Differential diagnosis of accident and resuscitation traumas

The purpose of this paper is to define the criteria for the differential diagnosis of trauma following resuscitation and road accidents. To this end, 311 cases of thoracic and epigastric trauma were selected from the 2893 medico-legal autopsies carried out between 1979 and 1982 at the Institute of Forensic Medicine of the University of Heidelberg. Cardiopulmonary resuscitation had to be considered as the cause of trauma in 140 of these, but 45 of this group were excluded from further evaluation as they had been the victims of blunt trauma and no clear-cut distinction was possible between trauma resulting from an accident and trauma resulting from resuscitation. Thus, we were left with 95 cases of internal injury that presented as emergencies and in whom death followed resuscitation, as a group for comparison with 171 road accident victims who had not received cardiopulmonary resuscitation. Rib fractures, predominantly on the left side, were established in half the cases resuscitated, sternal fractures also being found in one-third of these victims. Bleeding at various sites, including hemato-thorax, was rare, with an incidence of 15%, thus making it highly unlikely that serious traumas caused by resuscitation were a major factor in the cause of death. This paper encompasses an extensive discussion on serious injuries, such as aortic and gastric ruptures, in this connection.     

Paraquat (gramoxone) poisoning in south-west Hungary, 1977-1984. Toxicological and histopathological aspects of group intoxication cases

Fifty-six cases of paraquat poisoning were examined during the 8 years 1977-1984. The ratio of cases of accidental to intentional ingestion of the poison was 1:1; 23.2% of the total (13/56) survived several months or years. In 1983, 11 subjects accidentally drank 10-30 ml of gramoxone; eight of 11 died in 2 weeks. Toxicological investigations demonstrated rapid elimination of poison from the blood, as well as prolonged fixation of paraquat in the lung, kidney, liver, and spleen tissues. Histological examinations showed multiorgan failure from renal tubular necrosis and pulmonary hemorrhage with alveolar epithelial injury. Pulmonary proliferative changes were present in only two cases who survived 7 and 10 days and in which artificial ventilation was utilized.     

Drowning of a Friedreich's ataxia patient

We here report an unusual, apparently accidental death, in which weakness associated with a progressive neuromuscular disease, Friedreich's ataxia, apparently resulted in the drowning of the deceased. The possibility of neuromuscular disease as a rare cause of drownings should not be overlooked.     

Correlations on radioimmunoassay, fluorescence polarization immunoassay, and enzyme immunoassay of cannabis metabolites with gas chromatography/mass spectrometry analysis of 11-nor-delta 9-tetrahydrocannabinol-9-carboxylic acid in urine specimens.

Results obtained from three commercial immunoassay kits, Abuscreen, TDx, and EMIT, commonly used for the initial test of urine cannabinoids (and metabolites) were correlated with the 11-nor-delta 9-tetrahydrocannabinol-9-carboxylic acid (9-THC-COOH) concentration as determined by GC/MS. Correlation coefficients obtained based on 26 (out of 1359 total sample population) highly relevant samples, are 0.601 and 0.438 for Abuscreen and TDx. Correlation coefficients obtained from a parallel study on a different set of 47 (out of 5070 total sample population) highly relevant specimens are 0.658 and 0.575 for Abuscreen and Emit. The immunoassay concentration levels, that correspond to the commonly used 15 ng/ml GC/MS cutoff value for 9-THC-COOH, as calculated from the regression equations are 82 ng/ml and 75 ng/ml for TDx and EMIT and 120 ng/ml and 72 ng/ml for Abuscreen manufactured at two different time periods. The difference of these calculated corresponding concentrations provides quantitative evidence of the reagent specificity differences.     

Accredited to Africa: British diplomatic representation and African experience, c. 1960-95

How justified is the complaint sometimes voiced by British businessmen and other UK visitors to contemporary Africa that, compared to 'the [good old] colonial days', Britain's FCO representatives have no experience of Africa and little idea about who's who and what's going on in their bailiwick? The aim of this article is to construct a professional profile of Britain's Heads of Mission assigned to newly independent African states over the past 35 years, with a view to assessing the extent of their African experience. This period also neatly coincides with what in one sense can be interpreted as a single FO generation, in that the mean entry age into the Diplomatic Service is around 25 and the maximum retiring age is a strict 60. The statistical biodata on which the argument is premised are presented in the 19 Mission Tables appended. The article concludes with an examination of the major issues surrounding the question of 'African experience' among those Heads of Mission.     

New identification criteria for the Chilean population: Estimation of sex and stature

In the analysis of human skeletal or otherwise unidentifiable remains the assessment of sex is an initial vital element when rendering a biological profile. As such other aspects of the biological profile are sex-specific (e.g. stature and age) and cannot be successfully determined without this preliminary assessment. In addition, the estimation of stature is an essential parameter of the biological profile, which is often used to confirm or exclude presumptive identifications.The purpose of this study is to present newly developed local identification criteria for the estimation of sex from the postcrania and stature for Chileans. Linear discriminant functions were derived for the humerus and femur. Sexing accuracies of 87%, 86%, and 82% were achieved. Furthermore, new univariate predictive stature equations are presented using a Bayesian approach for the humerus, femur and tibia.