Complications following cell therapy

So far, the law in the Federal Republic of Germany still allows the injection of fresh-cell preparations from animals as a roborant to increase the vitality of the organism and to strengthen the body's immune defense system. The use of "sicca-cell" preparations was provisionally forbidden in 1987 by the Federal Health Organization (Bundesgesundheitsamt; BGA). Prohibition of fresh-cell injections would have exceeded the authority of this office, although the same serious reservations also applied in the case of this treatment method. Several publications that have appeared since 1955 have reported serious complications of this therapy, some life-threatening and some even lethal. Two further cases are now added: (1) A woman aged 69 had been receiving treatment with cell injections for 9 years. Immediately after an injection of sicca cells she collapsed and was hospitalized; 7 days thereafter she developed an ascending paralysis with increasing inability to swallow or breathe. She died 25 days after the injection as a consequence of central and peripheral respiratory failure. Autopsy revealed the alterations typical for acute Landry-Guillain-Barré-Strohl syndrome. (2) A 76-year-old healthy woman had been receiving treatment with fresh-cell preparations for several years. After an injection of cell suspensions a painful local swelling was observed. The symptoms were interpreted as the consequence of an iatrogenic local hematoma, and repeated punctures were performed to obtain blood. The patient was transferred to a surgical department for further therapy. Two days after the injection she suddenly died with signs of acute cardiovascular failure. Autopsy revealed the signs of a fulminating clostridial infection and also the characteristic signs of Landry-Guillain-Barré syndrome with involvement of the autonomic nervous system. In both cases the development of an inflammatory process in the peripheral nervous system could be interpreted as an immune-mediated allergic disease, related to the repeated injection of heterologous antigenic material containing nervous tissues. This hypothesis would also explain the two other cases already published and would be consistent with the observed perivenous leukoencephalopathy of the central nervous system. The human disease pictures correspond to the well-established animal models of EAEM (experimental allergic encephalomyelitis) and EAN (experimental allergic neuritis). The pathogenesis is discussed; the major role of the central and peripheral nervous system is stressed, with special reference to the risk of acute autonomic failure. The need for specific autopsy techniques for the investigation of the entire nervous system, including spinal cord, roots, spinal ganglia and peripheral nerves with sympathetic chains, is raised.     

Brief for 885 law professors in support of maintaining adherence to the Roe decision

This brief opposes the overturn of "Roe v. Wade" and resists weakening "Roe's central holding" that would allow states to overturn legal abortion. The brief was written for 885 law professors. "Roe" was not a "constitutional aberration," or "an exercise of raw, judicial power." Some members of the Supreme Court seem to think that the state has "an overriding interest" in protecting fetal life. Some Court members have questioned "Roe's" trimester framework. A person's decision to abort should be done privately. If women are not free to choose abortion, they will not have equality. There is an absence of "express rights of privacy and procreational freedom" in the Constitution. "Roe" was 1 instance of the Court's recognition of constitutional rights that are not named explicitly. Historical materials are drawn on to show the link between trends in society and the "judicial recognition of unenumerated rights." The most serious questions about "Roe" deal with its trimester framework. Justice Blackmun's majority opinion said that the 1st trimester of pregnancy was personal. "Roe" said that abortions created a medical risk at the beginning of the 2nd trimester. Therefore, the government was more interested in the health of the mother at that time. The state could then regulate abortion "in ways that are reasonable related to maternal health." The start of the 3rd trimester was when the fetus was viable. The right of a woman to end her pregnancy "offends powerful moral forces." Some of "Roe's" critics had their scientific facts wrong. Medical authorities think Justice O'Connor is mistaken when she says that "Roe" is "on a collision course with itself." The 23rd to 24th week of pregnancies where the fetal organs can "sustain life outside the womb." This has not changed since "Roe" was decided in 1973, nor is it likely to in the future. Some "amici" believe that the state can never have an interest in the fetus. The state can not have an interest in the fetus distinct from the woman who will give birth to it. During previability, restricting a woman's procreational rights would not be scientifically supportable. The state does have an interest in "upholding the value of human life." "Roe" is "within the mainstream" of constitutional jurisprudence and should be reaffirmed.     

Aednet: A single-discipline network in a multi-national setting

The computer-mediated network is a moderately expanding phenomenon. A major reason for this growth is the need for transferring technology to developing nations. But because many of these nations are not traditional users of advanced technology and because even the purveyors are not yet fully comfortable with the networks, the medium is not being used as much as perhaps it ought to be. In establishing a multinational network, one should be careful to treat all potential users with equity and not create an informational elite. Part of the challenge of such a system is making it accessible to operatives in the field. An effective way of introducing a network is to blend it with existing technologies, keep the costs down and the quality of information up, provide a usable information-retrieval system, and pay attention to microand macro-ergonomics. The Adult Education Network (AEDNET) of the Kellogg Project at Syracuse University has started working on a next-generation computer-mediated network system. It is proposed that AEDNET involve three action groups in the project: researchers, those interested in social implications, and users.     

Reviews

Terry Cox and Gary Littlejohn, eds., Kritsman and the Agrarian Marxists. (Library of Peasant Studies, No. 7), London: Frank Cass & Co. Ltd., 1984, 149 pp., £18.50.

S. G. Wheatcroft and R. W. Davies eds., Materials for a balance of the Soviet national economy 1928–1930 (with foreword by Richard Stone). Cambridge: Cambridge University Press, 1985, xxiv + 467 pp., £35.00, $59.50.

I. Birman, Ekonomika nedostach. New York: Chalidze Publications, 1983, 470 pp.

Richard F. Staar, USSR Foreign Policies After Detente. Stanford, Ca: Hoover Institution Press, 1985, xxvii + 300 pp., h/b $26.95, p/b $10.95.

John J. Maresca, To Helsinki: The Conference on Security and Cooperation in Europe 1973–1975. Durham, North Carolina: Duke University Press, 1985, xiii + 292 pp., £47.50.

Mark V. Kauppi and R. Craig Nation eds., The Soviet Union and the Middle East in the 1980s. Lexington, Mass, and Toronto: Lexington Books, D.C. Heath and Company, 1983, ix + 293 pp., £25.00.

Jonathan Haslam, The Soviet Union and the Struggle for Collective Security in Europe, 1933–1939. New York: St. Martin's, 1984, xii + 310 pp., $29.95.

Alfred L. Monks, Soviet Military Doctrine: 1960 to the Present. New York: Irvington Publishers, 1985, xii + 351 pp., $34.50.

Jeffrey D. Boutwell, Paul Doty, and Gregory F. Treverton eds., The Nuclear Confrontation in Europe. London: Croom Helm, 1985, 247 pp., £22.50.

Condoleezza Rice, The Soviet Union and the Czechoslovak Army, 1948–1983: Uncertain Allegiance. Princeton, N.J.: Princeton University Press, 1984, xiv + 303 pp. Tables. £40.40.

Vitaly Rapoport and Yuri Alexeev, High Treason: Essays on the History of the Red Army, 1918–1938. Translated by Bruce Adams. Durham: Duke University Press, 1985, xvii + 436 pp., £35.00.

Robert Conquest, Inside Stalin's Secret Police. NKVD Politics 1936–1939. Stanford, California: Hoover Institution Press, 1985, ix + 222 pp., $22.95.

Jeffrey T. Richelson, Sword and Shield. The Soviet Intelligence and Security Apparatus. Cambridge, Massachusetts: Ballinger Publishing Company, 1986, xix + 279 pp., $39.95 h/b, $16.95 p/b.

P. Marer, Dollar GNPs of the USSR and Eastern Europe. The Johns Hopkins University Press, Baltimore and London: For the World Bank. 1985, xiii + 241 pp., £20.00.

Moshe Lewin, The Making of the Soviet System: Essays in the Social History of Interwar Russia. London: Methuen, 1985, viii + 354 pp., £19.00 h/b, £8.95 p/b.

Eric P. Hoffmann and Robbin F. Laird, Technocratic Socialism: the Soviet Union in the Advanced Industrial Era. Durham: Duke University Press, 1985, viii + 228 pp. h/b £37.50, p/b £12.50.

Robert Cassen ed., Soviet Interests in the Third World. London: Sage Publications, 1985, xi + 329 pp., h/b £27.50, p/b £10.50.

Václav Havel et al., The Power of the Powerless: Citizens Against the State in Central‐Eastern Europe, Ed. John Keane, Introduction by Steven Lukes. London, Melbourne, Sydney, Auckland, Johannesburg: Hutchinson, 1985, 228 pp., £16.95.

Michael M. Boll, Cold War in the Balkans: American Foreign Policy and the Emergence of Communist Bulgaria, 1943–1947. Lexington, Ky.: The University Press of Kentucky, 1984, ix + 250 pp., £27.50.

Edward R. Girardet, Afghanistan: The Soviet War. London: Croom Helm, 1985, 259 pp., £17.95.

Henry S. Bradsher, Afghanistan and the Soviet Union. Durham: Duke University Press, 1985, viii + 384 pp., £12.95.

David W. Lovell, Trotsky's Analysis of Soviet Bureaucratization. London: Croom Helm, 1985, ix + 82 pp., £7.95.

Katerina Clark and Michael Holquist, Mikhail Bakhtin. Cambridge, Mass, and London: Harvard University Press, 1984, xi + 398 pp., £19.95.

Hans‐Georg Heinrich, Hungary. Politics, Economics and Society. London: Frances Pinter, 1986, xviii + 198 pp., £17.50.

Henry Rollet, La Pologne au XX^e Siècle. Paris: éditions A. Pedone, 1985, 603 pp., 240F.

Mieczyslaw F. Rakowski, Ein schwieriger Dialog. Aufzeichnungen zu Ereignissen in Polen 1981–1984. Mit einem Vorwort von Peter Bender. Econ Verlag. Düsseldorf‐Wien 1985. 269 pp. Index. DM. 38,00.

John Ambler, Denis J. B. Shaw and Leslie Symons eds., Soviet and East European Transport Problems. London and Sydney: Croom Helm, 1985, xix + 260 pp., £19.95.

Joan de Bardeleben, The Environment and Marxism‐Leninism: The Soviet and East German Experience. Boulder and London: Westview Press, 1985, xi + 338 pp., no price quoted.

John R. Lampe, The Bulgarian Economy in the Twentieth Century. London: Croom Helm, 1986 x + 245 pp., £25.00.

Pedro Ramet, Nationalism and Federalism in Yugoslavia, 1963–1983. Bloomington: Indiana University Press, 1984, xviii + 299 pp., $27.50.

Boris Meissner, Partei, Staat und Nation in der Sowjetunion. Ausgewdhlte Beitrage. Berlin: Duncker & Humblot, 1985, 544 pp., DM148.00.

Jiri Hochman, The Soviet Union and the Failure of Collective Security, 1934–1938. Cornell Studies in Security Affairs. Ithaca and London: Cornell University Press, 1984. 253 pp. $32.95.     

The impact of health maintenance organizations and competition on hospitals in Minneapolis/St. Paul

The Healthcare Educational and Research Foundation (HERF) in Minneapolis undertook a two-year research project to study the effects of health maintenance organizations (HMOs) and competition on the hospital industry in Minneapolis/St. Paul. This article summarizes HERF's major findings surrounding three key questions: (1) do the HMOs in Minneapolis/St. Paul use fewer hospital resources relative to conventional payers?; (2) do recent overall community trends in inpatient use suggest evidence of hospital utilization-reducing effects attributable to HMOs?; and (3) given the highly visible competitive process among Minneapolis/St. Paul providers, do hospital cost and revenue data suggest any evidence of cost-containment? The findings (based on data through 1982) indicate that for comparable patients, Twin Cities HMOs appear to use fewer medical care resources per hospitalized patient. There was, however, no clear evidence of community-wide, utilization-reducing effects directly attributable to the "competitive effect" of HMO introduction and development in the market. In addition, there was no empirical evidence that HMOs (which had enrolled 25 percent of the consumer market by 1982), or other large buyers of inpatient services, have selected hospitals on the basis of price as hypothesized by competition advocates.