Neurologia-Neurocirugia Psiquiatria最新文献

Social policy is defined; starting with the concept of health, actions are described and specified beyond the traditional medical model. Using drug dependency as an example, the concepts of damage and vulnerability are applied to illustrate how mental health actions operate in the development of social medicine and place it in the framework of social policy. The need for such a policy is outlined, with a strategy stemming from it. Priority actions in the mental health field are specified and it is shown that actions go beyond professional activities as understood in the traditional models.

A hypothesis is presented that multiple sclerosis (MS) may represent an unusual host response to measles virus, dependent upon when the measles virus is acquired. If acquired late in childhood or near adolescence, the risk of MS is increased. Evidence to support this hypothesis is still meager, but there is ample support from many types of infection for the idea that a host's response may vary with age at the time of infection. As measles virus titers are somewhat increased in MS, evidence for age-dependent alteration in host responsiveness to measles may be taken as further support for the hypothesis. In addition, epidemiologic and clinical data linking MS frequency and average age at the time of measles infection exist. In those areas where MS is rare, measles tends to occur early in life; where MS is common, measles tends to occur later. In case-control studies, measles occurred later in MS patients than in the control groups. Finally mechanisms which might explain an age-dependent alteration in host responsiveness were considered, including maturation of an immune system or maturation of a CNS target cell, e.g. the oligocyte. Additional studies are needed to establish a firmer basis for the concept that risk of MS might be determined, in part, by the age at which a certain infection (e.g. measles) is acquired. If the hypothesis is correct, the mass measles vaccination programs should start to produce a decline in MS frequency. Because the event causing MS is believed to occur before age 15 and MS begins on the average by age 30, a 15-year lag in the effect of measles vaccine on MS frequency is to be expected. Mass measles vaccination was began in 1965, thus by 1980, a decline in MS frequency might be looked for as a test of the hypothesis. Perhaps by the V Pan-American Congress of Neurology, we shall be able to report that MS is disappearing.

A review of different viewpoints on the theme "Death and the child" is made. When the child loses a loved object, he has to accept it in the outside world and manage the changes in his inner world. If the lost object is very needed, his ability to comprehend death is obstructed. When and how it is possible to help the child to understand death, is also examined. Depending of the age, development stage, previous relationships with the dead person, each child reacts differently. Effects of divorce on children are studied. A method that provides better avenues for ellaboration to children is presented.

In the study of children with language problems, particularly in reading and writing, it has been observed that some have an outstanding ability to produce artistic pictures and objects. These productions are perceptive, well organized and generally contain much action. Despite their pictorial skill these patients may have only a rudimentary use of coded symbolic graphic forms. Others display moderate ability in reading and writing. These patients frequently have the disorganized overacctive behavior and the motor clumsiness that is so common in the dyslectic child; some, however, are biologically effective. From this material we entertain the hypothesis that picture (artistic) productions are generated by the sub-dominant cerebral hemisphere, and that this function is quite distinct from the coded graphic operations resident in the dominant hemisphere. If this hypothesis is correct, it would seem socially benefical to allow these patients to develop their unique artistic ability to its full capacity, and not to overemphasize the correction of the disturbed coded symbol operations in remedial training.

Unlabelled: To determine the frequency and distribution of cysticercosis in Peru, we have reviewed the post mortem examinations of 12 years in the morgue in Lima (necropsies of persons apparently healthy, who died suddenly for different reasons) and in 11 hospitals: 6 in Lima (5 from adults and 1 from children) and from 5 hospitals from other cities located north and south of the capital. The material includes 50 000 necropsies and in those the frequency of cysticercosis was determined; its geographical distribution by states and regions and the frequency by age and sex. Comparison with other similar studies done in Latin America is made and prevalence determined. Frequency of porcine cysticercosis was determined in 82 452 animals killed in Lima in a 3 years period.

Conclusions: frequency of cysticercosis in Peru's hospitals is 1.15%, while in the morgue, which represents approximately what happens in general population in 0.15%. Prevalence is 450 for 100 000 inhabitants.

A fifteen-year study was made in the neurologic clinic of the school of medicine, of the City of Sao Paulo; 466 patients were examined clinically and with EMG determination of enzymes, biopsies and genetic counsel. The diagnosis varied much and some important findings at heart level, with overload, were discovered in some cases. In the cases in which the diagnosis was not confirmed; CPK was determined, which was increased in all cases, but was not so with GOT, GPT and LDH. A family pattern was found in the Duchenne Becker distrophy, limb-girdle syndrome, fascioscapulohumeral and oculopharyngeal. The biopsy exposed 15 of the 18 polymyositis cases. Genetic counsel was given to heterozygotes with PMD genes of great risk of presentation. An acute stage, detected by CPK dosage, was foreseen for adolescent heterozygotes.

In 78 children (5-13 years old) with minimal brain dysfunction, a comparative trial was carried out in order to evaluate three different treatment plans: carbamazepine alone, carbamazepine plus psychotherapy and psychotherapy alone. The improvement obtained in children who received carbamazepine (alone or with psychoterapy) was greater than that of patients treated with psychotherapy only. The difference was highly statistically significant (p=0.01). Carbamazepine was well tolerated. This trial has shown that carbamazepine is a useful aid in the treatment of behavioral and learning disorders occurring in children with minimal brain dysfunction.

The Argentine hemorrhagic fever (AHF) is an infectious disease, endemo-epidemical, of viral etiology, produced by the Junin virus and limited to the Buenos Aires Province, South of Córdoba, East of La Pampa, and South of Santa Fe. It generally assails rural workers at harvest-time, especially during corn-harvest. The incubation period of the disease does not exceed 12 days. A feverish syndrome with asthenia, adynamia, myalgias, migraine, photophobia, epigastralgia etc., appear. The patient has a facial erythema, petechias on the skin, enantema on the palate, conjunctive micropolyadenopaty injection. The laboratory shows a low erytro, leukopenia with aneosinophilia, thrombopenia and a urine with albuminuria and virous cells. After the fourth day, hemorrhage and a neurological case appears. The laboratory tends to normalize and cast appears in the urine. The most striking neurological signs are the following: muscular hypotonia, proprioceptive hyporreflexia or arreflexia, marinesco reflex, shakings, difficulty to stand and walk, oscillations in consciousness level, and ocular disturbances. The cytochemical test of the C.L. Rachis in the usual ways of the AHF is within its normal characteristics; on the other hand there are modifications in the nervous cases: the total proteins are nearly always increased and the cells augmented with a great predominance of mononuclear cells. The electroencephalogrammes were always abnormal, varying from a brief disorganization up to a diffusive and permanent slowness. The half of which additionally presented paroxisms generalized by slow waves. The pathological anatomy over the central nervous system makes us think that the lesion would not primitively neuronal but that the action of the virus would be indirectly done through the capillar wall. This capillar lesion is produced by multiple focuses. The neuronal destruction with necrosis by microinfarcts is minimum. The symptoms and neurological signs are present in 10% of the clinical cases; the death-rate in the nervous clinical cases having reached 50% of them. The premature treatment allows the death-rate to diminish and the cases that survive have not many after effects.