Necroscopic Examination Research Articles

BETA GLOBULIN IN THE CEREBROSPINAL FLUID IN THE PROGNOSIS OF INFLAMMATORY PROCESSES OF THE CENTRAL NERVOUS SYSTEM

Foi feita avaliação do comportamento da globulina beta do LCR em processos inflamatórios do SNC e/ou de seus envoltórios no sentido de verificar até que ponto podem ser úteis para o prognóstico as informações obtidas. Essa avaliação foi baseada no fato de a concentração dessa globulina no LCR estar relacionada ao metabolismo do parênquima nervoso, aumentando em condições que acarretem seu sofrimento. Os proteinogramas do LCR de 45 pacientes com processos inflamatórios do SNC e/ou de seus envoltórios, distribuídos em 6 grupos de casos, foram analisados segundo a possibilidade de o processo inflamatório estar acarretando, ou não, sofrimento do parênquima encefálico. A análise dos resultados mostrou que o estudo da concentração da globulina beta no LCR fornece elementos que permitem avaliar o comprometimento do parênquima encefálico nessas condições, aduzindo dados úteis para a avaliação prognóstica. A intensidade do aumento da concentração dessa globulina no LCR era maior do que a do aumento da concentração de albumina nos casos em que o processo inflamatório determinava comprometimento do parênquima encefálico.

Occipitocervical deformities, particularly the basilar impression

The authors outline the development of the spine and skull, particularly of axis, atlas and occipital bone. As neuro-skeletal dysmorphisms, the occipito-cervical malformations belong to the neurodysplastic group. They are classified as skeletal anomalies, associated nervous malformations and meningeal reactions. Vertebralization of the occipital bone and occipitalization of atlas, subluxation of odontoid process, dysplasia of the occipital bone, dystrophia brevicollis and other anomalies are discussed. Special care is given to the study of basilar impression; its concept, history, incidence, clinical and neurological symptoms, radiological characterization (craniographic, perimyelographic and iodoventriculographic aspects) and surgical treatment are reviewed. The authors report five cases of occipito-cervical malformations, which are the first references in Brazilian literature. In case 1 the anomalies (manifestation of occipital vertebra and Arnold-Chiari deformity) were disclosed at an operation for cisticercosis of the posterior fossa. In the following four cases invagination of the basilar portion of the occipital bone (basilar impression) could be radiologically demonstrated; in case 2 a suboccipital craniectomy and a laminectomy of atlas and axis were performed but the patient died a week later and the necroscopic examination confirmed the neuro-skeletal anomalies. In all cases there were several associated malformations. In case 2 there were occipitalization of the atlas, fusion of the first and second cervical vertebrae, supernumerary rib of the seventh cervical vertebra, supernumerary lumbar vertebra, and Arnold-Chiari deformity; at necropsy it was found a syringomyelic cyst on the cervical cord and a fibrous dural ring over the foramen magnum. Case 3 showed the syndrome of Klippel-Feil, besides supernumerary ribs of the seventh cervical and first dorsal vertebrae, Arnold-Chiari malfotmation and probable aplasia of cell groups in the nuclei of oculomotor and facial nerves. In case 4 there were occipitalization of atlas and Chiari deformity. In case 5 vertebral reduction in the cervical region was evidenced but bony coalescence could not be proved. In the last four cases the constitutional morphologic type was determined. Electroencephalograms of cases 3, 4 and 5 showed no abnormalities; in case 1 slow bilateral occipital waves were recorded. The authors call attention to the importance of the diagnosis of these anomalies susceptible of successful surgical correction, which can simulate many nervous diseases of untoward course, like lateral amyotrophic sclerosis, syringomyelia (which can be actually associated to the bony anomaly, as in case 2), sclerosis of dorsal funiculi of the spinal cord, tabes, multiple sclerosis, heredocerebellar ataxia, etc. The authors also stress the clinico-radiological differences between basilar impression and platybasia, frequently taken as synonyms. Although both anomalies may coexist (as in cases 4 and 5) their association is not an absolute rule; on the contrary, in case 2 the basal angle was in the inferior limit of normality and in case 3 it was much lower. Emphasis is put on the value of the Chamberlain's line and chiefly in the McGregor basal line for the correct diagnosis of basilar invagination of the occipital bone.

Mielite neuro-óptica: Estudo anátomo-clínico de um caso

O AA. apresentam um caso anátomo-clínico de mielite neuro-ópti-ca aguda. A moléstia evoluiu em 35 dias, tendo o quadro medular se completado no 31° dia. Nos três dias que precederam a morte, estabeleceram-se rapidamente as síndromes óptica (amauróse progressiva) e encefálica, esta com fenômenos bulbares graves. O doente faleceu por broncopneumonia de aspiração. A autópsia evidenciou edema encéfalo-medular e fenômenos inflamatorios de tipo não supurado nas vias ópticas, bulbo e medula; nesta, predominavam no entumescimento cervical, onde ocasionaram verdadeira secção transversa. O quadro anátomo-patológico mostrou particular eletividade para a substância branca dos cordões lateral e posterior da medula. A reação inflamatória era constituída por células linfocitóides, predominantemente, em tôdos os pontos atingidos.

RE-INFECTION IN CONSUMPTION.

That but a comparatively small percentage of consumptives actually succumb to a first attack of tuberculosis has been time and again demonstrated through necroscopic examinations. The question is no longer an open one. As a matter of statistics, indeed, not only is a first attack not fatal, but a large proportion of patients recover from it and their subsequent death is found to be due to causes disconnected with any pulmonary lesions. If that is so—if under reasonably auspicious circumstances there is a strong probability of a cure being effected where the lesion is yet in its initial stages, then to what cause or causes are subsequent relapses to be attributed? The ordinary received idea of the re-development of the tubercle can not certainly explain all or even the major part of the phenomena, for in a large number of cases the bacilli are, by postmortem examinations, found to have