Foram estudados 20 pacientes com meningites purulentas no período neonatal, internados no Hospital das Clínicas de Ribeirão Preto. É analisada a importância de se reconhecer sintomas e sinais mínimos, bem como o quadro clínico da doença já declarada. Os autores tecem considerações sobre o valor do diagnóstico precoce, diante da alta incidência de mortalidade e pelas sequelas graves que ocorrem, apesar do tratamento prolongado com antibióticos.

The cases of 20 patients admited with purulent meningitis in the neonatal period are reported. The authors analyse the importance in recognizing the minimal signals and symptoms, as weel as the clinical patterns of the manifested disease. Some considerations are draw about the values of the early diagnostic before the high incidence of mortality and the gravity of sequaele that occur besides the high doses and long term antimicrobial therapy.

Exames neurológicos e do líquido cefalorraqueano foram realizados em 82 pacientes, sendo que 27 eram chagas icos crônicos (com reação de Machado-Guerreiro positiva no sangue) e 55 não chagásicos. As alterações neurológicas e do LCR, foram mais freqüentes no grupo de pacientes chagásicos.

Clinical and cerebrospinal fluid studies were performed in 27 patients with chronic Chagas' disease in which the Machado-Guerreiro reaction in the blood serum was positive. The clinical and laboratorial changes were found more frequently in patients with Chagas' disease than in patients of control group.

Foram estudados os traçados eletrencefalográficos obtidos durante o sono noturno de 5 pacientes epilépticos. Os resultados demonstram que a atividade paroxística focal evidencia modificações tanto qualitativas como quantitativas quando registrada no l.° e 2.° estágios do sono. Por outro lado, o EEG com descargas difusas e bilaterais intensas na fase inicial do sono, apresenta ausência de paroxismo na fase paradoxal. Assim, a análise dos diversos estágios do sono evidencia diferenças qualitativas e quantitativas na atividade elétrica cerebral de pacientes epilépticos durante o sono noturno.

The sleep sistem results of the activity of two components: a descending component originated in the limbic structures, and an ascending system involving the bulbopontine structures which receives projections from the spinal cord components. Although the neocortex is not necessary for sleep mechanisms, it plays a very important role in sleep. Therefore, during the sleep state there is no significant quantitative difference in brain activity, but qualitative changes are recorded in EEG of epileptics patients during all night sleep.

Os autores apresentam os resultados obtidos com a lobotomia transorbitária em 54 pacientes de um hospital psiquiátrico privado. Fazem, inicialmente, uma revisão da experiência que já obtiveram com as diversas técnicas de lobotomia, salientando as principais indicações do método terapêutico. Apontam, como fatôres de importância para a seleção dos casos, a sintomatologia clínica (conduta anti-social agressiva, intensidade da tensão emocional e produtividade intelectual patológica), a necessidade da cooperação familiar e a escolha da técnica operatória. Descrevem a técnica da lobotomia transorbitária, modificada por Freeman e analisam o material clínico constante de 54 casos que puderam ser observados durante mais de 6 meses, dos 70 casos já submetidos ao mesmo método, no período de 1953-1955. Os resultados que obtiveram compreendem 16 casos de remissões totais, 10 de remissões parciais, 13 de boas melhoras, 14 inalterados e 1 falecido em conseqüência da operação. Avaliados os resultados de acôrdo com as possibilidades de readaptação familiar, social e de trabalho, os autores relatam que 21 pacientes obtiveram alta e retomaram suas atividades anteriores, 18 permanecem no lar sem atividade útil, 14 continuam internados. O método proporcionou 72,1% de resultados favoráveis, dos quais 38% com reintegração social. As neuroses obsessivas, as depressões ansiosas e as esquizofrenias paranóides constituíram os quadros clínicos melhor influenciados.

Freeman's transorbital lobotomy has been used in 70 patients from a private psychiatric hospital. The results obtained in 54 of these patients are presented. The authors present the results obtained with several techniques and analyse the indications for lobotomy. In the selection of patients which should be treated by psychosurgery, the authors consider several factors : the emotional tension, the aggressive antisocial behavior and the presence of rich morbid mental defects. The cooperation of patient's family is emphasized as one of the important factors contributing to the operation success. Freeman's technique is described. The follow-up in the 54 patients was at least of 6 months: 16 cases showed total remission of the symptoms, 10 cases showed partial remission, 13 cases have improved, 14 cases did not show any improvement and one patient died as result of the operation; 72.1 per cent of patients presented good results and in 38 per cent there was very good social recovery. From the psychiatric clinical aspects the best results were obtained in cases of obsessional neurosis, anxiety and paranoid schizophrenia.

Radiotherapy in high doses has been used in cases of symptomatic epilepsy with the purpose of to act against the focal epileptic activity, as coadjuvancy to the common medical treatment. Patients with clinical manifestations of epilepsy in whom convulsive foci were demonstrated in the EEG, have been selected; these foci have been recognized as well localized and well circunscribed, and in all them the etiology has been the same (atrophic lesions), according to the clinical and radiological (craniogram, pneumoencephalogram and arteriogram) examinations. The purpose of a so homogenous group was to study the results to be obtained in similar conditions. Twenty patients have been selected from a group of forty-eight, because it was possible to obtain a good follow-up for at least three months in each case. In all cases, a medical treatment (barbiturate plus hidantoi-nate) has been used in uniform manner, with the purpose of avoiding influence on the judgement of the value of radiotherapy, for it was impossible to interrupt the drug therapy. Radiotherapy has been used in high doses over the epileptic lesion, which had been localized by the EEG. Two different techniques were used; in both 200 kv, 0.5 mm. filter of Cu were employed. Fourteen patients were irradiated in four different areas, of 4 cm. in diameter each one; they received 150 r daily, 2 areas by day, performing an average total of 3,000 r. In the other 6 cases the technique of kinetic convergent radiotherapy was employed, using the Siemens apparatus; each patient received, through a cutaneous area, an average doses of 3,000 r into the focus and 2,000 r in the skin; they received from 100 r to 150 r in the focus daily. Studying the twenty cases individually, there was marked EEG improvement in 4, relative improvement in 8 and no change in 8; there was marked decrease in the number of seizures in 8, relative decrease in 10 and no change in 2; the mental status was markedly improved in 7, relatively improved in 6 and not changed in 7. The authors call attentiori to the following points: a) Radiotherapy seems to act directyl over the focal electric activity, for there was marked improvement in 4 cases, and relative improvement in 8 cases, immediately after its use; in 2 cases there was exacerbation of the focal activity later; b) In all cases there was decrease in the number of seizures just after radiotherapy; it was not possible, however, to associate this improvement only to radiotherapy, for there was increase of seizures in 2 patients when medical treatment was stopped; c) There was improvement of mental status in 13 cases, although it is important to remember that there was also improvement of the cerebral physiology due to the decrease in number of seizures and improvement of the emotional status of the patient related to their better clinical conditions; d) There was no relation between the number of seizures and focal activity evidenced by the EEG; e) There was no relation between the intensity of cerebral focal activity and the mental status of the patient. The authors conclude: 1) Radiotherapy in high doses decrease the epileptic cerebral focal activity; 2) It is impossible to affirm that the clinical improvement is due to radiotherapy only; 2 patients had increase of focal activity far away from radiotherapy, and 2 others presented increase in the number of seizures when medical treatment was discontinued.