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At least 19 recordsLinked to original sources

[Multicentric reticulohistiocytosis (lipoid dermato-arthritis). Apropos of a case with fatal outcome].

The authors report the case of a 37-year-old man affected by a seronegative polyarthritis associated at first with erythroderma and then with cutaneous and subcutaneous papulo-nodular structures and a xanthomatous eryption. Histological examination of the cutaneous nodules and of the synovial membrane confirmed the diagnosis of multicentred reticulohistiocytosis by showing the presence of lipid infiltrates in the histiocyte cells and of multinucleate giant cells. A study of the ultrastructure of the histiocytes revealed the presence of numerous intracytoplasmic vacuoles. In spite of antimalaria treatment, with cortisone and then with immuno-depressants, the outcome was fatal with a picture of acute reticulosis and neurological disorders. In discussing this case, the authors also make a general review of the subject.

Adult

Factors affecting a fatal outcome in road accidents.

The North Report mentioned the question of whether charges and/or sentencing should be modified by fatal outcome following offences involving bad driving. This note classifies factors relating to the accident, the casualty and medical care which may, often fortuitously, determine a fatal outcome. It is suggested that these should be borne in mind in deciding offences and sentencing.

Accidents, Traffic

Traumatism with fatal outcome in maritime workers.

102 work-related injuries with fatal outcome among crews of ships of Northern Water Basin in Russia were analysed. The alcohol use and abuse was a major risk factor in accidents and fatal injuries in seafarers and fishermen. Medical and social aspects of the problem, and prevention measures were discussed.

Accidents, Occupational

Group B streptococcal infections in neonates and infants. Report of 16 cases, with referrence to the fatal outcome in late-onset leucopenic cases.

Sixteen cases of group B streptococcal (GBS) infections in neonates and infants aged up to 3 months were detected from November 1973 to January 1977. Three patients presented with pneumonia, 10 with meningitis and 3 with both pneumonia and meningitis. All diagnoses were confirmed by positive blood and/or cerebrospinal fluid cultures. The serotypes involved were type Ia (2 cases), type II (4 cases) and type III (10 cases). Ten patients died (62.5%). Early antibiotic treatment did not appear to affect the outcome, but low peripheral leucocyte count indicated a uniformly fatal outcome in 6 cases where leucopenia was documented, and this appeared to be associated with late-onset disease. The current status of GBS disease is presented, with particular reference to the control measures at present available and the possibility of immunotherapy and vaccination.

Diagnosis, Differential

Headache angina with fatal outcome.

We report 2 fatal cases of angina pectoris in patients who complained primarily of headache during the ischemic attack. The first patient, who was hospitalized because of headache and chest pain, demonstrated repeated ST-segment elevation and fatal ventricular fibrillation on ambulatory ECG monitoring. The second patient had post-infarction angina preceded by headache and by ST-segment elevation in the precordial leads. She eventually died of reinfarction. The mechanism of the headache in relation to the angina pectoris is discussed.

Aged

Cells containing Langerhans cell granules in human lymph nodes of "atypical hyperplasia" with fatal outcome and leukemic reticuloendotheliosis.

Langerhans cell granules could be found in atypical histiocytes in lymph nodes of three patients with "atypical hyperplasia" with fatal outcome and one patient with leukemic reticuloendotheliosis. These atypical histiocytes might be derived from immature mesenchymal cells in lymph nodes and the Langerhans cell granules might be induced in these cells by a particular condition. Only one of the Langerhans cell granules seemingly associated with the plasma membrane could be observed in these atypical histiocytes and all of the granules were seen within the cytoplasm. Quite a number of Langerhans cell granules were located near the Golgi apparatus. Several atypical granules very similar to the Langerhans cell granules could also be observed in these atypical histiocytes. These Langerhans cell granules were assumed to be directly derived from the Golgi apparatus and/or derived from the atypical granules which were secreted from the Golgi apparatus. The relationship between the Langerhans cell granules and the microtubules must also be considered, because Langerhans cell granules were found near the centrioles and microtubules.

Adult

Toxic idiopathic megacolon: fatal outcome in a mentally retarded adolescent.

The case of an 18-year-old mentally retarded boy who had long standing idiopathic megacolon and pica is presented. Acute toxic dilatation of the colon complicating pseudomembranous colitis developed, with a rapidly fatal outcome. No similar case of relatively benign idiopathic megacolon complicated by pseudomembranous colitis and toxic megacolon has been reported. The pathophysiology of this rare combination is discussed.

Adolescent

[Fatal outcome of emphysema without increased bronchial resistance and 6 cases of chronic dyspneic hypoxemic bronchial disease with normal spirometry].

The cases of seven patients with dyspnea, hypoxemia and normal ventilatory tests are presented. Closing volume was measured in 6 and was increased. Two were heavy smokers, 2 were obese, and 2 were exposed to inhalation of industrial irritants. The last patient had severe dyspnea and pronounced hypoxemia which eventually resulted in pulmonary hypertension and right ventricular failure. Lung scan was normal. Plethysmography showed normal bronchial resistance. Autopsy revealed chronic bronchitis, bronchiolectasis and emphysema. This case was interpreted as an example of fatal outcome of small airway disease.

Adult

Isolated biotin-resistant deficiency of 3-methylcrotonyl-CoA carboxylase presenting as a clinically severe form in a newborn with fatal outcome.

The son of Kurdish, consanguineous parents (cousin marriage) presented from the first day of life with initially focal and later generalized attacks of epileptic seizures and a severe generalized muscular hypotonia. Urinary excretion of 3-hydroxyisovalerate and of 3-methylcrotonylglycine was persistently increased. Diagnosis of isolated biotin-resistant 3-methylcrotonyl-CoA carboxylase deficiency was confirmed in cultured fibroblasts. Psychomotor retardation was progressive, seizures and marked EEG abnormalities persisted. Treatment with leucine and protein-resistricted diet under hospital control did not significantly improve these conditions. The patient died from a cardiac and circulatory failure after a prolonged epileptic attack, with bronchial aspiration. The non-responsiveness of our patient to therapy and the fatal outcome indicate the existence of a severe neonatal variant of this otherwise rather benign genetic enzyme deficiency.

Amnion

Significance of endocrine studies in the general assessment and prediction of fatal outcome in head injury.

Serial basal blood glucose, serum insulin, cortisol, growth hormone, glucagon and catecholamine examinations were performed in 81 brain-injured patients. 32 patients with severe injuries of other parts of the body (chest, abdomen, limbs or polytrauma), and 17 patients with non-traumatic acute brain lesions served as double control. In the brain-injured patients there is a close relation between changes of the state of consciousness and those of basal blood glucose levels: the deeper coma the higher and wider is the pathological glucose-level range. Four types of blood-glucose changes could be identified in the background of which different alterations of each hormone level were observed. Fatal outcome could be predicted in a non-diabetic patient in the first days when seeing: 1) Fasting hyperglycaemia above 14 mmol/l; 2) Fluctuating basal blood glucose levels between 5 and 22 mmol/l; 3) Deeply depressed and unchanged basal insulin level; 4) Extremely high cortisol level; 5) Decreased plasma epinephrine level. These changes in the carbohydrate metabolism seen after acute brain lesions are not identical to diabetes mellitus.

Blood Glucose

[Intravenous abuse of crushed tablets. A case with fatal outcome].

We present a case of fatal vascular destruction and granulomatosis of the lungs from intravenous injections of dissolved tablets containing microcrystalline cellulose as filler material. Numerous microcrystalline cellulose pulmonary emboli and foreign body granulomas were detected, and the pulmonary parenchyma showed signs of disturbed circulation with focal necrosis and oedema.

Adult

[Accidents with fatal outcome in Finnish leisure boating 1986-1988].

All 291 fatal accidents (510 persons on board, 318 drowned) in water traffic in Finland in 1986-1988 were investigated by specific teams. Only some data of this extensive investigation are presented in this study. Staggering and falling in boat because of drunkenness, falling over and sinking of boat were the main causes of getting into water of the people aboard. Only 3.5% of the drowned had used life jackets and 9.7% of them could not swim. The reduced ability to swim because of alcohol and the exhaustion were in about half of the drowned the actual cause and the cold water in one third the background factor for drowning. The results indicate that fatal accidents in water traffic are a major problem of males (95.9%) and give important information for countermeasures.

Cause of Death

Multiple hornet (Vespa orientalis) stings with fatal outcome in a child.

A case of multiple hornet stings is described with a rapidly fatal course due to the combination of massive haemolysis, coagulopathy, rhabdomyolysis, hyperkalaemia, acute renal failure, encephalopathy, hepatotoxicity and hyperglycaemia. These features of systemic envenomation can all be attributed to the toxic properties of Oriental hornet venom described in in vitro and in vivo experimental studies. Greater awareness of these features, aggressive treatment of hyperkalaemia and early institution of treatments such as peritoneal dialysis and plasma exchange may prevent fatalities in such cases.

Acute Kidney Injury

[Scedosporium inflatum, a new pathogenic fungus. Report of 2 cases with a fatal outcome].

Scedosporium inflatum is a newly described human pathogen, their infections primarily involved musculoskeletal tissues. We report 2 fatal cases with disseminated S. inflatum infections in Spanish patients. The fungus was isolated from blood in both cases. Amphotericin B treatment was ineffective. In vitro susceptibility testing of one isolate against 7 antifungal agents is done. These cases illustrate the need to remain vigilant for this new emerging pathogen.

Aged

Acute scleredema with fatal outcome.

Death due to scleredema is rare. We report a patient with scleredema, which had an acute onset and rapid progression, leading to death within a month. Such an acute course terminating in fatality has not been described earlier.

Acute Disease

Fatal outcome arising from use of a sutureless "corkscrew" epicardial pacing electrode inserted into apex of left ventricle.

A 59-year-old man is described in whom the insertion of an epicardial sutureless "corkscrew" electrode resulted in fatal ventricular perforation. Fatal myocardial perforation can occur with this electrode and the apex of the left ventricle should never be used as the site of insertion. Necropsy also showed that the transvenous right ventricular electrode, inserted one year previously, had penetrated a tricuspid leaflet. This could have accounted for the ensuing pacing failure.

Electrodes, Implanted