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PubMed1989

Risk factor profiles of patients with sudden cardiac death and death from other cardiac causes: a report from the Coronary Artery Surgery Study (CASS).

Identification of patients at risk of sudden death is essential if optimal preventive treatment strategies are to be developed. In the Coronary Artery Surgery Study (CASS) Registry, 19,946 patients were analyzed to characterize baseline clinical, hemodynamic and angiographic features of patients dying from sudden cardiac death and to compare them with features of patients dying from other cardiac causes, of those dying from noncardiac causes and of survivors. Of the 11,843 medically treated patients, 1,621 died during a mean follow-up period of 5.0 years: death was sudden in 557 (34%), nonsudden but cardiac in 813 (50%) and noncardiac in 251 (16%). In 8,103 surgically treated patients, 824 deaths occurred during a mean follow-up period of 5.1 years: death was sudden in 204 (25%), nonsudden but cardiac in 390 (47%) and noncardiac in 230 (28%). In general, the patients (both medically and surgically treated) who died of cardiac causes, either suddenly or nonsuddenly, were similar to each other but significantly different from patients who either survived or died of noncardiac causes. Although patients with an increased risk of any type of cardiac death could be identified, there were no measures of angiographic or hemodynamic characteristics that were significantly different between patients with sudden cardiac death and those with nonsudden cardiac death. Identification of patients at high risk for sudden cardiac death will require approaches in addition to clinical, angiographic and hemodynamic assessment, such as electrophysiologic assessment or monitoring techniques to identify triggering mechanisms.

Coronary Disease↗
PubMed2006

Metamorphosis: the natural history of coronary heart disease. Sudden death is common. Unexpected death is not.

It is a common practice to perform percutaneous or open coronary artery revascularisation in CHD to prevent sudden or unexpected death. Such a practice assumes that sudden and unexpected death is common in stable patients with uncomplicated CHD. This is a retrospective analysis of 248 patients (199, 80% men, 49, 20% women) who had median age 65.1 when assessed after stabilisation of their CHD and were followed up to 25 years until their death. Myocardial revascularisation was only performed after the patients had stabilised if they developed either progressive clinical disability or acute coronary syndromes. At stabilisation, 181 (73%) were uncomplicated, 59 (24%) had heart failure (HF) and 8 (3%) had other comorbidities. At their last visit before death, 67 (27%) were uncomplicated, 121 (49%) had HF, 41 (17%) had cancer and 19 (8%) had other comorbidities. Their median age at death was 72.4 years. 77 (31%) died suddenly, 47 (19%) of HF, 39 (16%) of cancer, 35 (14%) of acute myocardial infarction (AMI) and 50 (20%) had miscellaneous modes of dying. Unexpected death occurred in 26 (10%) of cases: sudden 12, AMI 7, stroke 3, suicide 2, abdominal aneurysm 1, motor vehicle accident 1. We conclude that the clinical condition of most patients with CHD deteriorates between their initial stabilisation and their final visit before their death-metamorphosis. Only a small proportion of deaths occur in patients with stable CHD and no HF. Intervention in stable patients without CHF is unlikely to reduce sudden or unexpected death in patients with CHD.

Aged↗
PubMed1997

Physical activity protects against coronary death and deaths from all causes in middle-aged men. Evidence from a 20-year follow-up of the primary prevention study in Göteborg.

We set out to examine the long-term effect of work-related and leisure time physical activity on risk of death from coronary heart disease (CHD) and other causes. Data were obtained from a large prospective population study of 7142 participant men aged 47 to 55 years at baseline in 1970-1973 and without symptomatic CHD. Data on physical activity at work and at leisure were assessed by way of a questionnaire. After 20 years follow-up men with physically demanding work had a slightly higher mortality from all causes, but not from CHD. The association with all-cause mortality disappeared after controlling for smoking, occupational class, and alcohol abuse. Men who were physically active during leisure time had a lower risk of death from CHD, cancer, and all causes. After controlling for smoking, diastolic blood pressure, serum cholesterol, body mass index, diabetes alcohol abuse, and low occupational class, the most active men had a relative risk (RR) of dying from CHD of 0.72 (0.56-0.92 95% CI) and of all causes of 0.70 (0.61-0.80 95% CI). The adjusted relative risk for cancer death was of borderline significance. Noncardiovascular deaths other than cancer showed a strong relationship with low physical activity in the present study that remained after controlling for smoking, alcohol abuse, and other factors (adjusted RR 0.55 (0.42-0.73 95% CI)). The protective effect of CHD and on mortality was present after excluding the first 8 years of follow-up, and at all levels of other risk factors, such as smoking, diastolic blood pressure, serum cholesterol, and body mass index. In conclusion, this long-term study demonstrates the protective effect of leisure time physical activity on CHD death, cancer death, and on death from all causes. The effect on coronary death and on death from all causes was independent of other risk factors.

Aged↗
PubMed2001

Study of 2708 heroin-related deaths in north-eastern Italy 1985-98 to establish the main causes of death.

AIMS: To ascertain the causes of deaths among a very large cohort of heroin injecting drug users (IDUs) who, from 1985 to 1998, attended 36 Public Health Authority Centres for Drug Users (PCDUs) in north-eastern Italy. DESIGN: Retrospective analysis of data, obtained from the Annual Register of each Centre and the Municipal Registry Office of each local health district. SETTING: Thirty-six PCDUs in north-eastern Italy and Medical Service for Addictive Disorders of the University of Verona. PARTICIPANTS: All IDUs who had sought medical care at least once in the PCDUs during the study period. FINDINGS: Of 2708 deaths, overdose was found to be the major cause (37%), followed by AIDS (32.5%) and road accidents (9.4%). The percentage of deaths due to AIDS increased steadily from 2.7% in 1985 to 42.2% in 1996, and then decreased to 16.9% in 1998. Deaths due to overdose remained almost constant. The average age of death per year rose from 26 in the mid eighties to 34 in 1998. The mortality rate among IDUs proved much higher compared to the general population of the same age (13-fold, 95% CI, 11.3-14.6). The proportion of all deaths attributable to regular use of illegal opiates in the 15-34 age group in the general population in 1991 was 16%. HIV prevalence was not a significant factor in suicides and deaths by overdose. CONCLUSIONS: The mortality rate was 13 times greater than in the general population. To be female and to have dropped out of any kind of treatment proved an important risk factor for overdose. The fall in deaths from AIDS enhances the problem to prevent and treat HCV infection. Decisions in drug projects, in research and in training should be influenced by the strikingly high percentage of deaths due to drug use.

Accidents, Traffic↗
PubMed2002

Regulation of Fas-associated death domain interactions by the death effector domain identified by a modified reverse two-hybrid screen.

The adapter protein FADD consists of two protein interaction domains and is an essential component of the death inducing signaling complex (DISC) that is formed by activated death receptors of the tumor necrosis factor (TNF) receptor family. The FADD death domain binds to activated receptors such as Fas or other adapters such as TRADD, whereas the FADD death effector domain binds to procaspase 8. Each domain can interact with its target in the absence of the other domain, and this has led to the idea that the two domains function independently. FADD death domain interactions with Fas and TRADD are thought to occur on the same surface; however, the regulation of these interactions is poorly understood. We developed a modified reverse two-hybrid method that can identify mutations, which inhibit some protein-protein interactions without affecting other interactions. Using this method, we identified mutations in FADD that prevent binding to Fas but do not affect binding to TRADD. Surprisingly, these mutations were in the death effector domain rather than the death domain. To test whether the mutants function in mammalian cells, we expressed wild type or mutant FADD molecules in FADD-deficient cells. Wild type FADD rescued both Fas ligand- and TNF-dependent signaling, whereas the FADD death effector domain mutants rescued only TNF signaling. These data indicate that in contrast to current models, the death effector domain of FADD is involved in interaction with Fas.

Adaptor Proteins, Signal Transducing↗
PubMed2004

Basic fibroblast growth factor-induced cell death is effected through sustained activation of p38MAPK and up-regulation of the death receptor p75NTR.

Basic fibroblast growth factor (bFGF) induces cell death in cells of the Ewing's sarcoma family of tumors in vivo and in vitro. In this study we demonstrate that this is dependent on the rapid and sustained activation of p38(MAPK), in contrast to the transient activation of p38(MAPK) associated with bFGF-induced cell proliferation. Stem cell factor-induced survival of TC-32 cells was also associated with transient activation of p38(MAPK). Inhibition of p38(MAPK) by SB202190 and p38(MAPK) small interfering RNA reduces bFGF-induced death in TC-32 cells, consistent with the hypothesis that activation of p38(MAPK) is essential for induction of death by bFGF. This appears to be dependent on sustained activation of p38(MAPK), demonstrated by inhibition of bFGF-induced cell death following addition of SB202190 to TC-32 cells 5 min after exposure to bFGF (20 ng/ml) and activation of p38(MAPK). Prolonged activation of p38(MAPK) is accompanied by a rapid and sustained phosphorylation of Ras and ERK; inhibition of ERK phosphorylation using the MEK-1 inhibitor PD98059 rescued approximately 30% of cells from bFGF-induced death suggesting ERK plays a secondary role in the induction of death. This hypothesis is supported by observations in the A673 cell line; bFGF induced sustained activation of ERK and transient activation of p38(MAPK), which was not associated with cell death. These data demonstrate that sustained activation of p38(MAPK) is essential for activation of the death cascade following exposure of Ewing's sarcoma family of tumors cells to bFGF and provide evidence that activation of p38(MAPK) results in an up-regulation of the death receptor p75(NTR).

Animals↗
PubMed1999

"Avoidable" deaths in two areas of Sweden - analysis of deaths in hospital after injury.

OBJECTIVE: To describe causes of death and other characteristics of "avoidable" deaths in patients admitted to hospital after trauma, and estimate and analyse changes in the avoidable death rate during the years studied. DESIGN: Retrospective analysis of medico legal autopsy material. SETTING: One northern and one western area in Sweden 1988-1996. SUBJECTS: 335 cases who died in hospital after trauma. MAIN OUTCOME MEASURES: Avoidable death, defined as an Injury Severity Score (ISS) of 35 or less and Abbreviated Injury Scale (AIS) head of 4 or less and cause of death. RESULTS: We found 70 avoidable deaths (21%). Among these, 15 (21%) died of head injuries, 17 (24%) of thoracic, abdominal, or pelvic injuries, and 38 (54%) of medical complications. The number of deaths after trauma decreased considerably from 1988-90 to 1994-96, but the proportion who died in hospital remained almost constant. The proportion of avoidable deaths decreased from 22% to 17%, mainly because the proportion of deaths from medical complications was halved. CONCLUSION: The standard of Swedish in-hospital trauma care has improved, particularly with a reduction in post-traumatic complications. However, there is still room for improvement in the treatment of complications among elderly people.

Aged↗
PubMed2004

Cause of death during 13 years after coronary artery bypass grafting with emphasis on cardiac death.

OBJECTIVE: To describe the cause of death in the long term after coronary artery bypass grafting (CABG) with particular emphasis on cardiac death. PATIENTS AND SETTING: All the patients in western Sweden without simultaneous valve surgery and without previous CABG who underwent CABG in 1988-1991 in Göteborg, Sweden. DESIGN: Prospective, observational study for 10.6-13.6 years (i.e. until the end of 2001). Various factors contributing to death were described, with the emphasis on cardiac death. RESULTS: In all, 2000 patients were included in the survey. The all-cause mortality rate was 39%. Fifty-eight per cent of all deaths were judged as cardiac deaths. The most frequent cause of death was heart failure (65% among patients who died within 30 days after CABG and 36% among those who died >30 days after CABG). The second most common cause of death was myocardial infarction (56 and 29%, respectively), followed by cancer (0 and 24%, respectively), stroke (21 and 18%, respectively) and infection (8 and 11%, respectively). CONCLUSION: The factors most commonly contributing to death in the long term after CABG were, in order of frequency, heart failure, myocardial infarction, cancer, stroke and infection.

Aged↗
PubMed1999

Microbiology in sudden infant death syndrome (SIDS) and other childhood deaths.

The usefulness of post-mortem microbiology in the assessment of sudden unexpected deaths in infants and children has been debated by many pathologists. In our centre, microbiological investigations have been part of the post-mortem protocol for investigation of sudden deaths in infants and children for the past 12 years. The objective of this study was to review the microbiological findings for infants and children examined by our unit during the past 4 years in relation to gross and histological findings of the autopsy and the medical and social histories of the children. We reviewed 57 consecutive sudden deaths in infants and children examined by our Referral Centre between November 1994 and October 1998. These 57 sudden deaths were aged from 1 day to 4 years and 9 months including 40 cases of sudden infant death syndrome (SIDS) and 17 non-SIDS deaths. Results of the microbiological investigations of tissues and body fluids were assessed during the case review with reference to histological shock signs, severe gastric aspiration, and signs of acute thymic involution. Bacteria alone or in association with viruses were identified in 45/57 (79%) cases including 34/40 (85%) SIDS. The most frequent bacterial isolate was Escherichia coli (27), and the virus identified most frequently was enterovirus (8). C-reactive protein was increased in 10 out of the 42 cases tested including 8/32 (25%) SIDS. Significant gastric content aspiration was found in 17/57 (29.8%) including 13/40 (32.5%) SIDS. Histological signs of shock were present in 33/55 (60%) cases including 22/39 SIDS (56.4%). The microbiological findings were positive for 27/33 (81.8%). We conclude that post-mortem microbiology is essential in sudden death investigation. The conclusion that a death is unexplained if no microbiology was done is not valid, even if in some cases it may be difficult to know precisely in what way the pathogen contributed to the death.

Autopsy↗
PubMed1975

Precursors of sudden coronary death. Factors related to the incidence of sudden death.

Precursors of sudden death were sought in men--1838 civil servants in Albany, New York, and 2282 residents of Framingham, Massachusetts--under continuous surveillance for 16 years. In men 45-74 years old there were 234 deaths attributed to coronary heart disease (CHD) of which 109 occurred within one hour of onset of symptoms. More than half of all deaths due to CHD occurred outside the hospital and about 80 per cent of these were sudden. Most were unheralded by prior symptoms of CHD. Persons at high risk of death from CHD, including sudden death, can be identified long before the terminal unexpected catastrophe. The same precursive stigmata exist in persons subject ot coronary attacks whether or not immediately fatal. The risk of sudden death in these two populations was positively correlated with high blood pressure, the electrocardiographic pattern of left ventricular enlargement, obesity, and heavy cigarette usage. Sudden death is a common and possibly incidental expression of lethal coronary heart disease. The potential candidate for sudden death cannot be confidently distinguished from the individual who succumbs more slowly of myocardial infarction. The inescapable conclusion is that the prevention of sudden death requires the prevention of coronary attacks.

Adult↗
PubMed1998

Incremental prognostic value of myocardial perfusion single photon emission computed tomography for the prediction of cardiac death: differential stratification for risk of cardiac death and myocardial infarction.

BACKGROUND: The incremental prognostic value of stress single photon emission computed tomography (SPECT) for the prediction of cardiac death as an individual end point and the implications for risk stratification are undefined. METHODS AND RESULTS: We identified 5183 consecutive patients who underwent stress/rest SPECT and were followed up for the occurrence of cardiac death or myocardial infarction. Over a mean follow up of 642+/-226 days, 119 cardiac deaths and 158 myocardial infarctions occurred (3.0% cardiac death rate, 2.3% myocardial infarction rate). Patients with normal scans were at low risk (< or =0.5%/y), and rates of both outcomes increased significantly with worsening scan abnormalities. Patients who underwent exercise stress and had mildly abnormal scans had low rates of cardiac death but higher rates of myocardial infarction (0.7%/y versus 2.6%/y; P<.05). After adjustment for prescan information, scan results provided incremental prognostic value toward the prediction of cardiac death. The identification of patients at intermediate risk of nonfatal myocardial infarction and low risk for cardiac death by SPECT may result in significant cost savings when applied to a clinical testing strategy. CONCLUSIONS: Myocardial perfusion SPECT yields incremental prognostic information toward the identification of cardiac death. Patients with mildly abnormal scans after exercise stress are at low risk for cardiac death but intermediate risk for nonfatal myocardial infarction and thus may benefit from a noninvasive strategy and may not require invasive management.

Adenosine↗
PubMed2005

Thailand's national death registration reform: verifying the causes of death between July 1997 and December 1999.

A fundamental aspect of public health is the accuracy of death certification. Assessing the death registration system is a step toward improving the quality of death reporting. Thailand implemented a more rigorous and informative pilot death registration system in March 2001 in 18 provinces, followed by nationwide implementation in August 2003. Since Thailand is an industrializing nation, its experiences will be of interest to other developing nations planning similar reforms. The causes of all deaths in the 15 provincial pilot projects (of Thailand's 76 provinces) and a random sampling in Bangkok were investigated between July 1997 and December 1999. Health workers interviewed close relatives and three medical doctors reviewed hospital records to verify the causes of death. We were able to interview 78% of the relatives (i.e. 47,632 in number). Three-quarters (76%) of the deceased had sought prior medical care; 41% died in hospital and 54% at home. The overall agreement between the causes of death in our survey vs. that reported on the death certificate was 29%. The highest agreement was for: 'Ill-defined' causes (33%), 'Cancer and Tumors' (17%), 'External Causes' (16%), and 'Infectious Diseases' (10%). Considering the different patterns among age groups and sex, hypertension with stroke, cancer of the liver and bile duct, and HIV infection, were the highest ranking causes among females. Infectious diseases (especially HIV/AIDS), hypertension with stroke and accidents, were the leading causes of deaths among males. External causes were highest among children and young adults.

Adolescent↗
PubMed2005

Imaging plant cell death: GFP-Nit1 aggregation marks an early step of wound and herbicide induced cell death.

BACKGROUND: A great deal is known about the morphological endpoints of plant cell death, but relatively little is known about its sequence of events and/or its execution at the biochemical level. Live cell imaging using GFP-tagged markers is a powerful way to provide dynamic portraits of a cellular process that can in turn provide a descriptive foundation valuable for future biochemical and genetic investigations. RESULTS: While characterizing a collection of random GFP-protein fusion markers we discovered that mechanical wounding induces rapid aggregation of a GFP-Nitrilase 1 fusion protein in Arabidopsis cells directly abutting wound sites. Time-lapse imaging of this response shows that the aggregation occurs in cells that subsequently die 30-60 minutes post-wounding, indicating that GFP-Nit1 aggregation is an early marker of cell death at wound sites. Time-lapse confocal imaging was used to characterize wound-induced cell death using GFP-Nit1 and markers of the nucleus and endoplasmic reticulum. These analyses provide dynamic portraits of well-known death-associated responses such as nuclear contraction and cellular collapse and reveal novel features such as nuclear envelope separation, ER vesiculation and loss of nuclear-lumen contents. As a parallel system for imaging cell death, we developed a chemical method for rapidly triggering cell death using the herbicides bromoxynil or chloroxynil which cause rapid GFP-Nit1 aggregation, loss of nuclear contents and cellular collapse, but not nuclear contraction, separating this response from others during plant cell death. CONCLUSION: Our observations place aggregation of Nitrilase 1 as one of the earliest events associated with wound and herbicide-induced cell death and highlight several novel cellular events that occur as plant cells die. Our data create a detailed descriptive framework for future investigations of plant cell death and provide new tools for both its cellular and biochemical analysis.

Aminohydrolases↗
PubMed2001

Sudden infant death syndrome, bedsharing, parental weight, and age at death.

OBJECTIVE: To assess the role of parental bedsharing in sudden infant death syndrome (SIDS)-like deaths, this study examines the hypothesis that, compared with other SIDS cases, the age distribution of deaths associated with bedsharing should be lower in younger, less vigorous infants. METHODS: For 84 SIDS cases in Cleveland, Ohio, 1992 to 1996, age at death, maternal weight, and other risk factors for SIDS were compared for cases grouped according to bedsharing status. RESULTS: Mean ages at death were 9.1 weeks for 30 bedsharing and 12.7 for 54 nonbedsharing cases, counting 10 with missing information as nonbedsharing. Mean pregravid weights of bedsharing mothers exceeded those of nonbedsharing mothers (84.1 vs 67.0 kg). Mean ages at death for nonbedsharing infants, bedsharing infants of smaller mothers, and bedsharing infants of larger mothers were 12.7, 10.3, and 7.6 weeks, respectively. Large maternal size did not affect age at death in the absence of bedsharing. CONCLUSIONS: By demonstrating that among an urban population at high risk for SIDS, bedsharing is strongly associated with a younger age at death, independent of any other factors, this study provides evidence of a relationship between some SIDS-like deaths and parent-infant bedsharing, particularly if the parent is large.

Age Distribution↗
PubMedDate not supplied

Fear of death, death attitudes, and religious conviction in the terminally ill.

The way in which an individual's belief system about death affects fear of death (FOD) has been largely neglected in the thanatology literature. The present study addresses the dimension of certainty or uncertainty with which beliefs about death are held and examines the way in which such attitudes might affect the FOD in dying patients. Twenty terminally ill patients were administered three FOD measures and a death perspective scale which assessed eight death attitudes. FOD among the terminally ill at both the conscious and fantasy level was low. Increased age was associated with declining conscious FOD, independent of life expectancy. Of the eight death perspectives, the attitudes toward death as afterlife-of-reward most directly tap the dimension of certainty or uncertainty. A significant curvilinear relationship emerged between this death perspective and FOD, suggesting that beliefs are a less critical determinant of death fear than is the certainty with which these beliefs are held. The study raises research and clinical issues pertinent to understanding FOD in dying patients.

Adult↗
PubMed2005

Death anxiety and death depression in Spanish nurses.

This study examined the dimensional structure of Tomás-Sábado and Gómez-Benito's Death Anxiety Inventory and Templer, et al.'s Death Depression Scale-Revised. The responses of 244 Spanish nurses to the Spanish forms of both scales were evaluated by means of a principal axis factor analysis with direct Oblimin rotation. Five significant factors were identified: Internally Generated Death Anxiety, Death Depression, Externally Generated Death Anxiety, Death Threat, and Death Sadness, accounting for 51.6% of the variance. The distribution of the factor loadings for the items of both scales on the five factors supported the discriminant validity of the constructs specific to each of the scales and justified their use in evaluating death anxiety and death depression independently.

Adult↗
PubMed1993

[Neurological problems in the diagnosis of brain death--observation of spinally-mediated movements in brain-dead patients and proposal of a "brain death judging doctor" system].

We report two cases in which neurological examination met the Second Tentative Criteria for Brain Death of Chiba University Medical School, except for spontaneous contractions of the rectus abdominis muscle during apnea testing. In Case 1, a 54-year-old man with brainstem infarction, judgement of brain death was suspended initially, but was ultimately declared after the contractions were deemed to be spinal in origin. MRI findings after declaration and autopsy were compatible with brain death. In Case 2, a 27-year-old man with fulminant hepatitis and subsequent severe brain edema, judgement was postponed due to detection of the contractions at the second testing, and was ceased with family intent. Several cases of abnormal gross and fine movements in brain-dead patients have been reported. These paradoxical phenomena may confuse an inexperienced examiner and delay the declaration of brain death. Whether brain death should be considered real death of the person or not, neurologists should be aware of the occasional presence of neurological problems in the diagnosis of brain death, such as spinally-mediated movements. Since the major opposition to brain death is the distrust of medical doctors, we propose a pilot system of a "brain death judging doctor".

Adult↗
PubMed2005

Sudden unexpected child deaths: forensic autopsy results in cases of sudden deaths during a 5-year period.

The aim of the present study was to determine the incidence of various causes of sudden unexpected child deaths (SUCD) and to assess the importance of an autopsy in predicting the likelihood of finding a cause of death. A retrospective analysis of autopsy findings in 97 cases of SUCD between the ages of 0--11 years was undertaken at the Council of Forensic Medicine, Ankara during a 5-year period (1995--2000). Cases were classified as explained causes (80.42 per cent) and sudden infant death syndrome (SIDS) (19.58 per cent). A total of 25.77 per cent of the deaths occurred in the neonatal period, 45.31 per cent of them in the first year of life and the remaining 28.86 per cent after 1 year of life. The causes of neonatal deaths were respiratory pathology (five cases), birth complications (four cases), gastrointestinal pathology (one case), homicide (10 cases), and SIDS (five cases). The incidence of SIDS in the newborn period was 33 per cent. The incidence of unexplained causes of deaths in the postneonatal period was 31 per cent and the causes of deaths were respiratory pathology (15 cases), aspiration (five cases), gastrointestinal pathology (four cases), SIDS (14 cases), and other causes (four cases). The study of an entire population provides more reliable data regarding causes of sudden unexpected child deaths than does the study of small groups and it is also recommended that in addition to a through evaluation, a detailed autopsy must be performed for each case in experienced centers.

Age Distribution↗