ABSTRACT
The clinical and pathologic features of two unusual cases of Wilms' tumor are described. Both cases presented as sudden death due to tumor embolus. One patient, a 7-year-old girl, had a massive tumor embolus filling the right main pulmonary artery. The second patient, a 6-year-old boy, had pulmonary artery tumor embolus, widespread metastases to lungs, lymph nodes, mesentery, bowel, brain, and nerves, and tumor emboli in the myocardial and epicardial vessels and carotid artery. The renal vein was invaded in both patients. The histologic characteristics of the two tumors was strikingly similar, both showing a blastemal predominant pattern with minimal epithelial differentiation in the form of tubules. Anaplasia was not a feature. To our knowledge, the initial presentation of Wilms' tumor as sudden and unexpected death has not been previously described.
Subject(s)
Death, Sudden/etiology , Kidney Neoplasms/complications , Neoplastic Cells, Circulating , Wilms Tumor/complications , Child , Death, Sudden/pathology , Embolism/complications , Embolism/etiology , Female , Heart Diseases/complications , Heart Diseases/etiology , Humans , Kidney Neoplasms/pathology , Male , Neoplastic Cells, Circulating/pathology , Pulmonary Embolism/complications , Pulmonary Embolism/etiology , Pulmonary Embolism/pathology , Wilms Tumor/pathologyABSTRACT
3,4-Methylenedioxymethamphetamine (MDMA, "Ecstasy"), a synthetic analogue of 3,4-methylenedioxyamphetamine, has been the center of recent debate over its potential for abuse vs its use as a psychotherapeutic agent. Following its emergency classification in Schedule 1 by the Drug Enforcement Administration in 1985, 3,4-methylenedioxyethamphetamine (MDEA, "Eve") has appeared as MDMA's legal replacement. MDMA is thought to be safe by recreational users and by psychotherapists who support its use. The details of five deaths associated with the use of MDMA and MDEA are reported. In three patients, MDMA or MDEA may have contributed to death by the induction of arrhythmias in individuals with underlying natural disease. In another patient, use of MDMA preceded an episode of bizarre and risky behavior that resulted in accidental death. In another patient, MDMA was thought to be the immediate cause of death. Death as a consequence of the use of these drugs appears to be rare, but it does occur; this outcome may be more common in individuals with underlying cardiac disease.
Subject(s)
3,4-Methylenedioxyamphetamine/adverse effects , Amphetamines/adverse effects , 3,4-Methylenedioxyamphetamine/analogs & derivatives , 3,4-Methylenedioxyamphetamine/metabolism , Accidents , Adolescent , Adult , Arrhythmias, Cardiac/chemically induced , Asthma/complications , Chromatography, Gas , Female , Gas Chromatography-Mass Spectrometry , Heart Diseases/complications , Humans , Male , N-Methyl-3,4-methylenedioxyamphetamineABSTRACT
The effectiveness of previously untested disaster plans was demonstrated during the aftermath of the crash of Delta Airlines Flight 191 at D/FW International Airport on Friday, August 2, 1985. These plans, in effect for years and subjected to periodic review, were as yet untried before this first disaster at D/FW International since its opening. This paper outlines the disaster plans, the actual problems encountered, the logistics of a disaster of this kind, and insights gained from the experience.
