Assuntos
Neoplasias/fisiopatologia , Dor/prevenção & controle , Analgesia Epidural , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Plexo Celíaco/cirurgia , Cordotomia/métodos , Humanos , Dor/tratamento farmacológico , Dor/cirurgia , Nervos Periféricos/efeitos dos fármacos , Nervos Periféricos/cirurgia , Raízes Nervosas Espinhais/efeitos dos fármacosRESUMO
From March 1988 through March 1990, at the Philadelphia Medical Examiner's Office toxicology laboratory, samples from 77 decomposed human bodies were tested for the presence of cocaine, employing gas chromatography/mass spectrometry (GC-MS). The material analyzed included decomposed soft tissue, bloody decomposition fluid, mummified tissue, maggots, and beetle feces. Twenty-two cases (28.6%) were positive for cocaine, many of these cases in states of advanced decomposition. These findings indicate the usefulness of testing decomposed tissue for cocaine in all cases where its presence is suspected. This is contrary to what might be expected, since cocaine is generally labile and rapidly broken down by both enzymatic and nonenzymatic mechanisms.
Assuntos
Cocaína/análise , Mudanças Depois da Morte , Animais , Besouros/química , Dípteros/química , Fezes/química , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Larva/química , Músculos/químicaRESUMO
We describe a child with circulating anti-epithelial cell antibodies, autoimmune enteropathy with intestinal villous atrophy, and membranous glomerulonephritis. The patient had persistent diarrhea at 6 months of age, and a small bowel biopsy showed active enteritis, villous atrophy, and crypt hyperplasia. When the patient was, 10 months of age, nephrotic syndrome developed because of membranous glomerulonephritis. Results of tests for circulating immune complexes were negative. Indirect immunofluorescence studies revealed a circulating antibody directed against renal epithelial cells. Circulating antibodies directed against normal small intestine epithelial cells were also detected by the immunoperoxidase technique. Western blot and immunoprecipitation identified a 55-kd antigen, in both small bowel and kidney, that reacted with an antibody in the patient's serum. High-dose prednisone therapy induced a clinical remission, resolution of the small bowel injury, and diminished serum anti-epithelial cell antibodies; after dose reduction, clinical relapse occurred with villous atrophy and reappearance of anti-epithelial cell antibodies. When the patient was 45 months of age, persistent diarrhea recurred despite intravenous administration of corticosteroids, cyclosporine, and total parenteral nutrition. Autoantibodies to a 55-kd epithelial cell protein are temporally related to the development of enteropathy and nephropathy. Study of similar patients is needed to determine the role of such antibodies in this disorder.
Assuntos
Autoanticorpos/sangue , Doenças Autoimunes/imunologia , Glomerulonefrite Membranosa/imunologia , Enteropatias/imunologia , Intestino Delgado/patologia , Atrofia , Doenças Autoimunes/sangue , Doenças Autoimunes/tratamento farmacológico , Células Epiteliais , Epitélio/imunologia , Glomerulonefrite Membranosa/sangue , Glomerulonefrite Membranosa/tratamento farmacológico , Humanos , Imunoglobulinas/análise , Lactente , Enteropatias/sangue , Enteropatias/tratamento farmacológico , Intestino Delgado/imunologia , Masculino , Prednisona/uso terapêuticoRESUMO
Cocaine is one of the most widely abused substances in the United States, in part due to the availability of its inexpensive alkaloidal free-base form, "crack". A variety of medical complications, including sudden death, are known to occur in the adult-user population, regardless of the route of cocaine administration. We report 16 cases of infant death registered by the Philadelphia (Pa) Medical Examiner's Office over a 2-year period (1987 through 1989), where toxicologic analyses revealed the presence of cocaine and/or its metabolite, benzoylecgonine. Scene investigation documented that these infants, shortly before death, had been exposed to environments that contained the smoke from crack. We conclude that the route of cocaine administration in this infant population was the passive inhalation of crack smoke. It is possible that the cocaine may have contributed to the death of these infants. Thus, in addition to the adult users, infants and children exposed to environments where crack is smoked may inhale cocaine and potentially suffer from its adverse effects.
Assuntos
Cocaína , Respiração , Fumaça , Cocaína/efeitos adversos , Cocaína/sangue , Exposição Ambiental , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , MasculinoAssuntos
Doença das Coronárias/epidemiologia , Hipertensão/epidemiologia , Tecido Adiposo/metabolismo , Adolescente , Adulto , Idoso , Arteriosclerose/epidemiologia , Arteriosclerose/mortalidade , Autopsia , Bahamas , Pressão Sanguínea , Criança , Doença das Coronárias/etiologia , Doença das Coronárias/mortalidade , Gorduras na Dieta , Ácidos Graxos/análise , Humanos , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Hipertensão/patologia , Inalação , Iowa , Ácidos Linoleicos/análise , Ácidos Linoleicos/uso terapêutico , Masculino , Pessoa de Meia-Idade , New York , Ácidos Palmíticos/análise , Estados UnidosAssuntos
Anidrases Carbônicas/metabolismo , Concentração de Íons de Hidrogênio , Bexiga Urinária/metabolismo , Animais , Bicarbonatos/farmacologia , Bufo marinus , Dióxido de Carbono/farmacologia , Colômbia , República Dominicana , Histocitoquímica , Potenciais da Membrana , Microscopia Eletrônica , Mitocôndrias/enzimologia , Especificidade da Espécie , Bexiga Urinária/citologia , Bexiga Urinária/efeitos dos fármacos , Bexiga Urinária/enzimologiaAssuntos
Audiometria , Transtornos da Audição/epidemiologia , Serviços de Saúde Escolar , Adolescente , Regiões Árticas , Bahamas , Criança , Doença das Coronárias/epidemiologia , Dieta Aterogênica , Feminino , Finlândia , Humanos , Masculino , Programas de Rastreamento , Ilhas do Mediterrâneo , New York , Sudão , U.R.S.S. , IugosláviaRESUMO
The aims of the study were to confirm the prevalence of hypertension in Bahamians, to determine at autopsy the degree of coronary atherosclerosis in documented cases of hypertensive disease in Bahamians and to analyse depot fat for fatty acids in Bahamians. Blood pressure was measured by a standard technique in 1488, subjects of ages 10-69 years. The records of 1450 consecutive autopsies were examined and the degree of coronary atherosclerosis graded. There were 130 autopsies of Bahamians with clinical evidence of hypertension. Fatty acids were determined on fat biopsies by gas chromatography. A high mortality rate from and prevalence of hypertensive disease exist in the Bahamas, by contrast to a low mortality rate for myocardial infarction and an apparent low prevalence of coronary heart disease. Depot fat composition of Bahamians shows a high level of linoleic acid (C18:2) (13.3 percent) and a poly-unsaturated/saturated fat ratio of 0.51. The p/s ratio is greater than 0.5 in all countries where the incidence of coronary heart disease is low. It is postulated that the traditional Bahamian diet which is relatively rich in poly-unsaturated fats, modifies the effect of hypertension as a risk factor in the evolution of coronary heart disease in this population (AU)