Resumo em Português:

A presente modificação da técnica de neurorrafia, com emprego da microcirurgia, foi desenvolvida com base em trabalhos experimentais e, também, em observações clínico-cirúrgicas de pacientes portadores de lesões nervosas periféricas traumáticas, antigas e recentes. A sequência dos tempos e os cuidados cirúrgicos são descritos; aparecem esquematizados nos quadros 1 e 2. Os resultados experimentais demonstram que suturas de nervos feitas com a técnica proposta permitem melhor reinervação dos segmentos corpóreos afetados pela desnervação e podem evitar, também, quando feitas logo após a transecção do nervo, a total degeneração walleriana que normalmente ocorre no segmento distal à transecção. Os resultados obtidos em pacientes que estão sendo operados com esta técnica são encorajadores; serão assunto de futuras publicações.

Resumo em Português:

Estudo do LCR de recém-nascidos a termo e de parto normal, sem intercorrências perinatais, para verificar o quanto a xantocromia é devida à bilirrubinorraquia. Foi verificado que a bilirrubinorraquia é constante na primeira semana de vida e que sua concentração: não guarda relação com a concentração proteica total do LCR e/ou com os níveis de bilirrubina no soro; não sofre influência do número de hemácias e/ou de leucócitos presente na amostra. Os valores encontrados no LCR quanto ao número de leucócitos e de hemácias e às concentrações de proteínas totais e de bilirrubina são analisados na caracterização do LCR do recém-nascido normal na primeira semana de vida.

Resumo em Inglês:

The study was made in order to verify if the bilirubin content of the cerebrospinal fluid (CSF) is constant during the first week of life, and their relations to: the concentrations of total proteins in the CSF and bilirubin in the blood serum; the red blood cells and leucocytes present in the CSF sample. The study was made in 79 normal newborns without perinatal problems or obstetrical abnormalities. The gestational ages were stablished through maternal anamnesis and the clinical evaluation of the newborn was made according to the patterns established by Usher & col., Lubchenko & col. and Lubchenko. All the pregnancies were over 37 weeks. The vital conditions of the newborn immediately after the delivery were calculated according to the patterns proposed by Apgar and Apgar & James. The first complete clinical examination was made in the first twelve hours of life. The cranial sizes were situated within the limits accepted as normal. The deliveries were head-first (only two were breech presentation). The cry was immediate after birth, the breathing well established in the first minute of life and the cut of the umbelical cord was made after the first respiratory movement. The deliveries were made in delivery rooms or surgical rooms always assisted by an obstetrician and a pediatrician. The collecting of venous blood to determine the serum concentration of bilirubin was made soon after lumbar punction for collecting CSF. Samples were collected in the second day of life in all the 79 newborns studied; in 40 of them, new samples were collected in the 7th day of life. CSF samples were analyzed as to: total white cells count; total red blood cells count; total protein concentration; bilirubin and haemoglobin concentrations according to the Kronholm & Lintrup nomogram. General data pertinent to weight, height and cranial size of the newborn children studied were the following: weight: 3.213.1 ± 286.9 g; height: 49.24 ± 1.12 cm; cranial size: 35.29 ± 0.89 cm. Most CSF supernadant were either xanthochromic or slightly xanthochromic. The following values were found for cells, proteins and pigments in the CSF: 1. Total white cell count at the second day of life: mean of 4.44 cells/cu.mm., standard deviation 3.83; in the seventh day the average of cells was 4.40 cu.mm. and standard deviation 3.33; no significant difference was found between these two values. 2. Red blood cell count in the second day of life: mean 155.76 red blood cells/cu.mm. with standard deviation of 223.48; in the seventh day the mean was 74.10 red blood cells/cu.mm. and standard deviation was 123.72. The average number of CSF red blood cells at the second day of life was found to be larger than the mean value at the seventh day. 3. Total protein concentration: the average of total protein (mgm/100 ml) was 71.44 with standard deviation of 24.15 in the second day of life; at the seventh day the average was 69.27 with standard deviation of 22.21. There were no significant statistical differences between these values. 4. No haemoglobin was found but bilirubin was always present. The average of bilirubin at the second day of life was 1.96 micromol/liter with standard deviation of 0.17; in the seventh day of life the average was 1.89 micromol/liter with standard deviation of 0.20. The difference between the second and seventh days of life, although statistically significant, is inconspicuous for clinical and diagnostic purposes. No significant correlation was found between the bilirubin concentration in the CSF, and the respective white cells, erythrocytes or protein concentration. No significant correlation was found between protein and bilirubin in normal newborn's CSF. No significant correlation was found between bilirubin concentration in the serum and that of the CSF.

Resumo em Português:

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.

Resumo em Inglês:

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.

Resumo em Português:

Quatro pacientes que receberam anestesia epidural apresentaram mielopatia de longa evolução; em três ocorreu paraplegia completa e um apresentou uma síndrome medular lombo-sacra com retenção urinária. Todos os pacientes se queixaram de intensas dores radiculares imediatamente após a cessação do efeito analgésico da lidocaína. Dois pacientes apresentaram uma reação meningítica asséptica no líquido cefalorraqueano nas primeiras 24 horas. A paraplegia tornou-se completa em 2 a 10 meses após a anestesia; dois pacientes tiveram hipertensão craniana severa. Em alguns casos, senão em todos, esta afecção apresenta uma evolução em duas etapas, caracterizadas por meningite asséptica imediata, seguida, depois de um período silencioso de poucos meses, de sinais de aracnoidite adesiva espinal e intracraniana. A hipertensão intracraniana foi controlada por derivação ventriculo-peritoneal; em 2 pacientes houve melhora transitória pela administração de metil-prednisolona intratecal. Em dois pacientes houve recuperação quase completa da paraplegia.

Resumo em Inglês:

Four patients who received epidural anesthesia presented sustained myelopathy; three of them had complete paraplegia and one a lumbo-sacral myelopathy with urinary retention. All four patients complained of very intense radicular pains immediately after the analgesic effect of Lidocaine was over. Two patients in whom lumbar puncture was done in the first 24 hours presented an aseptic meningitic reaction in CSF. Paraplegia completed in two to ten months in three patients and in two of them severe intracranial hypertension developped at this time. It is proposed that the disease runs a two-stages course, at least in some cases, characterized by an aseptic meningitis, followed, after a silent period of some months, by signs of adhesive spinal and intracranial arachnoiditis. Intracranial hypertension was controlled by ventriculo-peritoneal shunt; in two patients a transitory effect of intrathecal injections of methyl-prednisolone acetate was observed. Two patients recovered almost completely from paraplegia.

Resumo em Inglês:

Sixty-seven cases of non-communicating hydrocephalus treated according to the Torkildsen's procedure are reported. The spinal fluid blockage was caused in 55 cases by supratentorial and in 10 cases by infratentorial tumors; in the remaining cases the spinal fluid interruption was due to non-tumoral causes. Ventriculography was the most important examination performed as far as the local diagnosis was concerned. 15 patients in this series disclosed lethal complications with signs of brain stem lesions. Patient survival was 3.9 years with variation ranging from 1 to 9 years. The following conclusions were drawn: 1) Ventriculocisternostomy is a valious method for the treatment of non-communicating hidrocephalus for it allows a more physiological drainage of the spinal fluid besides favouring the exploration of the posterior fossa in cases of doudtful pre-operative diagnosis. This procedure is of low cost and involves a relatively simple tecnique as compared with other procedures which demand the use of special valves. 2) According to the review of the pertinent literature the best results have been accomplished in cases where there is a non-tumoral aqueduct stenosis as well as in inoperable tumors of the third ventricle. 3) Bilateral drainage is mandatory in cases of bilateral obstruction of Monro's foramina. It has also been indicated in all cases as a precaution due to the possibility of occlusion of one catheter. 4) Ventriculocisternostomy should also be indicated as a prophylactic treatment of non-communicating hydrocephalus in cases of inoperable tumors of the sela or the basal ganglia with compression of the third ventricle but without completly blockage of the ventricle system. 5) Ventriculocisternostomy should be indicated with some reserve in cases of infratentorial tumors as well as in great supratentorial space-occupying lesions. It is however contra-indicated in cases of large tumors and in the inflammatory process involving the posterior fossa. 6) In the present series the obstruction of the draining-system was very uncommon being observed in only three patients. 7) No cases of spinal fluid fistula or meningitis were observed in the present study.

Resumo em Português:

Mediante o método de Greenwood-Yule e o teste estatístico mais sensível de que se dispõe atualmente, o x² de Halperin, foi testada a possível associação entre a prevalência de epilepsia e a ordem de nascimento de 238 pacientes. Estes pacientes foram obtidos em dois hospitais de São Paulo, na tentativa de se controlar sua classe social; tratava-se de epilépticos com variados transtornos psiquiátricos. Concluiu-se por uma associação estatisticamente significante entre a doença e a ordem de nascimento dos 238 pacientes, com uma sobre-representação nos primeiros e nos últimos nascidos.

Resumo em Inglês:

This paper deals with birth order and epilepsy. The Greenwood-Yule's method was applied, with the most powerful statistical test available, Halperin's modified chi-square. The authors concluded that there is a consistent positive association between this illness prevalence and birth order of the patients, being first and last born over-represented, irrespective of their sibship size. The data were obtained in two psychiatric hospitals in the city of São Paulo, being social class factor qualitatively controlled. All the 238 patients studied suffered a wide range of psychiatric symptoms.

Resumo em Português:

Os AA fazem revisão sobre a unidade motora em seu aspecto morfológico, fisiológico e farmacológico como base para o estudo e tratamento da miastenia grave e da síndrome miastênica. Estudos eletromiográficos, farmacológicos e eletrofisiológicos, realizados por diversos autores, determinam características especiais que definem a miastenia grave e a síndrome miastênica. Certos sinais e sintomas, comumente observados em casos de envenenamento por elapídeos, são semelhantes aos causados por drogas bloqueadoras neuromusculares.

Resumo em Inglês:

In order to understand the treatment of miasthenia gravis and miasthenic sindrome, the morphology, physiology and pharmacology of the motor unit were reviewed. Electromiographic, pharmacologic and electrophysiologic studies accomplished by several authors have special caractheristics which define miasthenia gravis and miasthenic sindrome. Certain venoms such as those from Elapidae can produce signals and symptoms resembling those produced by neuromuscular blocking drugs.

Resumo em Português:

São relatados os casos de quatro pacientes nos quais a queixa principal, na admissão a um hospital psiquiátrico, era o uso inadequado, constante e abusivo de medicação composta pela associação metaqualona-difenidramina. É feita uma descrição de seus quadros clínicos e são analisados aspectos de sua dependência por esta medicação. Chama a atenção o fato de serem todos os pacientes de nível sócio-cultural diferenciado e que três (dois homens e uma mulher) eram homossexuais, sendo que a última paciente apresentava-se mal ajustada em uma ligação heterossexual.

Resumo em Inglês:

The cases of four patients admited to a psychiatric hospital, with addiction to a drug, the association methaqualone-diphenhydramine, are reported. The clinical features of the cases and the dependence of the patients to the drug are commented. All the patients came from above average social classes and three of them (two men and one woman) were homosexuals, being the last patient badly adjusted on the heterosexual relationship.

Resumo em Português:

Meningiomas primários da calota craniana são raros. Na literatura de língua inglesa apenas 12 casos foram relatados. São apresentados 2 casos e discutidos aspectos etiológicos, clínicos e radiológicos.

Resumo em Inglês:

Primary intraosseous meningiomas of the skull are rarely found. A review of the English literature reveals that only 12 cases have been reported previously. Two new cases are added: both occurred in femmales with grew up on the right side, adjacent to cranial sutures. In one case the meningioma developped few weeks after a parieto-frontal traumatism. The etiology of these tumors, the plain film findigs and the angiographic appearence are discussed.

Resumo em Português:

É relatado um caso de ependimoma da cauda equina com metástases fora do sistema nervoso central, em uma criança do sexo feminino, com 1 ano e 4 meses de idade, confirmado mediante exame necroscópico completo. As metástases se localizaram no fígado, nos pulmões e em linfonodos inguinais. Os ependimomas representam o tipo de glioma mais frequente nessa região; entretanto, esses tumores dão metástases muito raramente. Revisando a literatura foram encontrados seis casos.

Resumo em Inglês:

A case of a papillary ependymoma of the spinal cord (cauda equina) with metastatic dissemination outside the central nervous system is reported. The patient was a one year old female child who died of pulmonary infection. Metastases were found in the liver, lungs and inguinal lymph nodes. Ependymoma is the most frequent type of glioma found in the cauda equina but metastatic dissemination is a rare occurrence. Only six cases have been recorded in the literature.

Resumo em Português:

É relatado um caso de síndrome de Klippel-Trénaunay-Parkes-Weber associada a angiomatose medular. O autor salienta ter encontrado na literatura somente uma referência com tal associação.

Resumo em Inglês:

A case of Klippel-Trénaunay-Parkes-Weber syndrome associated with spinal cord angioma is reported. The author points out that it was found only one reference in literature with such association.

Resumo em Português:

Relato de um caso de síndrome de Seckel apresentando resultados pneumencefalográficos e hormonais dignos de registro. As dosagens hormonais indicaram a existência de um distúrbio na atividade do hormônio de crescimento, havendo estímulo acima do normal do H.G.H. e inatividade sobre a curva dos ácidos graxos não saturados. O registro pneumencefalográfico de atrofia das circunvoluções cerebrais é o primeiro a ser publicado em paciente com síndrome de Seckel, podendo ser considerado como uma confirmação dos achados anátomo-patológicos relatados por McKusick (mierocefalia pongidea).

Resumo em Inglês:

A case of Seckel's syndrome in which the results of hormonal tests and pneumoencephalography findings are worth relating is reported. The hormonal dosages have shown a disorder in the growth hormone activity with an over normal stimulus of the H.C.H. and its inefficacy over the N.E.F.A. (non esterefied free acids) curve. Pneumoencephalographic examination has shown cortico-cerebral atrophy reported for the first time in a case of Seckel's syndrome; this result may be considered as confirming the pathological findings reported by McKusick (microcephaly pongidae).