Anomalies and alterations of the hyoid-larynx complex in forensic radiographic studies

The authors illustrate the anatomic interest of the hyoid-larynx complex in the differential diagnosis of traumatic lesions, purely anatomic anomalies, and lesions resulting from natural causes. Forty larynges from corpses undergoing autopsy at the Institute of Legal Medicine of the University of Trieste were studied during the period May 1996 to May 2001. The larynges were excised and examined through radiographic magnification with dedicated mammographic equipment. Triticeous cartilages were evidenced in 12 (30%), they were bilateral in 7 (17.5%) and monolateral in 5 (12.5%). These cartilages were more frequent in men (8 out of 26; 31%) than in women, 4 out of 14 (28.5%).Total fusion of the body of the hyoid bone with the greater horns was revealed in 10 (25%), partial fusion in 4 (10%), and evident articular rima between the body and the greater horns of the hyoid bone in 14 (35%).The lesser horns of the hyoid bone were symmetrical in 29 (72.5%), asymmetric in 11 (27.5), absent in 1 (2.5%). While confirming the validity of the radiographic method used, we conclude that great care should be taken when diagnosing traumatic lesions of the hyoid-larynx complex. This diagnosis is often difficult to establish owing to the considerable frequency of anatomic anomalies of the complex.     

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.     

Progressive Era Diplomat: Lloyd C. Griscom and Trade Expansion

The Progressive Era, from the late 1890s to the entry of the United States into World War One, was marked by a professional commitment to global trade expansion on the part of the State Department and the McKinley, Roosevelt, Taft, and Wilson administrations. Philosophically, the United States embraced the belief that a liberal, democratic, free-enterprise political and economic system would advance human progress on every continent, and that global free trade would remove many causes of war and conflict. Such a policy position attracted young and talented foreign service officers to serve in the American diplomatic corps. One young man was Lloyd C. Griscom, heir to one of the great American shipping fortunes. Griscom's career as a diplomat in Turkey, Persia, Japan, Brazil, and Italy between 1899 and 1909 revealed much about American political and economic interests during a period when the United States emerged as a major power.     

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.