Laparotomia / Laparotomy

Celiotomia, que significa precisamente incisão da parede abdominal em qualquer região, é considerado sinônimo de laparotomia, cuja acepção exata é "secção do flanco". A abertura da cavidade abdominal para fins diagnósticos e terapêuticos remonta a antiguidade, mas tornou-se rotineira a partir dos meados do século XX com o advento da anestesia geral, utilizando drogas curarizantes e entubação orotraqueal. Serão discutidos a classificação das laparotomias quanto a finalidade, direção, a complexidade e a relação com estruturas da parede abdominal.

Celiotomy, which precisely means incision of any region of the abdominal wall, is considered a synonym of laparotomy, whose exact definition is 'section of the flank'. Opening of the abdominal cavity for diagnostic and therapeutic purposes dates back to ancient times, but it became a routine procedure in the midtwentieth century with the advent of general anesthesia, by means of curaric agents and orotracheal intubation. We will discuss the classification of laparotomies according to their purposes, direction, complexity, and relation with abdominal wall structures.

Instrumental cirúrgico / Surgical instrumentation

Para a execução de cada uma das etapas do procedimento cirúrgico utilizam-se instrumentos distintos e são necessários ordem e método para permitir ao cirurgião executar o procedimento com precisão e rapidez. Para isso, o instrumental cirúrgico deve ser listado e preparado com antecedência, de acordo com o tipo de cirurgia a ser realizada e preferência do cirurgião.

Distinct instruments are employed during the accomplishment of each of the stages of a surgical procedure. For the surgeon to perform the procedure accurately and efficiently, order and method are mandatory. To this end, surgical instruments should be listed and prepared well in advance, according to the surgery type and the surgeon's preferences.

Snake antivenoms: adverse reactions and production technology: [review]

Antivenoms have been widely used for more than a century for treating snakebites and other accidents with poisonous animais. Despite their efficacy, the use of heterologous antivenoms involves the possibility of adverse reactions due to activation of the immune system. In this paper, alternatives for antivenom production already in use were evaluated in light of their ability to minimize the occurrence of adverse reactions. These effects were classified according to their molecular mechanism as: anaphylactic reactions mediated by IgE, anaphylactoid reactions: aused by complement system activation, and pyrogenic reactions produced mainly by the presence of endotoxins in the final product. ln the future, antivenoms may be replaced by humanized antibodies, specific neutralizing compounds or vaccination. Meanwhile, improvements in antivenom quality will be focused on the obtainment of more purified and specific product in compliance with good manufacturing practices and at an affordable cost

Economic evaluation of snake antivenom production in the public system

Snake antivenom, an expensive animal product, is presently the only effective treatment for the consequences of snakebite. In Latin America, antivenoms are mainly produced by public institutions with frequent shortages of the necessary supply. Here, we present an economical analysis of the factors affecting production cost, assuming a basic processing batch of 100 L hyperimmune plasma. Three annual production volumes were considered for two typical production technologies. The components of cost were classified as fixed, variable and semi-variable. We found that in all stages of production, fixed cost represents the major contribution to total cost, and is given essentially by manpower cost, particularly for low production volumes. Our estimation shows that antivenom cost can vary from US$ 2.4 to US$ 25 per 10 mL vial, depending on the production volume, the plasma processing technology used and the titer achieved during the immunization stage. We conclude that interested laboratories and authorities of countries with population at risk should consider the possibility of a joint production to improve the process efficiency, lower the product unitary cost and obtain the necessary supply for their own demand or that of other countries in need

Intraspecific variation of Bothrops pubescens (cope, 1869) venom in Uruguay (serpentes: viperidae)

In Uruguay, there was no information about the variations degree in Bothrops pubescens venoms until the present work, in which we investigated intraspecific venom variation using polyacrylamide gel electrophoresis (SDS-PAGE). We found some differences in the venom protein profile; however, they were not related to the parameters studied (geographic distribution, weight, sex, and captivity time). Moreover, we distinguished two different groups in relation to band densities at 49 and 57 kDa. Specimens with predominant density in the 49kDa band tend to be predominantly females. Weight distribution in this group extended for all the range (150-1500 g) with an average weight of 720 g. The other group (57kDa predominant band) showed restricted weight range (150-400 g) with an average weight of 280 g. Cluster analysis was also performed. The variability observed in the venom profile probably corresponds to genetic variations.(AU)