Rapid death from thrombotic thrombocytopaenic purpura following caesarean section.

We report a case of rapid death from thrombotic thrombocytopaenic purpura (TTP) in a young pregnant lady who developed full blown symptoms soon after caesarean section. Extensive intramyocardial confluent haemorrhages and widespread microthrombi in heart, brain, adrenals and kidney were found at autopsy. Thrombotic thrombocytopaenic purpura is an uncommon condition, which carries a high fatality rate if untreated. Awareness of this syndrome together with its high risk of sudden death underlines the importance of rapid diagnosis and treatment.     

Determination of cocaine and benzoylecgonine in human amniotic fluid using high flow solid-phase extraction columns and HPLC.

A new solid-phase extraction procedure for the determination of cocaine and benzoylecgonine in amniotic fluid, using high flow co-polymeric sorbents is reported. The recoveries of cocaine and benzoylecgonine within the range 0.1-1 mg/l were 95.7% and 50.3%, respectively. The use of high-flow sorbents allowed the easy extraction of amniotic fluid regardless of sample viscosity or physical nature. The use of these solid-phase columns provided many advantages over the more commonly used solvent extraction, including an increase in extraction speed and efficiency, reduced operator time, reduced solvent use and disposal volumes and exceptional extract quality. Further, the determination of amniotic fluid obtained from pregnant cocaine users may provide important information about handling of cocaine by the fetus at various gestational ages. The procedure was successfully applied to amniotic fluid from suspected cocaine abusers.     

Polymerase chain reaction (PCR) amplification and human leukocyte antigen (HLA)-DQ alpha oligonucleotide typing on biological evidence samples: casework experience.

The polymerase chain reaction (PCR) method of specific gene amplification was used in casework to synthesize millions of copies of the polymorphic second exon of the human leukocyte antigen (HLA)-DQ alpha (or DQA1) locus from a variety of evidence samples. The HLA-DQ alpha allelic variants in the amplified deoxyribonucleic acid (DNA) were determined in a rapid non-radioactive test by hybridization to sequence-specific oligonucleotide probes in both the dot-blot and reverse dot-blot formats. This genetic typing system has been subjected to blind proficiency testing; the performance of this test in the analysis of experimentally mixed samples was also evaluated. As of August 1990, over 250 cases have been tested and more than 2000 individual evidence (bloodstains, semen stains, individual hairs, bone fragments, and tissue sections) and reference samples have been analyzed. The first 198 of these cases are summarized in this paper; in 65% of the cases with conclusive results a suspect was included, and in 35%, all suspects were excluded. Individual cases as well as some of the general issues relating to forensic science analysis and this genetic typing system are discussed. The high rate of exclusion reported here combined with the ability of PCR to type old evidence samples suggests the relevance of this genetic test for postconviction review; two cases in which the convicted suspect was excluded are discussed.     

Sulfide concentrations in postmortem mammalian tissues

Postmortem changes in sulfide concentrations in body tissues were examined in autopsied rats exposed to hydrogen sulfide concentrations of 550 to 650 ppm, and in nonexposed rats and humans. Analyses were made by gas chromatography, following an extractive alkylation. Sulfide concentrations in the blood, liver, and kidneys of rats increased in both the exposed and nonexposed groups, depending on the lapse of time after death. On the other hand, the lung, brain, and muscle showed little or no change in sulfide concentration with elapse of time after death. The data obtained from human tissues were almost the same as those for rats, except data for blood, in which no or little increase of sulfide was observed.     

Trends in North Korean foreign policy

North Korea’s foreign policy track record in the post-cold war era is mixed. Most notable setbacks are the diplomatic normalization between the Soviet Union (now Russia) and South Korea; the reversal of its UN policy that paved the way for the simultaneous admission of the two Korean states to the world organization; and the diplomatic normalization between China and South Korea. On the credit side of Pyongyang’s diplomatic ledger are changes in its relations with Tokyo and Washington. While tangible results have yet to materialize, particularly in North Korea-Japan relations, the groundwork has nonetheless been laid for significant improvement. North Korea’s suspected nuclear weapons development program has played a major role in the unfolding of its relations with the United States. Conceptually, North Korean foreign policy can be explained in terms of its quest for three interrelated goals: security, legitimacy, and development. In the post-cold war era security appears to have emerged as the most important of the three goals. North Korea is at a crossroads. The choices it makes in foreign policy will determine not only the direction of its domestic policy but, ultimately, the survival of the regime itself. The external players in Seoul, Washington, Tokyo, Beijing, Moscow, and Vienna (the IAEA) have varying degrees of leverage over Pyongyang’s policy as well.     

Sudden death in angiodysplasia of the gastroesophageal junction.

A 22-year-old Korean soldier, who had received blows to the neck and epigastrium from an officer 10 h earlier, suddenly died after massive hematemesis. He had been in relatively good health except for episodes of blood-tinged vomiting approximately 5 and 7 months prior to this event. Postmortem examination revealed angiodysplasia involving the gastroesophageal junction, and the stomach was distended with blood. No abnormal findings were present around the whole viscera, and the duodenum was free of blood. The pathologic significance of upper gastrointestinal angiodysplasia as a potential source of bleeding and a chronologic correlation between the trauma and bleeding are discussed.     

Supreme auditing institutions: A politico-economic analysis

While the beneficial aspects of a public accounting office's activity are not disputed here, it is argued in this article that four major distortions are produced: the concern with administrative rationality overlooks costs elsewhere (Section 2); budgetary aspects are overvalued compared to other issues (Section 3); incentives-oriented behavior is suppressed (Section 4); and the evaluation is biased by concentrating on minor, instead of major, aspects of inefficiency (Section 5). Section 6 considers alternatives to public accounting offices and makes some suggestions for new institutional arrangements particularly for constitutional rules.     

Preadolescent peer friendships: A critical contribution to adult social relatedness?

The primary aim of this paper is to review the literature on preadolescent friendships in order to examine the relationship between preadolescent friendships and social support in adulthood. Social supports are important to health, both directly and as a stress buffer. Few studies, however, have specifically examined adult social supports from the perspective of their developmental precursors and critical developmental periods. Some data indicate that the preadolescent period may be of particular importance to the development of adult social skills and ties. Observational and empirical studies of preadolescent peer relationships, and in particular best friendships, suggest unique and critical contributions to adult social relatedness. Present research is suggestive but is insufficient to validate preadolescence as a critical period in adult social relatedness. Our review has implications for better understanding the mechanisms by which preadolescent friendships effect adult social support—an important mediator of the effects of stress on health. Further longitudinal study is needed.Received Ph.D. from University of Maryland. Research interests are social supports and psychological responses to trauma and disaster.Received M.D. from Yale University. Research interests are social supports and traumatic stress.