Complete Cardiac Rupture Associated with Closed Chest Cardiac Massage: Case Report and Review of the Literature

Chest skeletal injuries are the most frequent complications of external chest massage (ECM) during cardiopulmonary resuscitation, but heart and great vessels lacerations that are indeed very rare. We report the case of a 35‐year‐old workman who collapsed and underwent ECM by his co‐workers for almost 30 min. At autopsy, no external injuries, fractures or bruises of the ribs or sternum, were observed. A hemopericardium with a rupture of the heart was found, with no signs of pre‐existent cardiac disease. Bruises of thoracic aortic wall, lung petechiae, a contusion of the liver, and bruises of lumbar muscles were found. The cause of death was due to sudden cardiac death with an extensive cardiac rupture. This is an unusual report of massive heart damage without any skeletal or muscle chest injuries, secondary to cardiopulmonary resuscitation. This kind of cardiac lesions may be considered when thoracic–abdominal trauma, or medical history, is unclear.     

A review of the evolution and state of transboundary freshwater treaties

Internationally shared basins supply 60 % of global freshwater supply, are home to about 1/3 of the world’s population, and are focal points for interstate conflict and, as importantly, cooperation. To manage these waters, states have developed a large set of formal treaties, but until now these treaties have been difficult to access and systematically assess. This paper presents and makes publicly available the assembly and organization of the largest known collection of transboundary water agreements in existence. We apply for the first time a “lineage” concept to differentiate between independent agreements and groups of legally related texts, spatially reference the texts to a global basin database, and identify agreement purposes, goals and a variety of content areas. The 688 agreements identified were signed between 1820 and 2007 and constitute 250 independent treaties which apply to 113 basins. While the scope and content varies widely, these treaties nominally govern almost 70 % of the world’s transboundary basin area. In terms of content, treaties have shifted from an earlier focus on regulation and development of water resources to the management of resources and the setting of frameworks for that management. While “traditional” issues such as hydropower, water allocation and irrigation are still important, the environment is now the most commonly mentioned issue in treaty texts. Treaties are also increasingly likely to include data and information sharing provisions, have conflict resolution mechanisms, and include mechanisms for participation beyond traditional nation-state actors. Generalizing, treaties have become more comprehensive over time, both in the issues they address and the tools they use to manage those issues cooperatively.     

Impairment in the processing of fear gaze in adolescents with callous–unemotional traits

ABSTRACT

Callous and unemotional traits affect a subgroup of children and adolescents with severe conduct problems, characterized by lack of guilt, remorse, emotionality, and empathy, which trigger a chronic and severe antisocial pathway. One aim of the current study was to investigate if the results found by Dadds and his colleagues (Dadds et al., [2006]. Attention to the eyes and fear-recognition deficits in child psychopathy. British Journal of Psychiatry, 189, 280–281. doi:10.1192/bjp.bp.105.018150, [2008]. Reduced eye gaze explains ‘fear blindness’ in childhood psychopathic traits. Journal of the American Academy of Child & Adolescent Psychiatry, 47(4), 455–463. doi:10.1097/CHI.0b013e31816407f1) in the processing of the eye region of a fearful face in subjects with high levels of callous–unemotional traits could be replicated using event-related potentials (ERPs). From a sample of 48 male adolescent offenders, those who presented high CU (HCU) scores and low CU (LCU) scores were selected. Psychophysiological results show that HCU traits are associated with deficits in processing the eye region of fearful faces. These findings are discussed below.     

Road aggression among drinking drivers: Alcohol and non-alcohol effects on aggressive driving and road rage

This study specified aggressive driving (AD) and road rage (RR) and examined a number of alcohol and non-alcohol effects on and the reciprocity between the two behaviors in a drinking driving population. The sample contained 431 clients (79 percent men) who volunteered to complete a self-report survey from fifty alcoholism and substance abuse treatment facilities across New York State. All subjects were undergoing alcoholism treatment because of a drinking driving-related reason. Structural equation modeling with the LISREL program was employed to estimate the reciprocal effects between AD and RR. The results demonstrated that AD and RR were two separate behaviors that simultaneously influenced each other. Additionally, AD and RR, as problem behaviors, tended to be affected mostly by other problem behaviors, such as alcohol problems, impaired driving, and feelings of depression, rather than general situations or behaviors, such as the frequency of alcohol use, driving after drinking, and the experience of stressful life events. The findings convey a message to the criminal justice field as well as alcoholism and substance abuse treatment professionals that addressing the problem of road aggression requires special attention to persons with alcohol problems and especially those with multiple drinking driving offenses.     

Accidental death of disoriented persons in long term care facilities

Five cases of accidental death occurring in connection with physical restraints in long-term care facilities are reported. The position in which the deceased were found, autopsy findings, police investigations as well as the evaluation of each case under criminal law are described. The investigations by the prosecution as well as the attention of the public media have meanwhile contributed to an improvement of the technical standards and a reduction of the risk in applying such restraints under the Law on Medical Devices.     

Serum norharman and harman analysis using high pressure liquid chromatography/mass spectrometry and value of beta-carbolines as blood alcohol markers

Firstly, a method for LC-MS/MS-analysis of the beta-carbolines norharman and harman in serum was established and validated. Secondly, serum samples from persons during ethanol loading conditions were investigated (n = 26). Norharman was regularly found positive only in persons with BAC > 1.6@1000. In this subgroup harman was detected in 5 out of 9 cases. The finding of norharman concentrations > 50 pg/mL in the serum of 4 out of 5 control persons was of high interest. In addition serum samples of smokers (n = 9) were analyzed for the beta-carbolines. All samples from smokers were tested positive for norharman with concentrations > 50 pg/mL in 7 cases. These results were in accordance with recent reports in literature and underline that the beta-carbolines norharman and harman do not meet the criteria of alcohol state-markers and positive serum sample testing may result from endogenous as well as from exogenous sources.     

Partition coefficient, blood to plasma ratio, protein binding and short-term stability of 11-nor-Delta(9)-carboxy tetrahydrocannabinol glucuronide

11-Nor-Delta(9)-carboxy tetrahydrocannabinol glucuronide (THCCOOglu) is a major metabolite of tetrahydrocannabinol in blood. Despite its mass spectrometric identification already in 1980, further physicochemical data of THCCOOglu have not been established. Therefore, the octanol/buffer partition coefficient P and the blood to plasma ratio b/p for THCCOOglu concentrations of 100 and 500ng/ml were investigated. Protein binding of the glucuronide was established from spiked albumin solutions at a level of 250ng/ml as well as from authentic samples. The data were compared to those of 11-nor-Delta(9)-carboxy tetrahydrocannabinol (THCCOOH). In addition, the short-term stability of THCCOOglu in plasma at different storage temperatures was studied. Analysis was performed by LC/MS/MS. The glucuronide partition coefficient P (mean: 17.4 and 18.0 for 100 and 500ng/ml, respectively) was unexpectedly lipophilic at pH 7.4. Its blood to plasma ratios averaged 0.62 and 0.68 at 100 and 500ng/ml, respectively. THCCOOglu was highly reversibly bound to albumin (mean: 97%), and the mean fraction bound did not differ from that determined from authentic samples. THCCOOglu degraded even at a storage temperature of 4 degrees C and THCCOOH was identified as a major decomposition product.