Fatal diphenhydramine intoxication in infants

Diphenhydramine is an antihistamine available in numerous over-the-counter preparations. Often used for its sedative effects in adults, it can cause paradoxical central nervous system stimulation in children, with effects ranging from excitation to seizures and death. Reports of fatal intoxications in young children are rare. We present five cases of fatal intoxication in infants 6, 8, 9, 12, and 12 weeks old. Postmortem blood diphenhydramine levels in the cases were 1.6, 1.5, 1.6, 1.1 and 1.1 mg/L, respectively. Anatomic findings in each case were normal. In one case the child's father admitted giving the infant diphenhydramine in an attempt to induce the infant to sleep; in another case, a daycare provider admitted putting diphenhydramine in a baby bottle. Two cases remain unsolved; one case remains under investigation. The postmortem drug levels in these cases are lower than seen in adult fatalities. We review the literature on diphenhydramine toxicity, particularly as it pertains to small children, and discuss the rationale for treating these cases as fatal intoxications.     

Mobile autopsy teams in the investigation of war crimes in Kosovo 1999.

On request of the International Criminal Tribunal for the former Yugoslavia (ICTY), the Danish-Swedish forensic teams worked in Kosovo during the summer and the fall of 1999. The teams worked mainly as "mobile teams" at sites with few graves. Only two larger sites were examined. Most of the bodies were buried separately. A few "multiple burial" graves were examined, but no mass graves were encountered. The main purpose of the autopsies was to establish the cause and manner of death. Identification was of less importance, but a majority of the bodies had been identified prior to the autopsy. A total of 308 bodies, mainly males, were examined. The age varied greatly with a mean age of 47 years. The most common cause of death was gun shot wounds and the most common manner of death was homicide.     

The China model of Korean reunification

Like Germany's reunification, essentially the annexation of East Germany by West Germany, Korean reunification looms as most likely, ultimately and largely entailing South Korea's annexation of North Korea. The awesome cost borne by West Germany for reunification has been instructive to South Korea, particularly in recognition that the material and ideological gaps between North and South Korea are far greater than those which existed between East and West Germany. A possible solution to the negative implications of cataclysmic reunificationmay rest in gradual reunification of the Koreas, with an interim industrialization of North Korea by South Korea, based on the model of the economic development zones in southeastern China; hence, the “China Model”. In such a scenario the investors in North Korea's gradual industrialization would be (primarily) the huge conglomerate South Korean corporations chaebol which seek cheaper labor pools abroad. Investment by such corporations, in cooperation with the South Korean government, and possibly supplemented by western and Japanese capital investment, would presumably raise levels of productivity and the standard of living in the economically and agriculturally ravished North. The North-South gaps would thus be gradually reduced as would the financial and other burdens South Korea would otherwise have to bear for cataclysmic reunification.     

The admiralty and the Anglo-German Naval agreement of 18 June 1935

This essay offers a reappraisal of the Royal Navy's decisive role in the making of the Anglo-German Naval Agreement. It argues that the Admiralty's response to Hitler's offer of a fixed naval tonnage ratio was more rational and more complex than previous accounts would suggest. The premise here is that the only way to grasp Admiralty policy is to reconstruct the coherent set of financial, industrial, technical, diplomatic and strategic imperatives that shaped it. This approach reveals that the agreement represented the shrewd use of naval armaments diplomacy to achieve a long-term strategic goal. Far from being a blunder, concluding the agreement was a prudent measure consistent with an elaborate Admiralty programme that aimed to adjust the international naval order to advance Britain's prospects as the world's leading seapower.     

Fatal child abuse (caused by physical violence) in Germany during 1 January 1985 to 2 October 1990. Results of a multicenter study]

No reliable data are available on cases of lethal child abuse (by active force) in the area of Federal Republic of Germany prior to reunification (the former West Germany). In a multicenter study we therefore examined the police and court records for such cases occurring in the period 1 January 1985 to 2 October 1990 in nearly the entire area of Federal Republic of Germany. RESULTS: The study center received information on 58 cases of lethal child abuse. Extrapolated to all institutes of legal medicine, this corresponds to 62 cases in all of West Germany in the period studied. An approximately equal number of unreported cases should be added to this figure. Including unreported cases, at least 20 cases of lethal child abuse occurred per year; thus only one in every two cases ever came to light. Almost two thirds of the victims were younger than one year old. At autopsy 59% exhibited signs of repeated abuse at autopsy. By far the most common cause of death was direct impact from a blunt object, usually to the head. Mostly, the male person to whom the victim relates most closely (father, stepfather, partner of the mother) has killed the child. Twenty-one of the 74 persons charged saw the charges against them dropped or were acquitted due to lack of evidence; 51 received sentences ranging from one year probation to life. In the remaining two cases the outcome of the trial was unknown. Signs of abuse were readily apparent at autopsy in almost all cases. The high number of unreported cases underscores the need to educate medical students and practicing physicians to be on the look-out for signs of abuse and argues for an increase in the rate of autopsy.     

Adolescents view their mental health

A new 40-item behavioral checklist, the Adolescent Life Assessment Checklist (ALAC), was devised to be used with patient and nonpatient samples. A comparable form obtains information from a parent or guardian. Responses of 356 adolescents from three sources were analyzed for differences attributable to race, sex, age, sample source, and their interactions. A factor analysis was carried out on the average within-race-sex-source subgroup correlation matrix, resulting in seven meaningful and six usable oblique factors. Subscales were developed and corrections were computed to remove estimated differences due to race, sex, and age. Corrected scales significantly differentiate the three samples.This study was supported in part by MCHS Grant No. MC-R-390201, the Adolescent Clinic Foundation, and USPHSMH Fellowship Grant No. 0597921.Received her Ph.D. in psychology from Washington University, St. Louis; received a Foundations Fund for Research in Psychiatry interdisciplinary research-teaching grant, 1959–1965. Current research interests include test development, evaluation, and personality research.Received her M.D. from Medical College of Georgia at Augusta; her medical internship was at Michael Reese Hospital, Chicago, Illinois. Current research interests include stress, coping, and adaptation in children and adolescents.She is a licensed psychologist with the State of Ohio, with an M.A. from the University of Cincinnati. Current research interests include verbal behavior, psychotherapeutic efficacy, and dream research.Received his M.D. from College of Medicine, University of Cincinnati; his medical internship was with Boston City Hospital, and he is the founder of the Adolescent Clinic, Cincinnati General Hospital. Current research interests include growth and development and medical/social problems at adolescence.