Biomedical subjects
Publications and source records attributed to A Busuttil.
An adolescent boy who was being treated for psychiatric illness went missing. The body was discovered a year later, and he appeared to have committed suicide by inhaling the exhaust fumes from his motorbike. This report highlights the procedure used for the identification of his skeletonized body and the unusual nature of the source of exhaust fumes.
An unusual case of a homicidal gunshot wound to the chest is reported in which two bullets were fired in unison as tandem bullets from a handgun. At autopsy, two intact bullets were retrieved from the body of the victim, yet there was only one entrance wound and a single bullet track across the chest wall and thoracic organs. An examination of the weapon and ammunition supported the likelihood of tandem bullets and suggested the probable mechanism for this event. Very few similar cases have been documented.
The association between house fire fatalities and high blood-alcohol concentrations has been recognized as a particular problem in Scotland. Alcohol intoxication increases the risk of the outbreak of fire and decreases the intoxicated individual's ability to effect an escape. This survey investigates the reported blood-alcohol concentrations from all Scottish fire fatalities during the 11-year period 1980-90 and analyses the data by age, sex, year and geographical location. Alcohol intoxication in fires is shown both to be a national problem and one relevant to females as well as males. Fire prevention campaigns must continue to emphasize the risk of consuming excessive quantities of alcohol in the home whilst parallel efforts to reduce the objective risk should be encouraged.
Myocardial pathology and cardiac functional abnormalities known to occur in association with chronic alcohol abuse have been attributed to a direct toxic effect of ethanol on the intra-myocardial vasculature: alcohol-induced occlusion of small arteries with consequent secondary ischaemia leads to individual myocyte loss, focal fibrosis and compensatory cardiac hypertrophy. To assess the intra-myocardial arterial vessels an interactive semiautomated, computerised, high-resolution, video image-analysing system was used and the findings from hearts of alcoholics were compared with normal hearts collected at autopsy. The elastic laminae, stained with Van Gieson's stain, acted as the reference points for measurement of the diameters, circumferences and thicknesses of the vessels assessed. It was not possible to demonstrate any statistically significant morphometric changes within intra-myocardial vasculature. The same technique used is readily adaptable for the assessment of the blood vessels in other organs and tissues.
Data on all deaths after injuries in Lothian and Borders regions of south-east Scotland were collected prospectively over 2 years. Post-mortems were performed after all deaths and Injury Severity Scores (ISS) calculated. There were 331 deaths at a rate of 20 per 100,000 per year; of those who died 49 per cent were younger than 40 years and most were male; 37 per cent of deaths were caused by road traffic accidents, 16 per cent by falls and 15 per cent by hangings. Two hundred and forty-eight patients (75 per cent) were either dead when found or died instantly with unsurvivable injuries (ISS = 75). A further five patients died in the first hour after injury and before reaching hospital. Nineteen (7 per cent) died between 1 and 4 h after injury, 59 (17 per cent) died more than 4 h after. These results demonstrate the rate, causes and timing of deaths following injuries in one UK region. The pattern of these deaths differs markedly from that previously described in the US. There is no evidence to support the concept of a trimodal distribution of trauma deaths. The greatest potential to reduce the number of trauma deaths lies with prevention.
Fatal dwelling-house fires account for 10% of all accidental deaths in the United Kingdom with one-quarter of the deaths being of elderly people. No study had described the characteristics of elderly individuals who die in fires. We report results from a retrospective review of all fatal dwelling-house fires in Scotland from 1980 to 1990. Of 1096 people dying in fires, 243 (23%) were aged over 75. When compared with patients under the age of 75, older patients were significantly less likely to be smokers. Significantly more fires killing elderly people were caused by faulty or misused electrical items in the house, particularly electric blankets. These differences between elderly and younger individuals dying in dwelling-house fires may suggest that preventive strategies for the elderly population require a different emphasis from those for younger people.
Asymptomatic infection due to Bordetella pertussis has been suggested to be one cause of sudden infant death syndrome (SIDS). We examined developmental and environmental factors previously found to affect binding of another toxigenic species, Staphylococcus aureus, to human epithelial cells: expression of the Lewis(a) antigen; infection with respiratory syncytial virus (RSV); exposure to cigarette smoke; and the inhibitory effect of breast milk on bacterial binding. Binding of two strains of B. pertussis (8002 and 250825) to buccal epithelial cells was significantly reduced by treating the cells with monoclonal antibodies to Lewis(a) (P < 0.05) and Lewis(x) (P < 0.01) antigens. Both strains bound in significantly greater numbers to cells from smokers compared with cells from non-smokers (P < 0.05). HEp-2 cells infected with RSV subtypes A or B had higher binding indices for both 8002 (P < 0.001) and 250825 (P < 0.01). On RSV-infected cells, there was significantly enhanced binding of monoclonal antibodies to Lewis(x) (P < 0.05), CD14 (P < 0.001) and CD18 (P < 0.01); and pre-treatment of cells with anti-CD14 or CD18 also significantly reduced binding of both strains of B. pertussis. Pre-treatment of the bacteria with human milk significantly reduced their binding to epithelial cells. The results are discussed in relation to our three-year survey of bacterial carriage among 253 healthy infants, their mothers and local SIDS cases between 1993-1995 and in relation to the change to an earlier immunisation schedule for infants and the recent decline in SIDS in Britain.
BACKGROUND: Changes in the structure and integrity of the colon dependent on collagen content and crosslinkage occur with age. AIMS: This study using an animal model examines colonic collagen content and crosslinkage over the lifetime of rats on fibre deficient and higher fibre diets. METHODS: Two groups of 20 rats were fed either a fibre deficient diet (1.7 g NSP (non-starch polysaccharide)/100 g) or a higher fibre diet (13.3 g NSP/100 g) for 18 months. Diverticula were identified by postmortem examination. Caecal and colonic contents were weighed and assayed for short chain fatty acids. Collagen solubility in weak acid was measured to give an indication of the nature and amount of crosslinks in the collagen of the bowel wall. RESULTS: The incidence of colonic diverticula was greater (42.1% fibre deficient rats; 0% higher fibre rats). Colonic collagen solubility index in fibre deficient rats was significantly lower than higher fibre diet fed rats (p < 0.001 in all four sections of the large bowel). Rats with diverticula had the lowest solubility index (p < 0.001 in all four sections of the large bowel). Higher fibre diet rats had increased caecal and colonic contents, caecal and colonic tissue wet weights, and greater caecal short chain fatty acids. Fibre deficient diet fed rats had more pathological abnormalities. CONCLUSIONS: This animal model permits a study of the relation between collagen crosslinkage and the development of colonic diverticulosis. A higher fibre diet protects against collagen crosslinking and this is related to a decreased incidence of diverticula.
BACKGROUND/AIMS: Maternal diet may have an effect on the health of the offspring in middle and later life. This study used the laboratory rat as an animal model to examine whether the fibre content of the maternal diet during pregnancy affected subsequent development of colonic diverticula in the offspring fed lifelong fibre deficient or higher fibre diets. METHODS: The parents of experimental animals were fed either a diet that was known to predispose to colonic diverticulosis or a control diet for one month prior to mating. The offspring were fed one of these diets for 18 months. The incidence of colonic diverticulosis, submucosal collagen content, collagen solubility in weak acid, and the composition of intestinal contents were then measured. RESULTS: Offspring of rats fed a higher fibre diet from higher fibre diet fed parents had 0% incidence of colonic diverticulosis. When offspring (regardless of parental diet) were fed a low fibre diet for life the acid solubility was lowered compared with rats fed lifelong higher fibre diet mean (SD) (0.044 (0.0007) v 0.073 (0.0015) sigmoid colon (ratio of soluble:insoluble collagen)); 21.1% had diverticulosis and there was reduced fibre fermentation. However, when the diet of the parents of the fibre deficient diet fed rats was considered, the animals whose mothers had a fibre deficient diet had lower acid solubility (0.032 (0.0007)) and an increased incidence of colonic diverticulosis (42.1%) than the animals fed a fibre deficient diet from higher fibre diet fed parents (p < 0.01 in all instances). CONCLUSION: Maternal diet and the subsequent nutrition of the progeny seem to be of importance in the development of colonic diverticulosis in the rat.
OBJECTIVES: To analyse all child deaths in house fires in Scotland between 1980 and 1990. METHODS: Retrospective study of all child house fire fatalities based on the 'sudden death' investigation instigated by the procurator fiscal in whose jurisdiction the death occurred. The necropsy, toxicology, police, and fire brigade reports were examined in each case. RESULTS: There were 168 child deaths occurring in 118 house fires. In the 0-5 years age group 40% of deaths occurred in fires started as a direct result of the actions of children. The careless disposal of smoking materials was the most frequent cause of fatal fires killing older children. Upholstery and bedding were common materials of first ignition, accounting for over half the incidents. The majority of children were dead before the arrival of the emergency services and most died as a result of the inhalation of smoke. CONCLUSIONS: This survey emphasises the importance of 'self escape' which, particularly in the case of young children, requires the assistance of adult carers. The number of fires started as a result of children playing with sources of ignition raises important questions of supervision and the provision of a safe environment. There is, we contend, a need to highlight the importance of individual behaviour and responsibility while recognising the need to develop measures that are relevant to, and effective in, a particular socioeconomic context.
A survey of deaths of chronic drug abusers who came to medico-legal autopsy in the South-east of Scotland revealed a total of 179 fatalities in the six-year period between 1989 and 1994 inclusive. There was an almost linear increase in the number of such deaths reported to the Procurator Fiscal per year over this period, rising from 14 in 1989 to 45 in 1994. The majority of deaths (86%) were seen in males and the peak age at death was in the third decade of life. In the majority of cases (60%) death was deemed to be accidental and most were due to accidental drug overdoses, with methadone being the drug most commonly detected on toxicological analysis. The number of HIV-positive cases peaked in the years 1991 and 1992 with a decline over the subsequent two years.
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This paper considers 168 child (< 17 years) fatalities killed in house fires in Scotland. Data were obtained from the records retained by the procurators fiscal, as part of a survey into all Scottish fire fatalities during the period 1980 to 1990. Although these fires were generally perceived as being tragic "accidents," we conclude that they were largely a direct result of the activities of adults in the home. We analyze this in terms of contemporaneous supervision and the child-care environment. The role of alcohol in domestic fires is particularly important. Behavioral patterns of parents and caregivers are seen to be placing children in a very high risk category and fatality rate could be significantly reduced if behavior was modified to reduce the risk. Whether these considerations imply "neglect" is partly a question of definition. It is important to recognize that the fire safety message could usefully be integrated within a more general child care or family welfare scheme. Front line professionals in these fields are ideally placed to convey this message and to make a contribution towards reducing the risk of children being killed or injured in fire.
Development of colonic diverticulosis is a function of age and declining colonic wall mechanical strength. The latter is partly a consequence of changes in the collagen structure. Collagen from unaffected human colons (n = 20, age range 20-80 years) and those with colonic diverticulosis (n = 5, age range 67-80 years) were obtained at necropsy. The total collagen content was measured as the hydroxyproline content and cross linkage by collagen solubility in weak acid was studied. The colonic total collagen content was constant with age (mean (SD) 15.8 (0.3) mg/100 mg wet weight of tissue). The acid solubility of the collagen, however, increased after the age of 40 years: at over 60 years, colonic diverticulosis was associated with an increased acid solubility ratio compared with values in unaffected colons (15.3 (0.2); compared with 9.2 (0.2), p < 0.001). The cross linking of colonic collagen increases with age. These changes seem to be a factor in the aetiology of colonic diverticulosis.
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A congenital variant of the anatomical arrangement of the coronary arteries, that can be observed both angiographically and at autopsy, is the embedding of these vessels within a tunnel of the subepicardial myocardium. Both clinical and pathological claims and counterclaims have been made as to the functional consequences of this variation, the implication being that the contraction of the peri-vascular myocardium particularly at accentuated heart rates would cause occlusion of the blood flow within these arteries. The consensus is that this variant is only of significance when it occurs around a significant portion of a dominant left main coronary artery in which instances it may be the cause of sudden death during the course of strenuous exercise.