Resumo em Português:

Foi feita avaliação do comportamento da globulina beta do LCR em processos inflamatórios do SNC e/ou de seus envoltórios no sentido de verificar até que ponto podem ser úteis para o prognóstico as informações obtidas. Essa avaliação foi baseada no fato de a concentração dessa globulina no LCR estar relacionada ao metabolismo do parênquima nervoso, aumentando em condições que acarretem seu sofrimento. Os proteinogramas do LCR de 45 pacientes com processos inflamatórios do SNC e/ou de seus envoltórios, distribuídos em 6 grupos de casos, foram analisados segundo a possibilidade de o processo inflamatório estar acarretando, ou não, sofrimento do parênquima encefálico. A análise dos resultados mostrou que o estudo da concentração da globulina beta no LCR fornece elementos que permitem avaliar o comprometimento do parênquima encefálico nessas condições, aduzindo dados úteis para a avaliação prognóstica. A intensidade do aumento da concentração dessa globulina no LCR era maior do que a do aumento da concentração de albumina nos casos em que o processo inflamatório determinava comprometimento do parênquima encefálico.

Resumo em Inglês:

The CSF proteins of 45 patients with inflammatory diseases of the CNS were studied in order to evaluate the information that the beta-globulin content may bring about the occurrence of involvement of brain tissue. The material was distributed in 6 groups according to the diagnosis of the cases: 10 patients had spinal cord and/or radicular inflammatory disease, associated or not with leptomeningeal involvement (group 1); 5 had acute leptomeningitis (group 2); in 5 the diagnosis of tuberculous meningo-encephalitis was made (group 3); in 10, of cysticercosis of the CNS (group 4); in 5, of neurosyphilis (group 5); in 10, of encephalitides (group 6). Total protein content was determined by the turbidimetric method of the trichloroacetic acid. The protein fractions were analyzed through paper strip electrophoresis. The results were evaluated in respect to normal values previously reported. The high gamma-globulin content of the CSF in inflammatory processes of the CNS hinders the evaluation of the changes occurring in the content of the other globulins; the interference of such factor is more marked when the inflammatory process is chronic. In such conditions the evaluation of the content of the other globulin fractions is better achieved by comparison with the albumin content, the values reported for each globulin being statistically compared to those obtained for the albumin fraction. By this procedure it was shown that in all 45 cases changes in the alpha-globulin content were not different from that found for the albumin fraction and it was concluded that these data bring no evidences indicating interference of other factors than those related to the blood-CSF barrier for the explanation of the changes in the alpha-globulins content of the samples studied. Significant differences were found in respect to beta and gamma globulins. The changes found in the gamma-globulin support the possibility that the increase of this globulin is conditioned by the local production. Data concerning to beta-globulin in the cases of groups 5 and 6 showed that the increases in the amount of this globulin were more marked than those observed for the albumin. This difference was statistically significant. It brings evidence of participation of a different factor in the explanation of the finding other than those accepted for the albumin fraction. The discussion on the nature of this factor supports the possibility of its relation to the changes in the protein metabolism of the brain, since the damage of the latter was present in the cases of these groups of patients. These data are in agreement to the findings on the changes registered in the content of this globulin in the CSF in degenerative diseases as it is reported in the literature. The changes in the beta-globulin content of the CSF which are more marked than those found in the albumin content bring useful information when the data are analyzed in respect to their respective normal values; they point out to the possibility of brain damage by the inflammatory process. In the basis of such evidence cases of the groups 3 and 4 are considered and it was found that the data obtained did not differ from those resulting from the surgical or necroscopic examination and from the follow-up of the patients.

Resumo em Português:

O diagnóstico de megalencefalia deve ser feito em vida, especialmente pela possibilidade de confusão com hidrocefalia. Os dados anamnésticos e clínicos poderão, em alguns casos, sugerir esta hipótese diagnóstica; entretanto, são as punções ventriculares que, geralmente, orientam para o diagnóstico certo. As pneumografias confirmam o diagnóstico, podendo ser dispensadas nos casos típicos. Outros exames (radiografias do crânio, eletrencefalograma ou arteriografia cerebral) têm pouco valor. São apresentados 7 casos em que o diagnóstico foi feito em vida. Em um paciente havia também macroglossia e, em dois irmãos, mancha vinhosa ao nível da glabela. A incidência familiar foi observada em dois pares de crianças, sendo que em um dêles os pais eram consangüíneos. A casuística apresentada - relativa a um período de 7 anos - maior do que as encontradas na literatura compulsada, mostra que a megalencefalia não é tão rara como geralmente é admitido.

Resumo em Inglês:

Megalencephaly should be diagnosed during life, especially knowing that it could be confused with hydrocephalus. The diagnosis could be arrived at on the basis of clinical data in some cases, but mostly by way of the ventricular puncture. Pneumoencephalography or pneumoventriculography may confirm the diagnosis but it is not essential in a typical case. Other procedures like X rays of the skull, electroencephalograma or cerebral angiography are of little help. Seven cases diagnosed during life are presented. One patient had macroglossia; two brothers had a hemangioma at the glabella area. A familial tendency was noticed in two pairs of children, one of them with consanguineous parents. Judging by our series, which seems to be larger than others, megalencephaly is not such a rare condition as it is thought to be.

Resumo em Português:

Foram estudados 20 casos de miastenia grave mediante exame radiológico simples para evidenciar a persistência ou hipertrofia do timo e estudar, comparativamente, os resultados dêste método propedêutico com o uso do enfisema do mediastino seguido de pneumografia e/ou planigrafia. Com tal procedimento foi possível mostrar, em 18 dos casos, a persistência ou hipertrofia do timo. Em alguns casos foram analisados os diversos aspectos radiológicos do timo em suas relações com as medidas terapêuticas, adotadas em particular com o uso do ACTH, radioterapia e/ou timectomia; neste particular, os autores não puderam tirar conclusões definitivas por ser pequeno o número de casos estudados.

Resumo em Inglês:

The authors studied 20 cases of myasthenia gravis with radiological examination showing the persistence or hipertrophy of the thymus. In these cases were made radiological examination without contrast and with mediastinal emphysem. The persistent of hypertrophy thymus is proved by this last method in almos all cases. The several radiological aspects of the thymus were analysed and its relations with the therapeutic by ACTH, radiotherapy and/or thymectomy presented; however, in this field, the authors can't be conclusive because they have still a few cases.

Resumo em Português:

São analisados do ponto de vista clínico e eletrencefalográfico, 21 casos relativos a crianças com epilepsia abdominal. Os autores chamam a atenção para as dificuldades que freqüentemente surgem para estabelecer êsse diagnóstico em crianças e, principalmente, para correlacioná-lo à uma patologia cerebral. Representa o EEG um exame subsidiário de valor como auxiliar no diagnóstico, principalmente quando são registradas as disritmias 14 e 6 por segundo. É considerada também a importância das estruturas subcor-ticais e suas ligações com o lobo temporal na regulação da atividade do trato gastrintestinal.

Resumo em Inglês:

The clinical and electroencephalographic finding of 21 children with abdominal epilepsy are analised. There is inquestionably an overlopping between the clinical syndrome of abdominal epilepsy and cerebral pathology. The EEG is usually abnormal and often shows the "14 and 6 per second dysrhythmia" which is an indication of abdominal epilepsy. In basis of experimental and clinical evidence it seems probable that the state of activity of the gastro-intestinal tract is under cerebral cortex and lower centers influence.

Resumo em Português:

Foram estudados do ponto de vista neurológico 30 pacientes portadores de coriorretinite e com reação de Sabin-Feldman positiva para toxoplasmose: não foram encontradas alterações de importância nos exames neurológicos; em três casos o exame radiológico mostrou calcificações intracranianas; em todos os casos foi normal o exame de líquido cefalorraqueano. A análise dos registros eletrencefalográficos evidenciou, entretanto, a presença de anormalidades em 73,4% dos casos (disritmias paroxísticas, desorganização do ritmo de base e assimetria entre a atividade elétrica dos hemisférios cerebrais). O EEG é, portanto, um método útil para a demonstração de alterações cerebrais nos pacientes com toxoplasmose.

Resumo em Inglês:

Thirty patients with chorioretinitis and positive Sabin-Feldman dye test were studied concerning their neurologic aspects. There were no striking abnormalities in neurologic examination and skull X-rays. Otherwise electroencephalographic studies indicate that 73.4% of the 30 patients showed some degree of abnormalities. The most frequent changes consisted of paroxysmal sharp waves patterns, diffuse desorganization changes and as-symetrical brain waves activities. It should be emphasized the high incidence of electroencephalographic abnormalities in patients with toxoplasmosis.

Resumo em Português:

O presente trabalho é baseado no estudo dos perfis eletroforéticos das proteínas do líquido cefalorraqueano de 300 pacientes normais ou portadores de diversas entidades neurológicas. Analisando êste material, os autores verificaram que a gama-globulina é a fração protêica cuja variação tem grande importância na prática neurológica para o diagnóstico diferencial. A principal conclusão a que chegaram indica que há dois diferentes mecanismos que atuam na alteração do perfil eletroforético das proteínas do líquor: a) alteração da permeabilidade da barreira hêmato-encefálica; b) liberação intratecal de gama-globulina. Portanto, o método eletroforético não permite o diagnóstico de determinada entidade neurológica, mas indica o mecanismo fisiopatológico em atividade.

Resumo em Inglês:

This paper is based on the study of the protein profile of the cerebrospinal fluid of 300 neurological patients. This material was analysed in the same way as that one performed by Matiar and Schmidt (1958) and it was found almost the same results. These findings suggested the great value of the cerebrospinal fluid gamma-globulin concentration in the neurological differential diagnosis. In order to enlarge these studies in our own material, it was tried to find some correlation between albumin and globulin fractions expressed in mg/100 ml. The logarithm of albumin concentration was plotted graphically against the logarithm of globulin concentration; each disease was noted down as different symbols. It was verified linear bilogarithmic correlation between albumin and each globulin fraction. Graphs with albumin/alpha-globulin or with albumin/beta-globulin showed absence of characteristic disease behaviour. On the contrary, the graph with albumin/gamma-globulin showed a typical behaviour for neurolues and brain cysticercosis data. Assuming that the cases of spinal block may very well indicate the condition where the changes of the spinal fluid proteins were due to a modification of permeability of the blood-brain barrier, it was calculated the regression equation for the various gamma-globulin concentrations of these cases. It was found that most of the cases of brain tumors, intracranial hemorrhages, meningitis and polyradiculoneuritis were in perfect agreement with the cases of spinal block, suggesting that in these cases the protein changes were due to a modification of permeability of the blood-brain barrier. On the contrary, the great majority of the cases of neurolues and brain cysticercosis did not follow this pattern, suggesting that there was an increase of the spinal fluid gamma-globulin which must be originated intrathecally. These findings point out to two different mechanisms in the changes of the protein profile of cerebrospinal fluid and, therefore, electrophoresis did not allow the diagnosis of a determined neurological disorder, but it shows the particular physiopathological mechanism involved.

Resumo em Português:

Os autores relatam os efeitos da cinesioterapia em 24 crianças portadoras de déficits motores por lesão de nervos periféricos. A avaliação do grau de fôrça muscular foi feita mediante o emprêgo de testes musculares manuais, adotados pela National Foundation for Infantile Paralysis (New-York) e, de acôrdo com os déficits musculares existentes, foi seguido programa cinesioterápico com base nos exercícios de resistência progressiva de De Lorme; além disso os pacientes foram submetidos a exercícios para recuperar e desenvolver funções básicas da vida diária (preensão e marcha). Todos os pacientes foram medicados com ACTH e cortisona durante a fase aguda. Em 23 pacientes (99,8%) foi possível obter a recuperação da capacidade de preensão e da marcha; em um (0,2%) a recuperação da marcha foi parcial. O tempo médio de cinesioterapia durante a internação foi de 45 dias. Êstes resultados mostram que as polineuropatias periféricas em fase aguda são beneficiadas com a hormonioterapia e que a recuperação motora é abreviada com a utilização precoce da cinesioterapia. A cinesioterapia não só evita que se instalem seqüelas irremissíveis, como conserva o mecanismo efetor durante a regeneração nervosa, constituindo-se em valioso auxiliar da terapêutica medicamentosa.

Resumo em Inglês:

The authors describe the effects of kynesiotherapy in 24 children with motor impairments caused by peripheric nerve lesions. The evaluation of muscular strength was performed by manual musculary tests, used by the N.F.I.P. (N.Y.) and, according to the musculary deficits in each case, a kynesiotherapy program was followed, based on the progressive resistance exercises of De Lorme. The patients were also submitted to exercises to develop basic functions of daily living (prehension and walking). All the patients were treated with ACTH and cortisone during the acute period. In 23 patients (99.8%) it was possible to obtain the recuperation of the ability to prehension and walking; in one case (0.2%), a partial recuperation of walk. The rate duration of kynesiotherapy during the period of internation was 45 days. These results show that peripheric polineuropathies are beneficiated by hormonetherapy in the acute period and the motor recuperation is shortened using early kynesiotherapy.