LAP-banding obesity: a case of stomach perforation, peritonitis, and death

We present a case of peritonitis and death due to the misplacement of a laparoscopic adjustable band inserted through, instead of around, the stomach. This represents the first case in the published literature where a LAP-BAND perforated the stomach, followed by peritonitis and death. The morbidly obese female patient with a history of hypertension and arthritis was 47 years old, 5 feet 6 inches tall, weighed 361 pounds, and had a body mass index of 58.3. She underwent a 2-hour, elective, LAP-band insertion operation to achieve weight loss; 27 hours after band insertion, following the conduction of all FDA-mandated Lap-Band postoperative protocol (including a radiologic Gastrogrografin swallow), the patient was discharged with "no evidence of esophageal stasis or obstruction." She remained out of hospital care and in her residence until she called for and was taken by an ambulance to an alternate, local hospital (57 hours after band insertion), when gastric perforation was confirmed via x-ray and CT scans. No open surgery was attempted to repair the damage, and cardiac arrest ensued 7 hours after admission to the second hospital. The patient was pronounced dead 64 hours after LAP-band insertion. This unique case is significant, given that there were no deaths of this kind reported in The LAP-BAND(R) Adjustable Gastric Banding System Summary of Safety and Effectiveness Data by the United States Center for Devices and Radiologic Health, of the Food and Drug Administration, or in searches of the published literature.     

Population data for 12 Y-chromosome STRs in a sample from Brescia (northern Italy)

Twelve Y-chromosome STRs--DYS19, DYS389-I, DYS389-II, DYS390, DYS391, DYS392, DYS393, DYS385, DYS437, DYS438, DYS439--were typed in a population sample (n=104) of unrelated males from Brescia (northern Italy). A total of 91 haplotypes were identified by the 12 Y-STR loci. The haplotype diversity (98.68%), discrimination capacity (87.50%) and gene diversity were calculated.     

Geräusche von Freizeitanlagen

Nach Erfahrungen des Bayerischen Landesamtes für Umwelt treten in der Praxis Probleme bei der Abgrenzung von Freizeitanlagen gegenüber Sportanlagen auf. Seit Jahren gibt es keine eindeutige und abschließende Zuordnung, trotzdem existieren unterschiedliche Beurteilungsvorschriften. Zur schalltechnischen Beurteilung von Sportanlagen ist die 18. BImSchV (Sportanlagenlärmschutzverordnung) heranzuziehen. Zur schalltechnischen Beurteilung von Freizeitanlagen wird in vielen Bundesländern die vom Länderausschuss für Immissionsschutz erarbeitete Freizeitlärm-Richtlinie empfohlen oder vorgeschrieben. Sie weicht zwar, wie nachfolgende Gegenüberstellung aufzeigt, in Einzelpunkten von der 18. BImSchV deutlich ab. Ein Vergleich der nach beiden Vorschriften ermittelten Endergebnisse für ein und denselben Einzelfall führt aber unter Berücksichtigung aller Beurteilungskriterien oftmals zu einem unbedeutenden Unterschied. Dieser rechtfertigt es nicht, zwei unterschiedliche Vorschriften aufrecht zu erhalten.* Dipl.-Ing. (FH) Andrea Wellhöfer ist Mitarbeiterin im Referat Lärmschutz bei Anlagen und in der Planung des Bayerischen Landesamtes für Umwelt (bis 1. 8. 2005 Landesamt für Umweltschutz).     

Cause of death in heroin users with low blood morphine concentration

The blood morphine concentrations in cases of heroin-associated fatalities can vary considerably. Currently, a free-morphine concentration of > or = 100 ng/ml in blood is generally considered as potentially fatal. Moreover, it is a common observation that fatal cases of heroin-intoxication with blood morphine concentrations lower than 100 ng/ml occur. This poses the question of how the fatal cases with low blood morphine concentrations can be explained. In the study described here, 62 cases of morphine only intoxications were examined. The fatal cases were divided into two groups according to the free morphine concentrations measured in the blood of the heart (group I: free morphine concentration < 100 ng/ml, n = 21 cases; group II: free morphine concentration > or = 100 ng/ml, n = 41 cases). The two groups were compared as to circumstances of death, as well as to autopsy findings and histopathologic alterations. Overall, infections of the respiratory tract occurred significantly more often in group I (lower morphine concentrations) than in group II. In a second step, the group I cases were analyzed individually to get detailed information on the cause of death. In 19 of the 21 cases the authors could find a plausible explanation for death in combination with low free morphine concentrations in the blood.     

A New Index for the MMPI‐2 Test for Detecting Dissimulation in Forensic Evaluations: A Pilot Study

This pilot study is the starting point of a potentially broad research project aimed at identifying new strategies for assessing malingering during forensic evaluations. The forensic group was comprised of 67 males who were seeking some sort of certification (e.g., adoption, child custody, driver's license, issuance of gun permits, etc.); the nonforensic group was comprised of 62 healthy male volunteers. Each participant was administered the MMPI‐2. Statistical analyses were conducted on obtained scores of 48 MMPI‐2 scales. In the first step, parametric statistics were adopted to identify the best combination of MMPI‐2 scales that differentiated the two groups of participants. In the second step, frequency‐based, nonparametric methods were used for diagnostic purposes. Results: A model that utilized the best three predictors (“7‐Pt”, “L,” and “1‐Hs”) was developed and used to calculate the Forensic Evaluation Dissimulation Index (FEDI), which features satisfactory diagnostic accuracy (0.9), sensitivity (0.82), specificity (0.81), and likelihood ratio indices (LR+ = 4.32; LR? = 0.22).     

Rules and Speeches: How Parliamentary Rules Affect Legislators' Speech‐Making Behavior

By extending existing theories of legislative speech making, this study explores the importance of parliamentary rules governing floor debates for government and opposition parties. An original data set including speeches of members of the Italian Chamber of Deputies between 2001 and 2006 is used to test two hypotheses under different institutional scenarios, that is, rules either restricting or granting open access to the floor. Parliamentary rules are found to affect allocation of speaking time within both governing and opposition parties. Governing parties' leaders exploit their agenda control to a higher degree when allocating speaking time. Under restrictive rules, government party leaders control their MPs by essentially limiting the number of speeches and allocating them to frontbenchers. Restrictive rules give opposition party leaders an important chance to select MPs who are closer to their own position.