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At least 19 recordsLinked to original sources
PubMedDate not supplied

Fatal outcome of infantile oxalosis: case reports from three families and a review of literature.

Infantile oxalosis is a rare, autosomal recessive disorder. We present three unrelated cases of infantile oxalosis and their families, emphasizing its place as a cause of acute renal failure in infancy, and showing the clinical heterogeneity of the disease within the same family. The affected infants (two males, one female) were 2.5, 3.5, and five months old. Two families had first degree parental consanguinity; two revealed a history of nephrolithiasis; and one of these two had a member who received liver and kidney transplants because of primary hyperoxaluria type I. All the patients presented with the symptoms and findings of acute renal failure. Their hemoglobin levels were between 6.8-9.6 g/dl, urinalysis revealed (+) to ( +) proteinuria and microscopic hematuria. All had metabolic acidosis with BUN levels 67-113 mg/dl and creatinine 3.5-7.7 mg/dl. The abdominal ultrasonographies revealed normal sized hyperechogenic kidneys with the loss of corticomedullary junctions. Calcium oxalate crystals were demonstrated in retina and bone marrow of two patients, and in renal parenchyma of all the patients. The patients were treated with peritoneal dialysis. Renal functions continued to be abnormal (BUN: 47-168 mg/dl, creatinine: 2.8-11 mg/dl) after dialysis, and the outcome was fatal in all. In the presented families, because of the variation of the clinical presentation and the fatal outcome, presence of the multiple genetic loci appeared to be most likely. Further molecular studies will clarify the heterogeneity of this disorder.

Acute Kidney Injury↗
PubMed2005

Vector analysis correlating bullet trajectory to outcome after civilian through-and-through gunshot wound to the head: using imaging cues to predict fatal outcome.

OBJECTIVE: We identify radiographic imaging similarities found on head computed tomographic (CT) scans of patients with through-and-through gunshot wounds to the head with fatal outcomes. METHODS: A retrospective analysis was conducted over an 18-month period from June 2001 through December 2002. Two hundred seventeen gunshot wound patients were evaluated. Exclusion criteria included any patient with cardiopulmonary injury and instability, airway compromise, or extracranial injuries affecting prognosis. Thirty-seven patients with isolated gunshot wounds to the head were included, 10 of which were fatal. Vital signs, examination results, Glasgow coma scale (GCS) score, intracranial pressure monitoring, surgical data, days in the intensive care unit, and CT scan appearance were collected. A Cartesian xyz coordinate system was created centered on the dorsum sella. Bullet pathways on CT scans were plotted and graphed onto a standardized magnetic resonance imaging scan. RESULTS: Ten patients progressed to brain death. GCS score and pupil irregularity were associated with fatal outcome (P < 0.0001). CT scans showed that brain shift was more common in survivors. Seventy percent of nonsurvivors had minimal brain shift. A tram-track sign on CT scans correlated with fatal outcome (P = 0.005). Vector analysis of nonsurvivors showed an area of the brain approximately 4 cm above the dorsum sella that, when penetrated through the midline, led to brain death (P = 0.0006). This zone was coined the zona fatalis. CONCLUSION: We confirm that GCS score and diabetes insipidus correlated with fatal outcome. In the setting of low-velocity gunshot wounds, fatal outcome and low GCS score were associated with a tram-track sign on CT scans. Bullet passage through a particular supra-dorsum sellar transventricular zone was associated with fatal outcome.

Adolescent↗
PubMed2006

Multiple skeletal metastases from a giant cell tumour of the distal fibula with fatal outcome.

A giant cell tumour is a primary lesion of bone of intermediate severity. Its histogenesis is unclear. In a few cases pulmonary metastases have been described. Multiple skeletal metastases in the absence of sarcomatous change have been observed. We present a case report of a 25-year-old woman with a recurrent giant cell tumour of the distal fibula. After a second recurrence and six years after the initial diagnosis, she rapidly developed multiple bony metastases. The outcome was fatal.

Adult↗
PubMedDate not supplied

Fatal outcome in Eisenmenger syndrome.

AIM: To assess correlations between fatal outcome and histologic findings of pulmonary vascular disease in different situations of Eisenmenger syndrome, either during the natural course or early-late after surgery. MATERIAL AND METHODS: The clinical follow-up and fatal outcome of 20 patients affected by Eisenmenger syndrome were investigated. In addition to the pathologic report and gross reexamination of the heart, the lung tissue was studied by histology. Patients were divided into three groups: 6 non-operated patients who died during the natural course (Group 1), 11 patients who underwent correction of the congenital defect and died in the perioperative period (Group 2), and 3 patients who died late after surgery (Group 3). RESULTS: In Group 1, five patients (83%) died of cardiac arrest a few days after the onset of hypoxic attacks; in four patients histology showed Grade IV pulmonary vascular disease with diffuse fibrinoid necrosis in the distal pulmonary arterial vasculature. In Group 2, nine patients (82%) died on the first or second postoperative day after a refractory pulmonary hypertensive crisis, with histologic evidence in three patients of fibrinoid necrosis of the distal pulmonary small arteries and arterioles. In Group 3, two patients (67%) died suddenly, 6 and 18 years after cardiac surgery, following onset of dyspnea and cardiogenic shock; autopsy showed aneurysmal dilatation of the pulmonary artery with massive thrombosis in the setting of Grades III-IV pulmonary vascular disease without fibrinoid necrosis. CONCLUSION: Fatal outcome in Eisenmenger syndrome, either in the natural course or after refractory hypertensive attacks post surgery, is frequently associated with fibrinoid necrosis of the small pulmonary arteries and arterioles.

Adolescent↗
PubMed2001

Geographical pattern of female deaths from myocardial infarction in an urban population: fatal outcome out-of-hospital related to socio-economic deprivation.

OBJECTIVE: This study of myocardial infarction (MI) amongst urban women has sought to assess whether there are differences in fatal outcome, in-hospital respectively out-of-hospital, between residential areas defined in terms of socio-economic circumstances. DESIGN: Register-based surveillance study 1986-95. SETTING: Seventeen residential areas in the city of Malmö, Sweden. SUBJECTS: Women 20-74 years of age. MAIN OUTCOME MEASURES: Differences in fatal outcome, in-hospital respectively out-of-hospital, between residential areas were expressed in terms of age-adjusted odds ratios (ORs), calculated by means of logistic regression. Socio-economic circumstances in the areas were expressed in terms of a composite score. RESULTS: Between residential areas there were marked and statistically significant differences in incidence (range 124-328/10(5), P < 0.001, d.f.=16) and mortality (range 38-132/10(5), P < 0.005, d.f.=16). Area rates of mortality covaried with incidence (r=0.85, P < 0.001) and with odds ratios of fatal outcome out-of-hospital (r=0.52, P=0.031) but not in-hospital. The odds ratios of fatal outcome out-of-hospital decreased in a statistically significant stepwise fashion from areas in the lowest socio-economic quintile (reference) to areas in the highest socio-economic quintile (OR: 0.67, 95% CI: 0.48-0.94). There was no corresponding association with the odds ratios of fatal outcome in-hospital. CONCLUSIONS: The high rate of mortality from MI amongst women in areas with deprived socio-economic circumstances was related to deaths occurring out-of-hospital. In order to assess the preventive potential there is a need for further studies that may clarify to what extent the association with socio-economic circumstances can be explained by other factors and conditions known to influence the probability of survival.

Adult↗
PubMed1997

[Clostridium myonecrosis as a sequelae of intramuscular injections--description of 3 fatal outcomes].

In three fatal cases of clostridial myonecrosis, the following criteria were found: repeated intramuscular injections over several years with anti-inflammatory substances, delay in diagnosis in outpatient care, and following uncontrollable systemic septic complications, despite radical surgical treatment. Only early, aggressive surgical interventions can stop the rapid course of necrotizing soft-tissue infections.

Adult↗
PubMed1995

Prognostic factors of early sequelae and fatal outcome of Japanese encephalitis.

A clinical case control study to identify prognostic factors present at hospital admission associated with early sequelae and fatal outcome of acute Japanese encephalitis (JE) was carried out in Gusi county, Henan Province, central China from June to September 1991. A total of 70 patients with laboratory-confirmed acute JE were studied, of whom 3 cases died and 33 cases had neurological or psychiatric sequelae at the end of three months follow-up. The results showed that acute JE at younger age, with higher body temperature, high white cell count in CSF, and deep coma present at hospital admission were markers for unfavorable outcomes (sequelae or fatal). A history of the vaccination was not correlated with the early sequelae and fatal outcome of the disease. The paper suggests that early diagnosis and treatment and universal JE vaccination for all susceptible populations are keys for decreasing incidence of sequelae and fatal outcome of acute JE.

Acute Disease↗
PubMed2004

Pulmonary embolism associated with combined oral contraceptives: reporting incidences and potential risk factors for a fatal outcome.

BACKGROUND: It is established that combined oral contraceptive (COC) treatment increases the risk of a pulmonary embolism (PE), but specific risk factors for a fatal outcome from a PE remain to be determined. This study aimed to identify such risk factors, and to calculate the reporting rates of fatal and non-fatal PE. METHODS: Cases of suspected PE during treatment with COCs reported to the Swedish Adverse Drug Reactions Advisory Committee (SADRAC) between 1965 and 2001 were included. Medical records were scrutinized for potential risk factors for a venous thromboembolism (VTE). Annual sales data were obtained from the National Corporation of Pharmacies. RESULTS: A total of 248 cases of a suspected PE were reported; 207 non-fatal and 41 fatal. A VTE was verified in all fatal, and in 83.5% of non-fatal cases. The presence of nausea or abdominal pain, an age >35 years, concomitant treatment with other drugs which may increase the VTE risk, vein or lymph vessel malformation, and a deep vein thrombosis above the knee level were positively associated with a fatal outcome. Chest pain and previous COC use were negatively associated with a fatal outcome. The reporting rate of a PE with a verified VTE was 1.72 (95% confidence interval 1.47-2.00) cases per 100 000 treatment years, and of a fatal PE 0.25 (95% confidence interval 0.16-0.37) cases per 100 000 treatment years. CONCLUSION: Several specific potential risk factors for a fatal outcome from a COC-induced PE were identified. Recognition of these in combination with a high suspicion of VTE in COC users may reduce the risk of a fatal outcome.

Adult↗
PubMed2004

Cerebral venous and sinus thrombosis: patients with a fatal outcome during intravenous dose-adjusted heparin treatment.

INTRODUCTION: Although anticoagulation (AC) reduces the risk of a fatal outcome or severe disability in patients with cerebral venous and sinus thrombosis (CVST), prognosis of severe cases is still difficult to predict. The authors studied the clinical course of patients with CVST who died despite AC therapy to look for clinical features that might explain the lethal course of these patients. MATERIALS AND METHODS: Retrospective analysis of a series of 79 consecutive patients with CVST who were treated with a standard regimen of dose-adjusted iv heparin. Case histories of patients with a fatal outcome are presented. RESULTS: The authors identified eight patients with a fatal outcome. All patients were stuporous or comatose at the start of AC, and four patients showed markedly delayed intracranial circulation times, indicating extensive venous thrombosis. Two patients improved, but deteriorated secondarily after reduction or discontinuation of AC. Sufficient activated partial thromboplastin time levels were reached only after a delay in three patients, and critical deterioration occurred in two of them during this time. CONCLUSION: Although inadequate AC may have contributed to the fatal outcome, some patients with extensive venous thrombosis who are stuporous or comatose at the start of AC may carry an increased risk of death, despite heparin therapy. More aggressive treatment approaches, such as endovascular thrombolysis, may be needed for this subgroup of patients with CVST.

Adult↗
PubMed1997

Vertical transmission of cytomegalovirus, most probably by breast milk, to an infant with Wiskott-Aldrich syndrome with fatal outcome.

UNLABELLED: A 4-month-old boy with prenatally diagnosed Wiskott-Aldrich syndrome became ill with a severe cytomegalovirus (CMV) infection, the outcome of which was fatal. The parents had isolated the infant from other children and adhered to standards of hygiene in order to avoid CMV infection because their first child had died of Wiskott-Aldrich syndrome and CMV infection. The mother breast-fed her child although she was CMV IgG positive. The source of infection was most probably breast milk, which contained CMV at the time the infant developed the generalized CMV infection. CONCLUSION: In infants with immunodeficiency syndromes, CMV infection may have a fatal outcome. Since the virus can be transmitted by breast milk, the advantages and disadvantages of breast-feeding should, therefore, be weighed in newborn infants with an immunodeficiency syndrome whose mother is a CMV carrier.

Breast Feeding↗
PubMed1976

[Multicentric reticulohistiocytosis (lipoid dermato-arthritis). Apropos of a case with fatal outcome].

The authors report the case of a 37-year-old man affected by a seronegative polyarthritis associated at first with erythroderma and then with cutaneous and subcutaneous papulo-nodular structures and a xanthomatous eryption. Histological examination of the cutaneous nodules and of the synovial membrane confirmed the diagnosis of multicentred reticulohistiocytosis by showing the presence of lipid infiltrates in the histiocyte cells and of multinucleate giant cells. A study of the ultrastructure of the histiocytes revealed the presence of numerous intracytoplasmic vacuoles. In spite of antimalaria treatment, with cortisone and then with immuno-depressants, the outcome was fatal with a picture of acute reticulosis and neurological disorders. In discussing this case, the authors also make a general review of the subject.

Adult↗
PubMed1986

[Hemophagocytic syndrome associated with herpes simplex virus. Apropos of a case with a fatal outcome].

A male patient, aged 23 years, with no notable previous history, was admitted to hospital because of fever, splenomegaly, and pancytopenia. The bone marrow was infiltrated by mature looking histiocytes displaying erythrophagocytosis. Other findings included polyclonal hypergammaglobulinemia, elevated transaminases, hypofibrinogenemia, and hypertriglyceridemia. A diagnosis of virus-associated hemophagocytic syndrome was made and virology studies attributed it to herpes simplex virus type 1. Therapy with acyclovir, high dose i.v. immunoglobulins, and vinblastine was unsuccessful. With the addition of prednisone, a remission, with disappearance of histiocytic marrow involvement, was obtained but was of short duration, and the outcome was fatal.

Adult↗
PubMed2002

Fatal outcome from meningococcal disease--an association with meningococcal phenotype but not with reduced susceptibility to benzylpenicillin.

Penicillin has been the mainstay of treatment for meningococcal disease. Isolates of Neisseria meningitidis that are less susceptible to penicillin have been reported in several countries and in recent years have become more common. The clinical significance of this reduced susceptibility has not been investigated on a large scale. Hence, N. meningitidis isolates from culture-confirmed cases of meningococcal disease in England and Wales, between 1993 and 2000, were routinely serogrouped, serotyped and tested for susceptibility to penicillin. These data were linked to death registrations and analysed retrospectively. The changing trends in susceptibility were described and multivariate logistic regression was used to examine associations between strain characteristics and fatal outcome. The frequency of N. meningitidis isolates less susceptible to penicillin increased from < 6% in 1993 to > 18% in 2000. In particular, isolates expressing serogroup C with serotype 2b and serogroup W135 had a higher frequency of reduced penicillin susceptibility (49% and 55%, respectively). There was no evidence of an association between fatal outcome and infection with a less penicillin-susceptible isolate. Fatal outcome was associated with serogroup and serotype, with the odds of death for cases infected with C:2a and B:2a strains three-fold higher when compared with the baseline. For this large dataset the serogroup and serotype of the infecting strain influenced mortality from meningococcal disease and may be markers for hypervirulence. No association was found between reduced penicillin susceptibility and fatal outcome, but the increasing frequency of isolates less susceptible to penicillin highlights the need for continued surveillance.

Adolescent↗
PubMedDate not supplied

Imported malaria in an HIV-positive traveler: a case report with a fatal outcome.

We report a fatal case of malaria in an HIV-coinfected nonimmune traveler. The primary cause of death is discussed. The importance of prevention of malaria in nonimmune travelers is stressed. Prevention of malaria in nonimmune travelers should be regarded as a priority area for clinical practice and operational research.

Adult↗
PubMed1995

[A case of paracetamol retard poisoning with fatal outcome].

A case of fatal paracetamol (acetaminophen) poisoning in a 26-year-old woman who developed liver necrosis is described. The patient reported having ingested 11 g of a slow-release paracetamol preparation and a certain amount of alcohol and benzodiazepine. An unknown dose of phenobarbital (phenemal) had been ingested 24 hours previously, leading to a serum phenobarbital concentration of 0.195 mmol/l at the time of admission. The patient was initially treated with N-acetylcysteine intravenously. This treatment was discontinued after five hours due to a serum paracetamol concentration of 0.49 mmol/l, well below the "treatment line" paracetamol concentration of 0.8 mmol/l six hours after ingestion. Possible aggravating factors are discussed, including sustained high serum concentration of paracetamol due to the slow-release preparation and enzyme induction caused from concomitant phenobarbital and alcohol intake, as well as benzodiazepines displacing paracetamol from liver enzymes. These factors make serum paracetamol concentrations undependable; the importance of continuing N-acetylcysteine treatment in spite of "safe" serum concentrations in the above cases is stressed.

Acetaminophen↗
PubMed2002

Fatal versus non-fatal heroin "overdose": blood morphine concentrations with fatal outcome in comparison to those of intoxicated drivers.

The study was performed to distinguish fatal from non-fatal blood concentrations of morphine. For this purpose, blood levels of free morphine and total morphine (free morphine plus morphine conjugates) in 207 cases of heroin-related deaths were compared to those in 27 drivers surviving opiate intoxication. The majority of both survivors and non-survivors were found to show a concomitant use of depressants including alcohol or stimulants. Blood morphine levels in both groups varied widely, with a large area of overlap between survivors (free morphine: 0-128 ng/ml, total morphine: 10-2,110 ng/ml) and non-survivors (free morphine: 0-2,800 ng/ml, total morphine: 33-5,000 ng/ml). Five (18.5%) survivors and 87 (42.0%) non-survivors exhibit intoxication only by morphine. In these cases, too, both groups overlapped (survivors-free morphine: 28-93 ng/ml, total morphine: 230-1,451 ng/ml; non-survivors-free morphine: 0-2,800 ng/ml, total morphine: 119-4,660 ng/ml). Although the blood levels of free or total morphine do not allow a reliable prediction of survival versus non-survival, the ratio of free/total morphine may be a criterion to distinguish lethal versus survived intoxication. The mean of the ratio of free to total morphine for all lethal cases (N=207) was 0.293, for those that survived (N=27) 0.135, in cases of intoxication only by morphine 0.250 (N=87) and 0.080 (N=5), respectively. Applying a cut-off of 0.12 for free/total morphine and performing ROC analyses, fatal outcome can be predicted in 80% of the cases correctly, whereas 16% of the survivors were classified as dead. Nevertheless, in this study, all cases with a blood concentration of 200 ng/ml and more of free morphine displayed a fatal outcome.

Automobile Driving↗
PubMed2005

Predicting factors influencing the fatal outcome of burns in Kuwait.

A prospective study was carried out on a total of 2111 burn patients admitted at the Burn Center in Kuwait, during 1993 to 2001, with the purpose of predicting the risk factors influencing the fatal outcome. A total of 111 (5.3%) patients died, giving an annual average of 12 deaths, and a mortality rate of 0.64/100,000 population. The data, from the in-patient records, included the most commonly available demographic features viz. age, gender and nationality, as well as best recorded clinical factors, such as cause of burn, total body surface area (TBSA), duration of hospital stay and outcome, for analysis. Kolmogorov-Smirnov z test showed the median age (30 years) and TBSA (80%) significantly higher (p < 0.001) among those died as compared to 24 years and 10%, respectively in patients survived. The Chi-square test revealed a fatal outcome associated with gender and cause of burn. The multiple logistic regression model predicted patients, aged 60 years and above (OR: 9.9, p < 0.001), female gender (OR: 2.2, p < 0.016), Flame burns (OR: 3.5, p < 0.035), and TBSA > 90% (OR: 23.5, p < 0.001), as the most influencing risk factors for a fatal outcome at this burn center. Patients with these characteristics need to be given special attention during in-patient care.

Adolescent↗
PubMed2003

Predicting fatal outcome in the early phase of severe acute pancreatitis by using novel prognostic models.

BACKGROUND/AIMS: Survival in acute pancreatitis and particularly in severe acute and necrotizing pancreatitis is a combination of therapy-associated and patient-related factors. There are only few relevant methods for predicting fatal outcome in acute pancreatitis. Scores such as Ranson, Imrie, Blamey, and APACHE II are practical in assessing the severity of the disease, but are not sufficiently validated for predicting fatal outcome among patients with severe acute pancreatitis. The aim of this study was to construct a novel prediction model for predicting fatal outcome in the early phase of severe acute pancreatitis (SAP) and to compare this model with previously reported predictive systems. METHODS: Hospital records of 253 patients with SAP were retrospectively analyzed. 234 patients with adequate data were included to the test set to construct five logistic regression and three artificial neural network (ANN) models. Two models were tested in an independent prospective validation set of 60 consecutive patients with SAP and compared with previously reported predictive systems. RESULTS: The prediction model considered optimal was a logistic model with four variables: age, highest serum creatinine value within 60-72 h from primary admission, need for mechanical ventilation, and chronic health status. In the validation set, the predictive accuracy, determined by the area under the receiver operating characteristic curve value, was 0.862 for the chosen model, 0.847 for the ANN model using eight variables, 0.817 for APACHE II, 0.781 for multiple organ dysfunction score, 0.655 for Ranson, and 0.536 for Imrie scores. CONCLUSIONS: Ranson and Imrie scores are inaccurate indicators of the mortality in SAP. A novel predictive model based on four variables can reach at least the same predictive performance as the APACHE II system with 14 variables.

APACHE↗