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Biomedical subjects

M G Gilliland

Publications and source records attributed to M G Gilliland.

At least 19 recordsLinked to original sources
PubMed2001

Frequency of bronchopneumonia in children with survival interval before death.

Many children do not survive after presentation in extremis. Some survive varying intervals and are found to have bronchopneumonia at death. The question is raised whether bronchopneumonia is a consequence of survival rather than the initiating disease leading to collapse. A prospective study of the deaths of 156 children divided them into two groups: 80 children with head injury and 76 with causes of death other than sudden infant death syndrome. In 43 of the total group of children, bronchopneumonia was found. In the total group, 76 survived more than a day. Of these 39 had bronchopneumonia, 32 died of head injury, and 7 had other causes of death. Of the children surviving less than a day, 4 had bronchopneumonia at death--only 1 with head injury. If bronchopneumonia is present, it is more likely to have developed after the collapse than to have caused it in this population.

Bronchopneumonia↗
PubMed2000

Frequency of pulmonary hemosiderosis in Eastern North Carolina.

Pulmonary hemosiderosis has been attributed to airborne fungi in water-damaged homes in studies of a cluster of cases in infants and children in Cleveland, Ohio, in 1997. We have searched for such emerging infectious agents in the Coastal Plain of North Carolina, which is subject to intermittent flooding. Pulmonary tissue from 206 infants and young children whose deaths had been investigated from October 1978 to September 1996 was retained at East Carolina University School of Medicine. Ages ranged from premature newborns to 49-months. One hundred and ten deaths were attributed to sudden infant death syndrome (SIDS). New sections were cut and analyzed using hematoxylin and eosin, Prussian blue for iron, and Gomori methenamine silver for fungal organisms. Twenty-three infants and children had iron-containing macrophages. Sixteen of these had underlying illnesses, but 4 were originally diagnosed as SIDS. Only one of these had sufficient hemosiderosis to be considered as having pulmonary hemosiderosis and no fungi were present. One case without iron had fungi and was not originally diagnosed as SIDS. The single case of pulmonary hemosiderosis found in this rural area is not similar to the cluster in Cleveland. The study identifies no fungal organisms as emerging infectious diseases in this area.

Autopsy↗
PubMed1998

Fatal obliterative coronary vasculitis in Kawasaki disease.

We report a unique case of Kawasaki disease with late sudden death from obliteration of the lumen of the full length of the left anterior descending coronary artery. Sequential echocardiograms showed early uniform coronary dilatation that resolved before sudden death. The implications of obliterative "healing" of coronary ectasia are unknown.

Child, Preschool↗
PubMed1998

Interval duration between injury and severe symptoms in nonaccidental head trauma in infants and young children.

Forensic pathologists are frequently asked to describe the interval between injury and the onset of symptoms in child abuse head injury deaths. A prospective, postmortem study examined the interval between injury and onset of symptoms in 76 head injury deaths in which this information was available. The head injury deaths were divided by mechanism of injury. The mechanisms were shake (no impact), combined shake and blunt impact, and blunt impact (no history of shaking). The interval was less than 24 hours in 80% of shakes, 71.9% of combined, and 69.2% of blunt injuries. The interval was greater than 24 hours in more than 25% of each of these latter groups and was more than 72 hours in four children. The variable intervals between injury and severe symptoms warrant circumspection in describing the interval for investigators or triers of fact. It should be noted that in all of the cases where information was supplied by someone other than the perpetrator, the child was not normal during the interval.

Brain Injuries↗
PubMed1997

Certification of death by family physicians.

Death certificates are important because morbidity and mortality statistics often come from death-certification data. These statistics are vital in developing approaches to disease treatment and strategies for increasing longevity. It is often the primary care physician who is responsible for completing the death certificate, for explaining the cause of death to the family and, if appropriate, for referring some cases to the medical examiner. The primary care physician should have an explicit understanding of how to determine the cause and manner of death and should use succinct, clear language in completing the death certificate. When doubt exists or an external cause of death is a possibility, the coroner or the medical examiner is the appropriate public health official to contact.

Aged↗
PubMed1996

Shaken babies--some have no impact injuries.

One study has questioned the validity of shaking as a mechanism of head injury in children. A prospective, postmortem study investigated 80 deaths from head trauma to identify the roles of shaking and direct impacts. Evidence of shaking was defined as two or more of the following criteria: 1) finger marks and/or rib fractures, 2) subdural and/or subarachnoid hemorrhage, or 3) a history of vigorous shaking. Shaking to the exclusion of other head trauma was defined as the presence of two or more of the above criteria together with the complete absence of scalp or skull injuries. Nine (11.3%) of the 80 study deaths qualified as exclusively shaking injuries by this definition. Thirty (37.5%) of the deaths had direct injuries as well as two of the criteria of shaking; these deaths were classified as combined shaking and blunt trauma. Forty-one (51.3%) of the deaths had impact injuries without having two of the criteria of shaking. We reviewed the extent of ocular injuries in all the cases. We found ocular hemorrhages with increased frequency in cases with two or more of the criteria of shaking compared to cases with only impact mechanism of injury. Retinal hemorrhages continue to show themselves to be a good marker of infants injured by vigorous, intentional shaking. This study likewise confirms the observations of others that most, but not all, shaken babies have impact injuries as well.

Battered Child Syndrome↗
PubMed1995

Effect of cocaine on left ventricular function. Relation to increased wall stress and persistence after treatment.

BACKGROUND: To determine whether alterations in left ventricular (LV) function after a cocaine infusion are due to reduced myocardial contractility or changes in loading conditions, we examined LV function in 30 morphine-sedated, closed-chest dogs. We also wanted to determine the time course of the effects of cocaine on LV function after the infusion was stopped. METHODS AND RESULTS: Two-dimensional echocardiography and hemodynamics provided LV fractional shortening and end-systolic wall stress data. Radionuclide ventriculography was also performed. Four groups of dogs received saline or cocaine infusions of 10, 30, or 100 micrograms.kg-1.min-1. Cocaine was infused for 90 minutes with ECG and arterial pressure monitoring. Animals were monitored for an additional 120 minutes after the infusion ended. Arterial pressure rose over the course of the experiment in all four groups, but saline and cocaine 10 micrograms.kg-1.min-1 did not significantly change ejection fraction. Cocaine 30 and 100 micrograms.kg-1.min-1 acutely increased arterial pressure and heart rate but decreased ejection fraction from 0.64 +/- 0.06 to 0.45 +/- 0.08 and from 0.65 +/- 0.10 to 0.46 +/- 0.11, respectively. Additionally, cocaine 100 micrograms.kg-1.min-1 decreased fractional shortening from 36 +/- 9% to 23 +/- 12%. However, cocaine 30 and 100 micrograms.kg-1.min-1 also increased wall stress from 42 +/- 15 to 65 +/- 11 g/cm2 and from 37 +/- 15 to 90 +/- 33 g/cm2, respectively. These results were analyzed by use of the relation between wall stress and fractional shortening as an index of contractility. Fractional shortening after cocaine infusion was displaced downward as a result of increased wall stress rather than changes in contractility. In addition, alteration of afterload with phenylephrine (6 micrograms/kg) and sodium nitroprusside (10 micrograms/kg) before and during infusion of cocaine 100 micrograms.kg-1.min-1 showed similar regression lines for wall stress to fractional shortening. CONCLUSIONS: Ejection-phase indexes of LV function were reduced by cocaine in this model of conscious, sedated dogs, but effects were attributable to increased wall stress rather than to reduced myocardial contractility. These effects persisted for at least 2 hours after the infusion was stopped.

Angiography↗
PubMed1994

Systemic and ocular findings in 169 prospectively studied child deaths: retinal hemorrhages usually mean child abuse.

The presence and location of ocular hemorrhages were prospectively studied in 169 randomly selected child deaths referred to a medical examiner. Causes of death in the study group included natural diseases and various injuries involving the head, trunk, and asphyxia. Retinal hemorrhages were identified in 70 cases: 62 head injuries, four central nervous system diseases (but not other natural diseases), and four deaths of undetermined cause. The presence of retinal, peripheral retinal, optic nerve sheath, and intrascleral hemorrhages were strongly associated with head injury as compared to other injuries and natural diseases (Yates corrected P-values < 0.001). Among the head-injured with retinal hemorrhages, nine had a history of severe traumatic event (e.g., an unrestrained rear-seat passenger in high-speed collision) and 53 were victims of inflicted injury (e.g. violent shaking). In the absence of a verifiable history of a severe head injury or life-threatening central nervous system disease, retinal and ocular hemorrhages were diagnostic of child abuse.

Asphyxia↗
PubMed1994

Norepinephrine-induced left ventricular dysfunction in anesthetized and conscious, sedated dogs.

These studies were conducted to evaluate effects of high dose norepinephrine infusion on left ventricular function in anesthetized and conscious dogs. Separate groups of pentobarbital anesthetized closed-chest dogs received norepinephrine infusion for 90 min followed by 1 h of recovery. Arterial pressure, electrocardiogram, two-dimensional echocardiogram and an equilibrium radionuclide angiogram were monitored. One hour following infusion of norepinephrine, left ventricular ejection fraction was reduced in a dose-dependent fashion. Fractional shortening was similarly reduced, with increased left ventricular systolic and diastolic dimensions also observed. Left ventricular end-systolic wall stress was increased at 60 min following infusion of norepinephrine but not saline: saline, 68 +/- 8, norepinephrine, 4 micrograms/kg/min, 113 +/- 8 g/cm2. The left ventricular end-systolic wall stress/fractional shortening relationship showed reduction of contractility. In 10 conscious dogs pretreated with morphine, norepinephrine at 5 micrograms/kg/min x 90 min produced similar changes to those seen in anesthetized animals. Ejection fraction was reduced from 0.69 +/- 0.3 to 0.36 +/- 0.04 at 60 min post infusion. Fractional shortening was also reduced. Left ventricular end-diastolic dimension was increased. However, when animals were followed for 1 week, complete recovery occurred within 48 h. Histology showed mild contraction band necrosis in acute experiments and mild perivascular fibrosis in chronic experiments. Therefore, norepinephrine cardiotoxicity produced significant left ventricular dilation and reduction of ejection phase indices of left ventricular function associated with reduced contractility. In chronic dogs, histologic changes were mild, and left ventricular dysfunction was reversible.

Anesthesia↗
PubMed1993

Are retinal hemorrhages found after resuscitation attempts? A study of the eyes of 169 children.

Resuscitation attempts have been hypothecated to explain retinal hemorrhages in infants who are suspected victims of child abuse. This study was undertaken to test that hypothesis by postmortem ocular examinations following unsuccessful resuscitation attempts on a sample of 169 children selected by 19 prosectors willing to contribute to the study. Cardiopulmonary resuscitation had been attempted for a minimum of 30 min in 131 of the children, whereas 38 controls did not have such protracted attempts; 70 children with prolonged resuscitation attempts had no retinal hemorrhages, including eight children whose fatal blunt force injuries of the trunk represented extremes of the forces used in resuscitation attempts. Children who died of asphyxia, respiratory illnesses, sudden infant death syndrome, and various other causes had no hemorrhages; neither did 21 children who died of head injury or central nervous system (CNS) diseases, nor did 29 controls. Retinal hemorrhages were present in 70 children, 61 with prolonged resuscitation attempts and nine controls. Among those with attempted resuscitation, 56 had head injuries, and four had CNS diseases and sepsis, all recognized causes of retinal hemorrhages. The other death that involved a resuscitation attempt and retinal hemorrhages was an officially "undetermined" death. The child had come from a household with two prior child deaths and documented abuse. No case is found in this study to support the hypothesis that retinal hemorrhages are caused by resuscitation attempts.

Child↗
PubMed1993

Alcohol in decomposed bodies: postmortem synthesis and distribution.

Blood alcohol (ethanol) concentrations in decomposed bodies can mean drinking during life and/or endogenous production after death. The correct interpretation is important in medicolegal cases. This retrospective study of 286 autopsied medical examiner cases was undertaken to evaluate alcohol concentrations and distribution in various fluids and tissues in decomposed bodies. Cases with alcohol present were classified as endogenous production, ingestion, or unable to determine based upon one or more of the following criteria: the presence of ethanol in only one of more than one body fluids, an atypical distribution of ethanol in body fluids, reliable scene or historical information, the presence of C3 alcohols in body fluids. Alcohol was classified as endogenously produced in 55 cases. The presence of alcohol was attributed to ingestion in 130 cases. No alcohol was detected in 39 cases. We were unable to determine the source of the remaining 62 alcohol concentrations. The highest blood alcohol concentration derived from endogenous production was 0.07% in the cases with other fluids negative. The mean blood alcohol concentration was 0.06% and ranged as high as 0.16% in cases having atypical ratios. Alcohol was found in blood and bile while urine and vitreous fluid were negative or had lower concentrations in cases with endogenous production. We conclude that for the majority of cases in which endogenous blood production of alcohol occurs the concentration in blood may be as high as 0.15%.

Alcohol Drinking↗
PubMed1992

Effect of diltiazem on norepinephrine-induced acute left ventricular dysfunction.

The present study has examined the role of diltiazem as a protective agent in a canine model of norepinephrine cardiotoxicity. Effects of diltiazem, 20 micrograms/kg/min x 5 min pretreatment followed by 10 micrograms/kg/min x 90 min, or saline infusion were examined at baseline and 1 h after infusion of norepinephrine, 4 micrograms/kg/min for 90 min, in closed-chest anesthetized dogs. Left ventricular function was assessed by equilibrium radionuclide angiogram and two-dimensional echocardiogram. In 7 saline experiments, hypotension and increased heart rate were observed at 1 h post infusion. In the diltiazem-treated group (n = 7), mean arterial pressure and heart rate were unchanged. In the saline group, left ventricular ejection fraction fell from 0.50 +/- 0.04 to 0.28 +/- 0.04. Left ventricular ejection fraction was unchanged in the diltiazem-treated group: 0.52 +/- 0.03 to 0.55 +/- 0.07. Left ventricular end-diastolic volume was increased at 1 h post infusion in saline controls but not in the diltiazem-treated group. Measurement of fractional shortening from two-dimensional echocardiograms also indicated left ventricular dysfunction in the saline but not diltiazem-treated groups. Left ventricular end-systolic wall stress following norepinephrine infusion was significantly increased in the saline but not diltiazem-treated groups: 122.7 +/- 18.7 vs 67.6 +/- 19.7 g/cm2, respectively. In dogs receiving saline without norepinephrine infusion, no significant changes occurred over the course of the experiment. Histologic examination showed mild contraction band necrosis in saline controls but not in sham saline dogs. Diltiazem showed intermediate histologic evidence of injury, which was not further quantified. This study suggests that effects of norepinephrine on left ventricular function in the canine model of norepinephrine cardiotoxicity may be largely due to increased wall stress following a prolonged increase in afterload. Diltiazem pretreatment afforded significant protection of left ventricular function.

Animals↗
PubMed1992

Retinal hemorrhages: replicating the clinician's view of the eye.

The authors describe a technique for the gross examination of postmortem eyes of children who are suspected to have been the victims of deliberate trauma. By removing the anterior segment (cornea, iris, lens and pars plicata of the ciliary body) en bloc by a coronal incision through the pars plana just anterior to the ora serrata, the pathologist may view and photograph the fundus exactly as it would have been seen clinically. The photographs obtained with this technique correlate more closely with antemortem clinical examinations and photographs than conventional gross examination procedures and have been introduced as evidence in trials concerning the issue of retinal hemorrhages in injured children. The anterior segment and optic nerve are also examined to facilitate a comprehensive description of ocular findings.

Child↗
PubMed1991

Vitreoretinal traction and perimacular retinal folds in the eyes of deliberately traumatized children.

The pathophysiology of perimacular folds in eyes of deliberately traumatized children is disputed. The authors reviewed the clinical and forensic records and systemic and ocular findings at autopsy of three children with perimacular retinal folds who died after being violently shaken. Two of the children suffered direct head trauma in addition to being shaken; one patient was violently shaken without any physical or forensic evidence of direct head trauma. No direct ocular trauma was detected. In each case, the vitreous had partially separated from the retina but remained attached to the internal limiting membrane at the apices of the folds and the vitreous base, implicating traction in the pathogenesis of these folds. Although some intraocular findings in deliberately traumatized children may be explained by direct head injury, the possibility of both direct head trauma and shaking must be considered. Perimacular folds may develop without direct ocular or head trauma and may constitute evidence supporting violent shaking.

Battered Child Syndrome↗
PubMed1986

Disaster planning for air crashes. A retrospective analysis of Delta Airlines flight 191.

The effectiveness of previously untested disaster plans was demonstrated during the aftermath of the crash of Delta Airlines Flight 191 at D/FW International Airport on Friday, August 2, 1985. These plans, in effect for years and subjected to periodic review, were as yet untried before this first disaster at D/FW International since its opening. This paper outlines the disaster plans, the actual problems encountered, the logistics of a disaster of this kind, and insights gained from the experience.

Accidents, Aviation↗
PubMed1986

Rubber production in guayule: determination of rubber producing potential.

Optimum conditions for the rapid, efficient, nondestructive determination of rubber producing potential in guayule (Parthenium argentatum) were established. The rubber producing potential may be defined as the ability of the plant material to synthesize rubber from a precursor under specified conditions. To achieve this, stem slices taken from the first 5 centimeters of branches were incubated with [(14)C]acetate as precursor in 0.1 molar phosphate buffer (pH 6.5) at 26 degrees C for 16 hours in the light. The (14)C from labeled acetate and acetyl coenzymeA were efficiently incorporated into rubber whereas the (14)C from both mevalonic acid (MVA) and isopentenylpyrophosphate (IPP) were poorly incorporated. Incorporation of 68.6% of the (14)C from labeled IPP into the acetone extractable material suggests that most of the IPP was channeled down the lower terpenoid branch of the polyisoprene biosynthetic pathway. The incorporation of (14)C from labeled acetate into rubber was most efficient at temperatures between 20 and 25 degrees C. The rubber producing potential was also found to be dependent on light intensity. The roots which represent about one-third of the plant biomass not only had the highest rubber producing potential but also contained the highest amount of rubber (7.6%), indicating that the root system could be a major source of rubber. The mature stem bark also had a high rubber content and rubber producing potential, whereas the young stem had a low rubber content and a lower potential for producing rubber. The leaves showed little potential to incorporate labeled acetate into rubber and no more than 0.5% rubber was found in guayule leaves.

Journal Article↗
PubMed1982

Peritoneal lavage and angiography in the management of patients with pelvic fractures.

One hundred consecutive patients with pelvic fractures who had undergone peritoneal lavage and abdominal and pelvic angiography were retrospectively analyzed. Sixty-four patients with negative lavages were treated successfully without laparotomy despite a 20 percent incidence of subcapsular or intraparenchymal hematomas of the liver or spleen. Thirty percent of the patients with positive peritoneal lavages were successfully managed without laparotomy when abdominal angiography failed to identify a source of active bleeding. Abdominal angiography was 92 percent accurate in predicting the presence or absence of hemorrhage in 25 patients who underwent laparotomy. There were no false-positive angiograms. The overall false-negative rate was 2.12 percent. These occurred in two patients with torn mesenteric vessels. Pelvic angiography identified arterial pelvic bleeding in 18 percent of the patients. Eighty-four percent of patients with major pelvic bleeding had successful embolization with prompt cessation of arterial bleeding. We conclude that abdominal and pelvic angiography can be a useful adjunct to peritoneal lavage in detecting intraperitoneal hemorrhage and can be of therapeutic value for arterial pelvic bleeding.

Adolescent↗