Diagnostic value of post-mortem examination of the cardiac conduction system

Introduction (Aim)

Sudden unexplained death (SUD) is a common problem in forensic pathology. In many of these cases, the autopsy findings, toxicological examinations and patient history are inconclusive. Many studies suggest that in such cases, the cardiac conduction system (CCS) should be histologically examined. We decided to determine the diagnostic value of histological examination of the CCS.

Methods

We reviewed autopsy files from the period 2005–2007 and selected those cases in which the CCS had been sampled. These were divided into two groups, the first comprising cases with an obvious cardiac pathology (e.g. severe coronary disease, myocardial infarction, significant myocardial hypertrophy/dilatation, valvular disease, etc.) and the second comprising cases without obvious cardiac pathology (i.e. fatal injuries, intoxications and deaths unexplainable by routine procedures). The CCS was sampled according to a detailed protocol and examined under a light microscope. On the basis of the findings of histological examination of CCS, we formed subgroups of the aforementioned main groups.

Results

We analyzed 118 cases, of which 83 were males and 35 females. In 57% of cases, autopsy revealed gross pathological abnormalities of the heart. In 10 (15%) of them, examination of the CCS showed significant pathological changes (narrowing of the nodal artery and its branches, moderate to severe interstitial fibrosis, calcifications in the central fibrous body impinging upon CCS). In some, especially those with no acute findings, CCS disease can be considered to have been the cause of fatal arrhythmias. In 43% of cases, autopsy revealed no gross abnormalities of the heart, while histological examination of the CCS disclosed significant pathological changes in 4 (8%). Among them, CCS disease was regarded as the cause of death in one case and as a possible cause in another case.

Conclusion

As with other similar studies, our study showed that examination of the CCS can provide valuable information on the cause of death. We therefore consider that examination of the CCS should be performed in all SUD cases, especially those in which the cause of death cannot be established by routine procedures. Although we had only 1 confirmed cause of death linked to CCS disease and one possible, we had 14 cases with significant pathological CCS changes. This leads us to the conclusion that post-mortem examination of the CCS is of diagnostic value.     

Alfred Kazin and Poetry

Both memoir and literary criticism, this piece by Alfred Kazin’s daughter describes her father’s relationship to poetry through the lens of musicality. She suggests that what drove Alfred Kazin’s writing on poetry was not argumentation but rather what he himself called a “terrible and pulsating musical sense,” capable of vanquishing lifelong feelings of isolation and loneliness.     

US Media and Post-9/11 Human Rights Violations in the Name of Counterterrorism

This article adds to earlier research revealing that the American news media did not discharge their responsibility as a watchdog press in the post-9/11 years by failing to scrutinize extreme and unlawful government policies and actions, most of all the decision to invade Iraq based on false information about Saddam Hussein’s alleged weapons of mass destruction arsenal. The content analyses presented here demonstrate that leading US news organizations, both television and print, did not expressly refer to human rights violations when they reported on the torturing of foreign detainees during “enhanced interrogations” in US-run prison facilities abroad and the killing of civilians, including children, in US drone strikes overseas and outside theaters of war. Moreover, by framing torture and the “collateral damage” caused by drone-launched missile attacks episodically rather than in the context of human rights, the news media failed to alert the American public to the grave humanitarian violations in the so-called war on terrorism during the George W. Bush and Barack Obama administrations.     

Self-legitimation in the face of politicization: Why international organizations centralized public communication

International organizations (I0) have centralized their public communication to a large extent over recent decades by undertaking a broader codification of communication tasks as well as a departmentalization of these tasks within units of IO bureaucracies. The paper provides the first systematic analysis of this important development in institutional design using a novel data set on the organization of public communication in 48 IOs between 1950 and 2015. It identifies self-legitimation as a key driver of centralization in the face of increased levels of politicization, that is, public awareness and activism directed at IOs. Empirically, the study suggests that the centralization of public communication significantly increases as transnational civil society organizes and gains access to IO decision-making. Further, politicization in terms of contentious activism and public scandals substantially accounts for varying levels of centralization across IOs.