Reporting a fatality during tumescent liposuction

Deaths of patients during elective surgery have drawn attention to the danger of anesthesia. Tumescent local anesthesia is subcutaneous infiltration of large volumes of dilute lidocaine with epinephrine to produce vasoconstriction while delivering anesthesia over large areas without lidocaine toxicity. This report documents the case of a 38-year-old woman who attended an outpatient clinic to undergo liposuction of the abdomen and bilateral hips and thighs. According to one witness, around 30 min after anesthesia administration, the victim suffered an episode of tonic–clonic convulsion. When the emergency medical services arrived the patient was in asystole. She died in spite of attempted cardiopulmonary resuscitation. The patient had no significant past medical history including no history of allergies or any known complications with anesthesia. A complete autopsy was performed and possible causes of death such as myocardial infarction, aspiration of food or foreign body, and pulmonary embolism were discarded. Anaphylactic shock was considered a possible but unlikely explanation for the fatality. Toxicological analyses revealed the presence of lidocaine and mepivacaine in heart blood, at concentrations of 4.9 and 16.2 mg/L, respectively. All drugs involved in the case were detected using gas chromatography with nitrogen–phosphorus detector and confirmed using gas chromatography–mass spectrometry full scan mode after solid-phase extraction using Chem-Elut columns. An additional high-performance liquid chromatography coupled to diode-array detection screening also obtained the same results. Based on the autopsy findings, case history, and toxicology results, the forensic pathologists ruled that the cause of death was an overdose of local anesthetic agents. The Court of Law ruled the death as an involuntary homicide due to gross negligence.     

Multiple regression models for age estimation by assessment of morphologic dental changes according to teeth source

The aims of this study were twofold: (1). to measure parameters that contribute significantly to estimates of dental age, using a combination of classic methods and a computer-assisted image analysis procedure to avoid the bias inherent in observer subjectivity; and (2). to develop new mathematical regression models for age prediction according to postmortem interval. Two different populations were studied. Forty-three permanent teeth (Group I), extracted for valid clinical reasons, were taken from patients 25-79 years of age. The other population group (Group II) was composed of 37 healthy erupted permanent teeth obtained from human skeletal remains (age 22-82 years) with a postmortem interval ranging from 21 to 37 years. Morphologic age-related changes were investigated by measuring variables on intact and half-sectioned teeth. Multiple regression analyses were performed with age as the dependent variable for each sample source. In fresh extracted teeth, the variables that made the greatest contributions to predictions of age were dental attrition, dentin color, and translucency width, the latter measured with a computer-assisted image analysis method. In teeth from human skeletal remains, the variables that made the greatest contributions to age calculation were cementum apposition, pulp length measured by computer-assisted image analysis, dental attrition, root translucency, and dental color. We conclude by recommending different regression models to calculate age depending on the postmortem interval.     

Psychopathology and tattooing among prisoners

Tattooing has always been associated with criminals. Indeed, it is both an administrative and clinical problem in prisons. This article looks at the relationship between psychopathology and tattooing infractions within prison. Using a sample of 8,574 male inmates in the Colorado Department of Corrections, initial admission personality testing was compared to tattooing infractions within the next 2 years. Personality types more likely to engage in tattooing included Antisocial, Sadistic, Negativistic, and Borderline. Compulsive personality types engaged in relatively less tattooing. Clinical syndromes associated with more tattooing included Mania, Drug Abuse, Post-Traumatic Stress disorder, and Thought Disorder.     

The Disarticulated Movement: Barriers to Maya Mobilization in Post‐Conflict Guatemala

Over the last decades, indigenous movements have propelled the political empowerment of historically marginalized groups in Latin America. The Maya struggle for ethnic equality in Guatemala, however, since its reawakening during the peace process, has reached an impasse. Based on field research consisting of dozens of elite interviews, this article analyzes the patterns of and obstacles to present‐day Maya mobilization. It combines movement‐internal and ‐external factors in an overarching theoretical argument about indigenous movements' capacity to construct strong collective voices. In the Guatemalan case, organizational sectorization, the lack of elite consensus on key substantive issues, and unclear alliance strategies compromise the effectiveness of horizontal voice among Maya organizations. These problems are exacerbated by the lasting effects of the country's unique history of violence and state strategies of divide and rule, preventing the emergence of a strong vertical voice capable of challenging the Guatemalan state.