Anatomical brain asymmetries are subtle and still little studied in humans. Among all the animals, humans have the most asymmetric brains Crow (2004). The language faculty and handedness are localized on the left side. The objective this paper is to verify whether the temporal lobes are anatomically different. Our sample was composed of 40 post mortem adult brains of both sexes, which were investigated at the Human Anatomy Laboratory of the Nove de Julho University Center in Sao Paulo, Brazil. The brains were fixed in a solution of 5% paraformaldehyde. Three different measurements were taken using a pachimeter (Mitutoyo) and a goniometer (Card) on both hemispheres: Ml - the length of the lateral sulcus; M2 - the distance from the lateral sulcus to the inferior margin of the inferior temporal gyrus, and M3 - the angle formed between the lines of the collateral sulcus and the inferior margin of the inferior temporal gyrus. Results were submitted to a statistical analysis (ANOVA) and demonstrated that Ml was larger in the left hemisphere, by contrast with the data obtained for M2 and M3, which were larger in the right hemisphere. The measurements taken showed differences between the right and left temporal lobes

Las asimetrías anatómicas del cerebro humano son sutiles y aún poco estudiadas. Entre todos los animales, el Hombre es el que presenta el cerebro más asimétrico (Crow, 2004). En el lado izquierdo del cerebro se localiza la facultad del lenguaje, como también de la lateralidad manual. El objetivo del trabajo fue verificar si los lóbulos temporales son anatómicamente diferentes. La muestra estuvo compuesta de 40 encéfalos adultos, post mortem, de ambos sexos, del Laboratorio de Anatomía del Centro Universitario Nove de Julho, en Sao Paulo, SP, Brasil. Los encéfalos fueron fijados en solución de formalina al 5%. Fueron realizadas 3 medidas diferentes utilizando un pié de metro Mitutoyo y goniómetro (Carci), en ambos hemisferios: medida MI, largo del surco lateral; medida M2 distancia del surco lateral hasta el margen inferior del giro temporal inferior y la medida M3 el ángulo formado entre las líneas del surco colateral y margen inferior del giro temporal inferior. Los resultados se sometieron a análisis estadístico y mostraron que MI era mayor en el hemisferio izquierdo, en contraposición a los datos obtenidos en M2 y M3, que fueron mayores en el hemisferio derecho. Las medidas realizadas presentaron diferencias entre los lóbulos temporales derecho e izquierdo

São ainda mal estabelecidos os fatores prognósticos para a ocorrência de óbito nos envenenamentos por serpentes e as causas que o determinam. OBJETIVO: Determinar, no envenenamento ofídico, os fatores prognósticos e as causas mais prováveis do óbito. MÉTODOS: No período de 1988 a 1993 foram notificados 12.639 casos de acidentes por serpentes peçonhentas no Estado de São Paulo, com 43 óbitos (0,34%). Foram comparadas as variáveis obtidas das fichas de notificação dos acidentes com aquelas dos prontuários e/ou dos relatórios médicos dos casos de óbito. RESULTADOS: O diagnóstico quanto ao gênero da serpente foi realizado em 11.297 acidentes, sendo 9.828 (87%) por Bothrops, 1.359 (12%) por Crotalus e 110 (1%) por Micrurus, e em 41 casos de óbito, sendo 28 (68,3%) por Bothrops e 13 (31,7%) por Crotalus (p<0,05). Informação quanto a sexo e idade dos pacientes foi fornecida em, respectivamente, 12.620 e 12.527 acidentes. Pertenciam ao sexo masculino 9.783 (77,5%) pacientes picados e 35 (81,4%) que faleceram (p>0,05). Tinham 50 anos ou mais 15,9% dos pacientes picados e 41,8% daqueles que faleceram (p<0,05). As regiões anatômicas mais freqüentemente picadas foram: pé (42,2%), mão (20,6%), perna (17,6%) e tornozelo (13,1%), nos acidentes, e pé (35,7%) e perna (35,7%), nos casos de óbito (p<0,05). A alteração da coagulação ocorreu em 34 (91,9%) de 37 pacientes que evoluíram para o óbito. As manifestações e complicações mais referidas como possíveis causas de óbito foram: insuficiência renal (34-79,1%), insuficiência respiratória (28- 65,1%), choque (18-41,9%) e septicemia (18- 41,9%). Dentre os pacientes que evoluíram para óbito, excluindo-se um caso sem informação, 29,4% faleceram dentro dos primeiros dois dias após a picada. A insuficiência respiratória foi mais comum entre os que faleceram devido ao envenenamento crotálico e a septicemia só foi referida para o envenenamento botrópico. CONCLUSÃO: A maioria dos acidentes e dos óbitos é causada por Bothrops; são mais freqüentemente letais os envenenamentos por Crotalus, as picadas na perna e em pessoas com mais de 50 anos; a complicação mais comum nos casos fatais é a insuficiência renal.

The prognostic factors and the causes for obit occurrence in ophidian envenoming are yet not completely clear. PURPOSE: To determine the prognostic factors and the most probable causes for obit occurrence in ophidian envenoming. METHODS: In the State of São Paulo were notified 12,639 cases of accidents by venomous snakes from 1988 to 1993. There were 43 deaths (0.34%). The variables from the accident notification reports were compared with the promptuary notes and/or with the death records (in lethal cases). RESULTS: The snake genus was classified in 11,297 accidents and in 41 from the lethal ones. Bothrops was responsible for 9,828 (87%) accidents and 28 (68.3%) deaths, Crotalus for 1,359 (12.0%) accidents and 13 deaths (31.7%) and Micrurus for 110 (1%) accidents and no death (p<0.05). The information regarding to sex and age of the patients was available, respectively, in 12,620 and 12,527 accidents and in all lethal ones. There were 9,783 (77.5%) male patients in the accidents and 35 (81.4%) in the lethal cases (p> 0.05). Regarding to age, 15.9% of the patients and 41.8% of the ones who died were 50 years-old or more (p<0.05). The most frequently bitten anatomic regions were: foot (42.2%), hand (20.6%), leg (17.6%), and ankle (13.1%) in the accidents, and foot (35.7%) and leg (35.7%) in the lethal cases (p<0.05). Coagulation disorders occurred in 34 (91.9%) from 37 patients who died (those where this datum was available). The information above was not available in non lethal cases. The most common manifestations and complications implicated as possible death causes were: acute renal failure (34- 79.1%), acute respiratory failure (28- 65.1%), shock (18- 41.9%), and sepsis (18- 41.9%). Among all lethal cases but one without information, 29.4% of the patients died within the first two days after bite and 67.6% within the first 5 days. Acute respiratory failure was most common among the patients who died owing to crotalic envenoming, and sepsis was only seen in bothropic envenoming. CONCLUSION: Most of the accidents and obits are caused by Bothrops; Crotalus envenoming, leg bites, and accidents in 50 year-old patients (or more) are frequently lethal; the most common complication in lethal cases is acute renal failure.

Envenomation caused by snakes of the Bothrops genus produces a lesion in the bite site and can result in extensive necrosis. The dead tissue can be secondarily infected by bacteria that come from the snake, and the bacteria can be inoculated at the moment of the bite. The bacteria that most commonly cause infection are the enterobacteria, mainly Morganella morganii, Proteus rettgeri, Enterobacter sp., and Escherichia coli. Group D streptococci including here Enterococcus sp. and the Bacteroides sp. are also involved. Based on a study of the sensibility of these bacteria, it has been suggested that this infection must be treated with chloramphenicol, as a sole antimicrobial agent, or with the combinations of benzylpenicillin or ampicillin with aminoglycoside or trimethoprim/sulfamethoxazole. Although Governmental Health Services do not recommend the prophylactic use of antimicrobial drugs, it is not yet clear that such a procedure would not be useful in cases with a high probability of infection.

Two scorpion species of medical importance occur in the state of São Paulo: the native brown scorpion Tityus bahiensis (Perty) and the highly toxic yellow scorpion Tityus serrulatus Lutz and Mello, which was brought into the state. The study of accident data of patients admitted to the Vital Brazil Hospital of the Butantan Institute from l982 to l993 revealed a gradual increase in stings by T. serrulatus in contrast to those by T. bahiensis with a variation from 5.2% to 29.7%. Also, an inventory of the scorpions sent to the Laboratory of Venomous Arthropods of the Butantan Institute over the same period showed an expressive growth in the number of T. serrulatus specimens in contrast to that of T. bahiensis. These data suggest a significative proliferation of T. serrulatus in the state of São Paulo over the past 12 years, and a probable interspecific competition between T. serrulatus and the endemic T. bahiensis. The analysis of scorpion accidents reported to the state of São Paulo Health Department (Secretaria de Estado da Saúde de São Paulo) corroborated the higher severity of T. serrulatus envenoming. The results pointed to the possibility of an increase in severe envenoming and deaths by scorpion stings in the state of São Paulo. Aiming to contribute to scorpion prevention and control programs, the present geographical distribution of both dangerous species was mapped, pointing to the areas of higher risk of scorpionism in the state.