Post Death Research Articles

Histopathological analysis and in situ localisation of Australian tiger snake venom in two clinically envenomed domestic animals

Objective To assess histopathological changes in clinically envenomed tiger snake patients and identify tissue specific localisation of venom toxins using immunohistochemistry. Samples One feline and one canine patient admitted to the Murdoch Pet Emergency Centre (MPEC), Murdoch University with tiger snake ( Notechis sp.) envenoming. Both patients died as a result of envenomation. Non-envenomed tissue was also collected and used for comparison. Methodology Biopsy samples (heart, lung, kidney andskeletal muscle tissue) were retrieved 1–2 h post death and processed for histopathological examination using Haemotoxylin and Eosin, Martius Scarlet Blue and Periodic Acid Schiff staining. Tissues were examined by light microscopy and tissue sections subjected to immunohistochemical staining using in-house generated monoclonal and polyclonal antibodies against Notechis venoms. Results Venom-induced pathological changes were observed in the lungs, kidneys and muscle tissue of both patients. Evidence, not previously noted, of procoagulant venom effects were apparent, with formed thrombi in the heart, lungs (small fibrillar aggregates and larger, discrete thrombi) and kidneys. Immunohistochemical assays revealed venom present in the pulmonary tissue, in and around the glomerular capsule and surrounding tubules in renal tissue and scattered throughout the Gastrocnemius muscle tissue. Conclusion This work has shown pathological evidence of procoagulant venom activity supporting previous suggestions that an initial thrombotic state occurs in envenomed patients. We have shown that venom toxins are able to be localised to specific tissues, in this case, venom was detected in the lung, kidney and muscle tissues of clinically envenomed animals. Future work will examine specific toxin localisation using monoclonal antibodies and identify if antivenom molecules are able to reach their target tissues.

Use of Verbal Autopsy as a Proxy to Determine the Possible Cause of Neonatal Deaths

Introduction: Information on causes of death is extremely important for policy making, planning, monitoring, field research, future management statergies and epidemic awareness. The best method of finding the cause of death is by post mortem examination but since this is difficult, post death analysis by verbal autopsy is a good method to determine the same. Objective: To asses the role of verbal autopsy method in the investigation of neonatal death and to determine the probable, causes of neonatal death. Materials and Methods: A pre-tested questionnaire in Hindi was administered to 50 mothers and/or next of kin or other care givers of the deceased residing in villages around 200 Kms. of Bhopal and in urban slums of Municipal Corporation, Bhopal. Results: 84 % of the total death occurred with in seven days of birth, 88 % of death occurred in villages where health facilities were available. As per verbal autopsy 36 % and 20 % of the infants died because of Birth asphyxia and Respiratory Distress Syndrome respectively and further 2%, 4% and 6% because of neonatal tetanus, hypothermia and other causes respectively. Conclusion: Verbal autopsy could be one of the possible cost effective and a reliable tool for determining the causes of neonatal deaths at present. Key words: Verbal Autopsy; Neonatal death; Reliable respondents and category of villages. DOI: 10.3126/jnps.v31i1.2942J Nep Paedtr Soc 2010;31(1):44-48

Establishing nurse-led ventilator-associated pneumonia surveillance in paediatric intensive care

Preventing ventilator-associated pneumonia (VAP) is one of the Department of Health 'Saving Lives' initiatives. Whereas morbidity and mortality from VAP is well-documented in adults, it is poorly studied in children. We describe the establishment of a nurse-led VAP surveillance programme as part of an overall drive for patient safety and healthcare-associated infection reduction. All children admitted to a tertiary referral paediatric intensive care unit over a four-month period were studied. VAP was defined as pneumonia occurring >48 h post intubation. Diagnostic criteria were: (i) radiological: new/progressive infiltrates, consolidation or cavitation on chest X-ray; (ii) clinical: > or = 3 of new onset purulent bronchial secretions, leucopaenia or leucocytosis, core temperature > or = 38.5 degrees C or < or = 36 degrees C without other cause, significant positive respiratory culture or culture from another relevant site of infection. A flow diagram and teaching programme was developed for bedside nurses to facilitate investigations of suspected VAP. The nurse in charge collected data daily at midnight until 24h post extubation, discharge or death. Suspected cases of VAP were referred to infection control for secondary verification. A total of 158 intubated children were admitted over four months with 58 excluded (ventilated <24 h). Full data were obtained on all 100 children. VAP incidence was 5.6 per 1000 ventilator-days. We report successful introduction of a nurse-led VAP surveillance programme. Data acquisition in this study was dependent on nursing workload, however, and placed a significant time burden on the study leads. Although a relatively low VAP rate was demonstrated, VAP bundles with automated surveillance are being introduced.

Cardiac evaluation in pediatric patients waiting for liver transplantation

Background: Cardiovascular abnormalities are among common complication in patients with cirrhosis waiting for liver transplantation (LT). The aim of the present study was to investigate cardiac abnormalities among pediatric liver transplant candidates. Methods: We prospectively evaluated the pediatric patient aged less than 18 years listed for LT between 2006 and 2008. Besides history taking and physical examination all the patients underwent electrocardiogram, chest radiograph, contrast echocardiography and color Doppler echocardiography, as well as arterial blood gas analyses. Results: Totally 89 patients with mean age of 8.1Aƒ¯?½4.6 years were included in the study. The most common causes for liver disease were cryptogenic cirrhosis followed by biliary atresia and autoimmune cirrhosis. Clubbing was found in 27 out of 89 patients and was the most common abnormalities in physical examination. In 22 patients (24.7%) heart murmur was heard by a pediatric cardiologist. Sixty nine patients (77.5%) had normal cardiac findings in chest radiograph. Cardiomegaly was found in 17 (19.1%) patients as the most common abnormal finding in chest radiograph. Electrocardiogram showed sinus tachycardia in 16 (18%) patients. Eleven patients (12.4%) had tricuspid regurgitation as the most common abnormal findings in echocardiography. Thirteen (14.6%) patients had positive contrast echocardiography in favor of intrapulmonary shunt. Conclusion: As the leading cause of post transplant death after graft rejection are cardiovascular complications cardiac evaluation should be considered in all pediatric patients before LT to lower morbidity and mortality during and after transplantation.

Pre‐PCR Processes in the Molecular Detection of Blackleg and Soft Rot Erwiniae in Seed Potatoes

AbstractThe polymerase chain reaction (PCR) based detection of blackleg and soft rot erwiniae involves pre‐PCR processing steps which may compromise the sensitivity of detection. The aim of this study was to standardize these various steps to develop reproducible diagnostic PCR protocol for the detection of the three known soft rot erwiniae as they occur in the tuber, singly or in combination. Comparison of tuber peel and stolon end tissue as a starting material for enrichment of the bacteria indicated that tuber peel samples resulted in more representative and sensitive detection of the strains than extract from stolon end tissues. Substances of potato origin in the peel extract were found to be highly inhibitory to the PCR. Addition of the antioxidant Dethiotreitol to the samples before enrichment did not have any significant effect on detection during the 24 h period incubation of the peel extract at room temperature. Bulk washing of tubers with one rotten tuber included with the working sample caused surface contamination on 67–91% of the healthy tubers. Washing tubers individually circumvents the problem. The optimum temperature for enrichment of all the three strains was 27°C. At 37°C, Pectobacterium carotovorum failed to be detected while PCR on Pectobacterium atrosepticum and isolates of Dickeya spp. always produced amplification of the specific DNA fragments. Viability test on Nutrient Agar showed that only Dickeya isolates were viable after 48 h of incubation at 37°C suggesting that the detection of P. atrosepticum at 37°C was from dead or non‐viable cells. Post cell death detection experiment further confirmed that DNA was amplified from dead cells of all the strains at 27°C and 33°C whereas at 37°C, only DNA from dead cells of isolates of Dickeya and P. atrosepticum were amplified. There was no amplification from the dead cells of all isolates of P. carotovorum following the 48 h post death incubation at 37°C. The reason for this difference in post death longevity is not clear at this stage.

Selection of reference genes for normalisation of real-time RT-PCR in brain-stem death injury in Ovis aries

BackgroundHeart and lung transplantation is frequently the only therapeutic option for patients with end stage cardio respiratory disease. Organ donation post brain stem death (BSD) is a pre-requisite, yet BSD itself causes such severe damage that many organs offered for donation are unusable, with lung being the organ most affected by BSD. In Australia and New Zealand, less than 50% of lungs offered for donation post BSD are suitable for transplantation, as compared with over 90% of kidneys, resulting in patients dying for lack of suitable lungs. Our group has developed a novel 24 h sheep BSD model to mimic the physiological milieu of the typical human organ donor. Characterisation of the gene expression changes associated with BSD is critical and will assist in determining the aetiology of lung damage post BSD. Real-time PCR is a highly sensitive method involving multiple steps from extraction to processing RNA so the choice of housekeeping genes is important in obtaining reliable results. Little information however, is available on the expression stability of reference genes in the sheep pulmonary artery and lung. We aimed to establish a set of stably expressed reference genes for use as a standard for analysis of gene expression changes in BSD.ResultsWe evaluated the expression stability of 6 candidate normalisation genes (ACTB, GAPDH, HGPRT, PGK1, PPIA and RPLP0) using real time quantitative PCR. There was a wide range of Ct-values within each tissue for pulmonary artery (15–24) and lung (16–25) but the expression pattern for each gene was similar across the two tissues. After geNorm analysis, ACTB and PPIA were shown to be the most stably expressed in the pulmonary artery and ACTB and PGK1 in the lung tissue of BSD sheep.ConclusionAccurate normalisation is critical in obtaining reliable and reproducible results in gene expression studies. This study demonstrates tissue associated variability in the selection of these normalisation genes in BSD sheep and underlines the importance of selecting the correct reference genes for both the animal model and tissue studied.

Risk factors for hepatic veno-occlusive disease: a retrospective unicentric study in 116 children autografted after a high-dose BU-thiotepa regimen

At our Institute, during the last decade, the incidence of hepatic veno-occlusive disease (HVOD) appears to be on the increase among pediatric patients treated with BU-thiotepa (BU-TTP)-conditioning regimen. We thus performed a retrospective analysis to identify the risk factors for HVOD, which could explain such a change. In total, 116 patients treated at Institut Gustave Roussy, between May 1998 and December 2005 were eligible for this study having received BU-TTP as their first high-dose chemotherapy regimen, followed by autologous hematopoietic SCT (AHSCT). According to McDonald's clinical criteria, HVOD was diagnosed in 31% of these children. Demographic, clinical, biological and therapeutic parameters were evaluated in uni- and multivariate analyses that showed a significant correlation between previous carboplatin therapy and risk of developing post transplant HVOD (P=0.028). Comparable results were found for etoposide (P=0.048). In addition, a correlation between HVOD and risk of post transplant death was linked to its association with other types of organ failure (P=0.029). This study demonstrates that previous VPCARBO administration in conventional chemotherapy significantly increases the risk of HVOD among brain tumor patients later consolidated with BU-TTP followed by AHSCT.

An economic evaluation of vasoactive agents used in the United Kingdom for acute bleeding oesophageal varices in patients with liver cirrhosis

ABSTRACTObjective: To conduct an economic evaluation of terlipressin, octreotide and placebo in the treatment of bleeding oesophageal varices (BOV) where endotherapy could be used concomitantly.Methods: A discrete event simulation model was created with transition states: bleeding, no bleeding, no bleeding post transjugular intrahepatic portosystemic shunt, post-salvage surgery, and death. Efficacy data on survival, re-bleeding and control of bleeding were obtained from high quality studies reported in Cochrane meta-analyses. Baseline outcomes related to the course of disease and health-state utilities were derived from published sources. Vasoactive treatment costs and all related BOV costs were obtained from published UK sources.Results: The average aggregated treatment cost per person for all medical interventions at 1 year was lower for terlipressin-treated patients (£2623) compared with those treated using octreotide (£2758) or placebo (£2890). The incremental analysis comparing terlipressin with octreotide and placebo using a cost per quality adjusted life year (QALY) and cost per life year gained (LYG) approach indicated that terlipressin was the dominant BOV treatment option (i.e. it cost less and it was more effective). Based on a maximum willingness to pay of £20 000/QALY terlipressin was more effective and cost-saving compared to octreotide and placebo for simulations ranging from 42 days to 2 years. In point estimation analyses octreotide was dominant compared to placebo; however, probabilistic sensitivity analysis indicated that octreotide was unlikely to be cost-effective compared to placebo.Conclusions: The findings indicated that vasoactive treatment in BOV was cost-savingcompared to no vasoactive treatment. Furthermore, terlipressin was the more cost-effective vasoactive treatment for BOV in cirrhotic patients.

Erdosteine ameliorates PTZ-induced oxidative stress in mice seizure model

The role of oxygen-derived free radicals has been suggested in genesis of epilepsy and in the post seizure neuronal death. The aim of this study was to investigate whether erdosteine has a preventive effect against epilepsy and postepileptic oxidative stress. The mice ( n = 27) were divided into three groups: (i) PTZ-induced-epilepsy group ( n = 9); (ii) PTZ-induced-epilepsy + erdosteine group ( n = 9); (iii) control group ( n = 9). The animals were observed for a period of 30 min for latency to first seizure onset, total seizure duration, the number of seizure episodes. Then they were sacrificed and the brains were quickly removed, and frozen for biochemical analysis. Malondialdehyde (MDA), nitric oxide (NO), superoxide dismutase (SOD) and xanthine oxidase (XO) activities were carried out in the brain tissue. The latent period between PTZ induction and seizure are longer in the PTZ + erdosteine group than in PTZ-induced-epilepsy group ( P < 0.05). Biochemical analyses of brain tissue, revealed a significant increase in the MDA, XO and NO levels in the PTZ group according to erdosteine group. SOD level did not change in this group. While MDA and XO levels are significantly lower, SOD level is significantly higher in the PTZ + erdosteine group compared to PTZ and control groups ( P < 0.01). The present study demonstrated that erdosteine treatment both may increase latent interval between seizures and may decrease oxidative stress, thus may ameliorate neuronal death in brain during seizures. It may be used as an adjunct therapy in epilepsy.

Widowed Young Parents: Changing Perspectives on Remarriage and Cohabitation Rates and Their Determinants

This study investigated the incidence and determinants of remarriage and cohabitation among a sample of 35 widowed parents of school-aged children. Data from a U. S. longitudinal study of parentally bereaved children, with surviving parents of mean age 41, revealed—by contrast with prior findings and general lore—that virtually half (47. 5%) of the widows and widowers were either remarried or in substantial cohabitation relationships within five years post-death. Contrary to previous findings, there were no differences in remarriage rates between men and women. Other factors expected to influence the likelihood of remarriages, such as number and age of children, did not; income change pre–post death was a determinant for widows, as was widow's age within this relatively young sample of widows. There was a trend for surviving parents who exhibited fewer symptoms of psychopathology (on the BSI) at the initial Wave I assessment to more likely be remarried or cohabiting at Wave II than those exhibiting higher levels of psychopathology at the initial assessment. Possible interpretations of the divergence between prior reports or assumptions and these data are noted, as is the importance of studying the role of surviving parent remarriage and/or cohabitation(s) intrinsically, and correspondingly, their effects upon parentally bereaved children.

Risk factors for death after lung transplant in the US

We previously analyzed UNOS data from patients (pts) having lung transplant (LTX) with the 4 most common diagnoses to identify risk factors (RF) for death after LTX, limiting the analysis to <80% of pts. Analysis of pediatric pts showed that pts >11 yrs should be grouped with adults. Analysis of waitlist and post-LTX survival for other diagnoses resulted in 4 adult diagnostic groups and a 5th pediatric group. RF associated with increased risk of death while waitig were identified by another analysis. All pts having LTX from Jan.1/97 to Dec. 31/98 were studied. Group A(n=863): COPD and other obstructive diseases including sarcoid, mean PA <30. Group B(n=216): PPH and pulmonary vascular disease (1995–1998). Group C(n=294): CF, Group D(n=401): all pulmonary fibrosis, sarcoid, mean PA>30, BOOP. Group E(n=59): pts<12 years. To investigate if RF associated with increased risk of death on the waitlist were associated with risk of deatrh after LTX, group-specific Cox regression models were fitted with post LTX death as the outcome. Variables collected at listing or LTX were included in the models: demographic (age, height, weight, body mass index), hemodynamic (PA systolic, diastolic, mean, CO, wedge), pulmonary function (% FVC, FEV-1) or clinical (in hospital or ICU, functional status). One-year estimated survival was: Group A:81.6%, Group B:57.7%, Group C:81.7%, Group D:69%, (p<0.000). Death occurred in 466 pts. Group A:151 deaths, RF: increasing age, in ICU, CMV mismatch. Group B:104 deaths, RF: on ventilator. Group C:62 deaths, RF: previous transfusions, creatinine. Group D:136 deaths, RF: increasing PA systolic. Group E: only 13 deaths, RF incalculable. No variable associated with poor pulmonary function predicted increased risk of death after LTX. Hazard ratios for post-LTX death may be useful to develop a donor distribution algorithm that incorporates risk of death on the waiting list.

Predictors of death on the unos lung transplant waiting list

31/98 were studied. Group A(n 863): COPD and other obstructive diseases including sarcoid, mean PA 30. Group B(n 216): PPH and pulmonary vascular disease (1995-1998). Group C(n 294): CF, Group D(n 401): all pulmonary fibrosis, sarcoid, mean PA 30, BOOP. Group E(n 59): pts 12 years. To investigate if RF associated with increased risk of death on the waitlist were associated with risk of deatrh after LTX, group-specific Cox regression models were fitted with post LTX death as the outcome. Variables collected at listing or LTX were included in the models: demographic (age, height, weight, body mass index), hemodynamic (PA systolic, diastolic, mean, CO, wedge), pulmonary function (% FVC, FEV-1) or clinical (in hospital or ICU, functional status). One-year estimated survival was: Group A:81.6%, Group B:57.7%, Group C:81.7%, Group D:69%, (p 0.000). Death occurred in 466 pts. Group A:151 deaths, RF: increasing age, in ICU, CMV mismatch. Group B:104 deaths, RF: on ventilator. Group C:62 deaths, RF: previous transfusions, creatinine. Group D:136 deaths, RF: increasing PA systolic. Group E: only 13 deaths, RF incalculable. No variable associated with poor pulmonary function predicted increased risk of death after LTX. Hazard ratios for post-LTX death may be useful to develop a donor distribution algorithm that incorporates risk of death on the waiting list.

A new hydroxyl radical scavenger "EPC" on cadaver heart transplantation in a canine model.

This study was performed to determine if an "arrested" heart, resuscitated with cardiopulmonary bypass (CPB) after the cessation of beating, can be successfully transplanted, and whether a hydroxyl radical scavenger EPC can reduce ischemic and reperfusion injury during resuscitation of the arrested heart and following orthotopic heart transplantation. A total of 16 pairs of canines were divided into a control group of eight pairs and an EPC-treated group of eight pairs. Cardiac arrest of the donor heart was induced by the discontinuation of respiratory support after the induction of brain death. The cadaver heart was then resuscitated and core-cooled to myocardial temperature of 15 degrees C using CPB. The donor heart was harvested using cold cardioplegia and orthotopically transplanted. All of the transplanted hearts in the EPC group were weaned from CPB without any inotropic support after 60 min of bypass support, whereas all the animals in the control group required 5 micrograms/kg/min dopamine (P = 0.001). Moreover, cardiac function (Emax) 1 h after orthotopic heart transplantation was better preserved in the EPC group than in the control group, at 110 +/- 36% vs. 70 +/- 21% of the post brain death values (P = 0.02) These findings demonstrate that EPC reduces posttransplant reperfusion injury, and thus it may prove to be a valuable adjunct in this challenging model.

Right ventricular function in the donor heart.

Early morbidity and mortality post cardiac transplantation is frequently caused by right ventricular failure; this is usually attributed to an elevated pulmonary vascular resistance in the recipient. Brain death in the donor is recognised as causing left ventricular dysfunction, but its effects on the right ventricle have not previously been studied. The aim of this study was to investigate right ventricular function following brain death, using a canine model. The hearts of 33 dogs were instrumented with micromanometers, flow probes and dimension transducers to measure minor/major axes, and right and left ventricular free wall to septal distances. Left ventricular volume was calculated according to the prolate ellipsoid model and right ventricular volume was calculated according to the shell subtraction method. Systolic function for left and right ventricles was analysed by plotting ventricular stroke work vs. end-diastolic volume during a caval occlusion (preload-independent recruitable stroke work PRSW). Brain death was instigated by inflation of a subdurally placed intracranial balloon; subsequently blood pressure was maintained with intravenous fluid whilst no inotropic medications were given. Data were collected at baseline, and at 2 and 4 h thereafter. A two-tailed paired Student's t-test was applied to compare post-brain death data with baseline measurements. All animals had an initial hyperdynamic response post brain death ensued by the development of diabetes insipidus. Brain stem death was validated by neuropathological examination at the termination of the experiments. Right and left ventricular systolic function had deteriorated significantly 2 h post brain death by 34.4% (+/- 5.1%, P < 0.001) and 20.4% (+/- 3.4%, P < 0.001), respectively, from baseline PRSW [RV = 23.6 erg.10(3) (+/- 1.5), LV = 76.2 erg.10(3) (+/- 3.5)]. This deterioration remained at 4 h post brain death (29.4% (+/- 4.9%, P < 0.001) and 21.2% (+/- 4.3%, P < 0.001), respectively). (The results are expressed as mean and S.E.M.). Brain death causes a significant decrease in left and right ventricular function. The injury to the right ventricle is more prominent than the left ventricle, and at 2 h post brain death it is significantly greater. Failure of the right ventricle post transplantation in clinical practice may be related to this brain death induced injury. Further studies are required to investigate the mechanisms of this injury.

Developing strategies to assist sudden-death families: A 10-year perspective

Abstract In 1983, emergency department RNs from a 600-bed acute care hospital in the Midwest initiated a holistic nursing intervention that, focused on meeting the needs of the grieving survivor at the time of death notification, and for a period of 2 months after the death. The purpose of the intervention was to provide a supportive link with the survivor in which listening, crisis intervention, grief symptom normalization, and community referral were provided. The intervention included a grief assistance protocol, a system of telephone contacts during the 2-month post death period, and the use of a grief symptom assessment tool. Whereas a great deal of staff development and growth has occurred and the written materials have been, fine-tuned, the essential structure of this intervention remains in place today.

999-117 Computerization of the Application of Parametric Multivariable Risk Factor Analyses to Estimate the Risk of Events After Cardiac Transplantation

The consideration of multivariable analysis derived risk factors for post transplant events in the evaluation of potential cardiac transplant recipients and donors may serve to improve mortality and morbidity after cardiac transplantation. However, the application of this information is elusive due to the difficulty of applying all identified recipient and donor related risk factors, expressed as dichotomous and continuous variables, in the assessment of the risk of post transplant events for a single patient. The CTRD has reported multivariable risk factor analyses in the hazard function domain for post cardiac transplant events from all primary transplants from 30 transplant centers with 4.5 year follow-up. Variables analyzed in theses reports included multiple recipient and donor demographic information, recipient and donor mismatch variables, pre-transplant recipient and donor clinical variables, hemodynamic variables, surgical variables, initial immunosuppression variables, and post transplant event variables. Specific risk factors for post transplant events were identified and multivariable equations were derived and have been published. In order to facilitate the application of this information, a computer program was developed to allow the calculation of the estimated time-related risk of post transplant events including death, time to first infection, time to first rejection, and number of rejections in the first year. One enters the values for specified variables into the program. The program then calculates (utilizing solutions to the multivariable equations) and then displays the time-related actuarial and hazard function curves, with standard errors, for each event in graphical and tabular formats. Patient data may be stored, and data output may be printed. Different patients or clinical situations for the same patient may be compared on screen. The program is written in Microsoft C, version 6, and runs in PC-DOS. Computer requirements include 640 kb RAM, VGA graphics, and a floating point processor. Utilizing this software package, a clinician may compute and print an individual patient's time related risk profiles for post transplant death, infection, and allograft rejection. This information may be used for pre-transplant recipient education and selection, and donor-recipient matching prior to transplantation.

Glucose-insulin-potassium (GIK) prevents derangement of myocardial metabolism in brain-dead pigs

Brain death is associated with neuroendocrine changes resulting in reduced myocardial glycogen content. The purpose of this study was to investigate the effects of glucose-insulin-potassium (GIK), on myocardial metabolism in brain-dead pigs. Sixteen brain-dead pigs were given GIK infusion (n = 8), or Ringer solution (n = 8). At end-point (7 h post brain death) arterial concentrations and myocardial arteriovenous (a-v) concentration differences of glucose, lactate and free fatty acids (FFA) were assessed, and myocardial biopsy specimens were taken from the right atrium and left ventricle. Biopsies were also taken from five normal pigs. Myocardial glycogen content in the GIK group was significantly higher compared to the control group, but comparable to the non-brain-dead animals. There was a higher and significant myocardial uptake of glucose and lactate in the GIK group compared to the controls. Plasma levels of FFA were significantly lower in the GIK group, and the myocardial uptake of FFA was 5 times higher in the control group compared to the GIK group. There were no significant differences in hemodynamic variables among the groups. In conclusion, intravenous supply of GIK to brain-dead pigs results in increased myocardial glycogen content and seems to prevent abnormal myocardial metabolism, which may have clinical implications for the myocardial protection of donor hearts.

Family relationships in two types of terminal care

This study investigated parent's perception of family relationships in 87 parents from 48 families during the terminal illness and first year following a child's death from cancer. Using the Family Relationships Index, parents' perception of family relationships were compared: (a) to normative data and (b) between home and hospital terminal care. Data collection occured before death during the terminal phase, and two weeks, four months, and one year post death. The results of data analyses by confidence intervals and t-tests generally indicated that (a) parents' perceived family relationships to differ from “normal” families and (b) hospital based terminal care families presented evidence of better family relationships than home care based terminal care families.

The Response of Children to the Dying and Death of a Sibling

This study investigated the behavioral adjustment of sixty-one children ages four to sixteen years during the terminal illness and first year following a sibling's death from cancer. Using the Child Behavior Checklist, data on behavior problems and competence were collected from parents and teachers. Data collection occurred before death during the terminal phase, and two weeks, four months, and one year post death. The results of data analysis by t-test comparisons generally indicated that the bereaved siblings demonstrated significantly higher levels of behavior problems and significantly lower social competence in comparison to normal children. The implications for practice are discussed.

Adjustment to the death of a sibling.

Despite the recent increase in interest in terminally ill children and their families and the post death adjustment of parents, there has been little research examining the adjustment and self concept of surviving siblings in such families. This paper discusses the results of a preliminary descriptive study of 28 children (from 14 families) whose brother or sister had died of cancer between 18 and 30 months previously. Behaviour checklists were completed by parents and teachers and self concept scales administered to the children. A lengthy semistructured interview was carried out, and measures of parental adjustment were gathered. A high percentage of children were found to be exhibiting emotional or behavioural difficulties, or both, and the results indicated that low self esteem was common. Parental and child adjustment were not found to be related inter se, nor did they seem to relate to the child's self esteem. Thus for many children the loss of a sibling might cause long term distress. Further, many children who did not manifest overt difficulties perceived themselves unfavourably in comparison with either their ideal or their dead sibling.