Autopsy Findings in Botulinum Toxin Poisoning

Abstract: In the United States, foodborne botulism is most commonly associated with home‐canned food products. Between 1950 and 2005, 405 separate outbreaks of botulism were reported to the Centers for Disease Control and Prevention (CDC). Approximately 8% of these outbreaks were attributed to commercially produced canned food products. Overall, 5–10% of persons ingesting botulinum toxin die. Few reports exist pertaining to autopsy findings in cases of foodborne botulism. Here, we report the autopsy findings of a man who died after a prolonged illness caused by botulinum toxin exposure likely attributable to a commercially prepared food source. Despite extensive testing, our histopathologic findings were nonspecific. We therefore conclude that the forensic pathologist must become familiar with the neurotoxicity syndrome associated with this illness. Maintaining vigilance for botulism by carefully reviewing the decedent’s clinical history will aid in the early identification and control of outbreaks, either foodborne or terrorism‐related.     

Self-determination,group identity and the common will

ABSTRACT

Anna Stilz defends a political autonomy account of self-determination that, she argues, best explains our intuitions about why colonization, annexation and foreign occupation are wrong. These are wrong, on Stilz’s view, because they unilaterally coerce individuals living under those systems of government. I argue that Stilz does not show that her account of self-determination explains our intuitions about autonomy in these kinds of cases, because she does not have a separate argument for the value of belonging to particular political groups.     

An experimental comparison of adversarial versus inquisitorial procedural regimes

This article reports the results of a multiyear series of economicexperiments comparing the two dominant types of legal proceduresused in adjudication: (1) the 'adversarial' model of party-controlledprocedure versus (2) the 'inquisitorial' model of judge-controlledprocedure. The principal finding is that the relative fact-findingefficiency of the two systems, in terms of both the 'revelation'of hidden facts and the 'accuracy' of decision, depends significantlyupon the information structure. Under a 'private' informationstructure, inquisitorial procedure is relatively more efficient,whereas under a 'correlated' information structure, adversarialprocedure is relatively more efficient.     

Ochronosis Presenting as Methemoglobinemia

Ochronosis is the blue‐gray discoloration of collagen‐containing tissues due to homogentisic acid (HGA) deposition, secondary to endogenous alkaptonuria or exogenous enzyme inhibition. In renal disease, accumulation of HGA in serum can cause methemoglobinemia. A 60‐year‐old woman with renal disease and anemia presented with 3 days of weakness and months of gray skin discoloration. Her hemoglobin was 8.1g/dl with 24.5% methemoglobin. Despite treatment with methylene blue, exchange transfusion, and continuous renal replacement therapy, the patient died. Autopsy revealed gray discoloration and ochronotic pigment in the ribs and cartilage. Based on these findings, the patient was diagnosed with ochronosis, suggestive of alkaptonuria, complicated by methemoglobinemia. The differential diagnosis for blue‐gray skin discoloration includes argyria, methemoglobinemia, and ochronosis. This patient's clinical and autopsy findings suggested alkaptonuria complicated by methemoglobinemia due to progressive renal dysfunction. Development of methemoglobinemia in the setting of chronic skin discoloration and renal failure should prompt consideration of alkaptonuria.     

Fatality from diphenhydramine monointoxication: a case report and review of the infant, pediatric, and adult literature

As an antihistamine, diphenhydramine (DPH) is well known for its use in allergy treatment. Since its introduction in 1946, it has been marketed under various trade names, the most popular being Benadryl. Three years after its introduction, the first fatality due to DPH toxicity was reported in 1949.To better understand the incidence of fatalities due to DPH monointoxication, we reviewed deaths that were reported from 2 data sources: (1) the English-language literature using PubMed, from 1946 through 2003; and (2) the Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System (ARAAPCCTESS), from 1983 through 2002. The results were then tabulated using age, gender, clinicopathologic findings, and toxicology results.Combined results from both data sets show the following mean (and range) for age and DPH levels: Adult, 35.6 years (18-84) and 19.53 mg/L (0.087-48.5); pediatric, 8.6 years (1.25-17) and 7.4 mg/L (1.3-13.7); infant, 31 weeks (6 weeks-11 months) and 1.53 mg/L (1.1-2.2), respectively.Most deaths were certified as accident or suicide; however, 6 infant homicides were reported. The most common symptoms for all cases were cardiac dysrhythmias, seizure activity, and/or sympathetic pupil responses. The most common autopsy finding was pulmonary congestion.     

A Lockean Theory of Territory

In this article I defend a straightforward application of Lockean property arguments to territorial rights. The article is divided into three parts. In the first part I explain the difference between two rights to land: property rights and territorial rights. In the second part I explain why an individualistic account of a Lockean theory of territory cannot be used to theorise about territorial rights. In the third part I defend a collectivist version of Lockean theory of territory. I argue that it is possible to apply directly Lockean principles regarding land use to territorial rights. I punctuate my defence with examples where Lockean principles are intuitively helpful in resolving conflicts over territorial rights.     

Integrating the Accreditation Council for Graduate Medical Education general competencies into forensic pathology fellowship training

Since July 2004, forensic pathology fellowships have been required to provide training in 6 general competencies: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice. In anticipation of this movement, beginning in 2002 the Office of the Medical Investigator (OMI) of the state of New Mexico began incorporating specific training in the general competencies into the fellowship program. Our experience has shown that the additional instruction and evaluation have proven to be valuable in preparing fellows for a successful forensic pathology career, did not detract from the more traditional aspects of forensic pathology training, and in many instances improved our training and assessment procedures.