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.     

Parent-adolescent congruence on decision-making and its relation to adolescent adjustment

Much attention has been paid to the nature of parent-adolescent relationships, with a frequent conclusion being that it is a time of marked disagreement between parents and their adolescents. However, other literature suggests that this time is not inherently conflictual. The purpose of this study was to examine agreement and disagreement between mothers, fathers, and adolescents on specific issues. Then, adolescent adjustment was assessed, and the degree to which it was a function of congruence with parents was examined. A modified version of the Issues Checklist was used to measure intrafamily agreement; the Revised Behavior Problem Checklist and the Harter Scale of Child's Actual Competence were completed by adolescents' social studies teachers to assess adolescent functioning. Relative to their parents, adolescents reported that they should make more decisions alone, while both mothers and fathers reported that decisions should be made jointly among all family members. Only father-adolescent congruence was found consistently to be related to adolescent functioning. Possible explanations for the present results and relevant issues pertaining to family agreement are discussed.     

Is technology transfer to subsistence farmers doubling nothing?

Editors Note: This commentary touches on an aspect of technology transfer to the Third World that often is neglected: Can the technology recipients afford to use it? Although the authors focus on the economics of shrimp production by subsistence farmers, affordability is one of the major concomitant issues of transfer from developed to developing countries.     

Chronic disease and disadvantage: the new politics of HIV infection

HIV infection is now perceived as the end stage of a chronic disease that is spreading most rapidly among blacks and Hispanics. The politics of the HIV epidemic in the 1980s were dominated by four interacting factors: fear and fascination; who had the disease and to whom it seemed to be spreading; the endemic problems of United States social policy; and the impact on policy of advances in scientific knowledge. This paper analyzes the political history of each of these factors and describes the dominant policies of the federal government and the states regarding HIV in the areas of surveillance, prevention, research, and financing. Four uncertainties will have a profound influence on the future politics of the HIV epidemic: how the states and the federal government will address the general problems of paying for the care of people with chronic diseases and providing access to care for the uninsured and the underinsured; the number and distribution of the sexual behaviors that transmit infection with HIV and the effectiveness of policies to persuade people to modify these behaviors; precisely who uses addictive drugs and the effectiveness of measures to change their behavior; and the natural history of the virus.     

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.     

Civil procedure: Can the Scots learn from Woolf?

Conclusion So can the Scots learn from Woolf? The answer must be in the affirmative, for his review points up similar problems to those we encounter here. There is no room for complacency in the civil justice system in Scotland, particularly in the field of Information Technology, where court systems and expertise are sadly lacking. It is clear that there is a need for a system of case management in all civil courts, targeted in particular areas or on particular cases, but only after a rigorous reappraisal of court timetabling; and that the public will lose confidence in a civil justice system which does not meet their needs for speedy and affordable decisions, perhaps by turning their backs on it and seeking means of Alternative Dispute Resolution. As for written pleadings, perhaps the most that can be said is that the case for their complete abolition is “not proven”, but that thestatus quo should not be maintained is beyond reasonable doubt. Sheriff of Lothian and Borders at Edinburgh; Member, Sheriff Court Rules Council.