ABSTRACT
OBJECTIVE: Relate the occurrence of severe anaphylactic reactions caused by ant stings.METHODS: Case report of severe anaphylactic reaction caused by multiple ant stings, and revision of the literature (Medline and Lilacs). RESULTS: A male patient, white, 2 years-old, suffered multiple stings of small red ants of the species Solenopsis invictas, with the occurrence of severe anaphylactic reactions, and resulting in cortical blindness as a neurological sequel. CONCLUSIONS: The occurrence of such events, not very rare, should be taken in consideration by physicians, once such insects are common in our environment, and their sting can result, sometimes, in severe anaphylactic reactions.
ABSTRACT
OBJECTIVE: To review the hierarchy of bioethical principles when there are conflicting interests between the medical team and the child's parents in decision making in pediatrics. Our hypothesis is that when the parents decisions can be questioned, they loose the right to decide for their children. METHODS: The case of a 9-year-old girl from a Jehova's Witness family is presented. She was a candidate for renal transplantation but her parents were against blood transfusion in case it was required. A member of the medical team presented a denounce to the hospital Medical Ethic Committee and asked for advice. Several materials were reviewed for the ethic aspects involved: the Bioethic Live Plus 1973-4/96, literature provided by people from Jehova's Witnesses, the chapters about ethics in the main pediatric text-books, a journal on Bioethics published by the Brazilian Federal Medical Board, and the Child and Adolescent Act (Brazilian Law 8,069 from January 13th, 1990). RESULTS: The Committee's finding, based on ethic and legal aspects reviewed in the literature about similar cases, favors the beneficence principle under the justification of preserving life as an ultimate goal, and recommends the interference of the Children and Youth Court so that the patient's interest and greater benefits prevail. Nevertheless, it also recommends that the medical team should make every possible effort to avoid blood transfusion in order to respect this conception of life and protect the people who believe in it, in accordance with the fundamental principle of bioethics which postulates the respect for human dignity and autonomy of belief.
ABSTRACT
The acute inflammatory demyelinating polyneuropathy (Guillain-Barré Syndrome) might have a severe presentation but a good prognosis in children. It is an immune-mediated and inflammatory disorder of the peripheral nervous system. This retrospective study observed that GBS is frequently complicated by hypertension and other autonomic disorders. Cardiovascular instability is due to the involvement of the autonomic nervous system and results in labile blood pressure, cardiac dysrhythmias and hypovolemia. During a 13-year period (1982-1995), 21 children were admitted to the Pediatric Intensive Care Unit of São Lucas Hospital, Porto Alegre, south of Brazil. Eight patients were mechanically ventilated. Symptoms of autonomic disturbance were frequently seen, especially in patients with severe clinical evolution. Previous investigations of the mechanism of hypertension associated with GBS did not evaluate the etiology of these phenomena. With modern pediatric intensive care support the deaths are rare. There is no death in this studied group.
