCE ON TETANUS, 5., Ronneby, Sweden, 1978. Summaries of the presentations. Ronneby, 1973. p. 72.

23. NEEQUAYE, J. & NKRUMAH, F. K. - Failure of intrathecal antitetanus serum to improve survival in neonatal tetanus. Arch. Dis. Childh., 58: 276-278, 1983.

24. ONUORA, C. A.; SAMBO-DONGA, L. & YAHAYA, H. - Intrathecal antitetanus serum in the management of tetanus. E. Afr. med. J., 59: 52-55, 1982.

25. PARK, W.; NICOLL, M. - Experiments on the curative value of the intraspinal aòlministration of tetanus antitoxin. J. Amer. med. Ass., 63: 235-238, 1914.

26. PATEL, J. C; MEHTA, B. C; GOODLUCK, P. L.; RAO, S. S. & BORKAR, M. S. - Detection of free circulating toxin the blood and cerebrospinal fluid of some tetanus cases and its significance (Abstract). In: NISTICO, G. & STRONGOLI, M. C, ed. - INTERNATIONAL CONFERENCE ON TETANUS, 7., Copanello, Italy, 1984. Abstracts. Copanello, 1984, p. 114.

27. PENNA - Subaracnoid serum treatment of tetanus. J. Amer. med. Ass., 38: 602, 1902.

28. REINHARDT, F. - Intravenous and intrathecal application of tetanus antitoxim of human origin. In: INTERNATIONAL CONFERENCE ON TETANUS, 5., Dakar, 1975. Proceedings. Lyon, Fondation Merieux, 1975. p. 409-413.

29. REY, M.; DIOP-MAR, I. & ROBERT, D. - Treatment of Tetanus. In: VERONESI, R. - Tetanus: important new concepts. Amsterdam, Excerpta Medica, 1981. p. 207-237.

30. ROBERT, R.; ROTJFFINEAU, J.; CREMAULT, A.; BAUPLE, J. L.; POURRAT, O.; GIL, R. & PATTE, D. - Paraplégie reversible après injection intrathécale de fortesdoses de gammaglobulins humaines lors du traitment de tétanos de faible gravite - quatre observations. Presse méd., 13: 1947-1949, 1984.

31. ROGERS, J. - The treatment of tetanus by intraneural and intraspinal injections of antitoxin. J. Amer. med. Ass., 45: 12-18, 1905.

32. SANDERS, R. K. M.; JOSEPH, R.; MARTYN, B. & PEACOCK, M. L. - Intrathecal antitetanus serum (horse) in the treatment of tetanus. Lancet, 1: 974-977, 1977.

33. SANDERS, R. K. M. - Treatment of tetanus (letter). Brit. med. J., 2: 1979

34. SANDERS, R. K. M. - Intrathecal tetanus serum (letter). Lancet, 2: 1200, 1980.

35. SEDAGHATIAN, M. R. - Intrathecal serotherapy in neonatal tetanus: a controlled trial. Arch. Dis. Childh., 54: 623-625, 1979.

36. SHANN, F. - Intrathecal administration of tetanus antiserum (letter). Med. J. Aust., 24: 604-605, 1983.

37. SHERRINGTON, C. S. - Observations with antitetanus serum in the monkey. Lancet, 2: 964-966, 1917.

38. SINGH, A. K.; BANSAL, A.; GOEL, S. P. & AGARWAL, V. K. - Intrathecal antitetanus serum (horse) with steroid in the treatment of neonatal tetanus. Arch. Dis. Child., 55: 527-531, 1980.

39. SINGHI, S. & SINGHI, P. - Intrathecal ATS and high dosage diazepan in neonatal tetanus (letter). Arch. Dis. Child., 54: 650-651, 1979.

40. SMITH, J. W. G. - Intracerebral antitoxin experimental tetanus. Brit. J. exp. Path, 47: 17-24, 1966.

41. SPAETH, R. - Therapy of tetanus - a estudy of two-hundred and seventy-six cases. Arch, intern. Med., 68: 1133-1160, 1941.

42. TESTASOCCA, D.; TORRONI, P.; MAZZONI, A. L.; ZENOBI, G. & GUAZZINI, S. - Advancement in treating of tetanus: intravenous and peridural administration of human immunoglobulins (Abstract). In: NISTICÒ, G. & STRONGOLI, M. C, ed. - International Conference on Tetanus, 7., Copanello, Italy, 1984. Abstracts. Copanello, 1984. p. 133.

43. THOMAS, P. P.; CROWELL, E. B. & MATHEW, M. - Intrathecal anti-tetanus serum (ATS) and parenteral betamethasone in the treatment of tetanus. Trans. roy. Soc. trop. Med. Hyg., 76: 620-623, 1982.

44. VAKIL, B. J.; ARMITAGE, P. & LAURENCE, D. R. - Therapeutic trial of intrathecal human tetanus immunoglobulin in severe tetanus. A preliminary communication. In: INTERNATIONAL CONFERENCE ON TETANUS, 4., Dakar, 1975. Proceedings. Lyon, Fondation Merieux, 1975. p. 423-425.

45. VAKIL, B. J.; ARMITAGE, P.; CLIFFORD, R. E. & LAURENCE, D. R. - Therapeutic trials of intrathecal (intracisternal) administration of human tetanus immunoglobulin in severe tetanus. (Abstract). In INTERNATIONAL CONFERENCE ON TETANUS, 5., Ronneby, Sweden, 1978. Summaries of the presentations. Ronneby, 1978, p. 74.

46. VAKIL, B. J.; ARMITAGE, P.; CLIFFORD, R. E. & LAURENCE, D. R. - Therapeutic trial of intracisternal human immunoglobulin in clinical tetanus. Trans. roy. Soc. trop. Med. Hyg., 73: 579-583, 1979.

47. VERONESI, R.; BIZZINI, B.; HUTZLER, T. U.; FOCACCIA, R.; MAZZA, C. C; FELDMAN, C; FERREIRA, M. S.; DIETZE, R.; RODRIGUES, M. L. M. & TIMERMAN, A. - Eficácia do tratamento do tétano com antitoxina tetânica por via raquidiana e/ou venosa. Estudo de 101 casos, com pesquisa sobre a permanência da gamaglobulina humana F(ab)² no liquor e no sangue. Rev. bras. Clin. Terap., 9: 301-319, 1980.

48. VERONESI, R.; BIZZINI, B.; MAZZA, C. C; FOCACCIA, R.; FELDMAN, C; COSCINA, A. L. & HUTZLER, R. U. - Tratamento específico do tétano com uma fração F(ab') da imunoglobulina antitetânica injetada por via raquidiana. Rev. Hosp. Clín. Fac. Med. S. Paulo, 38: 147-149, 1983.

49. WELLHÕNER, H. H.; NIGGEMANN, B. & ERDMANN, G. - Spinal pharmacokinetics of liposome-entrapped tetanus antibodies. (Abstract). In: NISTICÒ, G. & STRANGOLI, M. C, ed. - INTERNATIONAL CONFERENCE ON TETANUS, 7., Copanello, Italy, 1984. Abstracts. Oopanello, 1984. p. 131.

Recebido para publicação 24/3/87.

Referências bibliográficas

1. ARNAUD, P. H.; CHARMEAU, A.; BOLOT, J. F. & FOURNIER, G. - Exploration de la sérothérapie intra -thécale dans le tétanos par la méthode des traceurs nucléaires. In: INTERNATIONAL CONFERENCE ON TETANUS, 4., Dakar, 1975. Proceedings. Lyon, Fondation Merieux, 1975. p. 427-453.
2. BHANDARI, B.; AJMERA, N. K. & JAGETIYA, P. R - Intratecal anti-tetanus serum in management of tetanus neonatorum. Indian J. med. Res., 72: 685-687, 1980.
3. BOLOT, J. F.; CANTON, P. H.; CARDINAUD, J. P.; STELLMANN, C. & TRIAU, R. - Sérothérapie intrathecal par gammaglobulins antitétaniques humaines. étude randomisée de 87 cas. In INTERNATIONAL CONFERENCE ON TETANUS, 4., Dakar, 1975. Proceedings. Lyon, Fondation Merieux, 1975. p. 455-460.
4. BOLOT, J. F.; FOURNIER, G.; CANTON, P.; CARDINAUD, J. P.; REY, M.; STELLMAN, C; TRIAU, R. & DIOP-MAR, I. - Intrathecal (I.T) human specific antitetanus (H.S.A.G.). A multicentric controlled trial (Abstract). In: INTERNATIONAL CONFERENCE ON TETANUS, 5., Ronneby, Sweden, 1978. Sumaries of the presentations. Ronneby, 1978. p. 75.5.
DIOP-MAR, I.; BADIANE, S.; DIAGNE, S.; STEL-LMANN, C. & REY, M. - Confirmation de l'efficacite de la sérothérapie intrathécale par une étude randomiseé de 245 cas. In: INTERNATIONAL CONFERENCE ON TETANUS, 4., Dakar, 1975. Proceedings. Lyon, Fondation Merieux, 1975. p. 461-465.
6. DIOP-MAR, I.; BADIANE, S. & BA, A. - Traitment du tétanos par le sérum antitétanique hetérologue intrathecal. Bull. Soc. méd. Afr. noire Langue franc., 23: 393-401, 1978.
7. DIOP-MAR, I.; BADIANE, S.; SOW, A. & BA, A. - Treatment of tetanus by intrathecal heterologous antitoxim (Abstract). In: INTERNATIONAL CONFERENCE ON TETANUS, 5., Ronneby, Sweden, 1978. Summaries of the presentations. Ronneby, 1978. p. 71.
8. DUREUX, J. B., modérateur - Table ronde: Progrès dans la sérothérapie du tétanos declare. In INTERNATIONAL CONFERENCE ON TETANUS, 4., Dakar, 1975. Proceedings. Lyon, Fondation Merieux, 1975. p. 467-484.
9. FLOREY, H. & FILDES, P. - Tetanus VIII. The treatment of tetanus in rabbits by large intrathecal doses of antitoxin. Brit. J. exp. Path., 8: 393-397, 1927.
10. GALLAIS, H. - Intérêt de l'administration intrathécale de sérum antitétanique et de corticóides pour le traiment du tétanos declare. Nouv Presse méd, 6: 1571, 1977.
11. GALLAIS, H.; MOREAU, J.; CORNET, C; ODEHOURT, K.; ABISSE, A. & ECHIMANE, A. - Therapeutic evaluation of 404 cases of tetanus - Advantages of intrathecal serotherapy (Abstract). In: INTERNATIONAL CONFERENCE ON TETANUS, 5., Ronneby, Sweden, 1978. Summaries of the presentations. Ronneby, 1978. p. 73.
12. GALLAIS, H.; ADAMA, S. & CASANOVA, P. - Our practical experience of intrathecal serotherapy obtained from a series of 727 cases of tetanus (Abstract). In: NISTICÒ, G. & STRONGOLI, M. C, ed. - International Conference on Tetanus, 7., Copanello, Italy, 1984. Abstracts. Copanello, 1984. p. 130.
13. GRECCO, J. B. - Antitetanus serum and prednisolone in the intrathecal treatment of puerperal and umbilical tetanus. In: INTERNATIONAL CONFERENCE ON TETANUS, 4., Dakar, 1975. Proceedings. Lyon, Fondation Merieux, 1975. p. 415-421.
14. GUPTA, P. S.; GOYAL, S.; KAPOR, R.; BATRA, V. K. & JAIN, B. K. - Intrathecal human tetanus immunoglobulin in early tetanus. Lancet, 2: 439-440, 1980.
15. HANAUSHE, A.; ERDMANN, G. & WELLHÕNER, H. H. - F(ab')₂- Tetanus - antiserum: distribution after intrathecal injection and further purification by affinity chromatography. In: INTERNATIONAL CONFERENCE ON TETANUS, 5., Ronneby, Sweden, 1978. Summaries of the presentations. Ronneby, 1978. p. 52.
16. HENDERSON, A.; GUY, P. & KNIGHT, J. R. - Severe tetanus complicating an open femoral fracture successfully managed using intrathecal human tetanus immunoglobulin and external fixation. J. roy Army med. Cps., 130: 185-187, 1984.
17. HUGUES-DAVIES, T. H. - Intrathecal immunoglobulin for tetanus (letter). Med. J. Aust., 2: 308, 1979.
18. ILDIRIM, I.; MEIRA, A. R. & FURCOLOW, M. L. - Tetanus (letter). New Engl. J. Med., 280: 1243, 1969.
19. ILDIRIM, I. - Intrathecal treatment of tetanus with antitetanus serum and prednisolone mixture. (In: EDSALL, G., ed. - INTERNATIONAL CONFERENCE ON TETANUS, 3., São Paulo, 1970. Proceedings. Washington, PAHO; WHO, 1972. p. 119-127.
20. ILDIRIM, I. - General and intrathecal serotherapy. In: INTERNATIONAL CONFERENCE ON TETANUS, 4., Dakar, 1975. Proceedings. Lyon, Fondation, Merieux, 1975. p. 371-382.
21. KESWANI, N. K.; SINGH, A. K. & UPADHYAYA, K. D. - Intrathecal tetanus antitoxin in moderate and severe tetanus. J. Indian med. Ass., 75: 67-69, 1980.
22. LIST, W. F. - Tetanus treatment with high doses of tetanus antitoxin (Abstract). In: INTERNATIONAL CONFERENCE ON TETANUS, 5., Ronneby, Sweden, 1978. Summaries of the presentations. Ronneby, 1973. p. 72.
23. NEEQUAYE, J. & NKRUMAH, F. K. - Failure of intrathecal antitetanus serum to improve survival in neonatal tetanus. Arch. Dis. Childh., 58: 276-278, 1983.
24. ONUORA, C. A.; SAMBO-DONGA, L. & YAHAYA, H. - Intrathecal antitetanus serum in the management of tetanus. E. Afr. med. J., 59: 52-55, 1982.
25. PARK, W.; NICOLL, M. - Experiments on the curative value of the intraspinal aòlministration of tetanus antitoxin. J. Amer. med. Ass., 63: 235-238, 1914.
26. PATEL, J. C; MEHTA, B. C; GOODLUCK, P. L.; RAO, S. S. & BORKAR, M. S. - Detection of free circulating toxin the blood and cerebrospinal fluid of some tetanus cases and its significance (Abstract). In: NISTICO, G. & STRONGOLI, M. C, ed. - INTERNATIONAL CONFERENCE ON TETANUS, 7., Copanello, Italy, 1984. Abstracts. Copanello, 1984, p. 114.
27. PENNA - Subaracnoid serum treatment of tetanus. J. Amer. med. Ass., 38: 602, 1902.
28. REINHARDT, F. - Intravenous and intrathecal application of tetanus antitoxim of human origin. In: INTERNATIONAL CONFERENCE ON TETANUS, 5., Dakar, 1975. Proceedings. Lyon, Fondation Merieux, 1975. p. 409-413.
29. REY, M.; DIOP-MAR, I. & ROBERT, D. - Treatment of Tetanus. In: VERONESI, R. - Tetanus: important new concepts. Amsterdam, Excerpta Medica, 1981. p. 207-237.
30. ROBERT, R.; ROTJFFINEAU, J.; CREMAULT, A.; BAUPLE, J. L.; POURRAT, O.; GIL, R. & PATTE, D. - Paraplégie reversible après injection intrathécale de fortesdoses de gammaglobulins humaines lors du traitment de tétanos de faible gravite - quatre observations. Presse méd., 13: 1947-1949, 1984.
31. ROGERS, J. - The treatment of tetanus by intraneural and intraspinal injections of antitoxin. J. Amer. med. Ass., 45: 12-18, 1905.
32. SANDERS, R. K. M.; JOSEPH, R.; MARTYN, B. & PEACOCK, M. L. - Intrathecal antitetanus serum (horse) in the treatment of tetanus. Lancet, 1: 974-977, 1977.
33. SANDERS, R. K. M. - Treatment of tetanus (letter). Brit. med. J., 2: 1979
34. SANDERS, R. K. M. - Intrathecal tetanus serum (letter). Lancet, 2: 1200, 1980.
35. SEDAGHATIAN, M. R. - Intrathecal serotherapy in neonatal tetanus: a controlled trial. Arch. Dis. Childh., 54: 623-625, 1979.
36. SHANN, F. - Intrathecal administration of tetanus antiserum (letter). Med. J. Aust., 24: 604-605, 1983.
37. SHERRINGTON, C. S. - Observations with antitetanus serum in the monkey. Lancet, 2: 964-966, 1917.
38. SINGH, A. K.; BANSAL, A.; GOEL, S. P. & AGARWAL, V. K. - Intrathecal antitetanus serum (horse) with steroid in the treatment of neonatal tetanus. Arch. Dis. Child., 55: 527-531, 1980.
39. SINGHI, S. & SINGHI, P. - Intrathecal ATS and high dosage diazepan in neonatal tetanus (letter). Arch. Dis. Child., 54: 650-651, 1979.
40. SMITH, J. W. G. - Intracerebral antitoxin experimental tetanus. Brit. J. exp. Path, 47: 17-24, 1966.
41. SPAETH, R. - Therapy of tetanus - a estudy of two-hundred and seventy-six cases. Arch, intern. Med., 68: 1133-1160, 1941.
42. TESTASOCCA, D.; TORRONI, P.; MAZZONI, A. L.; ZENOBI, G. & GUAZZINI, S. - Advancement in treating of tetanus: intravenous and peridural administration of human immunoglobulins (Abstract). In: NISTICÒ, G. & STRONGOLI, M. C, ed. - International Conference on Tetanus, 7., Copanello, Italy, 1984. Abstracts. Copanello, 1984. p. 133.
43. THOMAS, P. P.; CROWELL, E. B. & MATHEW, M. - Intrathecal anti-tetanus serum (ATS) and parenteral betamethasone in the treatment of tetanus. Trans. roy. Soc. trop. Med. Hyg., 76: 620-623, 1982.
44. VAKIL, B. J.; ARMITAGE, P. & LAURENCE, D. R. - Therapeutic trial of intrathecal human tetanus immunoglobulin in severe tetanus. A preliminary communication. In: INTERNATIONAL CONFERENCE ON TETANUS, 4., Dakar, 1975. Proceedings. Lyon, Fondation Merieux, 1975. p. 423-425.
45. VAKIL, B. J.; ARMITAGE, P.; CLIFFORD, R. E. & LAURENCE, D. R. - Therapeutic trials of intrathecal (intracisternal) administration of human tetanus immunoglobulin in severe tetanus. (Abstract). In INTERNATIONAL CONFERENCE ON TETANUS, 5., Ronneby, Sweden, 1978. Summaries of the presentations. Ronneby, 1978, p. 74.
46. VAKIL, B. J.; ARMITAGE, P.; CLIFFORD, R. E. & LAURENCE, D. R. - Therapeutic trial of intracisternal human immunoglobulin in clinical tetanus. Trans. roy. Soc. trop. Med. Hyg., 73: 579-583, 1979.
47. VERONESI, R.; BIZZINI, B.; HUTZLER, T. U.; FOCACCIA, R.; MAZZA, C. C; FELDMAN, C; FERREIRA, M. S.; DIETZE, R.; RODRIGUES, M. L. M. & TIMERMAN, A. - Eficácia do tratamento do tétano com antitoxina tetânica por via raquidiana e/ou venosa. Estudo de 101 casos, com pesquisa sobre a permanência da gamaglobulina humana F(ab)² no liquor e no sangue. Rev. bras. Clin. Terap., 9: 301-319, 1980.
48. VERONESI, R.; BIZZINI, B.; MAZZA, C. C; FOCACCIA, R.; FELDMAN, C; COSCINA, A. L. & HUTZLER, R. U. - Tratamento específico do tétano com uma fração F(ab') da imunoglobulina antitetânica injetada por via raquidiana. Rev. Hosp. Clín. Fac. Med. S. Paulo, 38: 147-149, 1983.
49. WELLHÕNER, H. H.; NIGGEMANN, B. & ERDMANN, G. - Spinal pharmacokinetics of liposome-entrapped tetanus antibodies. (Abstract). In: NISTICÒ, G. & STRANGOLI, M. C, ed. - INTERNATIONAL CONFERENCE ON TETANUS, 7., Copanello, Italy, 1984. Abstracts. Oopanello, 1984. p. 131.

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Datas de Publicação

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18 Fev 2011
Data do Fascículo
Out 1987

Histórico

Recebido
24 Mar 1987

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[1] 1. ARNAUD, P. H.; CHARMEAU, A.; BOLOT, J. F. & FOURNIER, G. - Exploration de la sérothérapie intra -thécale dans le tétanos par la méthode des traceurs nucléaires. In: INTERNATIONAL CONFERENCE ON TETANUS, 4., Dakar, 1975. Proceedings. Lyon, Fondation Merieux, 1975. p. 427-453.

[2] 2. BHANDARI, B.; AJMERA, N. K. & JAGETIYA, P. R - Intratecal anti-tetanus serum in management of tetanus neonatorum. Indian J. med. Res., 72: 685-687, 1980.

[3] 3. BOLOT, J. F.; CANTON, P. H.; CARDINAUD, J. P.; STELLMANN, C. & TRIAU, R. - Sérothérapie intrathecal par gammaglobulins antitétaniques humaines. étude randomisée de 87 cas. In INTERNATIONAL CONFERENCE ON TETANUS, 4., Dakar, 1975. Proceedings. Lyon, Fondation Merieux, 1975. p. 455-460.

[4] 4. BOLOT, J. F.; FOURNIER, G.; CANTON, P.; CARDINAUD, J. P.; REY, M.; STELLMAN, C; TRIAU, R. & DIOP-MAR, I. - Intrathecal (I.T) human specific antitetanus (H.S.A.G.). A multicentric controlled trial (Abstract). In: INTERNATIONAL CONFERENCE ON TETANUS, 5., Ronneby, Sweden, 1978. Sumaries of the presentations. Ronneby, 1978. p. 75.5.

[5] DIOP-MAR, I.; BADIANE, S.; DIAGNE, S.; STEL-LMANN, C. & REY, M. - Confirmation de l'efficacite de la sérothérapie intrathécale par une étude randomiseé de 245 cas. In: INTERNATIONAL CONFERENCE ON TETANUS, 4., Dakar, 1975. Proceedings. Lyon, Fondation Merieux, 1975. p. 461-465.

[6] 6. DIOP-MAR, I.; BADIANE, S. & BA, A. - Traitment du tétanos par le sérum antitétanique hetérologue intrathecal. Bull. Soc. méd. Afr. noire Langue franc., 23: 393-401, 1978.

[7] 7. DIOP-MAR, I.; BADIANE, S.; SOW, A. & BA, A. - Treatment of tetanus by intrathecal heterologous antitoxim (Abstract). In: INTERNATIONAL CONFERENCE ON TETANUS, 5., Ronneby, Sweden, 1978. Summaries of the presentations. Ronneby, 1978. p. 71.

[8] 8. DUREUX, J. B., modérateur - Table ronde: Progrès dans la sérothérapie du tétanos declare. In INTERNATIONAL CONFERENCE ON TETANUS, 4., Dakar, 1975. Proceedings. Lyon, Fondation Merieux, 1975. p. 467-484.

[9] 9. FLOREY, H. & FILDES, P. - Tetanus VIII. The treatment of tetanus in rabbits by large intrathecal doses of antitoxin. Brit. J. exp. Path., 8: 393-397, 1927.

[10] 10. GALLAIS, H. - Intérêt de l'administration intrathécale de sérum antitétanique et de corticóides pour le traiment du tétanos declare. Nouv Presse méd, 6: 1571, 1977.

[11] 11. GALLAIS, H.; MOREAU, J.; CORNET, C; ODEHOURT, K.; ABISSE, A. & ECHIMANE, A. - Therapeutic evaluation of 404 cases of tetanus - Advantages of intrathecal serotherapy (Abstract). In: INTERNATIONAL CONFERENCE ON TETANUS, 5., Ronneby, Sweden, 1978. Summaries of the presentations. Ronneby, 1978. p. 73.

[12] 12. GALLAIS, H.; ADAMA, S. & CASANOVA, P. - Our practical experience of intrathecal serotherapy obtained from a series of 727 cases of tetanus (Abstract). In: NISTICÒ, G. & STRONGOLI, M. C, ed. - International Conference on Tetanus, 7., Copanello, Italy, 1984. Abstracts. Copanello, 1984. p. 130.

[13] 13. GRECCO, J. B. - Antitetanus serum and prednisolone in the intrathecal treatment of puerperal and umbilical tetanus. In: INTERNATIONAL CONFERENCE ON TETANUS, 4., Dakar, 1975. Proceedings. Lyon, Fondation Merieux, 1975. p. 415-421.

[14] 14. GUPTA, P. S.; GOYAL, S.; KAPOR, R.; BATRA, V. K. & JAIN, B. K. - Intrathecal human tetanus immunoglobulin in early tetanus. Lancet, 2: 439-440, 1980.

[15] 15. HANAUSHE, A.; ERDMANN, G. & WELLHÕNER, H. H. - F(ab')₂- Tetanus - antiserum: distribution after intrathecal injection and further purification by affinity chromatography. In: INTERNATIONAL CONFERENCE ON TETANUS, 5., Ronneby, Sweden, 1978. Summaries of the presentations. Ronneby, 1978. p. 52.

[16] 16. HENDERSON, A.; GUY, P. & KNIGHT, J. R. - Severe tetanus complicating an open femoral fracture successfully managed using intrathecal human tetanus immunoglobulin and external fixation. J. roy Army med. Cps., 130: 185-187, 1984.

[17] 17. HUGUES-DAVIES, T. H. - Intrathecal immunoglobulin for tetanus (letter). Med. J. Aust., 2: 308, 1979.

[18] 18. ILDIRIM, I.; MEIRA, A. R. & FURCOLOW, M. L. - Tetanus (letter). New Engl. J. Med., 280: 1243, 1969.

[19] 19. ILDIRIM, I. - Intrathecal treatment of tetanus with antitetanus serum and prednisolone mixture. (In: EDSALL, G., ed. - INTERNATIONAL CONFERENCE ON TETANUS, 3., São Paulo, 1970. Proceedings. Washington, PAHO; WHO, 1972. p. 119-127.

[20] 20. ILDIRIM, I. - General and intrathecal serotherapy. In: INTERNATIONAL CONFERENCE ON TETANUS, 4., Dakar, 1975. Proceedings. Lyon, Fondation, Merieux, 1975. p. 371-382.

[21] 21. KESWANI, N. K.; SINGH, A. K. & UPADHYAYA, K. D. - Intrathecal tetanus antitoxin in moderate and severe tetanus. J. Indian med. Ass., 75: 67-69, 1980.

[22] 22. LIST, W. F. - Tetanus treatment with high doses of tetanus antitoxin (Abstract). In: INTERNATIONAL CONFERENCE ON TETANUS, 5., Ronneby, Sweden, 1978. Summaries of the presentations. Ronneby, 1973. p. 72.

[23] 23. NEEQUAYE, J. & NKRUMAH, F. K. - Failure of intrathecal antitetanus serum to improve survival in neonatal tetanus. Arch. Dis. Childh., 58: 276-278, 1983.

[24] 24. ONUORA, C. A.; SAMBO-DONGA, L. & YAHAYA, H. - Intrathecal antitetanus serum in the management of tetanus. E. Afr. med. J., 59: 52-55, 1982.

[25] 25. PARK, W.; NICOLL, M. - Experiments on the curative value of the intraspinal aòlministration of tetanus antitoxin. J. Amer. med. Ass., 63: 235-238, 1914.

[26] 26. PATEL, J. C; MEHTA, B. C; GOODLUCK, P. L.; RAO, S. S. & BORKAR, M. S. - Detection of free circulating toxin the blood and cerebrospinal fluid of some tetanus cases and its significance (Abstract). In: NISTICO, G. & STRONGOLI, M. C, ed. - INTERNATIONAL CONFERENCE ON TETANUS, 7., Copanello, Italy, 1984. Abstracts. Copanello, 1984, p. 114.

[27] 27. PENNA - Subaracnoid serum treatment of tetanus. J. Amer. med. Ass., 38: 602, 1902.

[28] 28. REINHARDT, F. - Intravenous and intrathecal application of tetanus antitoxim of human origin. In: INTERNATIONAL CONFERENCE ON TETANUS, 5., Dakar, 1975. Proceedings. Lyon, Fondation Merieux, 1975. p. 409-413.

[29] 29. REY, M.; DIOP-MAR, I. & ROBERT, D. - Treatment of Tetanus. In: VERONESI, R. - Tetanus: important new concepts. Amsterdam, Excerpta Medica, 1981. p. 207-237.

[30] 30. ROBERT, R.; ROTJFFINEAU, J.; CREMAULT, A.; BAUPLE, J. L.; POURRAT, O.; GIL, R. & PATTE, D. - Paraplégie reversible après injection intrathécale de fortesdoses de gammaglobulins humaines lors du traitment de tétanos de faible gravite - quatre observations. Presse méd., 13: 1947-1949, 1984.

[31] 31. ROGERS, J. - The treatment of tetanus by intraneural and intraspinal injections of antitoxin. J. Amer. med. Ass., 45: 12-18, 1905.

[32] 32. SANDERS, R. K. M.; JOSEPH, R.; MARTYN, B. & PEACOCK, M. L. - Intrathecal antitetanus serum (horse) in the treatment of tetanus. Lancet, 1: 974-977, 1977.

[33] 33. SANDERS, R. K. M. - Treatment of tetanus (letter). Brit. med. J., 2: 1979

[34] 34. SANDERS, R. K. M. - Intrathecal tetanus serum (letter). Lancet, 2: 1200, 1980.

[35] 35. SEDAGHATIAN, M. R. - Intrathecal serotherapy in neonatal tetanus: a controlled trial. Arch. Dis. Childh., 54: 623-625, 1979.

[36] 36. SHANN, F. - Intrathecal administration of tetanus antiserum (letter). Med. J. Aust., 24: 604-605, 1983.

[37] 37. SHERRINGTON, C. S. - Observations with antitetanus serum in the monkey. Lancet, 2: 964-966, 1917.

[38] 38. SINGH, A. K.; BANSAL, A.; GOEL, S. P. & AGARWAL, V. K. - Intrathecal antitetanus serum (horse) with steroid in the treatment of neonatal tetanus. Arch. Dis. Child., 55: 527-531, 1980.

[39] 39. SINGHI, S. & SINGHI, P. - Intrathecal ATS and high dosage diazepan in neonatal tetanus (letter). Arch. Dis. Child., 54: 650-651, 1979.

[40] 40. SMITH, J. W. G. - Intracerebral antitoxin experimental tetanus. Brit. J. exp. Path, 47: 17-24, 1966.

[41] 41. SPAETH, R. - Therapy of tetanus - a estudy of two-hundred and seventy-six cases. Arch, intern. Med., 68: 1133-1160, 1941.

[42] 42. TESTASOCCA, D.; TORRONI, P.; MAZZONI, A. L.; ZENOBI, G. & GUAZZINI, S. - Advancement in treating of tetanus: intravenous and peridural administration of human immunoglobulins (Abstract). In: NISTICÒ, G. & STRONGOLI, M. C, ed. - International Conference on Tetanus, 7., Copanello, Italy, 1984. Abstracts. Copanello, 1984. p. 133.

[43] 43. THOMAS, P. P.; CROWELL, E. B. & MATHEW, M. - Intrathecal anti-tetanus serum (ATS) and parenteral betamethasone in the treatment of tetanus. Trans. roy. Soc. trop. Med. Hyg., 76: 620-623, 1982.

[44] 44. VAKIL, B. J.; ARMITAGE, P. & LAURENCE, D. R. - Therapeutic trial of intrathecal human tetanus immunoglobulin in severe tetanus. A preliminary communication. In: INTERNATIONAL CONFERENCE ON TETANUS, 4., Dakar, 1975. Proceedings. Lyon, Fondation Merieux, 1975. p. 423-425.

[45] 45. VAKIL, B. J.; ARMITAGE, P.; CLIFFORD, R. E. & LAURENCE, D. R. - Therapeutic trials of intrathecal (intracisternal) administration of human tetanus immunoglobulin in severe tetanus. (Abstract). In INTERNATIONAL CONFERENCE ON TETANUS, 5., Ronneby, Sweden, 1978. Summaries of the presentations. Ronneby, 1978, p. 74.

[46] 46. VAKIL, B. J.; ARMITAGE, P.; CLIFFORD, R. E. & LAURENCE, D. R. - Therapeutic trial of intracisternal human immunoglobulin in clinical tetanus. Trans. roy. Soc. trop. Med. Hyg., 73: 579-583, 1979.

[47] 47. VERONESI, R.; BIZZINI, B.; HUTZLER, T. U.; FOCACCIA, R.; MAZZA, C. C; FELDMAN, C; FERREIRA, M. S.; DIETZE, R.; RODRIGUES, M. L. M. & TIMERMAN, A. - Eficácia do tratamento do tétano com antitoxina tetânica por via raquidiana e/ou venosa. Estudo de 101 casos, com pesquisa sobre a permanência da gamaglobulina humana F(ab)² no liquor e no sangue. Rev. bras. Clin. Terap., 9: 301-319, 1980.

[48] 48. VERONESI, R.; BIZZINI, B.; MAZZA, C. C; FOCACCIA, R.; FELDMAN, C; COSCINA, A. L. & HUTZLER, R. U. - Tratamento específico do tétano com uma fração F(ab') da imunoglobulina antitetânica injetada por via raquidiana. Rev. Hosp. Clín. Fac. Med. S. Paulo, 38: 147-149, 1983.

[49] 49. WELLHÕNER, H. H.; NIGGEMANN, B. & ERDMANN, G. - Spinal pharmacokinetics of liposome-entrapped tetanus antibodies. (Abstract). In: NISTICÒ, G. & STRANGOLI, M. C, ed. - INTERNATIONAL CONFERENCE ON TETANUS, 7., Copanello, Italy, 1984. Abstracts. Oopanello, 1984. p. 131.