Assigning cause for sudden unexpected infant death.

We have reached a conundrum in assigning cause of death for sudden unexpected infant deaths. We summarize the discordant perspectives and approaches and how they have occurred, and recommend a pathway toward improved consistency. This lack of consistency affects pediatricians and other health care professionals, scientific investigators, medical examiners and coroners, law enforcement agencies, families, and support or advocacy groups.

Sudden and unexpected death in early life: proceedings of a symposium in honor of Dr. Henry F. Krous.

Reported here are the proceedings of a symposium given in honor of Dr. Henry F. Krous upon his retirement as Clinical Professor of Pathology and Pediatrics at the University of California Schools of Medicine, and as Director of the San Diego SIDS/SUDC Research Project.

Brain biomarkers for identifying excited delirium as a cause of sudden death.

Excited delirium (ED) syndrome is a serious medical condition associated with acute onset of agitated violent behavior that often culminates in a sudden unexplained death. While the contribution of restraint, struggle and the use of conductive energy devices (CED) to the cause and manner of death raise controversy, a CNS dysfunction of dopamine signaling may underlie the delirium and fatal autonomic dysfunction. We conducted a mortality review for a case series of ninety excited delirium deaths and present results on the association of a 2-protein biomarker signature.

Gamma-hydroxybutyrate withdrawal syndrome.

Study Objective: Gamma-hydroxybutyrate (GHB) withdrawal syndrome is increasingly encountered in emergency departments among patients presenting for health care after discontinuing frequent GHB use. This report describes the characteristics, course, and symptoms of this syndrome.

Methods: A retrospective review of poison center records identified 7 consecutive cases in which patients reporting excessive GHB use were admitted for symptoms consistent with a sedative withdrawal syndrome.

Fatal automobile crash caused by cerebral toxoplasmosis.

An unusual case of cerebral toxoplasmosis leading to a fatal vehicular crash is presented. Massive intracerebral hemorrhage, a rare complication of cerebral toxoplasmosis in persons with acquired immunodeficiency syndrome (AIDS), caused sudden onset of increased intracranial pressure that led to loss of control of the vehicle and an ensuing fatal traffic crash.

Sudden-onset fatal asthma. A distinct entity with few eosinophils and relatively more neutrophils in the airway submucosa?

To determine the histologic differences in the airways of patients who died from sudden-onset asthma and the more common slow-onset asthma, we studied seven cases of fatal asthma. The numbers of eosinophils and neutrophils, as well as extracellular deposition of their respective granule contents in the airway mucosa and submucosa, were determined and statistically analyzed. Four of the seven patients had slow-onset asthma attacks in which the time interval between onset of asthma and death was more than 2.

Evaluation and identification of dismembered human remains.

On occasion, pathologists are confronted with cases involving dismembered human remains. Such cases present unique and interesting problems of postmortem identification. Four cases involving dismembered human remains are presented here and practical suggestions on how identification can be achieved are provided.

Laboratory investigation of deaths due to anaphylaxis.

To establish a useful laboratory protocol to investigate possible cases of fatal anaphylaxis, we measured mast-cell-derived tryptase levels and allergen-specific immunoglobulin E (IgE) antibody levels in sera obtained prior to or within 24 h after death from 19 anaphylaxis victims. Elevated serum tryptase levels (range = 12 ng/mL to 150 micrograms/mL) were found in nine of nine Hymenoptera sting fatalities, six of eight food-induced fatalities, and two of two reactions to diagnostic therapeutic agents. Tryptase levels were normal (less than 10 ng/mL) in 57 sequential sera obtained postmortem from six control patients.

Native valve endocarditis due to Pseudallescheria boydii in a patient with AIDS: case report and review.

A 53-year-old man with AIDS developed mitral valve endocarditis due to infection with the fungus Pseudallescheria boydii. A limited number of cases of prosthetic valve endocarditis caused by this organism have been described. We report a unique case of pseudallescheria infection of a native valve and describe this disease in a patient with AIDS.

Lymphatic filariasis in Madras, India.

This study examines the state of mosquito-borne lymphatic filariasis in Madras, Tamil Nadu, in southern India during the 1970s and into the 1980s. In its various forms it remains a public health problem of considerable magnitude in many tropical countries and affects both rural and urban populations [1. World Health Organization (Third Report).

Utilization behaviour patterns of Siddha clinics in Salem, Tamil Nadu.

In Tamil Nadu, indigenous Siddha medicine (SM) is officially recognized and extensively used. Yet very little research information or published material is available on the extent of utilization behaviour of Siddha medicine in urban settings. This study examines the current patterns of utilization and consumer behavioural characteristics of SM through a field-based questionnaire survey of a sample of 300 patients attending 15 Siddha clinics in Salem, Tamil Nadu.

Development of a rural community health care model based on Indian indigenous system of medicine.

Based on the principles of primary health care as outlined by WHO at the Alma Ata Conference in 1978, many voluntary organizations in India have been formulating, organizing and experimenting with the comprehensive rural community health Schemes. The goal is to indentify the felt needs at both individual and community levels and facilitate direct participation in decision making, develop suitable alternative, ecologically Sound indigenous models for socioeconomic well-being. In this context the Indian system of medicine has a useful and complementary role to play in the preventive and curative aspects of primary health care programmes.

Delayed immune hemolysis in a patient receiving cyclosporine after orthotopic liver transplantation.

Immune hemolytic anemia in patients after organ transplantation has been reported generally to be graft-cell-derived due to elaboration by the donor's "passenger" lymphocytes of the antibodies directed against the recipient's red cell antigens. In contrast, this report presents a case that illustrates postoperative red cell alloantibody production by the recipient of an orthotopic liver transplant. Anti-Jka, -c, and -S, detected in the recipient's serum 9 days after transplantation, resulted in significant hemolysis.

Malignant neoplastic emboli to the coronary arteries: report of two cases and review of the literature.

Two patients were seen with malignant neoplastic emboli to the coronary arteries. One, a 61-year-old woman with a malignant fibrous histiocytoma of the thigh and a solitary pulmonary metastatic lesion, died of an acute myocardial infarction due to a neoplastic coronary embolus after lobectomy. The other, a 51-year-old woman with bronchogenic adenocarcinoma, died of extensive cerebral metastases.

Comparison of four leukocyte differential methods with the National Committee for Clinical Laboratory Standards (NCCLS) reference method.

The authors compared four leukocyte differential counting methods with the National Committee for Clinical Laboratory Standards Reference Leukocyte Differential Method H20-T to determine the clinical sensitivity of the methods. The three-part differential performed by the Coulter Counter Model S-Plus IV and the Toa E-5000, when combined with instrument flags and defined laboratory checking limits for red blood cell and platelet values, are safe and efficacious screening methods for the presence of morphologic abnormalities. The Geometric Data Hematrak 590 proved comparable in clinical sensitivity to a random 100-cell eye-count differential.

Geographical approach towards the study of health - care system.

In this study the authors discuss the emerging trends in geography of health and health care system in detail and analyses the position of geography of Health in India and abroad.

Urban malaria control situation and environmental issues, Madras City, India.

Madras was one of 22 urban places in India where centrally sponsored urban malaria control schemes were introduced in 1971-1972. Yet since 1970, malaria cases have actually registered a significant increase in Madras. This paper deals with some critical environmental issues facing malaria control schemes.

The scope and limitations of insecticide spraying in rural vector control programmes in the states of Karnataka and Tamil Nadu in India.

The resurgence of malaria in India began in 1966 and the states of Karnataka and Tamil Nadu were no exception to this phenomenon. In both states the peak occurrence came in 1976. Malaria was largely confined to highly vulnerable and receptive areas.