Preexcitation in Hypertrophic Cardiomyopathy: A Case of a Fasciculoventricular Mahaim Fiber

STELLBRINK, C., et al .: Preexcitation in Hypertrophic Cardiomyopathy: A Case of a Fasciculoventricular Mahaim Fiber . A patient with hypertrophic cardiomyopathy (HCM) who presented with preexcitation pattern on the surface ECG suggestive of the Wolff-Parkinson-White (WPW) syndrome is described. Intracardiac electrophysiological study revealed a fixed anomalous QRS complex and a short fixed His-ventricular interval indicating a fasciculoventricular Mahaim fiber. As this specific form of accessory connection does not cause reentrant tachycardias, no treatment was required. It is important to distinguish this entity from atriofascicular or nodoventricular Mahaim fibers or the WPW syndrome in patients with HCM showing a preexcitation pattern in the surface ECG, as these may cause life-threatening arrhythmias in this patient population.     

广州市越秀区居民人口类型及死因统计分析

本文整理分析了广州市越秀区1980—1986年居民的人口年龄类型及死亡情况,该区居民的年龄中位数30.3岁,65岁及以上人口百分比为7.39％,人口年龄类型已踏入老年型,而从该区的死亡情况来看,前六位死因依次为恶性肿瘤、心脏病、呼吸系统病、脑血管病、消化系统病及意外伤亡,死亡率分别为141.76/10万、119.03/10万、107.78/10万、97.15/10万、28.14/10万、和24.81/10万,除意外伤亡外,前五位死因都是50岁以上死亡率明显升高,说明该区今后的卫生保健工作,应重视人口老龄化的问题,实做好老年性疾病的防治工作。     

Fatal poisonings in Jutland (Denmark) during the 1980s

Summary During the period 1980 through 1989 a total of 1029 cases of fatal poisoning (638 men and 391 women) were examined at the Department of Forensic Medicine, Aarhus University, Denmark. In 68% of the cases death had been caused by drugs, whereas acute alcohol poisoning and carbon monoxide accounted for 15% and 14% of the cases, respectively. Alcohol was detected in more than half of the 1029 fatal poisoning cases, and in 42% of all cases the blood alcohol concentration was above 0.8 g/kg. In 57% of the cases death was categorized as accidental, only in 31% of the cases as suicide. Accidental deaths were especially predominant amongst drug and/or alcohol abusers. Propoxyphene was the drug found to have caused most fatal poisonings during the decade (30% of the drug-related deaths). Most of the propoxyphene-related deaths occurred during the early and mid-eighties. Barbiturate poisonings were quite frequent during the first half of the eighties. However, the number of deaths caused by barbiturates decreased significantly after 1986, when most barbiturates were withdrawn from the market. The number of deaths caused by narcotics and analgesics increased during the survey period, while no specific tendency was observed concerning antidepressants.     

Unusual presentation and clinical variability in Belgian pedigrees with progressive external ophthalmoplegia and multiple deletions of mitochondrial DNA

We studied 14 patients from three unrelated Belgian pedigrees with a familial mitochondrial disorder and multiple deletions of mitochondrial DNA (mtDNA). In one family with an oculopharyngeal presentation there is a clear autosomal dominant inheritance. Progressive external ophthalmoplegia (PEO), “ragged red fibres” (RRF) and multiple deletions of mtDNA are common to all three families. Therefore a diagnosis of autosomal dominant progressive ophthalmoplegia with multiple deletions of mtDNA (adPEO) was made in one family at least. Our data confirm the previous observations that adPEO is a systemic disorder rather than a pure myopathy. In our pedigrees frequently associated features include axonal peripheral neuropathy, dysphagia, psychiatric illness, and sudden death. Mild ataxia, pes cavus and mitral valve prolapse with associated mitral insufficiency also occur. In some cases onset is atypical with neuropathy, adolescent onset myopathy or psychiatric illness. In such cases the common features of PEO and muscle weakness always complete the clinical phenotype later during the course of the disease. Biochemical studies on mitochondrial fractions prepared from one patient's muscle, revealed no abnormalities of respiratory chain enzyme activities.     

Cause of death after critical illness

This study reports the causes of death after discharge following treatment of life-threatening illness on an Intensive Therapy Unit. Details of survivors discharged between June 1985 and December 1988 were sent to the Registrar General for Scotland who subsequently issued copies of death certificates of those patients who had died between discharge and 1 January 1990. The results show that the commonest causes of death after discharge were malignancy and respiratory failure, although there is wide variation in the post-discharge mortality rates for different diagnostic categories. The admission diagnoses were identical to, or contributed to, the causes of death in 64% of patients who died after discharge. Eighty-five percent of patients who died from the same condition which prompted admission did so within a year following discharge, but after 2 years no deaths were attributed to the admission diagnosis.     

Effects of cadaver dissection on the attitudes of medical students

Summary: Summary. A study was conducted to determine whether the attitudes of medical students to death and caring changed during the 3 months following exposure to cadaver dissection. All first-year students were invited to complete a questionnaire immediately before their initial cadaver dissection experience, after 6 weeks, and after a further 3 months. The questionnaire reflected attitudes to death, violent death, death of someone known to the respondent and caring when someone known to the respondent is seriously injured. Ethnicity and previous exposure to dying has no effect on responses, but overall men students' reactions were significantly less than for women ( P < 0.001). The responses given on the final part of the questionnaire after 3 months were significantly lower than those to most questions in the first part of the questionnaire. The exceptions were those questions where the subject in the given scenario was known to the respondent, where reactions were rated significantly greater ( P < 0.001) in the follow-up questionnaire and can be explained on the basis that they were a personal referent.
Students rapidly develop a coping mechanism which enables them to view cadaver dissection as an occupation quite divorced from living human beings. During these early months of training solicitude decreases for those who die who are unknown to them, but concern for personal referents increases. Educators should be aware of the dramatic change of attitudes among students and the process of professionalization which might influence their caring of future patients.     

19例SARS死亡病例临床分析

为分析严重急性呼吸综合征(SARS)死亡患者的临床特征、治疗及死亡相关因素,对2003年5月6日至6月27日收治的220例SARS患者中19例死亡患者的临床、实验室、影像学资料、临床治疗及死亡相关因素进行回顾性分析。结果19例死亡SARS患者年龄24～86岁,平均(57.63±16.76)岁。大于45岁13例(68.4%)。男性15例(78.9%),女性4例(21.1%)。有明确接触史19例(100%)。并存基础病13例(68.4%)。死亡距发病时间14～54d,平均(35.37±11.66)d。临床表现主要有发热19例(100%),咳嗽12例(63.2%),畏寒5例(26.3%),气促10例(52.6%),胸闷11例(57.9%),肌痛5例(26.3%),腹泻6例(31.6%)。实验室检查血常规中早期白细胞总数正常或降低,淋巴细胞降低。血气分析低氧血症16例(84.2%);心肌酶肌酸激酶心肌型同工酶(CKMB)、乳酸脱氢酶(LDH)、α羟丁酸脱氢酶(HBDH)随病情的严重程度而进行性升高。T细胞亚群CD3、CD4、CD8绝对值随病情的严重程度而进行性降低。胸部X线双侧、肺病变面积>1/3者19例(100%)。临床诊断继发混合感染(细菌、真菌)19例(100%)。采用综合治疗,其中激素18例(94.7%)、机械通气15例(78.9%)。死于呼吸衰竭18例(94.7%)。提示年龄、合并基础病、肺部病变程度、低氧血症、T细胞亚群CD3、CD4绝对值降低、激素剂量、混合感染等是影响S     

37例创伤死亡病例分析

本文对住院因外伤致死者进行了一般分析，说明创伤造成死亡占总死亡人数之６３。７％，而其中６５％均为青壮年和中年，并着重对颅脑损伤的死亡情况加以分析，提出对特重型颅脑外伤当非手术疗法无效时，应行手术探查减压，另外对腹部挫伤和烧伤及开放性骨折引起死亡的病例进行了讨论。     

Cellular degeneration and synaptogenesis in the developing retina of the rat

We have investigated the time course and magnitude of cellular degeneration in the ganglion cell layer and the presumptive amacrine and bipolar regions of the inner nuclear layer during the development of the retina in the rat. Pyknotic profiles are present in the ganglion cell layer during the first 2 postnatal weeks, reaching peak numbers during the first 4 postnatal days (corresponding to the time of greatest loss of ganglion cells and their axons: Potts et al., '82; Lam et al., '82; Perry et al., '83). Two observations suggest that the majority of pyknotic profiles present in the ganglion cell layer during the second postnatal week are not ganglion cells. First, following injection of kainic acid into one superior colliculus, degenerating ganglion cells in the contralateral retina are cleared within 24-48 hours. Therefore, since most ganglion cell and axon loss occurs within the first postnatal week, few of the pyknotic profiles present in the second week are likely to be ganglion cells. Second, the time course of cellular degeneration in the ganglion cell layer during the second postnatal week follows a very similar pattern to that seen in the presumptive amacrine sublayer of the inner nuclear layer. Such a correspondence suggests that two phases of cell death occur in the ganglion cell layer: during the first postnatal week the majority of dying cells are ganglion cells, and in the second, most cell death is due to a loss of displaced amacrine cells. In the inner nuclear layer pyknotic profiles are most numerous in the presumptive amacrine region on postnatal days 6 and 7, and in the presumptive bipolar region on day 10. Synaptogenesis in the inner plexiform layer occurs later but reflects the order of cell death. Thus, conventional (presumed amacrine) synapses were first observed on day 11 and synaptic ribbons (indicative of bipolar synapses) on day 13. These observations suggest that amacrine and bipolar cells initiate synapses only after their numbers have stabilized.