Serum concentrations of cardiac troponin T in sudden death

Ischemic heart disease is the most common cause of sudden death of natural causes in most western countries. By autopsy, there may be no gross or histologic evidence of acute myocardial damage unless the patient survived for several hours following the event. Cardiac troponin in serum has become the recommended biochemical marker for myocardial injury in the clinical setting. We performed a prospective study on 102 autopsied subjects at the Central Hospital of Rogaland, Stavanger, Norway. Femoral blood was sampled for subsequent analysis of cardiac troponin T (cTnT). In the subjects with morphologic evidence of recent myocardial injury (n = 34), the mean serum cTnT level was 1.95 microg/L compared with 0.16 microg/L in the subjects with a noncardiac cause of death (n = 35) and 0.61 microg/L in the group with probable sudden cardiac death without morphologic signs of acute myocardial injury (n = 33). The observed differences in mean serum cTnT levels between the groups were statistically significant (P < 0.0001). These data suggest that elevated postmortem serum concentration of cTnT reflects ongoing myocardial damage and may support a diagnosis of cardiac-related death in cases associated with sparse or inconclusive morphologic findings postmortem.     

Medicolegal aspects of witnessed suicide due to gunshot to the head. Part 1: Circumstances and psychopathology

In the USA the frequency of witnessed suicide, i.e. suicide committed in the presence of at least one further individual, is reported to range between 5 and 15%. As up to now no detailed analysis of this special issue has been given in the medicolegal literature, this article presents and discusses a number of cases including 8 males and 1 female (age 19-58 years, mean 41.2 years) who had all committed suicide by inflicting a gunshot to the head. In 3 cases post-mortem blood alcohol concentrations of 1.73, 1.88 and 2.23 g/kg respectively were observed. Toxicological tests produced negative results. 5 cases had a medical history of psychiatric disorder with endogenous depression in 3, chronic alcohol abuse and drug abuse with concomitant psychosis in one case each. As far as the motives were known, domestic arguments were of prevailing importance. With one exception the suicides were committed at home. In 6 cases one witness was present, in 2 cases 2 individuals and in one case 22 persons witnessed the suicide. The reported cases are discussed in comparison with the psychiatric-psychological classification according to McDowell et al. with the aim to provide a solid and comprehensive medicolegal method to distinguish between homicide and suicide. Furthermore aspects of psychiatric sequelae and psychological support of the witnesses, which are also of importance for the forensic pathologist called to the scene, are discussed.     

Particle size analysis of soils under simulated scene of crime conditions: the interest of multivariate analyses

Two simulated scenes of crime have been studied. Soil traces adhering to boots, sport shoes and tissues have been compared with control samples using particle size analysis. Comparisons of percentage of particles per class interval and multivariate analyses were used to determine how the size distribution of each suspect sample varied compared to the original distribution. A loss of coarse fractions characterized most of the suspect samples even though they were derived from soils having different distributional patterns. However, the differences between control and suspect samples were found to be more important for soils dominated by extreme size classes than for soils rich in medium size particles. The differences among soil samples from the same source were found to be restricted to the extreme size classes. The finding of significant differences within size classes ranging from 1 to 0.063 mm should be then considered as a dissimilarity sign between trace sample and hypothetic control soil.     

Virtopsy--fatal motor vehicle accident with head injury

A man wearing no protective helmet was struck by a motor vehicle while riding a bicycle. He was loaded on his left side, and the impact point of his head was his occiput on the car roof girder. He was immediately transported to the general hospital, where he passed away. Postmortem examination using multi-slice computed tomography (MSCT) revealed an extensively comminuted fracture of the posterior part and the base of the skull. Observed were deep direct and contrecoup brain bruises, with the independent fractures of the roof of the both orbits. Massive subdural and subarachnoidal hemorrhage with cerebral edema and shifting of the mid-line towards left side were also detected. MSCT and autopsy results were compared and the body injuries were correlated to vehicle damages. In conclusion, postmortem imaging is a good forensic visualization tool with great potential for documentation and examination of body injuries and pathology.     

Demokratisierung und Freiheitsstreben: Die Perspektive der Humanentwicklung

Much of the literature on democratic transitions presumes that mass attitudes are important for the consolidation of democracies but not for the process of democratization. We challenge this premise on the basis of human development theory. From the perspective of this theory, democratization is an emancipative achievement that should be fuelled by broader emancipative forces among the population. Using the Values Surveys we measure these emancipative forces by people’s liberty aspirations, showing that mass liberty aspirations have a causal effect on a society’s democratic development. No other factor, not GDP/capita and not social capital, can explain away the effect of liberty aspirations on democratization. We conclude that human development theory illuminates emancipative forces in democratization that have so far been neglected.     

An unusual homicide case with subsequent suicide

In the medicolegal literature reports on homicides followed by suicide, especially in elderly people, are rare. In the present case, the victim, a 79-year-old woman, showed a rather unusual injury pattern: 3 gunshots to the head (with only 2 entrance wounds and 3 intracranial projectiles) and 2 stabs from a knife. The tools used for inflicting the stab wounds (a hunting knife and a double-edged dagger) were left in the victim's body after the offense. The 89-year-old husband hanged himself with an aerial cable after killing his wife. The police investigations and the autopsy findings suggested a combined homicide-suicide. The motive for the offense could be a so-called delusion of poverty associated with symptoms of depression.     

Schweizerische Aussenpolitik im Wandel: Internationalisierung,Globalisierung und Multilateralisierung

Ausgehend von den drei Entwicklungen, wie sie sich in den Schlagworten Globalisierung, Internationalisierung und Multilateralisierung ausdrücken, geht der Artikel der Frage nach, inwiefern sich die genannten Prozesse auch in der schweizerischen Aussenpolitik identifizieren lassen. In der Untersuchung, die sich auf Staatsverträge beschränkt, wird diese Frage mit einer quantitativen Vollerhebung der aussenpolitischen Geschäfte für je vier Jahre in den 80er und 90er Jahren untersucht. Die empirische Analyse, die auf insgesamt 821 Fällen beruht, führt zu teilweise überraschenden Ergebnissen. Die Hypothesen zur Internationalisierung und zur Globalisierung liessen sich zumindest teilweise bestätigen. Punkto Multilateralisierung weisen unsere Auswertungen jedoch darauf hin, dass es in der schweizerischen Aussenpolitik, was die Zahl der Staatsverträge betrifft, von den 80er zu den 90er Jahren zu keiner Verschiebung von der bi- zur multilateralen Zusammenarbeit gekommen ist.     

Justice, Democracy, and Hazardous Siting

In this essay we examine some issues of justice associated with the siting of hazardous industrial facilities. Utilitarian justifications of siting decisions are inadequate because they fail to address questions of fairness. Approaches that consider questions of distributive equity provide a better framework for siting justice, but are still incomplete. Limiting questions of justice to the distribution of benefits and burdens fails to examine the justice of procedures for deciding such issues of distribution. We argue that justice requires a participatory communicative democratic process for siting hazardous facilities, in two respects. It is prima facie unjust to impose a risk on citizens without their having participated in the siting process. Participatory communicative democratic procedures in facility siting, moreover, when structured according to specific norms of discussion and inclusion, are likely to yield the most just outcomes. We propose procedural as well as substantive conditions for such democratic procedures, and briefly apply these conditions to evaluate the siting of a landfill in Switzerland.