Biomedical subjects

J A Perper

Publications and source records attributed to J A Perper.

At least 37 records · Page 2Linked to original sources

PubMed1993

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

OBJECTIVE: The objective of this study was to determine the psychiatric risk factors for adolescent suicide. METHOD: Sixty-seven adolescent suicide victims were compared with 67 demographically matched community controls. Psychiatric disorder was assessed in suicide victims using a psychological autopsy protocol and in controls using similar semistructured psychiatric interviews. Risk factors were quantified by use of the odds ratio (OR), that is, the relative frequency of the occurrence of a given condition in the suicides compared with the controls. RESULTS: The most significant psychiatric risk factors associated with adolescent suicide were major depression (OR = 27.0), bipolar mixed state (OR = 9.0), substance abuse (OR = 8.5), and conduct disorder (OR = 6.0). Substance abuse was a more significant risk factor when comorbid with affective illness than when alone (OR = 17.0 versus 3.3). The majority of depressed suicide victims had a primary affective disorder (82%). A significant minority (31%) of depressed suicide victims had been depressed less than 3 months. Previous suicide attempts, suicidal ideation, and homicidal ideation also were associated with adolescent suicide. CONCLUSIONS: The development of effective treatments for youth who fit the above-noted risk profiles should be given high priority.

Adolescent↗

PubMed1993

The validity of diagnoses obtained through the psychological autopsy procedure in adolescent suicide victims: use of family history.

A test of validity of the psychiatric diagnoses obtained by the psychological autopsy procedure is described in a consecutive series of 67 adolescent suicide victims. Family history of mental illness in first-degree relatives of subjects was obtained blind to subject diagnosis using the family history method. It was hypothesized that subjects with a given diagnosis, compared with subjects without this diagnosis, would show an increased rate of this disorder among first-degree relatives. This hypothesis was supported insofar as specific associations between subject diagnosis and familial rates of illness were demonstrated for major depression, bipolar illness, conduct and antisocial disorder and substance abuse. These results provide further support for the validity of diagnoses obtained through the psychological autopsy procedure.

Adolescent↗

PubMed1993

Risk factors for completed suicide among adolescents with a lifetime history of substance abuse: a case-control study.

The risk factors for suicide in adolescents with substance abuse were assessed by comparing 23 adolescent suicide victims and 12 community controls with a lifetime history of definite or probable DSM-III substance abuse. Suicide victims were more likely than controls to show the following risk factors: active substance abuse, comorbid major depression, suicidal ideation within the past week, family history of depression and substance abuse, legal problems and presence of a handgun in the home. Recommendations for the identification and prevention of suicide among substance-abusing youth on the basis of these findings are presented.

Adolescent↗

PubMed1993

Stressful life events, psychopathology, and adolescent suicide: a case control study.

The relationship between stressful life events and adolescent suicide was assessed in 67 adolescent suicide victims and 67 matched community controls. In the year before death, suicide completers were more likely to have experienced: (1) interpersonal conflict with parents and with boy/girlfriends, (2) disruption of a romantic attachment, (3) legal or disciplinary problems. Legal or disciplinary problems were more commonly associated with suicide in conduct and substance abuse disordered youth. Interpersonal loss was more commonly associated with suicide in substance abuse as well. Even after controlling for psychopathology, legal and disciplinary problems in the past year were associated with an increased risk of suicide.

Adolescent↗

PubMed1993

Detection of fatal therapeutic misadventures by an urban medico-legal system.

Very few population-based studies have evaluated fatal therapeutic misadventures, in particular the adequacy of their detection. We therefore assessed the adequacy of the reporting and detection of fatal therapeutic misadventures in an urban setting medico-legal system. The coroner's files and the related hospital records were reviewed as to the circumstances of the incidents and the adequacy of notification by the care providers in Allegheny County, Pennsylvania, for the period of January 1, 1982 through December 31, 1991. The annual average rate of fatal misadventures was 2.2 per 100,000 hospital admissions or 4.7 per million inhabitants (total 63 cases). The survival time from the occurrence of the misadventure was within 24 h in 60% of the cases. University-related hospitals had double the rate of misadventure fatalities (118.2 per 100,000 beds per year), compared to that in community-based hospitals (53.9 per 100,000 bed per year). In more than half of the cases, the hospitals reported the incidents within an hour from the pronouncement of death, 28.6% within 5 h, and 19% after more than 5 h. In 10 cases (15.9%), the notification by the hospitals was clearly deficient in determining the manner of death. In a few cases, the incident was initially reported by the relatives, by the hospital pathologists, or by the media. A high likelihood of under-reporting of fatal misadventures to the medico-legal system is substantiated by comparing with the results reported by others. The possible measures to increase the monitoring and reporting, and to reduce the related mortality are further discussed.

Adult↗

PubMed1992

Gastrointestinal complications of cocaine abuse.

The mechanisms thought to be responsible for cocaine-associated gastrointestinal injury are presented. In addition, the literature available concerning the enteric consequences of cocaine use is reviewed.

Cocaine↗

PubMed1992

Hepatotoxicity associated with cocaine abuse.

The mechanisms evaluated in animals as being responsible for cocaine associated hepatotoxicity are presented. The importance of the P-450 enzyme system in cocaine associated hepatotoxicity is emphasized. Moreover, the putative critical role of free radicals in such injury is discussed. Finally, the growing literature on clinical cases of cocaine hepatotoxicity is reviewed.

Animals↗

PubMed1992

Cardiovascular complications of cocaine abuse.

Cardiovascular complications are among the most common and dangerous complications of cocaine abuse, ranging from episodic arrhythmias to myocardial infarction, strokes, cardiomyopathy, and sudden death. The central nervous system-mediated action of cocaine triggers an increase in circulating catecholamines, resulting in arterial vasoconstriction, increase in myocardial oxygen demand, myocardial ischemia, tachycardia, and other arrhythmias. The peripheral cardiovascular action of cocaine involves the inhibition of reuptake of catecholamines at adrenergic nerve terminals, with local release of epinephrine, direct stimulation and vasospasm of the coronary arteries, coronary intimal hyperplasia, inhibition of baroreceptors, interference with the electrical conduction through the myocardium, and direct myocardial toxicity. The cardiovascular complications of cocaine include cardiac dysrhythmias and hypertension, acute myocardial infarction, myocarditis, infectious endocarditis, ventricular dysfunction, dilated cardiomyopathy, hypotensive shock, and cerebral strokes. Cocaine-related vascular changes in the pregnant woman and fetus have been related to an increased incidence of abortion, abruptio placentae, and congenital anomalies of the fetus.

Cardiovascular Diseases↗

PubMed1992

Respiratory complications of cocaine abuse.

Upper respiratory and pulmonary complications of cocaine addiction have been increasingly reported in recent years, with most of the patients being intravenous addicts, users of freebase, or smokers of "crack." The toxicity of cocaine is complex and is exerted via multiple central and peripheral pathways. Recurrent snorting of cocaine may result in ischemia, necrosis, and infections of the nasal mucosa, sinuses, and adjacent structures. Pulmonary complications of cocaine toxicity include pulmonary edema, pulmonary hemorrhages, pulmonary barotrauma, foreign body granulomas, cocaine related pulmonary infection, obliterative bronchiolitis, asthma, and persistent gas-exchange abnormalities. Respiratory manifestations are nonspecific and include shortness of breath, cough, wheezing, hemoptysis, and chest pains. Severe respiratory difficulties have been reported in neonates of abusing mothers. In the absence of a cocaine-abuse history, it may be difficult to recognize the etiological role of cocaine, especially in the absence of needle tracks pointing to previous intravenous drug abuse and/or negative toxicology.

Cocaine↗

PubMed1992

Visual identification from videotape after electronic erasure of mutilating injuries.

A rapid method of identification by using computerized videotape erasure of mutilating injuries is presented. The identification of a human head, which was mutilated and severed in two major fragments, illustrates the application of the method. Following the reconstruction and suturing of the head fragments, the face was videotaped and the mutilating injuries were electronically erased. The televised broadcasting, in color, of the reconstructed face, free of injuries, elicited prompt visual identification by relatives of the deceased within < 1 h.

Adult↗

PubMed1992

Fatty liver, encephalopathy, and sudden unexpected death in early childhood due to medium-chain acyl-coenzyme A dehydrogenase deficiency.

A case of sudden death associated with fatty liver and encephalopathy is described in a 4-year old white boy with medium-chain acyl-coenzyme A dehydrogenase (MCAD) deficiency. The death was caused by hypoglycemia triggered by fasting and vomiting associated with a minor viral infection. The differential diagnosis of the hepatoencephalopathy is discussed in relation to other conditions, especially Reye's syndrome. The forensic pathologist should be familiar with MCAD and other deficiencies of beta-oxidation of fatty acids as a cause of sudden unexpected death in children in order to advise parents in genetic counseling to prevent disability or death of other affected, but still asymptomatic siblings.

Brain Diseases↗

PubMed1991

The presence and accessibility of firearms in the homes of adolescent suicides. A case-control study.

OBJECTIVE: The presence of guns in the home, the type of gun, and the method of storage were all hypothesized to be associated with risk for adolescent suicide. DESIGN: Case-control study. SUBJECTS: The case group consisted of 47 adolescent suicide victims. The two psychiatric inpatient control groups were 47 suicide attempters and 47 never-suicidal psychiatric controls, frequency-matched to the suicide victims on age, gender, and county of origin. SETTING: The cases were a consecutive community sample, whereas the inpatients were drawn from a university psychiatric hospital. MAIN OUTCOME MEASURE: Odds of the presence of guns in the home of suicide victims (cases) relative to controls. RESULTS: Guns were twice as likely to be found in the homes of suicide victims as in the homes of attempters (adjusted odds ratio, 2.1; 95% confidence interval, 1.2 to 3.7) or psychiatric controls (adjusted odds ratio, 2.2; 95% confidence interval, 1.4 to 3.5). Handguns were not associated with suicide to any statistically significantly greater extent than long guns. There was no difference in the methods of storage of firearms among the three groups, so that even guns stored locked, or separate from ammunition, were associated with suicide by firearms. CONCLUSIONS: The availability of guns in the home, independent of firearms type or method of storage, appears to increase the risk for suicide among adolescents. Physicians should make a clear and firm recommendation that firearms be removed from the homes of adolescents judged to be at suicidal risk.

Adolescent↗

PubMed1991

Liver failure occurring as a component of exertional heatstroke.

An unusual case of an exertional heatstroke in a healthy 25-year-old man is presented. Initially, the patient was deeply comatose and developed severe rhabdomyolysis and massive hepatic necrosis. Subsequently, he received a liver transplant with remarkable improvement in his mental status, although the rhabdomyolysis continued. The patient died 41 days after the transplant due to a complicating infection. Providing that infections can be effectively controlled, liver transplants might be a promising therapeutic alternative for the few patients who survive the initial neurological consequences of this unusual event.

Adult↗

PubMed1990

Technetium-99m MDP scintigraphy of rhabdomyolysis induced by exertional heat stroke: a case report.

A case of rhabdomyolysis induced by exertional heat stroke in a police officer recruit is reported. Technetium-99m methylene diphosphonate scintigraphy demonstrated marked uptake of the injured skeletal muscle. This bone-scanning agent provided an excellent means of localizing and evaluating the muscle injury of rhabdomyolysis. Nuclear medicine physicians should be aware of the special conditions and causes in which bone scan may demonstrate striking findings.

Adult↗

PubMed1990

The skin as a repository and masker of evidence.

The role of the skin as a repository and masker of evidence is evaluated. Skin examination and testing are very important in the (a) identification of victims and suspects (for example, by fingerprints, lip prints, and fingernail marks), (b) recognition of patterns and shape of injurious energy impacts (for instance, recognition of type of injury and particular weapon), and (c) recovery of embedded evidence (for example, glass, wood, powder, explosives, and paint). It is also important to realize that the skin may conceal evidence by masking significant and/or lethal internal injuries.

Bites, Human↗

PubMed1989

Spontaneous fatal perforation of aorta and vena cava by Mobin-Uddin umbrella.

A 60-year-old Caucasian woman died suddenly and unexpectedly after 4 days of dyspnea, lower back pain, and numbness of the legs. Autopsy revealed that death was due to perforation of both the aorta and the vena cava by the spikes of a Mobin-Uddin umbrella (an inferior vena cava filter designed to prevent recurrent pulmonary embolism) which was implanted 8 years prior to the patient's death. To prevent this type of lethal complication, it is suggested that the sharp spikes of the Mobin-Uddin umbrella be modified into curved, hook-like ends.

Aorta, Abdominal↗

PubMed1989

Marked decline of coronary heart disease mortality in 35-44-year-old white men in Allegheny County, Pennsylvania.

Trends in coronary heart disease (CHD) mortality were examined among 35-44-year-old white men during 1970-1986. Death certificates were obtained for 1,216 cases. All were coroner-certified natural deaths and noncoroner-certified deaths due to vascular diseases and diabetes mellitus. Autopsy data, coroner's reports, hospital records, physician's reports, and informants were used to validate diagnoses. The reviewers rejected 73 of 805 CHD certifications, but they validated 54 cases not certified as CHD on the death certificate as CHD. The CHD mortality rate fell from 90.6/100,000/year in 1970-1972 to 40.3/100,000/year in 1985-1986. Approximately two thirds of the decline was related to a decline in sudden deaths including 41.6% due to incident sudden CHD death. The proportion of diabetics among validated CHD deaths rose dramatically from 6.5% in 1970-1972 to 23.0% in 1985-1986. The CHD mortality rate among diabetics apparently did not decline during the 17 years of the study. We conclude that primary prevention has contributed substantially to the CHD decline in the 35-44-year age group. Better diagnoses and treatment, especially of angina pectoris and of patients after a myocardial infarction, may also have been important. Control of CHD in diabetics must take high priority in further prevention strategies.

Adult↗

PubMed1988

Risk factors for adolescent suicide. A comparison of adolescent suicide victims with suicidal inpatients.

The characteristics of adolescent suicide victims (n = 27) were compared with those of a group at high risk for suicide, suicidal psychiatric inpatients (n = 56) who had either seriously considered (n = 18) or actually attempted (n = 38) suicide. The suicide victims and suicidal inpatients showed similarly high rates of affective disorder and family histories of affective disorder, antisocial disorder, and suicide, suggesting that among adolescents there is a continuum of suicidality from ideation to completion. However, four putative risk factors were more prevalent among the suicide victims: (1) diagnosis of bipolar disorder; (2) affective disorder with comorbidity; (3) lack of previous mental health treatment; and (4) availability of firearms in the homes, which taken together accurately classified 81.9% of cases. In addition, suicide completers showed higher suicidal intent than did suicide attempters. These findings suggest a profile of psychiatric patients at high risk for suicide, and the proper identification and treatment of such patients may prevent suicide in high-risk clinical populations.

Adolescent↗