Biomedical subjects

J A Perper

Publications and source records attributed to J A Perper.

At least 19 recordsLinked to original sources

PubMed2000

Cardiopulmonary resuscitation-related injuries and homicidal blunt abdominal trauma in children.

Defendants accused of inflicting fatal abdominal injuries to children occasionally raise the defense that the injuries were caused by cardiopulmonary resuscitation (CPR). The purpose of this study is to answer the question: Does closed chest CPR result in fatal blunt abdominal injuries that can be mistaken for homicidal assault? To that end, a retrospective study was conducted of all homicidal blunt abdominal injuries in children 10 years and younger from the Dade, Broward, and Palm Beach Medical Examiner's Offices from 1981 through 1997. These were compared to cases of children who died of natural causes during the same time period in Broward County who had CPR (control group 1) and to children who died of nonvehicular accidental blunt abdominal trauma (control group 2). Children with life-threatening head injuries were excluded. Medical examiner records, autopsy reports, documenting photographs, and clinical records were reviewed. The data analyzed included subject demographics, whether CPR was performed and by whom, and autopsy findings. Thirty-three child homicides with fatal abdominal injuries were reviewed. Twenty-four (73%) of the homicides received CPR. There was no difference in the nature and severity of injuries between the 24 children who received CPR and the 9 who did not. Three hundred and twenty-four cases of pediatric natural deaths were reviewed, all of which had CPR. No traumatic abdominal injuries were found in any of the children who died of natural causes. Only four children who died of natural causes had evidence of extraabdominal trauma related to CPR. No cases of nonvehicular accidental blunt abdominal trauma were identified during the 17-year period, although there were nonvehicular accidental fatalities due to extraabdominal injuries. The likelihood of CPR-related primary abdominal trauma in child homicides is very low.

Abdominal Injuries↗

PubMed1996

Lower 3H-paroxetine binding in cerebral cortex of suicide victims is partly due to fewer high affinity, non-transporter sites.

Suicide has been associated with decreased serotonin transmission. Measurement of concentrations of serotonin, its precursors tryptophan (TRY) and 5-hydroxytryptophan (5-HTP) and its metabolite 5-hydroxyindoleacetic acid (5-HIAA), have been used as indices of serotonin activity, and with serotonin transporter binding, are indices of the integrity of serotonin nerve terminals. Most previous studies have not distinguished high affinity transporter binding from a very similar nontransporter binding site, where binding is not dependent on Na+ or Cl- and that does not have a known functional role. We therefore, assayed binding kinetics in prefrontal (PFC) and temporal cortex (TC) in matched pairs of suicide victims and controls using the selective ligand 3H-paroxetine, and employing 1 microM sertraline to define specific binding to the transporter and 10 microM sertraline which also displaces binding to the high affinity, nontransporter site. In addition, we measured concentrations of TRY, 5-HTP, serotonin and 5-HIAA in the same brain areas. The total number of 3H-paroxetine transporter and nontransporter binding sites (Bmax), was lower in the suicide group compared to controls in both Brodmann area 9 (prefrontal cortex; p = 0.02) and in Brodmann area 38 (temporal cortex, p = 0.01). In contrast, no differences were found in the number of high affinity transporter binding sites and concentrations of serotonin, 5-HIAA, 5-HTP or TRY (p > 0.05). We conclude that the number of serotonin transporter sites is not altered in Brodmann area 9 in suicide, and that fewer 3H-paroxetine and 3H-imipramine binding sites found in this region of cerebral cortex of suicides may be explained by a reduction in the nontransporter binding sites.

5-Hydroxytryptophan↗

PubMed1996

Coronary heart disease mortality and sudden death among the 35-44-year age group in Allegheny County, Pennsylvania.

Deaths among 35- to 44-year-old black and white men and women residing in Allegheny County, Pennsylvania, were investigated. All coroner-certified nontraumatic deaths and practitioner-certified deaths coded as heart, cerbrovascular, or arterial disease, diabetes mellitus, and sudden or ill-defined causes were studied. Using autopsy, coroner, hospital, physician, and/or informant information about medical history, characteristics, and circumstances of death, physicians validated the deaths as due to coronary heart disease (CHD) or another cause. In 1984 to 1989, 616 deaths were investigated, 384 of which were sudden (within 24 hours of onset). Overall CHD mortality was 35.4/100,000/y for white males, 8.4/100,000/y for white females, 61.3/100,000/y for black males, and 19.5/100,000/y for black females. Although rates varied widely, characteristics, circumstances, and disease history were similar across race-sex groups. CHD mortality was 73% higher in black than white males. Approximately 80% of CHD deaths were sudden.

Adult↗

PubMed1995

Coronary heart disease mortality and sudden death: trends and patterns in 35- to 44-year-old white males, 1970-1990.

Trends in coronary heart disease mortality and sudden death were studied in 35- to 44-year-old white male residents of Allegheny County, Pennsylvania. Deaths coded as any cardiac or vascular disease, diabetes, unexplained sudden death, and other rubrics were eligible for investigation, and the cause of death was validated by physicians examining multiple data sources about the deaths. During 1970-1990, 1,424 white male deaths were investigated, with 903 validated as coronary heart disease. In that time span, white male coronary heart disease mortality fell from 93.4 to 36.7 per 100,000 population per year, a 60% decline. Little proportionate change was seen in characteristics of the deaths, which were predominantly sudden and out-of-hospital. Diabetes mellitus history increased proportionately over time, largely because diabetics' mortality rates, unlike those of all other subgroups, did not fall. These observations support the contention that the decline in coronary heart disease mortality relates to risk factor modification more than to improvements in the treatment of coronary heart disease. Differences in death certification practices must be considered when interpreting and comparing vital statistics data.

Adult↗

PubMed1995

A comparison of blood lipid and lipoprotein values in young adults who die suddenly and unexpectedly from atherosclerotic coronary artery disease with other noncardiac deaths.

Postmortem blood lipid and lipoprotein analyses were conducted in a case-controlled study of young adults (ages 22-43) who died suddenly and unexpectedly of atherosclerotic coronary artery disease in Allegheny County, Pennsylvania. None of the individuals in the study group (n = 28 cases) had a significant medical or cardiac history except in the immediate antemortem period. The control group (n = 31) consisted of age- and sex-matched cohorts who died of noncardiac related fatalities and who had no evidence of CAD. The results indicated a male-to-female ratio of nearly 30:1 with a marked predominance of young white men. Mean total cholesterol (241 mg/dL), triglycerides (583 mg/dL), and low-density lipoproteins (LDL) (107 mg/dL) were all significantly elevated in the study group as compared to controls (p < 0.001, p < 0.018, and p < 0.001 for the three parameters, respectively). Mean Apolipoprotein B (98.7 mg/dL) was also significantly elevated compared to control values (p < 0.001). By contrast, mean high-density lipoprotein values (36 mg/dL) were not significantly different from control values (p = 0.35), and mean values of Apolipoproteins A1 (121 mg/dL) and A2 (37.6 mg/dL) were essentially identical to control values (p = 0.44 and p = 0.64, respectively). The differences in these biochemical markers between the two groups could not be explained by differences in postmortem interval or by the presence of recently ingested food. These findings indicate that elevations of plasma cholesterol, triglycerides, LDL, and Apolipoprotein B are important biochemical markers for the development of early and apparently clinically silent yet life-threatening coronary artery disease.

Accidents, Traffic↗

PubMed1995

Posttraumatic stress disorder in peers of adolescent suicide victims: predisposing factors and phenomenology.

OBJECTIVE: To examine the factors predisposing to posttraumatic stress disorder (PTSD) in peers of adolescent suicide victims. METHOD: One hundred forty-six adolescents who were the friends of 26 suicide victims were studied. Five percent (n = 8) developed PTSD after exposure to suicide. These 8 subjects with PTSD were compared to the remainder of the exposed subjects (n = 138). RESULTS: Subjects with PTSD were more likely than those without PTSD to have had a history of substance abuse, agoraphobia, and suicide attempts. Subjects who developed PTSD were more likely to have developed a new-onset depression, to have more severe grief, and to have been closer to the suicide victim. Subjects with PTSD tended to have more severe exposure to suicide and came from discordant households with a history of disruptions in key relationships. The 8 subjects who developed PTSD were compared to 38 subjects who developed new-onset depression but not PTSD. Those with PTSD were more likely to have had past substance abuse, prior suicide attempts, family history of panic disorder, a history of parent-child disruption, and a history of loss. Symptoms of intrusive visual images, hypervigilance, and avoidance of reminders discriminated subjects who had PTSD from new-onset depressives without PTSD. CONCLUSIONS: PTSD is an expectable outcome in youth exposed to suicide. Further work is required to differentiate symptoms of depression from PTSD.

Adolescent↗

PubMed1995

Research in adolescent suicide: implications for training, service delivery, and public policy.

Four domains of research in adolescent suicide are reviewed: (1) the role of psychopathology, (2) family history of psychopathology, (3) mental health treatments, and (4) firearms in the home. Based on the extant literature, recommendations are made for changes in training, service delivery, and public policy. Among the recommendations for training professionals are: an emphasis on diagnostic proficiency, skill and attentiveness in the assessment of the entire family unit, and assessment of the availability of firearms in the home. With respect to changes in service delivery, we recommend treatment of the entire family system, and treatment of psychiatric and substance abuse problems in the same setting, and we show the need for a continuum of intensity of care from inpatient to outpatient. With respect to policy changes, we recommended parity of mental and physical health insurance coverage, screening for psychiatrically at-risk youngsters in schools and physicians' offices, providing funding to support a continuum of care between inpatient and outpatient, and gun control laws to restrict access to handguns. We believe that these changes can result in a substantial reduction in the adolescent suicide rate.

Adolescent↗

PubMed1994

Suicide in affectively ill adolescents: a case-control study.

Sixty-three adolescent suicide victims with a history of affective illness were compared to 23 adolescent community controls with a lifetime history of affective illness, using a case-control design. Suicide victims were more likely to have had major depression, comorbid substance abuse, a past suicide attempt, family history of major depression, treatment with a tricyclic antidepressant, history of legal problems, and a handgun available in the home. There was a non-significant trend for bipolar depression to convey a higher risk for completed suicide than unipolar depression. Recommendations for the prevention of suicide among those with early onset affective illness are discussed in light of these findings.

Adolescent↗

PubMed1994

Sudden unexpected death in a male homosexual cohort.

There has been considerable debate as to the risk of suicide, accidents, and homicide in populations at high risk for HIV infection. The purpose of the present investigation was to determine the incidence of sudden and unexpected deaths in a well-defined cohort of homosexual and bisexual men prospectively studied since 1984. All subjects were enrolled in the Pitt Men's Study, the Pittsburgh, Pennsylvania, component of the Multicenter AIDS Cohort Study. Of this group, 861 were between the ages of 20 and 44, and 35% were seropositive for HIV. There were 70 deaths attributed to AIDS. Five additional deaths were classified as sudden and unexpected, an annual rate of 0.08% (80/100,000). Only one of these was classified by the coroner's office as a suicide; three were due to accidents, and one was a drug overdose of undetermined cause. Only two of the five unexpected deaths were HIV seropositive, and none had the diagnosis of AIDS. The sudden and unexpected death rate in this cohort did not significantly differ from the 0.07% (70/100,000) yearly incidence in the age- and race-matched male population. Thus, in this well-defined male gay cohort, there does not appear to be an increased risk of violent and drug-related deaths in persons at risk for, or with a diagnosis of, AIDS.

Acquired Immunodeficiency Syndrome↗

PubMed1994

Major depression or uncomplicated bereavement? A follow-up of youth exposed to suicide.

OBJECTIVE: To determine whether the depressive reactions experienced by youth exposed to suicide were uncomplicated bereavement or major depression by examining the longitudinal risk of recurrent major depression. METHOD: The 121 friends and acquaintances of 26 adolescent suicide victims were followed up 1 to 18 months after an initial interview that took place around 6 months after the death of the suicide victim. A demographically similar group of 138 unexposed controls was also followed up. RESULTS: The median duration of depression in the 37 subjects who became depressed after exposure was 8 months. The exposed group, compared with controls, had a higher rate of incident depression (RR = 1.7, 95% Cl = 1.0-2.8) during the follow-up period, even after adjustment for previous history of depression and other risk factors for depression. Within the group of exposed subjects, the rate of depression on follow-up was highest in those who developed a depressive disorder before exposure to suicide, intermediate in those who developed depression after exposure, and lowest in those who were not depressed at the first interview after exposure. There was no evidence of an increased incidence of suicide attempts in the exposed group relative to the unexposed controls on follow-up. CONCLUSIONS: The depressive reactions observed in youth exposed to suicide are most consistent with major depressive episodes on the basis of course and risk of recurrence. Exposure to suicide was associated with an increased risk of recurrent depression but not with an increased long-term risk of suicidal behavior.

Adjustment Disorders↗

PubMed1994

Familial risk factors for adolescent suicide: a case-control study.

Sixty-seven adolescent suicide victims and 67 demographically matched living controls were compared as to family constellation, familial stressors and familial loading for psychopathology. Suicide victims were less likely to have lived with both biological parents, were more likely to be exposed to stressors such as parent-child discord, physical abuse and residential instability and showed greater familial loading for depression and substance abuse. Multivariate analyses showed that family history of both depression and substance abuse and lifetime history of parent-child discord were most closely associated with adolescent suicide. Children who are the offspring of parents with depression or substance abuse should be psychiatrically screened. Family interventions to decrease discord may also be helpful in decreasing the risk of adolescent suicide.

Adolescent↗

PubMed1994

Sudden unexpected death in childhood due to unsuspected diabetes mellitus.

We report the case of an otherwise healthy 11-year-old girl who died suddenly of previously undiagnosed diabetes mellitus type I, following a 2-day minor upper respiratory infection. Insulin dependent diabetes mellitus (IDDM) is a rare cause of sudden death of apparently healthy children. This report demonstrates a recommended diagnostic pathway for IDDM from the substantiation of vesicular fatty liver to specific pancreatic histological and histochemical changes.

Child↗

PubMed1993

Factors associated with the decline in cirrhosis death rates among young adults in Allegheny County, Pennsylvania, 1973-1985.

From 1973 to 1985, the age-adjusted death rate from liver cirrhosis (International Classification of Diseases, Ninth Revision, code 571) dropped by 62.7% among adults aged 25-54 years in Allegheny County, Pennsylvania. The authors investigated factors associated with this decline by verifying causes of death on death certificates from medical records, coroner's reports, and autopsy reports. Although death rates from cirrhosis were slightly underestimated from death certificates, the underestimation did not alter the declining mortality trend. This decline in rates was significant after adjustment of the age, sex, and race effect using statistical modeling. No significant variability in the time trends was noted between sexes, races, and age groups. Neither did the trends in alcohol-related and "unspecified" cirrhosis differ. However, the trends varied significantly between the cirrhosis deaths certified by the coroner and by noncoroner physicians. From 1973-1975 to 1976-1978, the rate initially dropped by 51% among the coroner cases, whereas it dropped by only 9% among the noncoroner cases. By the period 1982-1985, the death rates of both coroner and noncoroner cases declined to approximately 50% of their 1973-1975 rates. These results suggest that the decline during the years 1973-1985 was real and that the trend was initiated by the pronounced decline during the early years in the coroner-certified cirrhosis deaths.

Adult↗

PubMed1993

Firearms and adolescent suicide. A community case-control study.

OBJECTIVE: To assess the association between firearms in the home and adolescent suicide. RESEARCH DESIGN: Matched, case-control. SETTING: Population-based community sample. SUBJECTS: Sixty-seven adolescent suicide victims and a demographically matched group of 67 living community controls. SELECTION PROCEDURE: The series of adolescent suicide victims was consecutive, with an overall participation rate of 74% (67/91). MEASUREMENTS AND RESULTS: The presence, type (hand-gun vs long-gun), number, and method of storage (locked vs unlocked, loaded vs unloaded) of firearms in the home were compared between the suicide victims and controls. Even after adjusting for differences in rates of psychiatric disorders between suicide victims and controls, the association between suicide and both any gun (odds ratio [OR] = 4.4, 95% confidence interval [CI] = 1.1 to 17.5) and handguns (OR = 9.4, 95% CI = 1.7 to 53.9) in the home were both highly significant. Long-guns in the home were associated with suicide only in rural areas, whereas handguns were more closely associated with suicide in urban areas. Handguns (OR = 12.9, 95% CI = 1.5 to 110.9) and loaded guns (OR = 32.3, 95% CI = 2.5 to 413.4) in the home were particularly significant risk factors for suicide in those with no apparent psychiatric disorder. CONCLUSIONS: When pediatricians are faced with a suicidal adolescent, they should insist on the removal of firearms from the home. Pediatricians should also inform parents that the presence of firearms may be associated with adolescent suicide even in the absence of clear psychiatric illness.

Adolescent↗

PubMed1993

Psychiatric impact of the loss of an adolescent sibling to suicide.

Twenty-five adolescent siblings of 20 adolescent suicide victims were psychiatrically assessed 6 months after the suicide, and compared to 25 demographically matched controls. Siblings were much more likely to show a new-onset major depression subsequent to exposure to suicide. New-onset depression was associated with previous psychiatric disorder, family history of any psychiatric disorder, and family history of major depression. Mothers of suicide victims, compared to the mothers of controls, were also more likely to be depressed 6 months after the suicide of their child. The development of a family-based intervention for families of adolescent suicides is recommended.

Adaptation, Psychological↗

PubMed1993

Fatal Clostridium perfringens and Escherichia coli sepsis following urea-instillation abortion.

Intraamniotic instillation of urea is a common mode of legal second-trimester pregnancy termination. Associated mortality rarely occurs and is most commonly due to amniotic fluid embolism, pulmonary thromboembolism, infection, hemorrhage, and disseminated intravascular coagulation (DIC). We present the case of an 18-year-old gravida 2, para 1 white woman at 18 weeks' gestation who underwent intraamniotic instillation of hyperosmolar urea and intracervical insertion of laminaria tents; 19 h later, she became unresponsive, academic, and went into shock. Coagulation studies were diagnostic of DIC. Bacilli were seen on peripheral blood smear. Autopsy showed marked subcutaneous emphysema of the anterior abdominal wall, necrosis and emphysema of the uterus, diffuse pulmonary alveolar damage, and renal cortical necrosis. Antemortem blood cultures grew Clostridium perfringens and Escherichia coli. Postmortem culture of the uterus grew E. coli. The source of infection was most likely the introduction of vaginal organisms via laminaria insertion. This is apparently the first reported case of death caused by Clostridium perfringens and E. coli sepsis following urea instillation.

Abortion, Induced↗

PubMed1993

Vehicular crashes and alcohol involvement in drivers at fault, and related fatalities.

This descriptive, population-based retrospective review of coroner's and related law enforcement agency's records, and hospital emergency-room records, evaluates the characteristics of fatal traffic crashes in Allegheny County, Pennsylvania, according to whether the driver at fault had been drinking alcohol or not, and examines the relationship between alcohol consumption of drivers at fault, and their respective victims. Our data suggest that passengers of alcohol-positive drivers are as much at risk for fatal crash injuries as are the drivers themselves. Nondrinking drivers should be designated to avoid such risks. The data also show a substantial proportion of crashes involving BAC-negative victims and alcohol-uninvolved drivers at fault. These non-alcohol-related crashes need further evaluation to enable better methods of prevention.

Accidents, Traffic↗

PubMed1993

Psychiatric sequelae to the loss of an adolescent peer to suicide.

OBJECTIVE: This study was designed to learn whether friends and acquaintances of suicide victims were at increased risk for depression, post-traumatic stress disorder, and suicidal behavior after exposure to suicide. METHOD: The social networks of 26 adolescent suicide victims, consisting of 146 adolescents, were interviewed 7 months after the death of the suicide victim and compared with 146 matched, unexposed controls. RESULTS: The rates of these disorders that had onset after exposure were elevated in the exposed group vs. controls: major depression, post-traumatic stress disorder, suicidal ideation with a plan or an attempt, but not suicidal attempts. Almost all of those exposed youth who developed new-onset suicidality did so in the context of a new-onset depressive episode. The majority of these new-onset depressive disorders began within 1 month of exposure. CONCLUSION: Postvention programs not only should focus on the prevention of imitation of suicidal behavior, but also should provide longer term follow-up for potentially bereaved and depressed youth exposed to suicide.

Adolescent↗