[Organization of medical support for troops, defending Leningrad and the people of the blockaded city].

The data on the composition of forces of medical services and organization of medical-evacuation support for troops defending the blockaded Leningrad are presented. The information about the health losses among the population of Leningrad as a result of bombing, shelling and disease is given. Extremely high rates of morbidity and mortality in residents were associated with hunger, hypothermia and emotional stress. The clinical picture of some diseases has different peculiarities because of alimentary dystrophy background. The city health service suffered huge losses: 482 medical institutions were destroyed, only about 300 people from 1.5 thousand of medical personnel in 1942 saved working capability. The health care service of the local air defense played an essential role in delivery of medical aid. The contribution of civil and military health workers in saving residents lives in the blockaded Leningrad was appreciated.

MORTALITY PATTERNS IN ENDANGERED HAWAIIAN GEESE (NENE; BRANTA SANDVICENSIS).

Understanding causes of death can aid management and recovery of endangered bird populations. Toward those ends, we systematically examined 300 carcasses of endangered Hawaiian Geese (Nene; Branta sandvicensis) from Hawaii, Maui, Molokai, and Kauai between 1992 and 2013. The most common cause of death was emaciation, followed by trauma (vehicular strikes and predation), and infectious/inflammatory diseases of which toxoplasmosis (infection with Toxoplasma gondii) predominated. Toxicoses were less common and were dominated by lead poisoning or botulism. For captive birds, inflammatory conditions predominated, whereas emaciation, trauma, and inflammation were common in free-ranging birds. Mortality patterns were similar for males and females. Trauma predominated for adults, whereas emaciation was more common for goslings. Causes of death varied among islands, with trauma dominating on Molokai, emaciation and inflammation on Kauai, emaciation on Hawaii, and inflammation and trauma on Maui. Understanding habitat or genetic-related factors that predispose Nene (particularly goslings) to emaciation might reduce the impact of this finding. In addition, trauma and infection with T. gondii are human-related problems that may be attenuated if effectively managed (e.g., road signs, enforcement of speed limits, feral cat [Felis catus] control). Such management actions might serve to enhance recovery of this endangered species.

Causes of death in forensic autopsy cases of malnourished persons.

PURPOSE: Medical examiners and forensic pathologists often encounter emaciated bodies in postmortem examinations. However, the main disease that caused death is often not clear and measures to prevent the unexpected death of malnourished persons have not been established. In this study, we examined the underlying causes of death among a large number of forensic autopsy cases that showed emaciation to clarify the features of sudden, unexpected death in malnourished persons. METHODS: Documents of autopsy cases without putrefaction handled during 2007-2010 by the Tokyo Medical Examiner's Office were reviewed (n=7227). The body mass index (BMI) was calculated for each case. The causes of death for cases with severe malnutrition (BMI<16; n=885) were closely examined. RESULTS: About 70% of all deaths in malnourished cases (BMI<16) was due to disease, and the causative diseases are more varied than in those with less severe malnutrition and those without malnutrition (BMI⩾16). A higher proportion of malnutrition as the cause of death was observed in younger persons for both sexes, and a higher proportion of having a history of psychiatric diseases was observed in younger deceased women. In addition, a higher proportion of alcohol-related digestive diseases was observed especially in younger men, some of whom had a history of alcohol dependence. On the other hand, the proportion of organic diseases, such as neoplasms and gastroduodenal ulcer, was higher in older deceased persons, especially among men. Around 70% of all respiratory diseases comprised pneumonia in both sexes. Among non-disease-related causes of death, poisoning was the most frequent cause in women under 55years old (35.3%), with the majority having had a history of psychiatric disease. CONCLUSIONS: Because autopsy cases of malnourished persons show various causes of death, physicians have to pay more attention in making death diagnosis in such cases. From a preventative point of view, early detection of organic diseases, a better approach toward managing psychiatric diseases, and implementation of vaccination for pneumonia will contribute to reduction of future unexpected deaths among malnourished persons.

Risk and indicators of condemnation of male turkey broilers in western France, February-July 2006.

A field study was conducted to estimate the sanitary condemnation proportion in male turkey broiler flocks, to describe the reasons for condemnation and the related macroscopic lesions, and to investigate whether primary production information would predict the risk of condemnation. Male turkey standard broiler flocks (117) were randomly selected in the 13 slaughterhouses located in Western France, from February to July 2006. The flocks were monitored from their arrival at the slaughterhouse until the results of the post mortem sanitary inspection. Information about rearing conditions, health history, catching and loading conditions, transportation to the slaughterhouse and slaughtering was also collected. Sampling design was considered in the calculations and the condemnation proportion was modelled using a negative binomial regression, accounting for clustering within slaughterhouse. The within-flock weighted average condemnation proportion was 1.8% (95% confidence interval, 1.3-2.3%). Emaciation, arthritis-polyarthritis and congestion were the main reported official reasons for condemnation, representing 76% of the condemned carcases. Three variables were significantly associated with increased risk of condemnation: observed locomotor disorders on the farm, high cumulative mortality 2 weeks before slaughter, and clinical signs observed by the Veterinary Services during the ante mortem inspection at the slaughterhouse. The final model explained 35% of the total variation in condemnation risk. Half of this explained variation could be attributed to locomotor disorders observed during rearing. The sensitivity and specificity of the model to predict a high flock condemnation risk were 80% and 74%, respectively, when using an optimum threshold of 0.95% to define high risk. The results of this study suggested that the variables found to be associated with condemnation proportion were markers of increased risk and could be used as indicators. These risk indicators can easily be retrieved from the pre-existing regulatory document transmitted before flock arrival at the slaughterhouse and could be used to screen flocks before slaughter, according to their expected risk of condemnation.

Polycyclic aromatic hydrocarbons (PAHs) in livers of California sea otters.

Concentrations of 16 polycyclic aromatic hydrocarbons (PAHs) were measured in livers of 81 adult female sea otters collected along the California coast in 1992-2002. Concentrations of summation operatorPAHs in livers of sea otters were in the range of 588-17400ng/g lipid wt (mean: 3880ng/g, lipid wt). On a wet weight basis, the concentrations ranged from 17 to 1430ng/g (mean: 146ng/g). Overall, di- and tri-cyclic aromatic hydrocarbons, namely, naphthalene, fluorene, phenanthrene/anthracene, and acenaphthylene, were the predominant compounds found in the livers. Although petroleum-related sources appear to be the major contributors to PAH exposure in sea otters, exposure sources varied by geographical sub-regions. Dibenz[a,h]anthracene was found to comprise a significant proportion of the summation operatorPAH concentrations in sea otters from the northern sub-region of the study area. No significant difference existed in the concentrations of summation operatorPAHs among sea otters that died from infectious diseases, emaciation, and noninfectious causes. Concentrations of summation operatorPAHs in livers of sea otters decreased significantly from 1992 to 2002. Because of the rapid metabolism of PAHs in marine mammals such as sea otters, further studies examining the association of PAHs with health effects should determine hydroxylated metabolites in livers.

A comparative analysis of polybrominated diphenyl ethers and polychlorinated biphenyls in Southern sea otters that died of infectious diseases and noninfectious causes.

Southern sea otters (Enhydra lutris nereis) from the California coast continue to exhibit a slower population regrowth rate than the population in Alaska. Infectious diseases have been identified as a frequent cause of death. Infectious diseases caused by varied pathogens including bacteria, fungi, and parasites were suggestive of compromised immunological health of mature animals in this population. To test the hypothesis that elevated exposure to immunotoxic contaminants such as polybrominated diphenyl ethers (PBDEs) and polychlorinated biphenyls (PCBs) contribute to disease susceptibility via immunosuppression, we determined concentrations of PBDEs and PCBs in livers of 80 adult female sea otters that died of infectious diseases, noninfectious causes, or emaciation. Concentrations of PBDEs and PCBs in sea otter livers varied widely (10-26,800 ng/g and 81-210,000 ng/g, lipid weight, respectively). Concentrations of PBDEs in sea otters were some of the highest values reported for marine mammals so far. Although PCB concentrations in sea otters have declined during 1992-2002, the mean concentration was at the threshold at which adverse health effects are elicited. Concentrations of PBDEs and PCBs were significantly correlated, suggesting co-exposure of these contaminants in sea otters. No significant association was found between the concentrations of PBDEs and the health status of sea otters. Concentrations of PCBs were significantly higher in otters in the infectious disease category than in the noninfectious category, suggesting an association between elevated PCB concentrations and infectious diseases in Southern sea otters.

Mortality in Laysan ducks (Anas laysanensis) by emaciation complicated by Echinuria uncinata on Laysan Island, Hawaii, 1993.

In November 1993, unusual mortality occurred among endangered Laysan ducks on Laysan Island, one of the remote refugia of the Northwestern Hawaiian Islands National Wildlife Refuge (USA). Ten live ducks were emaciated, and blood samples documented anemia, heterophilia, and eosinophilia. Pathology in 13 duck carcasses revealed emaciation, marked thickening of the proventricular wall, abundant mucus, and nodules in the gastrointestinal tract. Histology revealed granulomata associated with nematodes in the proventriculus, small intestines, and body walls of nine of 10 ducks examined on histology. We suspect that low rainfall and low food abundance that year contributed to enhanced pathogenicity of parasite infection, either through increased exposure or decreased host resistance. Because the Laysan duck is found only on Laysan island and is critically endangered, translocation of this species to other islands is being considered. Given that we have not seen pathology associated with Echinuria spp. in native waterfowl on other Hawaiian Islands and given the parasite's potential to cause significant lesions in Laysan ducks, it will be important to prevent the translocation of Echinuria spp.

Mortality rates and causes of death among emaciated cats.

OBJECTIVE: To determine mortality rates and causes of death for thin (i.e., lean or emaciated) cats and, if mortality rates were high, to determine factors associated with risk that cats would be thin. DESIGN: Cohort study. ANIMALS: 1,138 cats examined at 27 private veterinary practices in the northeastern United States. PROCEDURE: Body condition of the cats was scored (emaciated, lean, optimally lean, optimal, heavy, obese) between 1991 and 1992. Follow-up information on whether cats had developed any illnesses, whether cats had died, and, if cats had died, cause of death was obtained between 1994 and 1996. Mortality risk for emaciated cats was estimated, using cats in optimal condition as the reference group. RESULTS: Survival curves for emaciated cats were significantly lower than those for cats of other body conditions. Compared with cats in optimal condition, emaciated cats were 4.4 times as likely to die during the follow-up period. However, after adjusting for age and excluding cats that died within 1 year after body condition was scored, emaciated cats were no longer significantly more likely to die. Emaciated cats were more likely to die of an unknown cause than were cats of optimal condition. Risk factors for emaciated body condition included preexisting illness, age, and Siamese breed. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that emaciated cats had a significantly higher risk of death, compared with cats in optimal body condition. Serious illness and advancing age accounted for much, and perhaps all, of this increased risk of death.

Mass stranding of wedge-tailed shearwater chicks in Hawaii.

Unusual numbers of wedge-tailed shearwater (Puffinus pacificus) chicks stranded on Oahu (Hawaii, USA) in 1994. Compared to healthy wedge-tailed shearwater (WTSW) chicks, stranded chicks were underweight, dehydrated, leukopenic, lymphopenic, eosinopenic, and heterophilic; some birds were toxemic and septic. Stranded chicks also were hypoglycemic and had elevated aspartate amino transferase levels. Most chicks apparently died from emaciation, dehydration, or bacteremia. Because many birds with bacteremia also had severe necrosis of the gastrointestinal (GI) mucosa associated with bacteria, we suspect the GI tract to be the source of disseminated bacterial infection. The identity of the bacteria was not confirmed. The daily number of chicks stranded was significantly related to average wind speeds, and the mortality coincided with the fledging period for WTSW. Strong southeasterly winds were a distinguishing meteorologic factor in 1994 and contributed to the distribution of stranded chicks on Oahu. More objective data on WTSW demographics would enhance future efforts to determine predisposing causes of WTSW wrecks and their effects on seabird colonies.

[Evaluation on the clinical background on early death in patients with pulmonary tuberculosis during the past five years].

We evaluated the clinical background of early death (within 3 months after admission to our hospital) in patients with active pulmonary tuberculosis during the past five years (1992-1996). Among 65 active pulmonary tuberculosis patients who died during the past five years, 32 (49%) died directly of tuberculosis. Thirteen (41%) of those 32 patients died of acute respiratory failure and 9 patients (28%) died in emacitation state. Twenty two patients (69%) died within 3 months after admission to our hospital (the early death group) and 10 patients (31%) died after 3 months (the late death group). Thirteen patients (59%) in the early death group died of acute respiratory failure. On the other hand, none in the late death group died of acute respiratory failure but 4 patients died of chronic heart and/or respiratory failure and 4 patients died in emarciation state. Compared to the patients in the late death group, more patients in the early death group had long total delays (patient's and doctor's delays), had coexisiting diseases, had fallen into acute respiratory failure, and were under malnutrition. We evaluated the nutritional condition of patients using the Onodera's PNI (Prognostic Nutritional Index; 10 x serum almumin concentration + 0.005 x peripheral lymphocyte count) and the PNI value was lower among the patients in the early death group than among those in the late death group. To prevent death due to tuberculosis, we emphasize that it is important to start anti-tuberculosis therapy before patients fall into acute respiratory failure and/or malnutrition.

[Report of national survey on death due to tuberculosis in 1994 in national hospitals and the treatment and prognosis of tuberculous patients with mechanical ventilation].

1. National survey on died patients with active tuberculosis (tbc) or tbc sequelae had been held in national hospitals every five year from 1959 (3433 cases) to 1994 (688 cases). In 1994, 330 patients died due to pulmonary tbc. Recent study revealed the decreased rate of death due to operation, or far advanced cavitary cases, and the increased rate of nontuberculous death, aged people (> 60 yrs), and nontuberculous complications. Main causes of death in pulmonary tbc were lung insufficiency (about half) and general weakness (almost one fifth) in any survey. Rapid progression of pulmonary tbc had been increased cause of death (20.9% in 1994). Main attributable factors of death in 1994 in pulmonary tbc cases were severe condition on admission (38.4%), disturbed lung function (31.2%) and old age (33.2%). Delayed treatment (13.9%) and complications (12.1%) were increasing factors. Early death within 3 months from onset in 1994 was seen in patients < 60 yrs as well as in patients > 80 yrs. Severity due to delayed treatment and rapid progression were supposed to the causes of early death. 2. During 1994 to 1997, mechanical ventilation (MV; > 24 hours) was applied to 18 patients with active pulmonary tuberculosis; 10 acute respiratory failure (ARF), 5 chronic respiratory failure (CRF), 2 central nervous system tbc and 1 hemoptysis. Only one ARF case and three CRF ones survived. ARF cases had low PaO2/FIO2 (about 100), low albuminemia, short MV period (7 cases: < 7 days) and steroid therapy (9 cases). CRF cases had higher PaO2/FIO2 (294), longer MV period (4 cases: > 30 days) and all CO2 narcosis. 3. Noninvasive positive pressure ventilation (NIPPV) was applied to 23 patients with pulmonary tbc sequelae. In 13 patients with stable chronic respiratory failure (mean PaO2 91 mmHg, PaCO2 82 mmHg) 10 continued NIPPV and started home mechanical ventilation (HMV). In 10 patients with acute on chronic respiratory failure (mean PaO2 61 mmHg, PaCO2 92 mmHg) 2 patients fell into tracheal intermittent positive pressure ventilation (TIPPV). Eight patients recovered with NIPPV and 5 started HMV. NIPPV is supposed to be very effective to treat severe chronic hypercapmic respiratory failure.

Winter mortality of common loons in Florida coastal waters.

Diagnostic findings are presented for 434 common loons (Gavia immer) found sick or dead on Florida beaches from 1970 through 1994, primarily during the months of December to April. The most commonly recognized problem was an emaciation syndrome (66%), followed by oiling (18%), aspergillosis (7%), trauma (5%) and miscellaneous disease entities (1%). The cause-of-death for 3% of the birds was not determined. Many of the carcasses examined (n = 173) were obtained during an epizootic which occurred from January to March of 1983 in which more than 13,000 loons were estimated to have died. An emaciation syndrome, characterized by severe atrophy of pectoral muscles, loss of body fat and hemorrhagic enteritis, was the primary finding in this epizootic. It was postulated to have a complex etiologic basis involving synergistic effects and energy costs of migration, molting and replacement of flight feathers, food resource changes, salt-loading, intestinal parasitism, environmental contaminants, and inclement weather.

Prediction of low body weight at long-term follow-up in acute anorexia nervosa by low body weight at referral.

OBJECTIVE: The authors investigated the hypothesis that in acute anorexia nervosa a low body weight predicts a poor weight prognosis for the future. METHOD: The body mass indexes at referral of 272 female patients were examined in relation to the body mass indexes of these patients after a mean follow-up of 9.5 years. RESULTS: The overall correlation between body mass indexes at referral and at follow-up was r = 0.33. Despite this low correlation, the 100 patients with body mass indexes less than 13 kg/m2 at referral had low weights at long-term follow-up. Eleven of the 12 deceased patients were among these 100 patients, as were 24 of the 46 surviving patients whose body mass indexes were 17.5 kg/m2 or less at follow-up. CONCLUSIONS: For patients with anorexia nervosa, a body mass index less than 13 kg/m2 at referral indicates a substantial risk for chronic anorexia nervosa and death related to emaciation.

Causes of owl mortality in Hawaii, 1992 to 1994.

Eighty-one barn owls (Tyto alba) and five Hawaiian owls or pueo (Asio flammeus sandwichensis) from Kauai, Oahu, Lanai, Molokai, Maui and Hawaii (USA) were evaluated for cause of death, November 1992 through August 1994. The most common cause of death in barn owls was trauma (50%) followed by infectious disease (28%) and emaciation (22%). Most traumas apparently resulted from vehicular collisions. Trichomoniasis was the predominant infectious disease and appeared to be a significant cause of death in barn owls in Hawaii. Pasteurellosis and aspergillosis were encountered less commonly. No predisposing cause of emaciation was detected. Stomach contents from 28 barn owls contained mainly insects (64%) of the family Tetigoniidae and Gryllidae, and rodents (18%); the remainder had mixtures of rodents and insects or grass. Three pueo died from trauma and one each died from emaciation and pasteurellosis. We found no evidence of organochlorine, organophosphorus, or carbamate pesticides as causes of death in pueo or barn owls.

Notoedric mange in an ocelot (Felis pardalis) from southern Texas.

Notoedric mange was diagnosed in a free-ranging adult male ocelot (Felis pardalis) found dead in April 1994 in southern Texas (USA). The emaciated carcass had no body fat. The heart was enlarged and flaccid. There was a nonpurulent serosanguineous pericardial and peritoneal exudate. Severe encrusted skin lesions and alopecia extended from the head posteriorly to the shoulders. The forelegs and feet were less severely affected. We observed a massive infection of Notoedres cati in skin scrapings. Epidermal lesions included hyperkeratosis and parakeratosis with necrotic debris and foci of acute inflammatory cells surrounding mites and their eggs in the stratum corneum. There was mild acanthosis and spongiosis of the stratum germativum, but no chronic inflammation in the dermis. This is the first confirmed case in the ocelot, but notoedric manage has been reported from the bobcat (Felis rufus) in southern Texas. Thus, notoedric mange could pose an additional threat to the already endangered remnant population of the ocelot.

Perinatal mortality in caribou from the Porcupine herd, Alaska.

During the 1989 caribou (Rangifer tarandus) calving season on the Arctic National Wildlife Refuge, Alaska (USA), 61 calf carcasses were examined for cause of death and associated pathology. Dead calves were located by low-level aerial searches with two fixed-wing aircraft and a helicopter over high density calving areas between the Hulahula and Aichilik rivers. Primary diagnoses included emaciation (39%), malnutrition (8%), stillbirth (21%), trauma (16%), other primary causes (7%), and undetermined causes (8%). Twenty calves had contributory renal tubular degeneration. The findings indicate that factors contributing to nutritional deprivation in calves were the major cause of neonatal mortality; however, factors affecting stillbirth, abortion, or the urogenital system may have major effects on neonatal caribou and warrant further investigation.

Pathological findings in the Hawaiian monk seal.

Postmortem examinations were performed on 45 Hawaiian monk seals (Monachus schauinslandi) collected during field research on the beaches of the Northwestern Hawaiian Islands (USA) from 1981 to 1985. Both males and females of all age groups, perinatal through adult, were examined. Frequent findings included parasites, trauma, cardiovascular disease (congenital and acquired), and respiratory infections. Emaciation was a common condition. All animals except neonates were infected with parasites; infection was severe in several cases. Splenic hematopoiesis was a universal histopathologic finding. Some cases exhibited lesions consistent with renal, gastrointestinal, and toxic disorders; ectopic tissue calcification; gallstones; and ophthalmologic and dental problems.

Was disease involved in the decimation of Guam's avifauna?

Between 1982 and 1986, 402 (290 live, 112 dead) exotic, migrant or native resident birds on Guam were surveyed for disease-causing agents to determine the role of disease in the decline of native forest bird populations on Guam. Traumatic injury, primarily from collisions with motor vehicles and predation, was the most prevalent (46%) cause of death. Thirty-eight percent of the carcasses examined were in poor body condition largely as a result of inadequate nutrition in captive native birds and poultry and adipose exhaustion in errant migrants. A variety of commensal or opportunistic bacteria, including Salmonella spp., were cultured from 220 birds, and nothing remarkable was found in 15 fecal samples. Lastly, no haematozoans, the suspected cause for the decline of the Hawaiian avifauna, were observed in blood slides examined from 260 birds. Based on the results of the survey and other lines of evidence presented in the discussion, we concluded there were no data implicating disease in the decline of Guam's avifauna.

Diencephalic syndrome of emaciation (Russell's syndrome). Long-term survival.

Three cases of diencephalic syndrome are reported. Two of them, which have been observed postoperatively for more than 7 years, showed typical clinical and endocrinologic features at the time of their first admission, but showed mass signs uncharacteristic of diencephalic syndrome after recurrence of the tumor. Recent data showed a normal baseline for plasma growth hormone but abnormalities in provocation tests. The significance of age in the manifestation of the syndrome is briefly discussed, especially in relation to the tendency toward normalization in the growth hormone level at a later age.