Cerebrospinal fluid analysis in fatal thallium poisoning: evidence for delayed distribution into the central nervous system

The neurologic manifestations of thallium poisoning include a severely painful ascending peripheral neuropathy, autonomic dysfunction, cranial nerve abnormalities, and a toxic encephalopathy. Although thallium has a short half-life, these neurologic manifestations commonly progress, even as the blood concentration of thallium decreases. This suggests either that thallium persists in neuronal tissues or that it initiates an injury cascade that takes time to fully manifest. As the latter mechanism is consistent with many toxin exposures, the concept of a central nervous system reservoir for thallium is often discounted. A recent case provided a unique opportunity to evaluate this possibility. A 48-year-old man was acutely and chronically thallium poisoned by his common-law wife. During his initial exposures, only gastrointestinal symptoms manifested. Following an acute ingestion, hospitalization was required. Over 3 days, his symptoms rapidly progressed from a severely painful neuropathy to slurred speech, ptosis, confusion, coma, respiratory insufficiency, and death. Because of considerations of alternative diagnoses, 2 lumbar punctures were performed, one on admission and another on the day of his death. Serum thallium concentrations obtained from stored blood samples were paired with spinal fluid concentrations from the same days. On day 1, serum and spinal fluid concentrations were 8700 mu/L and 1200 mu/L, respectively. On day 3, although the serum concentration had fallen to 7200 mu/L, the spinal fluid concentration had increased to 2100 mu/L. This case provides evidence to support the hypothesis that thallium distributes into the central nervous system more slowly than the blood compartment, and this may in part account for the progression of neurologic findings in the setting of decreasing serum concentrations.     

Unsuspected meningoencephalitis in a case of assault by blunt force trauma

Reported is a case of an assault causing extensive blunt force injuries in which the clinical, radiologic, and postmortem findings were all consistent with death resulting from brain damage arising from the assault. The assailant was charged with murder. Subsequent full neuropathologic (including histologic) examination revealed the unsuspected finding of a widespread meningoencephalitis but no evidence of significant traumatic brain damage. The contributions of the infective process and of the trauma to death were felt to be unclear and a guilty plea to attempted murder was accepted. This case highlights the importance of a full neuropathologic examination, including histology, in cases of trauma to the head, even when the cause of death may initially appear obvious.     

Suicidal asphyxiation by using pure helium gas: case report, review, and discussion of the influence of the internet

Suffocation by inhaled gases has been reported involving a variety of gases. We report a case of suicidal asphyxiation by forced replacement of oxygen with helium by using a complex homemade mask. In this case, a young woman researched suicide on the Internet and found an advocated method of suicide using helium. To our knowledge, there is only 1 previously reported case of suicidal asphyxia by using helium.     

The Fragility of Law: Anti-Jewish Decrees,Constitutional Patriotism,and Collaboration Belgium 1940–1944

In October and November 1940, the German Military Command which ruled conquered Belgium, introduced a series of measures aimed at the identification and exclusion of the Jews of that country. The Belgian government of the day refused to allow the measures to be incorporated into Belgian law, but did permit, under their reading of the Hague Convention, government departments and local administrations to assist in implementing the German anti-Jewish Decrees. The Brussels Bar, Prosecutors and Court of Cassation refused to accept the authority of the Occupier to violate basic rights guaranteed under the Belgian Constitution. Officials in Antwerp, on the other hand, struck all lawyers identified as "Jews" from the Roll. This article examines these instances of "constitutional patriotism" and "constitutional betrayal" by these actors in the Belgian legal system, and offers some preliminary discussion of important questions about our historical and current understandings of legality, legitimacy and citizenship in light of this part of the Belgian experience of law under Nazi occupation. This revised version was published online in July 2006 with corrections to the Cover Date.     

Salvation or damnation?: Religion and correctional ideology

Fundamentalist affiliation and religious beliefs are generally related to more punitive attitudes toward criminals. Fundamentalists also tend to attribute criminality to individual dispositional factors, and in turn, such factors are related to punitiveness. Recently, it has also been found that compassionate dimensions of religion are related to treatment-oriented policies. It is still not clear which dimensions of religion are related to punitive or treatment ideology and what effects religious variables may have when tested against secular concerns about crime and crime attributions. In the present research, we test three models of punitiveness and one model of rehabilitation with demographic, secular, religious, and attributional factors. We found that those for whom religion is salient in their daily lives tend to believe that the death penalty should be reserved for older offenders and that those who believe in a punitive God tend to support harsher punishments.     

Vaccine trial results generate debate and calls for further research

The first large-scale human trial of an HIV vaccine produces disappointing results overall, but finds that the vaccine may have been effective among some of the minority populations participating in the trial. Whatever the significance of this finding (the debate continues), there was a consensus: (a) that the trial provided very useful information on how to conduct large-scale HIV vaccine trials; (b) that further research needs to be conducted; (c) that governments need to contribute more to vaccine research and development; and (d) that existing prevention efforts must be maintained or expanded.     

Home care and prescription drugs to be funded under medicare

Canada's first ministers have signed a health accord that could potentially lead to significant changes to Canada's health-care system. But the agreement is short on details and the new initiatives may not keep pace with the expectations of Canadians.