Separation of stomach contents using the sieve-tower technique]

The authors present a method to separate and preserve stomach contents for forensic purpose. Analysis by "sieve tower" technique is simple and quickly done during autopsy. Solid phases of stomach content are arranged size up and can be stored for subsequent examinations. With the fluid phase drug analysis or microscopic analysis to confirm identy of the foodstuffs may be done. By adding alcohol (70%) enzymatic digestion and bacterial degradation of the stomach content are stopped.     

Medicaid and access to child health care in Chicago.

In this article we examine how increasing the reimbursement of physicians and expanding Medicaid eligibility affect access to care for children in Cook County, Illinois, which overlies Chicago. Using Medicaid claims and other data at the zip-code level, we compare the places where Medicaid children live with the places where all the physicians who treat children and those who accept Medicaid patients have their practices. Our findings suggest that the recent changes in legislation are unlikely to benefit extremely poor children, who are more likely to live in depressed inner-city areas, where there are few physicians. "Near-poor" children whose homes are dispersed throughout the county, who are now eligible for Medicaid as a result of the recent changes, are likely to see improvements in their access to care. Further changes in policy, aimed at enhancing the capacity of institutions providing care, could improve access for the children of the inner city.     

Complications following cell therapy

So far, the law in the Federal Republic of Germany still allows the injection of fresh-cell preparations from animals as a roborant to increase the vitality of the organism and to strengthen the body's immune defense system. The use of "sicca-cell" preparations was provisionally forbidden in 1987 by the Federal Health Organization (Bundesgesundheitsamt; BGA). Prohibition of fresh-cell injections would have exceeded the authority of this office, although the same serious reservations also applied in the case of this treatment method. Several publications that have appeared since 1955 have reported serious complications of this therapy, some life-threatening and some even lethal. Two further cases are now added: (1) A woman aged 69 had been receiving treatment with cell injections for 9 years. Immediately after an injection of sicca cells she collapsed and was hospitalized; 7 days thereafter she developed an ascending paralysis with increasing inability to swallow or breathe. She died 25 days after the injection as a consequence of central and peripheral respiratory failure. Autopsy revealed the alterations typical for acute Landry-Guillain-Barré-Strohl syndrome. (2) A 76-year-old healthy woman had been receiving treatment with fresh-cell preparations for several years. After an injection of cell suspensions a painful local swelling was observed. The symptoms were interpreted as the consequence of an iatrogenic local hematoma, and repeated punctures were performed to obtain blood. The patient was transferred to a surgical department for further therapy. Two days after the injection she suddenly died with signs of acute cardiovascular failure. Autopsy revealed the signs of a fulminating clostridial infection and also the characteristic signs of Landry-Guillain-Barré syndrome with involvement of the autonomic nervous system. In both cases the development of an inflammatory process in the peripheral nervous system could be interpreted as an immune-mediated allergic disease, related to the repeated injection of heterologous antigenic material containing nervous tissues. This hypothesis would also explain the two other cases already published and would be consistent with the observed perivenous leukoencephalopathy of the central nervous system. The human disease pictures correspond to the well-established animal models of EAEM (experimental allergic encephalomyelitis) and EAN (experimental allergic neuritis). The pathogenesis is discussed; the major role of the central and peripheral nervous system is stressed, with special reference to the risk of acute autonomic failure. The need for specific autopsy techniques for the investigation of the entire nervous system, including spinal cord, roots, spinal ganglia and peripheral nerves with sympathetic chains, is raised.     

Injuries of the large arteries of the brain and vital reactions. An electron microscopy study

In 90 forensic autopsies (Craniocerebral injury, gunshot, stabbing, blow, strangulation, etc.), semithin sections of great arteries were prepared from around 770 Epon blocks and checked for vital reactions at the mural and intimal ruptures. In 21 cases in which death had occurred immediately or soon after the trauma, with three exceptions, there was a subsequent electron microscopic investigation. In all six mural ruptures and in five of ten intimal ruptures, thrombocyte aggregates were found at the rupture margins. In five intimal ruptures, the possibility of the occurrence of preparations injuries had to be considered. In five cases, the results of the histological study were negative. The success rate is limited in principle in such a screening test since there are technical difficulties in preparing serial sections on long vessels. Death was rapid and the thrombocytes were observed to adhere to the injured wall sites immediately after the trauma. The "thrombocyte sign" is thus of substantial importance as the earliest local vital reaction. In two control cases (strangulation), thrombocyte aggregates were found at intimal ruptures of the basilar artery, which were regarded as the results of stretching via the vertebral arteries during attacks to the neck. The healing processes of intimal ruptures and traumatic medial necrosis in incomplete ruptures occurring later in life are discussed. Even if a cadaver is a few days old, the histological findings at the level of the thrombocytes can be evaluated.     

Fertility,development, and family planning, 1970–1980: An analysis of cases weighted by population

A series of related studies (Freedman and Berelson, 1976; Mauldin and Berelson, 1978; and Tsui and Bogue, 1978) have presented empirical findings based on multiple regression analysis which indicated that family planning program effort (FP), as measured by an index developed by Lapham and Mauldin (1972), was the single most important predictor of (or influence on) fertility reduction in less-developed countries (LDCs). The basic results have been confirmed repeatedly. A more extensive data set was used to extend the analysis to a comparison of results of corss-sectional models circa 1970 and 1980. The study builds upon the results of past studies yet differs from them in several ways. All the variables in the present study were measured at 2 points in time: circa 1970 and circa 1980, allowing a comparison between cross-sectional models for 1970 and 1980. Among the cases included in this multivariate analysis was China, a country usually excluded for lack of data. The analysis was extend to 85 countries. Cases were weighted by population, having the effect of increasing the impact of larger countries such as India and China on the outcome of the analysis. Total fertility rate (TFR) was used as an indicator of fertility. For 1970, family planning program effort had the strongest direct influence on fertility (a result consistent with previous studies). Life expectancy at birth was the other direct influence. The direct influence of life expectancy at birth was less than that of family planning, but the total influence was greater. After life expectancy and family planning, school enrollment and relative educational status of women had the strongest indirect and total influences. The other variables all had a positive influence on fertility. When the total variance attributable was considered, directly and indirectly to each of the independent variables, urbanization, carlorie supply, and per capita gross national product all accounted for less than 5% of the variance in fertility, all of it indirect. Life expectancy, family planning, and school enrollment each explained (directly plus indirectly) more than 10% of the variance in fertility. The pattern differed somewhat for 1980. Calorie supply, per capita gross national product, and relative educational status of women had no influence, direct or indirect on fertility. Also for 1980, life expectancy had a stronger direct influence on fertility than family planning. Overall, life expectancy at birth, family planning program effort, and total school enrollment emerged as the principal influences on fertility.