The authors' first results show that tumor resections with 5-ALA in combination with intraoperative cortical stimulation have the advantages of both methods and, thus, provide additional safety for the neurosurgeon during resections of primary malignant brain tumors in eloquent areas. Nonetheless, more cases and additional studies are necessary to further prove the advantages of this multimodal strategy.

Abstract. Yellow rever vires transmission was very active in Maranhao State in Brazil in 1993 and 1994. An investigation was carried out to evaluate the magnitude of the epidemic. In 1993, a total of 932 people was exarnined for yellow rever from Maranhao: 70 were positive serologically, histopathologically, and/or by vires isolation, and another four cases were diagnosed clinically and epidemiologically. In Mirador (17,565 inhabitants), the incidence was 3.5 per 1,000 people (case fatality rate [number of deaths/number of cases diagnosed] = 16.4%), while in a rural yellow rever risk area (14,659 inhabitants), the incidence was 4.2 and the case-fatality rate was 16.1% (10 of 62). A total of 45.2% (28 of 62) asymptomatic infections were registered. In 1994,49 serum samples were obtained and 16 cases were confirmed (two by virus isolation, two by seroconversion, and 12 by serology). No fatal cases were reported. In 1993, 936 potential yellow rever vectors were captured in Mirador and a single strain was isolated from a pool of Haemagogus janthinomys (infection rate = 0.16%). In 1994, 16 strains were isolated from 1,318 Hg. janthinomys (infection rate = 1.34%) and one Sabethes chloropterus (infection rate = 1.67%). Our results suggest that this was the most extensive outbreak of yellow rever in the last 20 years in Brazil. It is also clear that the lack of vaccination was the principal reason for the epidemic, which occurred between April and June, during the rainy season, a period in which the mosquito population in the forest increases.Yellow rever is an important cause of severe illness and mortality in Latin America, where sporadic cases and/or periodic epidemics of the rural form (transmission occurs near the forest) of infection have been diagnosed almost every year. In Brazil, almost two-thirds of the territory is considered an enzootic area, involving alI of Amazonia and the midwestem part of Maranhao State in the northeast and Minas Gerais State in the southeast (Figure 1). From 1930 to 1992, 898 cases of yellow rever were reported, and 720 of these (80.1 %) were registered in the States of Para, Goias, and Mato Grosso. In the same period, only 15 confirmed, sporadic cases were recorded in the State of Maranhao (1.6% of alI Brazilian cases). The last case previously reported in Maranhao was in 1990 .1 During 1993-1994, yellow rever was largely distributed in Barra do Corda, Esperantinopolis, Mirador (1993), and Pastos Bons (1994), alI municipalities of Maranhao State. An exhaustive entomologic and serologic survey was done by the Instituto Evandro Chagas in Mirador (6°27'S, 44°32'W), and an entomologic survey was done in Pastos Bons (6°38'S, 44°55'W) to determine the magnitude of the epidemic and possible vector populations. In Pastos Bons, blood samples were collected only from febrile patients and people living in the same dwelling place, or the same village, and exposed, therefore, to the same risk of infection ( Figure 1). MATERIALS AND METHODSClinical observations and epidemiology. Human serum samp...

Mansonella ozzardi infections are common in the riverside communities along the Solimões, Negro and Purus Rivers in the state of Amazonas (AM). However, little is known about the presence of this parasite in communities located in regions bordering AM and the state of Acre. The prevalence rate of M. ozzardi infections was determined in blood samples from volunteers according to the Knott method. A total of 355 volunteers from six riverine communities were enrolled in the study and 65 (18.3%) were found to be infected with M. ozzardi. As expected, most of the infections (25%) occurred in individuals involved in agriculture, cattle rearing and fishing and an age/sex group analysis revealed that the prevalence increased beginning in the 40-50-years-of-age group and reached 33% in both sexes in individuals over 50 years of age. Based on the described symptomatology, articular pain and headache were found to be significantly higher among infected individuals (56 and 65% prevalence, respectively, p < 0.05). Sera from volunteers were subjected to ELISA using a cocktail of recombinant proteins from Onchocerca volvulus to evaluate the specificity of the test in an endemic M. ozzardi region. No cross-reactions between M. ozzardi-infected individuals and recombinant O. volvulus proteins were detected, thus providing information on the secure use of this particular cocktail in areas where these parasites are sympatric.

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RESUMOOs autores analisam material de biópsias de 378 casos de Leishmaniose Te¬ gumentar, causada por Leishmania braziliensis braziliensis, da localidade endêmi-ca de Três Braços (Estado da Bahia). O parásitos, embora escassos, foram encontrados em 63,7% dos casos da forma cutânea e em 37,5% dos casos da forma mucosa. As alterações dérmicas ou do córion da mucosa permitiram identificar cinco padrões histopatológicos: 1) Reação Exsudativa Celular, constituída por um infiltrado histiolinfoplasmocitário; 2) Reação Exsudativa e Necrótica, na qual ocorre uma necrose no seio do infiltrado inflamatório; 3) Reação Exsudativa e Necrótico-Granulomatosa, que corresponde ao quadro descrito como inflamação crônica granulomatosa com necrose; 4) Reação Exsudativa e Granulomatosa, onde se observa uma reação granulomatosa desorganizada, sem que esteja presente necrose tecidual; 5) Reação Exsudativa e Tuberculóide, caracterizada pelo granuloma tuberculóide. O estudo evolutivo realizado em 49 casos, mostrou que houve uma mudança de padrão histopatológico observada, em biópsias sucessivas, em 63,2% dos casos da forma cutânea e em 45,4% dos casos da forma mucosa. Através desse estudo, é possível afirmar-se que o padrão de Reação Exsudativa Celular constitui o quadro inicial e final da lesão, com os demais padrões aparecendo interposto durante a evolução da doença. ", MAGALHÃES -1979« -1984», MA-GALHÃES & col. -1982 24 -1983 25, NICOLIS & col. -1978 30, RIDLEY -1979 RIDLEY & COl. -1980«, RIDLEY & RIDLEY -1983», 1984 41 ), frutos do esforço para obter-se um melhor conhecimento sobre a' patogênese da doença, o que decerto irá influenciar na conduta a ser adotada em cada caso.O presente estudo, realizado com a mesma finalidade e utilizando material obtido por bióp-sias, encerra dois pontos de destaque. Um deles foi ter sido conduzido em uma área endê-

Experimental infection with Mansonella ozzardi of common haematophagous Diptera collected at a Ticuna Indian village on the upper reaches of the Solimões river in the Brazilian Amazon, showed that Simulium amazonicum and Simulium n.sp. are capable of supporting full development of the parasite. Natural infections with this filaria were found in both species including infective larvae in Simulium n.sp. No development of M. ozzardi occurred in Mansonia amazonensis, Culicoides insinuatus or Lepiselaga crassipes (Tabanidae). The dimensions of developing larvae of M. ozzardi in both species of black-fly were recorded. Infective larvae of this species may easily be distinguished from those of Onchocerca volvulus, also transmitted in the Amazon by a species closely resembling S. amazonicum, by the presence of a bifid tail and higher anal ratio in M. ozzardi.

RESUMOOs A A. analisaram as alterações histológicas encontradas em 162 casos de Leishmaniose Tegumentar da localidade de Três Braços, Estado da Bahia, dos quais 131 (80,9%) eram de portadores de lesões cutâneas e 31 (19,1%) de portadores de lesões mucosas. Analisaram, também, o comportamento clínico dos cinco padrões histopatológicos, já antes descritos, em relação à terapêutica. O melhor prognóstico esteve sempre ligado ao padrão de Reação Exsudativa e Granulomatosa, ou seja, a uma fase na qual o organismo, tendo lançado mão de um mecanismo endógeno de lise parasitária, já circunscreveu a área de necrose por uma reação granulomatosa, e esta é agora apenas o elemento residual. A ação terapêutica nessa fase somente acelera a resolução natural do caso. O grupo seguinte é amplo, e compreende os casos em que a lesão pertence aos padrões de Reação Exsudativa Celular (formas cutâneas), Reação Exsudativa e Necrótica e Reação Exsudativa e Necrótico-Granulomatosa. Nesses casos, o mecanismo de auto-controle da lesão encontra-se ainda em curso, e a ação terapêutica encurta o período de evolução natural. Os f.asos do padrão de Reação Exsudativa e Tuberculóide tiveram um prognóstico variável. Houve boa resposta à terapêutica quando o granuloma tuberculóide característico desse padrão surgiu em pacientes jovens, com curto tempo de evolução da doença e intradermorreação não exacerbada. Nos demais casos tuberculóides -. principalmente em pacientes adultos, com longo tempo de evolução da doença e intradermorreação exacerbada -, a resposta foi menos satisfatória. Em último lugar, com prognóstico reservado, ficaram os casos da forma mucosa que apresentaram o padrão de Reação Exsudativa Celular, onde o infiltrado pode estar desempenhando papel de auto-agressão. O presente estudo evoluiu para a proposição de uma classificação da Leishmaniose Tegumentar, baseada nos padrões histopatológicos observados. Esta classificação, estritamente morfológica, deverá ser de fácil aplicação para o Patologista e, como apresenta também uma correspondência clínico-evolutiva[ poderá constituir auxílio valioso ao médico envolvido no diagnóstico e tratamento da Leishmaniose Tegumentar. UNITERMOS: Leishmaniose tegumentar; Leishmania braziliensis braziliensis;Histopatologia. INTRODUÇÃOA Leishmaniose Tegumentar, endêmica em muitas regiões do Brasil, voltou a ser estudada

An unidentified microfilaria sharing characteristics with Mansonella ozzardi and Onchocerca volvulus was detected in blood samples from seven human volunteers, inhabitants of a community in the border of Amazonas and Acre State. They were detected during epidemiological studies carried out in some communities along Antimary, Acre, and Purus Rivers in the Brazilian Amazon. The most striking difference was presented in the shape of the cephalic space from this microfilaria which was different from those of M. ozzardi and with similarities to O. volvulus in this region, but no remarkable differences were observed at the caudal region. More accurate studies are being carried out in order to provide additional data and supporting evidences before establishment of a new species can be done.