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.     

IS AGE IMPORTANT? TESTING A GENERAL VERSUS A DEVELOPMENTAL THEORY OF ANTISOCIAL BEHAVIOR*

We tested competing hypotheses derived from Gottfredson and Hirschis (1990) general theory and Moffitt's (1993a) developmental theory of antisocial behavior. The developmental theory argues that different factors give rise to antisocial behavior at different points in the life course. In contrast, the general theory maintains that the factor underlying antisocial behavior (i.e., criminal propensity) is the same at all ages. To test these competing predictions, we used longitudinal data spanning from age 5 to age 18 for the male subjects in the Dunedin Multidisciplinary Health and Development Study. Using reports from three sources (parents, teachers, and the boys themselves), we estimated second-order confirmatory factor models of antisocial behavior. These models provided consistent support for the developmental theory, showing that separate latent factors underlie childhood and adolescent antisocial behavior. Moreover, we found that these childhood and adolescent factors related in ways predicted by Moffitt's developmental theory to four correlates of antisocial behavior: Childhood antisocial behavior was related more strongly than adolescent antisocial behavior to low verbal ability, by per activity, and negative/impulsive personality, whereas adolescent antisocial behavior was related more strongly than childhood antisocial behavior to peer delinquency. The two underlying latent factors also showed the predicted differential relations to later criminal convictions: Childhood antisocial behavior was significantly more strongly associated with convictions for violence, while adolescent antisocial behavior was significantly more strongly associated with convictions for nonviolent offenses.     

The use of either the nose or outer ear as a means of determining the postmortem period of a human corpse.

Presented in this paper are the initial results involving the use of the nose or outer ear as temperature measurement sites to determine the postmortem period of the human corpse. Simple mathematical models for both sites are developed based on cooling curves of five corpses. Analysis of errors between actual and calculated postmortem intervals suggest that in its present form, the described methods would not be suitable for use in accurately determining the time since death of human corpses.     

Symbols, rationality, and justice: rationing health care.

Proposals to ration health care in the United States meet a number of objections, symbolic and literal. Nonetheless, an acceptance of the idea of rationing is a necessary first step toward universal health insurance. It must be understood that universal health care requires an acceptance of rationing, and that such an acceptance must precede enactment of a program, if it is to be economically sound and politically feasible. Commentators have argued that reform of the health care system should come before any effort to ration. On the contrary, rationing and reform cannot be separated. The former is the key to the latter, just as rationing is the key to universal health insurance.     

Ethics and the Physician-Patient Relationship

Book Reviews in This Article:
Getting Rid of Patients: Contradictions in the Socialization of Physicians . By Terry Mizrahi
Physicians and Social Change . By John Colombotos and Corinne Kirchner
Changing Values in Medicine . Edited by Eric J. Cassell and Mark Siegler
Professional Ethics and Primary Care Medicine: Beyond Dilemmas and Decorum . By Harmon L. Smith and Larry R. Churchill
Physician—Patient Decision-Making: A Study in Medical Ethics . By Douglas N. Walton
With Dignity: The Search for Medicare and Medicaid . By Sheri I. David
The Dismissal of Students with Mental Disorders. Legal Issues, Policy Considerations, and Alternative Responses .
Courtroom Toxicology . By Marshall Houts, Randall C. Baselt, and Robert H. Cravey