Hypereosinophilic syndrome with cardiac infiltration and congestive heart failure in a cat.

Hypereosinophilic syndrome is an uncommon disorder in the cat. It is a heterogeneous group of conditions defined by a persistent hypereosinophilia associated with organ damage directly attributable to tissue hypereosinophilia. A seven-year-old castrated domestic shorthair cat presented to the emergency service for dyspnea. Initial physical examination identified the presence of a grade III/VI systolic left parasternal murmur with no gallop or arrhythmia. A snap N-terminal-pro hormone brain natriuretic peptide was abnormal, and a point-of-care ultrasound revealed mild pleural effusion, scant pericardial effusion, and an enlarged left atrium. There was leukemia (72.35 K/uL, reference range 4.5-15.7 K/uL) predominated by eosinophilia (33.84 K/uL; reference range 0-1.9 K/uL). On echocardiogram, there was concentric hypertrophy of the left ventricular walls with irregular endocardial borders. The left atrium was enlarged with evidence of spontaneous echogenic contrast. The mitral valve was thickened with a vegetative lesion on the anterior leaflet. Despite treatment, the patient experienced cardiopulmonary arrest, and cardiopulmonary resuscitation was unsuccessful. Complete necropsy with histopathology revealed eosinophilic infiltrates in multiple organs and the presence of a severe, acute-on-chronic, fibrinous, and eosinophilic-granulomatous endomyocarditis with mural thrombosis and marked endocardial fibrosis. This case represents an unusual presentation of the hypereosinophilic syndrome in the cat with cardiac involvement and congestive heart failure as a primary clinical sign.

Microcystin and pyriproxyfen are toxic to early stages of development in Rhamdia quelen: An experimental and modelling study.

The recent increase of freshwater eutrophication has favored cyanobacteria blooms and consequently the increase of toxins such as microcystin-LR in aquatic environments, but few is know about the associated effect of toxin and other compounds. Pyriproxyfen is an insecticide indicated by WHO (World Health Organization) to control Aedes aegypti mosquito (vector of Dengue, Chikungunya and Zika diseases), however, the effects are not well described to non-target species, such as fish. The early life stages (ELS) of fish are more sensitive to chemical stress due to higher metabolic rate, immature immune system and high superficial area/volume ratio. In the current study, ELS of R. quelen a Neotropical fish were exposed to environmentally realistic concentrations of microcystin (1, 10 and 100 µg L-1; M1, M2 and M3 groups, respectively) from an algal extract, pyriproxyfen (1 and 10 µg L-1, P1 and P2) and their association (co-exposure). The hatching, survival and larvae deformities were analyzed, and applied a mathematical model to evaluate the effects on the population size along further generations. Both compounds were toxic to embryos/larvae of fish, but the effects were more pronounced in M2, P1M2 and P2M1 for hatching and M2, P1M2, P2M1 and P1 for survival. Deformities prevailed in groups exposed to the chemicals at 48 hpf (hours post-fertilization) were suggestions of toxicological interaction in P1M2, P2M1 and P2M2 at 48 and 72 hpf. In 96 hpf, the levels of deformities were lower than in previous times. Model predicted population density over 100 years decreased to lower than 0.5 (50%) in all groups, except for P1M1, indicating risk of extinction. P1M2 had the worse results, followed by M2, P1M3 and P2M1. Cyanobacterial blooms can lead to microcystin-LR levels higher than M2 (10 µg L-1), and the suggestion of toxicological interaction with pyriproxyfen is relevant because both compounds may potentially coexist in aquatic environments. Finally, mathematical models may provide an ecological interpretation of the risk of exposure of fish.

Fatal leptospirosis in free-ranging Eurasian beavers (Castor fiber L.), Switzerland.

Leptospirosis was first diagnosed in free-ranging Eurasian beavers (Castor fiber L.) in Switzerland in 2010. Pathologic, serologic, molecular and epidemiologic analyses were carried out on 13 animals submitted for necropsy from 2010 through 2014. Typical lesions included alveolar haemorrhages in the lungs, tubular degeneration and interstitial nephritis in the kidneys. Microscopic agglutination test results were positive for serogroups Icterohaemorrhagiae, Australis, Autumnalis and Sejroe. Molecular analysis identified four distinct profiles belonging to serovar Icterohaemorrhagiae or Copenhageni. The severity and features of the lesions were consistent with a fatal disease associated with leptospires similarly to what has been reported in other animals and humans. The spatiotemporal occurrence of leptospirosis in beavers suggested an upstream spread of the bacteria and coincided with an increased incidence of leptospirosis in dogs and a case cluster in humans. However, an epidemiologic link among beaver cases and among species was not supported neither by the serologic nor molecular data.

Refluxo gastroesofágico em cadelas submetidas à ovário-histerectomia convencional ou videoassistida / Gastroesophageal reflux in dogs undergoing convencional or video-assisted ovariohysterectomy

A doença do refluxo gastroesofágico decorre do fluxo de conteúdo gastroduodenal para o esôfago e/ou órgãos adjacentes, o que leva à ampla gama de sinais e implicações clínicas. A incidência de refluxo gastroesofágico transoperatório em caninos é desconhecida. O objetivo deste trabalho foi, por meio da endoscopia flexível, avaliar a presença e quantificar o refluxo gastroesofágico em cadelas submetidas à ovário-histerectomia por duas abordagens cirúrgicas (convencional e videoassistida com dois portais), pré-medicadas com morfina. Cem por cento das cadelas submetidas à ovário-histerectomia videoassistida e 30% das cadelas submetidas à ovário-histerectomia convencional apresentaram algum grau de refluxo. A intensidade dos refluxos foi maior nas cadelas submetidas ao procedimento minimamente invasivo, visto que elas (10 entre 10 animais) apresentaram, no mínimo, um refluxo classificado em R4, enquanto as outras (três entre 10) apresentaram, no máximo, refluxos em grau R3, de acordo com a escala planejada para esta pesquisa. Concluiu-se que os procedimentos laparoscópicos sob o protocolo anestésico utilizado promovem mais refluxo gastroesofágico que os convencionais.(AU)

Gastroesophageal reflux disease occurs when gastric or duodenal contents flow back into the esophagus by retroperistalsis, which leads to several signs and clinical implications. The incidence of intraoperative gastroesophageal reflux in canines is unknown. The aim of this study was, using flexible endoscopy, to assess the presence and quantify gastroesophageal reflux in bitches undergoing ovariohysterectomy by two surgical approaches (conventional and video-assisted by two portals-access), pre-medicated with morphine. 100% of dogs submitted to video-assisted and 30% of dogs submitted to conventional ovariohysterectomy presented some reflux degree. Reflux intensity was higher in dogs submitted to the minimally invasive procedure, since they (10 out of 10 animals) had at least one reflux classified in R4 while the others (three out of 10) had a maximum reflux in degree R3 according to the planned scale for this research. The laparoscopic procedures under the used anesthetic protocol promote more gastroesophageal reflux than the conventional ones.(AU)

Refluxo gastroesofágico em cadelas durante ovário-histerectomia convencional submetidas a diferentes medicações pré-anestésicas / Gastroesophageal reflux in dogs undergoing conventional ovariohysterectomy using different premedications

A doença do refluxo gastroesofágico decorre do fluxo de conteúdo gastroduodenal para o esôfago e/ou para os órgãos adjacentes, o que leva à ampla gama de sinais e implicações clínicas. É desconhecida a incidência de refluxo gastroesofágico transoperatório em caninos. O objetivo deste trabalho foi, por meio da endoscopia flexível, avaliar a presença do refluxo gastroesofágico em cadelas submetidas a ovário-histerectomia com base nos fármacos analgésicos utilizados na medicação pré-anestésica (morfina, tramadol ou metadona). Concluiu-se que não houve diferença na incidência de refluxo gastroesofágico transoperatório, não tendo os fármacos testados influenciado de forma diferente esse comportamento; porém, alguns animais do grupo morfina apresentaram êmese pré-operatória. A gravidade dos refluxos foi maior nas cadelas submetidas ao uso da metadona, de acordo com o método de avaliação utilizado para esta pesquisa.(AU)

Gastroesophageal reflux disease arises from the gastroduodenal content flow to the esophagus and/or associated organs, which leads to the wide range of signs and clinical implications. Incidence of intraoperative gastroesophageal reflux disease in dogs is unknown. The objective was, through flexible endoscopy, to assess the presence of gastroesophageal reflux in dogs undergoing ovariohysterectomy based on analgesic drugs used in premedication (morphine, tramadol or methadone). It was concluded that there was no difference in the incidence of intraoperative gastroesophageal reflux, these drugs don't influence this behavior; however, in the morphine group some animals showed preoperative vomiting. The severity of the reflux was higher, but not significantly, in bitches undergoing the methadone according to the evaluator method used for this research.(AU)

Pain and distress outcomes in infants and children: a systematic review.

The aim of the present study was to systematically review the recent literature about pain and distress outcomes in children and critically analyze the methodological quality of the reports. The systematic review was based on the PRISMA statement and performed by selecting articles that are indexed in scientific databases. The methodological quality of reports was examined using STROBE statement, for observational studies, and CONSORT statement, for randomized controlled trials. The PedIMMPACT consensus was used to evaluate the psychometric quality of pain instruments. We analyzed 23 empirical studies, including 14 randomized controlled trials, seven cross-sectional studies, and two studies with cohort designs. Fourteen studies included preschool- and schoolchildren, and nine studies included infants. Regarding studies with infants, pain responses were evaluated by heart rate, crying and behavioral observation scales, and distress was evaluated only by salivary cortisol. Four-handed care and sensorial saturation interventions were used to evaluate efficacy to reduce pain and distress responses. Concerning studies with children, both pain and distress responses were evaluated by self- and hetero-reports, behavioral observation and/or physiological measures. Distraction was effective for reducing pain and distress during burn dressing changes and needle procedures, and healing touch intervention reduced distress and pain in chronic patients. All of the studies scored at least 60% in the methodological quality assessment. The pain outcomes included measures of validity that were classified as well-established by the PedIMMPACT. This systematic review gathers scientific evidence of distress-associated pain in children. Pain and distress were measured as distinct constructs, and their associations were poorly analyzed.

Audiovisual distraction for pain relief in paediatric inpatients: A crossover study.

BACKGROUND: Pain is a stressful experience that can have a negative impact on child development. The aim of this crossover study was to examine the efficacy of audiovisual distraction for acute pain relief in paediatric inpatients. METHOD: The sample comprised 40 inpatients (6-11 years) who underwent painful puncture procedures. The participants were randomized into two groups, and all children received the intervention and served as their own controls. Stress and pain-catastrophizing assessments were initially performed using the Child Stress Scale and Pain Catastrophizing Scale for Children, with the aim of controlling these variables. The pain assessment was performed using a Visual Analog Scale and the Faces Pain Scale-Revised after the painful procedures. Group 1 received audiovisual distraction before and during the puncture procedure, which was performed again without intervention on another day. The procedure was reversed in Group 2. Audiovisual distraction used animated short films. A 2 × 2 × 2 analysis of variance for 2 × 2 crossover study was performed, with a 5% level of statistical significance. RESULTS: The two groups had similar baseline measures of stress and pain catastrophizing. A significant difference was found between periods with and without distraction in both groups, in which scores on both pain scales were lower during distraction compared with no intervention. The sequence of exposure to the distraction intervention in both groups and first versus second painful procedure during which the distraction was performed also significantly influenced the efficacy of the distraction intervention. CONCLUSION: Audiovisual distraction effectively reduced the intensity of pain perception in paediatric inpatients. SIGNIFICANCE: The crossover study design provides a better understanding of the power effects of distraction for acute pain management. Audiovisual distraction was a powerful and effective non-pharmacological intervention for pain relief in paediatric inpatients. The effects were detected in subsequent acute painful procedures.

Pain and distress outcomes in infants and children: a systematic review

The aim of the present study was to systematically review the recent literature about pain and distress outcomes in children and critically analyze the methodological quality of the reports. The systematic review was based on the PRISMA statement and performed by selecting articles that are indexed in scientific databases. The methodological quality of reports was examined using STROBE statement, for observational studies, and CONSORT statement, for randomized controlled trials. The PedIMMPACT consensus was used to evaluate the psychometric quality of pain instruments. We analyzed 23 empirical studies, including 14 randomized controlled trials, seven cross-sectional studies, and two studies with cohort designs. Fourteen studies included preschool- and schoolchildren, and nine studies included infants. Regarding studies with infants, pain responses were evaluated by heart rate, crying and behavioral observation scales, and distress was evaluated only by salivary cortisol. Four-handed care and sensorial saturation interventions were used to evaluate efficacy to reduce pain and distress responses. Concerning studies with children, both pain and distress responses were evaluated by self- and hetero-reports, behavioral observation and/or physiological measures. Distraction was effective for reducing pain and distress during burn dressing changes and needle procedures, and healing touch intervention reduced distress and pain in chronic patients. All of the studies scored at least 60% in the methodological quality assessment. The pain outcomes included measures of validity that were classified as well-established by the PedIMMPACT. This systematic review gathers scientific evidence of distress-associated pain in children. Pain and distress were measured as distinct constructs, and their associations were poorly analyzed.

A single high dose of dexamethasone affects the phosphorylation state of glutamate AMPA receptors in the human limbic system.

Glucocorticoids (GC) released during stress response exert feedforward effects in the whole brain, but particularly in the limbic circuits that modulates cognition, emotion and behavior. GC are the most commonly prescribed anti-inflammatory and immunosuppressant medication worldwide and pharmacological GC treatment has been paralleled by the high incidence of acute and chronic neuropsychiatric side effects, which reinforces the brain sensitivity for GC. Synapses can be bi-directionally modifiable via potentiation (long-term potentiation, LTP) or depotentiation (long-term depression, LTD) of synaptic transmission efficacy, and the phosphorylation state of Ser831 and Ser845 sites, in the GluA1 subunit of the glutamate AMPA receptors, are a critical event for these synaptic neuroplasticity events. Through a quasi-randomized controlled study, we show that a single high dexamethasone dose significantly reduces in a dose-dependent manner the levels of GluA1-Ser831 phosphorylation in the amygdala resected during surgery for temporal lobe epilepsy. This is the first report demonstrating GC effects on key markers of synaptic neuroplasticity in the human limbic system. The results contribute to understanding how GC affects the human brain under physiologic and pharmacologic conditions.

Experimental study of inflammatory response and collagen morphometry with different types of meshes.

PURPOSE: To compare an inflammation score and collagen morphometry after incisional hernia repair with four different meshes at two time points. METHODS: Four types of mesh were used to repair an abdominal wall incisional defect in Wistar rats: high-density polypropylene (HW/PP); low-density polypropylene (LW/PP); polypropylene mesh encapsulated with polydioxanone coated with oxidized cellulose (PP/CE); and expanded polytetrafluoroethylene (ePTFE). An inflammation score based on histological analysis and collagen morphometry was performed after 7 and 28 days after operation (POD). RESULTS: Compared to LW/PP group at 7 POD, HW/PP group had lower (p = 0.014) and PP/CE group had higher inflammation scores (p = 0.001). At 28 POD, higher scores were seen in all the other groups compared to the LW/PP group (HW/PP, p = 0.046; PP/CE, p < 0.001; ePTFE, p = 0.027). Comparing groups individually at 7 and 28 PODs, all demonstrated lower inflammation score values at 28 POD (HW/PP, p < 0.001; LW/PP, p < 0.001; PP/CE, p = 0.002; ePTFE, p = 0.001). At 7 POD, higher amounts of collagen were detected in ePTFE compared to HW/PP (p < 0.001) and LW/PP (p = 0.004) and in PPCE group compared to HW/PP (p = 0.022). At 28 POD, no statistically significant difference was found. Comparing groups individually at 7 and 28 PODs, HW/PP and LW/PP showed larger amounts of collagen at the 28th POD, without any statistically significant differences for the PP/CE and ePTFE groups. CONCLUSIONS: Inflammation scores decreased in all groups at 28 POD. Collagen deposition was higher for non-composite meshes at 28 POD.

Reparo de lesão penetrante em parede torácica de cão, ocasionada por javali (Sus scrofa scrofa), com flape unipediculado de músculo reto abdominal / Unipediculated flap of muscle rectos abdominales to repair a penetrating injury caused by javali (Sus scrofa scrofa) on the thoracic wall of a dog

Lesões penetrantes no tórax causadas por interação animal são frequentes em cães e caracterizam-se por dano extenso e desvitalização dos tecidos moles adjacentes. Quando a musculatura local é insuficiente para a reconstrução, retalhos musculares podem ser mobilizados para reparar o defeito torácico. O presente relato tem como objetivo demonstrar uma alternativa para o reparo de defeito da parede torácica em um cão, ocasionada por interação com javali (Sus scrofa scrofa), utilizando flape unipediculado de músculo reto abdominal. Com base na literatura consultada, essa técnica reconstrutiva ainda não foi descrita. O flape de músculo reto abdominal mostrou-se uma alternativa viável no reparo de lesão extensa e infectada na parede torácica em cães.(AU)

Penetrating thoracic wounds caused by animal bites are common in dogs and are characterized by extensive trauma and adjacent soft tissue devitalization. When the local musculature is insufficient for the reconstruction, muscle flaps can be taken to repair the thoracic defect. The aim of the present report is to demonstrate an alternative to the thoracic wall defect repair in a dog which was attacked by javali (Sus scrofa scrofa), using unipediculated flap of the rectus abdominis muscle. Based on the literature, this reconstructive technique has not yet been described. The rectus abdominis muscle flap proves to be a useful alternative for the repair of extensive and infected thoracic wall lesion in dogs.(AU)

Cistopexia videoassistida em cadela com cistocele após prolapso uterino: relato de caso / Videoassisted cystopexy on a female dog with cystocele after uterine prolapse: a case report

O prolapso de vesícula urinária associado ao prolapso uterino é condição rara em cães e gatos. O tratamento preconizado para essa afecção é o reposicionamento anatômico das estruturas afetadas. No presente relato é descrito o manejo por meio de ovariossalpingo-histerectomia por celiotomia e, após dois dias, cistopexia videoassistida. Essa condição, conforme o conhecimento dos autores, não havia sido previamente descrita. A operação apresentou-se como possibilidade viável de tratamento, sem complicações pós-operatórias.(AU)

The urinary bladder prolapse associated with the uterus is a rare condition on dogs and cats. The recommended treatment is the anatomical repositioning of the affected structures by manual reduction or surgery procedure. The present report describes the management by video-assisted cystopexy two days after conventional ovariohysterectomy. This condition, according to the authors' knowledge, had not been previously described. The operation didn't showed postoperative complications, and presented itself as a viable treatment option.(AU)

Perfil das gestantes usuárias de álcool/drogas e o efeito na saúde e desenvolvimento dos filhos / Profile of pregnant using alcoho/drugs and their effects on children's health and development

O objetivo do estudo foi revisar artigos sobre prevalência do uso de álcool e/ou drogas ilícitas em gestantes, perfis das usuárias e efeitos do seu uso na saúde e desenvolvimento dos filhos. Os estudos foram selecionados na base de dados Scielo a partir de palavras-chave específicas e critérios de inclusão e exclusão. Foram encontrados 14 artigos. Os achados mostraram prevalências variando de 2,1 a 67,1% para álcool e 0,6 a 53,8% de drogas ilícitas nas gestantes. As prevalências dependeram de fatores sociodemográficos e clínicos. O uso abusivo de álcool e drogas ilícitas na gestação apresentaram efeitos negativos na saúde e desenvolvimento dos filhos. A revisão realizada mostra a relevância da implementação de políticas públicas de saúde para prevenção do uso de drogas em gestantes, especialmente as adolescentes (AU)

First detection of sarcoptic mange in free-ranging wild boar (Sus scrofa) in Switzerland.

In Switzerland sarcoptic mange is frequent in free-ranging wild carnivores but until recent years no cases had been recorded in wild ungulates. Since 2010, cases have been observed in wild boar in the cantons of Solothurn, Tessin and Thurgau. Here, we report the detection of mange-like skin lesions in wild boars by photo-trapping and the post-mortem findings in 6 culled animals presenting different stages of the disease. Potential sources of infection include mangy red foxes, outdoor domestic pigs and wild boars from surrounding countries. Disease spread in the wild boar population may become relevant not only for wildlife but also for domestic pig health in the future if piggeries' biosecurity is insufficient to prevent interactions with wild boar.

Clinical evaluation of hepatic transection on pediatric liver transplantation.

OBJECTIVES: Liver transplantation is an effective technique in the treatment of end-stage liver disease. The aim of this study was to evaluate the impact of hepatic transection, an advanced surgical technique able to tailor size to generate two grafts to from a single donor. MATERIALS AND METHODS: A retrospective study between January 2000 and September 2013, reviewing 91 pediatric patients who underwent 96 liver transplants from deceased donors. Patients were distributed into two groups: whole organ (WO, n = 39) and transected liver grafts (TLG, n = 57). The following were evaluated: etiology, anthrophometric parameters (age, weight, height, z score weight/age, and height/age), model for end-stage liver disease (MELD) or pediatric end-stage liver disease (PELD), previous surgeries, transfusion of blood components, 1-year survival rate, preoperative laboratory testing, from the second and seventh postoperative days, lactate during surgery, postoperative complications, duration of surgery, duration of cold and warm ischemia, types of biliary reconstruction, and laboratory testing of the donor. RESULTS: The anthropometric values showed significant differences (P < .05) between the groups. The average age was 124.7 months in the WO group and 33.6 months in the TLG group (P < .0001), while the weight was 28.0 kg and 7.4 kg, respectively (P < .0001). The analysis of z score weight/age showed that the TLG had greater acute and chronic malnutrition, probably due to the etiology of liver disease, present from birth in patients as young. Red blood transfusion was higher in the TLG group (P < .0006) due to the cut surface of the graft, emphasizing the use and improvement of hemostatic techniques. CONCLUSION: Despite differences between the groups, clinical and surgical complications were similar, showing that liver transection injury didn't change the results of transplantation. There was no impact on liver function, graft, or 1-year patient survival after liver transection. Second postoperative lactate is a predictive factor of death. Transection liver transplantation is an effective method as an alternative to pediatric liver transplantation.

Risk factors of pancreatic graft loss and death of receptor after simultaneous pancreas/kidney transplantation.

Simultaneous pancreas/kidney transplants require a long graft survival and the recipient to present with more benefits than risks. We evaluated the risk factors of receptor's death and pancreatic graft loss on 2 occasions (3 and 12 months' postoperatively) in 292 transplants in whom 22 variables were evaluated. Variables were selected, 9 receivers, 8 donors, and 5 variables related to the surgical procedure. All independent variables were compared with the dependent variables of pancreatic graft losses and patient deaths. Those considered significant according to univariate analysis were analyzed by using multiple logistic regression techniques in an attempt to develop a mathematical model capable of predicting both pancreatic graft and patient losses. Lastly, based on the resulting models with all significant variables, scores were created to determine the risk of patient death and pancreatic graft loss. In the adjusted multivariate analysis, the significant variables were donor age, receiver's body mass index, initial pancreas implant, iliac venous drainage, and use of induction therapy related to pancreatic loss within 3 months after transplantation. Independent risk factors regarding the loss of patients within 12 months were body mass index and receptor induction therapy. The variables related to pancreatic graft loss within 3 months were donor age, receiver body mass index, initial use of pancreatic graft, iliac venous drainage, and induction therapy; these variables can be used for creating a risk score. The donor body mass index and the induction therapy were independently related to patient loss within 12 months after the transplant.

Component analysis of hospital cost of pancreas-kidney transplant and correlations with different variables in a Brazilian hospital.

INTRODUCTION: Simultaneous pancreas-kidney transplantation is associated with a high rate of complications when it is compared with transplantation of other organs; these increased complications can result in increased financial costs of the procedure. The objective of this study was to determine operating costs and financial results of simultaneous pancreas-kidney transplantation and its different variables in a Brazilian hospital. PATIENTS AND METHODS: Between January 2008 and December 2011, the monthly costs of 105 patients were calculated. These patients were divided into 2 groups; the first consecutive 53 patients were labeled group I and the second set of 52 patients were labeled group II. The cost evaluation was made in US dollars. RESULTS: A total of 89 patients corresponded to the public health system and 16 patients to the supplementary health system. The percentage of hospital discharge was 92.4%. There was an increase in operating room costs in group II compared with group I with no statistically significant difference ($18,749.33 for group I and $17,608.26 for group II). The outcome of the operation was positive; it was greater for group II than for group I ($16,303.22 vs $3494.53). CONCLUSIONS: Simultaneous pancreas-kidney transplantation is a financially feasible procedure in Brazil, with the public health system being the main payment source.

Endovascular management of massive hemobilia as a late complication of percutaneous biliary drainage in a pediatric liver transplant recipient: a case report.

Development of biliary strictures after liver transplantation is not uncommon, and minimally invasive procedures are the first-line treatment of choice in most centers. Hemobilia is an infrequent, usually self-limited complication related to the initial biliary access procedure. Massive hemobilia with severe hemodynamic instability is a rare event, particularly as a delayed complication. The difficulty of obtaining surgical access makes management of this condition highly challenging. Endovascular embolization may represent an important treatment option in this setting.

Examining the side effects of sucrose for pain relief in preterm infants: a case-control study

Sucrose solution is recommended as relevant pain relief management in neonates during acute painful procedures; however, only a few studies have analyzed the potentially adverse effects of sucrose administration to preterm neonates. The goal of this study was to examine the potential side effects of sucrose for pain relief in preterm infants, assessing feeding and weight gain during hospitalization and their feeding patterns postdischarge. The study sample consisted of 43 preterm neonates divided into two groups: a sucrose group (SG, n=18) and a control group (CG, n=25) in which no sucrose was administered. The SG received 0.5 mL/kg 25% oral sucrose for 2 min prior to all acute painful procedures during three consecutive days. A prospective review of medical charts was performed for all samples. The study was done prior to implementation of the institutional sucrose guidelines as a routine service, and followed all ethical requirements. There were no statistically significant differences between groups in terms of weight gain, length of stay with orogastric tubes, and parenteral feeding. Postdischarge, infant nutritional intake included feeding human milk to 67% of the SG and 74% of the CG. There were no statistically significant differences between groups regarding human milk feeding patterns postdischarge. Neonate feeding patterns and weight gain were unaffected following the short-term use of sucrose for pain relief.