Paracoccidioidal granulomatosis of the brain.

A patient with South American blastomycosis (paracoccidioidomycosis) was studied using computed tomography (CT), which showed six granulomas in the brain. The patient was treated with amphotericin B and observed by repeated CT scans. Two of the lesions disappeared completely after the first cycle of treatment, and residual images, probably representing granulomas in the cicatricial stage, remained after completion of the treatment.

[Magnetic resonance imaging in multiple sclerosis: analysis of 270 cases]. / Ressonância magnética na esclerose múltipla: análise de 270 casos.

The author report a retrospective study of 270 cases of clinically proved MS and MRI in a State of Brazil (Parana) which is localized between the parallels 22 degrees a 30 degrees South. Comments are made about the age of the patients, number and localization of the lesions in the brain and spinal cord.

[Computerized tomography of the lumbar spine: analysis of 3 cases of metastases]. / Tomografia computadorizada da coluna lombar: análise de tres casos de metastase.

Computed Tomography is a non-invasive radio-diagnostic investigation of the spinal column since the availability of total body scanners. The authors present three cases of metastatic tumour of the lumbar spinal--two cases of multiple myeloma and one of sarcoma of the breast. After describing the normal anatomy, they analyze the nature of the lesions, their localization and their effects. The authors also comment the help CT gives for planning biopsies, radiotherapy and even surgeries in case of any lesion occupying space of the spinal column. The present investigation is therefore intended to contribute to existing knowledge by summarizing the author's experience with three cases of metastatic tumour of the lumbar spinal column.

[Computerized tomography of supratentorial meningiomas: results in 32 cases]. / Tomografia computorizada dos menigiomas supratentoriais: resultados em 32 casos.

Thirty two cases of supratentorial meningiomas diagnosed by computerized tomography and surgically proved are reported. The authors did not included in this series meningiomas of the orbit. The higher frequency is observed in the convexity area (eleven cases), followed by the sphenoidal ridge area (nine cases). There is a predominance in the females (65.6%) over the males (34.3%). The age varies from fourteen to seventy eight and only three patients are below thirties. Homogeneous contrast enhancement of all tumours was obtained by injecting a bolus of 75ml of Vasconray (30g of total iodine per patient) or 80ml of Hypaque 75 (30.8g of iodine). None of them showed the ring pattern observed in cases of abscess, gliomas or metastatic lesions. The edema seen around the tumours tended to be minimal, unless in those tumours located in the frontal region where the mass effect tended to be more pronounced. Hydrocephaly was observed in three cases.

Ultrastructure of human intramuscular blood vessels in development.

Muscles from human foetuses of nine weeks to nine months development were examined by electron microscopy. Capillaries, arteries and veins are frequent in the human foetal muscle at all stages of development. At nine weeks the vessels have the appearance of capillaries and basement membrane lies around the endothelial cells forming them. The capillaries are of continuous type which do not have apertures in their walls. Tight junctions are seen at some zones of adjacent endothelial cells of the capillaries. Sometimes, pericytes are also seen. At sixteen weeks vessels having the features of veins and of arteries can be identified between the muscle cells. Regarding the arteries, some of the endothelial cells are united to the smooth muscle cells and the intimal elastic lamina is interrupted where these cells approximate. The significance of this junction may be to anchor the intima to the media.

Ultrastructure of developing human muscle: the problem of multinucleation of striated muscle cells.

The authors studied by electron microscopy the muscle of 27 human foetuses ranging from 9 weeks to 9 months development. It was possible to observe that disintegration of the plasma membranes of adjacent myoblasts and myotubes which share a common basement membrane tube appears to occur in longitudinally disposed cells of those categories. This may help to explain how further nuclei may be incorporated into well developed myotubes and how the striated muscle cells become multinucleated during embryonic myogenesis and regeneration in vivo.

[Effect of corticoids in the acute phase of neurocysticercosis: preliminary note]. / Ação de corticóides na fase aguda da neurocisticercose: nota preliminar.

Neurocysticercosis is a major public health problem in the developing countries. Previous to the CT scan era its diagnosis was very restricted and conventional diagnostic methods were unreliable. It was also frequently necessary to submit patients to costly and dangerous surgical procedures to confirm the precise nature of the disease. The most striking type of neurocysticercosis diagnosed by CT is the acute or edematous type (Table 1). Patients with this type of neurocysticercosis are referred for examination with intracranial hypertension, in general with suspicion of space-occupying lesion. In the authors' experience it is possible to obtain a dramatic reduction of the brain edema in the acute stages of neurocysticercosis using corticosteroids, the use of which completely changes the clinical picture and the CT images.

[Akinetic pseudomutism (locked-in syndrome) in accidental Chagas' disease]. / Pseudomutismo acinetico ("locked-in" syndrome) em doença de Chagas acidental.

Chagas' disease is a major problem in Central and South America. The disease is caused by Trypanosoma cruzi, a protozoon which may inhabit the blood and tissues of both man and animals. Although it may produce marked enlargement of several hollow viscera, myocardial involvement is the hallmark of chronic Chagas' disease. The clinical picture of chronic Chagas myocardites is one of insidious, progressive, prolonged congestive heart failure and cardiac enlargement. The almost invariable arrhythmias make syncope and sudden death common in patients both with p6 without congestive heart failure. Electrocardiographic abnormalities occur in 87 percent of patients with chronic Chagas' disease and are often the initial manifestation of illness . Pathological findings include mural trombosis which often results in pulmonary and central nervous system embolization. Trypanosoma cruzi is in general transmitted to human beings by the bite of haematophagus insects of the reduviidae family, but in the last years reports pointing out the importance of blood transfusions as infectious sources of Trypanosoma cruzi are becoming more and more frequent. The authors present a case of a male young architect which contrated Chagas' disease probably by a blood transfusion and latter developed "locked-in" syndrome. It is discussed the importance of blood transfusion as a source of transmission of the disease even in non-endemic areas and the need to controlling all blood transfusions in countries where Chagas' disease is endemic. The authors also point out the importance of computed tomography in the diagnosis of lesions in the pons.

[Computerized tomography in agenesis of the corpus callosum: findings in 27 cases]. / Tomografia computadorizada na agenesia do corpo caloso: achados em 27 casos.

We describe a retrospective study of 27 cases of complete agenesis of the corpus callosum examined by CT and not associated to schizencephaly, holoprosencephaly and Dandy-Walker complex. Partial agenesis is also not included in the present study. The imaging findings are correlated to sex, age and symptoms.

[Ultrastructural studies of lymphocytes, polymorphonuclear cells and phagocytes in patients with Duchenne's disease]. / Estudos ultraestruturais de linfócitos, polimorfonucleares e fagócitos de pacientes com doença de Duchenne.

The authors have carried out an electron microscopy study of mononuclear cells and granulocytes obtained from 10 patients with Duchenne muscular dystrophy. Although several studies have demonstrated biochemical and immunological defects in these blood cells. no ultrastructural abnormalities were found in the present work.

Ultrastructure of cranial nerves of rats inoculated with rabies virus.

The V and VII cranial nerves of rats inoculated with rabies virus were studied by electron microscopy. The results were compared with the same cranial nerves of rats inoculated with rabies virus but vaccinated against the disease. The findings are those of axonal degeneration and intense demyelination of the nerves of the group of rats not vaccinated. The vaccinated rats showed some ultrastructural irrelevant alterations when compared with the other group. The degree of ultrastructural alterations found in the group of rats not vaccinated suggests that in rabies severe damage of the cranial nerves occurs and that this may be closely related to the clinical picture of the disease (hydrophobia). Furthermore, as far as the authors know, this has not been considered in the classic descriptions of rabies and it is possible that an immunologic process may take part in the demyelination observed in the present study.

Ultrastructure of peripheral nerves of mice inoculated with rabies virus.

Fourty adult female albino mice were inoculated in the right hind leg with rabies viruses of the street type. The mice were sacrificed with an interval of 24 hours each, starting in the next day after inoculation. From the 10th day ownwards the animals started presenting signs of paralysis, first on the leg where the viruses were inoculated anbnormalities were found in peripheral nerves compatible with axonal degeneration with secondary demyelination but the rabies viruses were not found in the axoplasm, myelin sheet, Schwann cell cytoplasm, endoneural or in the epineural structures.

[Isaacs syndrome: report of a case]. / Síndrome de Isaacs: relato de um caso.

The authors report a case of Isaacs syndrome observed in a 40 years old woman. The clinical picture included progressive muscular weakness, dysphagia, dysphonia, dyspnea and increased perspiration. Fasciculations, facial myokymia and pseudomyotonia were observed on physical examination. Electromyographic study at rest revealed continuous electrical muscle activity. Muscle histochemistry showed type II fibers atrophy and an ultrastructural study of the gastrocnemius muscle disclosed marked cysternal dilatation of the sarcoplasmatic reticulum. An excellent clinical response was observed with the use of carbamazepine. Some recent aspects of this rare syndrome are reviewed and discussed.

Hereditary spastic paraplegia associated with thin corpus callosum.

Autosomal recessive hereditary spastic paraplegia (AR-HSP) associated with thin corpus callosum was recently described in Japan, and most families were linked to chromosome 15 q13-15. We report two patients from two different Brazilian families with progressive gait disturbance starting at the second decade of life, spastic paraparesis, and mental deterioration. One patient presented cerebellar ataxia. Magnetic resonance imaging (MRI) of the head of both patients showed a thin corpus callosum. AR-HSP with a thin corpus callosum is a rare disorder, mainly described in Japanese patients. We found only 4 Caucasian families with AR-HSP with thin corpus callosum described in the literature. Further studies including additional Caucasian families of AR-HSP with thin corpus callosum are required to delineate the genetic profile of this syndrome in occidental countries.

[Acute schistosomiasis with brain involvement. Case report]. / Esquistossomose aguda com comprometimento cerebral. Relato de caso.

A case of acute schistosomiasis with magnetic resonance images (MRI) of the brain suggestive of demyelinating lesions, pyramidal disorder in the lower limbs and normal cerebrospinal fluid is presented. Diagnosis could be established by detection of antibodies on blood and cerebrospinal fluid. Schistosoma mansoni involves the spinal cord more often than the brain. Praziquantel associated to prednisolone was effective in this case. There are few reports of brain involvement with S. mansoni, but its prevalence is probably greater. Due to the paucity of studies, its pathophysiology and therapeutics remain to be better clarified. The immune and MRI aspects are emphasized.