Acute poisoning involving the pyrrolidinophenone-type designer drug 4'-methyl-alpha-pyrrolidinohexanophenone (MPHP)

A 36-year-old woman consulted the medical emergency unit of a private health center for abdominal pain and gastroenteritis of 5 days duration. Acute right pyelonephritis was diagnosed. Five hours after admission she became unconscious in a state of clinical shock. She was transferred to an intensive care unit but resuscitation attempts were unsuccessful and she died 3 h later. Three days after death, she was buried in the family vault. Five days after the burial, her husband lodged a complaint with the public prosecutor because he had not received a clear explanation from the physicians concerning the cause of his wife's death. After analysis of the medical records of the deceased by two forensic pathologists, a medicolegal autopsy was ordered by the public prosecutor. The corpse was exhumed and autopsy performed 9 days after death. Massive hemoperitoneum was diagnosed with a macroscopically ruptured subcapsular hematoma. Pathological study confirmed acute right pyelonephritis and demonstrated the precise cause of the hemorrhage: rupture of the hepatic artery at the hilar part, following infectious arteritis which was probably secondary to the acute pyelonephritis. To the best of our knowledge, this is the first published report of such a case.     

A review of the evolution and state of transboundary freshwater treaties

Internationally shared basins supply 60 % of global freshwater supply, are home to about 1/3 of the world’s population, and are focal points for interstate conflict and, as importantly, cooperation. To manage these waters, states have developed a large set of formal treaties, but until now these treaties have been difficult to access and systematically assess. This paper presents and makes publicly available the assembly and organization of the largest known collection of transboundary water agreements in existence. We apply for the first time a “lineage” concept to differentiate between independent agreements and groups of legally related texts, spatially reference the texts to a global basin database, and identify agreement purposes, goals and a variety of content areas. The 688 agreements identified were signed between 1820 and 2007 and constitute 250 independent treaties which apply to 113 basins. While the scope and content varies widely, these treaties nominally govern almost 70 % of the world’s transboundary basin area. In terms of content, treaties have shifted from an earlier focus on regulation and development of water resources to the management of resources and the setting of frameworks for that management. While “traditional” issues such as hydropower, water allocation and irrigation are still important, the environment is now the most commonly mentioned issue in treaty texts. Treaties are also increasingly likely to include data and information sharing provisions, have conflict resolution mechanisms, and include mechanisms for participation beyond traditional nation-state actors. Generalizing, treaties have become more comprehensive over time, both in the issues they address and the tools they use to manage those issues cooperatively.     

Abandoning Armed Resistance? The Ulster Volunteer Force as a Case Study of Strategic Terrorism in Northern Ireland

This article explores the Ulster Volunteer Force's (UVF) decision in May 2007 to abandon its campaign of “armed resistance” and pursue “a non-military, civilianized, role” in Northern Ireland. It does so by analyzing the UVF's actions in light of the academic literature on strategic terrorism. The central argument advanced in the article is that the UVF's decision to put its weapons “beyond reach” and re-structure its organization along civilian lines is (a) internally consistent with its stated policy of countering “violent nationalism,” (b) symptomatic of the transformation in the sociopolitical context since the 1994 paramilitary cease-fires, and (c) the logical outworking of the group's lack of popular legitimacy among its core Protestant working-class support-base. The article concludes with an assessment of the risks and possible dividends that the end of UVF terrorism holds for the Northern Ireland peace process.     

Catastrophe risk,insurance and terrorism

This article empirically investigates how the terrorist activity of September 11, 2001, was addressed by the insurance industry and government in the United States. It shows that the insurance system worked reasonably well in compensating losses suffered, albeit with various tribulations. It also demonstrates that the insurance industry, along with government as the ultimate risk manager, imaginatively reconfigured markets to continue terrorism insurance coverage in many contexts. The findings challenge many of Ulrich Beck’s contentions about catastrophe risks and insurability. At the same time, they indicate the fragility of the insurance system. Insurers’ perceptions and decisions about uncertainty – with potential for windfall profits as well as catastrophic losses – create crises in insurance availability and promote new forms of inequality and exclusion. Hence, while the insurance industry is a central bulwark against uncertainty, insurers can also play a key role in fostering it.     

Sudden unexpected death resulting from hypothalamic sarcoidosis

The authors report a case of sudden death in a 23-year-old woman in whom autopsy by the medical examiner revealed hypothalamic sarcoidosis. The decedent had experienced 6 months of amenorrhea and a 50-pound weight gain. She sought medical attention when she experienced headache, and after imaging and laboratory studies, she was suspected of having neurosarcoidosis. She appeared to respond well to corticosteroid therapy. However, 6 weeks after the beginning of therapy, she was found dead on the floor of her residence. Autopsy showed extensive granulomatous inflammation of the hypothalamus and adjacent structures. Previously reported cases of hypothalamic sarcoidosis are reviewed. A hypothesis for the mechanism of sudden death is presented.