Urinary incontinence, hyperthermia, and sudden death

An 84-year-old woman is reported whose death was associated with strenuous exercise on an extremely hot day (maximum temperature=43.1 °C, 109.6 °F). At autopsy there was evidence of exposure to high environmental temperatures with early putrefactive changes and mummification. There was underlying cardiomegaly with mild pulmonary emphysema. No significant injuries were detected. Toxicology revealed therapeutic levels of oxybutynin prescribed for urinary stress incontinence. Death was considered to be heat related, exacerbated by oxybutynin therapy, exercise, and cardiomegaly. Given that it has been predicted that there may be an increase in the number of heatwaves and in their intensity and duration, it is possible that such cases may be encountered more often in future. The assessment of all deaths occurring during conditions of extreme heat will require consideration of postmortem toxicology, particularly if there are underlying conditions such as stress incontinence that may be associated with anticholinergic drug therapy.     

Exposure to community violence and daily feeling states among urban African American youth

This longitudinal study examined the relationships between exposure to community violence and daily feeling states among 175 6th- through 8th-grade African American students. The relationships were tested both cross-sectionally and longitudinally over the 3-year span. Four daily feeling state subscales: contented, hostile, anxious, and dysphoric were developed from a factor analysis of the 30 Experience Sampling Method (ESM) feeling states. Cross-sectionally, regression analyses indicated that exposure to violence individually predicted most feeling states and more variability in most feeling states in 7th and 8th grades. When feeling states were entered into regressions together, fewer predicted violence exposure. Longitudinally, regression analyses revealed that more variability in dysphoric feelings in 6th grade predicted exposure to violence in 7th grade, while 6th-grade hostile and anxious feelings predicted 8th-grade exposure change. Longitudinal analyses did not indicate that exposure to community violence predicted later daily feeling states. Preventive and intervention implications are addressed.     

Sudden death and Angelman syndrome

Angelman syndrome is a condition characterized by developmental delay due to abnormalities in the maternally derived chromosome 15q11-q13. Typical features include impaired expressive language, an ataxic gait, and seizures. Hyperactivity may result in accidental bruises and abrasions, raising issues of possible inflicted injury. A fascination with water may predispose to drowning. A 5-year-old boy with an established diagnosis of Angelman syndrome is reported who died of upper airway obstruction due to massively enlarged tonsils complicating infectious mononucleosis. Assessment of the severity of underlying illness in developmentally delayed children may be difficult due to failure to vocalize worsening symptoms and distress. In addition, signs of upper airway narrowing due to infection in Angelman syndrome may be masked by the sucking and swallowing difficulties that affected individuals may have with drooling and excessive chewing and mouthing behavior.     

The Empirical Slippery Slope from Voluntary to Non-Voluntary Euthanasia

This article examines the evidence for the empirical argument that there is a slippery slope between the legalization of voluntary and non-voluntary euthanasia. The main source of evidence in relation to this argument comes from the Netherlands. The argument is only effective against legalization if it is legalization which causes the slippery slope. Moreover, it is only effective if it is used comparatively-to show that the slope is more slippery in jurisdictions which have legalized voluntary euthanasia than it is in jurisdictions which have not done so. Both of these elements are examined comparatively.     

Autopsy Reenactment – A Useful Technique in the Evaluation of Adhesive Tape Asphyxia

A 19‐year‐old woman was found dead with her face and head wrapped in plastic adhesive tape in a cupboard beside an opened helium cylinder. Despite the alleged presence of a suicide message on a social networking website, the unusual circumstances raised the possibility at the time of autopsy of either accidental death from sexual asphyxia or homicide. A carefully monitored reenactment demonstrated, however, that the type of commercial adhesive tape that had been used did not cause complete airway obstruction and that it was possible to wrap a considerable length of tape around the head and neck with the breath held. All of the features at autopsy were, therefore, compatible with self‐infliction. Asphyxial death was attributed to the combined effects of smothering from tape and anoxia from helium, an extremely rare combination in young females.     

Legal Change on Contraceptive Sterilisation

New and controversial medical procedures such as contraceptive sterilisation are often thought, at least initially, to be prohibited by the criminal law. This article examines how – without any formal legal intervention – contraceptive sterilisation for a consenting patient eventually became accepted as lawful in the United Kingdom. A prominent role was played by the medical profession, its organisations and its journals. A significant role was played by a little-known campaigning organisation in ensuring this legal change.