Concentrations of antimony in infants dying from SIDS and infants dying from other causes

BACKGROUND—A patient with cystic fibrosis (CF) and repeated calcium oxalate renal stones prompted us to investigate other children for risk factors for this recognised complication of CF.
METHODS—Twenty four hour urinary excretion of calcium, oxalate, and glycolate was measured in children with CF and no symptoms of renal tract stones. Normal diet and treatments were continued.
RESULTS—In 26 children (aged 5-15.9 years) oxalate excretion was correlated with age; 14 of 26 children had oxalate excretion above an age appropriate normal range. There was a positive correlation between oxalate excretion and glycolate excretion. Mean calcium excretion was 0.06 mmol/kg/24 h with 21 of 24 children having calcium excretion below the normal range.
CONCLUSIONS—Hyperoxaluria may reflect malabsorption although correlation between excretion of oxalate and glycolate suggests a portion of the excess oxalate is derived from metabolic processes. The hypocalciuria observed here may protect children with CF from renal stones.

     

Concentrations of antimony in infants dying from SIDS and infants dying from other causes.

OBJECTIVES: Raised concentrations of antimony have been found in infants dying of sudden infant death syndrome (SIDS). The presumed source of this antimony is toxic gases generated from fire retardants that are present in cot mattresses. The aim of this study was to determine the role of antimony in SIDS. DESIGN: Samples of liver, brain, serum, and urine were collected from all patients dying from SIDS and a group of aged matched control infants who had died of other causes. SETTING: Nationwide study in Ireland. SUBJECTS: 52 infants dying from SIDS and 19 control infants aged > 7 days and < 1 year. RESULTS: The median concentration of antimony in the liver and brain of infants dying of SIDS was < 1 ng/g, with no difference detected between the infants dying from SIDS and the control infants. The range of antimony in the serum of infants dying of SIDS was 0.09-0.71 microg/litre (median, 0.26). Although no difference was found between infants dying from SIDS and control infants, SIDS infants were found to have higher concentrations when compared with healthy infants in the 1st year of life, probably as a result of release of antimony into serum after death. Urine antimony concentrations in infants dying from SIDS were < 3.91 ng/mg (corrected for creatinine) and similar to values found both in control infants and healthy infants. CONCLUSION: There is no evidence to support a causal role for antimony in SIDS.     

The dying child and overt parental behavior.

In order to study the immediate grief reaction in parents of children dying in the hospital each parental reaction was scored on a 'grief reaction and intervention' (GRI) scale (minimum 0; maximum 4). The death events of 73 children comprised the study. The GRI score was 0 in 10 (13.7%), 1 in 19 (26.1%), 2 in 21 (28.7%), 3 in 15 (20.5%) and 4 in 8 (11%) cases; the mean (+/- SD) score was 1.89 (+/- 1.20). Crying, weeping spells, hostility, restlessness, denial of death, mutism, impulsivity and destructive behavior were observed. A significantly higher grief reaction was observed among parents of grown up children and those from an urban background. An intense reaction was also seen in cases when the course of illness was acute and death was not anticipated. Parents of male children of the first and second birth order also had higher GRI scores. Our findings suggest that socio-cultural factors may influence the intensity of the parental grief reaction.     

Circumstances of dying in hospitalized children

Conditions of dying in a tertiary children's hospital were assessed in a retrospective cohort study. Non-survivors, excluding newborns and emergency room patients, were allocated to four groups: brain death (BD), failed cardiopulmonary resuscitation (failed CPR), death following a do-not-resuscitate (DNR) order and death following withholding or withdrawal of therapy (W/W). In a 4-year period 190 (1.3%) of 14,903 admitted patients died. Of these 134 (71%) died on the paediatric intensive care unit, 42 (22%) on the ward and 14 (7%) in the operating room. W/W was found in 75 (39%), failed CPR in 57 (30%), BD in 32 (17%), and death following a DNR order in 26 (14%). Justifications for restrictions of treatment (W/W or DNR) were imminent death in 41 (41%), lack of future relational potential in 13 (13%) and excessive burden of disease in 47 (47%). In non-survivors analgesics and sedatives were frequently used to relieve suffering in the terminal phase. General principles for the approach of terminally ill children in whom death may become an option instead of a fate are discussed. Conclusion In the majority of children dying in hospital, death occurred following restrictions of life-sustaining treatment, comprising do-not-resuscitate or other forms of withholding or withdrawal of therapy. Received: 24 December 1997 / Accepted in revised form: 30 May 1998     

Extensive experience in supporting dying children

Long experience in Oncology has given rise to the necessity to focus more intensively on the issues of dying, death and mourning and to develop a coping support system for children and their families, which has been offered at the Children's Hospital of Tübingen University in collaboration with the "F?rderverein für krebskranke Kinder e. V." (Support foundation for children with cancer). We present the concept and experience of our approach emphasizing the significance of coping with loss and mourning.     

Risk factors for developing and dying from necrotizing enterocolitis

A case-control study was performed to identify risk factors for developing and dying from necrotizing enterocolitis (NEC). Eighty-six infants observed at The Johns Hopkins Hospital who had clinical and/or pathological evidence of this disease during the past 10 years were studied. Birth weight matched autopsied control infants without NEC were also studied for comparison with the autopsied infants who died with NEC. Patients with NEC had a mean birth weight of 1,620 +/- 198 g, and those who died from NEC had even lower birth weights (1,418 +/- 109 g). The development of NEC was correlated with significantly higher frequencies of oral feeding (p less than 0.005) and septicemia (p less than 0.001). Death with NEC was correlated with earlier onset and more extensive disease (both p less than 0.05), hypotension (p less than 0.001), septicemia (p less than 0.001), persistent respiratory distress (p less than 0.05), a patent ductus arteriosus (p less than 0.05), and lower 5-min Apgar scores (p less than 0.05). These findings suggest that NEC is caused by overwhelming hypotensive/ischemic injury to the intestines in association with enterosepticemia. Intestinal immaturity and oral feedings appear to be important predisposing factors in this condition.     

Euthanasia and caring for the dying in pediatric oncology

During the last 30 years pediatric oncology has developed therapeutic schemes for all kinds of tumors. Nevertheless, a third of the children suffering from malignancies have still to die. Therefore it is necessary to develop concepts, how to deal with the death of children and how to care for them and their families during the dying process, because the responsibility for these children does not end at the point of finishing therapy, but at the time of their death. Especially during this last part of life these children and their families need an extremely intensive care. Since most of the children want to die at home, we must also be able to care for them there, possibly in cooperation with a local colleague. This, of course, requires an adequate therapy against pain which is possible in most cases. The basement for an optimal care is to be very open to the children. If this openness is established right at the beginning of therapy it will later serve to cope with difficult situations. "Never to lie" is the most important principle. If the patients are not left alone during the dying process the claim for a final injection will be an exception. However, if euthanasia is required, it is rather an expression of despair and a cry for help. The application of very high doses of medicine, necessary in order to prevent pain, might lead to a shortening of life time. This is neither killing on demand nor euthanasia.     

死亡受体4和5在颅咽管瘤中的表达

目的研究肿瘤坏死因子相关凋亡诱导配体(TRAIL)的死亡受体(DR)4和DR5在颅咽管瘤细胞中的表达,探讨其临床意义。方法联合采用免疫组织化学和原位杂交方法检测颅咽管瘤28例和正常脑组织25例中DR表达。观察原位杂交前后颅咽管瘤和正常脑组织中DR表达差异性。结果免疫组织化学染色显示,颅咽管瘤28例均大量表达DR4和DR5,而正常脑组织25例中表达DR4 10例(40.0%),表达DR5 8例(32.0%)。颅咽管瘤组织DR蛋白高表达不同于正常脑组织DR蛋白低表达,两者差异有显著性(P<0.01)。原位杂交显示,DR在28例颅咽管瘤组织和大部分正常脑组织中均呈强阳性表达,两者差异无显著性(P>0.05)。结论颅咽管瘤细胞中普遍存在DR高表达,这可能为颅咽管瘤的凋亡诱导治疗提供新靶点。DR蛋白在正常脑组织和颅咽管瘤中的表达差异可能是TRAIL选择性诱导凋亡的机制之一。