Resumo em Português:

São estudados sintomas não neurológicos cuja regulação ora é central ora periférica; falando em regulação central o autor tanto subentende a psíquica, como a estritamente neural. Um mesmo sintoma pode ser ativado e exteriorizado por fatôres diversos; assim, um acesso asmático ou uma crise convulsiva podem irromper ou ser inibidos por fatôres de todo extrínsecos à síndrome. A regulação central ativadora ou inibidora será o fator patogênico ou terapêutico até decisivo, sem que, de modo algum, se possa falar em causa do sintoma; inversamente, um sintoma que foi inicialmente desencadeado por desregulação central pode tornar-se autóctone e a desregulação não será mais central, mas periférica e autônoma, às vêzes irreversível. Também é certo que cada sintoma pode evoluir independente do outro, tanto para melhorar como para piorar. A simultaneidade e identidade patogênica não significa equivalência evolutiva. Como o sintoma pode evolver anexando sucessivos elos fisiológicos que não lhe são intrínsecos, êsses elos podem assumir papel patogênico, passando mesmo a comandar o sintoma, embora sejam estranhos à causalidade dêle: o fenômeno antes periférico ganhou regulação central que é elo adicional estranho mas decisivo. Assim o sintoma que era "específico" passa a "inespecífico". Em vez de causa, o importante é o fator. E o fator pode subir tanto de importância que decide da evolução, inclusive pela irrever-sibilidade. Na cadeia de reações que o sintoma vai organizando, qualquer elo pode tornar-se o desencadeador e o mais importante. Regulação central e periférica do sintoma psicossomático é expressão dessa possibilidade.

Resumo em Inglês:

The author studies symptoms which are not neurological and which regulation could be central or peripheral; referring to the central regulation, the author implies the psychic as well as the neural one. The same symptom may be exteriorized and activated by different factors; thus the asthmatic crisis or the convulsive attack may be initiated or inhibited by factors which are extrinsic to the syndrome. The activating or inhibiting central regulation will be a pathogenic or therapeutic factor, even decisive, without any link whatsoever with the cause of the symptom; conversely, symptoms which have been initially brought about by central dysregulation can become autochtonous and the dysregulation then is no longer central but peripheral and autonomic and sometimes irreversible. It is also certain that each symptom can evolve independently from the other not only to get better but also to get worse. The simultaneousness and pathogenic identity do not mean evolutional equivalence. As symptoms can develop adding successive physiological links that are not intrinsic to them, these extrinsic links take on a pathogenic role, sometimes passing to command the symptoms though extraneous to their causality: the symptomatic phenomenon, previously peripheral, has gained central regulation which is an additional link, extraneous but a decisive one. In this way, the symptom that was "specific" becomes "non-specific"; instead of cause the factor is important. And the importance of the factor can rise so much to decide the evolution, including the irreversibility, and the cause is no longer found. In the chain of reactions that the symptom keeps on organizing, any link may becomes the trigger and the most important. Central and peripheral regulation of the psychosomatic symptom is the expression of this possibility.

Resumo em Português:

É relatada a presença de uma translocação 21-13/15 nos cariótipos com 46 cromossomos de um menino mongolóide (síndrome de Down), sendo o cromossomo anômalo transmitido pela mãe do paciente. São discutidas a possível deficiência do cromossomo 21 translocado, e a possivel origem da anomalia na família. É assinalada a presença de um cromossomo Y mar-cadamente grande, tanto nos cariótipos do paciente como nos do seu pai.

Resumo em Inglês:

The presence of a translocation 21/13-15 is related in 46 chromosomes, karyotypes of a mongoloid male child (Down's syndrome). The abnormal chromosome was transmitted by the mother of the patient. The possible deficiency of translocated chromosome 21 and the possible origin of the anomaly in the family was discussed and the presence of a markedly large Y chromosome in the karyotypes of the patient as in those of his father was also noted.

Resumo em Português:

Estudo baseado na análise dos dados referentes ao proteinograma do LCR de 28 pacientes com afecções degenerativas do SNC, de diversos tipos. A alteração principal encontrada foi o aumento do teor de -globulina, observado em 12 casos. O aumento dessa globulina ocorreu especialmente em casos com acome-timento predominantemente encefálico (10 casos). Não foi observada relação entre o aumento de β-globulina no LCR e os grupos etiopatogênicos a que pertenciam os casos estudados. O comprometimento metabólico da célula nervosa nas afecções degenerativas do SNC parece ser o principal responsável pelo aumento de β-globulina no LCR. Aspectos evolutivos de casos apresentados permitem verificar a relação existente entre a severidade e a extensão do processo degenerativo e o aumento dessa fração protêica no LCR.

Resumo em Inglês:

The total protein content and the protein fractions (paper electrophoresis) were determined in the CSF of 28 patients with degenerative diseases of the CNS. The diagnosis and the results obtained are presented in table 1. An increase in the β-globulin content of the CFS was the main change found. It was observed in 12 cases. The observation confirms the findings of other authors. The data were discussed and it was shown that the severity of the changes in the metabolism of nerve cells and the extension of the process are more able to explain the increase in the β-globulin content of the CSF. The occurrence of an increase in the β-globulin content of the CSF was related to the localization and extension of the disease process within the CNS and not to the etiology. The distribution of the cases according to the possible site of the lesion in the CNS shows that the increase in the β-globulin of the CSF was more frequent when signs of encephalic involvement were patent (table 2).

Resumo em Português:

Foi estudado o proteinograma do LCR e o do sôro de 45 pacientes com lepra lepromatosa. A alteração principal encontrada no proteinograma do LCR foi o aumento do teor de y-globulina, verificado em cêrca de um têrço dos pacientes (14 casos). O aumento dessa globulina ocorreu de modo mais freqüente nos casos com taxa de proteínas totais maior. O aumento de y-globulina no LCR não guardava relações com o sexo ou a idade dos pacientes, nem com o tempo de evolução, embora não tivesse sido registrado entre os casos cuja doença evoluía há 5 anos ou menos. A análise do material apresentado sugere que o aumento do teor de y-globulina que pode ocorrer na lepra lepromatosa seja secundário ao aumento dessa globulina no sangue. Entre os dados favoráveis a essa hipótese são apresentados os fatos de: os aumentos observados no teor dessa fração terem sido discretos na maioria das vêzes (11 casos); de os aumentos dessa globulina no LCR terem ocorrido na maioria das vêzes em casos com aumento dessa globulina no sôro e o de terem ocorrido sem que se alterasse a relação LCR/sôro do teor dessa globulina na maioria dos casos.

Resumo em Inglês:

The study is based on the observations concerning to 45 patients with leprcmatcus Jeprosy. The test of Mitsuda was negative in all of them. Alcohol-acid fast bacilli were found to be present in 6 cases in cutaneous lesions and/or in nasal cavity. The study of the CSF proteins comprised the determination of the total protein content and the analysis of the proteins fractions, the latter by papel strip electrophoresis. For each patient it was studied one sample of CSF, collected from the cisterna magna and normal concerning to its physics and cytologic properties; complement fixation tests for syphilis and cysticercosis were negative in all samples. For comparison purposes other data were studied: 1. the total protein content of blood serum and its protein fractions, the latter by paper strip electrophoresis also; 2. the age of the patients; 3. the probable time of disease. Results are presented in the table 2. The total concentration of CSF proteins was normal in 42 patients; it was slightly increased in three cases. Changes in electrophoretic pattern of CSF proteins were verified in several cases. The most frequent change was the increase of the y-globulin fraction (14 cases). Its occurrence in this form of the disease was related in a previous former study; the present data confirm such observation. The data discussed in this study show that the increase in the CSF y-globulin is probably related to change in the protein pattern of blood serum. It seems to be secondary to the increase of the y-globulin fraction in the latter.

Resumo em Português:

Foram analisados, do ponto de vista clínico e eletrencefalográfico, 25 pacientes portadores de epilepsia temporal com a finalidade de comparar a sintomatologia clínica evidenciada através da ativação pelo cardiazol com os achados eletrencefalográficos obtidos simultâneamente. Para facilidade do estudo, os pacientes foram divididos em grupos de acôrdo com a sintomatologia clínica. A eclosão de cada sintoma foi analisada objetivamente utilizando a ativação pelo cardiazol em doses fracionadas. Com isso foi possível estabelecer uma seqüência entre o quadro clínico e as alterações eletrencefalográficas. Em cada um dos casos estudados os resultados foram comparados com aqueles referidos na literatura.

Resumo em Inglês:

Based on the metrazol activation of 25 cases of temporal lobe epilepsy, the author analyzes the varied clinical manifestations and electroencephalo- graphic sequence. In order to appreciate more readily the various patterns of temporal lobe seizures the major types of manifestations have been grouped in separate tabulations. The material suggests that there may be an ordered arrangement of certain clinical and electroencephalographic patterns concerned the temporal lobe.

Resumo em Português:

Foram analisados do ponto de vista eletrencefalográfico 30 pacientes com "ilusões de memória": 29 pacientes apresentavam foco de projeção unilateral em um dos lobos temporais; um apresentava foco de projeção bilateral nos lobos temporais. Dos 29 casos com projeção unilateral, 18 apresentavam foco de projeção no lobo temporal esquerdo e 11 no lobo temporal direito. Em relação à situação do foco, 21 pacientes apresentavam foco profundo e 9 foco superficial.

Resumo em Inglês:

Electroencephalographic studies were carried out on 30 patients with "illusions of memory": 29 had unilateral discharges in the temporal lobe and one had bilateral discharges in the temporal lobes. Eighteen patients showed focal discharges in the left temporal lobe and 11 in the right temporal lobe. In 21 patients the electroencephalogram showed subcortical discharges and in 9 cases focal cortical discharges.

Resumo em Português:

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.

Resumo em Inglês:

The concentration of 2-sulphanilamido-5-methyl-pirimidine (SMP) was studied in the CSF and in the blood of 30 patients with diseases of the nervous system. Two groups of patients were considered. The first group was represented by 19 patients in whom the CSF was found to be normal: 10 cases of epilepsy, one case of hydrocephaly, three cases of peripheric neuropathy and five cases of chronic impairment of the spinal cord associated to gastricochloridria. Among the last patients, there was a diminution of the ab-sortion of vitamina B12 in two, as it was evidenced by the radiocyanoco-balamin absorption test (cases 15 and 19). The second group is represented by 11 patients with changes in the CSF composition: 4 patients with polyradiculoneuritis, one patient with neurosyphilis and 5 patients with cysticercosis of the central nervous system. CSF changes were characterized by the occurrence of protein-cytologic dissociation among the first 4 patients and by pleocitosis of the polynuclear type in the case of meningitis. Complement fixation tests for syphilis in the CSF were positive in the case of neurosyphilis and that for cysticercosis in the CSF of the last 5 cases. SMP was administered orally to all patients: 1 g was given initially, and 0.5 g after 12 and 24 hours. CSF and blood samples were collected 36 hours after the first administration. The concentration of sulfanilamide was determined by the method of Bratton and Marshall with a correction for SMP. The results are presented in the table 1. Table 2 shows the mean values obtained in the first group of patients. A positive correlation was found between the concentration of SMP in the blood and in the CSF among the cases of this group. The value of the correlation was statistically significant. The quotient between the concentration of SMP in the CSF and in the blood was represented by 0.203 ± 0.087. The blood concentration of SMP was found to be the lowest in the two cases with deficient absorption of radiocyanocobalamin. The results obtained for the first group of patients were used as a control for the results obtained for the second group of patients. The results were found to be similar in both groups of patients, with exception of two cases of polyradiculoneuritis. In these the quotient of CSF and blood titer of SMP was found to be increased, due to a relative higher titer in the CSF than in the blood. This is interpreted as due to deficient re-absorption of the CSF, which is admitted to occur in polyradiculoneuritis.

Resumo em Português:

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.

Resumo em Inglês:

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.