Acute abdomen as a cause of death in sudden, unexpected deaths in the elderly.

AIMS: This study profiles patients aged 70 years or above dying suddenly of an 'acute abdomen' and investigates the specific features associated with the conditions and their diagnoses. METHODS: A retrospective study using data obtained from autopsy and police reports held in the Forensic Medicine Section of the University of Edinburgh. RESULTS: From 1997 to 2000, out of 2121 autopsies of patients aged 70 or above, an 'acute abdomen' was considered as a primary cause of death in 111 cases. The number of cases increased over the period of study. Peptic ulcer disease was the commonest underlying cause of death. Twenty-nine (26.1%) cases were due to its complications, namely gastrointestinal haemorrhage and perforation. Sixty-nine (62.2%) patients were seen by a medical practitioner in circumstances arising from the onset of acute abdomen. In 27 (39.1%) cases a provisional diagnosis was recorded. CONCLUSION: The 'acute abdomen' is still an appreciably frequent cause of death in sudden, unexpected deaths in the older age group. Some of the deaths may have been preventable with an early diagnosis. A high level of vigilance and early attention to an 'acute abdomen' by medical practitioners is therefore advocated.

Acute myocardial ischaemia presenting as sudden death in the Lothian and Borders regions of Scotland, 1987 and 1997.

OBJECTIVES: To profile deaths from acute myocardial ischaemia presenting as sudden unexpected death in the years 1987 and 1997, and to review the diagnosis of those patients who sought medical attention. DESIGN: A retrospective study using data obtained from autopsy and police reports held in the Forensic Medicine Unit of the University of Edinburgh. RESULTS: Cardiovascular pathology was present in a significant proportion of cases. Clinically 'silent' events presenting as a sudden, unexpected death were common, comprising more than one-half of the events observed in 1987 and one-third of those in 1997. For symptomatic cases, respiratory and upper gastrointestinal symptoms were the most common presentation. The majority of patients seeking medical advice were misdiagnosed as either having a chest infection or indigestion. CONCLUSIONS: Doctors in the primary care setting should include acute myocardial ischaemia as a possible differential diagnosis of a number of symptoms which initially do not suggest a myocardial origin.

Incidence trends in house fire fatalities in eastern Scotland.

Fatal house fires occur more frequently in Scotland than elsewhere in Great Britain.(1,2) Over the last few years several educational campaigns were initiated to instruct the public in the risk factors associated with such fire fatalities and to promote the installation of functional domestic smoke detectors. An epidemiological survey of house fire deaths in the Lothian and Borders region of Scotland over the first half of the present decade, was carried out to evaluate any changing incidence trends by comparison with a survey of the fatalities from the first half of the previous decade. The impact of such campaigns in reducing house fires appears to be limited.

Hanging deaths in children.

Relatively little is known about death in children following hanging. This 12-year retrospective study in southeast Scotland revealed 12 such deaths among children <15 years of age, involving 10 boys and 2 girls. The rate of hanging deaths was 0.7 deaths/100,000 children/year and was equal to that from falls in children during this time period. The children who died following hanging were aged between 4 and 14 years. All 12 children were in cardiac arrest when found, and 11 were declared dead at the scene, demonstrating the limited potential to reduce the death rate through improved treatment. Scrutiny of the circumstances surrounding each death suggested that 6 of the deaths were accidents and 6 were suicides. There appears to be some, albeit limited, potential to prevent some hanging deaths in children through increased parental supervision, education, and restriction of access to ligatures.

Ultrasonically guided transvaginal oocyte recovery from calves treated with or without GnRH.

We investigated the effect of GnRH given after gonadotropin stimulation on follicle growth and oocyte quality in young calves in a transvaginal oocyte recovery program. A 60 mg MPA pessary was inserted into each of nineteen 5-mo-old Friesian calves for 7 d; on Day 5 they received 140 mg, s.c. FSH (Folltropin) and 200 IU, i.m. PMSG and on Day 8 ten of the calves received 40 micrograms, i.m. GnRH (Fertagyl). Follicles were measured and aspirated on Day 9 using an ultrasound unit with a 6 MHz transvaginal probe (Toshiba). Oocytes from individual calves were recovered, graded and cultured in maturation media for 2 h (+GnRH group) or 22 h (-GnRH group), then fertilized and cultured for 6 d in SOF containing 0.8% BSA and amino acids. Oocyte viability (Class A,B or C) and embryo morphology were recorded. This procedure was repeated on the 19 calves plus 5 others 1 m.o. later, after random allocation to their respective groups. Approximately 70% of the calves responded to gonadotropin stimulation (> 2 follicles over 5 mm in diameter). Calves receiving GnRH tended to have both a higher number of follicles > 2 mm in diameter (27.1 vs 18.7) and of aspirated follicles (22.0 vs 14.1); however, there was a large variability between individuals (0 to 83 follicles and 0 to 73 aspirated). The total number of oocytes collected (10.8 vs 10.9) was not affected by GnRH treatment, probably due to the poor recovery rates in the highly stimulated calves from the +GnRH group, but GnRH did improve the proportion of viable oocytes (6.5 vs 4.1) due to a lower number of Class E oocytes (1.4 vs 4.5; P < 0.05). In the GnRH group, 40% of the viable oocytes had matured at the time of collection versus 0% in the group not treated with GnRH. The necessity of different culture runs between times and treatments prevented any meaningful comparison between groups for embryo development. Following the transfer of 19 morula/blastocyst-stage embryos to recipients, 3 pregnancies were detected by ultrasound examination on Day 60, with 1 oocyte originating from the +GnRH group and 2 from the -GnRH group.

Effect of immunisation against leukaemia inhibitory factor on the establishment of pregnancy in sheep.

Leukaemia inhibitory factor (LIF), a pleiotropic cytokine, is implicated in blastocyst implantation in mice and maintains the development of ovine embryos in culture. Previously, LIF mRNA and protein were demonstrated in the endometrium throughout the oestrous cycle and early pregnancy in the ewe. In this study pregnant ewes were passively immunised against human recombinant LIF with polyclonal antibodies raised in cows by active immunisation. Ewes were immunised during two stages of early pregnancy: blastocyst development to hatching, and blastocyst elongation to implantation. Only animals passively immunised against LIF showed detectable LIF antibodies in their sera and in uterine lumina flushings by radioimmunoassay and Western blot analysis. Pregnancy was confirmed by ultrasound on day 55 and a 33.5% non-significant decrease in pregnancy rate of anti-LIF treated animals was observed, when compared to animals in control groups (untreated or treated with bovine anti-keyhole limpet hemocyanin). Cows actively immunised with recombinant human LIF and exhibiting high levels of LIF antibodies in their sera at the time of blastocyst implantation also showed a reduced pregnancy rate in comparison to control animals. Although LIF may not be obligatory for implantation in ruminants it does appear to have a role during the establishment of pregnancy.

The collection of oocytes from bovine ovaries.

Various needle sizes (17- and 20-g) and aspiration pressures (25, 50, 75 and 100 mmHg) were used to aspirate a total of 5,827 ovarian follicles from bovine ovaries from a slaughterhouse source to assess the impact on the quantity and quality of recovered immature oocytes. The cumulus oocyte complexes (COC's) were graded according to the presence and consistency of cumulus cells surrounding the oocyte and the data analyzed using general linear models. Overall recovery rates and the recovery of oocytes considered viable for IVM/IVF procedures (Classes A, B and C) were both significantly higher using a 17-g needle than a 20-g needle (P < 0.01). As the vacuum pressure increased so did the recovery rate of the total number of oocytes, although the number of viable oocytes reached a maximum at a calculated vacuum pressure of 55 mmHg for the 17-g needle and 77 mmHg for the 20-g needle, with an increased incidence of denuded oocytes at higher vacuum pressures. In a second experiment conducted on 1, 473 follicles, no significant difference was found between 17-g double (flushing) and 17-g single lumen needles in the recovery rate of either the total number or number of viable oocytes when using a vacuum pressure of 50 mmHg.

Suicide by fire in Scotland: 1980-1990.

Suicide by fire is relatively rare in the Western world, accounting for approximately 1% of completed suicides by all methods. This survey identified suicidal deaths among fatalities known to the Scottish Fire Brigades as having died in a fire incident during 1980 to 1990. It is accepted that this is just one possible definition of what constitutes a suicide by fire. Forty cases were identified as suicides from the circumstances of the death as narrated in the police and Fire Brigade reports of the incident. Autopsy and toxicological reports were examined for all cases and the characteristics of the victim and the incident are described. Most cases occurred in the home of the victim and three-quarters of the victims were pronounced dead at the scene or when first seen by a doctor. Smoke inhalation was the most frequently certified cause of death. Alcohol was present in less than half the cases and toxicological analysis for drugs was performed in the minority of cases. One-quarter of victims were reported to have made at least one suicide attempt previously. A range of apparently precipitating factors was observed: the number of cases which appeared to be impulsive responses to life events suggests that prevention is difficult.

Feed intake affects metabolic clearance rate of progesterone in sheep.

To study the inverse relationship between feed level and concentrations of peripheral plasma progesterone, 36 ovariectomised ewes were fed rations at levels calculated to maintain liveweight (M). On the seventh day, the ewes were given an intravenous infusion of progesterone and the metabolic clearance rate (MCR) was calculated. The ewes were then randomly allotted to receive either 1/2M, M or 2M rations for seven days at which time the infusion and blood sampling schedules were repeated. The mean (SE) MCR of infused progesterone in ovariectomised ewes fed either 1/2M, M or 2M rations for seven days was 7.1 (0.59), 9.9 (1.64 and 13.0 (1.19) litre h-1 kg-1 of liveweight, respectively. Differences in MCR of progesterone between ewes fed 1/2M and 2M rations were significant (P < 0.05). The inverse relationship between level of feed intake and plasma progesterone concentration was attributed to differences in clearance rate of progesterone rather than to changes in the entry rate of the hormone into the blood.

Liver blood flow and metabolic clearance rate of progesterone in sheep.

To study the effects of feeding on concentrations of peripheral plasma progesterone, ovariectomised ewes, given exogenous progesterone, were fed 750 g of chopped lucerne hay at either 09.00 (group A, n = 5) or at 15.00 (group B, n = 5) or were fed ad libitum regularly through the experimental period (group C, n = 5). Peripheral blood samples were taken from each ewe at 09.00, 11.00, 15.00, 17.00 and 23.00. In ewes of groups A and B, mean plasma progesterone concentrations declined significantly (P < 0.05) after feeding. Mean progesterone concentrations of group C ewes remained low and were significantly different (P < 0.05) from the pre-feeding values of group A and B ewes. These results showed that the metabolic clearance rate of progesterone changed with the act of feeding. In a second experiment, portal, hepatic and mesenteric vein cannulae were placed in ovariectomised ewes (n = 17). They were then fed a ration calculated to maintain liveweight for seven days (M ration). The ewes were then infused with progesterone into a jugular vein and with p-amino hippuric acid into a mesenteric vein. Ewes were then allotted to receive either half M or twice M rations for seven days after which the infusions and blood sampling procedures were repeated. The mean rate of blood flow in the portal vein was directly related to the level of feed offered when ewes received either 1/2M, M or 2M rations. The liver and gut region removed a mean of 96 per cent of the progesterone entering these tissues.(ABSTRACT TRUNCATED AT 250 WORDS)

Elderly suicides in the Lothian and borders region of Scotland, 1983-1988.

This study examined all the suicides in the over 60 age group in the Lothian and Borders region of Scotland during the period 1983-1988. The data was analysed according to a number of variables, primarily with the intention of identifying the characteristics of the elderly suicide population. With the exception of those persons who exhibit a history of previous attempts, it is concluded that no characteristics unique to that cohort exist. Hence the problem of an accurate and precise diagnosis and assessment of suicide risk is difficult and complex. Cases exhibiting recent contact with the medical profession illustrate the problems of preventive procedures once a valid initial assessment has been made. Medico-legal issues raised by these cases are noted. It is suggested that prevention must be considered as a general function of the care of the elderly rather than as a process appropriate to a 'high-risk' group.