胸外按摩致肋骨骨折法医病理学分析

目的　探讨胸外按摩致肋骨骨折特点。　方法　对 1990～ 2 0 0 0年间华西医科大学法医学院所做 30例胸外按摩致肋骨骨折的尸检进行法医病理统计分析。　结果　肋骨骨折男性 2 8,女性 2例 ,年龄为 18～ 6 8岁 ,胸外按摩骨折主要发生在疾病、电击伤、溺死及中毒病例 ,以第 6～ 9肋骨的腋前、中线骨折常见 ,多为左侧。　结论　胸外按摩与外伤所致肋骨骨折具有明显的区别。     

Social justice as a Holy Grail: The endless quest

This paper gives the author's impressions on the following aspects of justice: desert, equity, equality, need, and intergenerational equity. The author concludes that these different aspects cannot be reconciled but instead must be compromised. An example of such a compromise is provided by a discussion of welfare reform. The author claims that rights are correlative with duties, and that asserting the former has little meaning without specifying the latter. He then discusses justice toward groups rather than individuals. He proposes that maintaining cultural variety in the presence of a homogeneous superculture is a major problem of the contemporary world. The paper concludes with a discussion of various forms of power, particularly the integrative power that people acquire over each other by virtue of ties of loyalty and identity.     

Significance of functional and nutritive pulmonary circulation for vital reactions in the form of embolisms

The functional and nutritive circulation in the lungs is connected by anastomoses between the pulmonary and bronchial arteries. The anastomoses have the structure of blocked arteries from which arteriovenous anastomoses proceed to the peribronchial plexus. The pulmonary artery is provided with a flow impulse by the anastomoses, and oxygen-containing blood is admixed with the venous blood, thus forming an "aortalization" in the lungs. By diverting the bloodstream, venous blood can reach the bronchial artery. The peculiarities of the lung circulation are important for vital reactions in the form of macro- and microembolisms. Macroembolisms prove the functionality of the system if branches of the pulmonary artery are closed before the arteries are blocked. A hemorrhagic infarction either arises or does not arise, and the hemorrhagic infarction cannot exceed a certain limit. A microembolism is over and above the anastomoses. If the microembolism is greater, pressure in the arteria pulmonaris can cause blood from the pulmonary artery to overflow into the bronchial artery. Because arteriovenous anastomoses arise from the blocked arteries, microemboli can now reach the systemic circulation. Thus, the system described can explain the passage of microemboli into the systemic circulation, avoiding the capillaries of the lungs; on the other hand, larger microembolisms can prove the functionality of the system.     

Bicommunalism in Northern Ireland

Northern Ireland is a bicommunal society in which Protestantsare numerically dominant; Roman Catholics constitute virtuallyall of the remaining population. On the island as a whole, Protestantsare heavily outnumbered; the Republic of Ireland (the "South")has a population that is about 96 percent Catholic. Social segregationof the two northern communities is relatively distinct, andthere is little crosscutting between groups that might lessenbicommunal conflict. A reciprocal relationship exists betweenthe social system and political structures. Northern Irish politicalinstitutions followed the Westminster model, which facilitatedthe political exclusion of Catholics and impeded social as wellas political integration. The bicommunal social structure hasimpeded the development of more accommodating political structures.Geographic issues and external linkages compound the politicalproblem. Northern Irish politics can be viewed as a "dual dyad"in which the United Kingdom and the Republic of Ireland arecritical components. Psychological dimensions of Northern Irishbicommunalism further exacerbate the conflict.     

Special report on liability and insurance. An update on assignment of patient benefits under ERISA

While the holdings in Davidowitz and Arkansas Blue Cross & Blue Shield arose in different contexts, they both reflect the courts' increasing willingness to consider the importance of cost containment in the health insurance arena, even though patient accessibility to health care may be restricted as a result. If the holding in Davidowitz is not successfully appealed, providers may need legislative relief in order to retain their ability to take valid assignments of patient claims for payment from ERISA plans. It is uncertain whether such legislation can be sought at the state level or must instead come from Congress due to ERISA preemption of state legislation. Clearly, the district court decision on remand in Arkansas Blue Cross & Blue Shield will be closely watched for any light it may shed on this question. On a pragmatic note, providers who have not entered into "participation" agreements with insurers or other private payors may now have a greater incentive to do so, and "nonparticipating" providers who continue to obtain assignments from patients in order to collect directly from insurers or other private payors should determine on a case-by-case basis whether the source of the patient's benefits is a group health plan--which is likely to fall under ERISA and may contain nonassignment provisions--or some other form of coverage. For an additional perspective on insurers' responses to copayment waivers, see Newsletter, Vol. 6, No. 10, October 1991, at 7.