Liver histopathology in autopsied drug-addicts

Liver specimens of 150 randomly selected autopsied drug addicts from the province of Milan (Italy) were studied using light microscopy, polarized light and immunohistochemical methods. Simple histological changes and the main diagnoses are described. The main histological diagnoses in order of frequency were: non-specific reactive hepatitis (NSRH) (52%), chronic aggressive hepatitis (CAH) (24%), acute hepatitis (AH) (12%), normal liver (6%), steatosis only (3.3%) and cirrhosis (2%). In 24 cases (16%) one or more viral antigens (HBsAg, HBcAg and Delta Ag) were detected in hepatocytes by immunohistochemical methods. Three liver specimens revealed epithelioid cell granulomas, but in no case was birefringent material identified in the liver. AH and CAH were more frequent in the group of livers with viral antigens. Our histological and immunohistochemical data confirm the current opinion that, in most cases, liver pathology in drug addicts has a viral aetiology, while no significant pathogenic role has been identified for drugs, alcohol or contaminants. Recurrent infections by one or several viruses possibly explain the relatively peculiar histological features of hepatitis in drug addicts.     

Mental health policy for the 1990s: tinkering in the interstices

That public policy has abysmally failed the chronically mentally ill seems beyond genuine dispute. Successive reforms have foundered on the familiar shoals of overblown expectations and insufficient resources. In this paper, we review current policies affecting the chronic and disabled mentally ill, and we consider some approaches to reform. We begin by trying to identify and characterize the chronically mentally ill and their disabilities. Next, we consider the chaotic patchwork of federal and state programs that has come to replace the asylum. We then criticize several competing models of reform that we believe fail to make an empathic connection with the mentally ill. Finally, we urge a strategy of limited reform consistent with available empirical data about program effectiveness and sensitive to the likely economic, political, and legal constraints of the 1990s.     

Physician crimes and criminals. The historical and forensic aspects

The physician, like any other human being, is subject to emotional problems, greed, jealousy, and instability of an individual under stress as well as mental disease which may all bring out improper behavior or criminal activity. Over the last two centuries, there have been instances where physicians have committed deliberate acts of murder on wives, relatives, patients, and others. Their motivation has ranged from ridding themselves of a nagging wife or for insurance and inheritance gains to insane acts. The methods used have usually been associated with poisons and drugs, of which the physician may have great familiarity. The frequency of physician-involved murders seems to have increased in the past two decades with several sensational cases being the topics of media coverage and further review in books and visual media, including television and the movies. The investigation of these cases may be very difficult, especially when a drug may be given to a victim which could cause severe problems after small amounts are given. The detection of death as being a murder may be the first problem faced, the demonstration of the fatal agent in the body in the next problem, and probably the most difficult is finding a suspect with the medication in his or her possession or paraphenalia for injecting such as a syringe and needle. The stealth and cunning of the murderer may further complicate the picture for the investigator as well as the reputation of the physician in the community, which is often above reproach so that the public has to be convinced of the actual involvement of the suspect.     

Method of payment and the cesarean birth rate in a hospital in northeast Brazil

This paper examines factors associated with the cesarean birth rate, including medical condition and method of payment, in the largest maternity hospital of Fortaleza, Brazil. Data were collected on 5996 women who delivered at the Maternidade Escola Assis Chateaubriand from October 1980 to July 1981. All women were classified according to how they paid for their care: private (financed at least part of their care with own funds), insured (federal or state), or indigent. Private patients were found to be far more likely than patients in the other two groups to have cesarean deliveries, due primarily to the high percentage of private patients recorded as having prolonged or obstructed labor, combined with a high rate of prior cesarean sections. From this data, it appears likely that financial incentives did play a role in physician decisions on whether to perform cesarean deliveries.