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PubMed1991

A case of autoerotic asphyxia associated with multiplex paraphilia.

During the past 20 years, the sensational aspects of autoerotic fatalities have captured the attention of medical examiners, psychiatrists, law enforcement agents, and the public, as well as the individuals themselves who engage in these dangerous practices. Reports of deaths related to sexual asphyxia have been presented numerous times at national and international meetings and have been the topic of discussion on television talk shows and in the press. Autoerotic fatalities and all the sexual curiosities related to these activities have prompted death scene investigators to publish case reports, and even textbooks, on the subject. The case presented herein is one of a multicomponent paraphilia in which self-asphyxiation (autoasphyxiophilia) led to a fatal autoerotic event.

Accidents↗
PubMed1991

Sexual asphyxia in siblings.

We present an accidental autoerotic asphyxiation of a 24-year-old man. Further investigation revealed that 18 years earlier, his brother, then 13, had been found dead, hanging in the family bathroom. Although that death had been ruled a suicide, reevaluation of the death scene indicates that this was also an autoerotic asphyxiation. This is the first reported case of sexual asphyxia involving siblings.

Accidents↗
PubMed1992

Homicidal traumatic asphyxia associated with pebble impaction of the upper airway.

The news media tend to sensationalize murders involving multiple methods because of their inherent brutality. Similarly, when addressing a jury, prosecutors often emphasize the most grisly part of a murder to ensure a speedy conviction. This paper reports a case of a teenage boy who was murdered by the use of multiple methods of asphyxia. The methods of asphyxial death and the reconstruction of the sequence of events by the medical experts during the murder trial played an important role in the conviction and ultimate sentencing of the perpetrators.

Adolescent↗
PubMed1994

Suicidal asphyxia by gas mask.

Antichemical warfare kits that were issued to all Israeli residents 6 months before the Gulf War included masks of various types suited to the age of the user. During the war, 10 adults died of suffocation due to mishandling of the filter of the masks despite the offil Defense Authority's repeated instructions to be cautious. These masks remained in the possession of the population after the war. We report on six cases of suicidal asphyxia incurred by donning the gas mask tightly sealed that have occurred since 1991.

Adult↗
PubMed1998

Reexamination of custody restraint position and positional asphyxia.

The use of the hogtie restraint (also known as hobble or prone maximal restraint) by law enforcement and prehospital personnel has come under scrutiny because of reports of sudden deaths in persons placed in this restraint position. Some contend that this body position restricts chest and abdominal movement to the point that individuals are at risk for hypoventilatory respiratory compromise and "positional" asphyxiation. We review case reports of custody deaths in subjects placed in the hogtie position, as well as related medical literature regarding positional asphyxia. We also review the current research findings from human physiology studies that have investigated the effects of the hogtie position on respiratory and pulmonary function. We conclude that the hogtie restraint position by itself does not cause respiratory compromise to the point of asphyxiation and that other factors are responsible for the sudden deaths of individuals placed in this position.

Asphyxia↗
PubMed1994

The relationship among the quantitative perfusion-defect indices in Tc-99m HMPAO brain SPECT, IQ test, and involved extremities in children with cerebral palsy due to perinatal asphyxia.

Brain SPECT imaging was performed in 13 children with cerebral palsy (6 girls, 7 boys; age, 7-17 years) due to perinatal asphyxia with mental retardation and involved limbs were studied. The involved coronal slices were summated to a picture for the calculation of the perfusion defect indices as the quantitative and objective estimation of the perfusion defects in each brain. The records of IQ tests were scored from severe to mild mental retardation. Two experienced nuclear medicine physicians analyzed the results of the Tc-99m HMPAO brain SPECTs by visual interpretation. The involved limbs were judged by two pediatricians to be either the right or left side. The relationship among the Tc-99m HMPAO brain SPECTs, IQ test, and physical examinations of the extremities were established. The results showed that two cases of mild mental retardation had the smaller perfusion defect indices (< 0.1), six cases of severe mental retardation had the larger perfusion defect indices (> 0.30), and the other group was between the first two groups. Two cases of mild mental retardation did not have significant perfusion defects in the brain and involved limbs, and two cases with decreased visual acuity had definite perfusion defects in the occipital regions. The other cases had the matched perfusion defects of the brain with the involved limbs. The authors encourage the potential use of Tc-99m HMPAO brain SPECTs to predict the outcome of mental development and limb involvement.

Adolescent↗
PubMed1981

Cerebral perfusion pressure and abnormal intracranial pressure wave forms: their relation to outcome in birth asphyxia.

Intracranial pressure (ICP) studies were carried out in 14 infants with severe birth asphyxia and brain damage. A markedly low cerebral perfusion pressure (CPP) was noted in infants who died and in 1 infant who survived with cerebral palsy. The long-term ICP tracing revealed negative waves and plateau waves in 2 infants. Cushing response was noted in 2 infants who had elevated ICP. The value and significance of evaluated CPP and of abnormal waveforms are discussed.

Asphyxia Neonatorum↗
PubMed1981

Clinical significance of ventriculomegaly in children who suffered perinatal asphyxia with or without intracranial hemorrhage: an 18 month follow-up study.

One-hundred and thirty neonates who suffered perinatal asphyxia were divided into two groups according to maturity at birth. All the neonates were studied with computed tomography (CT) of the brain in the neonatal period and again at 6 months of age. They were all followed clinically until at least 18 months of age. Eleven infants (8%) developed progressive hydrocephalus needing surgical intervention, and 67 (51%) had ventriculomegaly that was not diagnosed as progressive hydrocephalus during the 18-month-long follow-up period. All 11 neonates who developed progressive hydrocephalus had had hemorrhage, but ventriculomegaly without progressive hydrocephalus was very common and as common among those who had had hemorrhage as among those in whom no hemorrhage was found in the neonatal CT scan. We conclude from this study that, although posthemorrhagic hydrocephalus is a not infrequent complication of intracranial hemorrhage in neonates, the diagnosis should be made with caution, since ventriculomegaly of etiologies other than progressive hydrocephalus is common in this group of patients. The CT scan should be evaluated together with the clinical course of the patient. This combined approach will minimize the risks of a false positive diagnosis of progressive hydrocephalus and subsequent overtreatment as well as lack of treatment in cases in which it is necessary.

Asphyxia Neonatorum↗
PubMed2000

The physiology of fetal heart rate patterns and perinatal asphyxia.

The purpose of electronic fetal heart rate (FHR) monitoring is the ongoing assessment of fetal oxygenation. FHR tracings are analyzed for characteristic patterns that signify specific hypoxic or nonhypoxic events. A working knowledge of fetal physiology and the fetal response to hypoxia can aid and refine clinical interpretation of FHR patterns during labor. This article reviews the fetal response to decreased oxygenation, the physiology of subsequent FHR patterns and the clinical presentation of asphyxia in the newborn.

Asphyxia Neonatorum↗
PubMed1994

Traumatic asphyxia.

Four patients showing classic physical stigmata of traumatic asphyxia were studied. Cervicofacial cyanosis and edema, subconjunctival hemorrhage, and multiple ecchymotic hemorrhage of the face, neck, and upper part of the chest were documented. Admission Glasgow coma scale scores ranged from 8 to 15. All but one had no associated injury. Skin discoloration resolved within 3 weeks. Complete resolution of subconjunctival hemorrhage occurred 1 month later. In our series, sore throat, hoarseness, dizziness, numbness, and headaches were common. Profound lower leg pitting edema, hemoptysis, hemotympanum, and transient visual loss were noted. Chest radiographic findings were normal in all patients. Microscopic hematuria was noted in one patient. Diagnosis is made from the history and characteristic appearance of the patient. Treatment is directed to the associated injury. Oxygen supplement with head elevation to 30 degrees is the mainstay of treatment. If the patient survives the initial insult, the prognosis is excellent.

Adolescent↗
PubMed2000

Cerebral hypothermia for prevention of brain injury following perinatal asphyxia.

The possibility that hypothermia has a therapeutic role during or after resuscitation from severe perinatal asphyxia has been a longstanding focus of research. Early studies using short periods of cooling had limited and contradictory results. We now know that resuscitation can be followed by a "latent" phase, characterized by transient recovery of cerebral energy metabolism, before secondary deterioration occurs with seizures, cytotoxic edema, and cerebral energy failure 6 to 15 hours after birth. Recent experimental studies have shown that moderate cerebral hypothermia initiated as soon as possible in the latent phase, before the onset of secondary injury, and continued for 48 hours or more is associated with potent, long-lasting neuroprotection. These encouraging results must be balanced against the well-known adverse systemic effects of hypothermia. Randomized clinical trials are in progress to test the safety and efficacy of cerebral hypothermia.

Animals↗
PubMed2006

Population pharmacokinetics of allopurinol in full-term neonates with perinatal asphyxia.

In newborn infants, allopurinol is being tested as a free radical scavenger to prevent brain damage caused by reperfusion and oxygenation after perinatal hypoxia and ischemia (birth asphyxia). To develop rational dosing schemes for future studies, knowledge of the pharmacokinetics in this patient group is essential. In the present study, a population pharmacokinetic model was designed and validated for allopurinol in this specific patient group. One-compartment and 2-compartment models were fitted to plasma concentration time data of 24 newborns entered in 2 clinical trials using nonlinear mixed effects modeling. A bootstrap procedure was performed to check the robustness of the model. The data were best described using a 1-compartment model with linear elimination. Estimated pharmacokinetic parameters were volume of the central compartment (V, 0.79 L/kg) and total body clearance (CL, 0.078 L/h/kg), with 42% and 60% interindividual variability, respectively. The median values for these parameters of 1000 bootstrap replicates were very similar (95% confidence intervals were 0.67 to 0.96 and 0.054 to 0.10 for V and CL, respectively), indicating the robustness of the model. A population pharmacokinetic model has been designed and validated which adequately describes the data of 2 clinical studies in critically ill newborn infants. The model will be used to design dosing strategies for future evaluation of the benefits of allopurinol in these patients.

Allopurinol↗
PubMed1994

Deaths associated with intrapartum asphyxia in Jamaica.

The Jamaican Perinatal Mortality Survey compared all 2069 perinatal deaths occurring during the 12 months between 1 September 1986 and 31 August 1987 with 10,086 survivors born in the 2 months of September and October 1986. The Wigglesworth classification identified 44% of the deaths as attributable to intrapartum asphyxia (IPA), and this grouping was largely confirmed by post-mortem examination where it had been carried out. About half of these babies weighted 2500 g+ and death should have been largely preventable. Comparison of the 813 IPA singleton deaths with 9919 singleton survivors using logistic regression showed independent associations with maternal employment status, the number of children in the household, maternal height, whether or not the mother was trying to get pregnant, or had ever used an intrauterine contraceptive device. Medical conditions such as syphilis, untreated vaginal infection, bleeding < 28 weeks, bleeding 28+ weeks, highest diastolic and first diastolic blood pressures and eclamptic fits antenatally were all strongly associated. Mothers who commenced antenatal care in the first trimester were at reduced risk as were those who took iron during pregnancy. There were substantial reductions in mortality in areas where better medical facilities were available. To this model, features of previous obstetric history were offered, but the only variables which entered were those relating to prior perinatal deaths and immediately preceding miscarriage and termination. Examination of specific features in the management of labour and delivery is a logical basis for the introduction of changes in practice. Caesarean section is unlikely to be appropriate but it is suggested that more active interventions in terms of use of forceps and/or vacuum extraction may be useful.

Asphyxia Neonatorum↗
PubMed1987

The dangers of premature extubation after severe birth asphyxia.

The records of all 91 neonates with asphyxia who were referred to the Royal Children's Hospital in 1982 and 1983 were reviewed and information was obtained on their subsequent neurological outcome. Thirty children had been extubated after their initial resuscitation, before transfer to the Royal Children's Hospital; 21 of these children had been extubated despite the fact that they had taken more than 5 min to take their first breath, and 11 (52%) of them died (while none of the nine infants who breathed within 5 min died). A paediatrician was involved with two-thirds of the 21 children who were extubated despite having more than 5 min to breathe. Twelve children required cardiac massage; seven of them were extubated and then reintubated before transfer, and six of the seven infants died. These findings suggest that many paediatricians are not aware of the importance of continuing ventilatory support in neonates who have suffered a severe asphyxial insult. Asphyxiated babies who require cardiac massage, and babies who do not start breathing within 5 min of birth, should not be extubated as soon as they have established regular respiration; they should remain intubated and be transferred to an intensive care unit.

Asphyxia Neonatorum↗
PubMed1992

Effects of total asphyxia on the development of synaptic junctions in the brains of mice.

Using ethanolic phosphotungstic acid staining, we studied the development of synaptic junctions in the brains of mice subjected to total asphyxia. One-day-old mice, Std:ddY strain, were put into a chamber continuously flushed with 100% CO2-gas for 35 min. The surviving mice (28.1%) were used as experimental models, while unasphyxiated littermates served as controls. The synaptic junctions in the frontal motor cortex and hippocampal cortex were studied at 20 and 60 days of age using E-PTA staining, and the numbers of synaptic junctions in both areas were counted. In comparison with the control animals, the frontal motor cortex of the subject mice showed a smaller increase in the number of synaptic junctions, both at 20 and at 60 days of age. In the hippocampal cortex, the number of synaptic junctions seen in the experimental mice brains was similar to that in the controls at 20 days of age; however, the number of synaptic junctions in the treated mice brains showed a slower rate of increase than in the controls at 60 days of age.

Animals↗
PubMed2000

Perinatal risk factors related to neurologic outcomes of term newborns with asphyxia at birth: a prospective study.

OBJECTIVES: The incidence of poor neurologic outcomes was studied in term newborns who had suffered severe asphyxia at birth. METHODS: Subjects were 152 newborns admitted to the NICU with a low Apgar score at 1 or 5 minutes. A 1-year prospective follow-up of neurological outcomes was carried out by a questionnaire survey concluded between April 1, 1996 and March 31, 1998. RESULTS: 1) The incidence of a poor neurologic outcome, including 15 neurologic sequelae and 6 deaths, was 13.8% among the subjects. 2) The risk of a poor outcome was increased by 13-fold in neonates with adverse neurological signs and 31-fold in those with hypoxic ischemic encephalopathy. CONCLUSION: The incidence of poor neurologic outcome was very high among term infants with low Apgar scores. These infants were 10 times to 20 times more likely to die, or to survive with permanent disabilities, than were infants without low Apgar scores.

Adult↗
PubMed1984

Cerebral function monitor in the neonate. II: Birth asphyxia.

The cerebral function monitor (CFM) records an integrated electroencephalogram on slow-running paper, and therefore is suited to long-term, continuous monitoring. This study describes CFM patterns of 31 neonates with birth asphyxia. Three distinct types emerged: (1) a normal pattern compatible with gestational age was uniformly associated with favorable clinical outcome; (2) a completely disorganized pattern was associated with sever injury and fatal outcome; and (3) a more subtle pattern showed reversal to a more immature gestational age. The three infants with the third pattern all survived, but with varying degrees of neurological deficit. It is concluded that the CFM can be of advantage in predicting outcome for asphyxiated neonates.

Asphyxia Neonatorum↗
PubMed1989

Correlation of asphyxia and other risk factors with outcome: a contemporary view.

The relationships between 14 maternal/prenatal, 24 perinatal and 12 asphyxia-related variables and outcome at 40 weeks, nine, 18 and 36 months were evaluated in a sample of 608 children enrolled in the multi-center National Heart, Lung and Blood Institute Collaborative study. Correlations were weak generally, although they tended to be stronger for perinatal variables and neurological outcome at 36 months. When the maternal/prenatal and perinatal variables (medical/biological), the SES-Composite Index (environmental/psychosocial) and the Early Neuropsychologic Optimality Rating Scale-9 (behavioral/developmental) were used as optimality scales, prediction was enhanced; however, it appeared that the environmental/psychosocial and behavioral/developmental scales were more predictive of 36-month outcome than were medical/biological variable groupings.

Aging↗