Medicaid and access to child health care in Chicago.

In this article we examine how increasing the reimbursement of physicians and expanding Medicaid eligibility affect access to care for children in Cook County, Illinois, which overlies Chicago. Using Medicaid claims and other data at the zip-code level, we compare the places where Medicaid children live with the places where all the physicians who treat children and those who accept Medicaid patients have their practices. Our findings suggest that the recent changes in legislation are unlikely to benefit extremely poor children, who are more likely to live in depressed inner-city areas, where there are few physicians. "Near-poor" children whose homes are dispersed throughout the county, who are now eligible for Medicaid as a result of the recent changes, are likely to see improvements in their access to care. Further changes in policy, aimed at enhancing the capacity of institutions providing care, could improve access for the children of the inner city.     

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.     

New voices from the ship of fools

Conventional left accounts of Thatcherism have stressed the authoritarian nature of its political rhetoric. This paper suggests that convergences between the new conservatism and more fundamentalist moral positions, meeting on the ground of obscenity and violence in the media, are a relatively recent development, associated with renewed strategic concentration on the question of law and order. Indeed, the libertarian right, in adhering to a utilitarian laissez-faire understanding of private pleasures, has presided over a positive proliferation of erotic and other gratifications. We argue that in the United Kingdom the authentic constituency of the moral right is an increasingly socially marginal one, rendered progressively more so by the rapid development of technologies of communication and entertainment.     

Injuries of the large arteries of the brain and vital reactions. An electron microscopy study

In 90 forensic autopsies (Craniocerebral injury, gunshot, stabbing, blow, strangulation, etc.), semithin sections of great arteries were prepared from around 770 Epon blocks and checked for vital reactions at the mural and intimal ruptures. In 21 cases in which death had occurred immediately or soon after the trauma, with three exceptions, there was a subsequent electron microscopic investigation. In all six mural ruptures and in five of ten intimal ruptures, thrombocyte aggregates were found at the rupture margins. In five intimal ruptures, the possibility of the occurrence of preparations injuries had to be considered. In five cases, the results of the histological study were negative. The success rate is limited in principle in such a screening test since there are technical difficulties in preparing serial sections on long vessels. Death was rapid and the thrombocytes were observed to adhere to the injured wall sites immediately after the trauma. The "thrombocyte sign" is thus of substantial importance as the earliest local vital reaction. In two control cases (strangulation), thrombocyte aggregates were found at intimal ruptures of the basilar artery, which were regarded as the results of stretching via the vertebral arteries during attacks to the neck. The healing processes of intimal ruptures and traumatic medial necrosis in incomplete ruptures occurring later in life are discussed. Even if a cadaver is a few days old, the histological findings at the level of the thrombocytes can be evaluated.     

Book reviews

Transborder Data Flows (Proceedings of an OECD Conference) Edited by Hans‐Peter Gassmann North Holland (Elsevier Science Publishers) 1985, US$74.00

Plastic and Electronic Money: New Payment Systems and Their Implications Patrick Frazer Woodhead Faulkner Limited 1985 £35

A User's Guide To Computer Contracting: Forms, Techniques and Strategies Davis, Allen, Bowman and Armstrong Harcourt Brace Jovanovich 1985, $75

Legal Protection of Computer Programs and Data C. Millard Sweet & Maxwell/Stevens 1985, £24

Piracy of Phonograms Gillian Davies ESC Publishing Ltd. 1986. 2nd edition. £17.95.

Biotechnology and Patent Protection—An International Review F. K. Beier, R. S. Crespi and J. Straus O.E.C.D. 1985, £5

Protecting Privacy in Two‐Way Electronic Services David H. Flaherty Mansell Publishing Company 1985, £23.50

High‐Tech Espionage Jay Tuck Sidgwick and Jackson Ltd 1980, £10.95     

The cutaneous ink sign: a tipoff to suicide or suicide notes

The presence of smeared or unsmeared ink on the skin resulting from the writing process has been observed in a number of suicide victims who have left suicide notes. The authors report a case of a palmar "cutaneous ink sign" and discuss its forensic science import.     

Reviews

Alexander Yanov, The drama of the Soviet 1960s: a lost reform. Institute of International Studies, University of California, Berkeley, 1984, 141 pp. $8.50.

Karen Dawisha, The Kremlin and the Prague Spring. Berkeley: University of California Press, 1984, xiv + 426 pp. £22.50.

Christer Jônsson, Superpower: Comparing American and Soviet Foreign Policy. London: Francis Pinter, 1984, viii + 248 pp. £18.50.

Joseph Nye, The Making of America's Soviet Policy. Yale University Press, 1984, £20.00.

Alexander Dallin, Black Box: KAL 007 and the superpowers. Berkeley and Los Angeles: University of California Press, 1985, xii + 130 pp. £14.25.

Alex Kozulin, Psychology in Utopia. Toward a Social History of Soviet Psychology, Cambridge Massachusetts, London: The MIT Press, 1984, xi + 179 pp. £16.65.

Timothy Edward O'Connor, The Politics of Soviet Culture. Anatolii Lunacharskii. Ann Arbor: UMI Research Press, and London: Bowker Publishing Company, 1984,193 pp. £35.50.

Alexander Vucinich, Empire of Knowledge. The Academy of Sciences of the USSR (1917–1970). Berkeley and London: University of California Press, 1984, x + 484 pp. £23.95

Lawrence Badash, Kapitza, Rutherford, and the Kremlin. New Haven and London: Yale University Press, 1985, xi + 129 pp. £20.00.

Mark Popovsky, The Vavilov Affair. Archon, Hamden, Connecticut, 1984, viii + 216 pp. £21.40.

Timothy Dunmore, Soviet Politics 1945–53 London: Macmillan Press Ltd., 1984, vi + 167 pp. £20.00.

George Ginsburgs, The Citizenship Law of the USSR, Law in Eastern Europe No. 25 (general editor F. J. M. Feldbrugge). The Hague, Boston, Lancaster: Martinus Nijhoff Publishers, 1983, 406 pp. £50.00.

R. F. Miller and F. Féhér (eds.), Khrushchev and the Communist World. London and Canberra: Croom Helm and Totowa, New Jersey: Barnes and Noble Books, 1984, 243 pp. £15.95.

Michael Haynes, Nikolai Bukharin and the Transition from Capitalism to Socialism, Beckenham, Kent: Croom Helm Ltd., 1985, vii + 136 pp. £14.95.

Bernd Bonwetsch (ed.), Zeitgeschichte Osteuropas als Methoden‐ und Forschungsprob‐lem. Osteuropaforschung: Schriftenreihe der Deutschen Gesellschaft fur Osteuropa‐kunde, Band 13. Berlin: Verlag Arno Spitz, 1985, 192 pp. DM 28,00.

Marie Lavigne, Economie Internationale des pays Socialistes, Paris: Armand Colin, 1985, 255 pp.

Marcel Drach, La crise dans tes pays de l'Est, Paris: Editions La Découverte, 1984, 127 pp. FF. 31.

L. Csaba, Kelet‐Europa a Világgazdaságban. (Eastern Europe in the World Economy), Budapest: Közgazdasági és Jogi Könyvkiadö, 1984, 316 pp., bibliography but no index.

Michael Shafir, Romania: Politics, Society and Economics, London: Frances Pinter, 1985, xvii + 232 pp. h/b £18–50, p/b £6.95.

Nicholas G. Andrews, Poland 1980–81. Solidarity versus the Party, Washington: National Defense University Press, 1985, xii + 351 pp.

Peter Raina, Poland 1981. Towards Socialist Renewal, London: George Allen & Unwin, 1985, vii + 472 pp. £20.00.

Stephen D. Kertesz, Between Russia and the West: Hungary and the Illusions of Peacemaking 1945–1947, London and Notre Dame: University of Notre Dame Press, 1985, xix + 299 pp. £18.95.

Mårta‐Lisa Magnusson (ed.), Bogen i Sovjet. Fra forfatter til laeser, Esbjerg: Sydjysk Universitetsforlag, 1985, 106 pp. p/b, 74–75 DK Kr.

Margit Nielsen, Udenrigsøkonomi i Østeuropa—tilpasning eller krise? Esbjerg: Sydjysk Universitetsforlag, 1985, 99 pp. p/b, 65–00 DK Kr.