Perfil epidemiológico de vítimas de queimaduras internadas em uma unidade no Distrito Federal do Brasil / Epidemiological profile of burning victims in a specialized unit in the Federal District of Brazil / Perfil epidemiológico de víctimas de quemaduras internadas en una unidad especializada en el Distrito Federal de Brasil

Objetivo: Descrever o perfil epidemiológico de pacientes vítimas de queimaduras que foram admitidos no centro de tratamento de queimaduras do Hospital Regional da Asa Norte, em Brasília-DF. Método: Trata-se de um estudo observacional do tipo transversal retrospectivo baseado na análise dos prontuários eletrônicos e do documento físico do livro de registro do centro de tratamento de queimaduras, de janeiro a dezembro de 2018. Os dados foram armazenados em banco de dados disposto no Microsoft® Office Excel e analisados no software R V3.6. Resultados: A amostra foi de 224 pacientes, com 62% do sexo masculino. A média de idade foi de 32,5 (±19,3) anos. Os agentes mais frequentes foram os térmicos (86%), com predomínio de agentes inflamáveis (54,68%), ocasionados por acidentes domésticos. A superfície corporal queimada média foi de 15%, com predomínio de queimaduras de segundo grau (78%). As regiões corporais mais atingidas (21,8%) foram os membros superiores. A maioria dos pacientes evoluiu com infecção de ferida (42,41%). A frequência de óbitos foi de 6%, sendo a sepse (53,85%), a causa de morte mais prevalente. Conclusão: O perfil dos pacientes estudados expressa o predomínio do sexo masculino, com queimaduras térmicas. A maioria evolui com alta e acompanhamento ambulatorial e os que vão a óbito têm como principal causa a sepse.

Objective: To describe the epidemiological profile of burn victims who were admitted to the Burn Treatment Center of Asa Norte Regional Hospital, in Brasília-DF. Methods: This is an observational retrospective cross-sectional study based on the analysis of the electronic medical records and the physical document of the Burn Treatment Center logbook from January to December 2018. Data were stored in a Microsoft® Office database Excel and analyzed using the software R V3.6. Results: The sample consisted of 224 patients, with 62% male. The average age was 32.5 (±19.3) years old. The most frequent burn causes were thermal (86%), with a predominance of flammable agents (54.68%), resulted of domestic accidents. The average burnt body surface was 15%, with a predominance of second-degree burns (78%). The most affected body regions (21.8%) were the upper limbs. Most patients evolved for a wound infection (42.41%). The frequency of deaths was 6%, with sepsis (53.85%) being the most prevalent cause of death. Conclusion: The profile of the patients studied has the predominance of males with thermal burns. Most evolve with discharge and outpatient follow-up and those who die had sepsis as the main death cause.

Objetivo: Describir el perfil epidemiológico de las víctimas de quemaduras que ingresaron en el Centro de Tratamiento de Quemaduras del Hospital Regional Asa Norte, en Brasília-DF. Método: Se trata de un estudio transversal observacional retrospectivo basado en el análisis de los registros médicos electrónicos y en el documento físico del libro de registro del Centro de Tratamiento de Quemaduras de enero a diciembre de 2018. Los datos se almacenaron en una base de datos Excel de Microsoft® Office y se analizaron con el software R V3.6. Resultados: La muestra consistió en 224 pacientes, con 62% del genero masculino. La edad promedio fue de 32,5 (±19,3) años. Las causas más frecuentes de quemaduras fueron las térmicas (86%), con predominio de agentes inflamables (54,68%), resultado de accidentes domésticos. La superficie del cuerpo quemada promedio fue del 15%, con predominio de quemaduras de segundo grado (78%). Las regiones del cuerpo más afectadas (21,8%) fueron las extremidades superiores. La mayoría de los pacientes evolucionaron para infección de las heridas (42,41%). La frecuencia de muertes fue del 6%, siendo la sepsis (53,85%) la causa más frecuente de muerte. Conclusión: El perfil de los pacientes estudiados tiene predominio de varones con quemaduras térmicas. La mayoría evolucionó con el alta y el seguimiento ambulatorio y los que murieron tuvieron la sepsis como la principal causa de muerte

Fatal cardiac tamponade associated with central venous catheter: a report of 2 cases diagnosed in autopsy.

The authors present 2 cases of fatal cardiac tamponade associated with the insertion of a central venous catheter. The first case occurred soon after the insertion of the catheter (early complication), and the second case, 4 days after (late complication). In both cases, the post-catheter insertion check chest x-ray film showed the tip of the catheter located within the heart silhouette. The diagnosis of cardiac tamponade was made only during the cadaverous examination. In the first case, the catheter was found to be in the right internal jugular vein at autopsy. The postmortem examination showed a clear liquid inside the pericardial cavity and the inferior vena cava injury. In the second case, the catheter had been inserted via the right subclavian vein puncture and there was a perforation of the right atrium at autopsy. The child was using total parenteral nutrition, and the intrapericardial liquid was milky. The incorrect placement of the catheter tip and unrecognized complications led the 2 children to death.

Self-induced fatal air embolism: accidental autoerotic death or suicide?

Autoeroticism comprises behavior deviations aimed at producing sexual gratification through the manipulation of one's own body. The use of asphyxia and the induction of pain (masochism) are well-known examples. "Atypical forms" of such behaviors have appeared in the literature as isolated cases. Fatal air embolism is most common in women (causing abortion), being very rare in men (urethral trauma). The authors present a probable case of air embolism associated with signs of autoeroticism, instrumented by the delivery of air through a system formed by a compressor (typical of those used in refrigerators), a syringe barrel, a segment of latex tubing (tourniquet), and a needle, which was found inserted into the glans penis of an adult male. The hypothesis of accidental death was chosen due to the findings at the scene. The body was decomposing when found, which hampered the conduction of examinations.

Child sexual abuse.

OBJECTIVE: To evaluate the prevalence of sexual abuse in the pediatric population of the Federal District and discuss the difficulties in interpreting the examination of the genitalia in this age group, both by general practitioners as medical expert forensic officers. METHODOLOGY: This is a retrospective, transversal, and epidemiological study on children younger than 12 years, who attended the Institute of Forensic Medicine of DF (IML-DF), Brasilia, Brazil, with suspicion of sexual abuse between 2008 and 2009. RESULTS: During this period, 3607 persons with suspected sexual abuse and 1762 (48.8%) children younger than 12 years were treated in IML-DF. Of this total, 238 (13.5%) were boys, and 1524 (86.5%) were girls. Among the boys, the average age was 6.5 years, and 9.6% were found to have injuries consistent with sexual abuse. In 43.4% of these cases, the perpetrator was known. The main lesions found were anal fissures and lacerations, bruises, and anal dilatation. In 20 cases (8.4%), the time interval between fact and examination precluded any conclusion. The girls (1524 cases) referred to the IML-DF were subjected to two types of tests: libidinous acts (773 to 50.7%) and rape (751 to 49.3%). In tests of libidinous acts, 5.3% had signs of sexual abuse perpetrated by acquaintances (68.2%), and 3.0% were inconclusive because of the long time lag between the examination and fact. In survey of rape cases, only 2.1% of subjects examined had lesions consistent with abuse. In 57 of 1524 cases, specimens were sampled for sperm test, and five cases (8.7%) showed positive results. The average age of girls being sexually abused (10.7 years) was higher than that for boys (6.5 years). DISCUSSION: Our findings confirm the discrepancy between the expectations of parents and the general practitioner, and the reality of the findings in specialized centers. Approximately 90% of child victims of abuse do not show evidence of physical damage. These were found in less than 10% of abused children. Physical signs of abuse often are difficult to recognize and should not be the only indicators.

Atherosclerosis in young Brazilians suffering violent deaths: a pathological study.

BACKGROUND: Atherosclerosis is the leading cause of coronary heart disease and ischemic stroke, which can cause sudden death in adulthood. In general, the clinical manifestations of cardiovascular diseases are caused by atherosclerosis, which is a process that starts during middle age. More recent studies indicate that the atherosclerotic process begins during childhood. METHODS: To evaluate the extent of atherosclerotic disease in young Brazilians, we conducted a study of the pathological alterations in the major arteries of victims of violent death. Samples of the right carotid artery, left coronary artery, and thoracic aorta of young victims of violent death were analyzed and graded in accordance with the histological atherosclerotic lesion types proposed by the American Heart Association. Samples were collected from 100 individuals who had died from external causes, aged from 12 to 33 years. RESULTS: The majority of cases (83%) were male, and 66% of deaths were homicides caused by firearms. The median age was 20.0 years and mean body mass index was 20.9 kg/m2. Of the right carotid artery specimens, 3% were normal, 55% had type I, 40% had type II, 1% had type III, and 1% had type IV atherosclerotic lesions. Of the left coronary artery specimens, 5% were normal, 48% had type I, 41% had type II, 3% had type III, and 3% had type IV lesions. Of the thoracic aorta specimens, none were normal, 13% had type I, 64% had type II, 22% had type III, and 1% had type IV lesions. Overall, 97.34% of arteries examined had some degree of atherosclerosis. The most common histological type was type II (foam cells). No thoracic aorta specimens were normal, and the coronary artery specimens had the most atherosclerosis. CONCLUSIONS: Our results show a high prevalence of atherosclerotic lesions among young people in Brazil. Intervention should be undertaken to decrease the rate of sudden cardiac death in the adult population.

Alcoolemia em vítimas fatais de acidentes de trânsito no Distrito Federal, Brasil / Blood alcohol concentration in fatal traffic accidents in the Federal District, Brazil

O objetivo do estudo foi analisar a presença de alcoolemia em vítimas fatais de acidentes de trânsito, no Distrito Federal, em 2005. De 442 óbitos, 163 foram resultantes de atropelamentos, 84 de capotagem e 195 de colisão. A alcoolemia foi dosada em 238 casos (53,7 por cento). A maioria das vítimas era jovem, entre 18 e 35 anos e do sexo masculino. Entre as vítimas de colisão, 44,2 por cento tinham níveis de alcoolemia acima de 0,6 g/l; nas vítimas de capotagens, esse percentual foi de 57,7 por cento e, entre os pedestres, 32,5 por cento. A diferença entre as proporções de vítimas com alcoolemia positiva foi estatisticamente significativa para os que sofreram acidentes de capotagem em relação aos demais.

The objective of the study was to assess the association between high blood alcohol levels and fatal victims of traffic accidents in the Brazilian Federal District, in 2005. A total of 442 casualties (163 pedestrians, 84 victims of overturns, and 195 of collisions) were studied. Blood alcohol concentration was analyzed in 238 cases (53.7 percent). Most victims were young males, aged between 18 and 35 years. Blood alcohol levels higher than 0.6 g/L were detected in 44.2 percent of collision victims; 57.7 percent of victims of overturns and 32.5 percent of pedestrians. The difference in proportions between overturn victims with blood alcohol concentration higher than 0.6 g/L and those victims of other traffic accidents was statistically significant.

[Blood alcohol concentration in fatal traffic accidents in the Federal District, Brazil]. / Alcoolemia em vítimas fatais de acidentes de trânsito no Distrito Federal, Brasil.

The objective of the study was to assess the association between high blood alcohol levels and fatal victims of traffic accidents in the Brazilian Federal District, in 2005. A total of 442 casualties (163 pedestrians, 84 victims of overturns, and 195 of collisions) were studied. Blood alcohol concentration was analyzed in 238 cases (53.7%). Most victims were young males, aged between 18 and 35 years. Blood alcohol levels higher than 0.6 g/L were detected in 44.2% of collision victims; 57.7% of victims of overturns and 32.5% of pedestrians. The difference in proportions between overturn victims with blood alcohol concentration higher than 0.6 g/L and those victims of other traffic accidents was statistically significant.

Dissimulação de drogas no corpo humano para efeitos de tráfico / The concealment of drugs inside human body for trafficking purpose

Introdução. A dissimulação de drogas dentro do corpo humano tem sido utilizada, pelos traficantes, para o transporte destas entre países (drogas dentro do aparelho gastrintestinal); para fugir de flagrantes (drogas deglutidas rapidamente); ou para entrada de drogas em presídios (escondidas em cavidades naturais como a vagina e o ânus). Objetivo. Analisar os casos suspeitos de dissimulação de drogas no interior do corpo. Métodos. Trata-se de estudo retrospectivo, transversal, série de casos, efetuado no Instituto de Medicina Legal do Distrito Federal, no período de janeiro a dezembro de 2007. Resultados. Realizaram-se 402 exames para pesquisa de corpo estranho em cavidades naturais e um exame cadavérico. Foram encontradas drogas ilícitas em 42 casos (10,4%), sendo 40 no sexo feminino (vagina) e dois no sexo masculino (ânus). As drogas puderam ser analisadas em vinte e seis indivíduos. A análise foi feita pelo Laboratório de Toxicologia do Instituto de Criminalística. O único exame cadavérico foi resultado de uma morte por intoxicação por cocaína, com rotura de um pacote, ingerido por um custodiado, para fugir de um flagrante. O resultado do exame toxicológico foi 25.310 micros grama/g, caracterizando o que é chamado de síndrome da embalagem. Conclusão. Os autores chamam a atenção sobre o tráfico de drogas para dentro de presídios, que virou moeda de troca, e para os riscos decorrentes desse tipo de atividade, bem como os meios diagnósticos e a conduta terapêutica.

Introduction. The concealment of drugs inside the human body has been used by traffickers to transport it between countries, to escape being caught in the act or to make it inside controlled places, like prisons. Objective. To analyze cases suspected of drug concealment inside the body. Methods. The authors present a retrospective study of cases occurring in 2007 at the Institute of Legal Medicine of the Distrito Federal, Brasilia, Brazil. Results. Four hundred and two examinations were performed for detection of foreign body in natural cavities anda cadaveric investigation. Among the examinations in natural cavities, drugs were found in 42 cases, 40 in females(vagina) and two in males (anus). The people involved in this type of crime are, in most cases, women who attempted to get illegal drugs into prisons. The drugs could be tested in twenty-six cases. The analysis was performed by the Toxicology Laboratory of the Institute of Criminology. The only case of death was the result of cocaine intoxication after rupturing of a swallowed package in a prisoner who tried to avoid being caught in the act. The result of the toxicology exam was 25,310 micron gram/g, and that characterizes the so called package syndrome. Conclusion. The authors draw attention to the trafficking of drugs into prisons, which then becomes a bargaining chip, the risks of such activity and the means of diagnosis and therapeutic approach.

Duplicaçäo de cólon: relato de caso e revisäo da literatura / Tubular duplication of the colon: a case report and review of the literature

Entre as duplicaçöes do trato gastrointestinal, as duplicaçöes de cólon säo menos freqüentes. O caso discutido é o de uma duplicaçäo de cólon transverso, de diagnóstico difícil, cujo principal sistema era distensäo abdominal. Com 4 anos de idade, a criança foi encaminhada à Unidade de Cirurgia Pediátrica do Hospital de Base do Distrito Federal(HBDF) devido a distensäo abdominal progressiva. O R-X simples de abdomen mostrava uma imagem compatível com um grande fecaloma. Durante a investigaçäo foi realizado clister opaco, que sugeria megacólon congênito. Após a realizaçäo de biópsia retal, que mostrou células ganglionares normais, foi instituído tratamento clínico para constipaçäo funcional. A criança retornou 3 meses depois com o mesmo quadro clínico. Foi repetida a biópsia retal(normal), sendo que os pais näo retornaram ao serviço para dar continuidade ao tratamento. Quatro anos mais tarde, a criança deu entrada no Pronto Socorro, com um quadro de obstruçäo intestinal baixa. Durante a laparotomia, constatou-se a presença de um volvo de intestino grosso, provocado por uma duplicaçäo de cólon que se iniciava em cólon transverso e se estendia distalmente por mais ou menos 50 cm. Foi realizada ressecçäo da duplicaçäo e anastomose primária. A criança evoluiu bem no período pós-operatório.

Síndrome de hipoperistaler intestinal com microcólon e megacistis / Megacystis-microcolon-intestinal hypoperistalsis syndrome: a case report

Os autores relatam um caso raro de dismotilidade intestinal conhecido como Síndrome de Hippoperistalse Intestinal com microcólon e Megacistis (SHIMM). Esta se manifesta no período neonatal com sintomas de pseudo-obstruçäo intestinal. Recém-nascido com 3.110 g, do sexo feminino, protando pequena onfalocele, com clínica de vômitos biliosos e raios-X mostrando velamento abdominal total. Durante correçäo cirúrgica da onfalocele, constatou-se um intestino curto, hipodesenvolvido e mal-rodado, associado a grande distensäo vesical. Foi realizada gastrostomia, vesicostomia e colostomia, além de biópsias seriadas que demonstraram presença normal de gânglios e filetes nervosos preservados. A hipotonia intestinal difusa impossibilitou a aceitaçäo de dieta enteral, permanecendo, deste modo, sob nutriçäo parenteral exclusiva. Evoluiu para óbito no 51§ dia, com a autópsia comprovando o diagnóstico. A SHMM caracteriza-se por um quadro de obstruçäo intestinal crônica, decorrente da falta de contratilidade intestinal, acompanhado de grande distensäo vesical. Näo existe tratamento estabelecido e o prognóstico é bem reservado.

Hernia hiatal em crianca: relato de quatro casos

Os autores relatam quatro casos de hernia hiatal tratados na Unidade de Cirurgia Pediatrica do Hospital de Base do Distrito Federal (HBDF) no periodo de marco de 1990 a maio de 1991. Durante este periodo foram realizadas pela Unidade de Cirurgia Pediatrica cerca de 950 cirurgias, sendo 50 por cento eletivas, entre as quais se incluem os quatro casos aqui relatados. Todos os pacienteseram do sexo masculino, com idades que variaram de 2 meses a 5 anos e 3 meses: dois pacientes apresentaram sintomas digestivos (vomitos pos-prandiais, perda de peso e dor retroesternal) e os outros dois, sintomas respiratorios (pneumonias de repeticao). Todos os pacientes foram submetidos a correcao cirurgica com reparo dos pilares diafragmaticos (tres com fundoplicatura de Thal e um com gastropexia). Os casos 1, 2 e 3 evoluiram sem intercorrencias, com desaparecimento completo dos sintomas. O caso 4, apresentando uma alteracao anatomica importante na regiao do hiato esofagico que impossibilitava a identificacao do ramo direito da crura diafragmatica, evoluiu com desaparecimento dos sintomas apesar da recidiva parcial da hernia de hiato. Obtivemos em relacao a todos a cura clinica (desaparecimento dos sintomas), sendo que o caso 4 nao obteve a cura radiologica total (juncao esofagogastrica totalmente abdominal) .

Aganglionase total de colon com envolvimento ileal / Aganglionosis total of colon with involvment ileal-relate of 4 cases

Os autores apresentam 04 casos de aganglionose total de colon com envolvimento ileal tratados no periodo de 1987 a 1991. Ressaltam a diferenca na forma de apresentacao clinica e dificuldades diagnosticas em relacao aomegacolon congenito classico. Os quatro casos compreendem: um obtido no decimo DPO de colostomia, duas criancas com ileostomia e uma ja submetida ao tratamento definitivo, com 18 meses de seguimento. A diminuicao dos indices de mortalidade esta diretamente relacionada ao reconhecimento precoce da patologia, tratamento clinico e cirurgico adequado .