Thread View: bit.listserv.mednews
1 messages
1 total messages
Started by David Dodell
Sun, 21 Jan 1996 00:00
HICN903 Medical News
Author: David Dodell
Date: Sun, 21 Jan 1996 00:00
Date: Sun, 21 Jan 1996 00:00
1116 lines
53167 bytes
53167 bytes
HICNet Medical News Digest Mon, 01 Jan 1996 Volume 09 : Issue 03
Today's Topics:
[MMWR 22-Dec] Case-Control Study of HIV Seroconversion in Health-Care
[MMWR] Hypothermia-Related Deaths --- New Mexico
2nd International Symposium on Brain Death
+------------------------------------------------+
! !
! Health Info-Com Network !
! Medical Newsletter !
+------------------------------------------------+
Editor: David Dodell, D.M.D.
10250 North 92nd Street, Suite 210, Scottsdale, Arizona 85258-4599 USA
Telephone +1 (602) 860-1121
FAX +1 (602) 451-1165
Internet: mednews@stat.com
Bitnet: ATW1H@ASUACAD
Mosaic WWW
*Asia/Pacific:
http://biomed.nus.sg/MEDNEWS/welcome.html
*Americas:
http://outland.cardinal.com/hicn
*Europe:
http://www.dmu.ac.uk/ln/MEDNEWS/
Compilation Copyright 1995 by David Dodell, D.M.D. All rights Reserved.
License is hereby granted to republish on electronic media for which no
fees are charged, so long as the text of this copyright notice and license
are attached intact to any and all republished portion or portions.
The Health Info-Com Network Newsletter is distributed biweekly. Articles
on a medical nature are welcomed. If you have an article, please contact
the editor for information on how to submit it. If you are interested in
joining the automated distribution system, please contact the editor.
Associate Editors:
E. Loren Buhle, Jr. Ph.D.
Tom Whalen, M.D., Robert Wood Johnson Medical School at Camden
Douglas B. Hanson, Ph.D., Forsyth Dental Center, Boston, MA
Lawrence Lee Miller, B.S. Biological Sciences, UCI
Dr K C Lun, National University Hospital, Singapore
W. Scott Erdley, MS, RN, SUNY@UB School of Nursing
Jack E. Cross, B.S Health Care Admin, 882 Medical Trng Grp, USAF
Albert Shar, Ph.D. CIO, Associate Prof, Univ of Penn School of Medicine
Stephen Cristol, M.D. MPH, Dept of Ophthalmology, Emory Univ, Atlanta, GA
anonymous ftp = vm1.nodak.edu; directory HICNEWS
FAX Delivery = Contact Editor for information
Subscriptions: Send email to: listserv@asuvm.inre.asu.edu
First Line of Text: subscribe mednews FirstName LastName
To Unsubscribe send email to: listserv@asuvm.inre.asu.edu
First Line of Text: unsubscribe mednews
----------------------------------------------------------------------
Date: Fri, 29 Dec 1995 11:48:31 -0500 (EST)
From: BUHLE@mscf.med.upenn.edu
To: hicnews
Subject: [MMWR 22-Dec] Case-Control Study of HIV Seroconversion in Health-Care
Message-Id: <01HZDMZK5SFU000HJ9@mscf.med.upenn.edu>
Case-Control Study of HIV Seroconversion in Health-Care Workers
After Percutaneous Exposure to HIV-Infected Blood -- France, United
Kingdom, and United States, January 1988-August 1994
Health-care workers (HCWs) are potentially at risk for human
immunodeficiency virus (HIV) infection through occupational
exposures to blood. Although prospective studies indicate that the
estimated risk for HIV infection after a percutaneous exposure to
HIV-infected blood is approximately 0.3% (1,2), factors that
influence this risk have not been determined. To assess potential
risk factors, CDC, in collaboration with French and British public
health authorities, conducted a retrospective case-control study
using data reported to national surveillance systems in the United
States, France, and the United Kingdom. This report describes the
study and summarizes results that suggest that risk factors for HIV
transmission include certain characteristics of the exposure and
the source patient; in addition, postexposure use of zidovudine
(ZDV) by HCWs was associated with a lower risk for HIV
transmission.*
Case-HCWs had a documented occupational percutaneous exposure
to HIV-infected blood (i.e., a needlestick or a cut with a sharp
object [e.g., scalpel or lancet]), HIV seroconversion temporally
associated with the exposure, and no other concurrent exposure to
HIV. Control-HCWs had a documented occupational percutaneous
exposure to HIV-infected blood and were HIV seronegative at the
time of exposure and at least 6 months later. Case-HCWs were
identified through reports to national surveillance systems for
occupationally acquired HIV infection operated by CDC, in
cooperation with state and local health departments (United
States), the National Public Health Network (Reseau National de
Sante Publique) (France), and the Public Health Laboratory Service
Communicable Disease Surveillance Center (United Kingdom).
Control-HCWs were identified through reports to a passive
surveillance project maintained by CDC since 1983 that includes
data from approximately 300 health-care institutions in the United
States (1).
The study included all case-HCWs reported in the United States
whose exposure occurred during January 1988-August 1994 and all
control-HCWs exposed after January 1988 whose 6-month follow-up
evaluation was completed as of August 1994. Case- and control-HCWs
reported in the United States before 1988 were excluded from the
analysis because information on some variables was not routinely
collected and because postexposure use of ZDV was infrequent before
1988 (1). For similar reasons, analysis was limited to case-HCWs
reported in France since 1990 and in the United Kingdom since 1989.
Information obtained about HCWs included age; sex; occupation;
work location; and whether postexposure antiretroviral agents were
offered, whether they were used, how long after the exposure the
first dose was used, daily dosage, and duration of treatment.
Information about source patients included stage of HIV infection
(acquired immunodeficiency syndrome [AIDS], symptomatic, or
asymptomatic), use of antiretroviral drugs at the time of the HCW's
exposure, and presence of terminal illness (i.e., death because of
AIDS within 2 months after the exposure). Information about
exposures included the type of device involved, gauge of
hollow-bore needle, type of procedure being performed, whether the
procedure was an emergency, use of gloves, time from use of the
device to exposure, presence of visible blood from the source
patient on the device, and severity of injury. Severity of injury
was defined as superficial (surface scratch, no blood appeared),
moderate (penetrated skin and blood appeared), or deep (deep
puncture or wound with or without bleeding).
The study included 31 case-HCWs (23 from the United States,
five from France, and three from the United Kingdom) and 679
control-HCWs (who were from 190 of the reporting health-care
institutions). Of the 31 exposures sustained by case-HCWs, 29 (94%)
were needlesticks (all with hollow needles) and two (7%) involved
other sharp objects. Of the 679 exposures sustained by
control-HCWs, 620 (91%) were needlesticks (including 594 hollow and
26 solid needles) and 59 (9%) involved other sharp objects.
For both case- and control-HCWs, 74% were exposed during 1990-1994,
when ZDV postexposure use had become more common (1). During
1990-1994, 17 (81%) of 21 case-HCWs had been offered ZDV, and from
September 1990 (when collection of information on whether ZDV was
offered to control-HCWs became routine) through 1994, 268 (79%) of
338 control-HCWs were offered ZDV. ZDV postexposure prophylaxis was
used by nine (29%) case-HCWs and 247 (36%) control-HCWs (crude odds
ratio=0.7; 95% confidence interval [CI]=0.3-1.7). Regimens for
case- and control-HCWs generally were 1000 mg/day for 3-4 weeks;
the small number of case-HCWs who used ZDV precluded assessment of
differences in ZDV regimens between case- and control-HCWs.
All variables that were statistically significant in the
univariate analysis and variables potentially important for
prevention (e.g., use of gloves, whether ZDV was offered, and
whether ZDV was used) were examined using logistic regression
analysis. Based on this analysis, factors associated with HIV
transmission included a deep injury, device visibly contaminated
with the source patient's blood, procedures involving a needle
placed directly in a vein or artery, and terminal illness in the
source patient. In addition, case-HCWs were significantly less
likely to use ZDV than control-HCWs (adjusted odds ratio=0.2, p
less than 0.01) (Table 1)**. The crude odds ratio for ZDV use
differed from the adjusted odds ratio because ZDV use was more
frequent, among both case- and control-HCWs, for exposures
characterized by the other factors. All factors in the model also
were significant when the analysis was restricted to case-HCWs from
the United States.
The degree of susceptibility to ZDV of HIV strains from source
patients and case-HCWs is unknown. Information about antiretroviral
treatment for source patients was available for seven case-HCWs and
124 control-HCWs who had used ZDV; five (71%) case-HCWs and 87
(70%) control-HCWs were exposed to blood from source patients who
had been receiving ZDV at the time of the exposure.
Reported by: State and territorial health depts. CDC Cooperative
Needlestick Surveillance Group. D Abiteboul, MD, Institut National
de Recherche et de Securite and Groupe d'Etude sur le Risque
d'Exposition au Sang, Paris; F Lot, MD, Reseau National de Sante
Publique, Saint Maurice, France. J Heptonstall, MRCPath, Public
Health Laboratory Service Communicable Disease Surveillance Center,
London, United Kingdom. Div of HIV/AIDS Prevention, National Center
for Prevention Svcs; Hospital Infections Program, National Center
for Infectious Diseases, CDC.
Editorial Note: The findings in this report indicate that, among
the HCWs in this study, an increased risk for HIV infection
following percutaneous exposures to HIV-infected blood was
associated with three factors. First, the risk increased if the
exposure involved a larger quantity of blood, indicated by 1) a
device visibly contaminated with the patient's blood, 2) a
procedure that involved a needle placed directly in a vein or
artery, or 3) a deep injury. Second, the risk increased for
exposures to blood from source patients with terminal illness,
probably reflecting the higher titer of HIV in blood late in the
course of AIDS or other factors, such as the presence of
syncytia-inducing strains of HIV (3,4). Finally, the analysis of
these data suggested that use of ZDV postexposure may be protective
for HCWs. After controlling for other factors associated with HIV
transmission risk, the model indicates that the risk for HIV
infection among HCWs who used ZDV was reduced by approximately 79%
(95% CI=43%-94%) (based on adjusted odds ratio=0.21; 95% CI=0.06-0.57).
However, the limitations of the study design must be
considered when interpreting these results.
A retrospective case-control study is not the optimal study
design for assessing ZDV efficacy. The optimal approach--a
prospective, placebo-controlled trial--has not been possible
because of the requirement for a large number of HCWs and the
relatively low rate of HIV seroconversion following occupational
exposure (1). The findings of this study also are subject to at
least five potential limitations. First, case- and control-HCWs
were identified using different data sources. Second, if
control-HCWs were more likely to have been offered or encouraged to
use ZDV, then use of the drug might be statistically associated
with lack of HIV seroconversion, even if ZDV is not truly
protective; however, available evidence does not suggest that
control-HCWs were more likely than case-HCWs to have been offered
ZDV. Third, reporting bias may have resulted if HCWs preferentially
reported exposures that they believed were more likely to result in
HIV transmission; this tendency presumably would be similar for
case-HCWs and control-HCWs. Fourth, ascertainment bias may have
affected some data, particularly subjective variables such as
severity of injury, because information for control-HCWs was
obtained prospectively soon after exposure but information for most
case-HCWs was obtained after HIV seroconversion; however, for most
variables evaluated, objective documentation from incident reports
and medical records was available. Finally, number of case-HCWs
evaluated was small.
Although failures of postexposure ZDV to prevent HIV infection
in HCWs have been documented (1), this is the first study of HCWs
exposed to HIV that assesses the effectiveness of ZDV as
postexposure prophylaxis. Studies involving animals have yielded
inconclusive results (5). In studies involving humans, ZDV was
reported to reduce the rate of perinatal HIV transmission (6) and
to be beneficial in treating early HIV infection (7); however, the
implications of these results for postexposure prophylaxis are
uncertain. The short-term toxicity of ZDV in HCWs primarily has
been gastrointestinal discomfort and fatigue (1,2,5,8).
ZDV is not approved by the Food and Drug Administration for
use as postexposure prophylaxis. In a previous statement, the
Public Health Service (PHS) concluded that a recommendation could
not be made for or against the use of ZDV postexposure prophylaxis
because of limited knowledge regarding its efficacy and toxicity
(9). PHS recommends that HCWs who may be at risk for occupational
exposure to HIV infection be informed of the considerations
pertaining to the use of ZDV for postexposure prophylaxis,
including the risk for HIV transmission after the exposure, factors
that may increase or decrease this risk, and the limited knowledge
regarding the potential efficacy and toxicity of ZDV postexposure
prophylaxis (9). If a decision is made to use postexposure
prophylaxis, it should be initiated promptly (9). PHS is evaluating
the implications of the study summarized in this report and other
available information in assessing the possible need for revision
of recommendations for managing occupational exposure to HIV--particularly
regarding postexposure use of antiretroviral agents.
References
1. Tokars JI, Marcus R, Culver DH, et al. Surveillance of HIV
infection and zidovudine use among health care workers after
occupational exposure to HIV-infected blood. Ann Intern Med
1993;118:913-9.
2. Henderson DK. HIV-1 in the health care setting. In: Principles
and practice of infectious diseases. 4th ed. Mandel GL, Bennett JE,
Dolan R, eds. New York: Churchill Livingstone, 1995:2632-56.
3. Ho DD, Mougil T, Alam M. Quantitation of HIV type 1 in the blood
of infected persons. N Engl J Med 1989;321:1621-5.
4. Richman DD, Bozzette S. The impact of syncytium-inducing
phenotype of human immuno-deficiency virus on disease progression.
J Infect Dis 1994;169:968-74.
5. Gerberding JL. Management of occupational exposures to
blood-borne viruses. N Engl J Med 1995;332:444-51.
6. CDC. Recommendations of the U.S. Public Health Service task
force on the use of zidovudine to reduce perinatal transmission of
HIV. MMWR 1994;43(no. RR-11):1-20.
7. Ho DD. Time to hit HIV, early and hard [Editorial]. N Engl J Med
1995;333:450-1.
8. Puro V, Ippolito G, Guzzanti E, et al. Zidovudine prophylaxis
after accidental exposure to HIV: the Italian experience. AIDS
1992;6:963-9.
9. CDC. Public Health Service statement on management of
occupational exposure to human immunodeficiency virus, including
considerations regarding zidovudine postexposure use. MMWR
1990;39(no. RR-1).
* Single copies of this report will be available free until
December 21, 1996, from the CDC National AIDS Clearinghouse, P.O.
Box 6003, Rockville, MD 20849-6003; telephone (800) 458-5231 or
(301) 217-0023.
** Information on terminal illness in the source patient was
missing for 19% of case-HCWs and 48% of control-HCWs; information
on visible blood on device was missing for 3% of case-HCWs and 6%
of control-HCWs. By recoding the missing values to zero and
including missing value indicator variables for these factors in
the model, these HCWs were retained in the analysis and their
potential confounding influence could be assessed. No significant
interactions were found among the risk factors in the model or
between the risk factors and the missing value indicators. When all
HCWs with missing values for any of the factors were excluded from
the analysis, all of the factors remained significant, with similar
adjusted odds ratios but larger confidence intervals.
------------------------------
Date: Fri, 29 Dec 1995 11:48:52 -0500 (EST)
From: BUHLE@mscf.med.upenn.edu
To: hicnews
Subject: [MMWR] Hypothermia-Related Deaths --- New Mexico
Message-Id: <01HZDN002DTC000HJ9@mscf.med.upenn.edu>
Hypothermia-Related Deaths -- New Mexico, October 1993-March 1994
Hypothermia is an unintentional lowering of the body
temperature to less than or equal to 95 F ( less than or equal to
35 C) (1). From 1979 through 1992, 10,550 persons in the United
States died from hypothermia, an average of 754 deaths per year
(range: 557-1021). Most of these deaths occurred during winter
months in three distinct climatic areas: northern states
characterized by moderate to severe cold temperatures during winter
(e.g., Illinois and New York); southern states where rapid changes
in temperature occur because of the effects of weather systems
(e.g., North Carolina, South Carolina, and Virginia); and western
states in areas of high elevations and profound declines in
temperatures at night (e.g., New Mexico and Arizona). From October
1993 through March 1994, a total of 23 deaths attributed to
hypothermia were reported to the New Mexico Office of the Medical
Investigator. This report summarizes the investigations of four of
these deaths and the epidemiology for all 23 cases.
Case Reports
Case 1. In November 1993, an 85-year-old man was found dead in a
drainage ditch behind a factory approximately 1 mile from the
nursing home in which he resided. He was fully clothed, and there
were no indications of trauma. Water in the drainage ditch was 3
inches deep; the overnight ambient low temperature had been
approximately 45 F (7 C). The man had last been seen by the nursing
staff 12 hours before being found.
Case 2. On November 1, 1993, an 81-year-old woman was found dead in
a shallow creek in an area of heavy plant growth known to house
homeless persons. There were no indications of trauma. She had last
been seen by her daughter on October 26 and was reported missing on
November 1. She had a history of high blood pressure and
arteriosclerotic coronary vascular disease.
Case 3. In January 1994, an 11-year-old boy was found in his bed
wet, cold, and without a pulse. Attempts to revive him were
unsuccessful. The toilet in a bathroom above his bedroom had
overflowed and water had been dripping on him all night. He had a
history of cerebral palsy, hydrocephalus, and seizure disorder; was
blind, deaf, and unable to speak; and had impaired mobility that
limited his ability to turn over.
Case 4. In February 1994, a fully clothed 34-year-old man was found
dead behind a grocery store after an overnight low temperature of
13 F (-11 C). He had a history of alcohol abuse and cerebral
injuries and he was found with a prescription vial of phenytoin in
his pocket. He had last been seen alive in the field behind the
store searching for a plastic sack in which to keep warm during a
snow storm.
Summary of Cases
Of the 23 deaths, seven (30%) occurred during February, and 17
(74%) occurred among men. The average age of decedents was 49 years
(range: 11-87 years). Eleven (48%) had evidence of recent alcohol
abuse. Eight (35%) deaths occurred in McKinley County, which is in
a desert area with elevations greater than 5000 feet above sea
level.
Reported by: R Zumwalt, MD, D Broudy, MPH, Office of the Medical
Investigator, New Mexico. Div of Environmental Hazards and Health
Effects, National Center for Environmental Health, CDC.
Editorial Note: From 1979 through 1992, the highest total number of
deaths attributed to hypothermia occurred in Illinois (660), and
the highest annual age-adjusted death rate (33 deaths per million
persons) occurred in Alaska. However, the findings in this report
underscore the risk for hypothermia-related deaths in states in
other latitudes. Of the 10 states with the highest combined ranking
for both number and rate of hypothermia deaths, only two (Illinois
and Alaska) are characterized by severe winter weather; the winter
climate is substantially milder in the other eight states (Alabama,
Arizona, New Mexico, North Carolina, Oklahoma, South Carolina,
Tennessee, and Virginia).
From 1979 through 1992, national death rates for hypothermia
varied by sex, race, and age. Although most deaths occurred among
males (71%) and whites (61%), sex- and race-specific average annual
death rates were higher for black males than white males (13.1
versus 3.2 deaths per million) and for black females than white
females (4.1 versus 1.4 deaths per million).* Approximately half of
all hypothermia deaths occurred among persons aged greater than 64
years. These demographic differences in hypo-thermia mortality may
reflect differences in socioeconomic status, nutritional status,
condition of clothing, or ease of access to adequate shelter.
Factors associated with the increased risk for hypothermia in
the very young and the elderly in mildly cool environments (65 F
[18 C]) include an impaired shivering mechanism, lower levels of
protective fat, limited mobility, lower metabolic rate, and chronic
illness (2). Other risk factors associated with hypothermia for all
groups include drinking alcoholic beverages, using neuroleptic
medications, hypothyroidism, mental illness, starvation,
dehydration, poverty, any immobilizing illnesses, and sustained
contact with material that promotes conductive heat loss (e.g.,
water, solvents, and metals) (2).
The onset of hypothermia is insidious: early manifestations
include shivering, numbness, fatigue, poor coordination, slurred
speech, impaired mentation, blueness or puffiness of the skin, and
irrationality (3). Early recognition and prompt treatment can
prevent morbidity and death. Specific prevention measures during
cold and inclement weather conditions include maintaining dry
clothes and wearing layered, insulated clothing (particularly head
gear, because 30% of heat loss occurs from the head) that does not
retain moisture (e.g., wool or polypropylene). In addition, persons
who are outdoors in such conditions for extended periods should
increase their fluid and calorie intake, find adequate shelter, and
avoid overexertion and sweating. Persons at increased risk for
hypothermia during such periods should be monitored by family and
neighbors.
High death rates in states with relatively mild winter
climates reflect, in part, the need for increased efforts to inform
the public and high-risk groups about the health risks of
environmental cold and about measures for preventing hypothermia.
During cold weather, health-care providers, public health agencies,
community-services organizations, and others can reduce the
occurrence of hypothermia-related morbidity and death by monitoring
groups at elevated risk during cold weather and ensuring that
adequate shelter is provided.
References
1. Kilbourne EM. Cold environments. In: Gregg MB, ed. The public
health consequences of disasters. Atlanta: US Department of Health
and Human Services, Public Health Service, CDC, 1989:63-8.
2. Merck Research Laboratories. The Merck manual of diagnosis and
therapy. Rahway, New Jersey: Merck Research Laboratories, 1992.
3. CDC. Hypothermia--United States. MMWR 1983;32:46-8.
* Numbers for other racial/ethnic groups were too small for
meaningful analysis.
------------------------------
Date: Fri, 29 Dec 1995 10:12:56 -0700
From: David Dodell <david@dental.stat.com>
To: hicnews
Subject: 2nd International Symposium on Brain Death
Message-Id: <19951229103738.00049e9a.in@dental.stat.com>
"5th International Meeting of the Quantified Neurophysiology Belgian Group"
(International conference Center, Havana, Cuba)
February 27-March 1, 1996
Dear colleagues:
Since ancient times, man has pondered the mystery of his own
death. It seemed that by knowing meaning of the his death, he
would be prepared to understand the reason of his life.
Over the centuries people were deemed dead when they stopped
breathing and when their hearts stopped beating. But the
technological advances provided by civilization enabled
artificial substitution of those functions that were considered
responsible of setting the limit between life and death. This
was documented by French neurologists and neurophysiologists at
the end of the 1950's.
The end of the 1960's was also prominent for further advances
in this area. The Ad Hoc Committee of the Harvard Medical School
proposed, for first time, a new definition of death on
neurological grounds. The Harvard's report appeared some months
after Christian Barnard's first transplantation of a human heart,
in December 1967. The year of 1981 was highlighted by the report
of the President's Commission for the Study of Ethical Problems
in Medicine and Behavioral Research to define death. The 1980's
and the early 1990's were characterized by multi-disciplinary
debates. There were still worldwide controversies about a concept
of human death on neurological grounds (whole brain, brainstem
death and higher brain formulations of death). There was also
disagreement on the diagnostic criteria of brain death, whether
clinical alone, or clinical and ancillary tests.
This was the scene we faced in 1992, when we convoked
colleagues to attend The First International Symposium on Brain
Death, held at the International Conference Center, Havana
(September 22-25, 1992). Delegates from twenty-one countries
attended this sunny city to discuss many controversial issues
concerning brain death and related issues.
It was a remarkable Conference. It was seemingly impossible
to gather such an impressive number of the most outstanding
personalities in the field. Some had previously offered important
contributions for the development of the human death concept.
Still others, were contributors on philosophical, theological,
bioethical, historical and sociological issues regarding brain
death. Further, others were skillful specialists trained in the
diagnosis of brain death, who were leaders in the establishment
of brain death criteria in their respective countries. Scientific
discussions in the Havana Conference were enriched by multi-
disciplinary approaches where most brain death-related issues
were included. Definitely, contradictions were evident in the
debates during the Symposium, therefore, the final consensus
among delegates was that the subject of brain death was clearly
not closed.
One of the most important achievements of the Symposium was
the proposal to organize an international group, commission, or
network within this field. This proposal was consummated in
Buenos Aires, during the last Congress of the International
Association of Bioethics (IAB). Under the sponsoring of the IAB,
an International Network on the Definition of Death was
organized. The tremendous actuality and the inherent
transcendence of this problem is beyond any doubt.
We are pleased to announce the holding of the "II
INTERNATIONAL SYMPOSIUM ON BRAIN DEATH, at the Havana
International Conference Center, from February 27 to March 1,
1996. Along with the Symposium will be held the "First Meeting
of the Network on the Definition of Death" of the International
Association of Bioethics, and the "V International Meeting of the
Quantified Neurophysiology Belgian Group".
The Proceedings of the Symposium will be published by Elsevier
Science, B. V. in a 300-page book that is already in press. It
will available at the Symposium with key note lectures on these
issues.
Our main goal is to provide a suitable scientific platform to
discuss all topics related to human death. Cubans, as hosts, will
sincerely offer, a warm hospitality. This small Caribbean Island,
with the greenness of its country and surrounded by an incredible
blue sea, will be a suitable scenario to remind that any
discussion about death is a reason for a better life.
We feel that any reason behind the efforts to enlarge our
knowledge about human death (and life), is then.. just a matter
of human dignity.
Prof. CALIXTO MACHADO, M.D., Ph.D.
President of the Organizing Committee
MAIN TOPICS:
- Definitions of human death
- Brain death criteria in different countries and states
- Ancillary tests in brain death
- Pathological findings in brain death and related states
- Brain death in childhood and anencephalics
- End-of-life dilemmas: persistent vegetative state, dementia,
terminal patient, euthanasia, etc.
- Legal considerations on brain death and related states
- Bioethical considerations on brain death and related states
- Philosophical, theological, sociological, historical and
cultural considerations on human death
- Brain death and organ transplantation
ORGANIZERS:
- Institute of Neurology & Neurosurgery of Havana.
(Director: Prof. SANTIAGO LUIS, M.D.)
- International Conference Center
SPONSORS:
- International Association of Bioethics
- Regional Program for Bioethics (Pan-American
Health Organization)
- Quantified Neurophsysiology Belgian Group
- Caribbean Organization for Brain Research (CARIBRO)
- C.U.C.A.I.B.A (Center that coordinates organ and tissues
transplants in Buenos Aires Province, Argentina)
- "Alfredo Thompson" Foundation for the Development of
Neuroscience (Argentina)
- Ministry of Public Health
- National Commission for Brain Death Diagnosis
- National Society for Neurosciences
- Cuban Society for Clinical Neurophysiology
- Hermanos Ameijeiras Hospital
- Institute of Legal Medicine
- Institute of Nephrology
- Psychiatric Hospital of Havana
- "Calixto Garcia" Hospital
ORGANIZING COMMITTEE:
Dr. Calixto Machado, M.D., Ph.D. President
Dr. Orlando D. Garcia, M.D.
Dr. Jose M. Roman, M.D.
Cira Ramos
Mirna Farach
Dr. Alina Gonzalez, M.D.
Dr. Miguel A. Buergo, M.D.
Lic. Giovanni Romero
Dr. Luis Zarrabeitia, M.D.
Dr. Joel Gutierrez, M.D.
Dr. Miguel Farach, M.D.
Dr. Jorge Garcia-Tigera, M.D.
Dr. Rene Zamora, M.D.
Dr. L=DFzaro Vidal, M.D.
WORKING LANGUAGE
Spanish and English, with simultaneous translation (Spanish-
English and English-Spanish)
SCIENTIFIC PROGRAM
The program will cover ten main topics. The scientific program
will included time for discussion. For each topic there will be:
- Key note lectures: 40 minutes
- Oral presentations: 20 minutes
- Round tables: 90 minutes
- Poster presentations: 90 minutes
- Lunch panels 90 minutes
PRELIMINARY PROGRAM
DEFINITIONS OF HUMAN DEATH
Brain ontogenesis. The life and death of the human being and
person.
Julius Korein (USA)
Death of the person or death of the organism?
Daniel Wikler (USA)
New controversies in the definition of death.
Stuart Youngner (USA)
A defense of the higher brain formulation of death.
Karein Gervais (CUBA)
Whole brain? Higher brain? A new formulation of death.
Orlando D. Garcia (CUBA)
A complete definition of death.
Bernard Gert (USA)
Somatic Integrative unity: A nonviable rationale for brain
death
Alan Shewmon (USA)
Non-Heart beating cadavers and the definition of death
Robert Arnold (USA)
A new definition of death based on the basic mechanisms of
consciousness generation in human beings.
Calixto Machado (CUBA)
CLINICAL APPROACH TO BRAIN DEATH AND RELATED ISSUES
The brain death state in medical science.
Katsuo Takeuchi and T. Shiogai (JAPAN)
Guidelines for the determination of death.
Calixto Machado and Orlando D. Garcia
Functional Neuroanatomy of the brainstem and its importance for
the determination of death
J. M. Cuba (PERU)
Two standards of death in Denmark.
E.O. Jorgensen (Denmark)
Spinal man after brain death.
E.O. Jorgensen (Denmark)
The case of respirator brain after intracranium injury.
T. Sawaguchi (JAPAN)
ANCILLARY TESTS IN BRAIN DEATH AND RELATED ISSUES
Neurophysiologic criteria from coma to brain death.
J. Paniagua-Soto, M. Pinero-Benitez and G. Vazquez-Mata (SPAIN)
Neurophysiological diagnosis of brain death.
Margarita Blanco (ARGENTINA)
Diagnostic reliability in loss of brainstem function evaluated by
brainstem auditory evoked potentials and somatosensory evoked
potentials in impending brain death.
T. Shiogai and K. Takeuchi (JAPAN)
Multimodality evoked potentials in the differential diagnosis of
brain death.
J.M. Guerit, M. De Tourtchaninoff, P. Hantson and P. Mahieu
(BELGIUM)
The problem of << brain death >> and organ donation in poisoned
patients.
P. Hantson, P. Mahieu, M. De Tourtchaninoff, and J.M. GuThetarit
(BELGIUM)
Role of the somatosensory evoked potentials in the diagnosis of
brain death.
E. Facco, M. Murani, F. Baratto and G.P. Giron (ITALY)
A contribution of multimodality evoked potentials and
electroretinography for the early diagnosis of brain death.
Calixto Machado (CUBA)
EEG in brain death diagnosis.
Enrique Delamonica (ARGENTINA)
Prolonged EEG activity in brainstem death.
A. Esteban, A. Traba, J. Prieto, R. Roldan and S. Santiago (SPAIN)
The low voltage EEG in coma.
W.T. Blume, D.K. McNeill, G.B. Young and P. Chiu (CANADA)
Accurate prediction of neurologic outcome after cardiac arrest.
Ted L. Rothstein (USA)
Study of intracranial circulation in brain-dead patients using
transcranial doppler sonography (TCD).
J.M. Domonguez-Roldan and F. Murillo-Cabezas (SPAIN)
Scintigraphic Techniques in the Diagnosis and Confirmation of
Brain Death.
H.P. Schlake, M. Scheubeck, R. Burger, Ch. Reiners, K. Roosen (GERMANY)
Heart rate variability in coma and brain death,
O. D. Garcia, C. Machado, J. M. Roman, A. Cabrera, L. Diaz-
Comas, B. Rivera, R. Grave de Peralta (CUBA)
BRAIN DEATH IN CHILDREN AND RELATED ISSUES
Brain death determination in infants and children
S. Ashwal (USA)
The American Neurological Association anencephaly policy: Can
medical speculations justify utilitarian homicide?
A. Shewmon (USA)
Consideration of anencephalic newborns as organ donors: Ethical
problems related to the determination of death
E.R. Winkler (CANADA)
Withdrawal of life-support in pediatric critical care
D. D. Vernon (USA)
PERSISTENT VEGETATIVE STATE
The persistent vegetative state and the concept of person
Ra.l de Velasco (USA)
The vegetative state
C. M. DeGiorgio (USA)
The persistent vegetative state in infants and children
S. Ashwal (USA)
The German term "Apallic Syndrome" vs. the Anglo-American term
"Persistent Vegetative State".
Th. Kallert (GERMANY)
Public policy and the persistent vegetative state.
William Winslade (USA)
Brain death and persistent vegetative state. Current debate in
Italy
Carlo a. Defanti (ITALY)
Multimodality evoked potentials in the permanent vegetative state
J.M. GuThetarit (BELGIUM)
BIOETHICAL, PHILOSOPHICAL, THEOLOGICAL, SOCIOLOGICAL AND CULTURAL
CONSIDERATIONS IN BRAIN DEATH AND RELATED ISSUES
History of death
Carlo a. Defanti (ITALY)
Treating the quick and the dead: conflicts in biological
constructs and the needs of a civil society.
Alta Charo (USA)
Redefining Death: Bioethical and Theological Implications
O. D. Garcoa and J. M. Rom=DFn (CUBA)
End-of-life care for non heart beating organ donors and their
families
B. Spielman and C. Simmons
Brain death - The Indian Perspective
S. Jain and M.C. Maheshawar (INDIA)
Brain death: The Japanese controversy
E. A. Feldman (USA)
Brain death in Japan
Margaret Lock (USA)
Brain death, medical futility and other confusing concepts:Lessons
in moral fallibility
Kenneth Goodman (USA)
Living organ donors
Steven Miles (USA)
Brain death and technological change
James J. Hughes (USA)
END-OF-LIFE DILEMMAS
Euthanasia: a report from the Netherlands
J.K.M. Gevers (THE NETHERLANDS)
Euthanasia and its present debate in medicine
F.J. Leon (SPAIN)
Terminal Patient
Berta Serret (CUBA)
End-of-life decision facing brain death. Actual ethical-
philosophical problems
Eduardo Fermin (CUBA)
PRE-SYMPOSIUM COURSES (February 26, 1996).
A day before the Symposium the following courses will be held:
- Annual meeting of the Institute of Neurology and
Neurosurgery
- Intensive care of the donors
- Immunology and organ transplants
- Single photon emission tomography (SPECT) in Neurosciences
- Sleep medicine
- Legal controversies in the diagnosis of death and organ
transplantation
- Terminal patient
- Bioethics and education
- Donation-Transplant Organization Systems
CALL FOR ABSTRACTS
Participants are invited to send abstracts concerned with all
aspects of Brain Death and Related Issues. Abstracts of lectures,
oral presentation, round tables, etc., must be received at the
symposium secretariat before January 10, 1996. Authors will be
notified of acceptance of their abstracts before February 10,
1996. Abstracts to be submitted are subject to the following
conditions:
- Abstracts must be submitted in English.
- Abstracts should not exceed 200 words.
- There must be no tables or figures.
- Type the title in capital letters. Do not underline the
title.
- Space two lines underneath the title.
- Type the author's name(s) in lower case and put the name of
the presenting author first. Include the name(s) of the
institution(s) where the work was done.
- Space two lines and type the entire abstract as one
paragraph in lower case.
- Do not use subtitles. When using abbreviations, spell out in
full the first time mentioned, followed immediately by the
abbreviation in parentheses.
- The abstract should be sent by E-Mail or Fax (preferably by
E.mail). Don't use regular mail, but an "over night" mail.
- Alternatively abstract may be sent on a floppy disk IBM
compatible, labeled with author name, title, preferred session
(using notation 1A, 2B, etc.), date, only one abstract per
diskette, using a higher version or ASCII.
- All papers sent in diskettes or by E-Mail will be included
in the Abstract Book of the Symposium (electronic version)
AUDIOVISUAL AIDS
- Single or dual slide projection of 35 mm slides
- Posters must be presented on a 0.95 m. wide by 2 m. high
maximum format.
- Videos must be presented in Betamax or VHS video format,
NTSC 3.58 standard.
- Videocassettes Betamax and VHS (NTSC 3.58)
- Films 16 and 35 mm. and Super 8
- Video Beam Multi-standard
REGISTRATION FEE
To register for the Symposium please complete the enclosed
registration form and send it to the Congress Secretariat before
January 10, 1996. Registration should be sent by E-Mail or Fax.
We suggest participants to register through one the
International Conference Center's representative travel agencies
(at least 30 days before the Congress) listed in this brochure.
It will provide the following services:
- Promotional inscription fee
- Information on the program
- Reception and acknowledgment of contributed papers
- Visa granting
- Air Ticket reservation
- Tourist packages and Optional tours
Registration fee
Through the International Conference Center=C6s Representative
Agencies
- Delegate $300.00 (USD)
- Accompanying person $150.00 (USD)
Without contacting the International Conference Center=C6s
Representative Agencies
- Delegate $350.00 (USD)
- Accompanying person $200.00 (USD)
The registration fee includes:
- Admission to all Scientific Sessions.
- Admission to the Industrial Exhibition.
- Conference bag
- Author and participant certificate
- Abstract book.
- Get-together and farewell parties.
- Transfer from Hotels to the Conference Center
Accompanying persons are those who accompany a full participant.
- Their fee covers:
- Congress bag with souvenirs.
- Admission to the opening ceremony.
- Get-together and farewell parties
- Havana City Tours (Optional)
The inscription fee of the Pre-Symposium Course is $30.00
The International Conference Center Representative Travel
Agency in USA is:
MARAZUL TOURS, Inc.
Bob Guild
Tower Plaza
4100 Park Ave.
Weehawken
NJ 07087
Tel.:212-319 9670 (Outside NJ: 800-223 5334)
Fax:212-310 9009
Participants from countries where there is no representative
agency should contact the Congress Organizing Committee:
Prof. CALIXTO MACHADO, M.D., Ph.D.
"II INTERNATIONAL SYMPOSIUM ON BRAIN DEATH"
President of the Organizing Committee
PALACIO DE LAS CONVENCIONES
Calle 146 entre 11 y 13, Playa
Apartado 16046
La Habana, Cuba
Tel.: (537) 327501 or 322233
Fax: (537) 22-8382 / 219496 / 218270
E.Mail: braind@infomed.sld.cu
Telex: 511609 palco cu
ACCEPTED TRAVELER'S CHECKS AND CREDIT CARDS
1. Accepted international credit cards
- Visa (starting with numbers 45 or 49)
- Mastercard
- Carnet
- JCB
2. Traveler's checks NOT ACCEPTED in Cuba:
- American Express
- Pinto Sotomayor to Brazil
HOTEL INFORMATION
Through the agencies of the International Conference Center
(ICC) hotel accommodation can be reserved at REDUCED RATES in
first class or tourist class. If you are not able to contact a
Representative Travel Agency, please make your reservation
contacting directly the Organizing Committee.
All request for extra booking forms and additional information
can be directed to the nearest International Conference Center
Agency in/from your country or directed to the Organizing
Committee.
TRAVEL INFORMATION. VISA
If you decide to arrange the trip to Havana through an
International Conference Center agency, the agency will guarantee
you the visa or tourist card. Entry to the country is granted to
all foreigner taking part in congresses organized in Cuba,
regardless of their nationality in
Participants must meet the normal requirements, i.e. they must
posses valid travel documents and sufficient means of support.
Participants requiring a visa for entry to Cuba are strongly
advised to make their application to the Cuban Embassy or
Consulate in their home countries, at least one month before the
intended date of travel.
Visa application procedures are faster when the acknowledgment
of registration is included. All registered participants will
receive such confirmation once their registration has been
processed by the Symposium secretariat and their payment has been
made.
In absence of the above, participants are advised to fax or
E.mail, at least 30 days in advance, the following data:
- Name and surname.
- Maiden name.
- Sex.
- Date and place of birth (please write out the name of the
month).
- Passport No.; date of issue; expiration date.
- Citizenship/Nationality.
- Occupation.
- Full home address.
- Expected date of arrival in Havana.
- Expected duration of stay in Cuba.
- Flight No. / Airline.
LETTER OF INVITATION
On request, the Secretariat will be glad to send you a
personal invitation for the Symposium. It should be understood
that such an invitation is not a commitment on the part of the
organizers to provide any financial support.
CUBA IN A NUTSHELL
The Republic of Cuba is an archipelago consisting of the
island of Cuba, the Isle of Youth and around 1600 cays and
islets. Its total area is 110,922 square kilometers and it has o
population of nearly 10.8 million. The long, narrow island of
Cuba resembles a large crocodile. It is 1250 kilometers long and
has 289 natural beaches along its coastline. Cuba's climate is
subtropical. Average annual temperature is 250C (770F). The
average high and low are 35oC (95oF) and 19oC (66oF).
Politically and administratively, Cuba is divided into 14
provinces and a special municipality. Havana, the capital, has a
population of nearly 2 million. Cuban fauna includes over 8,000
species and there are no species harmful to man.
Sugar ant its by-products are the main economic commodities.
Other important economic branches are tourism, fishing, tobacco
(famous all over the world), citrus fruits and coffee.
The national culture has well-defined features resulting from
the fusion of several cultures, mainly Spanish and African. Among
Cuba's main tourist attractions is Varadero beach, stretching
over 20 kilometers of fine white sand, transparent sea and palm
trees. Guama is a recreate Taino Indian village built on piles in
a lagoon. The Isle of Youth with its many natural caves, long ago
shelter of pirates and corsairs, which inspired Robert Louis
Stevenson's Treasure Island. Cayo Largo is a paradise where
nature is your only host. The Vinales Valley, with its typical
pincushion hills, is plenty of marvelous tobacco fields, the
best in the world. Cuba's best attractions, however, are its
people and rhythms of their music.
HAVANA
Havana was founded by the Spaniards on the southern coast of
Cuba and was later transferred to its current location. Its
territorial and urban development started during the second half
of the 17th century, but was not until the 19th century the city
attained its splendor.
For over two centuries Havana's harbor was the most important
in the western hemisphere. It was the meeting place of the fleets
on their voyage back to Spain. It was a bulkward of the royal
arsenal, with one of the largest shipyard in the worlds .
Impressive fortresses were erected: La Fuerza Castle (1538),
the oldest in Cuba and the second oldest in the Americas; The
Morro Castle, guarding the harbor; La Cabana Fortress, completed
in the 18th century, where a cannon is still fired at nine
o'clock every night, a tradition which dates back to colonial
times when it signaled the hour when all them doors in the city
wall were closed. The city was enclosed by a wall which served as
limit and protection. Some sections of this wall have been
preserved.
Old Havana, a remnant of its colonial grandeur, is the best
preserved colonial architecture complex in the Americas. That's
why, on December 4, 1982, UNESCO declared Old Havana a part of
the world cultural heritage.
The prodigious architecture of Colonial Havana is here for all
visitors to see. An example of it is the San Francisco Square,
the second oldest in Cuba, located near the port, a major
commercial center of the old city.
The most beautiful sites in Old Havana are the Cathedral
Square, the streets of San Ignacio and Empedrado, with their
cobblestones, the Callejonn del Chorro, the palaces of the Marquis
of Arcos, the Counts of Casa Bayona, and the Marquis of Aguas
Claras, now housing El Patio restaurant.
Some religious buildings are of particular beauty: the Church
of El Angel, the Church and Convent of Santa Clara, and the
Church of La Merced, with an unpretentious facade contrasting
with its gold-encrusted altar.
El Templete was erected at the of foot of a ceiba tree, where
the first tow hall meeting was held and the first mass
celebrated.
Havana offers tourists numerous hotels, restaurants and night
clubs which will surely make for a pleasant stay. Among the most
outstanding hotels are the Inglaterra Hotel, decorated in 19th
century style, the Presidente Hotel, with an atmosphere of old
luxury, the Havana Riviera, the Habana Libre, the Nacional and
the Capri hotels, with comfortable rooms overlooking the city and
the sea. The world famous and refreshing mojito and our most
typical Cuban dishes are to be found at La Bodeguita del Medio.
El Floridita offers international cuisine and a special
daiquiro. La Torre de Marfil and El Mandaron specialize in
Chinese food, while La Casa de los Vinos and El Baturro have on
their menus a wide variety of Spanish fare. El Emperador, La Torre
and 1830 are special treats for gourmets.
World famous for its wonderful shows and tropical setting,
Tropicana presents visitors with two options: "Bajo las
Estrellas", show under the stars, surrounded by exuberant
vegetation, and the dazzling "Arcos de Cristal".
Havana, a city with a particular beauty and a charm of its
own, awaits your visit, certain of meeting all your expectations.
VENUE
The Havana International Conference Center, located in an
alluring site surrounded by beautiful gardens, is only a few
minutes away from downtown Havana and its major hotels.
The center has a plenary hall seating 1475, two rooms for 400
persons each, a number of other well-equipped conference rooms
and wide exhibit areas. The center is staffed with PCOs and
provides conference services (typing pool, translation,
interpretation, photocopying, design and printing), catering
services (restaurant, self-service cafeteria and snack bars),
medical post and communications facilities. It also has a store
and a library.
Havana International Conference Center also boast an excellent
exhibition hall (PABEXPO), 1,000 m. away from its central
facilities.
REGISTRATION FORMS
"II INTERNATIONAL SYMPOSIUM ON BRAIN DEATH"
International Conference Center, Havana, February 27 - March 1,
1996
Name:____________________________________________________________
Address:_________________________________________________________
Postal Code:____________________________Country:_________________
Affiliation:_____________________________________________________
Tel:________________________Fax:_________________________________
E.Mail:____________________________________________________________
Accompanying Person:
Yes__ No__ If yes, How many?_________________
Any inquires may be directed to:
Prof. CALIXTO MACHADO, M.D,, Ph.D.
"2nd INTERNATIONAL SYMPOSIUM ON BRAIN DEATH"
President of the Organizing Committee
PALACIO DE LAS CONVENCIONES
Calle 146 entre 11 y 13, Playa
Apartado 16046
La Habana, Cuba
Tel.: (537) 327501 or 322233
Fax: (537) 22-8382 / 219496 / 218270
E.Mail: braind@infomed.sld.cu
Telex: 511609 palco cu
---
Internet : david@dental.stat.com
WWW : http://www.stat.com/~david
Telephone: +1-602-860-1121
FAX : +1-602-451-1165
------------------------------
End of HICNet Medical News Digest V09 Issue #03
***********************************************
---
Internet: david@stat.com FAX: +1 (602) 451-6135
WWW: http://www.stat.com/~david
Thread Navigation
This is a paginated view of messages in the thread with full content displayed inline.
Messages are displayed in chronological order, with the original post highlighted in green.
Use pagination controls to navigate through all messages in large threads.
Back to All Threads