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The diagnosis "death due to hypothermia" is mainly based on circumstances and gross autopsy findings like frost erythema and gastric erosions. Up to now, there are no reliable histologic criteria available to confirm the diagnosis "death due to hypothermia." However, fatty changes of organs have been reported already in the literature as a histological finding contributing to the diagnosis "death due to hypothermia." To evaluate these reports, cases with well-documented hypothermia (study-group; n=83), cases with other causes of death (control-group; n=25) and additionally also seven cases with a past medical history of diabetes mellitus were investigated. Renal tissue autopsy samples were taken from both the left and the right kidney and investigated for signs of fatty degeneration within the renal tubule epithelium. The results were compared with regard to macroscopic signs of hypothermia (Wischnewski-ulcers, erythema), as reported in the autopsy protocols. The results lead to the conclusion, that fatty degeneration is a very reliable histologic diagnostic criterium in cases of hypothermia, comparable to the significance of Wischnewski-ulcers.
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PMID:Fatty degeneration in renal tubule epithelium in accidental hypothermia victims. 1506 52

We report a case of star fruit intoxication in a 60-yr-old male patient with a past medical history of diabetes mellitus and chronic renal failure. Clinical effects included hiccups, hearing impairment, urine retention, and disturbed consciousness. Star fruit intoxication was also the suspected cause of hypothermia, an unusual symptom. The patient remained comatose after receiving two sessions of hemodialysis. However, after a 6 h session of charcoal hemoperfusion following the second hemodialysis treatment, his consciousness returned to normal within 1 day. While no previous study on hemoperfusion therapy in star fruit intoxication has been reported, in view of the fatal outcome of star fruit intoxication in uremic patients, hemoperfusion may be an alternative therapy if intensified hemodialysis fails.
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PMID:Chronic renal disease patients with severe star fruit poisoning: hemoperfusion may be an effective alternative therapy. 1590 95

Heat and cold are environmental factors which severely affect the cardiovascular system. An increase in the body core temperature (hyperthermia) from approximately 36.5 to 39 degrees C causes a doubling of the cardiac output. In connection with vasoconstriction in the splanchnic circulation and in skeletal muscle this results in large increases of skin blood flow. The underlying vasodilatation is evoked by reflex regulation of the efferent sympathetic system. While there is a reduction of alpha-adrenergic vasoconstriction, there is also evidence for active sympathetic cholinergic and nitric oxide-dependent vasodilatation. In the presence of risk factors, e.g. age and diabetes, the circulatory adaptation to heat stress may be compromised. During a reduction of the core temperature (hypothermia) there is a reflex adrenergic vasoconstriction (noradrenalin) of the skin. Cardiac output falls below a core temperature of 34 degrees C due to increasing bradycardia. The reflex vasoconstriction following cold exposure may be aggravated at higher ages, which may cause steeper increases of arterial blood pressure. Due to the reflex nature, the regulatory processes are severely compromised during anaesthesia.
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PMID:[Hyperthermia and hypothermia. Effects on the cardiovascular system]. 1755 14

Anesthesia for patients with Steinert's syndrome (myotonic dystrophy, MD) is a challenge for the anaesthetist. MD is a multisystemic disease and the neuromuscular symptoms can be associated with sleep apnea, endocrine disorders (diabetes, hypogonadism, hypothyroidism), cardiac, gastroenteric or cognitive disorders (mental deficiency, attention disorders). The diagnosis is facilitated when one or more of these symptoms are associated with the neuromuscular symptoms; however, the latter are not always present at the onset, which makes the diagnosis of MD a difficult and often late one. The choice of drugs and the choice of anesthesia in these patients can be very challenging for many reasons. A myotonic crisis can be triggered by several factors including hypothermia, shivering and mechanical or electrical stimulation. These patients are very sensitive to the usual anesthetics such as hypnotics and paralyzing agents (both depolarizing and nondepolarizing). The following case report describes pathophysiological considerations and a technique for anaesthesia during thoracic surgery that has been able to assure hemodynamic peroperative stability, early extubation and prolonged respiratory autonomy in a patient affected by this genetic disorder.
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PMID:Anesthesia and myotonic dystrophy (Steinert's syndrome). The role of total intravenous anesthesia with propofol, cisatracurium and remifentanyl. Case report. 1766 Jul 41

Our previous studies demonstrated the usefulness of screening determinations of acetone as an initial diagnostic criterion in deaths due to hypothermia, alcoholic ketoacidosis, diabetes mellitus, starvation and some poisonings. In alcoholemia, particularly in cases of prolonged ethanol consumption, the above-mentioned conditions may not result in acetonemia, despite marked concentrations of beta-hydroxybutyrate acid (beta-HBA). Therefore, for the purpose of the present study, the method of beta-HBA determination was modified using GC-MS-EI and applied to analyze 47 autopsy blood samples of individuals who died suddenly due to unknown causes. In 15 cases, the concentration of beta-HBA was higher than 1000 micromol/l; in six subjects from this group, the acetone concentration was lower than 250 micromol/l. In some cases, thus, the use of beta-HBA as an additional diagnostic criterion allows for explaining the pathomechanism of premortal metabolic disturbances.
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PMID:[Diagnostic usefulness of the beta-hydroxybutyrate/acetone ratio in medico-legal diagnostics of sudden deaths]. 1790 21

Hyperphosphorylated tau is the major component of paired helical filaments in neurofibrillary tangles found in Alzheimer's disease (AD) brains, and tau hyperphosphorylation is thought to be a critical event in the pathogenesis of the disease. The large majority of AD cases is late onset and sporadic in origin, with aging as the most important risk factor. Insulin resistance, impaired glucose tolerance, and diabetes mellitus (DM) are other common syndromes in the elderly also strongly age dependent, and there is evidence supporting a link between insulin dysfunction and AD. To investigate the possibility that insulin dysfunction might promote tau pathology, we induced insulin deficiency and caused DM in mice with streptozotocin (STZ). A mild hyperphosphorylation of tau could be detected 10, 20, and 30 d after STZ injection, and a massive hyperphosphorylation of tau was observed after 40 d. The robust hyperphosphorylation of tau was localized in the axons and neuropil, and prevented tau binding to microtubules. Neither mild nor massive tau phosphorylation induced tau aggregation. Body temperature of the STZ-treated mice did not differ from control animals during 30 d, but dropped significantly thereafter. No change in beta-amyloid (Abeta) precursor protein (APP), APP C-terminal fragments, or Abeta levels were observed in STZ-treated mice; however, cellular protein phosphatase 2A activity was significantly decreased. Together, these data indicate that insulin dysfunction induced abnormal tau hyperphosphorylation through two distinct mechanisms: one was consequent to hypothermia; the other was temperature-independent, inherent to insulin depletion, and probably caused by inhibition of phosphatase activity.
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PMID:Insulin dysfunction induces in vivo tau hyperphosphorylation through distinct mechanisms. 1807 75

We experienced a case of pulseless electrical activity (PEA) during posture change after epidural anesthesia. A 79-year-old man was scheduled for open reduction of left femoral neck fracture. Past history included severe diabetes, which is hardly controlled even by hypodermic injection of insulin before surgery. We performed epidural anesthesia at L3-4 level in right lateral position. Shortly after turning the patient to supine position, the patient became unconscious and blood pressure was unmeasurable. ECG showed sinus rhythm and he was diagnosed as PEA. Loss of consciousness was prolonged even after recovery of blood pressure by intravenous injection of epinephrine 1 mg. The patient underwent therapeutic hypothermia (target temperature 34 degrees C) over a period of 48 hours. The patient showed no neurological dysfunction after recovery from therapeutic hypothermia. We consider that the cause of PEA is blood pressure decrease associated with epidural anesthesia and diabetic autonomic neuropathy.
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PMID:[Pulseless electric activity during postural change after epidural anesthesia]. 1827 74

The archived head-space chromatograms of ethanol determinations in autopsy blood in the years 1996-2003 were analysed. One hundred and two cases with elevated acetone level >250mmol/l were selected in which the biochemical profiles of volatile alcohols (methanol, isopropanol and n-propanol) were determined after "post-hoc" calibration of the constant internal standard. Based on the files obtained from the Prosecutor's Office, the circumstances of death and those preceding death (alcoholism, prolonged or single consumption of alcohol, intoxications with other substances, hypothermia, undernourishment, diabetes) were analysed and the most probable cause of endogenous or exogenous ketonaemia were determined. All cases of unexplained deaths in alcoholics with the ethanol concentration <0.4g/l occurred after withdrawal of long-term consumption of alcohol while all alcoholics with the ethanol concentration >0.4g/l died during the so-called drinking bout. In the group of hypothermia-related deaths with ethanol concentrations <0.4g/l, the acetone concentration was statistically significantly higher than that in hypothermia group with ethanol concentration >0.4g/l in which "congeneric" concentrations of methanol and isopropanol were additionally observed. Furthermore, an algorithm of further diagnostic management was suggested to distinguish the most likely origin of acetonaemia, i.e. accumulation of exogenous "denaturants" of alcohol consumed and cases of endogenous ketogenesis.
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PMID:Acetonaemia as an initial criterion of evaluation of a probable cause of sudden death. 1884 83

Dietary supplementation with resveratrol may produce calorie restriction-like effects on metabolic and longevity endpoints in mice. In this study, we sought to determine whether resveratrol treatment elicited other hallmark changes associated with calorie restriction, namely bradycardia and decreased body temperature. We found that during short-term treatment, wild-type mice on a calorie-restricted diet experienced significant decreases in both heart rate and body temperature after only 1 day whereas those receiving resveratrol exhibited no such change after 1 wk. We also used ob/ob mice to study the effects of long-term treatment because previous studies had indicated the therapeutic value of resveratrol against the linked morbidities of obesity and diabetes. After 12 wk, resveratrol treatment had produced no changes in either heart rate or body temperature. Strikingly, and in contrast to previous findings, we found that resveratrol-treated mice had significantly reduced endurance in a treadmill test. Quantitative reverse transcriptase-polymerase chain reaction suggested that a proposed target of resveratrol, Sirt1, was activated in resveratrol-treated ob/ob mice. Thus, we conclude that the bradycardia and hypothermia associated with calorie restriction occur through mechanisms unaffected by the actions of resveratrol and that further studies are needed to examine the differential effects of resveratrol in a leptin-deficient background.
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PMID:Resveratrol treatment in mice does not elicit the bradycardia and hypothermia associated with calorie restriction. 1905 39

Today the populations of haemophilia patients in many countries have a higher life expectancy than previously known, and age-related disorders such as arterial disease are expected to become more prevalent, calling for surgical intervention. Cardiac surgery constitutes a major haemostatic challenge because of sternotomy, the need of total heparinization, extracorporal circulation, mild hypothermia and cardiac arrest. To evaluate our current experience and results with cardiac surgery in patients with haemophilia the present case series report on six patients with haemophilia A (Severe = 1, Moderate = 1, Mild = 4) undergoing cardiac surgery (coronary artery bypass grafting; CABG = 2, aortic valve replacement = 1, CABG + aortic valve replacement = 2, ventricular resection + mitral valve reconstruction = 1). The present paper provides detailed information on the haemostatic treatment regimens adopted (factor concentrate dosages, timing and duration) and postoperative thromboprophylaxis (dosing and duration of low molecular weight heparin). Moreover, we present data on concomitant disorders (hypertension, hypercholesterolaemia, atrial fibrillation and diabetes), left ventricle ejection fraction (30-60%), type of anaesthesia, total amount of heparin (34 500-53 500 IU) and duration of extracorporeal circulation (80-115 min). Clinical outcomes included: re-operation because of bleeding (none), transfusion requirements, peri- and postoperative blood loss and complications and postoperative development of inhibitors (none). Clinical outcomes were compared with a control group of patients (n = 5993) without haemophilia and we found no difference in postoperative morbidity. Adopting meticulously supervised haemostatic treatment regimens, we have successfully performed major cardiac surgery in patients with haemophilia A. The clinical outcome as well as the severity and incidence of postoperative complications were similar to patients without haemophilia.
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PMID:Cardiac surgery in patients with haemophilia. 1917 27


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