[Neuropsychology of primary progressive multiple sclerosis]. / Neuropsicología de la esclerosis múltiple primaria progresiva.

INTRODUCTION: Cognitive impairment is a symptom of multiple sclerosis (MS); however, in the primary progressive form of the disease (PPMS), data on the prevalence and type of cognitive impairment are controversial. AIM: To evaluate the frequency of cognitive impairment, according to the diagnostic criteria defined by Thompson, in Brazilian patients with PPMS attending a referral center for the treatment of MS in Rio de Janeiro, Brazil. SUBJECTS AND METHODS: A battery of neuropsychological tests was used to evaluate the following cognitive functions: screening for dementia, attention/concentration, speed of information processing, verbal fluency, memory and abstract/conceptual thought. The Beck scale was used to evaluate mood disorders. Twenty-six patients with PPMS and 26 controls paired for gender, age and education level were evaluated. Statistical analysis was based on the study performed by Rao. RESULTS: The frequency of cognitive impairment in the PPMS patients in the present study was 50%. The cognitive functions most affected were: recent memory (60%), verbal fluency (40%) and speed of information processing (40%). Depression was more common in the PPMS patients compared to the control group; however, no association was found between cognitive impairment and depression. CONCLUSION: These results confirm the presence of cognitive impairment in PPMS and emphasize the need for further studies with larger sample sizes.

[Paracoccidioides brasiliensis (Lutz, 1908) isolated by hemoculture in a patient with the acquired immunodeficiency syndrome (AIDS)]. / Paracoccidiodes brasiliensis (Lutz, 1908) isolado por meio de hemocultura em um paciente portador de síndrome de imunodeficiência adquirida (SIDA).

A case of an AIDS patient with positive blood culture for Paracoccidiodes brasiliensis is reported. The patient was a 29-years-old male born in Nova Londrina (Paraná State, Brazil) who presented splenomegaly and fever of unknown origin. Three blood cultures were performed, each one of them for aerobic bacteria, mycobacteria and fungi. Cultures for aerobic bacteria and mycobacteria were negative. However, the yeast phase P. brasiliensis was isolated from two cultures in BHI agar, 20 days after inoculation in Negroni medium. The patient was classified in group V according to the Centers for Disease Control (CDC) criteria for AIDS, due to a Pneumocystis carinii pneumonia. Treatment was discontinued due to an individual decision of the patient on the second dose of amphotericin B. This antibiotic was replaced by ketoconazole in the daily dose of 800 mg. The patient died one year after the isolation of P. brasiliensis on blood culture.

Histopathology of lymphoid organs in experimental leishmaniasis.

Hamsters (Mesocricetus auratus) were inoculated with L. (L.) chagasi and killed on days 7, 15, 30, 45 and 60 after infection. The lymphoid organs developed initial proliferation of the B lymphocyte zone with recovery by the 60th day group when pyroninophilic cells were prominent. The T lymphocyte area showed a progressive selective decrease of lymphocytes and cellular density with cellular pleomorphism including macrophages, plasma cells and reticular cells. The mean volume of the white pulp increased with the lymphoid follicle hyperplasia but returned to its initial level by day 60. The main red pulp change was marked hyperplasia of the phagocytic mononuclear cells containing parasites from the 30th day of infection onward. These changes are compatible with the humoral and cellular immunoresponse found in patients with visceral leishmaniasis (VL).

Familial osteochondritis dissecans.

Two examples of familial osteochondritis dissecans are described, one affecting a mother and daughter and the other a father and son. The mother and daughter both have genu valgum and are short statured. This combination of features has not been reported previously. Radiographs of lesions affecting knee, elbow, hip and ankle joints demonstrate the wide spectrum of radiological abnormality that can occur in this condition.

The management of intussusception.

A scheme of management to achieve maximum success in hydrostatic reduction of intussusception is presented. This takes into account patient selection, radiological technique and the follow-up clinical assessment. By standardizing the management we have increased our success rate and avoided laparotomy in 64% of our patients. Most of the patients in whom the technique failed had infarcted bowel which required resection.

Unilateral pulmonary blood flow loss in a young patient.

A case of total unilateral loss of pulmonary perfusion with almost normal ventilation, in a 21-year-old male patient is described, and the problem of interpretation in an asymptomatic patient is illustrated.

Pneumonia intersticial por Pneumocystis carinii em criancas desnutridas.Apresentacao de quatro casos. / Interstitial pneumonia caused by Pneumocystis carinii in malnourished children. Report of 4 cases

Os autores apresentam quatro casos de pneumonia por Pneumocystis carinii associados com desnutricao. Relatam o resumo clinico e os principais achados anatomo-patologicos dos casos. A autopsia mostrou acentuada atrofia do timo e de mais areas perifericas timo-dependentes e a presenca de numerosos parasitas nos alveolos pulmonares

Anticorpos anti-Biomphalaria em soros de pacientes e camundongos infectados por Schistosoma mansoni. / Anti-Biomphalaria antibodies in sera of patients and mice infected by Schistosoma mansoni

Com a finalidade de estudar a ocorrencia e a dinamica de surgimento de anticorpos anti-Biomphalaria no soro de seres humanos e camundongos infectados por Schistosoma mansoni, analisaram-se atraves de reacao de hemaglutinacao passiva 52 soros de pacientes comprovadamente parasitados pelo trematodeo e 40 soros de camundongos experimentalmente infectados. Como grupos controle utilizaram-se, no primeiro caso, 42 soros de individuos nao esquistossomoticos e, no segundo, 15 soros de camundongos nao infectados pelo helminto. Os resultados revelaram que nos pacientes esquistossomoticos e especialmente nos camundongos experimentalmente infectados os titulos do anticorpos anti-Biomphalaria sao mais elevados do que nos grupos controles. O exame de camundongos infectados, em diversas ocasioes, revelou a presenca de anticorpos anti-Biomphalaria, em niveis pouco variaveis, a partir do 15o dia apos a infeccao e, pelo menos, ate o 95o dia, ocasiao em que se encerrou o experimento

Linfoma folicular gigante e esquistossomose mansonica. / Giant follicular lymphoma and schistosomiasis mansoni

Os autores relatam seis casos de Linfoma Folicular Gigante do baco associado com esquistossomose mansonica, todos em mulheres naturais de zonas endemicas e residentes em Sao Paulo ha mais de nove anos. Apresentam o resumo clinico e a anatomia patologica de cada caso e tecem comentarios etiopatogenicos e pidemiologicos, principalmente quanto a possivel implicacao da esquistossomose mansonica nessa doenca linfo-proliferativa. Estes casos somam-se a oito ja descritos anteriormente por outros Autores em area endemica da esquistossomose no Brasil