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At least 19 recordsLinked to original sources

Effects of dependency among causes of death for cause elimination life table strategies.

A study is made of the effects of associated causes of death, and of dependency among causes of death, by observing the relative importance of one cause of death when another is eliminated under various competing risk models. Two disease pairs, cancer and infectious disease and stroke and ischemic heart disease, are selected for analysis because they represent different types of disease dependence. Crude probabilities of death for each disease are calculated for the U.S. white male population in 1969. Next, the effects of the complementary disease in a pair are hypothetically eliminated in one of three ways: (a) a standard competing risk adjustment for cause elimination when deaths are singly caused (Chiang, 1968), (b) lethal defect-pattern of failure computations for multiply caused death when no causal order is inferred (Manton et al., 1976), and (c) relative susceptibility, computations for multiply caused deaths when causes are ordered (Wong, 1977). The paper closes with a discussion of the relative merits of the three types of adjustments.

Actuarial Analysis

[Sudden death caused by massive air embolism during respirator therapy in the newborn].

A premature male infant with hyaline membrane disease succumbed suddenly during continuous positive pressure respirator therapy. Autopsy revealed a very rare complication to be the cause of sudden death: air embolization to pulmonary veins, right ventricle and superior and inferior venae cavae as well as interstitial and subpleural emphysema, pneumothorax, pneumomediastinum and pneumopericardium. The important role of lymphatic vessels as a port of entry for air is stressed.

Embolism, Air

Death caused by recreational cocaine use.

Sixty-eight deaths associated with the recreational use of illicit cocaine were investigated by the Medical Examiner's Office of Dade County in Florida. Most fatalities occurred since 1975. Although 29 involved the use of other drugs (usually heroin), 24 persons died directly of the toxic effects of cocaine. Respiratory collapse and death occurred rapidly after the intravenous injection of cocaine. Oral or nasal ingestion resulted in a symptom-free interval lasting as long as an hour followed suddenly by generalized seizures and death. Toxicological analysis could not causally relate lidocaine hydrochloride or other adulterants to the untoward reactions. The data suggest that the rate of absorption, the peak blood concentration, and the prior use of cocaine all contribute to the possibility of a fatal reaction. Despite current belief, cocaine cannot be considered a safe recreational drug.

Adolescent

Sudden death caused by interaction between a macroglobulin and a divalent drug.

Intravenous injection of the divalent X-ray contrast medium ioglycamic acid ("Biligram") induced intravascular precipitation and sudden death of a patient owing to reaction with his monoclonal macroglobulin. Mice reacted similarly in passive transfer experiments. The corresponding monovalent compound, acetrizoic acid, was also bound to the IgM but did not induce precipitation and had no apparent ill-effects on mice in passive transfer experiments.

Animals

Death caused by brain herniation during hemodialysis.

Brain edema with brain herniation during or after dialysis has been reported previously. However, coexisting lesions of the central nervous system (CNS) which might play a facilitating role were present in these case reports. Described here is an 18-year-old white man with renal failure who developed clinical signs consistent with brain herniation while receiving his first hemodialysis treatment. He died two days later, after discontinuation of the supportive therapy and after the confirmation of brain death. Autopsy results documented brain edema with uncal and cerebellar tonsillar herniation without other coexisting pathologic lesions. The etiology of brain edema during the initial phase of dialysis is discussed.

Adolescent

[2 cases of death caused by hepatic insufficiency after jejuno-ileal bypass for obesity].

Reference is made to 2 cases of fatal liver failure following jejuno-ileal by-pass for obesity, in which necropsy shown micronodular and the rarer fragmentary necrosis, in addition to serious steatosis. Liver alterations following by-pass are usually reversible and respond to the infusion of medicaments. The indication for surgical re-establishment of continuity, in which, if timely, leads to normalisation of liver shape and function, must be chosen without hesitation when changes, albeit reversible, appear to threaten life and resist treatment, and in all cases where biopsy points to progression towards irreversible sclerosis.

Adult