Miastenia grave: avaliação clinica e terapêutica de 55 casos

Foram estudados 55 casos de miastenia grave, avaliando os sinais e sintomas clínicos que ocorreram no início e na evolução dos pacientes, bem como os procedimentos diagnósticos e avaliação das medidas terapêuticas utilizadas. No manejo dos pacientes foram utilizados anticolinesterásicos, corticoesteróides, azathioprina, plasmaferese e timectomia, sem que fosse possível encontrar relação estatística significante entre os diferentes procedimentos com respeito à resolução da doença. Dos 55 casos, 9 (16,6%) obtiveram remissão total, 41 (74,5%) permaneceram com a doença ativa necessitando de tratamento sintomático e 5 (9.09%) faleceram. Houve relação estatística significante entre os sinais de insuficiência respiratória, crises miastênicas e timoma somente no grupo de pacientes que faleceram (um por insuficiência respiratória restritiva secundária a cifoescoliose severa, três com timoma e um caso durante a timectomia)

Cell-Mediated Immunity in Untreated and PUVA Treated Atopic Dermatitis

In 22 adult patients with atopic dermatitis, lymphocyte subpopulation counts, mitogenic responses to several PHA and Con A concentrations, nonspecific mitogen induced, and indomethacin sensitive suppressor cell functions and leukocyte migration inhibitory factor production were investigated. Patients with severe atopic dermatitis had normal PITA and Con A responses, although somewhat lower than matched controls, while mild AD patients equalled controls in this respect. No significant differences between AD patients and controls were detected with respect to lymphocyte subpopulations, suppressor cell function or leukocyte migration inhibitory factor production. Methoxalen plus ultraviolet light (PUVA) therapy induced significant clinical improvement in 9 out of 10 treated patients. A concomitant decrease of the mitogenic responses and increase of the Con A induced nonspecific suppressor cell activity was recorded, while other immunological parameters remained unaffected by the therapy. Thus PUVA therapy induces both local clinical and systemic immunological manifestations. The possibility that the observed immunological changes would be operative in the PUVA induced healing process, however, seems unlikely, as the present study did not disclose any obvious relationship between immune parameters and severity of atopic dermatitis