SUDDEN AND UNEXPECTED DEATH IN INFANCY AND CHILDHOOD

PEDIATRICS ◽  
1956 ◽  
Vol 17 (5) ◽  
pp. 663-699 ◽  
Author(s):  
Lester Adelson ◽  
Eleanor Roberts Kinney

One hundred twenty-six consecutive cases of sudden and unexpected death in children between the ages of 10 days and 2 years were studied. Anatomic and microbiologic studies were carried out and an investigation was made at the home in each case. Both sexes were equally vulnerable. Eighty-five per cent of the children were less than 6 months old. The peak incidence was at 2 months. Ninety-nine children were found dead and 27 were observed to die. The same variety and severity of anatomic lesions were found in both categories. Sixteen children in the same age range who died rapidly following known lethal voilence were studied as a control group. Of the nontraumatic sudden death ("unexplained") series 106 (84 per cent) revealed microscopic inflammatory changes in 1 or more sites of the respiratory tract, and histologic evidence of inflammatory disease in other organs was seen in many cases. Acute hemorrhagic pulmonary edema was a common anatomic finding (82 per cent). It was usually accompanied by visceral and cerebral congestion and hemorrhages. Special investigative procedures including staining of the liver for glycogen, determination of the glucose level of the cerebrospinal fluid and study of the adrenals for sudanophilia and birefringence indicated that these factors are without significance in sudden death in early life. A variety of congenital and acquired abnormalities, the presence of which had been unsuspected, was demonstrated at necropsy. Eleven per cent of the 126 cases showed no anatomic abnormalities other than the circulatory phenomena. No single bacterial organism or group of organisms was isolated with any degree of consistency from any site. All attempts to isolate viruses were negative. Ante-mortem symptomatology, circumstances of death, history of contact with infectious disease, and past history of repeated respiratory infection were without prognostic significance and were not pathognomic as to the cause of death. Eighty children had histories of mild illness for 48 hours or less prior to death. Fifty-three children had received some form of treatment during this interval. Sixty-nine children had histories of contact with infectious diseases. Forty-one children had past histories of repeated respiratory infections. The cases came from every social level. Sixty-five per cent had received good care while 35 per cent had received poor care. Many of the control cases showed inflamatory disease in the respiratory tract similar to that seen in the natural death group as well as anatomic evidence of lethal trauma. The inflammatory lesions are thus not incompatible with life. Several hypotheses are offered in an effort to link microscopic inflammatory respiratory tract changes with hemorrhagic pulmonary edema and sudden death. Anatomic and anamnestic evidence exclude mechanical suffocation by bedding. No statement as to the cause of death of an infant who has died suddenly and unexpectedly should be made without complete gross and microscopic studies and thorough investigation of the scene and circumstances of death.

1996 ◽  
Vol 81 (2) ◽  
pp. 922-932 ◽  
Author(s):  
A. Podolsky ◽  
M. W. Eldridge ◽  
R. S. Richardson ◽  
D. R. Knight ◽  
E. C. Johnson ◽  
...  

Ventilation-perfusion (VA/Q) mismatch has been shown to increase during exercise, especially in hypoxia. A possible explanation is subclinical interstitial edema due to high pulmonary capillary pressures. We hypothesized that this may be pathogenetically similar to high-altitude pulmonary edema (HAPE) so that HAPE-susceptible people with higher vascular pressures would develop more exercise-induced VA/Q mismatch. To examine this, seven healthy people with a history of HAPE and nine with similar altitude exposure but no HAPE history (control) were studied at rest and during exercise at 35, 65, and 85% of maximum 1) at sea level and then 2) after 2 days at altitude (3,810 m) breathing both normoxic (inspired Po2 = 148 Torr) and hypoxic (inspired Po2 = 91 Torr) gas at both locations. We measured cardiac output and respiratory and inert gas exchange. In both groups, VA/Q mismatch (assessed by log standard deviation of the perfusion distribution) increased with exercise. At sea level, log standard deviation of the perfusion distribution was slightly higher in the HAPE-susceptible group than in the control group during heavy exercise. At altitude, these differences disappeared. Because a history of HAPE was associated with greater exercise-induced VA/Q mismatch and higher pulmonary capillary pressures, our findings are consistent with the hypothesis that exercise-induced mismatch is due to a temporary extravascular fluid accumulation.


2008 ◽  
Vol 132 (12) ◽  
pp. 1903-1906
Author(s):  
Amy C. Gruszecki ◽  
Gerald McGwin, Jr ◽  
C. Andrew Robinson, Jr ◽  
Gregory G. Davis

Abstract Context.—Forensic pathologists regularly investigate the deaths of individuals with a history of drug abuse. Autopsy, including toxicology testing, reveals no cause for death in a subset of this cohort. Objective.—To determine whether deaths with an undetermined cause and manner of death are associated with a history of drug abuse. Design.—Retrospective matched case-control study of 52 decedents whose cause of death remained undetermined following autopsy, matched 1:2 to a control group of living patients admitted for cholecystectomy according to age and date of death or procedure. Results.—Individuals whose cause of death was undetermined were 5.3 times (95% confidence interval, 1.9– 14.5) more likely to have a history of drug abuse than were patients with cholecystitis. Conclusions.—Decedents with a history of chronic drug abuse appear to be at an increased risk of dying by their chronic drug abuse, even in the absence of any anatomical or toxicologic finding at autopsy to account for death.


2021 ◽  
pp. 34-37
Author(s):  
B. Yu. Kuzmichev ◽  
O. S. Polunina ◽  
L. P. Voronina ◽  
T. V. Prokofieva ◽  
E. A. Polunina

Objective. To create a personalized mathematical model of the development of complications – cardiogenic shock and pulmonary edema in patients with myocardial infarction (MI) with chronic obstructive pulmonary disease (COPD) depending of the homocysteine (HCY) level and the COPD phenotype.Materials and methods. The study included 88 patients with MI and COPD with various phenotypes: 25 patients with emphysematous phenotype, 22 patients with a mixed phenotype, 20 patients with chronic bronchitis phenotype, 21 patients with eosinophilia and bronchial asthma (BA). As a control group, 50 somatically healthy individuals were examined. Gender anamnestic, clinical, and laboratory – instrumental indicators were studied and analyzed to develop a predictive mathematical model. The level of HCY was determined by enzyme-linked immunosorbent assay in all patients.Results. It was found that in patients with MI and COPD with different COPD phenotypes, the level of HCY was statistically significantly higher than in the control group. The highest level of HCY was in patients with the chronic bronchitis phenotype and was 45 [14.1; 51.9] mmol/l, which was statistically significantly higher than in patients with the phenotype with eosinophilia and BA, with emphysematous and mixed phenotypes. Predictor factors were selected using the logit regression method from gender-anamnestic, clinical, and laboratory – instrumental indicators to create a mathematical model with the highest prediction accuracy. HCY level and COPD phenotype were predictors of the mathematical model for predicting the development of complications – cardiogenic shock and pulmonary edema in patients with MI and COPD. It was also found that the threshold value of HCY for predicting the development of cardiogenic shock and pulmonary edema in patients with MI and COPD was 0.82 ± 0.51 confidence interval [0.72–0.91] mmol/l (p < 0.001).Conclusion. The personalized mathematical model initiated for predicting the development of complications-cardiogenic shock and pulmonary edema in patients with MI and COPD, depending of the HCY level and the COPD phenotype, has a high sensitivity (85%) and prognostic significance (92%), which allows us to recommend it for use in clinical practice.


2020 ◽  
Vol 73 (11) ◽  
pp. 2416-2420
Author(s):  
Olena О. Taranovska ◽  
Volodymyr К. Likhachov ◽  
Ludmyla М. Dobrovolska ◽  
Oleg G. Makarov ◽  
Yanina V. Shymanska

The aim: To determine the serum FAMG in the I and II trimester of pregnancy in women with a past history of chronic endometritis, and to clarify its impact on the development of pathology of pregnancy. Materials and methods: The level of FAMG was determined at 6-8 and 16-18 weeks of gestation in 135 pregnant women with a past history of chronic endometritis, who received treatment of chronic endometritis at the stage of pregravid preparation and 168 women who became pregnant without its prior treatment. The dependence of the development of pre-eclampsia on the level of FAMG at the early stages of pregnancy has been evaluated. Results: At 6-8 weeks of pregnancy, the level of FAMG in women with a past history of chronic endometritis was 20.6% lower (122.4 ± 7.6 ng/ml) compared to the control group. In FAMG of 90.3 ± 4.3 ng/ml at 6-8 weeks of gestation, spontaneous abortion occurred in 100% of cases within the next 2 weeks. FAMG lower than 122,1 ± 3,0 ng/ml can be the predisposing factor for the development of pre-eclampsia. Conclusions: Reduced FAMG in the beginning of pregnancy in women with untreated chronic endometritis in the past history increases the incidence of miscarriages at the early stages by 2.6 times, and by 1.8 times the probability of preeclampsia development. Treatment of chronic endometritis at the stage of pregravid preparation promotes the increase of FAMG by 24,6% compared to untreated women that reduces the probability of complications during the subsequent course of pregnancy.


2017 ◽  
Vol 13 (3) ◽  
pp. 285-291 ◽  
Author(s):  
Frederik Nybye Ågesen ◽  
Bjarke Risgaard ◽  
Sára Zachariasardóttir ◽  
Reza Jabbari ◽  
Thomas Hadberg Lynge ◽  
...  

Background Stroke is the fifth leading cause of death in young individuals globally. Data on the burden of sudden death by stroke are sparse in the young. Aims The aim of this study was to report mortality rates, cause of death, stroke subtype, and symptoms in children and young adults who suffered sudden death by stroke. Methods We conducted a retrospective, nationwide study including all deaths within Danish borders between 2000–2009 and 2007–2009 in persons aged 1–35 years and 36–49 years, respectively. Two physicians identified all sudden death cases through review of all death certificates. All available autopsy reports and records from hospitals and general practitioners were retrieved and a neurologist identified all sudden death by stroke cases. Results Of the 14,567 deaths in the 10-year period, there were 1,698 sudden death cases, of which 52 (3%) were sudden death by stroke. There was a male predominance (56%) and the median age was 33 years. The incidence of sudden death by stroke in individuals aged 1–49 years was 0.19 deaths per 100,000 person-years. Stroke was hemorrhagic in 94% of cases, whereof subarachnoid hemorrhage was the cause of death in 63% of cases. Seventeen (33%) cases contacted the healthcare system because of neurological symptoms, whereof one was suspected of having a stroke (6%). Conclusions Sudden death by stroke in children and young adults occurs primarily due to hemorrhagic stroke. We report a high frequency of neurological symptoms prior to sudden death by stroke. Increased awareness among healthcare professionals towards stroke symptoms in children and young adults may lead to earlier detection of stroke, and thereby potentially lowering the incidence of sudden death by stroke.


2017 ◽  
Vol 98 (6) ◽  
pp. 921-927 ◽  
Author(s):  
S P Kokoreva ◽  
O A Razuvaev

Aim. To identify risk factors for mycoplasma pneumonia at the outbreak of respiratory mycoplasmosis in the children’s collective using a comprehensive statistical analysis. Methods. 120 children aged 12-15 years from the focus of respiratory mycoplasmosis outbreak were observed. They were divided into two groups: study group - 33 children with mycoplasma pneumonia, and control group - 56 children from the focus of infection, 14 of which during the observation period had no disease simptoms, and 42 children had other forms of respiratory mycoplasmosis. Results. 6 factors influencing the development of mycoplasma pneumonia were identified in children from the focus of respiratory mycoplasmosis outbreak. The correlation analysis was performed and one-dimensional models of the chance of developing pneumonia were constructed by calculating odds ratios. Past history of pneumonia increases the risk for pneumonia by 23.46 times, passive smoking in a child - by 2.77 times. At the same time, emergency prevention with immunotropic drugs reduces the risk for pneumonia by 8.93 times, daily walking - by 3.31 times, walking for more than 2 hours - by 3.83 times, increasing fruit in the diet - by 3.09 times and taking multivitamins - by 2.56 times compared to cases when these measures were not taken. The binary logistic regression was calculated to build a multidimensional research model. The sensitivity of this model was 87.88%, specificity - 91.07%. Conclusion. At the outbreak of respiratory mycoplasmosis the risk factors for the development of mycoplasmal pneumonia are pneumonia in past medical history, smoking in a child’s family; preventive measures are long-term daily exposure to fresh air, emergency prevention with immunotropic, complex multivitamin preparations with trace elements and lactic acid bacteria, dietary intake corrected for fruit intake.


2017 ◽  
Vol 29 (4) ◽  
pp. 457-464 ◽  
Author(s):  
Josepha DeLay

Postmortem lesions and cause of death were evaluated retrospectively for 963 horses examined as part of the Ontario Racing Commission Death Registry over a 13-y period. The Death Registry was established in 2003 to identify factors leading to death or euthanasia of racehorses in this Canadian province. Postmortem examination was carried out on 56% of horses reported to the Death Registry and included Standardbred, Thoroughbred, and American Quarter Horses. Musculoskeletal injury was the most common reason for death associated with racing or training among all racehorses and involved 68% of horses. A history of sudden death during or immediately following exercise was described for 31% of racing- or training-associated deaths, and in 16% of all horses in the study. Sudden death occurred in horses of all breeds, and our report describes lesions associated with sudden death in a series of Standardbreds. The cause of death in these cases was most frequently attributed to cardiopulmonary lesions. The cause of death was undetermined in 20% of sudden death cases, and it is speculated that cardiac arrhythmia may have contributed to these deaths. Injection-associated death was documented in 4% of the study population. Lesions among horses whose death was not associated with exercise were similar to those in other equine populations, and lesions involving the gastrointestinal system were most common. Standardization of pathology reporting of pulmonary and other lesions in racehorse postmortem cases would allow direct comparison of results among racehorse populations.


Author(s):  
Q Zhang ◽  
LC Ang

Premature mortality among epilepsy patients is well recognized. Except a few identifiable causes of unnatural death, more than half of the epilepsy related death remains unexplained after extensive workup. These cases are classified as sudden unexpected death in epilepsy (SUDEP). SUDEP incidence varies significantly depending on the population, the methods documenting cause of death and the availability of Neuropathological examination. An accurate diagnosis of the cause of death is needed for epilepsy related death. The goal of this study is to present the relevant clinical data, the general autopsy and Neuropathology findings of epilepsy related death investigated in London Health Sciences Center during the period of 2000 to 2011. We identified 71 cases with known history of chronic epilepsy. In the 29 cases of epilepsy associated death, the causes of death have been classified as cardiac, pulmonary, accidental (e.g. drowning), toxic (e.g. drug overdose) and non-related causes. Forty two cases are considered to be SUDEP, and were categorized according to the recently proposed SUDEP Definition and Classification. Half of the SUDEP cases have no specific Neuropathological findings. The most common identifiable lesions in SUDEP cases are perinatal/neonatal destructive lesions (29%), hippocampal sclerosis (24%), and focal cortical dysplasia (20%). These are followed by neuronal heterotopia (9%), previous head trauma (9%), and cavernoma (5%).LEARNING OBJECTIVESThis presentation will enable the learner to:1.Review cause of death in epilepsy related deaths2.Discuss the practice guideline in neuropathology autopsy of epilepsy related deaths


2019 ◽  
Vol 7 ◽  
pp. 817-823
Author(s):  
Rokas Šimakauskas ◽  
Martinas Baltuonis ◽  
Sigitas Laima ◽  
Sigitas Chmieliauskas ◽  
Dmitrij Fomin ◽  
...  

Introduction. Pulmonary thromboembolism (PTE) is not an uncommon cause of sudden, unexpected death. Autopsy is the gold standard for cause of death determination in cases of suspected PTE. Mortality rates due to PTE are not estimated accurately. Objective. The aim of this study was to analyze distribution patterns and risk factors of sudden deaths due to PTE. Methods. Retrospective analysis of Lithuanian State Forensic Medicine Service autopsy data, period 2014-2018. A total of 4533 cases were reviewed; 80 cases met the criteria of immediate cause of death being PTE and were included in the study. PTE epidemiology, risk factors, clinical and pathoanatomical characteristics were described by reviewing scientific literature and statistical databases. Results. PTE as the cause of sudden death was diagnosed in 37(46.25%) men and 43(53.75%) women. Median age at the time of death was 62.8±17.2 years. Death occurred in hospital in 21(26.25%) cases. Trauma was the underlying cause of PTE in 11(13.75%) cases; 9(81.8%) patients were admitted to hospital after a traumatic event. Cardiac hypertrophy was observed in 70(87.5%) autopsies. Abdominal subcutaneous fat thickness was 4.08±2.64 cm in men and 5.35±2.69 cm in women. Deep vein thrombosis (DVT) was confirmed upon microscopic examination in all cases, being the underlying cause of death in 67(83.75%) cases. Conclusion. Sudden death due to PTE usually occurs at an older age and in absence of medical care. PTE is common after sustaining severe traumatic injuries which, when not immediately lethal, are managed in hospital. Cardiac hypertrophy and obesity may increase risk of death due to PTE. Undiagnosed and untreated DVT is often the underlying cause of sudden death due to PTE.


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