Polyclonal systemic immunoblast proliferation: an unusual hematologic entity presenting as a medical examiner case

A 43-year-old woman who was receiving oral antibiotics for several days for a superficial foot infection developed a persistent rash, fever, and lymphadenopathy, despite discontinuation of the antibiotic and administration of steroids for a presumed drug reaction. Hours after a subsequent visit to the emergency room for worsening symptoms, she died at home. At autopsy, there was a florid, systemic proliferation of polyclonal plasma cells and immunoblasts infiltrating nearly every organ and tissue of the body, most notably the lymph nodes and spleen. The polyclonal nature of the process was confirmed by immunofixation electrophoresis and immunohistochemistry. Cases of fatal polyclonal systemic immunoblast proliferations are extremely rare, and the trigger for such proliferations is not always known. We review the literature on this unusual entity and discuss the clinical and pathologic findings.     

Chronology of a homicide and an attempted suicide by DNA analysis of selected blood stains on the weapon (knife)]

A five-year-old boy was fatally injured by a stab and a cut to the throat. The suspected offender, an acquaintance of the victim's mother, stated that he had been disturbed by the boy while attempting suicide and had therefore killed the boy. The suspect showed superficial cuts on both wrists and three shallow stabs on the right-hand side of the abdomen. The purpose of the forensic investigations was to answer the question if the suspect's statement could be confirmed or if the attempted suicide took place after killing the boy. The blood-smeared blade of the knife was divided into different sectors with the cutting edge and the tip of the blade being examined separately from the sides. The blood traces from the different blade sectors were then typed in 12 different DNA regions by PCR (polymerase-chain-reaction). It could be demonstrated that the strong blood traces on the sides of the blade originated from the victim alone, whereas in the area of the edge and the tip of the blade the amount of the victim's blood was negligible compared with that of the suspected offender. The explanation for this finding is that in the areas of the edge and the tip of the knife the blood of the victim must have been replaced by the blood of the suspected perpetrator, which means that the suicidal injuries were the last to be caused by the knife.     

Determination of drug levels in larvae of Protophormia terraenovae and Calliphora vicina (Diptera: Calliphoridae) reared on rabbit carcasses containing morphine

Two species of blow flies (Diptera: Calliphoridae) were reared on tissues from rabbits administered different dosages of morphine. These species, Protophormia terraenovae and Calliphora vicina are among the first wave of insects colonizing a dead body. Two series of 3 rabbits were given dosages of 10, 20, and 40 mg/h of morphine over a 3 h period via ear artery perfusion. A morphine blood level plateau was attained after 1 h of perfusion. Two other rabbits were used as controls. Samples of tissues collected from rabbits using a coelioscopic technique were determined to have morphine concentrations similar to those encountered in human overdoses and were correlated with dosages of morphine administered. All samples from control rabbits were negative for morphine. Larvae and puparia of both species were regularly collected from each rabbit for toxicological analysis. Concentrations of morphine in larvae reared on rabbit carcasses containing morphine were significantly lower than concentrations found in the tissues. There was a decrease in concentration in morphine observed in transition from feeding 3rd instar larva to puparium. A correlation between larval concentration and tissue concentration was found only in feeding 3rd instar larvae.     

Private benefit, joint ventures, and the death of healthcare as an exempt purpose

The private benefit doctrine has become the IRS' main policing tool for tax exemption in healthcare. The IRS' modern interpretation of private benefit has clearly become the major limitation on exempt status. This Article begins by tracing the common law origins of this doctrine and how it became such an integral part of the IRS' analysis. Next, the author looks at policy issues regarding alternative analysis to the private benefit doctrine in cases of joint ventures between healthcare providers and for-profit investors. Finally, Professor Colombo questions the expanded use of this doctrine, arguing that in its current form it has no sound legal or policy under-pinnings.     

Legal considerations of sleep deprivation among resident physicians

Medical training in the United States often takes the form of a grueling endurance test in which patients are often those most at risk. This Article discusses sleep deprivation among resident physicians in the United States with an eye towards resolving the problem through legal channels. It analyzes the effects of sleep deprivation on resident physicians, with subsequent discussion of the implications for patient care and medical training. Next, it makes comparisons to medical training in other developed nations, as well as regulations that exist in the airline and trucking industries, where public safety is a principal concern. Furthermore, this Article discusses proposals to mend the dilemmas created by sleep-deprived resident physicians through statutory and regulatory reform, deterrence by way of tort law, and unionization or collective bargaining.     

Consent,commercialisation and benefit-sharing

This article considers two issues in relation to the increasing commercial exploitation of biological materials: first, whether the consent of the individual who is the source of biological material is needed for the material to be used commercially; and secondly, whether the source has any right to share in the profits. Whilst the legal requirement for consent to commercial use is uncertain, the overwhelming view from ethical statements suggests that such consent is appropriate. With regard to profit-sharing, source individuals have no legal right to share in the profits of commercial exploitation of their sample. However, there is support in some ethical statements for benefit-sharing with source individuals and their communities.     

Authors Index Volume 12

Authors Index

Authors Index Volume 12