ABSTRACT
The jararacuçu, one of the most dreaded snakes of Brazil, southern Bolivia, Paraguay and northeastern Argentina, is a heavily-built pit viper which may grow to a length of 2.2 m. Up to 1000 mg (dry weight) of highly-lethal venom may be milked from its venom glands on a single occasion. It has accounted for 0.8% to 10% of series of snake bites in São Paulo State, Brazil. We examined 29 cases of proven jararacuçu bites recruited over a 20-year period in two São Paulo hospitals. Severe signs of local and systemic envenoming, (local necrosis, shock, spontaneous systemic bleeding, renal failure) were seen only in patients bitten by snakes longer than 50 cm; bites by shorter specimens were more likely to cause incoagulable blood. Fourteen patients developed coagulopathy, six local necrosis (requiring amputation in one) and five local abscesses. Two became shocked and four developed renal failure. Three patients, aged 3, 11 and 65 years, died 18.75, 27.75 and 83 h after being bitten, with respiratory and circulatory failure despite large doses of specific antivenom and intensive-care-unit management. In two patients, autopsies revealed acute renal tubular necrosis, cerebral oedema, haemorrhagic rhabdomyolysis at the site of the bite and disseminated intravascular coagulation. In one survivor with chronic renal failure, renal biopsy showed bilateral cortical necrosis; the patient remains dependent on haemodialysis. Effects of polyspecific Bothrops antivenom were not impressive, and it has been suggested that anti-Bothrops and anti-Crotalus antivenoms should be given in combination.
Subject(s)
Bothrops , Snake Bites/therapy , Adult , Aged , Animals , Antivenins/administration & dosage , Blood Coagulation Disorders/etiology , Brazil , Child , Child, Preschool , Crotalid Venoms/analysis , Fatal Outcome , Female , Humans , Kidney Failure, Chronic/etiology , Male , Prospective Studies , Retrospective Studies , Rhabdomyolysis/etiology , Snake Bites/mortality , Snake Bites/pathologyABSTRACT
OBJECTIVE: To develop and study an experimental model for severe pancreatitis-associated lung injury. DESIGN: Prospective, randomized, controlled trial. SETTING: University pulmonary laboratory. SUBJECTS: Seventy-eight male Wistar rats. INTERVENTIONS: Pancreatitis was induced by taurocholate injection into the pancreatic duct. Data were compared with data from sham-operated animals. MEASUREMENTS AND MAIN RESULTS: Pulmonary mechanical measurements were performed in anesthetized and mechanically ventilated rats. Alveolar pressure was obtained by the alveolar capsule technique. Lungs were fixed at functional residual capacity by immersion in liquid nitrogen and were submitted to morphometric studies. Dynamic pulmonary elastance was found to be increased in the acute pancreatitis group (2.25 +/- 0.21 vs. 1.62 +/- 0.10 cm H2O/mL [p < .05]). Morphometric signs of distal airway contraction and vasoconstriction were observed. Increased intraalveolar edema rate (55.6 +/- 12.7% vs. 22.6 +/- 9.6% [p < .001]) was detected in the animals with acute pancreatitis. A high degree of pulmonary unevenness and polymorphonuclear infiltration were also detected in the lungs of the acute pancreatitis animals. CONCLUSIONS: In this severe pancreatitis-associated lung injury model, the mechanical and morphologic alterations were similar to those alterations observed in the adult respiratory distress syndrome. This model may prove to be a useful tool to investigate mechanisms and mediators of the respiratory failure induced by acute pancreatitis and other forms of adult respiratory distress syndrome.
Subject(s)
Lung Diseases/etiology , Pancreatitis/complications , Pulmonary Alveoli/pathology , Acute Disease , Animals , Disease Models, Animal , Humans , Lung Diseases/metabolism , Lung Diseases/pathology , Male , Pancreatitis/chemically induced , Prospective Studies , Rats , Rats, Wistar , Respiratory Distress Syndrome/etiology , Taurocholic AcidABSTRACT
The APACHE II system can stratify acutely ill patients on hand of simple physiological measurements. In a retrospective study, 121 patients were stratifyed in regard to the mortality rates in three groups: first one with the mortality rate of 10% second one with 47%, and the third one with 100%. Mortality rates predicted and observed were similar (40.5% and 39.7%, respectively, p greater than 0.8; 95% confidence interval 31.8% to 49.7%). The APACHE II system is useful for accurate stratification of patients and the evaluation of treatment efficacy.
