Sudden death and sepsis after splenectomy

This paper has reported two deaths occurring in young adults who had undergone splenectomy for trauma several years before developing pneumococcal sepsis. Tissues at autopsy demonstrated a disproportionate autolysis for the postmortem interval. One victim also showed diffuse serosal hemorrhages, presumably as a result of disseminated intravascular coagulation. Both showed evidence of residual splenic implants but such implants clearly did not provide protection against sepsis. The mechanisms whereby the spleen protects from sepsis appear to be that of a mechanical filter and an immunological organ producing antibody or antibody-like substance. How much splenic tissue and what relationships to the system circulation are necessary to provide protection remain undiscovered.     

Morphological findings after tracheotomy and laryngeal intubation (author's transl)]

4 fatal cases after tracheotomy and 35 cases after endotracheal anaesthesia were examined taking pathomorphological aspects into consideration. In long-period intubation mucous membrane necroses occurred as of the 4th day. After 6 days' intubation skeletizations of the tracheal rings were established in each case. Infections of the decubial ulcers and errosion haemorrhages from the necrotically altered tracheal wall were frequent complications. Faulty intubation of the oesophagus and the right bronchus, aspirations and reflex-related circulatory failure during intubation as well as hypoxic damage as a result of the windpipe opening being impaired are discussed from the morphological point of view.     

Animal experiments on the detection of an exposure to "chemical mace" (author's transl)]

To answer the question whether a negative result of gas chromatographic blood analysis for components of chemical mace proves that no or at most only slight tear gas exposure can have occurred, animal experiments were carried out. In the blood of 10 guinea pigs, which were exposed to the contents of chemical mace for 1--6 h, the solvants 1,1,2-trichloro-1,2,2-trifluorethane (freon 113) and 1,1,1-trichloroethane could easily be detected--even 23 h after the end of exposure or after a storage of the blood samples for 18 weeks--whereas the lacrimator chloracetophenone (CN) could not be found at all. In vitro experiments showed that CN relatively quickly reacts with components of blood. Therefore, blood samples should be analyzed for CN after withdrawal as soon as possible. In case of inhalation of the contents of chemical mace, i.e., after the comparatively mildest form of CN application, most probably no traces of the lacrimator at all can pass into the blood due to the quick reaction of CN with proteins of the respiratory surface of the lung.     

Diagnosis and the dole: the function of illness in American distributive politics

This article argues that the concept of illness has certain properties that make it a convenient administrative device for managing a need-based redistributive system in a society whose primary distributive system is based on work. These properties--cultural acceptance of illness as a legitimate excuse for not working, objective standards for identifying illness, and restrictiveness--have led to the widespread use of illness as an eligibility criterion for many social benefits, including cash transfers, services, privileges and exemptions. Paradoxically, the traditional rationales for using illness as one of the keystones of categorical welfare policy are eroding, yet welfare programs based on illness certification are growing rapidly. To explain this anomaly, the author suggests that medical certification as a distributive mechanisms serves certain latent political functions, such as allowing welfare programs to be responsive to political unrest, siphoning off opposition to controversial policies by the granting of medical exemptions to intense opponents, are reducing political conflict by using physicians as arbiters.     

Expanded School Mental Health: Challenges and Opportunities in an Emerging Field

Reviews the need for and development of expanded school mental health (ESMH) programs, which provide a continuum of mental health promotion and intervention through school–community partnerships. Since ESMH is a relatively new, but increasingly prominent field, countless issues are being addressed in practice and research and in efforts to bridge practice and research. We review particular content and context dimensions of ESMH in need of development including quality assessment and improvement, empirically supported practice, improving assessment and outcome evaluation, involving educators in the work, understanding school environments, and tailoring programs through qualitative research. Summaries of articles that amplify these themes are provided.