Sudden unexpected death in epilepsy: is death by seizures a cardiac disease?

RESULTS: Sudden unexpected death in epilepsy (SUDEP) gains more and more acknowledgment across the various interdisciplinary fields. Accordingly, we performed in a prospective setting a case-control study of all SUDEP cases in a well-defined part of Denmark (Northern Jutland), between January 1998 and September 2000. We attempted to look into the cardiopathologic mechanism behind this phenomenon by assessing the degree of myocardial fibrosis in SUDEP patients versus controls. The histologic evaluation was possible in 65% of the cases (15/23) whose death was attributed to SUDEP and in 71% (15/21) of controls. Forty percent of the SUDEP cases (6/15) presented several foci of fibrotic changes in the deep and subendocardial myocardium in contrast to 1 control (6.6%, P = 0.03). None of the subjects from the SUDEP group showed fibrotic changes in their conduction system as compared with 1 control (6.6%). The quantitative evaluation of fibrosis demonstrated a trend toward more fibrosis in the deep and subendocardial myocardium of the SUDEP cases. Forty percent of cases in the SUDEP group were men (6/15), characteristically young at time of death (mean age 38 years) and with a late epilepsy onset (mean age 21 years). Antemortem, 73% of the SUDEP patients (11/15) had experienced infrequent seizures (self-reported). We conclude that the SUDEP cases displayed significant fibrosis of the myocardium when this was assessed by qualitative means. This fibrosis may be the consequence of myocardial ischemia as a direct result of repetitive epileptic seizures, which, associated with the ictal sympathetic storm, may lead to lethal arrhythmias.     

Homicide attempt with a Japanese samurai sword

The use of Japanese swords for homicidal attempts is rare. A Japanese samurai sword is a sharp and cutting object. When faced with the use of this weapon, one must distinguish between stabs and incised wounds. Incised wounds can rarely lead to death, but because of the size of the weapon, stabs usually cause much more serious injuries. Stabs also imply a penetrating movement, whereas incised wounds can be the consequence of protective circular blows. Therefore, it is important to distinguish clinically between these two kinds of wounds. We report a case where the perpetrator argued he had given a circular blow, unfortunately hitting the victim. The pieces of evidence are discussed.     

Uncertainty and Turnout

This article develops a model that simultaneously considersindividual turnout and vote choice while also accounting foruncertainty about candidates. The theoretical development ofthis model implies that the effects of uncertainty on turnoutvary with the strength of individual preferences. Applicationof the model to individual choice in the 1996 American presidentialelection confirms that decreasing uncertainty about the charactertraits of the candidates decreases the probability of abstentionfor individuals with strong preferences but increases the probabilityof abstention for individuals with weak preferences.     

Use of subpopulation data in Australian forensic DNA casework

DNA profiling evidence presented in court should be accompanied by a reliable estimate of its evidential weight. In calculating such statistics, allele frequencies from commonly employed autosomal microsatellite loci are required. These allele frequencies should be collected at a level that appropriately represents the genetic diversity that exists in the population. Typically this occurs at broadly defined bio-geographic categories, such as Caucasian or Asian. Datasets are commonly administered at the jurisdictional level. This paper focuses on Australian jurisdictions and assesses whether this current practice is appropriate for Aboriginal Australian and Caucasian populations alike. In keeping with other studies we observe negligible differences between Caucasian populations within Australia when segregated geographically. However segregation of Aboriginal Australian population data along contemporary State and Territory lines appears to mask the diversity that exists within this subpopulation. For this reason datasets collated along more traditional lines may be more appropriate, particularly to distinguish the most genetically differentiated populations residing in the north of the continent.