Neurologia-Neurocirugia Psiquiatria最新文献

The author proposes that in institutions the orthodox way of observing the patient psychotherapeutically has to be changed by concepts of brief therapy; for this it is required to understand the dynamics of the patient and his response to treatment. Other important points in relation with the above are the institution (locale, furniture and paramedical personnel) and the time available to approach the patient. The author states that to achieve a good therapeutic result in a short time there are three requisites for the therapist: personal analysis, supervised clinical experience and training in psychodynamics.

Of the results obtained by numerous investigators in the study of the acetylcholine-acetylcholinesterase system, it is quite clear that it is altered significantly in the convulsive state. In the present work, a study of the acetylcholinesterase activity (AChE) in serum was made in 53 patients with different type of epilepsy during the intercritical period. A significantly high increase in the enzymatic activity (p less than 0.001) was found, compared with that of the controls, unrelated with the probable etiology of the process nor with some symptoms. We observed, nevertheless, a tendency towards diminished enzymatic activity with an increase of the severity of the electroencephalographic picture, and we interpreted this as a compensating effect. The AChE activity in serum and cerebrospinal fluid of a group of epileptic patients subjected to stereotaxic operations was studied before and after surgery, observing a significantly diminished activity of AChE in serum (p less than 0.001) after surgery. This asserts the hypothesis of the compensating increase of the AChE activity in serum, which tends to normalize once some of the factors producing the decompensation are eliminated.

Two years ago, we performed a precocious evolutive EEG study of a specimen not selected from the virus ME to ECHO 4 burst (cepa prima) late 1972 to early 1973 (6). Some time between the appearance of the first symptoms and the 8 weeks following, alterations of cerebral electrogenesis became manifest in this study. These alterations disappeared or dimished in significance in the more tardy outlines: focalization tendency, tendency to change from "suffering" to "irritative" aspect. During this year, the test has been repeated on 82% of these patients, plus at the same time a minimum clinical survey. Until now, the results are the following. There are no clinical signs of the CNS in any case. School progress has not been affected, except moderately, for two patients. The EEG has become totally normal in more than 2/3 of the cases. Persistent EEG net signs of minimum "suffering" in three cases. There are "irritative" generalized signs in only 2 patients and "irritative" certified focal signs in 6 patients. Other EEG manifestations are of doubtful interpretation due to the age of the patients.

Primary amebic meningoencephalitis (PAM) is an infectious disease essentially confined to the central nervous system (CNS) and caused by free-living ameboflagellates of the genus Naegleria (N) and Acanthamoeba (A). N produces an acute fulminant, usually fatal hemorrhagic-necrotizing meningoencephalitis, associated with an inflammatory reaction composed of neutrophils, eosinophils, macrophages and a few lymphocytes. The incubation period is between 3-7 days. Typically, PAM occurs in healthy, young individuals, who frequently have a history of swimming or washing their face in infested waters. The portal of entry into the CNS is through the olfactory neuroepithelium, at the level of the cribriform plate and invasion of the amyelinic submucosal nervous plexus. Trophozoites are the only amebic forms found in the lesions. By contrast, A produces a sub-acute or chronic granulamotous meningoencephalitis (AM) with multinucleated foreign body giant cells, lymphocytes and monocytes. Cysts and trophozoites may be present in the lesions. AM have been reported in chronically ill debilitated individuals, some of them under immunosuppressive therapy, without history of recent swimming. The portal of entry into the CNS appears to be by hematogenous route. The incubation period is unknown, but perhaps more than 10 days. This comparison indicates that infection due to Naegleria produces a clearly defined clinco-pathological entity, which differs significantly from that due to Acanthamoeba, and both species of amebus should be considered in the differential diagnosis of amebic meningoencephalitis.

The author mentions the needs and the type of work psychiatrists do in a general hospital; he underlines the importance of good communication between the psychiatrists and the general practitioner. Success depends on the selection of patients and of the analytic framework the author uses. It is mentioned that the therapist-patient relationship can be damaging or beneficial according to the way it is handled.

To date, there is little information available on stroke risk factors in a major ethnic minority such as Mexican-Americans (M-A) in the USA. Forty-three M-A patients were admitted to The Methodist Hospital and Ben Taub General Hospital (Houston) for a 12-month period, with diagnosis of atherosclerotic stroke. Thrombosis was diagnosed in 31 patients (72%), embolism from atherosclerotic sources in seven (16.4%), and parenchymal hemorrhage in five (11.6%). Hypertension was a common risk factor in all groups, being higher in hemorrhage followed by thrombosis and embolism. Arteriosclerotic heart disease was a common risk to all stroke types. TIAs, hyperlipidemia, diabetes, associated atherosclerotic lesions, smoking, obesity, erythrocytosis and sedentary life were significantly associated with embolism; less so with thrombosis or hemorrhage. Gout was only associated with thrombosis. These results indicate similar risk factors for Anglo-saxons and M-A in the USA with some minor differences between the Mexican and the USA stroke series.

An epidemiology analysis is carried out in a hospital population of 500 epileptic patients older than 14 years of age, pertaining to the outpatient department of the Instituto de Neurología, Hospital de Clínicas, Monevideo". This information gathered, corresponds to the period, 1966-1975. Specially formulated records of precoded-type data were used for this research and the data was processed by automation. This work deals fundamentally with a descriptive study in which the character of the population and of its epilepsy is studied by means of 20 items. Analyzed from within the social aspects, the school attendance and the occupation of the patients, amounts, similar to those of the general population of the country, were found. An elevated incidence of family epilepsy antecedents (17%) in the group and also of perinatal pathology (19%), is emphasized. An analytic study of the clinical type of crisis and of the factors unleashed by the attacks is made. Dividing the population into two groups, according to the beginning of epilepsy, before or after the 25 years, the different etiology for both groups is specially pointed out, the juvenile epilepsy predominating in the unknown etiology, genetics and that which is produced by perinatal pathology, while in the tary epilepsy, the vascular and tumoral etiology, above all, is most frequent.

CNS involvement includes: 1) acute phase: scattered focal meningoencephalitic lesions, meningeal and cerebral edema, disseminated microgranulomas containing microgliocytes and situated in relation to cerebral blood vessels, and moderate cerebral fluid pleocytosis. Acute chagasic meningoencephalitis is always fatal, and does not become chronic, as occurres with the myocardial lesions; 2) chronic phase: tromboembolic phenomena due to the chronic myocarditis, and cerebral and cerebelar atrophy of obscure pathogenesis and without inflammatory changes. B) vegetative nervous system involvement includes: 1) acute phase: neuronal destruction, with neuronal loss of varying intensity; 2) chronic phase: visceral dilatation due to neuronal loss during the acute phase.

A Community Psychiatry program was begun, based on the needs and requests of a clinic (this approach is restricted because there are institutional factors that only the institution can change). The work was aimed at sensitizing the beneficiaries and change clinic factors modifiable through operative group technique. When a great deal of every day stereotypes appeared, role playing was used: as a result, people in the clinic realized how they acted and how they asked from others behaviors that they themselves found difficult to show. As results, it was found that when workers were confronted with reality, desertion from operative groups appeared, with projection of problems (them, not me), great fear of change (fantasized in different ways), group passivity and the image of the institution, that the group saw as a persecutor.