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We characterized the impact of the metabolic syndrome (MetS) and its components on cardiovascular adverse events in patients with symptomatic chronic multivessel coronary artery disease, which have been followed prospectively for 2 years.Patients enrolled in the MASS II study were evaluated for each component of the MetS, as well as the full syndrome.The criteria for MetS were fulfilled in 52% of patients. The presence of MetS (P0.05), glucose intolerance (P=0.007), and diabetes (P=0.04) was associated with an increased mortality in our studied population. Moreover, despite a clear tendency for each of its components to increase the mortality risk, only the presence of the MetS significantly increased the risk of mortality among nondiabetic study participants in a multivariate model (P=0.03, relative risk 3.5, 95% confidence interval 1.1-6). Finally, MetS was still associated with increased mortality even after adjustment for diabetes status. These results indicate a strong and consistent relationship of the MetS with mortality in patients with stable coronary artery disease.Although glucose homeostasis seems to be the major force driving the increased risk of MetS, the operational diagnosis of MetS still has information for stratifying patients when diabetes information is taken into account.

A determinação da atividade enzimática da adenosino-deaminase (ADA) no líquido cefalorraqueano (LCR) de pacientes com síndrome da imunodeficiência adquirida (AIDS) pode sinalizar, ainda que de modo inespecífico, a atividade de patologias associadas. Os níveis de atividade de ADA, estudados no LCR de 263 pacientes, estavam aumentados naqueles com patologias associadas em relação aos controles normais e em relação aos pacientes com AIDS que não apresentam alterações ao exame de LCR. No entanto, os níveis de ADA detectados no LCR não apresentaram diferença estatística ao se considerarem os seguintes grupos de pacientes distribuídos segundo os achados no próprio LCR: com anticorpos para toxoplasmose, sífilis ou citomegalovírus; com C. neoformans ou seus antígenos; com bacilos álcool-ácido-resistentes; com linfomas.

Phenobarbital plasma levels were studied in a group of 25 newborn infants. Phenobarbital was administered i.v. in all cases throughout the study period. The mean loading dose was 19.4 mg/kg, ranging from 16.4 to 20.5, and the mean maintenance dose was 4.0 mg/kg/day, varying from 2.6 to 5.0. We obtained mean plasma levels of 22.9 micrograms/ml, 24 h after administering the loading dose. Mean plasma levels at 4, 7, 14 and 21 days were in the therapeutic range (15-40 micrograms/ml), with only a few cases falling outside of it. There was no difference in plasma phenobarbital levels between term and pre-term infants. Side effects were not seen in infants without a severe neurological impairment prior to drug administration.

HTLV-l antibodies were investigated in serum and in CSF of 150 patients with neurologic disorders mainly myelopathies. The patients were considered into three groups according to the possible relationship of their disease to the presence of HTLV-l antibodies: no relationship risk (control group), occasional risk group, and possible risk group. In this latter are 56 patients with crural spastic paraparesis or paraplegia of unknown etiology (SP). HTLV-l antibodies were tested by the passive particle-agglutination method for anti-ATLA antibody detection. The search was negative in all patients of the control group, and positive (serum and/or CSF) in 16.5% of the patients from the second group and in 55.4% of the SP patients group. Clinical patterns in SP cases with HTLV-l antibodies were those of tropical spastic paraparesis (TSP). CSF patterns considered (cytology, protein content and gamma-globulins rate) were different between TSP group with HTLV-l antibodies in CSF and SP group with no HTLV-l antibodies detection either in serum or in CSF. The difference was significant. Results of this investigation confirm the high incidence of TSP in Brazil, and bring additional indication for searching HTLV-l antibodies in the CSF.

In this preliminary report the results of PCR for detection of DNA sequences (65 KDa antigen) of Mycobacterium tuberculosis in CSF samples from 20 patients are registered. In 10 patients there were clinical and laboratory findings suggesting the diagnosis of tuberculous meningitis (test group). In the other 10 patients, clinical and laboratory findings suggested meningitis or meningo-encephalitis from other etiologies (control group). In 7 patients from the test group antigenic DNA sequences of Mycobacterium tuberculosis were found in CSF by PCR; positive results were not registered in the control group.

Attention given to prophylaxis of neurocysiticercosis (NC) is far beyond minimal needs among several regions of the in-development world, and for this reason incidence of the disease persists high among them. This investigation was carried out to show the extent of the problem by analysing the incidence of NC in a region of Brazil (São Paulo). CSF immunodiagnosis of NC by detecting antibodies to Cysticercus cellulosae in a neurodiag-nostics laboratory is evaluated for this purpose. Cases studied in a 63-year period (1929-1992) are reviewed. Total cases in this period is 139,000, and for 1,573 (1.13%) diagnosis is NC. Special characteristics were not detected for colour and sex prevalence. Age bracket prevalence is from 21 to 40 years old (55.3%) high rates occurring for women between 21 to 30 years old, and for men between 31 to 40. Cases distribution in five consecutive decades (1942-1991) shows no decreasing tendency: average incidence is 1% for the 50 years, and it is over this average for the last three decades. Data confirm that incidence continues expressively high throughout the 50 years covered by this study. A atenção dada à profilaxia da neurocisticercose (NC) encontra-se aquém do mínimo necessário em várias regiões do terceiro mundo, motivo pelo qual nelas a incidência da doença continua alta. Esta investigação foi feita para mostrar a importância do problema pela análise da incidência da NC em uma região do Brasil (São Paulo). Para tanto foram considerados os dados de um laboratório de neurodiagnóstico em que o imunodiagnóstico de NC é baseado na detecção de anticorpos a Cystioercus cellulosae no líquido cefalorraqueano (LCR). Os casos estudados no período de 63 anos (1929-1962) são revistos. O número de casos nesse período foi 139.000, o diagnóstico sendo NC em 1.573 deles (1,13%). Não foram encontradas características especiais de prevalência para cor e idade. A prevalência quanto a faixa etária se encontra entre 21 e 40 anos de idade (55,3%), sendo maior para mulheres entre 21 e 30 anos de idade e, pana homens entre 31 e 40. A distribuição dos casos em 5 décadas consecutivas (1942-1991) não mostra tendência a decréscimo: a incidência média foi 1% para os 50 anos, encontrando-se acima da média a incidência nas 3 últimas décadas. Esses dados confirmam que a incidência se mantém expressivamente alta nos 50 anos abrangidos pelo estudo.

In a seven year time period (July 1984 to June 1991) were studied CSF samples of 36,216 new patients, 470 of them infected by HIV. Number of AIDS patients represents 1.30% of total cases examined in the laboratory during this time period. Normal CSF was observed in only 16 cases (3.4%). Associated pathologies occurred in 66% of cases. Opportunistic infections predominated among them (227 cases). Data support indication for CSF examination in HIV infected patients. This exam must be as complete as possible.

Immunomodulator therapy migration in relapsing remitting multiple sclerosis: a study of 152 cases

Sessenta e dois casos de neurossífilis sintomática foram tratados com penicilina G, na dose diária de 20 ou 24 milhões de UI. por via intravenosa, durante 15 a 30 dias. O tempo médio de acompanhamento foi de 30 meses. Antes do tratamento, 41 pacientes apresentavam pleocitose ao exame do LCR. Seis meses e doze ou mais meses depois, foi constatada pleocitose em 4 (9,8%) e em 3 pacientes (7,3%), respectivamente. A proteinorraquia e os títulos das reações de Wassermann do soro e do LCR reduziram-se lentamente depois do tratamento. O teor de globulinas gama do LCR e os índices de imunoprodução local do sistema LCR ainda encontravam-se elevados depois do primeiro ano após tratamento. Os resultados da penicilinoterapia intravenosa em altas doses constatados neste estudo não diferiram daqueles obtidos com penicilinoterapia intramuscular em baixas doses registrados na literatura.

Investigation on the behavior of immunoglobulins IGG, IGA and IGM in the CSF in cases of cysticercosis of the CNS, based on data pertaining to two different series of cases. The first series comprises 30 samples of CSF, and the second one, 5 samples. It was demonstrated that IGG is the one representing the largest contingent. IGG concentration keeps in proportion with the gamma globulin concentration, of which it represented an 88% average in the cases studied. Participation of IGG in the protein profile of the CSF is greater than the usually referred; the results for the material analyzed showed 16%. It was verified a proporcionality also between IGG concentration and the titer of positive complement fixation test for cysticercosis; there is a positive correlation, whose numerical expression was found to be significant, in the samples studied.

Forty four pacients with primary acute and subacute meningomyeloradiculopathies were studied in respect to the evolutive aspects of the cerebrospinal fluid (CSF) cell-protein dual in several periods of the disease. The tendency of CSF hypercytosis to normal values of cell count occurred in most cases (96%) at the end of the period in which the study was performed (60 days). The CSF protein levels had a similar but slower behavior pattern when compared with hypercytosis. The comparative analysis of clinical improvement of two groups of patients (treated and not treated with ACTH or corticosteroids) showed a statiscally significant difference between the two groups favouring the former. This fact enhances the possibility that an auto-immune process plays an important role in cases of primary meningomyeloradiculopathies.

Foram estudadas 133 amostras de LCR provenientes de 115 pacientes para verificar o teor da PBM, fragmento P1 43-88. Os casos foram subdivididos em subgrupos de acordo com o diagnóstico nosológico. No grupo controle (50 casos de pacientes com cefaléia crônica) não houve detecção de PBM em qualquer das amostras; dos casos de neurocisticercose (44), em 4 havia presença da PBM; nos de esclerose múltipla (8) em três havia PBM; em um caso de neuroes-quistossomose, forma medular, também foi detectada a presença da PBM. Considerações de ordem neuroimunológica são tecidas sobre os resultados encontrados. Cerebrospinal fluid (CSF) from 115 patients with several neurological disorders were tested for the presence of myelin basic protein (MBP), fragment P1 43-88. Cases were divided into groups according to neurological diagnosis. The control group (50 patients with chronic headache) presented normal CSF composition and presented no evidence of the presence of MBP. MBP was found in: four cases of the 44 of neurocysticercosis; three of the 8 cases of multiple sclerosis; one case of schistosomiasis with spinal cord involvement. Neuroimmunological data are discussed considering results found in this investigation.

Mural thrombi in the cavities of the heart are commonly found in chronic Chagas' cardiopathy and embolic phenomena may result from them. Acute cerebrovascular insults resulting from embolic occlusion of cerebral arteries are described in Chagas' disease since 1953. The purpose of this investigation was to evaluate the incidence of this type of cerebrovascular embolic insult. Two groups of patients successively admitted to a general hospital were studied: the first of 63 cases of chronic Chagas' cardiopathy; the second of 84 cases of acute cerebrovascular disease. The brain insult was non-hemorrghagic type in 59 cases of the second group. The evaluation pertinent to the first series showed that embolic cerebrovascular insult occurred in 3.17% of the cases. Concerning the second series the incidence of embolic cerebrovascular insult secondary to chronic Chagas' cardiopathy was 4.76% when all cerebrovascular insults were considered, and 6.78% when only non hemorrhagic cerebrovascular insults were considered.

Six cases of meningeal melanomatosis are reported. The cytomorphological analysis of cerebrospinal fluid lead to diagnosis in all of them. Emphasis is given to morphological characteristics of the tumor cells and specially to the melanin dark brown pigment, observed in all cases here reported.

O comportamento do dual citoproteico do LCR é instrumento adequado para a compreensão e o acompanhamento evolutivo de processos inflamatórios do sistema nervoso central. O surto inflamatório sinalizado por eosinófilos na cisticercose do sistema nervoso central é semelhante, quantitativa e qualitativamente, ao que ocorre em processos inflamatórios monofásicos de etiologia viral. No entanto, pode ocorrer dissociação de comportamento das globulinas gama, gradativa e persistentemente aumentadas com relação ao citoproteinograma clássico. Tal fato pode ser expressão de imunoagressão semelhante à que ocorre em processos inflamatórios do sistema nervoso central com componente autoimune, como a neurossifilis e a esclerose múltipla.

Foram estudadas a concentração proteica total e o perfil proteico de 40 RN-PT sadios. Os resultados encontrados foram comparados àqueles obtidos para 40 RN a termo igualmente sadios, selecionados segundo critérios semelhantes, cujo LCR foi analisado mediante os mesmos métodos e no mesmo laboratório. Os dados obtidos confirmam ser, em média, a concentração proteica total superior no RN-PT que no RN a termo e a diferença encontrada foi estatisticamente significativa. O perfil proteico mostrou-se, em média, também diverso. As diferenças encontradas permitiram caracterizá-lo como de "tipo misto", sendo salientada a ausência frequente da sub-fração táu. The total protein concentration and the protein profile were studied in 40 healthy premature newborn infants at the second day of life. The results were compared to those obtained for 40 full-term healthy newborn infants. Results pertinent to this last group were reported previously. Results here reported confirm that there is a higher total protein concentration in the cerebrospinal fluid of the premature newborn infant. Statistical analysis shows that the difference is significant (t : 2 -16) The mean protein profile shows a protein fractions distribution proper to the "mixed profile type". The absence of tau-fraction was the most commonly finding observed in this way. Data were compared to those reported in the literature, and they were also considered proper to immaturity conditions of blood brain barrier.

Foi estudado sistematizadamente o LCR de 50 pacientes com AIDS que apresentavam sintomatologia passível de ser atribuída a comprometimento do SNC. Somente 5 apresentavam o quadro do LCR dentro dos limites normais. Em um, ocorriam células neoplásicas (linfoma); em 10, Cryptococcus neoformans; reações imunológicas foram positivas para sífilis em três e para toxoplasmose em 4. Um dos casos de criptococose apresentava simultaneamente toxoplasmose e desenvolveu sífilis, ulteriormente. Em outro dos casos de criptococose durante a evolução surgiram leveduras do gênero Candida. Considerando os achados, são discutidos quanto ao LCR aspectos: da reação inflamatoria na vigência de imunodeficiência; do comprometimento da BHE; do comprometimento do SNC; de efeitos de massa que podem ocorrer, como aqueles provocados por tumores e granulomas. Cerebrospinal fluid (CSF) was analysed in 50 AIDS patients in this investigation. CSF analysis included: pressure, aspect, colour, cytology (cell number, cytomorphology, and lymphocyte subpopulations), proteins concentration and their electrophoretic distribution, chloride and glcosis concentration, GOT and LDH activity, immunology for cysticercosis, syphilis and toxoplasmosis, bacteriology, and mycological examinations (direct, cultures, Cryptococcus neoformans antigen test). Diagnostic changes were: lymphoma cells in one patient, cryptococcosis in 10, toxoplasmosis in 4, candidiasis in 1, and syphilis in 3. Cryptococcosis occurred in association with toxoplasmosis in one patient who developed syphilis in the follow-up; oligoclonal distribution of gamma globulins ocurred in this case. In another case of cryptococcosis, candidiasis appeared during the course of the disease. Changes in the CSF composition observed are discussed in order to evaluate: aspects of CSF inflammatory response in report to immunodeficiency; blood-brain barrier involvement; CNS damage; intracranial mass effects.

Com o objetivo de padronizar modelo experimental de imunossupressão foram selecionados dois lotes de 50 camundongos impúberes, cada um dividido em grupos de 10, e submetidos a ação de dexametasona. O estudo foi dividido em dois experimentos. No primeiro experimento foi utilizado o primeiro lote de animais e foram estabelecidas as condições para obtenção de modelo de imunossupressão em camundongos mediante administração de dexametasona diluída na água de consumo e ingerida ad libitum pelos animais. Entre os critérios utilizados para avaliar a vigência de imunossupressão são realçados: a ocorrência de eriçamento de pelos, leucopenia por diminuição do número de linfócitos e hipotrofia do baço comparativamente aos controles, com hipoplasia intensa de todas as estruturas linfóides. No segundo experimento foi empregado o segundo lote de animais e foi estudado o comportamento do modelo experimental estabelecido. Os animais receberam, por via intraperitonial, número aproximado delO6 leveduras com os caracteres morfológicos do Cryptococcus neoformans, provenientes de culturas de cepas patogênicas ao homem e isoladas do líquido cefalorraqueano de pacientes com neurocriptococose. Apesar de haverem sido identificadas leveduras em cortes histológicos de pulmão, fígado e baço em todos os camundongos inoculados, somente ocorreu o óbito naqueles em que havia acometimento do sistema nervoso central pela levedura (aproximadamente 50% dos animais). A discussão dos resultados obtidos e seu significado inclui considerações sobre o possível papel desempenhado pela função barreira hêmato-encefálica no evento constatado.

Anticorpos antitreponêmicos da classe IgM foram pesquisados no soro e no LCR de 9 casos de neurossífilis sintomática, antes e, em diversos momentos, depois do tratamento. Esses anticorpos foram investigados mediante reações de imunofluorescência (IgM-FTA-Abs), hemadsorção em fase sólida e imunoenzimática (ELISA). Os títulos das reações reduziram-se, mas houve persistência da reatividade no soro e no LCR no segundo ano após tratamento.

Registro de três casos de hidrocéfalo com pressão normal cuja etiopatogenia estava na dependência da reação inflamatória do sistema continente do líquido cefalorraqueano própria à neurocisticercose. Os aspectos clínicos, do líquido cefalorraqueano, da cintilografia isotópica, do pneumencefalograma são discutidos. Após a derivação ventrículo-jugular efetuada, houve melhora do quadro clínico próprio à síndrome de hidrocéfalo com pressão normal nos três casos. Trata-se do primeiro estudo em que a síndrome é descrita na dependência da neurocisticercose. Three cases of normal pressure hydrocephalus are reported. Cysticercosis of the central nervous system was found to be the main etiopathogenic factor responsible by the syndrome in these cases. Clinical and diagnostic aspects of the cases, and the good results of ventriculo-jugular derivation concerning the clinical aspects of the syndrome are pointed out. This is the first report in the literature concerning to normal pressure hydrocephalus resulting from cysticercosis of the central nervous system.

Cerebrospinal fluid (CSF) samples of 200 patients who presented central nervous system (CNS) pathologies were evaluated for antibodies to Trypanosoma cruzi (T. cruzi). The evaluation was made through: complement fixation test (CFT) in 69 patients, indirect (IgG) immunofluorescence test (IFT) in 118, and by CFT and IFT in 13. In 50 cases the IFT has been made also in concentrated (20 X) CSF samples. Results were evaluated in report to CNS pathology, CSF cells and proteins, and tests in the CSF for other CNS infections (syphilis, cysticercosis, schistosomiasis, toxoplasmosis). These tests were based on techniques similar to those adopted for the search of antibodies to T. cruzi, and were conducted concomitantly to tests for T. cruzi in the same CSF sample for everyone of the cases. Antibodies to T. cruzi were found in three patients. The first was a patient committed by the acquired immunodeficiency syndrome (AIDS) in whom there occurred exacerbation of the acute stage of Chagas' disease. The second is a patient who is committed by epilepsy, and an acute stroke occurred in the third patient: Chagas' disease had been previously diagnosed in them through the demonstration of antibodies to T. cruzi in the blood serum.

São apresentados 18 casos de criptococose do sistema nervoso central e são tecidos comentários a propósito do tratamento e das dificuldades respectivas, especialmente em pacientes transplantados renais. É chamada a atenção para as eventuais possibilidades de nova droga introduzida para o tratamento da afecção e empregada em um dos casos relatados, o miconazole. Results obtained in the treatment of cryptococcosis of the central nervous system with amphotericin-B, 5-fluorocytosine and miconazole are evaluated. The evaluation is based upon 18 cases. Emphasis is given to data pertinent to aspects proper to 7 of them, submitted to chronic immunossupressive treatment due to previous kidney transplantation. Side effects varied from case to case in the patients submitted to amphotericin-B and 5-fluorocytosine treatment. The intrathecal and the intraventricular administration of amphotericin-B was followed by complications of several types. Miconazole was used in one case. Its intravenous and its intrathecal administration did not provoke remarkable side effects.

Total cell count of cerebrospinal fluid (CSF) in normal newborn infants has shown no more than 12 leucocytes and 600 red cells by cubic millimeter, as it was previously reported by one of us5. Results on CSF cytomorphology are reported in this study. CSF cytomorphology was studied in 21 normal newborn infants: 2 days old (17 cases) and 7 days old (4 cases). The samples were collected through lumbar puncture. Cytomorphological examinations were carried out after preparing the samples by accelerated gravitational sedimentation in Suta's chamber; the sediments were stained by Leishman's technique. Cytomorphology was type II in most of the cases. Lymphocytes and reticulomonocytes were found in all cases, the relative proportion being 11-59% and 41-78% respectively. Polinuclear neutrophils were found in 12 cases, and the higher relative proportion observed for them was 17%. Eosinophil cells occurred in 3 cases, in the proportion of no more than 2%. Macrophages occured in 12 cases, and the higher proportion observed was 10%. The average values were: lymphocytes 34,6%, reticulomonocytes 60.4%, polinuclear neutrophils 2.9%, eosinophil cells 0.2%, macrophages 1.9%. Linear cell groupings occurred in 3 cases; their nature was morphologically related to choroid cells. Polymorph groupings of undiferenciated reticular cells were found also. They occurred in 5 cases, and their origin was related to cells of arachnoid membrane.

Registro de dois casos de criptococose do sistema nervoso central, em um deles associada a candidíase. Em ambos foram utilizados no tratamento anfotericina-B e 5-fluorocitosina. Em função dos resultados obtidos são feitas considerações quanto à utilidade de cada uma das drogas no tratamento da criptococose, bem como quanto ao uso associado de ambas. Two cases of cryptococcosis of the central nervous system are reported. The treatment was based on the association of amphotericin-B with 5-fluorocytosine. Details on the therapeutic proprieties of these drugs are discussed considering the results obtained. Amphotericin-B was administered intravenously and intrathecally in the two cases. The total amount of amphotericin administered intravenously in the first case was 5.375 mgm, and the oral doses of 5-fluorocytosine were not superior to 100 mgm/kg/of body weight. This patient died 130 days after the first symptoms of the disease. The second patient had been submitted previously to kidney transplantation after bilateral nephrectomy, and inmunossupressive drugs were administered to him since then. Candidiasis and cryptococcosis of the central nervous system developped two years later. 5-fluorocytosine was administered orally (200 mgm/kg of body weight) and amphotericin-B. The total amount of this drug administered intravenously was 2.00 mgm. There was complete clinical and laboratory remission of the mycoses in this case.

Cerebrospinal fluid (CSF) and serum samples of 10 patients with neurocysticercosis under treatment by praziquantel were studied in four occasions: before treatment (day 0) and during treatment on three occasions (days 1, 7 and 21). The immunological reaction analyzed were: ELISA-G and ELISA-M; immunofluorescence-G and immunofluorescence-M; complement fixation. The changes and the variability of results observed through these reactions in this study bring new data that confirm neuroimmunological findings already described in the disease. Acute phase response was found in CSF in 6 cases and only in one case in serum by ELISA-M and immunofluorescence-M. ELISA-G in CSF and serum showed a better sensitivity than the other reactions for diagnosis and for follow-up. Emphasis is given to the importance of the simultaneous realization of several immunological reactions in CSF and serum in patients with neurocysticercosis.

Data on 16 patients with spinal cord involvement by Schistosomiasis mansoni are evaluated as to the clinical course and the evolution of cerebrospinal fluid changes. According to evidences of radicular involvement cases were divided in two groups: myelitis (9 cases) and radiculomyelitis (7 cases). Cerebrospinal fluid changes were evaluated as to cytology, total protein content and gammaglobulins. Partial remission of clinical symptomatology was more common among patients of the second group than among those of the first group. There was not relationship of CSF changes and their course with the clinical course of the disease. Cerebrospinal fluid changes and their course were not related to clinical aspects of the disease and their course. Remission of hypercytosis was more common than the remission of protein changes along the evolution in the two groups of cases considered.

Estudo clínico e laboratorial de dois casos de meningorradiculomielopatia esquistossomótica. Considerações são feitas sobre a fisiopatologia e manifestações neurológicas desta parasitose. A positividade das reações imunológicas para Schistosoma mansoni no líquido cefalorraqueano e as melhoras obtidas mediante terapêutica adequada foram valorizadas para o diagnóstico. The clinical and laboratory findings in two cases of shistosomal meningoradiculomyelopathy due to Schistosoma mansoni are reported. In case 1 the onset and the evolution of the disease assumed a progressive character; the neurologic examination showed a picture similar to the Brown-Sequard syndrome. In case 2 the onset was acute and the neurologic examination has shown a complete transverse myelopathy syndrome at the middle toracic level. The cerebrospinal fluid examination showed in the two cases: cells counts increased, normal or low sugar and increased protein. The study of CSF protein profile showed increased gamma-globulin in the two cases. The immunological reactions in the blood and CSF were positive in the two cases. Good results were obtained with especific therapy.

O autor procura avaliar os problemas ligados à imunobiologia da cisticercose e os recursos laboratoriais atualmente existentes para o diagnóstico baseando-se, especialmente, em dados sobre a infestação do sistema nervoso central. A análise é conduzida mediante revisão de conhecimentos relacionado à biologia do cisticerco, ao quadro histopatológico por ele desencadeado e às reações biológicas que se patenteiam em exames paraclínicos. Esses fatores são discutidos em relação a aspectos peculiares da doença e orientam as conclusões, entre as quais é apontada a necessidade de estudos mediante experimentação animal e a oportunidade de estudos sobre imunoproteínas para o esclarecimento de pontos ainda duvidosos da patogenia. Present concepts on the immunobiology of cysticercosis are reviwed considering the experience on cysticercosis of the central nervous system. For this puspose data related to cysticercus biology, to histopathology of the disease, to biologic aspects evidenced through laboratory investigations and radiology are discussed and evaluated. The lack of experimental studies is stressed and the importance of studies on immunoproteins are pointed out. Informations resulting from these studies might explain many of the doubts that are patent when the concepts on the pathogeny of the disease are considered.

Para mostrar a utilidade da técnica de Suta no estudo da citologia do LCR são apresentados 4 casos nos quais foi demonstrada a presença de células de natureza neoplásicas. Os achados são analisados frente à citologia normal do LCR e classificados segundo variante da classificação de Papanicolaou aplicável à citologia do LCR.

Foi estudada a relação entre as concentrações de 2-sulfaniIamido-5-metilpirimidina (SMP) no LCR e no sangue após a administração oral da droga a 30 pacientes. Do total, 19 apresentavam LCR normal e eram portadores de afecções crônicas não inflamatórias do sistema nervoso. Nos restantes o LCR apresentava alterações de tipos diversos; 4 eram portadores de polirradiculoneurite; um, de meningite crônica; um, de neurolues; 5, de neurocisticercose. Os resultados referentes aos pacientes com LCR normal mostraram que há correlação estatisticamente significativa entre as taxas de SMP no LCR e no sangue. A concentração de SMP no LCR é cêrca da quinta parte da encontrada no sôro. Entre os pacientes com LCR alterado foi encontrado aumento da relação em dois casos de polirradiculoneurite; em ambos havia concentração elevada de SMP no LCR. Nos demais os valôres encontrados para a relação não se afastavam daqueles verificados para pacientes com LCR normal.

Tendo como objetivo analisar a hiperproteinorraquia que ocorre na neuropatia diabética, foi estudado o proteinograma do LCR de 22 pacientes portadores dessa afecção. Para fins comparativos, em 17 dêles foi feito na mesma ocasião o estudo do proteinograma do sôro. A sintomatologia neurológica foi avaliada de modo semiquantitativo. Foi verificado aumento discreto da concentração protêica total do LCR em 7 casos (32%). O perfil eletroforético (eletroforese em papel) das proteínas foi do tipo encontrado no LCR normal, em todos os casos. Discretas alterações quanto ao teor de uma ou outra fração foram registradas. O perfil protêico não apresentava particularidades relacionadas ao fato de ser normal ou aumentada a concentração protêica total do LCR. A relação entre a percentagem no LCR e no sôro de cada uma das frações mostrou alterações do balanço protêico entre LCR e sôro. As alterações eram devidas a modificações globulínicas do proteinograma do sôro. Não foi encontrada correlação significativa entre a concentração protêica do LCR e a do sôro. O resultado da avaliação semiquantitativa da sintomatologia neurológica de cada caso foi correlacionado à concentração protêica total e de cada fração protêica do LCR. Não foi demonstrada correlação estatisticamente significante entre os dados analisados. Entretanto, os valôres obtidos sugerem: correlação da proteinorraquia total com a sintomatologia neurológica; dentre as frações protêicas, maior participação da globulina nessa correlação. Em vista dos resultados obtidos para os casos estudados, os autores consideram que o aumento da proteinorraquia total na neuropatia diabética não pode ser pôsto na dependência de alterações peculiares a uma ou outra fração protêca do LCR. Igualmente, não depende de modificações do proteinograma do sôro e não pode ser explicado em função direta da intensidade do quadro neurológico. É discutida a possibilidade de estar a hiperproteinorraquia relacionada às alterações da barreira hemoliquórica, secundárias às lesões vasculares que acompanham o diabetes mellitus. The present study was carried out in order to investigate the nature of the increase in the cerebrospinal fluid (CSF) protein content described in diabetic neuropathy. The CSF proteins were studied in 22 patients with clinical signs of diabetic neuropathy. The total protein content and the electrophoretic pattern (paper electrophoresis) of the proteins were studied in one CSF sample of each patient. The CSF sample was collected through lumbar puncture. For comparative purposes, the total protein content and the electrophoretic pattern of the blood serum proteins were determined in 17 patients. For the same purpose the impairment of the nervous system was evaluated in a semi-quantitative way. The CSF protein concentration was increased in 7 cases (32%). The increases were slight. The electrophoretic patterns were found to be similar to those found in normal conditions. The relative values found for each of the protein fractions were increased in some instances. Such increases were slight and did not change the protein pattern of the CSF. Among these changes, that regarding the y-globulin was observed in 3 cases. The CSF protein pattern did not show changes related to the total protein content of the sample. Changes in the serum protein pattern did not induce changes in the CSF protein pattern. The correlation between the total protein content of CSF and serum was not statistically significant. In the cases studied no statistically significant correlation between the degree of neurological involvement and the CSF proteins was found. However, the data suggest a trend to correlation between the neurological picture and the total protein content of the CSF, particularly with β-globulin.The results show that the increase in the total protein content of the CSF in diabetic neuropathy is not related to changes regarding one or more of the protein fractions of CSF. It is not dependent also on the protein concentration in the blood serum and/or the changes found in its protein pattern. The degree of the nervous impairment in itself cannot be directly related to the increase in the CSF proteins. The importance of damage in the blood-CSF barrier is pointed out by data of the literature concerning the protein fractions in diabetic patients. Such damage cannot be excluded in the discussion of the results found. Its presence would enhance the passage of proteins to the CSF, thus resulting an increase in the total protein content. Changes in the protein pattern in such conditions are absent or slight, as it was found in the cases studied.

Estudo comparado do proteinograma do LCR e do soro sanguíneo de 20 pacientes com esquistossomose mansoni. Foi possível verificar que as modificações do proteinograma do LCR decorriam das modificações do proteinograma do soro ou então de modificações da barreira hêmato-liquórica. Estas últimas foram caracterizadas em 6 casos. Reações inflamatórias da parede vascular, passíveis de ser observadas na doença são apontadas como a possível causa de alterações da barreira hêmato-liquórica, por acometimento de vasos da leptomeninge. O comportamento do teor de globulina gama no LCR encontrava-se aumentado em 10 pacientes: em 6 o aumento era secundário ao aumento do teor no sangue; em três decorria de modificações da barreira hêmato-liquórica; em um era sugestiva de haver reação inflamatória leptomeníngea na possível dependência da esquistossomose mansoni. The proteins of cerebrospinal fluid and blood sera were studied in 20 unselected cases of schistosomiasis mansoni. It was found that the changes in the CSF protein fractions are secondary to the changes in the protein fractions of blood sera or result from damage of the blood — CSF barrier. This mechanism explained the changes in protein fractions of CSF in 6 patients. The changes in the blood — CSF barrier were atributed to the impairment of leptomeningeal vessels due to vasculitis that may occur in schistosomiasis. The gamma globulin content in the CSF was elevated in ten cases: in six it depended of high gamma globulin content in blood sera; in three it depended on changes in the blood — CSF barrier. In one patient the CSF gamma globulin content was suggestive of local inflammatory changes in the leptomeninges, possibly dependent on schistosomiasis mansoni.

O presente estudo compreende a análise do proteinograma do LCR de 14 pacientes portadores de mielose funicular; em 12 foi feito também o estudo do proteinograma do sôro. Os resultados foram analisados e relacionados a outros aspectos dos casos estudados, como o tempo de duração da doença, a intensidade da sintomatologia neurológica, as alterações hematológicas e a capacidade de absorção da radiocianocobalamina. O proteinograma do LCR era do tipo liquórico propriamente dito, apresentando como particularidade o aumento do teor de β-globulina, o qual é descrito como representativo das afecções de tipo degenerativo do SNC. No soro a principal modificação verificada foi a presença da fração intermediária entre as globulinas β e γ, fato anteriormente assinalado por Furtado. A análise estatística permitiu verificar que havia estreita correlação entre o teor de β-globulina no LCR e a intensidade do quadro neurológico. O teor liquórico de β-globulina parece estar vinculado ao predomínio da lesão central sôbre a periférica, predomínio que se correlaciona ao déficit de absorção de vitamina B12. O teor de β-globulina no LCR mostrou-se também proporcional à deficiência de fator intrínseco no suco gástrico. Por outro lado, a elevação do teor dessa fração proteica no LCR mostrou-se inversamente proporcional à absorção intestinal de vitamina B12. O aumento de β-globulina no LCR parece, por isso, refletir mais de perto o acometimento do sistema nervoso central na verdadeira moléstia de AddisonBiermer. Nos casos em que não havia déficit do fator intrínseco o teor dessa globulina no LCR motrava-se mais próximo da normalidade. Cerebrospinal fluid proteins of 14 patients with funicular myelosis were studied by paper electrophoresis. The serum proteins were also studied in 12 of these cases. The results were discussed regarding other data, as the length of disease, neurologic symptoms, hematologic changes, the absorption of radiocyanocobalamin. The CSF protein profile was mainly altered in the β globulin fraction, which attained pathologic levels in 6 cases. The serum protein profile revealed the intermediate fraction between β and γ globulins in 6 cases, as described by Furtado. Statistical analysis demonstrated the amount of the CSF β-globulin fraction to be proportional to the intensity of the central nervous system impairment. The correlation was not so well defined regarding to peripheral lesions. The amount of CSF β-globulin was found to be proportional to the intrinsic factor deficiency of the gastric juice, and to be inversely proportional to the index of radiocyanocobalamin absorption. Thus the increase in the CSF β-globulin fraction appears to be more apparent in cases of funicular myelosis in which the true Addison-Biermer disease is manifest.

Registro de caso de paciente com polirradiculoneurite, forma ascendente, com comprometimento de nervos cranianos e distúrbios respiratórios. Houve remissão progressiva da sintomatologia, com desaparecimento completo das alterações neurológicas cêrca de 7 meses depois do início da doença. O quadro liquórico (LCR lombar) se caracterizava por dissociação proteíno-citológica e positividade de reações imunológicas para sífilis cujo título diminuiu progressivamente, à medida em que decrescia a hiperproteinorraquia. O perfil protêico do LCR era de tipo misto, com aumento de albumina, normalizando-se à medida em que decrescia a proteinorraquia. A positividade das reações para sífilis no LCR, observada no caso decorre da passagem para o LCR, de imunoproteínas do sôro no qual as reações para sífilis eram positivas. Com a redução da intensidade da estase, tornaram-se negativas tais reações no LCR, embora persistisse a positividade no sôro. A favor dessa hipótese são lembrados os dados referentes ao perfil protêico do LCR, não compatíveis com aquêles observados na neuros-sífilis. Report of a case of polyradiculoneuritis with positivity of immunologic tests for syphilis in the CSF in a 36 years old man. Sensitive disturbances first appeared soon followed by ascending impairment of the motricity. One month later there occurred respiratory changes, diplopia, disphagia and involvement of the left facial nerve. Diplopia and respiratory disturbances disappeared one week later. Progressive remission of the remaining symptoms occurred later. Two months later, the neurologic examination showed only absence of the deep reflexes of the extremities, muscular hypotony and some degree of paresthesic sensations. Voluntary movements and muscle power were normal. Objetive disturbances of sensibility had disappeared. Nine months after the onset of the disease the neurologic examination was normal. CSF changes (table 1) were characterized by protein-cytologic dissociation and by the positivity of immunologic tests for syphilis. The protein pattern of the CSF was of the "mixed type" and the relative concentration of the albumin fraction was increased (paper electroforesis). Immunologic tests for syphilis were positive in blood serum also. Repeated spinal taps showed progressive reduction of the CSF protein concentration. The changes in the protein pattern tend to disappear with the decrease of the total protein concentration. Two months after the onset of the disease, the disturbances in the protein pattern were no longer present. The titers of the immunologic tests for syphilis in the CSF decreased rapidly. This fall accompanied the decrease in the total protein concentration. One month after the first CSF examination the immunologic tests for syphilis in the CSF were negative. Data concerning to the positivity of the immunologic tests for syphilis in the CSF were discussed. The changes were correlated to the alterations in the protein balance between blood and the CSF occuring in polyradiculoneurites rather than to neurosyphilis. Some data are in agreement with this idea. First, the decrease in the total amount of CSF proteins was accompanied by the decrease in the titer of antibodies. Also, the changes found in the protein pattern of the CSF were not similar to the findings in neurosyphilis. A marked increase in the y-globulin fraction is the main change in neurosyphilis. This was not found even when the total protein content of the CSF was moderately increased. The findings indicate that in the case reported the positivity of immunologic tests for syphilis observed in the CSF was secondary to the disturbances in the protein balance between blood and CSF. The passage of the imuno-proteins present in the blood to the CSF was a manifestation of the altered protein balance occurring in polyradiculoneuritis.

Foram estudadas 5 crianças com subnutrição grave por ocasião da admissão, durante a recuperação e por ocasião da cura clínica. Em cada ocasião foram estudados: peso, estatura, teores de hemoglobina e colesterol, glicemia ,eletroforese de proteínas, teste de Gesell, dados de exame neurológico, pneumencefalograma, eletrencefalograma e líquido cefalorraqueano. Apesar de recuperação clínica e bioquímica muito satisfatória, o teste de Gesell mostrou pequena recuperação neuropsicomotora no último estudo em comparação com o grave retardo global observado à admissão. Todos os pacientes apresentavam atrofia cortical difusa no primeiro estudo pelo pneumencefalograma: três dos 4 pacientes submetidos a novo exame após a cura clínica ainda apresentavam a referida alteração. Os estudos eletrencefalográficos e de líquido céfalorraqueano não evidenciaram alterações praticamente em todos os estudos. The cases of 5 children with severe malnutrition, marasmic type, aged four to fourteen months are reported. The patients were sturied at admission in the hospital and 45-60 days and 4-5 months later. Eeach study included: hemoglobinemia, cholesterolemia, glycemia, weight, height, Gesell test, neurological examination, pneumoencephalogram, electroencephalogram and cerebrospinal fluid examination. Biochemical and physical recuperation was very good. Gesell test show an important and homogeneous deficiency, even at the third study. All patients presented cortical atrophy at the pneumoencephalogram in the first study: 4 patients were re-studied 4-5 months later and only one become normal. No changes in electroencephalogram and cerebrospinal fluid were found. It was not possible to evaluate the significancy of the poor psychosocial environment from where the patients came in the aetiology of the mental deficiency.

Estudo anátomo-clínico de caso de paciente com glioblastoma multiforme da porção cervicotorácica da medula espinhal. A partir da sede primitiva o tumor invadia o espaço sub-aracnóideo, formando manguito que envolvia a medula desde a dilatação cervical até a região lombar. Apesar do crescimento tão extenso no espaço sub-aracnóideo, não foram encontradas metástases leptomeníngeas à distância. Considerações são feitas sobre a freqüência com que o glioblastoma é observado entre os tumores medulares e sobre os modos pelos quais esse glioma costuma invadir as leptomeninges. Também no caso registrado foi verificada hipoglicorraquia, achado relatado com certa freqüência no comprometimento leptomeníngeo por neoplasias. The case of a 17 year old patient with glioblastoma multiformis of cervico-thoracic region of the spinal cord whose disease was first manifested almost 7 months prior to death is reported. Initial symptoms of sphincter disfunction were soon followed by clinical signs of transverse myelopathy in the upper thoracic region. A complete block of the spinal canal was found on manometric tests. The cerebrospinal fluid was xanthochromic and coagulated immediatly; total protein concentration was markedly increased and glycosis content was low. Descendent perimyelography showed that blocking was complete at the level of first thoracic vertebral body and that it was caused by an intramedullar expanding process. About two months before death symptoms referred to spinal cord impairment assumed an ascending character. Signs of peripheral motor neuron impairment appeared in the upper extremities. Progressive signs of intracranial hypertension appeared and preceeded death. A transient cardiac arrest and apnea occured. The patient, maintained under artificial respiration, remained in comatous state until death, two days later. Brain edema was found at post-morten examination. Cerebral meninges were normal. The upper portions of the spinal cord were enlarged and their consistency was increased. The structures of the inferior portion of cervical region were completely substituted by neoplasic tissue. The central portion of cervical enlargement as well as the upper and middle portions of thoracic region were also invaded by neoplasic tissue. Ischaemic necrosis occurred in the first cervical segments. Histologic examination showed that the tumor was a glioblastoma multiformis. In the inferior portion of cervical cord the neoplasy invaded the leptomeninges, growing extensively in the subarachnoid space, surrounding the spinal cord. Nerve roots were also invaded by neoplasic tissue. Literature data concerning to the low incidence of glioblastoma among tumors of the spinal cord were quoted. The leptomemeningeal invasion by the tumor found was discussed. In spite of its extension, meningeal gliomatosis was discarded since subarachnoid and medullar portions of the tumor were continuous, no metastatic tumoral growths related to other areas of subarachnoid space were found and tumor cells were not found in the cerebrospinal fluid.

Estudo da osmolalidade de 22 amostras de LCR e de 22 amostras de sôro. As amostras de LCR foram colhidas de pacientes sem afecções do sistema nervoso central e sem alterações metabólicas gerais e, as de sôro, de pessoas sadias. A osmolalidade foi determinada em osmômetro de Fiske. Os resultados são expressos em mOsm/kg d'água e estão reunidos nas tabelas 1 (LCR) e 2 (sôro); na tabela 3 são apresentadas as estimativas correspondentes. Não foram encontradas diferenças significativas entre a osmolalidade do LCR e do sôro. Êste dado confirma resultados consignados na literatura, obtidos pelo mesmo método, mas baseados na análise de menor número de casos. The osmolality of the cerebrospinal fluid (CSF) in normal conditions was evaluated through the results in 22 CSF samples obtained from patients with any evidence of central nervous system diseases as well with any disease that might interfer with general metabolic conditions. For comparative purposes it was studied the serum osmolality in a series of 22 healthy people. The osmolality was evaluated by the Fiske's osmometer. Results are presented in table 1 (CSF), table 2 (blood sera) and their estimatives are grouped in table 3. The results reported confirm that there are any significative differences between the values of CSF and of blood serum osmolality in normal conditions.

A case of primary amebic meningoencephalomyelitis due to Naegleria sp observed in a 14 years old boy is reported. Symptoms due to myelitis at the dorsal level assumed ascending character during the first days of disease. Manifestations due to encephalic involvemente were discrete. Cerebrospinal fluid changes were marked by pleocytosis, and the eosinophil cells participation in the cytomorphological profile was persitently high. Amphotericin-B was used intravenously (25 mgm/day) until 1,500 mgm of total dosis. Remission of encephalitis manifestations was prompt, as well as of meningeal signs. Cerebrospinal fluid changes disappeared progressively. Sensitive-motor changes due to spinal cord involvement persisted as permanent sequelae. Naegleria sp., was isolated from the cerebrospinal fluid in the acute stage of the disease, as well as, from the water of a lagoon where the patient used to swim.

Estudo da composição do LCR de 54 recém-nascidos prematuros sadios no segundo dia de vida. Os prematuros estudados precediam de gestações sem inter-corrências com parto não-traumático, apresentavam Apgar entre 6 e 9 aos 5 minutos de vida e não apresentavam anormalidades quanto ao exame clínico, neurológico, hematimétrico e gasométrico. Da composição do LCR foram estu-dades a citometria e as concentrações de proteínas totais, glicose, bilirrubina e hemoglobina. As estimativas encontradas permitem aceitar como limites das variações fisiológicas da composição do LCR do RN-PT os seguintes valores: leucócitos até 16 por mm ³; hemácias até 1.280 por mm3; proteínas totais até 300 mg/100 ml; bilirrubina de 10 a 80 µM/l; hemoglobina até 8 µM/l; glicose: cerca de 2/3 da concentração no sangue. Em relação à composição do LCR de 79 recém-nascidos normais a termo, avaliada mediante os mesmos métodos e no mesmo laboratório, são significativamente maiores as concentrações de proteínas totais e de bilirrubina, bem como estar presente a hemoglobina, pigmento não demonstrado no recém-nascido a termo. É discutida a importância da imaturidade da barreira hêmato-liquórica quanto às características do LCR apontadas, considerando-se encontrar-se ela ainda menos diferenciada no recém-nascido prematuro que no recém-nascido a termo. The cerebrospinal fluid (CSF) composition was studied in 54 premature infants. The pregnancy was normal and the delivery normal and non traumatic in all of them, and the 5 minutes Apgar score ranged from 6 to 9. No abnormalities were found on physical examination including neurological examination. Blood cell countings and blood gasometry were normal. CSF composition was studied as to: total cell count and total protein, glucose, bilirrubin and hemoglobin concentrations. Data found permit to stablish as physiologic the following values: leucocytes, until 16 per cumm; erithrocytes, until 1,280 per cumm; total protein content until 300 mgm/100 ml; bilirrubin until 80 µM/l; hemoglobin until 8 µM/1; glucose, two thirds of the concentration found in the blood. Protein, bilirrubin and hemoglobin are significantly increased as compared to values found for the CSF of 79 fullterm normal newborn babies evaluated previously. Hemoglobin was not detected in the CSF of any full term newborn baby. The differences found are probably due to a less efficient blood-CSF barrier in premature infants as compared to full-term newborn babies.

Foram estudadas 44 amostras de liqüido cefalorraqueano (LCR) de 11 pacientes em que foi possível fazer diagnóstico etiológico de comprometimento do sistema nervoso central (SNC) por leveduras do gênero Candida. Todos os pacientes apresentavam fatores de risco para a afecção. Cinco apresentavam quadro de meningite crônica a esclarecer; dois, síndrome de imunodeficiência adquirida; dois, traumatismo crânioencefálico seguido de meningite crônica; um, coagulação intravascular disseminada seguida de septicemia; um, candi-díase sistêmica pós-transplante renal. O diagnóstico etiológico foi feito pelo exame do LCR, possibilitando em 9 o isolamento da levedura por crescimento em meio de cultura. Em dois o diagnóstico foi feito pela presença das leveduras ao exame direto e, em um deles, também pela positividade da reação de fixação de complemento para Candida realizada em três amostras sucessivas de LCR. Discute-se a importância das alterações encontradas no exame do LCR na candidíase do SNC. This study is based on the analysis of 44 cerebrospinal fluid (CSF) samples from 11 patients with central nervous system (CNS) Candida infection. Risk factors for CNS fungal infection were present in all patients. Five had a chronic meningitis syndrome; two had acquired immunodeficiency syndrome (AIDS); two had cranial trauma followed by chronic meningites; one had intravascular disseminated coagulation syndrome and sepsis; and one had systemic candidiasis after kidney transplant. Etiological diagnosis was made in all by the CSF examination. Nine cases had positive CSF culture for Candida. Two patients presented the yeast in the direct examination, and one of them had reagent complement fixation test for Candida in three sucessive samples of CSF. Changes found in the CSF composition are discussed in order to evaluate the inflammatory response to CNS infection by Candida.

Para avaliar a informação que pode ser obtida mediante o estudo do líquido cefalorraqueano (LCR) em acidentes vasculares cerebrais (AVC) foram analisados os dados de 1500 casos. Três tipos fundamentais de AVC podem ser considerados do ponto de vista do LCR: AVC LCR tipo 1, sem hemácias e sem xantocromia (incolor); AVC LCR tipo 2, sem hemácias e com xantocromia; AVC LCR tipo 3, com hemácias e com xantocromia. Os dados quanto a cada grupo são discutidos bem como suas correlações. O papel de alterações metabólicas sistêmicas, da barreira hêmato-encefálica e do comprometimento do parênquima do sistema nervoso central são discutidos na interpretação dos achados. Considerações finais são feitas quanto à utilidade do estudo do LCR em AVC frente a avanços em outras técnicas de investigação, como as de neuroimagem. In order to evaluate information on acute stroke through the study of cerebrospinal fluid (CSF) data em 1500 patients were analysed in the first 48 hours following stroke. Cases were distributed in three groups according to CSF basic findings: type 1, CSF without erythrocytes and without xanthochromy; type 2, CSF without erythrocytes and with xanthochromy; tipe 3, CSF with erythrocytes and with xanthocromy. Data on each type are discussed as well as correlation findings. Systemic metabolic disturbances, blood-brain barrier impairment and central nervous system lesions are discussed as to the role they have in CSF changes observed in stroke. Indication of CSF exam in stroke is reviewed taking into account progress in neuroimaging techniques.

Foram estudadas 333 amostras de liqüido cefalorraqueano (LCR) de pacientes com suspeita clínica e/ou diagnóstico de meningite bacteriana aguda para avaliar o comportamento das provas do látex para os agentes etiológicos H. influenzae Upo b, N. mening tidis A e C, S. pneumoniae. Os resultados foram comparados aos do exame bacteriscópico direto pelo método de Gram e do exame bacteriológico feito a partir do isolamento bacteriano em culturas. Os resultados mostraram que as provas do látex, quando realizadas no LCR, são de grande auxílio diagnóstico imediato para a identificação do agente etiológico em meningite bacteriana aguda devido à sua rapidez e facilidade de execução. Das 106 amostras de LCR em que um desses três agentes etiológicos era o responsável pelo quadro de meningite bacteriana aguda, sua presença foi evidenciada pela prova do látex em: 98,2% para H. influenzas tipo b, 15,8% para N. meningitidis A ou C, 96,S% para S. pneumoniae. Discute-se o fato de estar iniciada a antibioticoterapia em grande número de casos de meningite bacteriana em nosso meio, antes que seja colhida a amostra de LCR que se destina a comprovar a infecção meníngea. The study is based on 333 cerebrospinal fluid (CSP) samples from patients with clinical diagnosis of acute bacterial meningites. The aim of the study is a critical evaluation on latex agglutination tests in CSF for H. influenzae type b, N. meningitidis A and C, and S. pneumoniae. These tests are compared with direct examination (Gram method), and culture results. It was shown that results of the latex test in the CSF are basic for rapid diagnosis of etiological agent in a bacterial meningitis. Data on 106 CSF samples confirmed the etiology through latex tests in 98.2% for H. influenzae type b, in 15.8% for N. meningitidis A or C, in 96.8% for S. pneumoniae. Emphasis is given for evidence of antibiotic therapy previous to CSF collection, which may be responsible for the great number of negative results registered in the present series.

The authors present a review of 21 cases with the diagnosis of type I amyloid neuropathy based on epidemiological data, clinical evolution and histopathological findings. They call attention to the possibility of cranial nerves involvement (hyposmia, diplopia, masseterian hypotrophy, peripheral facial paralysis, hypoacusis, dysphonia, laryngeal paralysis, dysphagia, and trapezium muscle hypotrophy), to the severeness of the digestive symptoms, to the precocity of the autonomic disorders, and to the rather high incidence (6 cases) of heart involvement. The electromyography showed anterior horn involvement in 3 cases. The electrocardiography showed repolarization disorders in 11 cases, left ventricular overload in 6 cases and atrioventricular block in 5 cases. The serum proteins electrophoresis showed frequent abnormalities, but no typical curve could be obtained. The barium-contrasted X-rays of the gastrointestinal tract showed no anatomical lesions, but functional abnormalities (hypo or hypermotility) were found in 14 examinations. The Schilling test showed impairment of vitamin B12 absorption in 50% of the cases. However, with the concomitant administration of intrinsic factor (3 cases) there was improvement of its absorption. This proves that the gastric mucosa plays an important role in the disease malabsorption. The test with labeled-triolein showed slow absorption in 2 cases and steatorrhea in 3 (6 tests). For the confirmation of the amyloid deposits, the best histopathological procedure was nerve biopsy. In men, when the nerve biopsy was negative, testicular biopsy has shown to be a good option. Os autores apresentam uma revisão de 21 pacientes com diagnóstico de neuropatia amilóide tipo I, firmado sobre os dados epidemiológicos, a evolução clínica e os achados histopatológicos. Chamam a atenção para a possibilidade de comprometimento de vários nervos cranianos, para a gravidade do quadro digestivo, a precocidade dos distúrbios neurovegetativos e a incidência relativamente alta de sintomatologia cardíaca. Constituem contribuição para o melhor conhecimento da afecção, os estudos sobre a síndrome digestiva feitos através de exames radiológicos e dos testes de absorção de vitamina B12 e trioleína radioativas.

Avaliação dos resultados de estudo prospectivo da evolução de 100 pacientes com neurocisticercose (NC) aos quais foi administrado praziquantel (PZQ). A evolução foi avaliada por mais de dois anos em 63 casos (máximo 118 meses) e levou em conta os aspectos clínicos, da TC e do LCR. Resultados favoráveis predominaram (72,5%), particularmente entre aqueles pacientes nos quais as manifestações clínicas da NC não eram acompanhadas de hipertensão intracraniana de caráter permanente e progressivo. Os resultados obtidos são favoráveis à indicação do PZQ em pacientes com NC.

Foi estudado sistematizadamente o líquido cefalorraqueano (LCR) de 170 pacientes com síndrome de imunodeficiência adquirida (AIDS). Todos apresentavam títulos positivos no soro para o vírus da imunodeficiência humana (HIV). Em todos havia sinais e sintomas sugestivos de comprometimento do sistema nervoso. O período do estudo esteve compreendido entre julho de 1984 e abril de 1989. Dos 170 casos estudados, 8 (4,7%) apresentavam exame de LCR dentro dos limites normais. Células neoplásicas (linfoma) foram observadas em três casos. Meningite asséptica de etiologia não esclarecida foi encontrada em 34 casos (20,1%). Em 88 casos foi possível determinar, no LCR, alterações que permitiram o diagnóstico etiológico. Destes, 78 casos apresentavam acometimento do SN de etiologia infecciosa: criptococose ocorreu em 28 (35,9%); toxoplasmose em 20 (25,6%); sífilis em 10; candidíase em 3; doença de Chagas em 2; tuberculose em 1; nocardiose em 1; esquistossomose em 1. Presença de anticorpos para outros vírus foi detectada em 7 casos. Bactérias foram isoladas em 5 casos. A pesquisa de anticorpos anti-HIV foi efetuada no LCR em 55 casos, tendo resultado positiva em 48 (87,3%). Associação de duas ou mais etiologias infecciosas ocorreu em 15 casos. Discute-se a importância do exame do LCR sistematizado nos casos com suspeita ou comprovação diagnóstica de AIDS. Cerebrospinal fluid (CSF) was analysed in 170 AIDS patients. All of them showed HIV positive serological tests. All of them showed neurologic syndromes related to AIDS. The time period of the investigation was July 1984 - April 1989. In 8 cases (4.7%) CSF composition was normal. Lymphoma cells were observed in three cases. Aseptic meningites occurred in 34 cases (20.1%). Aetiological diagnosis of associated infection was established in 88 cases: cryptococcosis in 28 (35.9%); toxoplasmosis in 20 (25.6%); syphilis in 10; candidiasis in 3; Chagas disease in 2; tuberculosis in 1; nocardiosis in 1; schistosomiasis in 1. Antibodies for other virus were detected in 7. Bacteria were isolated in 5 cases. Anti-HIV antibodies were tested in CSF samples of 55 cases: they were found in 48 (87.3%). Two or more associated infections were observed in 15 cases. Changes of CBF composition in AIDS are discussed taking into account changes reported.

Estudo do proteinograma do líquido cefalorraqueano lombar de 40 recém-nascidos normais com 2 dias de vida. Em relação ao proteinograma do líquido cefalorraqueano do adulto normal, os achados desta investigação demonstram maior concentração proteica e maior participação relativa no perfil proteico da albumina, da globulina alfa-1 e da globulina gama. Estes achados são próprios ao perfil de tipo transudativo, encontrado em certas condições patológicas no adulto. A incompleta maturidade funcional da barreira hêmato-liquórica ao nascimento parece ser a principal responsável pelas características do proteinograma do líquido cefalorraqueano encontradas no recém-nascido normal. The protein fractions of lumbar cerebrospinal fluid (CSF) were studied in 40 normal newborns 2 days-old. The results were compared to those found in normal adult peoples. It was shown that the relative concentrations of albumin, alpha-1 globulin, and gamma globulin are more conspicuous in the newborn than in the adult. The protein pattern in the normal newborn is similar to the transudative pattern described in the adult life in several pathologic conditions. The findings were related to the blood — CSF barrier conditions in the newborn. The incomplete functional maturity of blood — CSF barrier at this time of the life was considered to be the main factor responsible by the CSF protein pattern which was found.