Violência doméstica contra crianças e adolescentes: um desafio / Domestic violence against children and adolescents: a challenge

OBJETIVO: Estudar crianças e adolescentes vítimas de violência doméstica da Unidade de Emergência Referenciada Pediátrica (UERP) do Hospital das Clínicas (HC) - Universidade Estadual de Campinas (UNICAMP) e ambulatório especializado, entre janeiro de 2003 e dezembro de 2007, enfatizando o abuso sexual. MÉTODOS: Analisou-se: gênero, idade, procedência e classificação. Para as vítimas de abuso sexual estudou-se: tipo de abuso (estupro), local (doméstico/urbano), duração (aguda/crônica), autor (conhecido; incestuoso), alterações no exame médico, notificação ao conselho tutelar, medicação antirretroviral e sorologias (HIV, Lues, hepatite B e C). Dividiu-se em dois grupos com relação ao tipo de abuso e ao autor e associou-se a gênero, idade e duração. Para a comparação calculou-se o Qui-quadrado ou Exato de Fisher (significância p < 0,05) e a razão de chance prevalente bruta. RESULTADOS: Do total (551), predominou a negligência (33,9%) e abuso sexual (31,9%), sendo 55,9% nas meninas e 50% até 5 anos. Do abuso sexual (95), 80% eram meninas e 58,9% entre 5-10 anos. Observou-se estupro entre 39% e atentado ao pudor em 59,6%; 72,6% foram em área doméstica, 81,1% por autor conhecido, 31,6% por relação incestuosa, 47,4% crônica e 76,5% sem alteração clínicas, sendo 81,1% encaminhados ao conselho tutelar. Medicação antirretroviral foi indicada para 49,1% dos pacientes, e sorologias: HIV em 46 (48,4%), Lues em 42 (44,2%), hepatite B em 44 (46,3%) e hepatite C em 45 (47,4%), todas negativas, mais frequente nas vítimas de estupro (p = 0,00). Ocorreu associação entre estupro e idade (10 e 15 anos p = 0,01) e autor incestuoso e duração crônica (p = 0,01). CONCLUSÃO: Apesar de não refletir a realidade, serve como alerta aos pediatras.

OBJECTIVE: To study children and adolescents victims of domestic violence treated at the Referenced Pediatric Emergency Unit of the Hospital de Clínicas of the Universidade Estadual de Campinas and its specialized outpatient clinic between January 2003 and December 2007, emphasizing sexual abuse. METHODS: The variables gender, age, origin, and classification were studied. For victims of sexual abuse, the following variables were also studied: type of abuse (rape), location (domestic/urban), duration (acute/chronic), perpetrator (known, incestuous), alterations at medical examination, notification to child protection agencies, and antiretroviral medication and serology (HIV, syphilis, hepatitis B and C). Patients were divided into two groups according to the type of abuse and type of perpertrator and they were associated with gender, age, and duration. For the comparison, chi-squared or Fisher's exact test were performed (significance p < 0.05), as well as raw prevalence odds ratio. RESULTS: Of the total cases of abuse (551), neglect (33.9%) and sexual abuse (31.9%) predominated; the victims were female in 55.9% of the cases, and 50% were up to 5 years of age. Of the sexual abuse cases (95), 80% were female, and 58.9% were between 5 and 10 years of age. Rape was observed in 39% and indecent assault in 59.6%; 72.6% occurred in the domestic area, 81.1% by known perpetrator; 31.6% were incestuous, 47.4% were chronic, and 76.5% had no clinical alterations. 81.1% were referred to child protection agencies. Antiretroviral medication was prescribed to 49.1% of patients, and serological tests (HIV in 46 [48.4%], syphilis in 42 [44.2%], hepatitis B in 44 [46.3%] and hepatitis C in 45 [47.4%]%), all of which were negative, were more frequent in rape victims (p = 0.00). There was an association between rape and age (10 and 15 years, p = 0.01) and between incestuous perpetrator and chronic duration (p = 0.01). CONCLUSION: Although this study does not reflect reality, it can be used as a warning to pediatricians.

Topographical relationships among the portal branchesand the hepatic tributaries in the left lateral division or the liver of brazilian individuals

The left lateral division or left anatomical lobe of the liver is subdivided into posterior lateral or S2 and the anteriorlateral or S3 segments. Because this lobe is widely used in hepatic transplantation, the ramifications of the portal veinand of the hepatic veins have been extensively studied. The aim of this study was to investigate the frequency ofcases in which it is possible to delimit the S2 and S3 hepatic segments. Forty livers from Brazilian subjects ofEuropean and African descent were fixed in neutral formalin solution and dissected. In segment S2, there was alwaysa portal branch located dorsally to the left hepatic tributary. In segment S3, there were three types of interdigitationsdistributed among two portal branches and two hepatic tributaries. In type A (26/40 cases, 65%), the tributariescrossed the dorsal portal branch posteriorly. In subtype A1 (19/26 cases), the tributaries pinched the ventral branch,and in subtype A2 (7/26 cases), they crossed the ventral branch posteriorly. In type B (11/40 cases, 27.5%), the twotributaries pinched the dorsal portal branch, with both pinching the ventral portal branch in subtype B1 (7/11 cases)but only the ventral tributary crossing the latter branch in subtype B2 (4/11 cases). In type C (3/40 cases, 7.5%), theventral and dorsal tributaries crossed the dorsal portal branch anteriorly, with both vessels also crossing the ventralportal branch anteriorly in subtype C1 (2 cases) and only the ventral tributary crossing this branch in C2 (1 case). Inall cases, it was possible to differentiate S2 from S3, even when in type C cases there was no hepatic tributaryseparating them. Moreover, in 23/40 cases (57.5%) there was a fissural umbilical vein greater than 5 mm in diameterand, in 5/23 cases this vein superficially crossed the portal branch destined to segment S3.