An autopsy case of malignant hyperthermia

A report is made of a 44-year-old female who died of malignant hyperthermia during general anesthesia for an operation of left subtrochanteric femoral fracture. Symptoms began with increases in heart rate and blood pressure after the introduction of anesthesia with halothane and were accelerated by the administration of succinylcholine, followed by muscle rigidity and high temperature. The typical wine red urine was observed. The oral temperature of 42 degrees C was recorded within 1 h after succinylcholine. The rectal temperature was 30 degrees C 22 h after death. Severe pulmonary edema and tubular necrosis of the kidney were found by postmortem examination. No latent myopathy was observed. The creatine phosphokinase levels in plasma obtained after the onset of malignant hyperthermia and at the time of autopsy were abnormally high and were 5632 and 34,854 mU/ml, respectively. Plasma myoglobin levels were 130,000 and 2.8 X 10(6) ng/ml, respectively.     

Nonprofit and for-profit medical care: shifting roles and implications for health policy

The contemporary expansion of investor-owned health care facilities has stimulated much controversy but little response from policymakers. We believe this results from the apparently ambiguous relationship between ownership and socially valued outcomes. In our assessment, this ambiguity occurs largely because the effects of ownership are mediated in complex ways by characteristics of the services being delivered and the training of health care providers. Reviewing both the history and current performance of nonprofit and for-profit health care facilities, we identify some of the more important of these mediating factors. Taking these into account, there is a consistent influence of ownership on the delivery of health services. On the basis of this analysis, we discuss appropriate policy responses to the future growth of investor-owned health care organizations.     

An analysis of a prehistoric homicide from northern California

An analysis was performed on a prehistoric human vertebral column recovered during an archaeological excavation in the Sierra of northern California. Fifteen burials believed to represent the Maidu culture of 400 to 700 years ago were recovered. The vertebral column from one of the individuals is particularly significant because of three embedded projectile points. The analysis attempts to recreate the trajectory of each point; to determine the possible extent of damage done by each with emphasis upon which could have been fatal; and by employing available ethnographic and archaeological data, to suggest the possible circumstances surrounding the violent event. The conclusion suggests that death may have resulted from any of the three wounds and was probably the result of an intratribal dispute.     

Gas chromatographic determination of cresols in the biological fluids of a non-fatal case of cresol intoxication

A simple and rapid method for analysis of free and conjugated cresols in biological fluids was developed. Prior to and following freeing of the conjugated cresols by acid hydrolysis in a sealed ampoule, free cresols were extracted by Extrelut column extraction, determined by gas chromatography, and confirmed by gas chromatography-mass spectrometry. In a non-fatal case of cresol intoxication a 46-year-old male had ingested about 100 ml of a saponated cresol soap solution. The concentrations of xylenol (2,4- and/or 2,5-dimethylphenol) and p- and m-cresol in the serum sample collected on admission were 15.8 micrograms/g, 43.3 micrograms/g and 73.8 micrograms/g, respectively. The total cresol concentration of 117 micrograms/g in the serum is within the range of fatal concentrations, and it is suspected therefore that the patient's recovery was due to adequate therapy alone.     

Lifting the 'No Haste,Be Patient' Policy: Implications for Cross-Strait Relations

Cross-Strait relations remain deadlocked following Chen Shui-bian's inauguration as Taiwan's president. Amid this political stalemate, Chen's administration decided to change the 'no haste, be patient' ( jie-ji yueng-ren ) policy while refusing to endorse the 'one China' principle. While this policy change is in response to domestic demands, Chen and his ruling Democratic Progressive Party (DPP) are unlikely to reap any benefit from these actions without active cooperation from China's leaders. Beijing will continue to use its economic clout in an attempt to pull Taiwan into political union, as Taipei needs to nurture an environment favourable for domestic and foreign investment in Taiwan in order to maintain its competitive edge over China and thus preserve its de facto independence. Beijing's leaders will need to rethink their rigid stand on the 'one China' principle, since increased cross-Strait economic integration may not lead to the expected political union they desire.     

Making Tradeoffs in Federal Block Grant Programs: Understanding the Interplay Between SSBG and TANF

Welfare reform gave states the option of transferring up to10 percent of their annual federal Temporary Assistance forNeedy Families (TANF) award to the Social Services Block Grant(SSBG). Drawing on administrative data, we consider the impactof TANF transfers on SSBG. We find evidence suggesting thatmore innovative states, states that experienced larger TANFcaseload declines, and states that transferred a higher percentageof TANF funds to the Child Care Development Fund (CCDF) havetransferred higher portions of their TANF allocations to SSBG,all else equal. Preliminary analysis of changes in SSBG expenditurepatterns from FY 1995 to FY 2000 indicates that states are transferringsignificant sums to SSBG, but that TANF transfers do not appearto have a consistent effect on SSBG spending priorities acrossstates.     

Identification and quantification of p-hydroxyethylamphetamine as a novel metabolite of ethylamphetamine in rat by gas chromatography-mass spectrometry

Ethylamphetamine and two major metabolites in urine, obtained after intraperitoneal administration of the drug to rats, have been isolated by gas chromatography-mass spectrometry. We have also synthesized an authentic sample of p-hydroxy-N-ethylamphetamine by a simple method. In rat, the metabolic pathway of ethylamphetamine is similar to that of amphetamine and methylamphetamine according to quantitative analysis of the major metabolites using a selected ion monitoring (SIM) method.     

Congressional Party Defection in American History

In this paper, we analyze the roll‐call voting behavior of House and Senate members who changed party affiliation during the course of their political careers. We analyze members who switched during the stable periods of the three major two‐party systems in American history: the Federalist‐Jeffersonian Republican system (3d to 12th Congresses), the Democratic‐Whig System (20th to 30th Congresses), and the Democratic‐Republican System (46th to 106th Congresses). Our primary findings are that the biggest changes in the roll‐call voting behavior of party defectors can be observed during periods of high ideological polarization and that party defections during the past 30 years are distinct from switches in other eras because of high polarization and the disappearance of a second dimension of ideological conflict.     

Evaluation of a nonequilibrium isoelectric focusing (IEF) method for the simultaneous typing of esterase D (EsD), red cell acid phosphatase (AcP1), phosphoglucomutase (PGM1), adenylate kinase (AK), and adenosine deaminase (ADA)

A nonequilibrium isoelectric focusing method incorporating the chemical spacers MOPS and HEPES was developed and subsequently evaluated for its ability to reliably discriminate common and rare phenotypes in the esterase D (EsD), red cell acid phosphatase (AcP1), phosphoglucomutase (PGM1), adenylate kinase (AK), and adenosine deaminase (ADA) isoenzyme systems. The validation procedures used were blind testing, comparison of results to conventional methods, and evaluation of known rare variant phenotypes. This method proved to be a quick and reliable method for typing all five isoenzyme systems, while providing an excellent probability of discrimination (PD = 0.96).     

Sleep violence--forensic science implications: polygraphic and video documentation

During the past century, infrequent, anecdotal reports of sleep-related violence with forensic science implications have appeared. Recent rapid developments in the field of sleep-disorders medicine have resulted in greater understanding of a variety of sleep-related behaviors, and formal sleep-behavior monitoring techniques have permitted their documentation and classification. Sleep-related violence can be associated with a number of diagnosable and treatable sleep disorders, including (1) night terrors/sleepwalking, (2) nocturnal seizures, (3) rapid eye movement (REM) sleep-behavior disorder, (4) sleep drunkenness, and (5) psychogenic dissociative states occurring during the sleep period. Potentially violent automatized behavior, without consciousness, can and does occur during sleep. The violence resulting from these disorders may be misinterpreted as purposeful suicide, assault, or even homicide. Sleep-related violence must be added to the list of automatisms. A classification system of both waking and sleep-related automatic behavior is proposed, with recommendations for assessment of such behavior.