HIV-infection in forensic autopsy cases

Sudden and unexpected death and violent death of persons with a high risk of acquiring HIV-infections, especially homosexual males and intravenous drug abusers, have to be investigated by forensic autopsies. Therefore every forensic pathologist has to be aware of this infection and should try to make the proper diagnosis. Three typical cases are described: (1) suicide by hanging, (2) homicide by cutting the throat and (3) intravenous heroin overdose. Merely retrospectively it could be cleared up that the deceased were homosexual but did not manifestly suffer from AIDS. The morphological findings in the lymph nodes and the postmortem serological findings are described in detail.     

Destruction of intracerebrally applied red blood cells in cervical lymph nodes. Experimental investigations

In rabbits, intracerebrally applied erythrocytes can move with the cerebrospinal fluid along connecting pathways between the subarachnoid space and the cervical lymph nodes. This study compares the time dependency for the degradation of intracerebrally injected erythrocytes in the brain as well as in the cervical lymph nodes. Rabbits were killed at various predetermined intervals after the intracerebral erythrocyte injection. Microscopic and histologic examination of the brain and the cervical lymph nodes revealed the following findings: (1) Erythrophages first appeared in the brain 24 h after the injection; siderophages, 4 days after the injection. Siderophages were still demonstrable at the conclusion of the study, i.e. 240 days after the injection. (2) In the cervical lymph nodes erythrophages were first observed 1 h after the injection; siderophages, 9 h after the injection. Only isolated erythrophages and siderophages were found in the lymph nodes 12 days after intracerebral injection of red blood cells. Later on no erythrocytes or siderophages were observed in the lymph nodes. The findings indicate that non-phagocytized red blood cells arriving at the lymph nodes were ingested by local macrophages. The extremely rapid ingestion and digestion of the red blood cells by lymph node macrophages as well as the possible reasons were discussed.     

Developmental states,civil society,and public health: Patent regulation for HIV/AIDS pharmaceuticals in India and Brazil

While both India and Brazil are seriously affected by the HIV/AIDS epidemic, each country has chosen a different approach to providing affordable pharmaceutical treatment. Whereas the Indian government has paved the way for market-driven solutions, Brazilian public authorities are strongly involved in the research and production of HIV/AIDS medication. Brazilian regulations permit comprehensive and free provision of HIV/AIDS drugs, whereas the majority of the affected population in India does not receive adequate pharmaceutical treatment. To explain the different policy outputs, we draw on the developmental state literature. Efficient decisionmaking structures, a devoted bureaucracy, and effective policy instruments enable public authorities to provide public goods even in the context of relative scarcity. We show that the assumptions of developmental state theory have to be complemented by the assessment of civil society actors' potential to trigger governmental interventions in the market.     

Identification of mechanical asphyxiation in cases of attempted masking of the homicide

Five homicides are described that had remained unexplained as to the causes of death after gross pathology. Although general signs of asphyxiation were present, they were lacking injuries specific of strangulation or oro-nasal occlusion. The diagnoses of asphyxiation were established by microscopical investigation of the lung and confirmed by subsequent police inquiries. An oro-nasal occlusion was involved in three cases, a strangulation or an oro-nasal occlusion, in another case. The victims were young and healthy. Toxicological investigations remained negative in four cases; one victim was anaesthetized by bromazepam and ether and had a blood alcohol concentration of 80 mg/100 ml. Lung histology and electron microscopy revealed acute emphysema, the development of a haemorrhagic-dysoric syndrome and a microembolism syndrome. With regard to the haemorrhagic-dysoric syndrome, the development of alveolar-interstitial edema is particularly important. This finding may also be diagnosed by light microscopy in semi-thin sections. It is emphasized that the combined action of several pathomechanisms is responsible for the rapid manifestation of the pulmonary lesions. Especially, the haemorrhagic-dysoric syndrome is brought about by the combined action of inspiratory intrapulmonary vacuum and raised intracapillary pressure. The complex pattern allows to compile the diagnosis of mechanical asphyxia even if there is no corresponding injury.