Hyperostosis cranii ex vacuo in adults: a consequence of brain atrophy from diverse causes

Hyperostosis cranii ex vacuo is diffuse thickening of the bones of the cranium occurring after successful ventricular shunting in hydrocephalic children, presumably as a compensatory phenomenon. We present three adults with severe brain atrophy and correspondingly severe skull thickening. In each, the cause of cerebral atrophy was well defined, and none had undergone ventricular shunting. In two, brain atrophy resulted from different temporally discrete insults sustained in adult life, ischemic in one and traumatic in the other. In the third case. progressive brain atrophy resulted from a primary neurodegenerative disorder, Hallervordan Spatz disease. Our observations suggest that hyperostosis cranii ex vacuo is a more general phenomenon than has been previously recognized, and point to a relationship between dynamic changes in brain size and skull thickness. We suggest that such relationships should be taken into account in anthropometric evaluation of the skull.     

Fault lines in China's economic terrain

When the research on which this paper is based began in late 2001, the working title was "Major Adversities Confronting China's Continued Rapid Economic Growth." Recognizing the frequently neglected but nonetheless important function of book titles, and after consultation with publicists both within and outside RAND including colleagues in China, the author and collaborators changed the book's title to the perhaps more appealing one affi xed to this paper, as well.1 The term "fault lines" refers to adversities, vulnerabilities, and obstacles to sustained economic growth, and these words are used synonymously in this paper.     

Sudden death associated with food and exercise

Exercised-induced anaphylaxis occurs in conjunction with significant physical exertion. Anaphylaxis occurring when an individual exercise within a few hours of ingesting a particular food is an unusual variant. Cardiovascular symptoms can be the sole manifestation of exercise-induced food allergies, in which case death may mimic sudden cardiac death during physical exertion due to other pathologic causes. We report the sudden and unexpected death of an individual following the ingestion of hazelnuts and almonds, to which the individual was not previously known to be allergic. The decedent collapsed during vigorous dancing. The death was not associated with cutaneous or laryngeal manifestations of anaphylaxis. Awareness of the variable manifestations of food-precipitated anaphylaxis is necessary to correctly establish the diagnosis. An elevated serum tryptase level may be indicative of an allergic reaction, and allergen-specific IgE levels may be used to confirm the particular antigen.     

Alligator attacks in southwest Florida

The American alligator inhabits bodies of fresh water in Florida and other southeastern states. Although attacks on pets are frequent, alligator attacks on humans are relatively rare because of the animal's natural fear of man. Because of the rarity of attacks on humans, the pathologic findings and pathophysiology of death in such cases have not been well characterized in the literature. We report three cases of fatal alligator attacks that occurred in southwest Florida, each with different pathologic findings and mechanisms of death. Although the cause of death in each case was attributed to the alligator attack, the mechanisms of death differed and included exsanguination because of amputation of an extremity, overwhelming sepsis, and drowning. These cases illustrate the varied pathophysiologies associated with deaths due to alligator attacks on humans and the features that distinguish alligator bites from those of other aquatic predators.     

Charred body: virtual autopsy with multi-slice computed tomography and magnetic resonance imaging

The correct examination of a charred body is a forensic challenge. Examination, interpretation, and conclusion in respect to identification, vital reactions, toxicological analysis, and determining cause and manner of death are all more difficult than without burns. To evaluate what can be seen in the case of a charred body, we made an examination with the new radiological modalities of cross-section techniques, via multi-slice Computed Tomography (MSCT) and Magnetic Resonance Imaging (MRI), prior to performing the classical forensic autopsy. In a charred body case of a single motor vehicle/fixed object collision with a post crash fire, the radiological methods of MSCT and MRI made it possible to document the injuries caused by burn as well as the forensic relevant vital reactions (air embolism and blood aspiration). In conclusion, we think postmortem imaging is a good forensic visualization tool with a great potential for the forensic documentation and examination of charred bodies.     

On the adolescent process as a transformation of the self

The purpose of this paper is to clarify and extend the psychoanalytic theory of adolescence. Three sources of data are used: biographical source material about Freud's adolescence, introspective accounts from the self-analysis of psychoanalysts, and other biographical vignettes and reports from the psychoanalytic literature. It is proposed that a change in the self emerges as the pivotal focus during adolescent development. An intense peer relationship serves to maintain narcissistic balance and the cohesion of the self. This allows deidealization of archaic parental imagoes and their transformation into newly internalized idealizations. The newly acquired idealizations consolidate into a stable ego ideal which eliminates the need for an alter ego relationship. The self-objects chosen for these new idealizations are related to the need to overcome specific disappointments in the archaic self-objects. The stability of the new ideals depends on the invulnerability of the idealized self-objects. Transient states of narcissistic disequilibrium manifest as turmoil. Presented at a meeting of The Chicago Psychoanalytic Society on May 23, 1972.Received M.D. from the University of Maryland; psychiatric training at the Cincinnati General Hospital; graduate of The Chicago Institute for Psychoanalysis. Main interests are the development of psychoanalysis from a historical perspective and the psychology of adolescence.Received M.D. from New York University; psychiatric training from Associated Psychiatric Faculties of Chicago; graduate of The Chicago Institute for Psychoanalysis. Main interest is the intellectual history of psychoanalysisReceived M.D. from the University of Chicago; psychiatric training at Michael Reese Hospital, Chicago; graduate of The Chicago Institute for Psychoanalysis. Main interest is psychoanalytic metapsychology of development.     

Brain amino acid abnormalities in liver disease--a postmortem study

In a postmortem exploratory study, we examined whether specific amino acid abnormalities associated with liver diseases in vivo may also be detected in human brain samples obtained at clinical autopsies. The branched-chain amino acids (BCAA: valine, leucine, isoleucine) were decreased in the group of patients with liver diseases compared with the control group, whereas the aromatic amino acids (AAA: phenylalanine, tyrosine) were increased. However, the ranges overlapped significantly and were not statistically different. The molar ratio BCAA/AAA was determined to be 1.92 in the collection of patients with liver diseases compared with 2.27 in the control group. In patients with liver disease, ornithine concentrations in the brain appeared significantly decreased whereas glutamine was significantly increased. No significant difference was found in the brain concentrations of proline. Amino acid analysis may contribute to the understanding of pathophysiological mechanisms of liver disease, which are discussed, and may supplement the postmortem diagnosis.