Biomedical subjects
Publications and source records attributed to I Bouska.
Immunohistochemical investigation of heart conductive system showed that degenerative changes described by James (9) in some cells of the system had a nature of programmed death. Extinction of certain of number of cells of a reducted part of the system was found in membranous septum. Apoptotic antigen (21) could be proved in some destructed cells by using anti-Bax and anti-bcl-2 antibodies.
Histochemical and immunohistochemical findings in respiratory tract of suddenly deceased infants were a bit different from those with violent death immediately after trauma. The bronchial wall inflammatory infiltration and foci of peribronchial lymphatic tissue did not show any substantial difference in both groups but findings in lung interstitium proper did. A regular finding was the presence of activated macrophages in interstitium and alveolar lumina and an increase of B and T lymphocytes in lung tissue as well. Lung findings in suddenly deceased infants do not have character of a shock lesion bud represents an initial phase of acute inflammation.
BACKGROUND: Abuse and/or neglect of children can lead not only to serious health damage but in extreme cases to death. A lethal outcome in the abused child is an incomplete group of seriously damaged children; it, however, makes possible not only numerical comparison but also assessment of trends. The objective of the present work was an analysis of deaths of children who died in conjunction with the use of force in the family. METHODS AND RESULTS: The author analyzed a group of 75 children, 47 boys (63%) and 28 girls (37%) aged less than five years: it covers the period of 25 years (1964-1988) and administrative area of the capital of Prague and former Central Bohemian region with a total number of 2 million population. Newborn babies killed by the mother during delivery or immediately after delivery (63 subjects) were not included in the group. According to analysis by age the following number of deaths was recorded in different groups: 0-1 year 45 deaths (60%), 1-2 years 13, 2-3 years 11, 3-4 years similarly as 4-5 years 3 deaths each. The ratio of boys:girls was 47:28. The most frequent cause of death were head injuries (31-41%), followed by suffocation 15x, injury of abdominal organs 6x, intoxications (4x, incl. 3x carbon monoxide), multiple injuries 4x, injuries of thoracic organis 3x, starvation 2x, hypothermia 2x, thermal damage 1x. The findings on necropsy are not useful only for assessing the cause of death, the mechanism of damage and the time when the damage was inflicted but the spectrum of types of damage can help clinical and social workers in the prevention of the battered child syndrome. CONCLUSIONS: Child abuse and neglect in families can lead not only to serious health damage but it can be also fatal. In an area with a population of 2 millions in the course of 1964-1988 75 deaths of children aged less than five years were recorded (ratio: 2.5:1 million per year). Mechanical injuries predominate (89%) in particular head injuries (41%).
The author analyzed data obtained by means of questionnaires from 58 children who died of the diagnosis of SIDS in the Central Bohemian region. A total of 81 data were evaluated pertaining to pregnancy, delivery, case-history of the mother and child, living and conditions and the death. The assembled data were compared with data in the literature. The authors confirmed the multifactorial etiology of SIDS. The questionnaire used was recommended for nationwide investigations of sudden infant deaths.
The authors examined, using histochemical methods, the AV conduction system in five infants and two children who died unexpectedly with a congenital heart disease. The activity of "glycogen dependent" phosphorylase in the AV conduction system was mostly negative or weak. The probable cause of this finding is hypoxia, although the effect of hypotrophy must be admitted. In groups of cells penetrating into connective septal tissue a decrease of oxidoreductases and hydrolases was found. These findings may be associated with regressive changes in the postnatal reduction of the AV conduction system.
The authors refer to the frequently difficult diagnosis of gastrointestinal complications of major burns, particularly in childhood, to weight the factors co-responsible for the development of those complications and to stress the importance of the patient's history. They report on the case of three and a half year-old child to demonstrate the fatal course of a late diagnosed complications -- perforating cholecystitis. Autopsy showed the chronic nature of the disease with acute exacerbation in the course of treatment. No case similar to this one has yet been seen at the Prague Burns Centre in any age category.
In 21 sudden and unexpected deaths of infants and three young children who died unexpectedly with known pathological conditions the authors examined by histochemical methods the atrioventricular node and bundle of His. The activity of "glycogen dependent" phosphorylase and the PAS reaction was in the majority week or negative. The probable cause of this finding is hypoxia, although other influences cannot be ruled out (inflammation, hypotrophy, autolysis). The activities of other enzymes (oxido-reductases ATPase, acetylcholine sterase, non-specific 1-naphtyl acetate esterase and acid phosphatase) were similar as in the normal conduction system.
The authors examined by histochemical methods the atrioventricular node and the bundle of His in five infants who died from unnatural deaths and in a four-and-half-year-old child who died immediately following haemorrhagic infarction of the gut. Both structures differed, similarly as in adult age, from working muscle by a lower oxidation capacity, higher activity of the pentose-phosphate shunt and a high acetylcholine esterase activity.
The authors examined a group of 47 children who died at the age of 1-9 months, incl. 19 female and 28 male children. In 23 the death was described as sudden and in 24 as unexpected. From 19 dead children a virus was isolated: in 14 one or two serotypes of enterovirus were found, in two the virus of parainfluenza 3 in two adenoviruses (type 2, 7). A total of 46 viral strains were isolated. By immunofluorescence in tissues antigens of the parainfluenza virus 3 and adenovirus were detected. Immune complexes were not detected in tissues. The distribution of vaccination polioviruses in organs and tissues after a known interval following vaccination was recognized. In some of the infants a possible causal relationship between the virological and morphological findings was found and the authors discuss the possible pathogenetic role of the revealed changes in sudden death.
The conducting system of young rats was studied by histochemistry during autolysis at room temperature lasting 1, 3, 6, 24 and 48 hours. The results were compared with working muscle tissue. The most sensitive was the "glycogen-dependent" phosphorylase and the activity decreased after 1 hour. It was slightly detectable as late as after 24 hours when the working muscle was already negative. Other enzyme activities (oxidoreductases and hydrolases) were practically uninfluenced by 6 hour autolysis. A substantial decrease of activities was found in conducting system after 48 hours in comparison to the working muscle. A solitary relatively strong residual activity belonged to acetylcholine-esterase in the conducting system. Detection of acetylcholine-esterase can be useful in identification of the conducting system even later after death.
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A comparison was made between interferon production by fibroblasts obtained from the excision of muscular tissue in suddenly deceased infants (SIDS) and that from children operated on at the surgical and orthopedic clinics. While the fibroblasts obtained from the surgically treated children formed interferon in a great quantity, the fibroblasts collected from suddenly deceased children generally failed to produce any interferon.
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In a group of 84 children who died at the age of 3 weeks to 15 years, icl. 37 sudden deaths, 16 unexpected deaths, 12 deaths immediately after an accident and 19 children who died some time after an accident, the authors investigated and evaluated by statistical methods the incidence of waves of myocardial cells in left and right ventricle. Waves in the right ventricle were significantly more marked (at the 5% level) than in the left ventricle. Their presence was inversely related to the presence of haemorrhage and cellular infiltration of the myocardial interstitium. The author did not detect a significant relationship with sex, age, duration of the disease, diagnosis, manifestations of cardiac failure and oedema or pneumonia. The findings suggest that waves of myocardial cells cannot be considered quite specific for ischaemic heart damage.
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