RESUMO
Data on 32 cases of Bothrops alternatus (the 'urutu' lance-headed viper) bite admitted to a Brazilian teaching hospital from 1985 to 1992 were retrospectively surveyed. The majority of the bites occurred within the household area, i.e. in the house or its environs (56.3%), in the 15-49 years age group (74.2%), and in the lower limbs (84.3%). The male to female ratio was 1 to 1. 59.4% of the patients were given the antivenom within two hours of the bite. Bites in the household area were commonest in old ladies, whereas all the cases associated with leisure activities, and the majority of the bites associated with labour in the field occurred in men. All patients had local pain and oedema; prolonged clothing time was present in 96.9% of the cases, haemorrhage in 40.6%, blisters in 21.9% and necrosis in 9.4%. A tourniquet was used by 43.8% of the patients. A median of 4 ampoules of antivenom were administered. There was no death in this series. There was no significant trend between increasing age and necrosis, nor between time interval between bite and antivenom administration and occurrence of blisters or necrosis. Presence of blister(s) was associated with necrosis (p = 0.007), but use of a tourniquet, altered clotting time or presence of haemorrhage were not. These findings, compared with those of case series of bites of other species of Bothrops, and contrary to the popular belief, indicate that B. alternatus bite is not always severe, and has even a lower rate of complications.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Bothrops , Mordeduras de Serpentes/epidemiologia , Adolescente , Adulto , Fatores Etários , Animais , Antivenenos/uso terapêutico , Brasil/epidemiologia , Criança , Coleta de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade , Mordeduras de Serpentes/complicações , Mordeduras de Serpentes/terapia , Fatores de TempoRESUMO
Onze pacientes portadores de deficiência de hormônio de crescimento (DHC) foram tratados por três anos com hormônio de crescimento recombinante autêntico (HCr), em doses de 0,35 a 0,5U/Kg/semana. A velocidade de crescimento pré-tratamento de 2,91 ñ 1,58cm/a elevou-se a 11,07 ñ 2,52cm/a no primeiro ano, 8,62 ñ 2,81cm/a no segundo e 7,63 ñ 1,84 no terceiro ano de terapêutica. Embora tenha ocorrido importante ganho na idade estatural (deltaIE = 4,9 ñ 1 anos), houve também aceleraçäo significante da idade óssea (deltaIO = 4,3 ñ 1,4 anos), com relaçäo deltaIE/deltaIO de 1,1 ñ 0,2. Como o ganho em altura foi acompanhado de proporcional avanço de IO, a possibilidade de obter altura final normal näo seria alcançada a näo ser que a terapêutica com HCr seja instituída mais precocemente, antes do déficit estatural ser demasiadamente severo, como foi na maioria dos pacientes
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Hormônio do Crescimento/uso terapêutico , Transtornos do Crescimento/tratamento farmacológico , Fatores de Tempo , Estatura , Fator de Crescimento Insulin-Like I/análise , Hormônio do Crescimento/administração & dosagem , Hormônio do Crescimento/deficiência , Transtornos do Crescimento/etiologia , Determinação da Idade pelo EsqueletoRESUMO
Eleven growth hormone deficient (GHD) subjects were treated regularly for 3 years with an authentic recombinant growth hormone preparation (0.35 to 0.5U/kg/week). Growth velocity (GV) increased from a mean o 2.91 +/- 1.58cm/year during the 1st year to 8.62 +/- 2.81cm/y in the 2nd and 7.63 +/- 1.84cm/y in the 3th year of follow up. During that period height age (delta HA) increased by 4.9 +/- 1 years while bone age advanced 4.3 +/- 1.4 year (delta BA) resulting in a delta HA/delta BA of 1.1 +/- 0.2. Since the height increment was associated with BA advancement the final height within normal range could not be attained. Thus, GHr therapy should be instituted before the height deficit would became intense as it happened in the majority of our patients. Early diagnosis and therapy of GHD is important, when growth retardation is less severe, in order to allow a better final height.
Assuntos
Transtornos do Crescimento/tratamento farmacológico , Hormônio do Crescimento/uso terapêutico , Adolescente , Determinação da Idade pelo Esqueleto , Estatura/efeitos dos fármacos , Criança , Pré-Escolar , Esquema de Medicação , Feminino , Transtornos do Crescimento/etiologia , Hormônio do Crescimento/deficiência , Humanos , Fator de Crescimento Insulin-Like I/análise , MasculinoRESUMO
OBJECTIVE: We assessed the ability of desmopressin to stimulate the pituitary-adrenal axis in patients with Cushing's syndrome. DESIGN AND SUBJECTS: The cortisol response to 5 ot 10 micrograms of intravenous desmopressin was evaluated in 31 patients with Cushing's syndrome of several aetiologies and in 15 normal subjects. RESULTS: Cortisol responses were observed in 15 out of 16 patients with pituitary dependence and in two patients with adrenal nodular hyperplasia, the increase above baseline ranging from 61 to 379% in the responders. Eight patients with adrenal tumours and one with the ectopic ACTH syndrome did not respond to desmopressin, having shown changes in their cortisol levels from -5 to 42% above baseline. Responses occurred in two out of the 15 normal individuals, whose cortisol increased 58 and 69% above baseline, respectively. Stimulation tests with standard agents as lysine vasopressin or ovine corticotrophin-releasing hormone were performed in the same patients and there was a high degree of concordance. No serious adverse reactions were observed in the tests with desmopressin. CONCLUSIONS: Desmopressin was able to stimulate the pituitary-adrenal axis in patients with Cushing's disease and, like corticotrophin releasing hormone, it may prove useful in the differential diagnosis of Cushing's syndrome.