Iatrogenic deaths following treatment for hypertrophic obstructive cardiomyopathy: case reports and an approach to the autopsy and death certification

Hypertrophic cardiomyopathy (HCM) is a disease process which results in a large, heavy heart, with hypertrophy of the interventricular septum (IVS) and left ventricle. HCM accounts for a significant number of cases of sudden cardiac death each year, most infamously in young athletes. The prevalence of the disease has increased over the past several years due to advances in clinical diagnosis and molecular genetic studies. Over this same period, new forms of treatment also have emerged. One such treatment is alcohol septal ablation (ASA). ASA is a procedure performed by a cardiologist, via cardiac catheterization, by injecting pure ethanol into selected arteries which supply the IVS, resulting in a targeted myocardial infarction. This infarct then retracts and forms a scar, decreasing the outflow obstruction and improving the patient's clinical symptoms.The authors report 2 cases of death following ASA treatment of HCM. The first, a 56-year-old male, had his ASA procedure 10 days prior to death. The second decedent, a 76-year-old female, had her procedure only 30 hours before death. These case reports are followed by a discussion about HCM, including pathology, treatments, and treatment-related pathology, before closing with a discussion about death certification in the cases presented and therapy-related deaths in general.     

Combined homicide-suicide in Galveston County

Combined homicide-suicides have been classified based on the psychopathology of the perpetrator and the nature of the relationship between perpetrator and victim(s). To further understand the nature of this tragic phenomenon and to test the validity and practicality of a previously suggested classification system, investigators systematically collected data on all combined homicide-suicide events that occurred in Galveston County, Texas over a continuous 18-year period (n = 20). The most common psychopathological finding for perpetrators was high serum alcohol levels that suggested intoxication. Most combined homicide-suicides fell into one of the relational categories and most of these, as predicted, were of the consortial type, possessive subtype. As expected, due to the small sample size, the less common types of combined homicide-suicide were not represented in this sample.     

The Queen and the `Bolton Seven'

This note examines the case of a group of gay men who, having engaged in consensual sexual acts together, became known as the `Bolton Seven' following their conviction in 1998 for offences of buggery and/or gross indecency. More particularly the note scrutinises the implications of the ages of the participants (one of whom, at 17 , was unable to give lawful consent to sexual intercourse with a man) in the light of the enactment of Part I of the Sex Offenders Act 1997 which introduces a system of compulsory registration by some convicted and cautioned sex offenders with the police (including men convicted of, or cautioned for, buggery or gross indecency). The note explores the justification for inclusion of these offences within the remit of the1997 Act together with the cultural construction of gay men as predatory and as constituting a risk to younger members of society. It also analyses some of the effects of the registration requirement in terms of it constituting a potential violation of fundamental rights such as equality and respect for private life. This discussion is located particularly within the context of the jurisprudence of the European Court of Human Rights and the introduction of the Human Rights Act 1998 in the U.K.. This revised version was published online in July 2006 with corrections to the Cover Date.     

Detection of Gamma-Hydroxybutyric Acid in Various Drink Matrices via AccuTOF-DART*

Abstract: A new screening method for detecting gamma-hydroxybutyric acid (GHB) in drink matrices, using the IonSense, Inc. (Saugus, MA) direct analysis in real time (DART) ion source coupled to a JEOL exact mass time-of-flight mass spectrometer (AccuTOF), was validated and compared with the current screening methodology. The DART ion source allows for analysis of samples under ambient conditions with little to no sample preparation. Fifty drink specimens were spiked at levels of 1, 2, 3, and 4 mg/mL GHB, and analyzed on the AccuTOF-DART. Positive detection of GHB occurred for each of the samples at each concentration level, giving 100% accuracy for the samples tested. Twenty-five of the 50 drink specimens were spiked at 1 mg/mL GHB and tested using a color test known as the GHB Color Test #3. Only two of these 25 specimens tested positive for the presence of GHB, giving only 8% accuracy. Implementation of this new methodology as a screening tool for GHB analysis will quickly eliminate negative specimens allowing the examiner to focus analysis time on those that screened positive.     

Grey Power: Towards a Political Economy of Older Voters in the UK

The impact of age on voting behaviour and political outcomes has become an issue of increasing interest, particularly in the UK. Age divides in voter turnout and political preferences have led to claims that age is the ‘new class’. In this article, we contrast existing ‘cultural backlash’ and political economy explanations of the age divide in politics, and challenge the view that older people are predominantly ‘left behind’, culturally or economically. We show that older people have distinct material interests, related to housing wealth and pensions’ income, that are visible in their political preferences. We argue for the development of a new political economy of age.