Assessment of maxillary sinus fluid volume for postmortem diagnosis of drowning.

INTRODUCTION: Drowning is a comprehensive and exclusive diagnosis at autopsy. Autopsy findings such as pleural effusion and waterlogged lungs contribute to the diagnosis. Herein, we aim to reveal the practical usefulness and postmortem changes of the maxillary sinus fluid volume to diagnose drowning. METHODS: We evaluated 52 drowning and 59 nondrowning cases. The maxillary sinus fluid volume was measured using a computed tomography (CT) scan, and pleural effusion volume and lung weight were manually measured at autopsy. The utility of these three indices for diagnosing drowning and its postmortem changes was evaluated. RESULTS: The maxillary sinus fluid volume was significantly higher in drowning cases than in other external causes and cardiovascular death cases. Receiver operating characteristic curve analysis revealed that a total maxillary sinus fluid volume >1.04 mL more usefully indicated drowning (odds ratio, 8.19) than a total pleural effusion volume >175 mL (odds ratio, 7.23) and a total lung weight >829 g (odds ratio, 2.29). The combination of maxillary sinus fluid volume and pleural effusion volume more effectively predicted drowning than one index alone. Moreover, the maxillary sinus fluid volume was less influenced by the postmortem interval than the other two indices up to a week after death. CONCLUSION: Maxillary sinus fluid volume can be more useful than pleural effusion volume and lung weight with higher sensitivity and odds ratio for diagnosing drowning. IMPLICATIONS FOR PRACTICE: Fluid accumulation in both the maxillary sinuses strongly predicts drowning in the postmortem imaging.

[Assessment on intermittent intravenous cyclophosphamide pulse therapy in diffuse proliferative lupus nephritis].

OBJECTIVE: To determine whether intravenous cyclophosphamide pulse therapy (IVCY) is effective for treating patients with diffuse proliferative lupus nephritis (DPLN) who were 1) refractory to methylprednisolone pulse therapy (MP) or 2) could not be treated with MP because of severe diabetes or steroid induced psychosis. METHODS: Seven patients with biopsy proven DPLN were studied after informed consent. Five of them received IVCY after a failure to achieve renal remission with at least 2 cycles of MP therapy. Of the other 2 patients, one had severe diabetes and the other a history of steroid induced psychosis. Bolus therapy with cyclophosphamide (0.5 g/m2 body surface area) was given once a month for 6 consecutive months and then once every 3 months for a total treatment period of 1 year. All patients were given oral prednisone, 0.5 mg/kg per day. The prednisone dose was tapered to the minimal dose required for controlling the disease. After 1 year, the renal status of the patients were evaluated. RESULTS: At 1 year, 4 of the 7 patients achieved substantial improvement. Although the other 3 patients did not satisfy the definition of substantial improvement, none of them had progressive disease. Adverse events were mild and did not require any treatment, with 2 cases of leukocytopenia without fever or major infection. No cases of hemorrhagic cystitis or amenorrhea were observed. CONCLUSIONS: IVCY was 1) effective in the treatment of DPLN which was refractory to MP and 2) relatively safe with minimal side effects.

[A Japanese language version of the health-promoting lifestyle profile].

The development and initial psychometric evaluation of a Japanese version of the Health-Promoting Lifestyle Profile II (HPLP II) is described. The 52-item instrument was translated into Japanese and was found to be culturally relevant and reliable in a pilot study. The Japanese version was then administered to adiverse but predominantly Japanese group of 337 subjects residing in northern Japan. The Japanese version of the HPLP II was evaluated using factor analysis and reliability measurement. Six factors similar to those isolated previously during psychometric assessment of the English language version were extracted. Those six dimensions comprise the HPLP II subscales of: 1. Health responsibility, 2. Spiritual growth, 3. Physical activity, 4. Interpersonal relations, 5. Nutrition, and 6. Stress management. The alpha reliability coefficient for the total scale was 0.94 and the 2-week retest reliability was 0.91; the alpha coefficients for the subscales ranged from 0.70 to 0.87. The Japanese language version of the HPLP II appears to have sufficient validity and reliability for use by researchers who wish to describe the health-promoting components of lifestyle among the Japanese population and to explore differences and similarities in the health-promoting lifestyle of Japanese and American subjects or those of other ethnic groups. Further evaluations of measurement with different populations appears warranted. This instrument will enable researchers to investigate patterns and determinants of health-promoting lifestyle, as well as the effects of interventions to alter the lifestyle.

[Prognosis of patient with intractable diseases in Wakayama Prefecture--a follow-up study based on medical care certificates].

To clarify the prognosis of patients with intractable diseases, a baseline survey of patients who received financial aid for intractable disease treatment between April 1984 and March 1985 was performed in Wakayama Prefecture, followed by a follow-up survey over a period of 8 years. Based on public welfare-subsidized system in Wakayama Prefecture, all patients with intractable diseases were checked up annually their certificates of financial aid for treatment. The results obtained were as follows: Parkinson's disease had the highest rate of discontinuation of medical care at 65%, followed by idiopathic thrombocytopenic purpura (ITP) at 64%, aplastic anemia at 55%, ulcerative colitis (UC) at 54%, and Behcet's disease at 50%. Systemic lupus erythematosus (SLE) had the lowest rate of discontinuation of medical care at 32%. Discontinuation was due to death in approximately 50% of the patients with SLE, scleroderma, dermatomyositis and polymyositis, and aplastic anemia. Of these, the causes of death in more than 50% were directly related to the primary diseases. However, in patients with SLE and aplastic anemia, 25% discontinued care because of cure or alleviation. Some patients remained in remission even though the prognosis for these diseases is not generally considered to be favorable. Transfer of jurisdiction to the Disabled Persons Welfare Act was seen in 28% of patients with Parkinson's disease, 24% with Behcet's disease, and 23% with ossification of posterior longitudinal ligament, diseases which are believed to cause restriction in daily activities of patients in some cases. On the other hand, cure or alleviation was the reason for discontinuation in 60-70% of patients with Buerger's disease, UC and ITP.(ABSTRACT TRUNCATED AT 250 WORDS)