This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Max Robinowitz, MD; Maj Renu Virmani, MC
USAF Armed Forces Institute of Pathology Washington, DC

Maj Matthew Phillips, MC
USAF Keesler Air Force Hospital Biloxi, Miss

JAMA. 1987;257(10):1329.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

In Reply.—

We have investigated further the circumstances of death in the six patients in question and the detailed findings are listed in the Table.

Two of the six patients had myocardial contraction bands. Additional myocardial sections from the heart of the patient with rhabdomyolysis and hyperkalemia revealed multiple foci of myocyte necrosis with lymphocytic and plasma cell infiltrates. The differential diagnosis is idiopathic myocarditis, resolving catecholamine necrosis, or shock-induced myocardial necrosis. We favor the last, as the patient survived three days after circulatory collapse.¹ Findings from the toxicology screens were negative in all six; none had prior history of cardiovascular complaints, syncope, or drug- or anesthesia-related problems.

Malignant hyperthermia is associated with marked elevations of catecholamine levels, especially norepinephrine, and would be expected to induce myocardial contraction band necrosis.^2,3 It is still possible that malignant hyperthermia may have been present in some of the recruits, as susceptibility . . . [Full Text PDF of this Article]

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?