Neurologia-Neurocirugia Psiquiatria最新文献

An operational group is defined; how operational groups theory was applied at an ISSSTE clinic is described. It is underlined how operational groups promote change around the corerstone of a "task". The vicissitudes of an operational group with four psychiatrists who worked in community psychiatry at the ISSSTE, are described.

Since there is no satisfactory animal model for multiple sclerosis (MS), a need exists to study various tissues of the affected patient himself. Leukapheresis is a relatively non-invasive technique for obtaining large numbers of leucocytes from patients and control patients. Using ACD-B solution as anticoagulant, the procedure can process 3 500 ml. of blood in about 2 hours, and yield an average of 6.7 billion lymphocytes. The circulating blood count and differential leucocyte count are not changed significantly at the end of the procedure, although the platelet count drops slightly. Leukapheresis has been performed 6 times in four MS patients representing all stages of the illness. The data indicate that the procedure, as performed, is safe in MS patients and do not adversely alter the course of the illness. Leukapheresis is not suggested for therapy at this time. However, if further study suggests that circulating lymphocytes in the MS patient have a cytolytic function in the central nervous system (CNS), the procedure might merit a trial in a controlled treatment program. At present, leukapheresis will probably be most useful as a research tool, to aid study of the role of the lymphocyte in the pathogenesis of MS.

Subacute sclerosing panencephalitis (SSPE) is a progressive, fatal inclusion cell encephalitis of children and adolescents caused by persistent measles virus within the central nervous system (CNS). Because studies in man have failed to elucidate the pathogenesis of this condition, animal studies are necessary. Persistent infection of the hamster CNS can be achieved with a hamster adapted SSPE agent. Animals inoculated intracerebrally with this virus raise antibodies to all known antigens of measles virus and some display clinical signs and pathological changes similar to those noted in human SSPE. Persistent CNS infection occurs only if the hamster is inoculated at a critical age (18 to 25 days of life) or if adults are given transient immunosuppression during acute infection. The biological behavior of the virus isolated from hamster CNS appears to change from a complete to a defective state coincidents with the appearance of serum antibodies to measles virus. Adult hamsters from whom the thymus was removed in the newborn period develop a subacute, uniformly fatal infection when exposed to the SSPE agent. These studies suggest that SSPE may develop in man when measles virus invades the immature CNS at a critical age or when the immune system is uncompletely developed or is inhibited. The finding that transient immunosuppression allows development of persistent CNS infection in adults suggest that immunological malfunction is the significant factor. Of interest, antibody appears to alter viral behavior to a defective, intracellular state thus enhancing viral survival in the host. Once a defective, CNS infection is achieved, lack of, or inhibition of the host cellular immunes response allows it to persist. Methods of therapy in light of these findings will be discussed.

Clinicians have noted resemblance between ALS with predominantly lower motor involvement and a chronic type of poliomyelitis. Occasional cases of ALS show lymphocytic infiltrations in the neuropathology. Cytoplasmic inclusion bodies as well as possible transmission of ALS to the monkey, were noted by Soviet investigators. Major questions about the latter remain, but inclusion bodies have been seen in cases outside the USSR, and search for a virus has been pursued. So far, efforts at culture, including the technique of co-cultivation, have not been successful in 3 different laboratories using material from ALS autopsied within 2 hours of death. Nor has such material and specimens from other cases produced transmissible disease in animals of laboratories where kuru, Jakob's disease and SSPE have been transmitted. Study of serum antibodies has also been negative. These negative culture, transmission and antibody studies do not exclude a viral etiology: in kuru, for example, many years passed before transmission was demonstrated, which remains the only evidence of kuru's infectivity. Evidence of an immunologic disorder in ALS has been obtained from kidney biopsies, the lack of any clinical benefit from immunosuppression may indicate that the kidney finding reveals a response to infection, though whether viral or even relevant is unknown. Two recent ALS cases will be illustrated in which virus-like particles were demonstrated post mortem by electronmicroscopy. In one, myxovirus-like tubules were seen mainly in motor neurons; in the other, picorna-virus-like crystals were found in skeletal muscles. Different viruses can cause identical disease, but 2 different viruses in different sites in ALS also suggest that at least one type of particle is an adventitious finding of no general significance. An additional impetus to continue the search is the slowly progressive type C-virus myelitis in wild mice. This disease has many dissimilarities to ALS, including different morphology of the virus, but may provide a model for slow-virus amyotrophy.

The state of medicine and neurology in the past years, since 1962, is described. The initial personnel with which neurology and neurosurgery began working, the manner in which the group was formed and the subsequent formation of specialists in this area are commented. We describe the hours and subjects studied by the residents and the modifications that the program has experienced since 1962, until 1971, in which a program of philosophy, social and political lectures, combined with the specialization classes, exists. An evaluation system, created by the group and number of specialists formed since its initiation, also exists. Subsequent to their formation, physicians integrate neurologist and neurosurgeon teams and are situated in areas of provinces which cover a population of 500 000 to 1 500 000 inhabitants.

Hippocrates probably first described mumps parotitis, but not until 1758 was affection of the central nervous system reported in this disease. Mumps meningitis, encephalitis, myelitis, polyradiculitis and cranial neuritis are now well known, and may occur without clinical parotitis. Meningitis occurs most commonly, encephalitis, cranial neuritis and polyradiculitis less often, and myelitis rarely. They may present individually or in combination. A patient is described who first developed acute mumps meningoencephalitis, without clinical parotitis. Transverse myelitis occurred two weeks later, and finally optic neuritis ten days following the myelitis. Slow but complete recovery followed. Attention is directed to the various ways mumps can affect the nervous system. This virus should always be considered among possible etiologic agents causing such neurologic syndromes.

The immunological responses of patients with clinical signs of SSPE were examined by the direct migration inhibition, complement-mediated antibody cytoxicity and the lymphocyte-mediated cytotoxicity assay techniques. Peripheral lymphocytes migrated similarly to controls when exposed to measles antigen. Lymphocytes from SSPE patients responded to a SSPE strain of measles infected cells in a manner similar to lymphocytes from controls. A factor which interfered with the expected activity of sensitized lymphocytes to measles virus was detected in some cerebral spinal fluid obtained from SSPE patients. The blocking activity varied from 100% in 4 of 20 patients with SSPE to no blocking in 2 of the SSPE patients. The occurrence of blocking factor in SSPE patients could not be related to sex or age of the patient, serum of CSF antibody levels, and duration of disease or outcome.

We have analyzed 105 cases of Status Epilepticus of variable etiology, cared for over a period of 3 years at the "Instituto de Neurología y Neurocirugía". Age, sex, origin, duration of illness before attending the Institute, Conscience variations, clinical crisis types, condition of Status Epilepticus appearance and unleashing factors were considered. Various complementary investigations were performed, although dissimilar in each case. Follow up EEG's were realized in 60% of the patients and pretherapeutic EEG's were done in less than 50%. The necessary time to control the Status was explained, depending on its duration before commencing treatment. Of 93 surviving patients, it was possible to learn the cause of epilepsy only in 43. The necroscopy study of 12 cases demonstrated that death in 9 patients was inevitable for various causes (tumorous, infectious, vascular, etc.) almost always intricate. In other 3 autopsied patients, only signs of cerebral hypoxia and non-neurologic infectious complications were found. In the discussion, the hypoxia-edema-hypoxia mechanism is insisted upon, as well as the need of breaking this circle as an important part of the treatment of these patients.

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.