Purpose Coronary artery aneurysms (CAA) may remain silent after Kawasaki disease (KD) until adulthood when myocardial ischemia can lead to sudden death. We postulated that there would be young adults with sudden, unexpected death due to CAA from KD who would have a state-mandated autopsy performed by the San Diego County Medical Examiner’s Office (SDCMEO). Methods We reviewed all autopsy cases <35 years of age from 1997–2012 at the SDCMEO with a cardiovascular cause of death (n=154). Results We found 2 cases meeting inclusion criteria. Case 1 was a 22-year-old Korean male with chronic ischemic changes due to a partially occluded and diffusely calcified 15mm aneurysm at the bifurcation of the left main coronary artery. Interview of the mother revealed that this patient had been diagnosed with KD complicated by giant aneurysms at age two years. Case 2 was a 30-year-old Hispanic male with myocardial infarction due to thrombosis of a calcified left anterior descending artery aneurysm. Histologic findings included diffuse myocardial fibrosis and a recanalized aneurysm in the right coronary artery. Interview of the family revealed a KD-compatible illness in childhood. Immunohistochemical staining showed expression of transforming growth factor β pathway molecules in the aneurysmal arterial wall. Conclusions In a medical examiner’s office serving a population of approximately 3 million people, 2 of 154 (1.3%) cardiovascular deaths in persons <35 years were attributed to cardiovascular complications of KD in childhood. Antecedent KD should be considered in the evaluation of all cases of sudden, unexpected death in young adults.
An investigation was carried out into the effects of dexrazoxane and doxorubicin on hepatic protein synthesis in vivo. The protocol included 8 groups of rats and involved a pretreatment stage of 30 min followed by a treatment stage of either 2.5 or 24 h. Male Wistar rats ( 0.15-0.20 kg) were pretreated with either dexrazoxan e (100 mg/kg; 5 ml/kg) or saline (0.15 mol/l NaCl; 5 ml/kg). At 30 min after the pretreatment , rats were again injected with either doxorubicin (5 mg/kg; 10 ml/kg) or saline (0.15 mol/l NaCl; 10 ml/kg) in the treatment phase. Rats were sacri ced at either 2.5 or 24 h after the last doxorubicin or saline injection. Rate of protein synthesis were measured 10 min prior to sacri cing rats, with a ooding dose of L-[4-3 H]phenylalanine . Liver was analyzed for the protein synthetic capacity (C s , mg RNA/g protein), the fractional rate of protein synthesis (k s , %/d), and the RNA activity (k RNA mg protein/d/mg RNA). Complementary analysis included plasma albumin, total protein and activities of alkaline phosphatase , and aspartate aminotransferase . In the 2.5-h study, doxorubici n alone had no effect on any of the above variables. Dexrazoxane alone increased C s , k s and k RNA at 2.5 h. Combined dexrazoxan e doxorubicin increased hepatic C S and k s with concomitant reductions in total plasma protein. In the 24-h study, doxorubicin alone had no effect on any of the variables. Dexrazoxan e alone had no effect on either C S , k s , or k RNA but raised plasma activities of alkaline phosphatas e and aspartate aminotransferase. Combined dexrazoxan e doxorubicin increased C s and k s and decreased total plasma protein and increased plasma aspartate aminotransferas e activities at 24 h. In conclusion, there is no evidence that acutely doxorubicin per se has measurable effects on hepatic protein synthesis in vivo in an acute period. However, acutely dexrazoxan e increases hepatic protein synthesis, which may represent its putative cytotoxic effects, as indicated by raised serum activities of liver enzymes. A combination of both dexrazoxane doxorubici n appears to have a greater effect in increasing liver protein synthesis than dexrazoxan e alone.
Background The Special Olympics Pennsylvania Summer Games attract over 2000 athletes each year. Volunteer medical staff ensures their safety throughout this period. However, few studies have examined the incidence of orthopedic injury and sickness in this group, especially with a large sample. Objective Identify the incidence of orthopedic injury and Illness at the Special Olympics Pennsylvania Summer Games based on demographic criteria and identify the incidence of transports required for advanced care. Methods Data was collected from logs provided by Special Olympics Pennsylvania. The data were analyzed and stratified by gender, age, sport, and type of encounter. We summarized the data and compared it to data from other years and the average. Results An average of 1971 athletes competed annually. On average, 10% (N=144) of competitors required medical care. Males comprised 58.2% (N = 837) of encounters, females 33.6% (N = 483), and in 8.1% (N = 117) of encounters gender was not identified/recorded. The mean age of participants was 29 years of age (range from 10 to 83). 56.6% (N= 813) of encounters required first aid management only. Injuries made up 31.7% (N = 455) of total encounters, and 11.8% (N=169) of encounters were classified as illnesses. Basketball was the sport with the most injuries, 49.5% (N = 711). An average of 9.8 transports was required annually. Conclusions Special Olympics athletes suffer the same injuries as regular athletes, but they are also prone to various medical disorders that regular athletes are not.
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