Massive systemic silicone embolism: a case report and review of literature

Subcutaneous injections of inert or quasi-inert plastic material designed to smooth out wrinkled skin or to create a more esthetically sought appearance have become very popular with the American public in general, and, in particular, with certain groups highly focused on their physical image. The case of the injection procedure has attracted into the field of plastic medicine a substantial number of illegal, incompetent, and unscrupulous operators. Their ignorance of involved medical risks and procedures not uncommonly results in severe complications, disfigurement, and death of patients. We report the typical pathological and chemical findings of a systemic fatal silicone embolism in a 53-year-old heterosexual woman following illegal chronic injections of silicone in her hips and buttocks. The injected subcutaneous silicone apparently migrated rapidly from the interstitial subcutaneous tissue into the general blood stream resulting in a fatal systemic silicone embolism. An analysis of the presented case in conjunction with a review of the pertinent medical literature, including a recent article, revealed a marked similarity in the clinicopathologic findings between silicone embolism and fat embolism.     

Identification of animal species by protein radioimmunoassay of bone fragments and bloodstained stone tools

In forensics and archaeology, it is important to distinguish human from animal remains and to identify animal species from fragmentary bones and bloodstains. We report blind tests in which a protein radioimmunoassay (pRIA) was used to identify the species of six bone fragments lacking morphological specificity and 43 bloodstained lithic tools, knapped experimentally and soaked in blood of known animal and human origin. The submitters of the bone fragments and the bloodstained tools each listed a number of possible species, from which the testers selected the best match with the pRIA results. All six bone fragments were correctly identified: three humans, a deer, a dog, and a cow. Forty-three tools were stained with blood from a wide variety of species including ungulates, carnivores, a fish, and a bird. On 40 of these 43, at least one species (or blood-free control) was identified correctly. Some of the tools were stained with blood of two different species. A mixture of sheep and musk ox blood was correctly identified; in several other mixtures, only a single species was detected. Two tools with human blood and one with human sweat were correctly reported as human. There was a single false positive (one of three controls reported as weakly bovine) and no false negatives. We conclude that the pRIA technique shows a high degree of accuracy in discriminating human from animal bone fragments and bloodstains and in identifying animal species.     

Relinquishing custody as a requisite for receiving services for children with serious emotional disorders

A review of the literature was conducted to assess the extent and nature of the practice of requiring parents to transfer custody in order to receive public funding for intensive services needed by their child/adolescent who had a serious emotional disorder. The review focused on the legal and policy basis of this practice as well as its social and psychological impact on child and family. We conclude that the practice of transfer of custody as a requirement for receiving financial aid occurs in a majority of states, though the actual extent of this practice is not known. The major factor influencing the use of transfer of custody appears to be the absence of an appropriate and adequate system of services for children and adolescents with serious emotional disorders. We recommend that the practice of requiring custody transfer for the sole purpose of receiving services be abolished and offer several suggestions for improving acess to services.Preparation of this article was supported in part by the National Institute of Mental Health (NIMH) under contract no. 89MF761903. The authors are grateful to John Burke and Kelly Kelleher of the Division of Biometry and Applied Sciences, NIMH for their assistance on this project. Laurie Flynn, Executive Director for the National Alliance for the Mentally Ill, was very helpful during the informative stage of the project. Barbara Friesen, Director of the Research and Training Center at Portland State University, gave us useful guidance throughout the project. We thank Stephen Hill, Consultant to the National Governors' Association, for his help. We are grateful to Amy Hewitt and Carol Ishler for their assistance in preparing this report. We also would like to acknowledge several individuals who assisted us with research reported in this article. We are grateful to Governor Richard F. Celeste of Ohio for his letter of support for the state survey of custody transfer practices. We appreciate the efforts on behalf of this survey by staff from the State of Ohio, particularly Jean Ellen Stevens, Administrative Assistant to the Director of the Department of Mental Health. Margraret McNally assisted in the compilation of data for both surveys.     

Gauging support for innovative farmland preservation techniques

Given growing concerns about the loss of farmland in the US, governmental and nonprofit groups are seeking innovative, cost-effective methods to preserve lands that will elicit additional landowner participation. This article describes four innovative farmland preservation techniques and derives implications for the policy process through interviews of key stakeholders: program administrators, lawmakers, and landowners. Experts on farmland preservation were also interviewed to ensure stakeholder perceptions substantively inform the policy process. Four techniques were selected for assessment from approximately 30 novel techniques. Reactions to these policy options reflect stakeholder perceptions of a baseline condition; the perceptions help evaluate which options are likely to survive the policy process and what attributes will lead to their acceptability because few of these techniques have yet become policy. Although the stakeholders may have more limited experience with the policy process, land preservation experts validated many of the results and the possibility of success in the “rough and tumble” of the policy process. Of the four investigated techniques rights of first refusal was the most favored, although respondents thought effective implementation would require careful targeting and a dedicated funding source. Experts agreed this technique was most likely to survive in the political arena. Agricultural conservation pension was also viewed favorably, though it was considered administratively difficult to implement. Several experts thought that, though inchoate, the pension plan could potentially be more cost effective than rights of first refusal. Land preservation tontines were perceived to be an interesting concept, but confusing, difficult to implement, and ill-defined. Term conservation easements were viewed unfavorably because they did not preserve land permanently.