Death secondary to a donkey's bites

We present a unique case of death due to the assault and bites of a donkey on a 65-year-old man. The farmer, found dead in his farmyard, had a very deep wound in the anterior region of the neck, with a sharp transection of the trachea and severe bleeding by several minor vessels wall disruptions. The cause of death was established to be massive bleeding combined with asphyxia due to aspiration of the blood. Moreover, multiple contusions with associated skin abrasions and perforations were present. The general impression of the injuries was consistent with an animal's bite marks. Herbivorous or omnivorous bite attacks on humans are rare; instead, these animals attack by kicking, trampling, and kneeling, resulting in secondary blunt injuries. The donkey is usually a docile animal, but its behavior can be aggressive during the mating season, and the possibility of biting should not be underestimated, as illustrated by the 2 cases published previously as well as by the case presented here.     

Acute flurazepam intoxication: a case report

A fatality due to ingestion of flurazepam is reported. Flurazepam is a benzodiazepine, a widely prescribed hypnotic drug for use in sleep disorders. There are only few documented reports of the disposition of flurazepam in deaths due to overdose. A 68-year-old woman was found deceased at home with no evidence of trauma or asphyxia. Toxicologic analyses were performed and drug levels measured by means of gas chromatography coupled to mass spectrometry. The flurazepam concentration in each specimen was as follows: heart blood 2.8 microg/mL, bile 323 microg/mL, and urine 172 microg/mL. Presence of flurazepam into gastric content was observed too. Based on the autopsy findings, patient history, and toxicologic results, the cause of death was determined to be acute intoxication of flurazepam and the manner, suicide.     

Medicolegal aspects of an unusual uterine perforation with multiload-Cu 375R

Perforation of the uterus is one of the most serious complications associated with insertion of intrauterine contraceptive devices (IUD). According to recent studies, this lesion occurs in 0.87 per 1000 cases, but statistics generally fluctuate between 0.05 and 13 per 1000 insertions. "Primary" perforations occur at the time of IUD insertion, and "secondary," or delayed, perforations are usually assumed to be caused by reactive uterine contractions. We report an unusual case of uterine perforation, which occurred 9 days after the insertion of a Multiload-Cu 375 IUD. The criteria for differential diagnosis between primary and secondary complications are discussed, particularly from the perspective of medical malpractice cases.     

Fatal embolism of the anterior spinal artery after local cervical analgetic infiltration

A 66-year-old man received a local infiltration of cortisone and xylocain in the left paravertebral region between the fifth and sixth cervical vertebrae. Respiratory failure occurred 2.5 h later with subsequent successful resuscitation. During the following 2 months of assisted ventilation up to the patients death, tetraplegia with concurrent full consciousness throughout was observed. Magnetic resonance imaging confirmed an ischaemic lesion of the upper anterior cervical myelon. The forensic autopsy revealed pneumonia as cause of death. Neuropathology confirmed anterior infarction at the C2/C3 level of the cervical myelon, with obstruction of the anterior spinal artery by an epithelialised fibrocartilaginous embolus. The autoptic findings suggest that this embolus stems from the site of previous analgetic infiltration, with accidental laceration of an intervertebral disc and subsequent transportation of discous material via injection canula into an artery.     

Immunohistochemical quantification of pulmonary mast-cells and post-mortem blood dosages of tryptase and eosinophil cationic protein in 48 heroin-related deaths

Recent studies suggest that many fatal heroin overdoses are caused by anaphylactoid reaction. In the present study we measured tryptase and eosinophil cationic protein in post-mortem blood of 48 deaths after heroin injection. We also investigated the presence and pulmonary distribution of mast-cells using specific immunohistochemical antibody for tryptase and morphometric evaluation in those cases of heroin-related deaths. The data were compared with 44 subjects who died following head trauma and to 32 cases of fatal anaphylactic shock. In the heroin-related death cases, the measurements of serum tryptase levels and eosinophil cationic protein dosages resulted in particularly elevated concentrations compared with the trauma cases. Nevertheless, the data that our study supplies by immunohistochemical techniques indicate that when mast-cells count in the lung was determined, no definite pattern was obtained between fatal heroin overdose cases and the control groups. Furthermore, the wide range of morphine concentrations found in post-mortem blood samples suggest that the term ‘overdose’ is relative and does not sufficiently characterize death associated with heroin addiction. Our study confirms that elevated concentrations of serum tryptase are associated with many heroin-related deaths. At this moment to attribute the cause of these deaths to ‘heroin overdose’ ignores the likely causal contribution of other possible systemic reactions to the mechanism of death.     

Decentralization and access to social services in Colombia

Decentralization is meant to improve access to public services, but relatively few studies examine this question empirically. We explore the effects of decentralization on access to health and education in Colombia using an original database covering over 95 % of Colombian municipalities. We show that decentralization improved enrollment rates in public schools and access of the poor to public health services. In both sectors, improving access was driven by the financial contributions of local governments. Small increases in own-shares of spending led to surprisingly large increases in the access of the poor in both sectors. Our theoretical model implies that where local information dominates productive efficiency, elected local governments will provide services better tailored to local needs. Decentralizing such services should increase their use by the public. Together, theory and empirics imply that decentralization made the Colombian state more accountable. It provided local officials with the information and incentives they need to allocate resources in a manner responsive to voters’ needs and improve the impact of public expenditures.     

Decentralization as a constraint to Leviathan: a panel cointegration analysis

This paper extends the empirical literature about the effects of fiscal decentralization on the growth of government along three dimensions. It distinguishes between the effects of the level of decentralization from the way local governments finance their expenditures (common pool versus own resources); it uses a panel cointegration approach to separate the long run effects of decentralization from the short run dynamics; and it extends and revises the datasets generally used in these empirical analyses. The results show that the amount of revenue raised by sub-national governments leads to a long-term fall in the size of government but grants have the opposite effect. In addition, a greater decentralization of expenditure leads to greater overall spending. When the short-term is considered these influences work slowly, as the speed of adjustment towards the desired government size is relatively sluggish. In addition, in the short run, there is also a clear effect from the role of local revenue raising powers that stimulates the growth of government. These results appear robust to changes in the composition of the variables, countries and periods included the sample.     

Swiss worlds of welfare

Are there different worlds of welfare in Swiss cantons, analogous to different national welfare state regimes? Are the welfare regimes made up of functionally related sub-regimes in the field of employment, education, taxation and social security, as argued in recent analyses of ‘varieties of capitalism’? And can the variations between such cantonal welfare regimes be explained by the same politico-institutional variables that account for the development of national welfare states? These are the guiding questions of this article. We find strong empirical evidence for large inter-cantonal variation in welfare state policies. The sub-regimes are not functionally connected, however. Their variation is related to different sets of variables, indicating a weak functional link between them. Developments and causal structures are specific to the various subregimes. In addition, it is socio-economic and not politicoinstitutional variables that have had the strongest imprint on the overall structure of cantonal welfare regimes.