First report of hepatic hematoma after presumed Bothrops envenomation.

In Latin America, Bothrops envenomation is responsible for the majority of accidents caused by venomous snakes. Patients usually present local edema, bleeding and coagulopathy. Visceral hemorrhage is extremely rare and considered a challenge for diagnosis and management. We report the first case of hepatic hematoma owing to the bothropic envenomation in a 66-year-old man who was bitten in the left leg. He presented local edema, coagulopathy, and acute kidney injury. Radiological findings suggested hepatic hematoma, with a volume of almost 3 liters. The hepatic hematoma was gradually absorbed without the need for surgical intervention with complete resolution in 8 months.

First report of hepatic hematoma after presumed Bothrops envenomation

ABSTRACTIn Latin America, Bothrops envenomation is responsible for the majority of accidents caused by venomous snakes. Patients usually present local edema, bleeding and coagulopathy. Visceral hemorrhage is extremely rare and considered a challenge for diagnosis and management. We report the first case of hepatic hematoma owing to the bothropic envenomation in a 66-year-old man who was bitten in the left leg. He presented local edema, coagulopathy, and acute kidney injury. Radiological findings suggested hepatic hematoma, with a volume of almost 3 liters. The hepatic hematoma was gradually absorbed without the need for surgical intervention with complete resolution in 8 months.

Apendicite aguda complicada na criança: antibioticoterapia em doses múltiplas versus dose única diária

Introdução: a apendicite aguda é a causa mais comum de abdome agudo cirúrgico em crianças. Nos casos de apendicite complicada, o manejo pós-operatório é fundamentado na antibioticoterapia, a qual é objeto deinúmeros estudos atualmente. Objetivos: comparar desfechos pós-operatórios e custos entre os esquemas intravenosos de ceftriaxone e metronidazol em doses únicas e múltiplas, utilizados no pós-operatório de crianças submetidas à apendicectomia por apendicite aguda complicada. Métodos: foi realizada uma revisão retrospectiva dosprontuários dos pacientes submetidos à apendicectomia por apendicite aguda complicada, os quais tivessem sido tratados no pósoperatório com ceftriaxone e metronidazol em doses únicas diárias (esquema 1), ou ceftriaxone em dose única diária, associado ao metronidazol fracionado em três doses (esquema 2). A amostra totalizou 346 pacientes. Resultados: as taxas de intercorrências foram semelhantes nos dois grupos, para picos de febre (p=0,718), dias de dor abdominal (p=0,052) e íleo paralítico (p=0,246). Não houve nenhuma associação entre os esquemas e a ocorrência de obstrução intestinal, deiscência de sutura eevisceração (p=1,000). A ocorrência de abscesso intra- abdominal também não pode ser associada ao esquema antibiótico (p=0,771). A diferença total de custos entre os esquemas foi de R$2.666,04.Conclusões: não houve diferença estatisticamente significativa em nenhum dos desfechos avaliados, quando comparados os dois esquemas. Foram observados maiores custos hospitalares no esquema 2.

Background: appendicitis is the most common abdominal emergency in children. In cases of complicated appendicitis, postoperative management is grounded upon the use of intravenous antibiotics, which is the aim of many studies nowadays. Objectives: comparing postoperative outcomes and costs between once-a-day and multiple doses of intravenous ceftriaxone and metronidazole, used in the postoperative of children submitted to apendicectomy for complicated acute appendicitis. Methods: a retrospective review was conducted of patients submitted to appendicectomy for complicated acute appendicitis, who were treated in the postoperative with once-a-day ceftriaxone and metronidazole (group1) or once-a-day ceftriaxone, associated with metronidazole divided into three doses a day (group 2). The sample totaled 346 patients.Results: the rate of postoperative intercurrences was similar in both groups: fever (p=0.718), abdominal pain (p=0.052) and paralytic ileus (p=0.246). There was no statistic association between the antibiotic regimens and bowel obstruction, suture dehiscence and eviscerationrates (p=1.000). Intraabdominal abscess incidence also couldn´t be associated with the different regimens (p=0.771). The difference in the hospital costs between the two groups was $1.615,68. Conclusions: There was no significatively statistic difference in any analyzed parameters, when the two groups were compared. It was observed higher costs for the hospital in group 2.

[Evaluation of the epidemiological profile and the mortality rate of the patients with primary cutaneous melanoma in Florianopolis - SC, Brazil]. / Avaliação do perfil epidemiológico e da mortalidade dos pacientes com diagnóstico de melanoma cutâneo primário no município de Florianópolis - SC, Brasil.

BACKGROUND: Melanoma is the cutaneous cancer which has the greatest lethality. Santa Catarina is the Brazilian State that contributes the most to increase this rate. OBJECTIVES: To estimate the mortality rate of melanoma in the fifth year of illness. METHODS: The sample comprises 81 reports of primary cutaneous melanoma, in 75 patients, diagnosed in lorianopolis - SC in 2002 and 2003. The protocol of research includes age, sex, patient's color, anatomical location, histological type, degree of invasion, Breslow index, inflammatory reaction, ulceration, regression, angiolymphatic invasion and tumor staging. The patients were contacted by telephone to verify their status (alive, killed by melanoma or dead for another reason). Fisher's exact test and Kaplan-Meier's survival curve were used for the statistical analysis. RESULTS: The patients' profile was: female, white, 51.3 years of age, with invasive melanoma on the trunk and limbs, extensive spreading type, Breslow 2.63 mm. The mortality rate was 7.0%, greater among men (11.1%), Breslow above 4.0 mm (66.0%), with ulceration (33.3%) and stage IV (80.0%). The average survival period was 56.7 months. CONCLUSIONS: The mortality rate of primary cutaneous melanoma was 7.0%; ulceration and the final staging were the factors with statistic significance on the result.

Análise dos resultados maternos e perinatais do diabetes mellitus na gravidez

Introdução: O diabetes mellitus é a desordemmetabólica mais comum da gestação. Essa associaçãotraz múltiplos efeitos deletérios ao binômio materno-fetal.Objetivos: Descrever o manejo médico e osprincipais resultados maternos e perinatais das gestaçõescomplicadas por diabetes.Métodos: Realizou-se um estudo tipo coortehistórica, na Maternidade Carmela Dutra (Florianópolis? SC). A amostra abrange 349 gestantes diabéticas,internadas ao longo de sete anos (2000-6, inclusive), e288 recém-nascidos.Resultados: A maioria das pacientes apresentavamdiabetes mellitus gestacional, sendo tratadas com dieta.A necessidade de insulina predominou no 3º trimestre dagestação, com dose média de 34,85 UI diárias. Aintercorrência materna mais freqüente foi a doençahipertensiva específica da gestação (25,24%). Aincidência de abortamento foi de 1,37%. As principaisindicações clínicas de interrupção da gestação foram:macrossomia estimada por ultra-sonografia (9,25%),sofrimento fetal (8,56%) e doença hipertensiva específicada gestação (6,50%). A via de parto predominante foi acesárea (69,20%). O peso médio dos recém-nascidosfoi igual a 3.430,44 g. Ocorreu macrossomia em 17,18%e, hipoglicemia, em 10,07% dos recém-nascidos, commaior prevalência dessa nos macrossômicos (p=0,0369).A incidência de hipoglicemia nos recém-nascidos depacientes com diabetes mellitus gestacional foi maiorno subgrupo tratado com insulina (p=0,0085). Asincidências neonatais de icterícia e síndrome da angústiarespiratória foram de, respectivamente, 22,92% e13,49%. A taxa de mortalidade neonatal precoce foi de1,38%.Conclusões: A maioria das gestantes forammanejadas adequadamente com dieta. Houve importantesobreposição de hipertensão nessas pacientes. O índicede perdas gestacionais foi baixo.

Background: Diabetes mellitus is the most commonmetabolic disorder associated to pregnancy. Thisassociation results in multiple adverse pregnancyoutcomes.Objective: Describing the medical management andmain maternal and perinatal outcomes of gestationscomplicated by diabetes mellitus.Methods: The study design was a historic cohort,developed in Carmela Dutra Maternity. The sampletotaled 349 diabetic pregnants, admitted there over sevenyears (2000-6 inclusive), and 288 newborns.Results: Most of the patients had gestational diabetesmellitus and were treated with diet alone. Treatment withinsulin began predominantly in the third trimester, withmean daily dose of 34.85 IU. Pregnancy-inducedhypertension was the most frequent maternalintercurrence (25.24%). Miscarriage incidence was1.37%. Main clinic indications of pregnancy interruptionwere: macrosomia estimated by ultrasonography(9.25%), fetal compromise (8.56%) and pregnancyinducedhypertension (6.50%). Cesarean deliveryoccurred in 69.20%. Mean birth weight was 3420.44 g.Macrosomia occurred in 17.18% of the newborns andhypoglycemia in 10.07%. Hypoglycemia had higherprevalence in the macrosomic infants (p=0.0369). Amongnewborns of patients with gestational diabetes mellitus,hypoglycemia incidence was higher in the subgrouptreated with insulin (p=0.0085). Neonatal incidences ofjaundice and respiratory distress syndrome were,respectively, 22.92% and 13.49%. Early neonatal deathrate was 1.38%.Conclusions: Most of the diabetic pregnants weremanaged with diet alone. There was importantsuperposition of hypertension in these patients.Pregnancy loss rate was low.

Avaliação do perfil epidemiológico e da mortalidade dos pacientes com diagnóstico de melanoma cutâneo primário no município de Florianópolis - SC, Brasil / Evaluation of the epidemiological profile and the mortality rate of the patients with primary cutaneous melanoma in Florianopolis - SC, Brazil

FUNDAMENTOS: O melanoma é o câncer cutâneo com maior letalidade. Santa Catarina é o estado brasileiro com maior número de casos desse tumor. OBJETIVOS: Estimar a taxa de mortalidade por melanoma no quinto ano de doença. MÉTODOS: A amostra compreendeu 81 laudos de melanoma primário cutâneo, em 75 pacientes, emitidos em Florianópolis - SC em 2002 e 2003. O protocolo de pesquisa incluiu idade, sexo, cor do paciente e localização anatômica, tipo histológico, grau de invasão, índice de Breslow, infiltrado inflamatório, ulceração, regressão, invasão angiolinfática e estadiamento do tumor. Foi feito contato telefônico com os pacientes para verificar seu status (vivo, morto por melanoma ou morto por outra causa). Para análise estatística, utilizou-se o teste exato de Fisher e a curva de sobrevida de Kaplan-Meier. RESULTADOS: O perfil dos pacientes foi: feminino, branco, 51,3 anos, melanoma invasivo em tronco ou membros, tipo extensivo superficial, Breslow 2,63 mm. A taxa de mortalidade por melanoma cutâneo foi de 7,0 por cento, maior entre homens (11,1 por cento), com Breslow superior a 4,0 mm (66,0 por cento), com ulceração (33,3 por cento) e em estádio IV (80,0 por cento). A sobrevida média foi de 56,7 meses. Conclusões: A taxa de mortalidade por melanoma primário cutâneo foi de 7,0 por cento, e a ulceração e o estadiamento final foram os fatores com significância estatística sobre o resultado.

BACKGROUND: Melanoma is the cutaneous cancer which has the greatest lethality. Santa Catarina is the Brazilian State that contributes the most to increase this rate. OBJECTIVES: To estimate the mortality rate of melanoma in the fifth year of illness. METHODS: The sample comprises 81 reports of primary cutaneous melanoma, in 75 patients, diagnosed in lorianopolis - SC in 2002 and 2003. The protocol of research includes age, sex, patient's color, anatomical location, histological type, degree of invasion, Breslow index, inflammatory reaction, ulceration, regression, angiolymphatic invasion and tumor staging. The patients were contacted by telephone to verify their status (alive, killed by melanoma or dead for another reason). Fisher's exact test and Kaplan-Meier's survival curve were used for the statistical analysis. RESULTS: The patients' profile was: female, white, 51.3 years of age, with invasive melanoma on the trunk and limbs, extensive spreading type, Breslow 2.63 mm. The mortality rate was 7.0 percent, greater among men (11.1 percent), Breslow above 4.0 mm (66.0 percent), with ulceration (33.3 percent) and stage IV (80.0 percent). The average survival period was 56.7 months. Conclusions: The mortality rate of primary cutaneous melanoma was 7.0 percent; ulceration and the final staging were the factors with statistic significance on the result.

The effects of metabolic stress and vagotomy on emotional learning in an animal model of anxiety.

The aim of the present study is to evaluate the role of the blood glucose (BG) level in emotional learning in the elevated plus maze (EPM), an animal model of anxiety. In Experiment 1, male Wistar rats were submitted to different EPM trial lengths (1- or 5-min). Blood samples were withdrawn before and after the maze exploration, through a polyethylene cannula chronically implanted into the jugular vein. In Experiment 2, the animals received either saline or 2-deoxy-D-glucose, a glucoprivic drug (2-DG, 250 or 500 mg kg(-1)) by i.p. route, 30 min before a 5-min EPM exposure and were retested in the maze (Trial1/Trial2 EPM procedure) 24 h later. In an independent group of rats, blood samples were withdrawn 0, 5, 15, and 30 min after 2-DG administration, through the jugular vein, to determine BG. In Experiment 3, the animals underwent a vagotomy and were tested in a Trial1/Trial2 EPM procedure four weeks later. The results showed that rats exploring the EPM for 5 min displayed increased fear and higher hyperglycemia than those exploring the EPM for 1 min. In addition, rats submitted to 5-min EPM Trial1 length displayed higher level of fear on Trial2, as well as higher percentage of shortening of the %Open arm entries and %Open arm time from Trial1 to Trial2, which characterizes the occurrence of emotional learning. In contrast, rats previously vagotomized or treated with 2-DG (500 mg kg(-1)) showed the same level of fear on both EPM trials and a low percentage of shortening, from Trial1 to Trial2, of the %Open arm entries and %Open arm time, indicating poor emotional learning. The data is discussed regarding the role of glycaemia in emotional learning in the EPM.