RESUMO

Fluid resuscitation administered before hemorrhage control for trauma victims sustaining blunt abdominal injury is controversial. Prehospital fluid resuscitation is limited by difficulty in delivering large volumes of fluid in the field and time delays associated with gaining vascular access. Venous access is often a clinical dilemma in severely hypovolemic children. Intraosseous infusion is considered a useful technique for the administration of fluids in emergency situations when peripheral intravascular access is not possible. This study investigated the effectiveness of intraosseous versus intravenous infusion of hypertonic saline solution in an uncontrolled hemorrhagic shock swine model. We also tested the effect of the different sites of infusion on the intra-abdominal bleeding. Relevant hemodynamic parameters were monitored and blood samples were collected. After liver injury, 20 anesthetized immature pigs were randomized to three groups: intraosseous access, intravenous access and control. After 20 min of uncontrolled hemorrhage, the hypertonic saline solution begins in the intraosseous access and intravenous access groups of animals. Thirty minutes later, the animals were killed and intra-abdominal blood loss was measured. All the pigs presented lower pressures and lower cardiac output after 20 min of hemorrhagic shock. The intravenous and intraosseous access groups did not show a better hemodynamic performance after 10 min of fluid resuscitation. At the end of the experiment, all animals were hemodynamically similar without an improved answer to a fluid resuscitation. There were no significant differences between groups regarding intra-abdominal blood loss. It was concluded that the hypertonic saline solution in this experimental model did not promote hemodynamic improvement and there were no differences between the two sites of fluid resuscitation regarding intra-abdominal blood loss.

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The blood-brain barrier (BBB) controls the biochemical environment of the brain with variable permeability when comparing adults to children. Based on the knowledge that there is a greater vulnerability in the BBB of young subjects submitted to biochemical variations in the blood and in the brain, an experimental model was designed to study small volume resuscitation. Young Wistar rats were submitted to hemorrhage and resuscitated with 7.5% NaCl solution before undergoing a qualitative evaluation of their BBB. Thirty male rats were anesthetized and divided into four groups: Group 1 - submitted to hemorrhagic shock restored with hypertonic saline solution (HSS); Group 2 - submitted to hemorrhagic shock without volume restoration; Group 3 - receiving only HSS, and Group 4 - control. The data analyzed were: mean arterial blood pressure, base excess, sodium, chloride, urea, blood osmolarity and blood glucose levels. After infusing a 2% Evans blue solution, qualitative analysis of the BBB was carried out. Group 1 presented final mean blood pressure levels equivalent to groups 3 and 4. Group 2 had a significant difference in the final base excess when compared to the other groups. In groups 1 and 3, mean sodium and chloride, as well as serum osmolarity, were more elevated than groups 2 and 4. Macroscopic examination of the brain did not reveal any changes in color, which could be attributed to the opening of the BBB. It was concluded that the 7.5% NaCl solution in this experimental model did not promote qualitative changes in the BBB.

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OBJECTIVE: To evaluate positive responses to skin tests for immediate hypersensitivity to allergens in children with asthma and rhinitis at different ages. METHOD: We observed positive skin test reactivity in prick tests using fifteen allergens of same origin (total dust and Dermatophagoides sp.; Dermatophagoides pteronyssinus; Dermatophagoides farinae; Blomia tropicalis; Penicillium sp; Alternaria alternata; Cladosporium herbarium; Aspergillus fumigatus; Bermuda grass; forage grass; dog and cat epithelia; feathers; Blatella germanica and wool). We placed 713 selected patients into different age groups - Group I: 6 to 11 months; Group II: 1 to 3 years and 11 months; Group III: 4 to 8 years and 11 months; and Group IV: 9 to 15 years. We used the chi-square test for statistical analysis. RESULTS: The total significant differences between these groups were: I to II = 5; II to III = 5; II to IV = 5; III to IV = 6; I to III = 10; and I to IV = 10. CONCLUSION: Skin test reactivity is acquired progressively with age, and can be observed as early as at 12 months. Reactivity is significantly more positive from the age of 4 on.

RESUMO

FIRST REPORT: male child with repeated pulmonary infections from the age of 4 months. He was diagnosed as IgA deficiency (undetectable IgA levels) at the age of 3 years, when he presented repeated bouts of pneumonia and tonsillitis. Several immunologic evaluations were made between the ages of 4 months and 8 years. At 8 years and 9 months, the diagnosis of IgA deficiency was confirmed, and associated IgG2 and IgG4 deficiency (29.0 mg/dl y 0.01 mg/dl) with normal total IgG serum level was found. With the administration of intravenous gammaglobulin, the lung infections remitted and the subsequent clinical course has been uneventful up to now. SECOND REPORT: a boy with repeated infections since the age of 2 months. IgA deficiency was diagnosed at 1 year 7 months (undetectable serum IgA levels). At age 51/2 years, his clinical course worsened and more serious infections appeared. A new immunologic study revealed IgA deficiency associated with CD4 cell deficiency (432 cells/mm3) and normal CD3, CD19, and CD8 levels. Despite intensive antibiotic treatment and care, the child died. The findings suggest an association of IgA deficiency and common variable immunodeficiency.

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Frente a la importancia que adquirió el trauma pediátrico, analizamos retrospectivamente en un período de 9 años, los casos de niños y adolescentes en la sala de primeros auxilios y guardia general pediátrica de la Santa Casa de San Pablo, con especial interés en la epidemiología y morbimortalidad del trauma torácico. Cuarenta y tres niños ingresaron con 56 lesiones torácicas. Hubo un predominio de hemoneumotórax, neumotórax, hemotórax y contunsión pulmonar. Veintiun pacientes sufrieron heridas penetrantes. Alrededor de un 55 por ciento tenían lesiones asociadas. El 90 por ciento fueron tratados con drenaje simple u observación clínica exclusiva. Se presentaron complicaciones en 12 casos (28 por ciento), la mayoría de tipo infeccioso. Fallecieron 3 niños, que ppresentaron lesiones asociadas severas, con TRISS<0,81. Las conclusiones que surgen de la casuística presentada son la universalidad de los parámetros investigados, una mayor gravedad del traumatismo contuso, el mayor nivel de agresividad urbana y la necesidad de organizar y sistematizar la atención del niño traumatizado

Assuntos

RESUMO

Frente a la importancia que adquirió el trauma pediátrico, analizamos retrospectivamente en un período de 9 años, los casos de niños y adolescentes en la sala de primeros auxilios y guardia general pediátrica de la Santa Casa de San Pablo, con especial interés en la epidemiología y morbimortalidad del trauma torácico. Cuarenta y tres niños ingresaron con 56 lesiones torácicas. Hubo un predominio de hemoneumotórax, neumotórax, hemotórax y contunsión pulmonar. Veintiun pacientes sufrieron heridas penetrantes. Alrededor de un 55 por ciento tenían lesiones asociadas. El 90 por ciento fueron tratados con drenaje simple u observación clínica exclusiva. Se presentaron complicaciones en 12 casos (28 por ciento), la mayoría de tipo infeccioso. Fallecieron 3 niños, que ppresentaron lesiones asociadas severas, con TRISS<0,81. Las conclusiones que surgen de la casuística presentada son la universalidad de los parámetros investigados, una mayor gravedad del traumatismo contuso, el mayor nivel de agresividad urbana y la necesidad de organizar y sistematizar la atención del niño traumatizado

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