Kiss of the spider

We discussed many interesting topics today. Here's some info on two of them.

Brown recluse spider bites: These spiders belong to the Loxosceles genus and are commonly found in the south, west and midwest US so we don't see cases in Toronto that often. The brown recluse spiders have a brownish colour with a violin like mark on their head, though victims often fail no notice the spider. Bites typically occur on the upper arm, thorax, or inner thigh and happen most commonly indoors. Bites are rare on hands and feet.

The initial brown recluse bite is painless and is followed by a red plaque that can necrose in the next 24-48h and form an eschar over the ensuing days. Systemic symptoms are rare. Treatment consists of general wound care and tetanus prophylaxis. Sometimes Dapsone is used for prevention of wound progression, but there is no evidence from human studies. Here's a good review article from NEJM on Loxosceles and other spider bites.


Treatment of AAA: We touched briefly on the relative advantages of endovascular vs. open repairs for AAA. Remember that aneurysm size is a key factor on deciding how to manage AAA:

- For aneurysms 3 - 4 cm we do survelillance with U/S every 2-3 years
- For aneurysms 4 - 5.4 cm surveillance is more frequent, every 6 mo- 1 year
- At or above 5.5 cm the risk of rupture becomes greater and consideration for repair is recommended, if the aneurysm is > 2x the diameter of the normal aorta repair is also recommended
- Any symptomatic aneurysm should be considered for repair !!!

While short term mortality for endovascular repair is lower, the 2 year outcomes show similar mortality with more complications as compared to surgery. This recent trial and its accompanying editorial give a good overview of the current thinking on the topic.

Cheers