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1.
Aerosp Med Hum Perform ; 91(1): 51-55, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31852575

RESUMO

BACKGROUND: The risks associated with high positive Gz (+Gz) aerobatic flight, especially with respect to +Gz-induced loss of consciousness (G-LOC), are well known. Less appreciated is the effect of negative Gz (-Gz) flight on subsequent +Gz maneuvers, known as the "push-pull effect." This is an example involving the loss of an F-16 and pilot that was caused by the push-pull effect.CASE REPORT: The mishap pilot (MP) was killed during a training flight when his F-16 crashed without an ejection attempt. The MP, while transitioning from prolonged -Gz flight to sustained +Gz flight, maneuvered the mishap aircraft (MA) from -2.06 Gz to +8.56 Gz in less than 5 s. At this point, there were only minimal control inputs for 5 s, indicating the MP experienced transient incapacitation, most likely due to G-LOC or almost loss of consciousness (A-LOC). The MP's subsequent recovery attempt was interrupted by ground impact. The Accident Investigation Board (AIB) concluded the MP experienced G-LOC due to the push-pull effect.DISCUSSION: Since this is not the first time the push-pull effect has resulted in G-LOC mishaps, the adverse effects of such maneuvers should continue to be emphasized during military physiological training, as well as during general aviation (GA) aerobatics training. Furthermore, A-LOC, instead of being considered a discrete phenomenon, may need to be included in a broader G-LOC definition that encompasses the entire continuum of G-LOC and A-LOC.Metzler MM. G-LOC due to the push-pull effect in a fatal F-16 mishap. Aerosp Med Hum Perform. 2020; 91(1):51-55.


Assuntos
Medicina Aeroespacial , Aeronaves , Militares , Inconsciência/etiologia , Aceleração , Adulto , Evolução Fatal , Gravitação , Humanos , Masculino , Fatores de Tempo
2.
Clin Exp Dermatol ; 45(1): 56-62, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31267575

RESUMO

BACKGROUND: Wheat-dependent exercise-induced anaphylaxis (WDEIA) is a severe allergic condition in which wheat ingestion together followed by physical exercise induces anaphylaxis. For patients with WDEIA, omega-5 gliadin is considered to be one of the major allergens. AIM: To analyse the clinical features and allergen spectrum of WDEIA and to investigate the relationship between WDEIA and serum levels of platelet-activating factor (PAF), interleukin (IL)-9 and IL-33. METHODS: Medical histories and conditions of WDEIA cases were collected and summarized, with allergen tests of wheat proteins measured at the same visit. Of the 33 patients enrolled, 13 also had serum levels of PAF, IL-9 and IL-33 measured. The healthy control (HC) group consisted of 13 healthy individuals, who also underwent both the wheat-protein allergen tests and the inflammatory-mediator tests. RESULTS: All patients experienced severe allergic reaction during exercise after wheat ingestion. Manifestations of WDEIA included facial oedema, generalized urticaria and respiratory symptoms. Unconsciousness was also observed in 21 cases. In the patient group, 57.6% were confirmed as hypersensitive to glyceraldehyde-3-phosphate dehydrogenase (GAPDH), while 54.5% were allergic to omega-5 gliadin. PAF concentration was significantly higher in patients with WDEIA compared with HCs, whereas there was no significant difference in IL-9 or IL-33 between the two groups. CONCLUSIONS: WDEIA is a rare type of anaphylaxis. GAPDH and omega-5 gliadin may be the most common allergy-causing wheat proteins for Chinese people. PAF may be associated with the onset and development of WDEIA.


Assuntos
Anafilaxia/etiologia , Exercício Físico/fisiologia , Gliadina/imunologia , Triticum/efeitos adversos , Hipersensibilidade a Trigo/etnologia , Adolescente , Adulto , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Triticum/imunologia , Inconsciência/etiologia , Hipersensibilidade a Trigo/imunologia
3.
Tidsskr Nor Laegeforen ; 139(16)2019 11 05.
Artigo em Norueguês | MEDLINE | ID: mdl-31686471

RESUMO

BACKGROUND: Periventricular nodular heterotopia (PNH) is an embryonal neuronal migration disturbance of the brain. The condition is rare and genetically heterogeneous, often caused by mutations in the FLNA gene. The most common symptoms are epileptic seizures. PNH is often associated with other conditions such as cardiovascular abnormalities. CASE PRESENTATION: A young man was admitted to hospital after a first episode of loss of consciousness. The patient was in normal general condition upon admission, and the clinical examination revealed no abnormalities. However, cerebral imaging performed upon admittance showed PNH, while an extended cardiac examination revealed atrioventricular block with the indication for a pacemaker. After pacemaker implantation and introduction of antiepileptic drug therapy, the patient has been free of symptoms. INTERPRETATION: PNH is a condition that needs multidisciplinary assessments.


Assuntos
Heterotopia Nodular Periventricular , Adulto , Bloqueio Atrioventricular/diagnóstico por imagem , Bloqueio Atrioventricular/terapia , Eletrocardiografia , Humanos , Masculino , Heterotopia Nodular Periventricular/complicações , Heterotopia Nodular Periventricular/diagnóstico por imagem , Heterotopia Nodular Periventricular/terapia , Tomografia Computadorizada por Raios X , Inconsciência/etiologia , Adulto Jovem
4.
Medicine (Baltimore) ; 98(48): e18168, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770265

RESUMO

RATIONALE: Recent years have witnessed a marked improvement in the safety and accuracy of nerve blocks with the help of ultrasound and other visualization technologies. This study reports a challenging case of a severe complication during the ultrasound-guided stellate ganglion block. PATIENT CONCERNS: A 28-year-old male patient with refractory migraine complained episodic pulsatile pain with photophobia, haphalgesia of the scalp for 3 years. INTERVENTIONS: Ultrasound-guided stellate ganglion block with 4 ml of 1% lidocaine was administrated. OUTCOMES: A sudden loss of consciousness and tonic-clonic seizure was occurred after negative aspiration and test dose. Further sonographic examination revealed a variation in the left vertebral artery, which remained unrecognized during the needle insertion because of its sliding ability under the differential pressure applied by the probe. LESSONS: Inadvertent intra-arterial injection of a local anesthetic agent could be minimized under the ultrasound guidance with various protective strategies, including the determination of any prior variation, optimizing the block route, maintaining a constant probe pressure, and using saline for the test dosage. This case resulted in the implementation of new protocols of the ultrasound-guided stellate ganglion block in our department.


Assuntos
Bloqueio Nervoso Autônomo , Complicações Intraoperatórias , Lidocaína , Convulsões , Gânglio Estrelado , Inconsciência , Artéria Vertebral , Adulto , Anestésicos Locais/administração & dosagem , Anestésicos Locais/efeitos adversos , Bloqueio Nervoso Autônomo/efeitos adversos , Bloqueio Nervoso Autônomo/métodos , Humanos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/terapia , Lidocaína/administração & dosagem , Lidocaína/efeitos adversos , Masculino , Erros Médicos/prevenção & controle , Transtornos de Enxaqueca/cirurgia , Assistência ao Paciente/métodos , Convulsões/etiologia , Convulsões/terapia , Gânglio Estrelado/diagnóstico por imagem , Gânglio Estrelado/cirurgia , Resultado do Tratamento , Ultrassonografia de Intervenção/métodos , Inconsciência/etiologia , Inconsciência/terapia , Artéria Vertebral/anatomia & histologia , Artéria Vertebral/lesões
5.
Am J Phys Med Rehabil ; 98(10): 859-865, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31441834

RESUMO

OBJECTIVE: Concussion with transient loss of consciousness is a commonly observed but poorly understood phenomenon with mounting clinical significance. This study aimed to examine the relationship between head motion in varying planes and transient loss of consciousness in athletes with brain injuries. STUDY DESIGN: A case-control design was used. The Ultimate Fighting Championship database was screened for events ending with knockouts from 2013 to 2016. Time of strike, striking implement, strike location, and head motion were recorded for all knockout strikes (cases) and for a subset of nonknockout strikes (controls). Characteristics of winners and losers were compared using two-tailed t tests. Multivariate logistic regression was used to determine odds ratios for strike characteristics associated with transient loss of consciousness. The Kaplan-Meier estimate was used to describe the temporal distribution of knockouts. RESULTS: One hundred thirty-six fights were identified and 110 videos were included. Head motion in the axial plane was strongly associated with transient loss of consciousness (odds ratio, 45.3; 95% confidence interval, 20.8-98.6). Other predictors of transient loss of consciousness were head motion in sagittal and coronal planes, nonfist striking implements, and strikes to the mandible or maxilla. The Kaplan-Meier survival curve demonstrated a decreasing rate of knockouts through time. CONCLUSIONS: Rotational head acceleration, particularly in the axial plane, is strongly associated with transient loss of consciousness.


Assuntos
Traumatismos Craniocerebrais/fisiopatologia , Artes Marciais/lesões , Inconsciência/etiologia , Adulto , Estudos de Casos e Controles , Traumatismos Craniocerebrais/etiologia , Feminino , Cabeça/fisiopatologia , Humanos , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Movimento (Física) , Razão de Chances
7.
Forensic Sci Int ; 301: 263-270, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31185439

RESUMO

BACKGROUND: No means exists to classify the overall credibility of physical torture allegations, which relies on qualitative forensic medical criteria. OBJECTIVES: To develop procedures for processing physical data from torture allegations in order to achieve robust credibility assessments. To assess inter-observer variation in semi-quantitative evaluations. To analyse the importance of physical aspects for the overall assessment of allegations of torture. To assess the correlation between a quantitative description of physical aspects of torture and the appraisal of credibility based on the semi-quantitative model. METHODS: We developed a semi-quantitative model to assess credibility of physical torture allegations and a model to describe allegations quantitatively. Information about physical aspects of ill-treatment in 202 extensive reports made by psychologists (part of a Basque Country Governmental project) was appraised individually and jointly by the two authors in the semi-quantitative model. Inter-observer variation was appraised. The assessed credibility based on physical details was compared with the psychologists' overall assessments and with the quantitative scoring of physical data. FINDINGS: The inter-observer agreement was substantial with kappa values of 0.64-0.77. Peer-reviewing revealed an error; using the defined criteria in the models facilitated achievement of common opinions. Comparison of credibility assessments found by different means suggests that physical data may be given a low priority in the overall assessment of torture allegations. There was a strong correlation (r=0,86, p<0.001) between the semi-quantitative credibility assessment and the quantitative scoring of physical aspects of torture, reinforcing the validity of both means. CONCLUSION: Peer-reviewing of physical aspects of torture based on a qualitative /semi-quantitative /quantitative multi-step analysis leads to robust assessments of credibility. A procedure is needed on how to merge the credibility assessments of the psychological and the physical data into an overall conclusion. We suggest that the highest level of the two evaluations should constitute the overall credibility assessment. LIMITATIONS: The examinations were done years after the detentions, they were not focused on physical details and the data we used was retrieved retrospectively.


Assuntos
Decepção , Psiquiatria Legal , Psicologia Forense , Tortura , Adulto , Coleta de Dados , Documentação , Edema/etiologia , Fadiga/etiologia , Feminino , Hematoma/etiologia , Humanos , Entrevistas como Assunto , Masculino , Variações Dependentes do Observador , Dor/etiologia , Revisão por Pares , Inconsciência/etiologia , Adulto Jovem
9.
J Forensic Leg Med ; 66: 1-3, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31173945

RESUMO

Non-fatal strangulation is a very common but often underestimated cause of severe injury. In this case, a woman experienced several episodes of manual strangulation in an episode of domestic violence which involved loss of consciousness, confusion and neck pain, particularly over the trachea. CT angiogram of the neck showed a small perforation of the trachea at the level of the thoracic inlet. The prevalence of non-fatal strangulation in the Australian general population is unknown, but a study in Western Australia measured a prevalence of 7.4% of women presenting to a sexual assault service. A systematic review analysing data from 9 countries in North America and Europe, estimated a lifetime prevalence by an intimate partner of between 3.0% and 9.7% of all women (1). US data suggests that of those experiencing intimate partner violence, prevalence ranges from 27 to 68% (2, 3). This article considers the limited science known about the injuries sustained from non-fatal manual strangulation, much of which is extrapolated from case reports in the literature.


Assuntos
Asfixia/etiologia , Violência Doméstica , Lesões do Pescoço/complicações , Traqueia/lesões , Confusão/etiologia , Enfisema/diagnóstico por imagem , Feminino , Humanos , Cervicalgia/etiologia , Tomografia Computadorizada por Raios X , Traqueia/diagnóstico por imagem , Inconsciência/etiologia , Adulto Jovem
11.
Am J Phys Med Rehabil ; 98(12): 1067-1071, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31206359

RESUMO

OBJECTIVE: Loss of consciousness is an indicator of the severity of traumatic brain injury and the ascending reticular activating system has been considered as a main structure for consciousness. However, no study on the relation between loss of consciousness and ascending reticular activating system injury in traumatic brain injury has been reported. We investigated the relation between loss of consciousness, severity of traumatic brain injury, and ascending reticular activating system injury using diffusion tensor tractography. DESIGN: One hundred twenty patients were recruited. Three components of ascending reticular activating system, fractional anisotropy, and tract volume were measured. RESULTS: In lower dorsal and ventral ascending reticular activating system, fractional anisotropy and tract volume value in mild group were higher than those of moderate and severe groups, and there was no difference between moderate and severe groups. In upper ascending reticular activating system, fractional anisotropy value in mild group was higher than in moderate group, and it was higher than in moderate group than in severe group. Tract volume value in mild group was higher than in severe group. Loss of consciousness showed moderate negative correlations with tract volume value of lower dorsal ascending reticular activating system (r = -0.348), fractional anisotropy value of lower ventral ascending reticular activating system (r = -0.343), and fractional anisotropy value of upper ascending reticular activating system (r = -0.416). CONCLUSIONS: Injury severity was different among the three traumatic brain injury groups in upper ascending reticular activating system but did not differ between moderate and severe groups in lower dorsal and ventral ascending reticular activating system.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Transtornos da Consciência/etiologia , Tegmento Pontino/lesões , Índice de Gravidade de Doença , Adulto , Lesões Encefálicas/complicações , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Transtornos da Consciência/diagnóstico por imagem , Transtornos da Consciência/patologia , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Inconsciência/diagnóstico por imagem , Inconsciência/etiologia
12.
Undersea Hyperb Med ; 46(2): 153-157, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31051060

RESUMO

In 2018, the Medical Panel of the NATO Underwater Diving Working Group (UDWG) discussed the question of the rescue and management of a submerged unresponsive compressed-gas diver. The Panel reviewed the 2012 recommendation by the UHMS Diving Committee with respect to the specific recommendation in a convulsing diver using a half-face mask and separate mouthpiece, to delay surfacing until the clonic phase had subsided if the mouthpiece was in place. There is a paucity of scientific, epidemiological, experimental and observational human studies to substantiate this guidance. Experimental animal studies suggest that the likelihood of a complete airway obstruction during an ongoing seizure is low and that there is a high likelihood of surviving pulmonary barotrauma caused by complete airway closure. Airway management and control is an essential step in the management of the unresponsive diver and would be challenging to achieve in the underwater environment. Even in the military setting, it will be difficult to provide sufficient training to enable divers to handle such a situation. In this very rare scenario it is considered that emergency guidelines should be clear, concise and easy to follow. The UDWG therefore recommends that all unconscious military divers in this situation should be rescued to surface without waiting for clonic seizures to subside. Training organizations for recreational and occupational divers should consider whether this guidance should be applied for civilian divers as well.


Assuntos
Mergulho/efeitos adversos , Guias de Prática Clínica como Assunto , Trabalho de Resgate/normas , Convulsões , Inconsciência , Barotrauma/complicações , Tomada de Decisões , Fidelidade a Diretrizes , Humanos , Lesão Pulmonar/etiologia , Militares , Trabalho de Resgate/métodos , Convulsões/etiologia , Inconsciência/etiologia
13.
Epileptic Disord ; 21(2): 192-196, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30977731

RESUMO

The aim of this study was to investigate the frequency of loss of responsiveness (LOR) in patients with psychogenic non-epileptic seizures (PNES) and to characterize the patients' clinical variables that may be associated with such a manifestation. In this retrospective study, all patients with documented PNES, who were investigated at Shiraz Comprehensive Epilepsy Center at Shiraz University of Medical Sciences, from 2008 to 2018, were investigated. During the study period, data was available for 324/325 patients with PNES. In total, 275 patients (85%) reported LOR during their seizures, but this was not the case for 49 patients (15%). The model, generated by regression analysis, was shown to be significant (p=0.0001) and LOR could be predicted in 84% of the patients. Closed eyes during seizures (OR: 4.4; 95% CI: 2.101-9.235; p=0.0001) and seizure-associated injury (OR: 3.5; 95% CI: 1.402-8.686; p=0.007) were significantly associated with LOR based on the model. Patients with PNES may frequently report LOR, which is significantly associated with seizure-related injuries. Therefore, it is important to apply appropriate management strategies for patients with PNES and LOR in order to prevent or decrease the possibility of any associated consequences, including ictal injury.


Assuntos
Transtornos Psicofisiológicos/fisiopatologia , Convulsões/fisiopatologia , Inconsciência/fisiopatologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Transtornos Psicofisiológicos/complicações , Estudos Retrospectivos , Convulsões/etiologia , Inconsciência/etiologia , Adulto Jovem
14.
Kyobu Geka ; 72(3): 204-208, 2019 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-30923297

RESUMO

We herein report a rare case of solitary fibrous tumor (SFT) producing high-molecular-weight insulin-like growth factor Ⅱ(big IGF-Ⅱ). A 51-year-old woman with a large mass in the right thorax suffered from repeated loss of consciousness due to hypoglycemic attack. A hematological examination revealed low values of serum insulin and C-peptide despite her hypoglycemia. We therefore regarded her giant thoracic tumor as the cause of the hypoglycemic attack. She underwent resection of the tumor and was diagnosed with SFT pathologically. After the surgery, her blood sugar level stabilized immediately, and she has had no hypoglycemic attacks since. Although we identified big IGF-Ⅱ in a preoperative serum sample by a Western immunoblot analysis, it was not detected after surgical resection. Positivity for big IGF-Ⅱ was observed in the tumor cells by immunohistochemical staining. We therefore concluded that big IGF-Ⅱ produced by the SFT caused the hypoglycemic attack in this patient.


Assuntos
Hipoglicemia/complicações , Tumores Fibrosos Solitários/complicações , Neoplasias Torácicas/complicações , Inconsciência/etiologia , Feminino , Humanos , Hipoglicemia/sangue , Fator de Crescimento Insulin-Like II/metabolismo , Pessoa de Meia-Idade , Doenças Raras/complicações , Doenças Raras/metabolismo , Doenças Raras/cirurgia , Tumores Fibrosos Solitários/metabolismo , Tumores Fibrosos Solitários/cirurgia , Neoplasias Torácicas/metabolismo , Neoplasias Torácicas/cirurgia
16.
BMJ Case Rep ; 12(3)2019 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-30862668

RESUMO

Transient loss of consciousness (TLOC) is a common presentation to the emergency department and has a multitude of causes from benign to potentially fatal. We describe the case of a young female presenting with TLOC during sexual activity that was subsequently diagnosed with subarachnoid haemorrhage. She had normal neurology and only moderate headache. She was subsequently transferred to a neurosurgical unit and underwent endovascular coiling of a small anterior communicating artery aneurysm. She was discharged 15 days later without sequelae.


Assuntos
Aneurisma Intracraniano/complicações , Comportamento Sexual , Hemorragia Subaracnóidea/complicações , Inconsciência/etiologia , Adulto , Angiografia Cerebral , Procedimentos Endovasculares , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Hemorragia Subaracnóidea/diagnóstico por imagem , Vasoespasmo Intracraniano
17.
Iran J Kidney Dis ; 13(1): 32-35, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30851717

RESUMO

INTRODUCTION: Central nervous system (CNS) involvement is the most common extrarenal involvement in hemolytic uremic syndrome (HUS). There are limited reports on clinical cause of chronic neurologic problems in HUS. We evaluated residual neurologic involvement in children with HUS. MATERIALS AND METHODS: This cross-sectional study was conducted on 58 patients with a diagnosis of HUS referred to 2 tertiary pediatric centers. Neurological examinations was performed on all of the patients and they were followed up between 2001 and 2015. Data including demographic variables, type of HUS, neurological symptoms, and other complications were recorded. Neurological involvements that occurred after 6 months from the acute phase of HUS were considered as chronic neurological involvement. RESULTS:  Among 58 patients who were included in the study, 31 (53.4%) had neurological manifestations (31 with acute and 19 with chronic complications). There was no significant difference in acute neurological manifestations between typical and atypical HUS, while chronic neurological manifestations were more frequents in patients with atypical HUS (P = .05). The most common presentations were seizure and decreased level of consciousness. Chronic neurologic problems were found in follow-up visits of 11 patients with acute and 8 without acute involvement. Hypertension was associated with chronic manifestations (P = .01). CONCLUSIONS: According to our results, residual neurological problems were not infrequent in HUS and they were more related with atypical form of disease. Evidence of hypertension is a significant variable for persistence of neurologic problems.


Assuntos
Sistema Nervoso Central/fisiopatologia , Síndrome Hemolítico-Urêmica/complicações , Hipertensão/etiologia , Convulsões/etiologia , Inconsciência/etiologia , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Diálise Renal/efeitos adversos
18.
Eat Weight Disord ; 24(5): 969-974, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30712218

RESUMO

PURPOSE: Anorexia nervosa is a chronic disease which may result in various complications. In pediatric clinical practice, it is common to observe complications related to progressive cachexia caused by malnutrition; however, cases of severe complications, like electrolyte disorders, which represent a direct threat to life, due to polydipsia, are rarely observed. The purpose of this study is to highlight that excessive drinking is of primary importance in anorexia nervosa patients, as it can result in severe medical complications, including increased risk of death. METHODS: We report the case of a 13-year-old girl with anorexia nervosa, who was referred to hospital with seizures, disorders of consciousness, and cardiorespiratory failure. RESULTS: The unstable condition of the patient was attributed to hyponatremia (119 mmol/l), decreased serum osmolality (248 mmol/kg), and decreased urine osmolality (95 mmol/kg) caused by polydipsia (water intoxication) and persistent vomiting. The presented girl was drinking large amounts of water prior to a weigh-in to falsify her low body weight. CONCLUSIONS: Polydipsia is a common problem reported by patients with eating disorders, but one which rarely leads to serious clinical complications, due to severe hyponatremia. This case underscores the importance of careful evaluation of fluid intake and the need for regular monitoring of serum electrolytes in patients with anorexia nervosa. All clinicians treating patients with such disease, as well as the parents of sick children, should be familiar with this life-threatening condition. LEVEL IV: Evidence obtained from multiple time series with or without the intervention, such as case studies.


Assuntos
Anorexia Nervosa/complicações , Hiponatremia/etiologia , Polidipsia/complicações , Insuficiência Respiratória/etiologia , Convulsões/etiologia , Inconsciência/etiologia , Adolescente , Feminino , Humanos
19.
J Forensic Sci ; 64(5): 1551-1554, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30791122

RESUMO

The case of a 69-year-old man, equipped with an ICD and suffering from several chronic cardiac diseases, who died in a car accident, was presented. We analyzed electrogram records from the ICD explanted from the body during the autopsy, which showed that the driver had suffered from malignant ventricular arrhythmia-ventricular fibrillation (VF). A thorough analysis of the details of the accident, as well as the timing of VF and the rhythm observed after the discharge of the ICD showed that the direct cause of the accident was the episode of arrhythmia resulting in a loss of consciousness. Therefore, the presented case illustrates the usefulness of postmortem analysis of electrogram records from ICDs in the reconstruction of road traffic accidents. In such cases, if the victims are implanted with ICDs, it should be a routine procedure performed by forensic pathologists.


Assuntos
Acidentes de Trânsito , Desfibriladores Implantáveis , Inconsciência/etiologia , Fibrilação Ventricular/diagnóstico , Idoso , Humanos , Masculino
20.
Anaesthesia ; 74(5): 630-637, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30786320

RESUMO

A decision by a society to sanction assisted dying in any form should logically go hand-in-hand with defining the acceptable method(s). Assisted dying is legal in several countries and we have reviewed the methods commonly used, contrasting these with an analysis of capital punishment in the USA. We expected that, since a common humane aim is to achieve unconsciousness at the point of death, which then occurs rapidly without pain or distress, there might be a single technique being used. However, the considerable heterogeneity in methods suggests that an optimum method of achieving unconsciousness remains undefined. In voluntary assisted dying (in some US states and European countries), the common method to induce unconsciousness appears to be self-administered barbiturate ingestion, with death resulting slowly from asphyxia due to cardiorespiratory depression. Physician-administered injections (a combination of general anaesthetic and neuromuscular blockade) are an option in Dutch guidelines. Hypoxic methods involving helium rebreathing have also been reported. The method of capital punishment (USA) resembles the Dutch injection technique, but specific drugs, doses and monitoring employed vary. However, for all these forms of assisted dying, there appears to be a relatively high incidence of vomiting (up to 10%), prolongation of death (up to 7 days), and re-awakening from coma (up to 4%), constituting failure of unconsciousness. This raises a concern that some deaths may be inhumane, and we have used lessons from the most recent studies of accidental awareness during anaesthesia to describe an optimal means that could better achieve unconsciousness. We found that the very act of defining an 'optimum' itself has important implications for ethics and the law.


Assuntos
Suicídio Assistido/ética , Suicídio Assistido/legislação & jurisprudência , Inconsciência/etiologia , Pena de Morte/métodos , Ética Médica , Europa (Continente) , Eutanásia Ativa Voluntária/ética , Eutanásia Ativa Voluntária/legislação & jurisprudência , Humanos , Consciência no Peroperatório , Legislação Médica , Estados Unidos
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