Resumo em Inglês:

In order to analyse the paper strip electrophoresis contribution to the knowledge of cerebrospinal fluid (CSF) proteins in cysticercosis of the central nervous system (CNS) 40 patients were studied (identification data in table 1); the clinical forms and diagnostic data of 30 of them, who had CNS cysticercosis (cases 1 to 30) are summarized in the table 2; cysticercosis of the CNS might play a role in the pathologic condition presented by the remaining 10 patients. CSF protein fractions were examined in all the cases (results in tables 4 and 7) and those of blood sera in cases from 1 to 15 (results in table 5) by paper strip electrophoresis under the specifications previously reported54. A second examination of CSF protein fractions was made some time later in 4 cases (results in table 6). CSF samples were analysed also in respect to cytology, total protein content, Pandy and colloidal benzoin reactions and complement fixation tests for syphillis and cysticercosis (results in table 3). The values obtained for CSF protein fractions were compared to norma) values found in 30 control subjects; these normal values were detailed in a prior publication55 and are summarized in table 8. This comparison shows that CNS cysticercosis produces changes in the electrophoretic prophiJe of CSF proteins (table 9); an increased y-globulin fraction was the main change observed, commonly associated to a low j8-globulin relative concentration. An inversion of a1/a2 quocient was found in 4 cases. The contributions to the study of CNS cysticercosis resulting from the electrophoretic analysis of CSF proteins are discussed in three groups: 1 - Informations obtained by paper electrophoresis of CSF proteins are independent from those resulting from the other laboratory aspects studied. Thus, if the protein fractions of blood sera are considered, although the changes found have mean values similar to those found to the CSF protein fractions (table 10), it was observed that there are individual differences in the protein fraction relative concentrations in blood and CSF (table 11), no correlation being found between them. Considering CSF itself, changes in its protein fractions induced by CNS cysticercosis are similar in ventricular and subarachnoid samples (lumbal and cisternal) (table 13); their intensity is related to the intensity of the whole of CSF changes (table 12). Informations obtained by electrophoretic analysis of CSF proteins, however, differ from those resulting from the other examinations conducted in the CSF sample as was shown in the analysis of cytology (tables 14 and 15), total protein content (table 16), colloidal benzoin reaction and positivity of complement fixation test for cysticercosis. 2 - The clinical value of data achieved by CSF proteins electrophoresis is discussed. Results may have an important role in diagnosis, in the knowledge of its clinical forms (table 17) and in the control of evolution if pathogenetic mechanisms involved in disease are considered. Cases 31 to 40 illustrate the clinical aspects of contributions given by CSF electrophoresis. 3 - The CSF protein fractions changes found in CNS cysticercosis justify their classification among those changes commonly observed in subchronic and chronic inflammatory diseases of the CNS and/or its leptomeningeal coverings. It is assumed in the literature that there occurs a local production of globulins, specially the y-globulin fraction, in such pathologic conditions. Concerning CNS cysticercosis, if CSF total protein content and electrophoretic data on its fractions are considered together (table IS and 19; graph. 1), it is possible to evidence that at least two mechanisms participate in the origin of protein changes (tables 20 and 21; graph. 2) : blood-CSF barrier disturbances are able to explain data concerning albumin, a and globulin changes, which are similar; the local production of y-globulin is the hypothesis most reliable to explain the peculiar changes of this fraction. This hypothesis agrees with literature data concerning other chronie inflammatory diseases of the CNS. The probable role of y-globulin in carrying specific antibodies is pointed out through correlative exploration of its concentration in the CSF sample and the corresponding positivity of complement fixation test for cysticercosis.

Resumo em Português:

Foram estudados os aspectos histológicos da regeneração nervosa após secções de nervos por diversos métodos cirúrgicos, visando a prevenção do neuroma de amputação. O material - nervos ciáticos de 72 cobaios - foi dividido em 12 grupos conforme a técnica cirúrgica empregada. As peças foram fixadas em formol a 20% neutralizado com carbonato de magnésio e impregnadas pelo método de Boeke com viragem em ouro pelo método de Castro, ou fixadas em álcool amoniacal e impregnadas pelo nitrato de prata reduzido de Cajal. Os diversos métodos cirúrgicos empregados determinaram variações no desenvolvimento das alterações degenerativas e principalmente proliferativas, permitindo classificá-las em quatro graus: no grau I predominam as alterações degenerativas, sendo as proliferativas representadas por discreto aumento de neurofibrilas não entrecruzadas; no grau II, as alterações proliferativas são mais evidentes, havendo entrecruzamento de neurofibrilas; no grau III as alterações proliferativas predominam, ocorrendo, nos botões terminais, aumento de fibrilas com entrecruzamento; no grau IV as alterações proliferativas dominam o quadro histológico (dicotomização das fibras, fibrilas terminando-se por formações argénticas fortemente impregnadas, acentuado entrecruzamento). A reação de grau I foi considerada como ausência de neuroma. Nos métodos cirúrgicos que oferecem maior proteção ao nervo seccionado, há menor incidência de neuromas, pois os meios utilizados para a proteção da extremidade nervosa determinam hiperplasia do tecido conjuntivo cicatricial que envolve o coto proximal, dificultando a proliferação dos filetes nervosos e a influência da substância neurotrópica formada pelas células de Schwann e pelos tecidos circunvizinhos.

Resumo em Inglês:

Histological aspects of nervous regeneration after section of peripheral nerves by different surgical procedures were studied aiming the prevention of the amputation neuroma. The material (sciatic nerves of 72 guinea pigs) was divided into 12 groups according to the surgical technique used. The pieces were fixed with 20% formol solution neutralized by magnesium carbonate and impregnated by Boeke's method with gold turn-over according to Castro's method or fixed with ammoniacal alcohol and impregnated by Cajal's reduced silver nitrate. The different surgical methods employed have determined variations in the development of degenerative and proliferative alterations, which were classified in four grades : in grade I predominates the degenerative alterations being the proliferative ones represented by a slight increase in the number of neurofibrillae not intercrossed; in grade II the proliferative alterations are more striking and there is intercrossing of the neurofibrillae; in grade III the proliferative alterations predominate and there is an increase of intercrossing fibrillae at the boutons terminaux; in grade IV the proliferative alterations dominate the histological picture (fibrillar dicotomization, argentophile granules at the end of the fibrillae, marked intercrossing). Grade I reaction was considered as absence of neuroma. With surgical methods that offer better protection to the bisected nerve the incidence of neuroma is smaller since the procedures for this protection determine a hyperplasia of the connective tissue; the resulting scar hinders the proliferation of fibrillae and the influence of neurotropic substances elaborated by Schwann cells and by the neighbouring tissues.

Resumo em Português:

O autor inicia o trabalho referindo as bases bioquímicas, fisiopatológicas e anátomo-patológicas do tratamento da miastenia pelo ACTH. Na miastenia grave há diminuição da síntese da acetilcolina no organismo, atuando o ACTH no sentido de aumentar esta síntese seja diretamente, por ativação da colinacetilase, seja indiretamente, mediante a redução da massa dos tecidos linfóides, em particular do timo, responsáveis pela elaboração de substâncias que diminuem a síntese da acetilcolina. O autor empregou o ACTH "Armour" e a Cortrofina "Organon", nas doses de 2,5 a 25 mg, sempre pela via intravenosa, diluídos em 250 a 1.000 ml de soluto glicosado a 5%, administrado gota a gôta, na velocidade média de 20 gôtas por minuto, durante 8 horas. Como medicação associada foi administrada a Prostigmina a todos os pacientes, substituída, depois, em alguns casos, pelo Mestinon ou pela Mytelaze. Como adjuvantes foram empregados o cloreto de potássio (2 a 8 g por dia) e o sulfato de efedrina (25 mg 3 vêzes ao dia). Os pacientes foram mantidos em regime hiperprotéico e acloretado, sendo tomados todos os cuidados inerentes ao uso do ACTH. Foram estudados 10 pacientes portadores de miastenia com sintomatologia acentuada (8 casos) e média (2 casos). Todos os doentes vinham sendo tratados com drogas anticolinesterásicas em doses adequadas (Prostigmina, Mestinon, Mytelaze) e a sua sintomatologia respondia cada vez menos a esta terapêutica. Em alguns casos haviam sido tentados outros tratamentos (timectomia, denervação do seio carotídeo, irradiação da região tímica) sem resultado. É de notar que as remissões espontâneas neste grupo de enfermos foram excepcionais e de curta duração. A evolução foi acompanhada do ponto de vista clínico, com a sintomatologia classificada como muito acentuada, acentuada, média e leve. Em todos os casos houve remissão completa ou quase completa da sintomatologia após dosagens variáveis de ACTH; no caso 2, por exemplo, somente na terceira série de ACTH, foi conseguida remissão da sintomatologia acentuada para leve. Dos 10 casos relatados neste trabalho, em 6 houve agravação dos sintomas miastênicos nos primeiros 10 dias de tratamento. O autor considera o ACTH, utilizado por via intravenosa, como importante contribuição na terapêutica da miastenia grave, sendo especialmente indicado nas formas severas que não regridem mediante o emprego dos medicamentos anticolinesterásicos habitualmente usados.

Resumo em Inglês:

The author presents the biochemical, physiopathological and anatomo-pathological bases of the treatment of myasthenia gravis by ACTH. In this disease there is a reduction of the synthesis of acetylcholine in the body; ACTH stimulates this synthesis, diretly by activation of cholinacetylasis, or indirectly, through reduction of the mass of lymphoid tissues, especially of the thymus, which are responsible for the elaboration of substances which reduce the synthesis of acetylcholine. The author used ACTH "Armour" and Cortrophine "Organon", in the doses of 2.5 to 25 mgm., diluted in 250 to 1,000 ml. of a 5% glycose solution; administration was always by intravenous way, in an average rate of 20 drops/minute, during 8 hours. As associate medication all patients received Prostigmin, which was later replaced, in some cases, by Mestinon or Mytelaze. As accessory medicaments were used potassium chloryde (2 to 8 grams per day) and ephedrine sulfate (25 mgm. 3 times a dayly). Patients were kept in an hyperproteic and achlorated diet and all precautions indicated when using ACTH were employed. Ten patients with myasthenia were studied. All patients had been treated before with anticholinesterasic drugs (Prostigmin, Mestinon, Mytelaze) in proper doses and their reaction to this therapy decreased gradually. In some cases other treatments had been tried thymectomy, denervation of the carotid sinus, radiation of the thymic region) without any result. Spontaneous remission in this group of patients were exceptional and for only short periods. Evolution was followed up from the clinical point of view. In all cases complete or almost complete remission occurred after a variable dosage of ACTH. In case 2, for instance, only after the 3rd series of ACTH remission of a severe symptomatology to a slight one was attained. In 6 of the 10 cases myasthenic symptoms became worse during the first 10 days of treatment. The author considers intravenous administration of ACTH as an important contribution to the therapy of myasthenia gravis, being especially indicated in the severe forms, which does not decrease through the use of anticholinesterasic drugs usually employed.