Neurologia-Neurocirugia Psiquiatria最新文献

A hamster-adapted SSPE agent was shown to cause a productive infection in weanling hamster brain, which changed to a cell-associated or defective infection coincident with the appearance of measles antibodies in serum. Antibodies to measles hemagglutinin, hemolysin and neucleocapsid antigens developed in serum, which also contained neutralizing activity for regular measles virus. The agent recovered from the brains prior to the appearance of serum antibodies was infectious in cell-free media, capable of rapidly destroying Vero-cell cultures and able to progressively destroy primary hamster brain cultures. In contrast the agent recovered from the brain after serum antibodies were present, was infectious only within cells destroyed Vero-cells ineffectively and spread slowly through primary brain tissue cultures releasing minute amounts of extracellular virus intermittently. Nevertheless, infected giant cells in the primary brain cultures contained both the HA & HL measles antigens in their cytoplasmic membranes. This in vivo conversion of a productive to a cell-associated cerebral infection appeared to be caused by the host antibody response and may mirror the initial events of human SSPE and possibly other slow or latent measles infections of the CNS.

In 1972, prepaid medical care for government employees provided by their social security institute, ISSSTE, was reorganized. A division of planning and technical standards was established, within which a Department of Psychiatry was included. Psychiatric care was restructured at three levels: psychiatric hospital, psychiatric OPD at clinic and hospital level and a pilot program in community psychiatry. A three-year psychiatric residency program was established, in addition to participation in other postgraduate, in-service training and monographic courses. Systematic research was started, as well as a publications program, working relationship with other institutions and societies were enhanced. A descriptive example is Child Psychiatry. Most frequent diagnoses are reviewed, and development of services is followed in relation to pediatric departments.

Central nervous system (CNS) lesions were studied from weanling hamsters inoculated with the HBS strain of subacute sclerosing panencephalitis (SSPE) virus. The animals showed clincial signs of acute encephalitis between 8 and 18 days post-inoculation (PI), but all survivors were clinically recovered by day 21 PI. Nevertheless, 13 of 14 hamster brains examined by light and electron microscopy between days 21 and 59 PI had chronic lesions which contained morphologic evidence of persistent viral infection. The lesions developed preferentially in the subependymal areas of the lateral and fourth ventricles and involved degeneration of ependyma with subsequent damage to adjacent parenchyma. All CNS cell types were involved in degeneration. Viral inclusions occurred in both CNS parenchymal cells and in inflammatory cells. Giant cells were particularly common. No budding virus was seen in chronically infected animals, a finding in accord with previous studies. Demyelination was a common constituent of most lesions. It occurred in the presence of inflammatory cells and macrophages, and in later lesions, some remyelination was seen. It is suggested that the damage to myelin is a secondary phenomenon and is not a cellular immune reaction. The possible reasons underlying the latent nature of the virus and the similarities between this condition, canine distemper encephalomyelitis and human SSPE are discussed. It is concluded that the experimental chronic disease is a valid model for the study of human SSPE and may have usefulness in the understanding of other chronic CNS conditions of man, e.g. multiple sclerosis. Additional Key Words: Latent infection; Paramyxovirus; Slow Viruses; Demyelination; Inmmunologic defects; Multiple Sclerosis.

The study of two groups of right handed aphasics, group A and group B, is presented. Each group was formed by four subjects, both groups showed an aphasic syndrome craracterized by alteration in the efferent sphere of oral and written language, principally in the latter. There was almost no alteration in the sensory interchange sphere, except for a right hypoesthesia and astereognosis in two subjects of each group. The aspect in which both groups differed profoundly was the efferent sphere of written language. Group B patients could not write with the dominant hand because of a right hemiplegia. Nevertheless, they could do it with the left, nondominant hand. Group A patients were unable to write with either hand in spite of the absence of motor deficit or incoordination which could explain this inability. The different possible topographical localizations responsible for the deficit are analyzed. It is concluded that there are three main possibilities that could explain the writing difficulty found in group B patients: a) a lesion located in the white frontal matter of the left hemisphere just underneath the kinesthetic area; b) a lesion in the kinesthetic dominant area itself; c) a lesion in the dominant cerebral hemisphere white matter underlying the primary receptor somesthetic and the primary effector areas, but without directly involving them, and extending also in depth toward the anterior third of the corpus callosum. Any one of these lesions could impair the transmission of information from the dominant kinesthetic hand area to the primary effector motor area of both cerebral hemispheres.

Since most of the patients who attend for psychiatric consultation at a clinic are little motivated for psychotherapy, analytic group therapy was attempted, with basis on studies on psychological genetics, on groups management, and on the theories of Freud, Klein and Bion. Several open groups were handled, with the following achievements: 1. A decrease in anxiety, and increase in the objective vision of reality and in increase in the ability to see past and present conflicts. 2. A greater tolerance to agressive and sexual instincts and to frustration. 3. A greater personal acceptance, ability to sublimate productively and elimination of clinical symptoms. Varying degrees of improvement, and lesser need for psychiatric medication and hospitalization were obtained. Several problems were encountered: a) Desertion of 30% of patients from the sessions, due to the disapearance of symptoms buth with no character changes (resistances). b) Temporary absence or habit of arriving late to the sessions (resistances). c) Overwhelming passivity. The groups were handled in cotherapy and the work was supervised with experienced therapists. To attempt solving the above mentioned problems a better selection of patients was made, complete clinical histories were elaborated, a battery of psychological tests was made, and diagnosis, dynamics and prognosis of each case were outlined; this allowed the evaluation of middle and long term treatment. It was suggested to change the technique to that of operative groups.

It is of great emotional impact to lose upper or lower limbs; adequate psychological handling of such a loss is described. Mourning will bary if amputation was programmed or carried out without warning. In the group, individual conflict, depression and the problem of function loss are handled, more than problems of the patient vis-a-vis the institution. Characteristics of the group are described.

In a social security system that includes prepaid, integral medical care, psychiatric services function in prevention, treatment and rehabilitation in a close relationship with the rest of medical care, the psychotherapies are part of an eclectic system of psychiatric attention, but also of the psychological aspects of institution-patients, institution-beneficiaries and institution-staff relationships. Within diverse psychotherapeutic schools, common denominators of the therapeutic process are outlined, as well as the background philosophy of the system.

In a warm desertic and irrigated region, with population 250 000 Northwest of Mexico, in Hermosillo, Sonora, along 8 weeks, 51 patients showed the following clinical data: fever, vomiting, neck rigidity, drowsiness and increase of cells and proteins in the CSF. In 12 patients good correlations were found between positive serologic results using SLE antigen by means of HI, CF and NT. Four paired sera showed fourfold increases in titers to SLE by means of HI or CF. With VEE antigen no such increases were found. The cases were scattered geographically, most of them occurred within an urban area, and affected people in 13 localities. The outbreak developed from August to September, 1974, the attack rate was 22/100 000, 69% of the patients being children under 15 years of age. The case fatality rate was 20%. A prosperous chicken industry existed in the region and epizootics were not reported in either domestic or wild animals at that time.