Frequent Primary Cause Research Articles

Acute lower respiratory illnesses during the first three years of life

Lower respiratory tract illnesses (LRIs) occurring during the first 3 years of life among children enrolled in the Tucson Children's Respiratory Study have been studied for evidence of viral, mycoplasmal and Chlamydia trachomatis infections. This report examines those from whom adequate acute and convalescent sera were available at the time of the LRI. Two groups were compared: those in whom culture and/or antigen detection yielded an etiologic agent (N = 110); and those who did not (culture negative, N = 124). Seroconversions (> or = 4-fold titer rise) to respiratory syncytial virus; influenza virus types A and B; parainfluenza virus types 1, 2 and 3; or adenovirus were found in only 0 to 5% of the culture negative group. No significant differences between groups with regard to frequencies of seroconversion to influenza type C, parainfluenza virus type 4, human coronaviruses 229E and OC43 or cytomegalovirus were detected, which suggests that these agents may not be frequent primary causes of LRIs among otherwise healthy children. Significant differences in seroconversions to Epstein-Barr virus were detected, suggesting that Epstein-Barr virus may contribute to LRI morbidity; however, its exact role remains to be defined.

Analysis of recreational off-road vehicle accidents resulting in spinal cord injury.

Twelve cases of spinal cord injury (SCI) resulting from recreational off-road vehicle (ORV) accidents seen during a three-year period at a spinal cord injury center were analyzed using structured interviews and record reviews. Seven accidents involved three-wheel all-terrain vehicles (ATVs), one involved a four-wheel ATV, and four involved two-wheel trailbikes. The analysis of accident victim characteristics showed that all age groups are at risk, and that most victims were young adult men vehicle drivers with experience and wearing helmets. Spinal injury levels were cervical, three; thoracic, three; and thoracolumbar, six. Categorized accident hazard patterns were loss of control, six; tipover, four; and hidden obstacle, two. Contributing causative factors to the accident occurrence were poor driver judgment, seven, and vehicle instability, eight. Speeding was the most frequent primary cause of ORV accidents. We discuss vehicle and driver performance characteristics as they relate to risk of accident occurrence. The frequency of ORV accidents as an etiology of traumatic SCI at our center was 8%, compared to 8% for diving accidents and 11% for motorcycle accidents. We recommend, in view of the high risk of severe injury, widespread public education about ORV accident prevention.

Hypernatremia in elderly patients. A heterogeneous, morbid, and iatrogenic entity.

The causes, therapy for, and consequences of hypernatremia in elderly patients are not well understood. We found that in 15,187 consecutive hospital admissions, 162 (1.1%) patients who were at least 60 years of age had serum sodium levels that measured greater than 148 meq/L. Of that 162, 57% had become hypernatremic in the hospital; the remaining 43% were hypernatremic at hospitalization. The mean peak serum sodium level was 154 meq/L (range, 149 to 182), and mean water deficit, 9% of total body water (range, 6% to 30%). The most frequent primary causes were complications of surgery (21%), febrile illness (20%), infirmity (11%), and diabetes mellitus (11%), with more than 40 causal factors identified. Depression of sensorium correlated with severity of hypernatremia (p less than 0.001). The mortality rate (42%) was seven times that of age-matched hospitalized patients, but was not predicted by severity of hypernatremia. Mortality increased with increasing rates of fluid replacement (p less than 0.008). Hypernatremia in elderly patients is usually iatrogenic and often a marker for severe associated systemic illness.

Spectrum of diseases for house staff education on a VA general medicine inpatient service.

A significant portion of internal medicine residency training in the United States today occurs in general medicine sections of Veterans Administration hospitals. The authors studied the demographic, diagnostic, and prognostic characteristics of the patients treated by house staff members rotating through the general medical wards of the Houston, Texas, Veterans Administration (VA) Medical Center. In 2,131 admissions over 13 months, the most frequent primary causes of admissions included congestive heart failure, pneumonia, exacerbation of chronic obstructive lung disease, and malignancy. In 85 percent of the admissions, two or more chronic diseases were present. In 53 percent of admissions, the patients were deemed to be moderately or severely ill on admission. The data indicate that the residents' experience is representative of problems encountered by practicing internists and that VA hospitals make a significant contribution to internal medicine training and thus to the provision of health care for the nation.

A multicenter study of outcome in systemic lupus erythematosus. II. Causes of death.

Causes of death were examined for 1,103 systemic lupus erythematosus patients who were followed from 1965 to 1978 at 9 centers that participated in the Lupus Survival Study Group. A total of 222 patients (20%) died. Lupus-related organ system involvement (mainly active nephritis) and infection were the most frequent primary causes of death. Causes of death were similar throughout the followup period. Hemodialysis had little impact on the length of survival for patients with nephritis. Active central nervous system disease and myocardial infarction were infrequent causes of death. There were no deaths from malignancy.

MESENTERIC ARTERY OCCLUSION WITH INTESTINAL GANGRENE. TWO-STAGE OPERATIVE PROCEDURE WITH THROMBECTOMY, FOLLOWED BY "SECOND LOOK" TO PERMIT RESECTION OF IRREVERSIBLY DAMAGED PORTION OF INTESTINE.

Acute occlusion of the superior mesenteric artery is followed by infarction of the small intestine and ascending colon. The extent of such infarction depends on the localization and size of the (primary or secondary) thrombosis. As the Table shows, the most frequent primary cause is embolism in some authors' experience and thrombosis in others'. In animals, complete interruption of the mesenteric circulation leads to irreversible changes after a period ranging from four hours (Nelson et al, Lillehei et al) to seven hours (Glotzer et al). In man, where some residual blood flow may persist, the intestine is capable of recovery after periods of up to 24 hours following the onset of the crisis, provided the circulation be restored to normal (Shaw et al, Klass, Kleitsch, Miller et al, Saris et al). In animal experiments, Glotzer and co-workers confirmed that the intestinal wall exhibits an astounding power of resistance to ischemia.

On the role of infections in neonatal mortality

Summary Carefully conducted postmortem studies in relatively large series of stillborn fetuses and of infants dying in the neonatal period indicate that infection is a much more frequent primary cause of death than is indicated by vital statistics. Furthermore, in an even greater number of infants whose primary cause of death is attributed to some other disturbance, infection is present exerting a variable role as a contributory cause of death. Further reduction in perinatal mortality resulting from infection should be a distinct possibility and could be responsible for a significant decrease in the total mortality rate in this age group. It is evident that attention to a variety of factors is essential for the reduction of deaths due to infection in the perinatal period and that reliance mainly on antibiotic prophylaxis or therapy is not sufficient. These factors include improvements in the nutrition, hygiene, and health of the pregnant woman, a decrease in the incidence of premature births, a high index of suspicion of the possible presence of infection in infants born after premature rupture of amniotic membranes or prolonged or traumatic labors, and a return to rigid isolation techniques within maternity wards and nurseries. The roles of natural and artifically induced immunity deserve continued and increased investigation. At the moment it is clear that the premature infant is deprived of immune factors from the mother which significantly reduce his capacity to compete with infection.

Age and the incidence of fires in electrical installations

The paper reviews data on the occurrence of fires due to defects in fixed electrical installations amongst a population of about 2.5 million consumers over the years 1951?53 inclusive. The correlation between age of installation and the incidence of fires is examined, and it is shown that for installations more than fifteen years old the incidence of fires is roughly proportional to the age of installation. There is no clear indication of any maximum safe life. Installations less than 15 years old are considered as a separate class, being subject to innovations in housing construction and installation practice. Incomplete data on the types of equipment revealed as defective and on the nature of the defects are reviewed. There is no clear indication that any one type of equipment is particularly subject to the effects of age. The most frequent primary cause of fire is defective wiring, and the most frequent secondary cause fortuitous contact between wiring or earth-continuity conductors and composition gas-pipes. Apart from the latter, there seems no single type of defect the elimination of which could lead to outstanding reduction in the incidence of fires.