Patent ductus arteriosus as a natural cause of pulmonary hemorrhage in infants: a medicolegal dilemma

Patent ductus arteriosus (PDA) is a recognized risk factor for massive pulmonary hemorrhage (MPH) in the newborn and is generally seen in association with other MPH risk factors such as prematurity. We report 6 cases of sudden and unexpected death of infants older than 4 days with MPH and PDA at autopsy. The cases were reviewed for other factors that could contribute to MPH to ascertain whether PDA is directly linked to MPH. Histology samples were examined for distribution of hemorrhage in the lungs and iron stained for hemosiderin evaluation. All of the cases had clinical histories and scene examinations which raised the differential diagnosis of mechanical asphyxia in the form of so-called overlayings. The diagnostic dilemma of attributing the MPH to the PDA as the sole cause, dual cause, or incidental finding is discussed. These cases illustrate the medicolegal dilemma faced by the pathologist, as well as the need for further research into the potential association of PDA with MPH.     

Exposure to interpersonal violence as a predictor of PTSD symptomatology in domestic violence survivors

This study examines the interrelationships between childhood abuse, exposure to maternal domestic violence, and posttraumatic stress disorder (PTSD) symptomatology in a multiethnic sample of 111 adult female residents of a domestic violence (DV) shelter. Participants completed structured interviews about the DV and their prior violence exposure, as well as the Impact of Event Scale-Revised. As hypothesized, there was high co-occurrence between exposure to maternal DV and childhood physical and sexual abuse, and the frequency of lifetime violence exposure predicted PTSD symptomatology. A series of multiple regressions indicated a more complex pattern of relationships, in which specific forms of prior violence exposure predicted different PTSD symptom dimensions. A history of witnessing maternal DV predicted intrusion symptoms, and a history of childhood sexual abuse predicted hyperarousal symptoms. Ethnicity was not related to levels of violence exposure or to PTSD symptoms. Clinical implications of the findings are discussed.     

Medical treatment of dementia patients at the end of life: can the law accommodate the personal identity and welfare problems?

This article considers whether two significant philosophical objections to autonomy-based legal approaches to decision-making for incompetent individuals could be accommodated by the law. These philosophical objections are known as the personal identity and welfare problems. The article first sets out the autonomy-based approaches and their objections. Next, the present legal position is briefly canvassed in a comparative vein. Finally, the article suggests how the personal identity and welfare problems might be accommodated were legislators minded to do so, by proposing specific statutory amendments to the recent English legislation on advance decisions and evaluating their viability, particularly in light of the European Convention on Human Rights.     

Using pre- and post-surgical foot and ankle radiographs for identification

An evaluation of the effect of surgical intervention on foot and ankle radiographic comparisons was performed. In this study, 34 sets of pre-surgical ("premortem") and post-surgical ("postmortem") foot and ankle radiographs were retrospectively evaluated simulating a postmortem identification. In each radiographic set, the films were separated by a surgical event to reproduce the effects of an alteration in the anatomy. The radiographs included both matches and mismatches. This study also presents a numerical representation of the reliability of a radiographic match following a surgical procedure. Results indicate that surgical intervention with subsequent healing does not preclude positive identification in foot and ankle radiographic comparisons.     

Identification of decomposed human remains from radiographic comparisons of an unusual foot deformity

A case of positive identification from decomposed human remains using an unusual foot deformity is presented. Scrutiny of the decedent revealed foot deformities, which upon examination, prompted further inquiry. Radiographic comparisons and defleshing each foot established bilateral talipes equinovarus (TEV, clubfoot). Positive identification was based upon unique skeletal features present in the radiographs.     

Municipal Expenditures Through Thick and Thin

This article examines changes in the revenue and expenditurepatterns of twelve major cities (six fiscally healthy; six fiscallydistressed) from fiscal years 1964 to 1979. The purpose of theexaminatin is to determine whether resource scarcity resultsin significantly different expenditure patterns, especiallyfor essential services (police, fire sanitation, and sewerage),social services (welfare, health, hospitals, and public housing),capital spending, and personal sevices (salaries). The resultsshow that changes inrevenue patterns are not significantly relatedto changes in expenditrue patterns, with the exception of capitalspending. The results support the theory that cutback budgetarystrategies are not significanely different from expansionarybudgetary strategies. Incrementalism (decrementalism) prevails.