Study on the organ weight of sudden death cases

The progressive B-cell destruction at the onset of type 1 diabetes and the relevance of residual B-cell function to metabolic control prompted us to try to prevent further B-cell destruction in new-onset type 1 diabetic patients. Having already shown positive effects of sulfonylreas in long-standing IDDM patients, we decided to try the association of gliclazide with insulin in newly diagnosed IDDM patients. Therefore, 22 patients were randomly assigned to either gliclazide, 160 mg/24 h, or placebo (in association with standard insulin treatment) from the third week since the onset of the disease. Patients were studied every 6 months for 18 months. The insulin need was similar in the two groups at time 0, but thereafter it steadily decreased in the GCZ group becoming at 6, 12 and 18 months, respectively 65%, 42% and 39% of that of the PL group. The metabolic control was very similar in the two groups throughout the study. The residual B-cell function (fasting and post-breakfast C peptide), which was similar in the two groups at time 0, remained unchanged or improved in the GCZ group, whereas it decreased in the PL group. In conclusion, the combined insulin-gliclazide treatment appeared to improve B-cell function during the first 18 months of type 1 diabetes, inducing a major reduction of the insulin need with respect to patients treated with insulin alone.     

Prevention of sudden death and the countermeasures--emergency cardiopulmonary resuscitation]

The aim of this study was to analyse inspiratory crackles in patients with Pulmonary Fibrosis (PF) and Bronchiectasis (BE). One case of Chronic Obstructive Pulmonary Disease (COPD) has also been included. The relationships between the time of occurrence of crackles (T) in the breath cycle and the corresponding flow at the mouth (F) and volume (V) have been investigated. The linear correlations between the flow, volume and time have been investigated by Pearson's R-test and the same variables have been analysed by Principal Component Analysis (PCA) in order to verify the effective dimension of these data. The results show a strong correlation between the time of occurrence and the volume in all the examined cases. PCA shows that in all cases F and V account for more than 90% of variation. These results suggest that placing crackles on the flow-volume plane does not cause loss of information.     

A clinical and pathological study of 46 cases of sudden and unexpected death

A series of 46 autopsied adult cases of sudden and unexpected natural death were investigated. In this study, sudden and unexpected death was defined as any death occurring with 24 hours of onset of symptoms in a person with or without probable cause of death suggested by medical history. The cases included 31 males and 15 females aged 26 to 85 years (mean 66.6 years). Age distribution peaked in seventies. The lesions causing sudden and unexpected death according to the most frequent organ systems were, diseases of the heart (acute myocardial infarction with or without old infarct, 20; old myocardial infarction without acute infarction, 2; dilated cardiomyopathy, 2; sarcoidosis, 1; amyloidosis, 2; and valvular disease, 2), the aorta (ruptured aneurysm, 6; dissecting aneurysm, 2), the respiratory tract (pulmonary embolism, 7; pulmonary hypertension, 1), the alimentary tract (intestinal obstruction, 1), and other diseases (cause unknown, 1). The cardiovascular lesions were found in 78.2% of cases autopsied. The sudden and unexpected death caused by acute myocardial infarction was found in 47.8%, and acute myocardial infarction seemed to play a major role in cardiac sudden death in these series. The respiratory lesions were found in 17.4%. Four of seven cases with pulmonary embolism died in two weeks after surgical operation. The most common underlying disease was post-operative condition.     

Pathology of sudden death in the young

Demographic trends reveal the elderly to be the fastest growing segment of the population. Physicians can therefore anticipate encountering increasing numbers of older patients with alcohol-related problems. These problems include liver disease, dementia, confusion (masquerading as dementia), peripheral neuropathy, insomnia, late-onset seizure disorder, poor nutrition, incontinence, diarrhea, myopathy, inadequate self-care, macrocytosis, depression, fractures, and adverse reactions to medications. Despite the prevalence of alcohol use in older people, their risks and problems are often unrecognized. We reviewed published literature on the determinants and consequences of alcohol-related problems in persons aged 65 years and older and the usefulness of available screening measures. Thirteen of 25 eligible studies on determinants and consequences met quality criteria and were reviewed. Nine additional studies on screening tests were also evaluated. Determinants include history of alcohol use and abuse, social isolation, and reduced mobility; consequences consist of risks of hip fracture from falls, neoplasms, and psychiatric illness. Currently accessible screening tests focus on high levels of alcoholic beverage use and abuse and dependence. They are not useful in screening for hazardous consumption that may result from relatively low levels of alcohol use alone or in combination with medications, medical illness, or preexisting diminished physical, emotional, or social function. Research is needed on the consequences of lower levels of alcohol consumption on the physical and psychosocial health of older individuals and on methods for distinguishing alcohol-related from age-related problems. Existing screening tests should be expanded or new screening methods developed in anticipation of a growing public health problem.     

Non-pharmacologic prevention of sudden cardiac death

Non-pharmacologic therapy has revolutionized the management of arrhythmias and prevention of sudden cardiac death (SCD). Of particular importance is the introduction of radiofrequent catheter ablation (RFCA) and implantable cardioverter-defibrillator (ICD). RFCA is effective and useful in the treatment and prevention of SCD, especially in supraventricular tachyarrhythmias related to dual or accessory atrioventricular pathways. There are some limitations in using this method in the prevention of SCD in ventricular tachyarrhythmias. RFCA is very successful, particularly in the treatment of bundle branch reentrant ventricular tachycardia and ventricular tachycardia in patients without structural heart disease. RFCA can be used as a palliative treatment of incessant or frequent VT before and after ICD implantation. Antibradycardia pacing decreases SCD not only by the removal of serious bradyarrhythmias but also by prevention of the occurrence of malignant ventricular tachyarrhythmias induced by bradyarrhythmia. Antitachycardia pacing is used in the prevention of SCD only as a part of ICD device. Implantation of an antitachycardia pacemaker as an isolated permanent treatment of tachycardias is currently almost not used. This method was replaced by RFCA in supraventricular tachyarrhythmias and by ICD in ventricular tachyarrhythmias. ICD is a very perspective non-pharmacologic approach to SCD prevention, particularly as transvenous leads were introduced and device construction was simplified. ICD is indicated especially in patients with spontaneous sustained hemodynamically significant ventricular tachycardia/ventricular fibrillation and when antiarrhythmic drug treatment, RFCA or antitachycardia surgery are ineffective, intolerated, contraindicated or cannot be performed. ICD as the treatment of first choice instead of antiarrhythmic drugs as well as prophylactic ICD implantation in asymptomatic patients at high risk is a subject of discussion. ICD decreases the incidence of SCD significantly. However, the decrease in overall mortality was not verified. Antitachycardia surgery is less frequently used after RFCA, and ICD have been introduced. At present, this therapy is reserved only for the cases of failure of RFCA or the impossibility to use RFCA and ICD. Surgical therapy can be combined also with concommitant surgical correction of associated structural heart disease. Sympathectomy is used in prevention of malignant ventricular tachyarrhythmias and SCD in patients with congenital long Q-T syndrome. Selective left cardiac sympathetic denervation significantly reduces the risk of SCD in these patients but does not remove it completely. Heart transplantation is the last alternative of non-pharmacologic prevention of SCD. It is indicated in cases when all pharmacologic and non-pharmacologic approaches have been exhausted. Heart transplantation is the only effective modality for the improvement of long-term prognosis in patients with malignant ventricular tachyarrhythmias and advanced chronic heart failure.     

Predictors of sudden cardiac death in hypertrophic cardiomyopathy

Patients with hypertrophic cardiomyopathy (HC) die suddenly. Proposed risk factors for sudden cardiac death (SCD) in HC are youth, a family history of SCD, syncope, and ventricular tachycardia. Hemodynamic variables have not convincingly proved to be risk factors for SCD. Therefore, this study was designed to examine predictors of SCD in a large number of patients with HC during long-term follow-up periods. The relation of studied variables (clinical, electrocardiographic, echocardiographic, hemodynamic, and exercise test findings) to SCD in 309 patients with HC who were initially diagnosed during 1971 through 1994 (mean follow-up 9.4 years) was examined by multivariate analysis. SCD occurred in 28 patients. Independent predictors of SCD were a smaller difference between peak and rest systolic blood pressure during exercise testing (p=0.006), and higher left ventricular outflow tract pressure gradient at rest (p=0.003). Exercise-related SCD occurred in 8 patients and exercise-unrelated SCD in 20 patients (mean age 28 vs 47 years, p <0.05). Thus, patients of exercise-related SCD were younger and had smaller increases in systolic blood pressure during exercise testing, whereas patients with exercise-unrelated SCD were older and had higher left ventricular outflow tract pressure gradient.     

The significance of sIL-2R detection in various hepatic diseases]

A patient with an idiopathic bilateral vestibulopathy described two types of oscillopsia, one induced by head movement, the other induced by changing pressure in the right external auditory canal. This is the first report of both types of oscillopsia occurring in the same individual and illustrates their different mechanisms and symptomatology.     

Comparison of [125I]iodomelatonin binding sites in infant cerebellum of sudden infant death syndrome and non-sudden infant death syndrome

A tributyltin chloride (TBTCl)-resistant bacterium, Alteromonas sp. M-1, was isolated from coastal seawater. This bacterium grew in medium containing 125 microM TBTCl. TBTCl added to the medium was taken up by this bacterium, however, the amount of TBTCl in the cellular fraction was low after the logarithmic phase, suggesting the existence of a TBTCl-efflux system. A genetic library was constructed using plasmid vector pUC 19. Three positive clones were obtained, by which E. coli was transformed to TBTCl resistance. Of the three clones, the shortest fragment from HindIII-library was analyzed. This fragment was 1.8 kb long and contained one complete open reading frame. The predicted amino acid sequence of this open reading frame had a homologous domain to transglycosylases of bacteriophage and E. coli. TBTCl-tolerant marine bacteria other than Alteromonas sp. M-1 were obtained from natural seawater to which TBTCl was added. DNA-DNA hybridization was performed between the three cloned fragments from Alteromonas sp. M-1 and chromosomal DNA of the TBTCl-tolerant bacteria. Some strains hybridized with the fragments and some did not, suggesting that several genes are responsible for TBTCl tolerance.     

Angiography in non-traumatic brain haematoma. An analysis of 100 cases

PURPOSE: The primary purpose of this project was to study the anatomical characteristics of intracerebral haematoma (ICH) in order to determine features that may negate the need for angiography in some patients. MATERIAL AND METHODS: The study was prospective and designed to investigate the underlying cause of non-traumatic ICH in 100 cases assessed by conventional angiography. Patients were excluded if there was a history of trauma or known pre-existing brain abnormality. All patients were examined with CT and angiography within 4 days of the ictus. RESULTS: Ruptured aneurysms or arteriovenous malformations (AVMs) were diagnosed on the initial angiogram in 49% of cases: 27 AVMs and 22 aneurysms. One case of superior sagittal sinus thrombosis was also detected. Vascular abnormalities were found most frequently in the under-40 age group and in cases in which subarachnoid haemorrhage, intraventricular haemorrhage or extracerebral haematoma accompanied the ICH. The temporal lobe was the most frequent anatomical location (37%). When a temporal lobe haematoma extended into the Sylvian fissure from the inferior pole of the temporal lobe or when it was associated with subarachnoid haemorrhage, structural abnormalities were found in over 90% of cases. CONCLUSIONS: There are groups of patients with ICH in whom the CT features are highly suggestive of AVM or aneurysm rupture. If the initial angiography is negative in these cases, careful follow up by repeat angiography and/or MR imaging is essential. However, potentially treatable abnormalities cannot be excluded with certainty by the distribution of the haematoma on CT alone, even if there is a history of pre-existing hypertension.     

Phenomenon of sudden death: Part 2

We examined differences in approaches to HIV-related infection control practices in two university teaching hospitals in the United States and Nigeria. Health care workers (n = 202 in Nigeria and 186 in the USA) responded to a previously validated measure of infection control practices. There were significant differences in the estimated probability of treating a person with HIV disease (higher in USA), and a greater probability of peer ridicule as a way of enforcing group norms on infection control in Nigeria. Peer enforcement of norms was significantly lower in the USA. In both countries, more precautions would be taken if it was known that the patient was HIV infected. Infection control practices were more likely to be followed in the USA compared with Nigeria if they were praised for this activity, if appropriate facilities (sharps containers, gloves, etc.) were nearby, and if they felt that infection control procedures were effective. These data point to the importance of normative social pressures in Nigeria and of knowing the patient is HIV infected in the USA and feeling that infection control procedures are effective ways of avoiding occupational HIV infection. The role of normative pressures and assumptions about HIV infection status as well as cues and availability of facilities for infection control appear to differ between these health care workers in Nigeria and the USA.     

Brown fat retention in sudden infant death syndrome

This study was undertaken to confirm the findings of Naeye with regard to the pathological retention of the so-called brown fat cells in the periadrenal adipose tissue of infants who die of the sudden infant death syndrome. The percent of multilocular fat cells was determined in histological sections of periadrenal adipose tissue obtained from a series of 289 autopsies. In general, our morphological observations confirm his. However, our results indicate that the percent of periadrenal multilocular cells cannot be used as a diagnostic criterion in any single case. Futhermore, we consider that the mechanism for this delay in transformation remains unclear.