Main Cause Of Early Mortality Research Articles

Prompt triage and treatment of the persons with abdominal injuries after the earthquake

The main causes of early mortality after the earthquake are traumatic shock, hemorrhage and dehydration, and the ratios of shock and hemorrhage are high in patients with abdominal injuries. Prompt triage is very important to persons with abdominal injuries who were rescued in 48 hours after the earthquake. Primary triage should be carried out in the rescue field, and then followed by the secondary triage in the hospital. We improved the efficiency and accuracy of triage by following the principle of 5 steps, 3 categories and 1 indication. Nineteen persons with identified abdominal injuries and unstable vital signs received operation. The false positive rate was 5% (1/19), and the successful rate of the operation was 95% (18/19). During the process of rescue, the lives of the injured persons should be put in the first place. The operation should be performed under the principle of simpleness, rapidity and safeness. Key words: Earthquake; Abdominal injury; Triage

Early mortality in patients with community-acquired pneumonia: causes and risk factors

The first 48 h of evolution of patients with community-acquired pneumonia (CAP) are critical. The aim of the present study was to determine the frequency, causes and factors associated with early mortality in CAP. Nonimmunocompromised adults hospitalised with CAP were prospectively observed from 1995 to 2005. Early deaths, defined as death due to any cause < or = 48 h after admission, were compared with all patients who survived > 48 h. Furthermore, early deaths were compared with late deaths (patients who died > 48 h) and with survivors. Of 2,457 patients, 57 (2.3%) died < or = 48 h after admission. Overall mortality was 7.7%. The main causes of early mortality were respiratory failure and septic shock/multiorgan failure. Independent factors associated with early deaths were increased age, altered mental status at presentation, multilobar pneumonia, shock at admission, pneumococcal bacteraemia and discordant empiric antibiotic therapy. Currently, early mortality is relatively low and is caused by pneumonia-related factors. It occurs mainly among the elderly and in patients presenting with altered mental status, multilobar pneumonia and septic shock. Pneumococcal bacteraemia and discordant antibiotic therapy, mainly due to lack of coverage against Pseudomonas aeruginosa are also significant risk factors.

Analysis of fatal risk factors for severe acute pancreatitis: a report of 141 cases

To investigate the risk factors affecting the mortality of severe acute pancreatitis (SAP). The clinical data of 141 patients with SAP treated from January 2001 to October 2005 were analyzed retrospectively. All the patients were divided into 2 groups, the death group and the survival group. Fifteen potential factors influencing the prognosis of SAP were analyzed with Logistic regression analysis. Thirty-four cases (24.1%) among the 141 patients died. There were significant differences between the two groups in age, body mass index, length of stay, APACHE II score, multiple organ dysfunction syndrome (MODS) and abdominal compartment syndrome (ACS) (P < 0.05). Multiple-factor Logistic regression analysis indicated that the MODS (OR = 67. 358, P < 0.01), APACHE II score (OR =9.716, P < 0.01) and ACS (OR = 5.775, P < 0.05) were the independent risk factors affecting the prognosis of SAP during its early stage, whereas pancreatic infection (OR = 9.652, P < 0.01), MODS (OR = 5.212, P < 0.05) and celiac hemorrhage (OR = 4.707, P < 0.05) were the independent risk factors during the advanced stage of SAP. MODS,especially respiratory dysfunction and renal dysfunction,is the main cause of early mortality for SAP, whereas infection, multiple organ dysfunction and celiac hemorrhage may impact the later mortality. Therefore early prevention and correct management on the risk factors play critical roles in reducing the mortality of SAP.

Disceratose congênita: relato de caso e revisão da literatura

A disceratose congênita é doença hereditária rara, caracterizada pela tríade de pigmentação reticulada da pele, distrofia ungueal e leucoceratose em mucosas. Alterações dentárias, gastrintestinais, geniturinárias, neurológicas, oftalmológicas, pulmonares e esqueléticas associadas têm sido relatadas. A falência medular é a principal causa de morte precoce e também é descrita predisposição para doenças malignas. Afeta principalmente homens, e reconhecem-se formas recessivas ligadas ao X, autossômicas dominantes e recessivas. Relata-se o caso de uma criança do sexo masculino, que apresentava a tríade clássica das lesões sem antecedentes familiares. Faz-se revisão da literatura com o objetivo de enfatizar a necessidade do acompanhamento médico multidisciplinar, de modo a permitir diagnóstico precoce das possíveis complicações.

A syndrome resembling human systemic sclerosis (scleroderma) in MRL/lpr mice lacking interferon-gamma (IFN-gamma) receptor (MRL/lprgammaR-/-).

MRL/lpr mice develop a systemic autoimmune disease characterized by autoantibodies and inflammatory lesions in various organs. The main cause of early mortality is glomerulonephritis. We previously found that MRL/lprgammaR-/- mice are protected from glomerulonephritis and have an increased life span compared with their MRL/lprgammaR+/+ littermates. We now carried out a histopathological study of a selection of organs of MRL/lprgammaR-/- mice. Mice were killed as soon as they showed clinical signs of disease. In the majority of animals skin lesions were the first apparent pathology. Mononuclear cell infiltrates were frequent in skin, lungs and kidneys, and they occurred also in liver, salivary glands and heart. In infiltrated areas there was an abnormal accumulation of bundles of collagen. In the lungs of MRL/lprgammaR-/- mice, and occasionally in other organs, small and middle-sized arteries and veins showed intimal proliferation, resulting in a narrowed lumen. Alveolitis was widespread. Mononuclear cell infiltrates and excessive production of collagen in the skin and several visceral organs, thickening of vascular intima and autoantibodies are characteristic features of human systemic sclerosis. Thus, MRL/lprgammaR-/- mice might represent a model for that disease.

Intraaortic balloon pumping for predominantly right ventricular failure after heart transplantation

Background. Right ventricular failure from elevated pulmonary vascular resistance in the recipient is a main cause of early mortality after heart transplantation. When pharmacologic treatment is insufficient, mechanical circulatory assistance has been used to support the failing right ventricle. Considering right and left ventricular interdependence, we investigated whether intraaortic balloon counterpulsation (IABP) might also alleviate predominantly right ventricular dysfunction after heart transplantation. Methods. Among 278 cardiac recipients, 12 adult patients underwent mechanical circulatory support for cardiac allograft dysfunction. Five patients were treated with percutaneous IABP for early postoperative low cardiac output syndrome characterized by predominantly right ventricular failure. Clinical data and hemodynamic variables were recorded before and during IABP treatment. Results. Cardiac index (CI) and mean arterial pressure (MAP) increased (CI 1.7 ± 0.1 to 2.5 ± 0.2, MAP 53 ± 12 to 71 ± 7, p < 0.05) within 1 hour after IABP, whereas central venous pressure (CVP) and pulmonary artery wedge pressure (PAWP) decreased (CVP 21.6 ± 1.7 to 13.8 ± 3.1, p < .05; PAWP 14.8 ± 4.9 to 12.4 ± 3.7, nonsignificant). Within the next 12 hours, CI and mixed venous oxygen saturation increased ( p < 0.05) and pulmonary artery pressure decreased ( p < 0.05). All 5 patients were weaned successfully and 4 are long-term survivors with adequate cardiac performance at 1 year follow-up. Conclusions. Intraaortic balloon pumping is a minimally invasive circulatory assist device with proved efficiency in low cardiac output syndromes. This report shows that low output syndrome caused by predominantly right ventricular allograft failure may be an additional indication for IABP.

1.4 Mb candidate gene region for X linked dyskeratosis congenita defined by combined haplotype and X chromosome inactivation analysis.

Dyskeratosis congenita (DC) is a rare inherited disorder characterised by the early onset of reticulate skin pigmentation, nail dystrophy, and mucosal leucoplakia. In over 80% of cases bone marrow failure...

Pulmonary transplantation

Between November 1983 and March 1991, we performed 50 single and 40 double lung transplants in 82 recipients. Early deaths occurred in six (13 %) single and in eight (21 %) double lung transplant recipients. Late deaths occurred in 11 (28%) single and in one (3%) double lung recipients. Twenty-three of 37 (62%) single and 17 of 24 (71%) double lung transplant recipients have survived at least 1 year after the operation. In patients surviving at least 3 months after the operation (36 of 47 single lung transplant [77%] and 28 of 37 double lung transplant recipients [76%]), significant improvement occurred in arterial blood gases, pulmonary function tests, and exercise capacity. During our initial experience, airway anastomotic complications were the main cause of early morbidity and mortality. With newer surgical techniques and improved perioperative care, airway complications are now uncommon. Infectious complications, either bacterial (Pseudomonas cepacia) or viral (cytomegalovirus), are now the main cause of early mortality. Chronic rejection in the form of obliterate bronchiolitis has become a frequent cause of late morbidity. (J Thorac Cardiovasc Surg 1992;103:295—306)