É relatado um caso de paciente apresentando a forma crônica da doença de Chagas, no qual foi observada a presença de encefalite chagásica aguda, com demonstração de leishmanias no sistema nervoso central. O caso é único na literatura, sendo interpretado como devido a agravamento da forma crônica da doença de Chagas pela presença de leucemia linfática crônica associada. A existência de leucemia linfática pode levar à extinção de clones linfocitários responsáveis por fenômenos imunitários, criando, assim, condições para o agravamento e agudização da forma crônica da doença de Chagas.

PLATES 70 TO 72(Received for publication, October 30, 1961) Homografts of the heart have been performed for over 50 years, since Carrel performed the first of this procedure in 1907 (1).In 1933 Mann and his coworkers (2) developed their technique for homotransplantation of the intact mammalian heart. They anastomosed the carotid artery of the recipient to the aorta of the graft and the pulmonary artery of the graft to the external jugular vein of the recipient. Histologie studies of the graft revealed infiltration with lymphocytes, large mononuclears, and polymorphonuelear cells. In 1948, Sinitsyn (3) maintained the coronary circulation of a homografted heart through the action of its own left ventricle. In 1953, Luisada (4) maintained the circulation of the homografted heart during the operative procedure by anastomosing the left subclavian artery of the homograft to the carotid artery of a donor animal. The technique of Mann was later used by Downie (5) in 1953, Wesolowski (6) in 1953, Sayegh and Creech (7) in 1957, and by Reemtsma and Creech (8) in 1960. Metabolic studies on the transplanted heart were performed by Lee and Webb (9), and by Reemtsma, Delgado, and Creech (8). Lee and Webb (9) found that in the normothermic homogrMt the coronary flow averaged 128 cc per 100 gm of left ventricle per minute, with a range of from 80 to 140 ec. The myocardial oxygen consumption averaged 6.4 cc per minute. Studies on the carbohydrate metabolism of these hearts showed myocardial utilization of glucose, lactate, and pyruvate. An early negative balance of pyruvate was a frequent occurrence. Reemtsma, Delgado, and Creech (8), using the procedure of Mann, found marked variations in the oxygen consumption of the homografts. Myocardial lactate production rather than consumption was observed in the majority of their experiments.It is the purpose of this report to describe and define the metabolic changes accompanying rejection of the homogra~ted canine heart. In addition, observa-*

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