Polyclonal systemic immunoblast proliferation: an unusual hematologic entity presenting as a medical examiner case

A 43-year-old woman who was receiving oral antibiotics for several days for a superficial foot infection developed a persistent rash, fever, and lymphadenopathy, despite discontinuation of the antibiotic and administration of steroids for a presumed drug reaction. Hours after a subsequent visit to the emergency room for worsening symptoms, she died at home. At autopsy, there was a florid, systemic proliferation of polyclonal plasma cells and immunoblasts infiltrating nearly every organ and tissue of the body, most notably the lymph nodes and spleen. The polyclonal nature of the process was confirmed by immunofixation electrophoresis and immunohistochemistry. Cases of fatal polyclonal systemic immunoblast proliferations are extremely rare, and the trigger for such proliferations is not always known. We review the literature on this unusual entity and discuss the clinical and pathologic findings.     

Mitochondrial DNA analysis of the presumptive remains of Jesse James

We report here the results of mtDNA analysis of remains exhumed in July, 1995 from Mt. Olivet Cemetery in Kearney, Nebraska, that are thought to be those of Jesse James. The remains were poorly preserved, presumably due to wet and slightly acidic soil conditions, and insufficient DNA for analysis was obtained from two bone samples. However, two of four teeth, and two hairs recovered in 1978 from the original burial site on the James Farm, did yield reproducible mtDNA sequences. These mtDNA sequences from the teeth and hairs were all identical, suggesting that they came from the same individual; furthermore, this mtDNA sequence was identical to mtDNA sequences determined from blood samples from two maternal relatives of Jesse James. Therefore, either the remains are indeed those of Jesse James, or they are from an unrelated individual who, by chance, happens to have the same mtDNA sequence. To assess the probability that an unrelated individual would have the same sequence, we searched the forensic mtDNA database, and found that this sequence does not appear among the 2426 mtDNA sequences therein. Hence, the mtDNA analysis supports the identification of the exhumed remains from Mt. Olivet Cemetery as those of Jesse James.     

Once again: risk of injury caused by blank pistols

The nature and extent of the use of blank pistols in Hamburg (according to the Hamburg crime statistics about 300 to 400 such cases per year; 34 cases involving head and neck wounds from 1989 to 1999 were investigated at our institute; among these 8 suicides, no homicide) as well as patterns of injuries caused by close distance blank pistol shots were analysed. 7 of these cases are described in detail. The results of our studies corroborate the warning statements made by many criminological and medico-legal experts regarding the danger inherent in these allegedly harmless weapons. Blank cartridge pistols can, when shot from a close distance, cause most severe injuries involving penetration into body cavities and bodily organs (especially in the head and neck), and even perforation of the skull. Therefore, we call for a much stricter control of weapons of this kind.     

The New Water Legislation of Zimbabwe and South Africa – Comparison of Legal and Institutional Reform

Recently, several new pieces of water legislation have been promulgated in both Zimbabwe and the Republic of South Africa. The new acts are an attempt to correct injustices of a colonial past and to trigger development towards effective, equitable and efficient integrated water resources management influenced by the policy decisions in Agenda 21 and the need to respect economic and social human rights. This article aims at identifying and describing factors of prime importance in the process of legal and institutional reform. Major factors are earmarked and derived from the proceedings in Zimbabwe and are compared with the situation in South Africa. Thorough analysis by the author of proceedings, preambles, memoranda, legislation and addenda has induced roughly 5 major reform issues: The call for equitable water distribution based on a widely consented water resources management strategy; The need for effective and efficient integrated water resources management conducive to stakeholder participation through decentralisation processes; The redressing of legal shortcomings in former water legislation with the emphasis on the introduction of integrated approaches; The introduction of instruments of cost recovery for water resources management; The need to develop human resources capacity and institutional strength within the implementing agencies.For both Southern African states, these issues appear to be of comparable importance as major triggers for legal and institutional reform, although not always in the same sense.The resulting most important legal and institutional changes are presented, discussed and compared. Finally, prospects for and constraints on implementation of the new water legislation in these countries are compared.     

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.     

Osler-Weber-Rendu syndrome--pathological manifestations and autopsy considerations

An 18-year-old university student with Osler-Weber-Rendu disease collapsed in the bathroom. Attempted resuscitation was unsuccessful. Her past history included recurrent epistaxes, mucosal telangiectasias, intracranial arteriovenous malformations with previous hemorrhage, a single pulmonary arteriovenous malformation, recent onset of grand mal seizures, and depression. There was a positive paternal family history. At autopsy the pulmonary arteriovenous malformation was confirmed. In addition, within the brain there were widespread areas of gliosis with hemosiderin deposition and small vascular malformations. No other significant abnormalities were detected and toxicological screening revealed only moderately elevated levels of carbemazepine. Death was attributed to epilepsy associated with glial scarring from previous microhemorrhages. The detection of vascular malformations in the lung or brain at autopsy should prompt careful examination of all tissues for similar lesions. Given the possibility of Osler-Weber-Rendu disease in such cases, fibroblast cultures should be undertaken to enable molecular studies to proceed. The heritable nature of this disorder necessitates accuracy of diagnosis at autopsy; once the diagnosis is confirmed family screening should be recommended.     

An investigation of the psychological characteristics of stalkers: empathy, problem-solving, attachment and borderline personality features

This study examined the psychological characteristics of a sample of self-reported stalkers in comparison with a control group, on measures of empathy, problem-solving skills, attachment, and borderline personality features. Stalkers were identified by their endorsement of specific behavioral items, consistent with a widely adopted definition of stalking, denoting behaviors that: (a) are repeatedly directed toward an identified target; (b) are intrusive and unwanted; and (c) evoke fear in the victim. Stalkers scored significantly higher than controls on measures of insecure attachment and borderline personality features, suggesting that the stalking group demonstrates a general pattern of inadequate interpersonal attachment, has limited abilities to form and maintain appropriate relationships, is emotionally labile and unstable, and experiences ambivalence regarding their interpersonal relationships. Treatment implications are discussed herein.