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.     

Fatal decompression sickness following therapeutic hyperbaric environment (author's transl)

In Hannover/Germany in 1976 a so called "Society for Regenerative Hyperbaric Therapy" (Gesellschaft für Regenerative Uberdruck-Therapie) subjected 20 patients within two coupled multi-place chambers to a simulated hyperbaric environment, equivalent to a maximum of 4 ata, followed usually by gradual reductions of the pressure. The patients were of an average age of 67.2 years and were afflicted by various disorders. During one of the "dives" a patient developed air embolism of the central nervous system. During ensuing confusion of the chamber was opened suddenly, with resultant explosive reduction of the high pressure. This resulted in five letal accidents of decompression sickness. Post mortem examination revealed diffuse distribution of gas bubbles throughout the entire body. By elecronmicroscopy each bubble was covered by an osmiophilic coat. Post mortem findings are discussed and correlated with well-known and new clinical symptomes. These observations present for the first time fatal accidents of decompression sickness in humans, associated with hyperbaric air-therapy.     

Pitfalls in the diagnosis of drug smuggler's abdomen

Narcotics "body packing" can be detected in abdominal X-rays by the ring shadow caused by air trapped in the packs. In a series of 82 cases admitted for abdominal X-ray in Helsinki, Finland, in 1982 through 1988, we encountered 9 (11.0%) true positives, 3 (3.6%) false positives, and 1 (1.2%) false negative. The false positives were due to the constipation often associated with the narcotics abuse. The false negative X-ray diagnosis was attributable to an inexperienced radiologist. False negatives may also be associated with packets containing marijuana, packs with few wrappings, aluminum-foil coated packs, and machine-packed narcotics. Searching for trapped air in radiographs, repeated X-raying by an experienced radiologist, use of computed tomography, or combined urinary drug screening may be applied to diminish false findings and to avoid unnecessary arrest for the purpose of fecal screening over several days.     

Contribution à une analyse narrative de la théorie institutionnelle

Conclusion Que faut-il penser de la co-existence de trois modèles différents pour interpréter l'élément central de la théorie institutionnelle de MacCormick? Cette pluralité de modèles n'est source de perturbations que pour ceux qui tiennent à défendre l'idée selon laquelle il n'y a qu'une seule forme possible de discours juridique. Dès qu'il est accepté — comme hypothèse de base — que les formes d'organisation de ce type de discours peuvent être multiples, la perspective est inversée.C'est le schéma explicatif — dit schéma narratif — qui est alors unique. Quant aux différentes variantes de la formule de MacCormick, elles représentent les altérations de cette définition en fonction de paramètres identifiables — et identifiés — comme le statut des différents actants et acteurs, la définition de l'objet de valeur final dont ils cherchent à s'emparer et les objets de valeur d'usage dont ils se servent.L'éclatement de la formule de Maccormick ne correspond alors plus à un rejet mais bien à une mise en question. Cette remise en question débouchant sur la reconnaissance de plusieurs schémas narratifs, nous devons nous demander dans quelle mesure notre perception de la phasep correspond à l'idée que s'en fait MacCormick. S'agit-il seulement de la procédure au sens juridique du mot ou de tout un ensemble d'actes permettant de persuader un destinateur comme un juge ou une administration de la coïncidence entre un parcours narratif effectif et le type idéal de parcours narratif qu'ils tirent de la lecture des normes juridiques?S'il s'agit bien de la procédure au sens juridique de ce mot, il faut alors préciser au terme de cette analyse sémio-narrative que l'ensemble des phénomènes pragmatiques — comme les interactions dans le cas d'une procédure orale — ne sont pris en compte ni par la formule de MacCormick, ni par la présente discussion mais qu'ils relèvent d'une recherche particulière sur cette dimension supplémentaire, certes compatible avec la théorie sémiotique mais pas avec la théorie institutionnelle de MacCormick. Pour conclure, nous dirons donc qu'il est possible d'intégrer certains éléments de cette dernière théorie dans un cadre plus général mais qu'elle sera vite transformée à la fois de l'intérieur par la reconnaissance d'une pluralité des formes du discours et de l'extérieur par son intégration partielle dans un schéma plus large qui vise à décrire un phénomène dans son intégralité.     

'Designing Better Health Care in the South': A Case Study of Unsuccessful Transformational Change in Public Sector Health Service Reform

This article presents a case study of a project known as 'Designing Better Health Care in the South' that attempted to transform four separately incorporated health services in southern Adelaide into a single regional health service. The project's efforts are examined using Kotter's (1996) model of the preconditions for transformational change in organisations and the areas in which it met or failed to meet these preconditions are analysed, using results from an evaluation that was commenced during the course of the attempted reform. The article provides valuable insights into an attempted major change by four public sector health organisations and the facilitators and barriers to such change. It also examines the way in which forces beyond the control of individual public sector agencies can significantly impact on attempts to implement organisational change in response to an identified need. This case study offers a rare glimpse into the micro detail of health care reform processes that are so widespread in contemporary health services but which are rarely systematically evaluated.     

经行政程序处理完的事情，当事人能否请求司法救济

请求司法救济是公民、法人运用法律武器保护自己合法权益的手段,但在司法实践中有些当事人不能正确运用法律武器保护自己的权利,且将行政程序处理完的事情请求司法救济。本文作者从几个方面分析了该案当事人的脱法行为,阐述了行政程序与法律程序在该案中适用范围及一事不再理原则在实践中的运用。