A computer-based method for cause of death classification in stillbirths and neonatal deaths

BACKGROUND: In large-scale epidemiological studies of stillbirths and neonatal deaths a method is needed to replace detailed medical record audits in order to determine the cause of death. METHODS: A computer-based method is presented for determination of the cause of death in stillbirths and in neonatal deaths. It utilizes information in the Swedish medical registries. The study comprises 6044 dead infants born in Sweden from 1983-1990. For each infant the program determines 31 basic characteristics which are important in deciding the cause of death. Based on these characteristics a modified Wigglesworth's classification is used to find the cause of death. The validity of the method was checked by comparing the computer generated information with information obtained by scrutinizing medical records for a 10% representative sample (603 infants). RESULTS: Specificity and sensitivity for each basic characteristic varied, but for the modified Wigglesworth cause of death classification the concordance was 88%. The weakest data refer to intrauterine deaths, where pertinent information was often missing in the medical registries. CONCLUSION: The method can be used for large-scale epidemiological studies.     

Experimental leukocyte-induced pulmonary vasculitis with inquiry into mechanism

Intravenous transfusions of washed allogeneic or autologous leukocytes in rabbits resulted in lesions of pulmonary periarteritis 48 hours later. Intact leukocytes were required. Systemic anaphylaxis, generalized Shwartzman reaction, alternate pathway complement activation and inert particle microembolism failed to produce identical lesions. Leukocytes tagged with radioactive chromium were found within arterial thromboses with proximal vasculitis. Generation or release of inflammatory factors plus thromboembolism would explain the pathogenesis of the lesions described. Specific mechanisms may be quite complex. Similar lesions have not been described in studies of pulmonary leukocyte entrapment or experimental microembolism of the lung. This model may be useful for studying pathogenetic mechanisms in pulmonary vasculitis and may have clinical implications.     

Resection of a vertebral hemangioma after preoperative embolization. Case report

Preoperative arterial embolization of a vertebral hemangioma allowed surgical excision of the vertebral body, restoration of normal anatomic continuity of the spinal canal, and improvement in myelopathy.     

The oxytocin challenge test

In a group of 152 high-risk pregnancies, 266 oxytocin challenge tests were reviewed. There were 137 patients with persistently negative oxytocin challenge tests with only one false-negative test being recorded. Fifteen patients who displayed a positive test at some time in their antepartum course are discussed along with other aspects of the oxytocin challenge test.     

Headache characteristics in subarachnoid haemorrhage and benign thunderclap headache

One third of patients with aneurysmal subarachnoid haemorrhage (ASAH) present with headache only. A prompt diagnosis is crucial, but these patients must be distinguished from patients with non-haemorrhagic benign thunderclap headache (BTH). The headache characteristics and associated features at onset in subarachnoid haemorrhage and benign thunderclap headache were studied to delineate the range of early features in these conditions. In this prospective study, one of two observers interviewed 102 patients with acute severe headache by means of a standard questionnaire. The patients were alert on admission and had no focal deficits. ASAH was subsequently diagnosed in 42 patients, non-aneurysmal perimesencephalic haemorrhage (PMH) in 23 patients, and BTH in 37 patients. Headache developed almost instantaneously in 50% of patients with ASAH, 35% of patients with PMH, and 68% of patients with BTH and within 1 to 5 minutes in 19%, 35%, and 19%, respectively. Loss of consciousness was reported in 26% of patients with ASAH, 4% of patients with PMH and 16% of patients with BTH, and transient focal symptoms in 33%, 9%, and 22% respectively. Seizures and double vision had occurred only in ASAH. Vomiting and physical exertion preceding the onset of headache were more frequent in patients with ASAH (69% and 50%) and those with PMH (83% and 39%) than in those with BTH (43% and 22%). Headache developed almost instantaneously in only half the patients with aneurysmal rupture and in two thirds of patients with benign thunderclap headache. In patients with acute severe headache, female sex, the presence of seizures, a history of loss of consciousness or focal symptoms, vomiting, or exertion increases the probability of ASAH, but these characteristics are of limited value in distinguishing ASAH from BTH. Aneurysmal rupture should be considered even if focal signs are absent and the headache starts within minutes.     

Improved coverage in dynamic contrast-enhanced cardiac MRI using interleaved gradient-echo EPI

An interleaved gradient-echo echo-planar imaging (IGEPI) sequence was modified for and applied to dynamic contrast-enhanced imaging of the heart. Using IGEPI, images with 3.0 x 3.9 mm nominal in-plane resolution are acquired in 100 ms, enabling eight slices per heartbeat for a heart rate of 60 beats/min. The acquisition speed and use of saturation prepulses allows acquisition of short- and long-axis images during the same contrast bolus. IGEPI maintains the acquisition characteristics required for performing a quantitative first-pass perfusion analysis as well as providing improved coverage compared with conventional fast gradient echo.