Abrão Anghinah

Recuperação espontanea da função nas lesões do sistema nervoso central

A rewiev of the mechanims responsible for the spontaneous recuperation of function in patients with lesions of the central nervous sistem is made. The spontaneous reorganization theories of the nervous structures and the vicarious function are also referred to. In the last two decades experimental contributions have been accentuated, specially the one conducted by the group of researchers directed by Windle and Guth, who had shown the possibility of regeneration in the central nervous system, as well Lawrende and Kuypers, Brodal, Goldberger and others, which defended the vicarious function as the probable mechanisms of recuperation.

Arsênico em nervos periféricos normais do homem

As a contribution to the knowledge on inorganic arsenic concentration in peripheral nerves, a study was carried out in 20 nerve fragments (10 from N. ulnaris and 10 from N. tibialis) excised during necropsy from 20 corpses less than 24 hours after death and showing no apparent disease of the nervous system. The samples were ashed in an oven overnight at 550°C. The ashes were dissolved in a known volume of 2N-HC1. In this solution inorganic arsenic was determined by the Kingsley-Schaffert method. The results revealed no significant concentrations (vestiges) of inorganic arsenic in the peripheral nerves.

Biochemistry of the normal dura mater of the human brain determination of water, sodium, potassium, calcium, phosphorus, magnesium, copper, iron, sulfur and nitrogen contents

The concentrations of water, sodium, potassium, calcium, phosphorus, magnesium, copper, iron, sulfur, and nitrogen were determined in samples of apparently normal dura mater removed from 18 subjects recently dead by craniocerebral trauma. The average concentrations expressed in dry weight were: water 79.55 g/100 g ± 2.52; sodium 1.63 mequiv/100 g ±0.27; potassium 3.68 mequiv/100 g ± 0.66; calcium 119.84 mg/100 g ± 107.40; phosphorus 68.2 mg/100 g ± 34.5; magnesium 0.61 mequiv/100 g ± 0.37; copper 249.8 /xg/100 g ± 109.4; iron 0.82 mg/100 g ± 0.28; sulfur 490.7 mg/100 g ± 22.5; nitrogen 3.33 g/100 g ± 0.17.

Avaliação clinico-quantitativa da ação do Ciba 34.647-Ba sobre a espasticidade

Using the clinical quantification of the neurologic symptomatology the authors made observations and avaliated the action of Ciba 34.647-Ba, a GABA derivative, in 12 patients suffering from spasticity and motor incapacity due to spinal cord lesions. The results are reported emphasizing the effects of the drug on the main components of spasticity (hypertonus, hyperactivity of the deep reflexes, clonus and automatisms). Some theories explaining the mechanism of action of the drug are mencioned. References are made about doses, duration of action, tolerance and side-effects.Using the clinical quantification of the neurologic symptomatology the authors made observations and avaliated the action of Ciba 34.647-Ba, a GABA derivative, in 12 patients suffering from spasticity and motor incapacity due to spinal cord lesions. The results are reported emphasizing the effects of the drug on the main components of spasticity (hypertonus, hyperactivity of the deep reflexes, clonus and automatisms). Some theories explaining the mechanism of action of the drug are mentioned. References are made about doses, duration of action, tolerance and side-effects.

Recuperação da motricidade voluntária do membro superior de pacientes com hemiplegia após acidente vascular cerebral: avaliação prognostica

O estudo tem por finalidade o registro e a analise dos principais fatos que ocorrem durante a recuperacao da motricidade voluntaria do membro superior em pacientes com hemiplegia apos AVC, tendo por objetivo contribuir para a avaliacao do prognostico. De particular interesse foi a observacao comparativa do retorno espontâneo da motricidade voluntaria nos varios segmentos do membro superior em 88 pacientes com hemiplegia apos AVC hospitalizados na fase aguda da afeccao. Dos 88 pacientes hemiplegicos estudados, com diagnostico suficientemente esclarecido e evolucao acompanhada durante periodo satisfatorio para permitir conclusoes, 56 casos (grupo 1) atingiram melhora clinica, com remissao parcial ou completa da sintomatologia neurologica (discreto deficit de forca, hiperreflexia e hipertonia) e recuperacao de todos os movimentos voluntarios nas varias articulacoes do membro superior, enquanto 32 pacientes (grupo 2) com persistencia da sintomatologia neurologica, particularmente a hipertonia, apresentaram melhora clinica discreta e recuperacao parcial de movimentos do membro superior. A quantificacao clinica de sinais neurologicos utilizada no presente estudo, tornou possivel registrar as modificacoes mais importantes ocorridas durante a evolucao dos 88 pacientes. Este criterio permitiu destacar quantitativamente a regressao espontânea da sintomatologia e a determinacao do nivel critico de estabilizacao (plato). A analise dos dados fornecidos pelos dois grupos estudados permitiu concluir que: o ponto critico de regressao da sintomatologia e recuperacao da motricidade voluntaria ocorre em media, 70 dias apos ter-se instalado a hemiplegia; o computo medio de 256 pontos, que foi obtido 70 dias apos a instalacao da hemiplegia, representa o nivel critico de estabilizacao; embora a precocidade de aparecimento de movimentos iniciais logo apos a instalacao da hemiplegia seja dado importante para o prognostico, o autor acredita ser de capital importância a caracterizacao dos tipos de movimentos iniciais. Levando em conta os tipos de movimentos iniciais o autor observou que, quando nos pacientes com hemiplegia apos AVC, os movimentos de flexo-extensao e oponencia do polegar aparecem precocemente de forma isolada ou associada a movimentos da articulacao proximal (ombro), ou central (cotovelo) e de esperar melhor prognostico do que nos pacientes cujo movimento inicial e representado por flexao do cotovelo e/ou flexao-aducao do braco.

Reeducação e recuperação espontânea da motricidade após lesões do sistema nervoso central

A review is made of the current concepts on the several techniques (kinesitherapy programs) used with the purpose of recovering motor impairments caused by damage of the central nervous system. In this way data are gathered for the discussion and explanation of the intricate mechanisms involved in reeducation and recovery of the motor hability.

Polineuropatia periférica arsenical: tratamento com penicilamina. Dosagem de arsênico inorgânico em nervo periférico, sangue e urina

Os autores registram caso de paciente na qual, apos intoxicacao aguda por arsenico inorgânico, instalou-se quadro de polineuropatia periferica. Foram verificadas altas concentracoes de arsenico no nervo periferico estudado (1,48 mg/100 g peso seco, e 0,49 mg/100 g peso fresco) e na urina. Antes do tratamento com penicilamina a quantidade de arsenico excretada na urina era de 80,0 micro/100 ml; apos 7 dias de tratamento a excrecao passou a ser de 150,2 micrograma/100 ml. Estes resultados bioquimicos foram acompanhados de progressiva melhora clinica.

Reeducação e recuperação de funções motoras: registro de um caso com inversão de funções entre membros superiores e inferiores

The unusual case of a 4-year-old girl with the probable diagnosis of kernicteurs, having psychomotor retardation and showing a reversal of functions between the lower and upper extremities is reported. Submitted to adequate training the patient improved markedly, and at a 3 months interval, she already used satisfactorily her hands, could stand leaning against the wall and was able to walk with support. The findings in this case suggest that at least some of the lost functions which do not recover spontaneously are able to return through an adequate reeducation program.

Infiltração leptomeníngea por glioblastoma multiforme da medula cervicotorácica

The case of a 17 year old patient with glioblastoma multiformis of cervico-thoracic region of the spinal cord whose disease was first manifested almost 7 months prior to death is reported. Initial symptoms of sphincter disfunction were soon followed by clinical signs of transverse myelopathy in the upper thoracic region. A complete block of the spinal canal was found on manometric tests. The cerebrospinal fluid was xanthochromic and coagulated immediatly; total protein concentration was markedly increased and glycosis content was low. Descendent perimyelography showed that blocking was complete at the level of first thoracic vertebral body and that it was caused by an intramedullar expanding process. About two months before death symptoms referred to spinal cord impairment assumed an ascending character. Signs of peripheral motor neuron impairment appeared in the upper extremities. Progressive signs of intracranial hypertension appeared and preceeded death. A transient cardiac arrest and apnea occured. The patient, maintained under artificial respiration, remained in comatous state until death, two days later. Brain edema was found at post-morten examination. Cerebral meninges were normal. The upper portions of the spinal cord were enlarged and their consistency was increased. The structures of the inferior portion of cervical region were completely substituted by neoplasic tissue. The central portion of cervical enlargement as well as the upper and middle portions of thoracic region were also invaded by neoplasic tissue. Ischaemic necrosis occurred in the first cervical segments. Histologic examination showed that the tumor was a glioblastoma multiformis. In the inferior portion of cervical cord the neoplasy invaded the leptomeninges, growing extensively in the subarachnoid space, surrounding the spinal cord. Nerve roots were also invaded by neoplasic tissue. Literature data concerning to the low incidence of glioblastoma among tumors of the spinal cord were quoted. The leptomemeningeal invasion by the tumor found was discussed. In spite of its extension, meningeal gliomatosis was discarded since subarachnoid and medullar portions of the tumor were continuous, no metastatic tumoral growths related to other areas of subarachnoid space were found and tumor cells were not found in the cerebrospinal fluid.

Distrofia muscular progressiva: avaliação do grau de déficit motor pelos testes musculares manuais

The author used the manual muscle tests in 17 patients with progressive muscular dystrophy. The data related to the degree of motor impairment showed that it is symmetrical in its distribution, but the larger joints are more deeply involved. On the other hand, varying impairment of the agonist and antagonist muscles of the same synergic unity accounts for the vicious attitudes usually seen. The author found a greater impairment in flexors of the head and trunk, in adductors of scapula, adductors of hips, flexors and extensors of limbs and in the dorsiflexors of the feet. This last feature is not conceded by some authors, for whom the gastrocnemius is the muscle most involved in the disease. The author holds the view that in spite of the untoward prognosis of the disease, exercises to avoid vicious positions must be performed.