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At least 163 records · Page 9Linked to original sources

PubMed2003

Effect of a delta receptor agonist on duration of survival during hemorrhagic shock.

OBJECTIVES: Selective delta receptor agonists have been shown to stabilize membrane physiologic processes, reduce metabolic rates, and provide protection against ischemic insults through K(ATP) channel opening in a variety of organ beds. However, their potential for affecting outcomes in states of generalized ischemia has not been explored. The authors examined the effect of the nonselective delta receptor agonist, DADLE (D-Ala2-Leu5-enkephalin), on hemodynamic stability and duration of survival in an animal model of severe hemorrhagic shock. METHODS: Conscious Sprague Dawley rats with indwelling catheters were hemorrhaged at a rate of 3.25 mL/100 grams over 20 minutes after half of the group received 1% DADLE (1 mg/kg IV). Following the hemorrhage, all rats were continuously monitored for heart rate (HR), mean arterial pressure (MAP), and life signs for up to three hours (death defined as apnea, systolic blood pressure < 30 mm Hg without pulsations, and electroencephalographic silence). Survival rates and hemodynamic trends were compared between the control and DADLE-treated groups. RESULTS: In the 14 rats studied (8 DADLE; 6 controls), initial hemorrhage resulted in similar hemodynamic shock (average MAP fall: 118 to 59 vs 119 to 55 mm Hg). Analysis of survival at 3.5 hours revealed statistically significant differences between the control and DADLE groups. While 50% of the DADLE group survived past the three hours, no control animals were still alive at the end of the experimental period. The MAP trended downward and the HR increased for the control group, but all hemodynamic parameters stabilized in the rats treated with DADLE. CONCLUSIONS: Most current strategies for treating shock focus on the supply side of resuscitation. The coordinated various actions of DADLE have the potential to work in concert in the intact organism to improve overall survival during severe hemorrhagic shock. In an animal model of severe hemorrhagic shock, there was improvement in hemodynamic stability and a prolonged survival with DADLE treatment. Physiologic manipulation with DADLE appears to be a way to improve survival during shock with possible clinical implications.

Animals↗

PubMed2004

Incidence and electrophysiological characteristics of spontaneous ventricular tachyarrhythmias in high risk coronary patients and prophylactic implantation of a defibrillator.

OBJECTIVES: To assess the incidence and electrophysiological characteristics of spontaneous ventricular tachyarrhythmias after implantable cardioverter-defibrillator (ICD) implantation for primary prevention. DESIGN: Prospective observational study. PATIENTS: 41 consecutive patients, who fulfilled MADIT (multicenter automatic defibrillator implantation trial) I criteria, except for suppressibility by procainamide, and who received a prophylactic ICD. INTERVENTIONS: Subpectoral implantation of an ICD. MAIN OUTCOME MEASURES: Incidence of ventricular tachyarrhythmias and their electrophysiological characteristics with respect to timing of the arrhythmia, tachyarrhythmia cycle length, mode of termination, and clinical relevance. RESULTS: During a mean (SD) follow up of 30 (21) months 18 of 41 (43.9%) patients experienced 142 appropriate ICD treatments. The mean (SD) time to first event was 9.6 (15.1) months. One patient had ventricular fibrillation (VF), 12 patients ventricular tachycardia (VT), and five both VT and VF. The mean (SD) cycle length of monomorphic VT was 306 (42) ms. Of 142 episodes, 117 (82.3%) were terminated by antitachycardia pacing and another 25 (17.6%) by ICD discharges. Cumulative survival of hypothetical death, defined as treated VT with a cycle length < 260 ms or VF, was 83.2% after one year and 78.4% after two years. CONCLUSIONS: Patients with a left ventricular ejection fraction < 35%, a history of myocardial infarction, non-sustained VT, and inducible VT/VF are at high risk of VT/VF early after implantation. Therefore, implantation of a tiered treatment defibrillator seems to be justified.

Aged↗

PubMed1999

Risk factors for early death in acute ischemic stroke and intracerebral hemorrhage: A prospective hospital-based study in Asia. Asian Acute Stroke Advisory Panel.

BACKGROUND AND PURPOSE: In Asia, there has been no international study to investigate the risk factors for early death in patients with ischemic stroke and intracerebral hemorrhage. METHODS: We conducted a prospective study of consecutive patients with acute stroke who were admitted to 36 participating hospitals in China, India, Indonesia, Korea, Malaysia, the Philippines, Singapore, Taiwan, Thailand, and Vietnam. With the use of a simple identical data sheet, we recorded the demographics and cardiovascular risk factors of each patient. Early death was defined as death on discharge from the acute hospital. RESULTS: We enrolled 2403 patients with ischemic stroke and 783 patients with intracerebral hemorrhage. Among patients with ischemic stroke, previous use of antiplatelet drugs (adjusted odds ratio [OR] 0.53; 95% confidence interval [CI] 0. 30 to 0.95) and relatively young age group 56 to 75 years (OR 0.65; 95% CI 0.42 to 1.00) were protective factors; atrial fibrillation (OR 2.23; 95% CI 1.40 to 3.57), ischemic heart disease (OR 2.03; 95% CI 1.37 to 3.05), diabetes (OR 1.52; 95% CI 1.04 to 2.22), and ex-smoker status (OR 2.18; 95% CI 1.18 to 4.05) were risk factors for early death. Among patients with intracerebral hemorrhage, hypertension (OR 0.56; 95% CI 0.38 to 0.82) and young age group 56 to 75 years old (OR 0.55; 95% CI 0.34 to 0.87) were associated with lower death rate, whereas diabetes (OR 1.74; 95% CI 1.01 to 2.98) was a risk factor for early death. CONCLUSIONS: In Asian patients with stroke, previous use of antiplatelet drugs nearly halved the risk of early death in patients with ischemic stroke, whereas atrial fibrillation, ischemic heart disease, diabetes, and ex-smoker status were risk factors for early death. Among patients with intracerebral hemorrhage, diabetes was associated with early death, whereas young age group and hypertension were associated with lower death rates, though no clear explanation for the hypertension association could be discerned from the data available.

Acute Disease↗

PubMed2006

Preventable trauma deaths: from panel review to population based-studies.

Preventable trauma deaths are defined as deaths which could be avoided if optimal care has been delivered. Studies on preventable trauma deaths have been accomplished initially with panel reviews of pre-hospital and hospital charts. However, several investigators questioned the reliability and validity of this method because of low reproducibility of implicit judgments when they are made by different experts. Nevertheless, number of studies were published all around the world and ultimately gained some credibility, particularly in regions where comparisons were made before and after trauma system implementation with a resultant fall in mortality. During the last decade of century the method of comparing observed survival with probability of survival calculated from large trauma registries has obtained popularity. Preventable trauma deaths were identified as deaths occurred notwithstanding a high calculated probability of survival. In recent years, preventable trauma deaths studies have been replaced by population-based studies, which use databases representative of overall population, therefore with high epidemiologic value. These databases contain readily available information which carry out the advantage of objectivity and large numbers. Nowadays, population-based researches provide the strongest evidence regarding the effectiveness of trauma systems and trauma centers on patient outcomes.

Journal Article↗

PubMed1983

Sudden unexpected deaths in a Japanese community--Hisayama study.

Six hundred and fifty-eight autopsy cases of both sexes in a general population of Hisayama town (autopsy rate 85%) were examined to determine the frequency and causes of sudden and unexpected death. Seventy-three sudden deaths (11.1%) were identified when sudden death was defined as death occurring within 24 hours after the onset of clinical symptoms. Thirty-nine deaths (54%) were due to intracranial hemorrhage (cerebral and subarachnoid) and 17 (23%) were due to coronary heart disease. An instantaneous death occurred within one hour was observed in 20 of the 73 cases (27%), of which 8 were attributed to coronary heart disease (40%) and one (0.5%) to subarachnoid hemorrhage. Pathologic evidence of recent myocardial infarcts or coronary thrombosis was found less frequently in cases who died within one hour than in those who died between one and 24 hours. An annual incidence of sudden death due to various etiologies, calculated from the population study on Hisayama residents who were aged 40 or over, was 1.7/1,000. Deaths from coronary heart disease in this community were much less common as compared with those reported in Western communities.

Adult↗

PubMed1997

Seasonal variation in the incidence of sudden death according to occupation of householder in Japan.

To examine the relationship between overwork and the occurrence of sudden death, the relation between occupation and seasonal variation in sudden death was studied. A total of 8481 cases of sudden death (among subjects aged over 24 years) were selected from all deaths between 1984 and 1986 in the Niigata Prefecture, Japan, based on a death certificate survey. Sudden death was defined as death within 24 h of the onset of the underlying disease. We divided subjects into 4 groups according to the occupation of the householder: agricultural workers, employees, the self-employed, and other occupations. As the incidence of sudden death in the 'other occupation' group did not show any significant seasonal variation, this group was considered to be a control group. Among young to middle-aged men (25-65 year old), the incidence of sudden death was higher than in the control group for agricultural workers in April and September and for employees in March and September. However, in older men (over 65) the incidence for agricultural workers was higher only in April. Among women, there was no such spring rise in the incidence of sudden death in any occupational group. The months featuring a high incidence of sudden death coincided with the busiest occupational months only for people who were actually working and not for those who had already retired.

Adult↗

PubMed1999

Sudden death in the general population in Okinawa: incidence and causes of death.

Sudden unexpected death is generally considered to be caused by acute myocardial infarction and/or arrhythmia. To document the incidence and causes of sudden death in Japan, where the incidence of myocardial infarction is low, the present study examined death certificates, hospital records, the forensic medical records, and the police records of residents of the southern part of Okinawa island who died at the age of 20-74 years during a 3-year period from January 1, 1992 to December 31, 1994. Sudden death was defined as death within 24 h from the onset of unexpected symptoms. The study documented 126 (87 men and 39 women) sudden deaths. The crude incidence rate was 0.37/1,000 person per year (0.51 in men and 0.23 in women). According to the death certificates, 78 cases died of heart diseases. However, the cause of death could be determined by examination of all available records in only 64 cases: myocardial infarction in 10, non-ischemic heart diseases in 13, and stroke in 23 cases. Even when the analysis was limited to the cases who died within 1 h from the onset of symptoms, heart disease was the cause of death in only 22% of the cases while the cause of death could not be determined in 53% of the cases. Only 13% of those diagnosed as heart diseases on the death certificate were verified. The agreement rate between the diagnosis reached by the re-evaluation of the records and that on the death certificate was 82% for stroke and 33% for other diseases. In Okinawa, Japan, the frequencies of heart disease and stroke as the cause of sudden death may be similar. Except for stroke, the diagnosis appearing on the death certificate has substantial inaccuracy.

Adult↗

PubMed2002

Pediatric cardiac surgery with echocardiographic diagnosis alone.

The diagnostic accuracy of echocardiography alone and the safety of cardiac surgery using this diagnostic approach were retrospectively assessed in 111 children operated for congenital heart defects (CHD) during a 3.5-yr period ending in October 2001. Preoperative diagnosis was compared with the intraoperative findings obtained by surgical inspection. Perioperative death was defined as death within 30 days postoperatively. Of the patients, 70% were operated on in infancy. Seventy-six percent (84 of 111) underwent surgery after echocardiographic diagnosis alone. A high percentage of patients with patent ductus arteriosus (100%), partial atrioventricular canal (100%), coarctation of the aorta (89%), ventricular septal defect (86%), atrial septal defect (85%), and total anomalous pulmonary venous connection (75%) was operated without prior catheterization. Diagnostic errors occurred in 2.4% (2 of 84) of patients with echocardiography only and in 7.4% of patients with catheterization. No error in either group was related to surgical morbidity or mortality. There were five (6.0%) perioperative deaths in the echocardiography group and two (7.4%) in the catheterization group, with no difference in the mortality between the groups. In conclusion, many patients with CHD can be accurately diagnosed by echocardiography alone, and can safely undergo surgery without catheterization, not increasing the overall risk.

Adolescent↗

PubMed2004

[Unnatural and unexplained death in a paediatric intensive-care unit, 1993-2002].

OBJECTIVE: To analyse the causes of unnatural death in a general paediatric intensive-care unit. DESIGN: Retrospective and descriptive. METHODS: The cause of death was reviewed for all deceased children who were admitted to the paediatric intensive-care unit of the Emma Children's Hospital/Academic Medical Centre in Amsterdam, the Netherlands from 1993 through 2002. Three investigators independently categorised the cause of death as 'natural' or 'unnatural'. Unnatural death was defined as death by external cause, such as drowning, suffocation or violence, whether intentional or not. For all patients who died an unnatural death the cause of death and (if available) results of autopsy were analysed. RESULTS: During the study period, 5523 patients were admitted to the ICU, of whom 360 (6.5%) died during the period of admission. In 45 (12.5%) of these this was an unnatural death. In 7 (16%) patients there was a suspicion of death by deliberately caused injury. In 4 of these patients forensic autopsy was performed. The results of autopsy confirmed the suspicion of child battery in 3 patients, whereas in 1 case the diagnosis was refuted. CONCLUSION: In 16% of the children who died of unnatural causes there was a suspicion of child battery. A forensic autopsy was useful in all cases to confirm or refute the suspicion of child battery, but was not carried out in all cases.

Autopsy↗

PubMed2005

[Gender difference of sudden death].

The survey of sudden death (SD), defined as death within 24 hours from the onset of underlying cause, was conducted in Niigata. The survey was based on all summary death certificates for the period 1984 to 1986. The underlying cause was divided into 4 groups: acute myocardial infarction (AMI), cerebrovascular accident (CVA), other circulatory diseases (OCD) and non-circulatory disease (NCD). The SD incidence ratio of male to female was 1.7, 1.3, 1.3, and 1.5 for AMI, CVA, OCD, and NCD, respectively. OCD accounted for 50.1% of underlying causes in male and 53.1% in female. The proportion of OCD cases with histories of diseases related to atherosclerosis (e.g. hypertension, diabetes, etc) increased with age in both sexes, accounting for 38.5% in male and 36.4% in female aged 75 years old or over.

Cardiovascular Diseases↗

PubMed1990

[Can sudden cardiac death be prevented by treatment with anti-arrhythmia drugs?].

Sudden cardiac death is defined as death due to a primary cardiac cause or mechanism, occurring within one hour of the onset of acute illness in a person thought to be free of, or with symptomatically mild, heart disease, or simply prehospital death. Of persons dying suddenly, 90% have coronary artery disease, less commonly, dilated cardiomyopathy or hypertrophic cardiomyopathy, preexcitation syndrome, long QT-syndrome, conduction disturbances, congenital or valvular heart disease as well as cardiac tamponade are responsible. In the USA, the incidence of sudden cardiac death is approximately 450,000 per year, in the Federal Republic of Germany the number lies at about 70,000 to 80,000. The most important risk factors for sudden cardiac death are impaired left ventricular ejection fraction, myocardial ischemia and arrhythmias. In general, sudden cardiac death is caused by ventricular fibrillation which arises mainly by degeneration of ventricular tachycardia (VT). The terminal arrhythmia, it is assumed, is precipitated by premature ventricular beats originating in an arrhythmogenic substrate. MEDICAL ANTIARRHYTHMIC TREATMENT IN PATIENTS WITH CORONARY ARTERY DISEASE AFTER MYOCARDIAL INFARCTION: STUDIES WITH CLASS I DRUGS: The results of nine large, randomized , controlled studies are available in which the mortality of patients on antiarrhythmic treatment has been studied (Table 1). Two studies each were carried out with aprindine, phenytoin, mexiletine and tocainide as well as one study with endainide, flecainide or morizicine. With the exception of the CAST study, no study showed a significant difference between treated patients and the control group with respect to mortality or incidence of sudden cardiac death. The CAST study was terminated after ten months because the administration of flecainide and encainide led to overall mortality of 7.7% vs. 3.0% in the control group and the rate of sudden cardiac death at 4.5% was significantly higher in the treatment group than the 1.2% incidence found in controls (Table 2). For nearly all of the studies described, the patient groups were not sufficiently large and subgrouping according to patient characteristics was not carried out such that possibly, inhomogeneity of the entire collective may not have been recognized precluding identification of some individuals who may have shown benefit from antiarrhythmic treatment. The necessity for treatment in many of those receiving drugs is questionable since generally the rhythm profile of the patients was not taken into consideration for the decision to treat. Proarrhythmic effects, accordingly, were also not assessed. Individual treatment and dosage adjustment by monitoring with effectiveness criteria was carried out in one study only in which, even here, criteria for effectiveness were arbitrarily capable of eliciting antiarrhythmic actions. Calculation of mortality rates was carried out on the basis of the total number of deaths in the respective groups without taking into consideration that by the end of the study, in the treatment group the medication had been discontinued in up to 40% of the patients. STUDIES WITH CLASS II DRUGS: For treatment with beta-receptor blockers there are 15 large, controlled, randomized, long-term studies available in which total mortality and the incidence of sudden cardiac death were studied.(ABSTRACT TRUNCATED AT 400 WORDS)

Anti-Arrhythmia Agents↗

PubMed1989

[Early postoperative complications in elective splenectomy in hematologic diseases].

This study analyses frequency of complications and mortality after elective splenectomy done for various hematological diseases, dependent on the spleen weight. From 1979 to 1988 year, 236 patients were treated by splenectomy for various haematological disorders, including: autoimmune disorders (90), Hodgkin's disease (34), lymphoproliferative diseases (96) and myeloproliferative diseases (16 patients). In the early postoperative period, complications occurred in 51 (21.61%) patients, 10 of which (4.24%) died. Considering the size of the spleen (more or less than 1500 gr) there was no difference in the early postoperative mortality (p greater than 0.05; 3.30%:5.38%), while postoperative complications occurred significantly more often in patients with massive splenomegaly (p greater than 0.05; 1259%:3548%). The most frequent complications were septical (8.90%), prolonged fever (5.51 x), and postoperative bleeding (2.97%), while cardial, pulmonary and urinary complications occurred seldom, but more often caused patient's death. Defining the appropriate indications for splenectomy, performing suitable preoperative preparations and postoperative care, mortality was diminished from 7.14% in the period, 1979-1983 year, to 2.17% in the period 1984-1988.

Adolescent↗

PubMed1989

[Prediction of operative mortality by a discriminant analysis for organ functions in patients with esophageal cancer--organ function index].

An "organ function index" (OFI) predicting the risk of operative mortality was presented. OFI was estimated on the basis of dysfunction of the systemic organs in patients with esophageal cancer. The pulmonary, cardiac, hepatic and renal functions were assessed by 23 parameters in 108 patients when they were admitted. Operative death was defined as death due to operative complications occurring within 120 days after esophagectomy or by-pass operation. For a discriminant analysis, patients were limited to those in the early period (from October 1981 until December 1985) when the incidence of operative mortality was relatively higher and the parameters were also limited to statistically evaluable ones. Then, a discriminant analysis was performed using data on 18 parameters of four organs in 35 patients each of whom had no deficit in these data. Operative death occurred in 8 out of these 35 patients. Based on the data, an equation to calculate OFI was generated. It consisted of 7 parameters regarding pulmonary, hepatic and renal functions. The values of OFI less than zero predicted no operative death while those more than zero did predict operative death. The prediction rate on presence or absence of operative mortality by this equation was 91.4% in 35 patients. For clinical application, the predictable risk of operative mortality based on OFI was classified as high (OFI less than 1.4), intermediate (0 less than OFI less than 1.4), or low (OFI less than 0).(ABSTRACT TRUNCATED AT 250 WORDS)

Discriminant Analysis↗

PubMed1985

European coronary surgery study.

The results of the European Study apply to the patients who met the inclusion criteria of this study: men, aged under 65, with angina pectoris of more than three months' duration, 50% or greater intraluminal diameter narrowing in at least two major coronary arteries and good left ventricular function (ejection fraction greater than or equal to 50%). The results imply that prophylactic coronary bypass surgery should be considered only for those patients with angina who are at risk of premature death defined by the non-invasive prognostic predictors (ischemic abnormalities in the resting ECG, marked ST-depression during exercise, peripheral arterial disease, age) and the extent and size of coronary obstructions. The severity of angina is of limited relevance in this context. The patients in a low risk phase of the disease do not require surgery unless they have unacceptable symptoms in spite of adequate medical treatment. No evidence emerges to support the assumption that coronary bypass surgery protects against future myocardial infarction. Although surgery relieves angina pectoris and improves physical performance, it does not significantly delay retirement from work over a period of five years.

Adult↗

PubMed1984

Do not resuscitate and the removal of life support.

Although the right to terminate life-sustaining treatment is clear from the medical, ethical, and moral perspective, the legal methodology is fragmented and variable depending upon the jurisdiction in which you practice. A few general principles do emerge which may be useful for the clinical gastroenterologist. DNR orders may be entered into a patient's orders provided the patient, if competent, or his or her family or guardian, if the patient is incompetent, gives informed consent. In no circumstance should the physician enter the order without obtaining the responsible party's informed consent. Proper documentation in the chart is recommended and the views of an ethics-type committee are desirable if available. If your hospital or institution does not have a DNR policy, encourage its development. Termination of life support decisions should be made upon sober reflection by the physician, patient, and/or family or guardian. The decision must be based on a full appreciation of the underlying medical illness, the prognosis and expectation for meaningful recovery, and the physician should be certain to obtain informed consent. The decision should not be made hastily, keeping in mind that the passage of time allows for a more dispassionate decision by all of the parties. Submission of the case before an ethics or prognosis committee is recommended. A hospital or institutional policy regarding termination decision-making is highly desirable. If unsure, legal counsel should be sought before terminating life support. Jurisdictions which define death by both cardiopulmonary and neurologic criteria make the termination decision easier in that brain-dead patients can be removed from life support without risk of liability.(ABSTRACT TRUNCATED AT 250 WORDS)

Brain Death↗

PubMed1994

[Apoptosis and diseases].

Apoptosis, a form of cell death defined by morphological and biochemical characteristics, is involved in many important physiological phenomena including embryogenesis, organ involution, maintenance of homeostasis and biodefense systems of the body. Impaired regulation of apoptosis may play a part in the etiology of malformation and disfunction of various organs causing autoimmune diseases, immunodeficiency diseases or neurodegenerative diseases. Apoptosis is also related to cancer. Elucidation of the mechanism of apoptosis may provide new insights into the pathophysiology of a variety of diseases, and its specific regulation may lead to exciting new therapies for these diseases.

Animals↗

PubMed1997

Inflammation and apoptosis.

Apoptosis is a highly regulated form of programmed cell death defined by distinct morphological and biochemical features; it plays an important role in embryogenesis and the maintenance of cellular and tissue homeostasis in multicellular organisms. Its perturbation has been implicated in a wide range of patho-physiological stages, including autoimmune, bacterial, and viral disease, and degenerative disorders. The critical role of apoptosis in eliminating harmful or injured cells from tissues suggests its participation in inflammatory processes and in the resolution of inflammatory reactions. In this article, we briefly review the molecular mechanism of apoptosis and the role of apoptosis in inflammation.

Animals↗

PubMed1983

Refining the definition of death for Australian legislation.

In the article Mr. Smith considers the need for reform in the area of defining when death occurs and the various approaches that exist to define death. He then analyses the stages of the developments in the various Australian jurisdictions and discusses the substantive content of the basic definition adopted and the practical implications of any enactment. The author suggests that the concept of death should be legislatively enacted in relevant pieces of legislation which call for a resolution of the question at the present time and a more general separate statement defining death should be avoided at the moment. Conceptually death should be defined as the permanent and irreversible loss of consciousness of the individual as determined by irreversible cessation of the brain stem function. The actual operational criteria of death should form the subject of a circular published by the relevant statutory health authority for the guidance of medical practitioners in relation to the specific problems they face.

Australia↗