Sickle cell lung disease and sudden death: a retrospective/prospective study of 21 autopsy cases and literature review

Sudden death in the setting of sickle cell lung disease (SCLD), is periodically seen in the practice of medical examiners. The goal of the present study was to identify the most common pathologic findings of SCLD associated with sudden or unexpected death. A retrospective/prospective review of 21 autopsy cases from sickle cell patients between 1990 and 2004 was performed. Review of medical records, autopsy reports, and H&E-stained slides of lung tissue was performed. Oil-Red-O and elastic staining of lung tissue were evaluated. All cases were screened for both acute and chronic forms of SCLD. Patients admitted for sickle cell pain crisis ranged in age from 8 months to 65 years. Fifteen out of 21 cases (71.4%) showed significant pulmonary pathology. The most frequent lung findings included pulmonary edema (47.6%), pulmonary thromboembolism (38.1%), fat emboli (33.3%), pulmonary hypertension, grades I-IV (33.3%), and microvascular occlusive thrombi (28.5%). Our study demonstrates higher-than-expected percentages of acute and chronic sickle cell-related lung injury such as fat embolism (33.3%) and pulmonary hypertension (33.3%), with right ventricular hypertrophy (33.3%). Therefore, we propose a simple and high-yield autopsy algorithm of ancillary procedures that should be applied on all known and suspected autopsy cases of sickle cell disease.     

Identification and quantification of phenobarbital in a mummified body 10 years after death

Abstract: This article reports the determination of phenobarbital in the mummified body of a 56‐year‐old man found completely mummified 10 years after his death. When alive, he was being treated for epilepsy with phenobarbital, and the recent analyses, performed with both immunochemical techniques and gas chromatography with mass spectrometry (GC‐MS), have revealed the presence of this substance in various tissues: the mean content of barbiturate in the mummified liver tissue was 93 μg/g, 216 μg/g in the heart, 17 μg/g in the lungs, 12 μg/g in muscles, and 31 μg/g in the skin. Preliminary screening tests with immunochemical techniques to evaluate the presence of other drugs were also performed. The sample resulted negative for all substances tested. Phenobarbital can be identified and quantified thanks to its excellent chemical stability and a hypothesis of what the concentrations in the fresh tissue could have been has also been reported.     

A Direct Aqueous Derivatization GSMS Method for Determining Benzoylecgonine Concentrations in Human Urine

A sensitive and reliable method for extraction and quantification of benzoylecgonine (BZE) and cocaine (COC) in urine is presented. Propyl‐chloroformate was used as derivatizing agent, and it was directly added to the urine sample: the propyl derivative and COC were then recovered by liquid–liquid extraction procedure. Gas chromatography–mass spectrometry was used to detect the analytes in selected ion monitoring mode. The method proved to be precise for BZE and COC both in term of intraday and interday analysis, with a coefficient of variation (CV) <6%. Limits of detection (LOD) were 2.7 ng/mL for BZE and 1.4 ng/mL for COC. The calibration curve showed a linear relationship for BZE and COC (r² >0.999 and >0.997, respectively) within the range investigated. The method, applied to thirty authentic samples, showed to be very simple, fast, and reliable, so it can be easily applied in routine analysis for the quantification of BZE and COC in urine samples.     

Is My Femininity a Liability? Longitudinal Associations between Girls’ Experiences of Gender Discrimination,Internalizing Symptoms,and Gender Identity

Journal of Youth and Adolescence - Gender discrimination is a common experience for adolescent girls and has implications for their mental health and identity development. Guided by...     

Reform: economic policy administration

Beginning in 1992, Italy has undergone a dramatic process of fiscal consolidation. Within that framework, the policy strategy has covered a broad range of objectives and addressed the main structural imbalances of the Italian economy. This paper describes how the new policy course has been reshaping the role of the State within the Italian economy, with a view of reducing the State's weight and direct involvement in the management of businesses. This has also implied a profound transformation at the decisional and administrative levels, as testified by the ongoing merge of two separate administrations, the former Ministry of the Treasury and Ministry of the Budget, into a single entity.     

Ist das neue Umwelt-Rechtsbehelfsgesetz europarechtskonform?

Zusammenfassung Das Umwelt-Rechtsbehelfsgesetz ist am 15.12.2006 in Kraft getreten. Damit kam der deutsche Gesetzgeber seinem Auftrag zur Umsetzung des Gemeinschaftsrechts – wenngleich sehr versp?tet – nach. Schon vor dem Erlass des Gesetzes war die Umsetzung der v?lker- und europarechtlichen Vorgaben ein hei? diskutiertes Thema und auch nach der Umsetzung in deutsches Recht erhitzt die Frage nach der Europarechtskonformit?t des Gesetzes weiterhin die Gemüter. In diesem Beitrag sollen einige der umstrittenen Bestimmungen des Gesetzes n?her beleuchtet und auf ihre Vereinbarkeit mit dem Gemeinschaftsrecht geprüft werden.     

Unity, Diversity and the Fragmentation of International Law: How Much Does the Multiplication of International Organizations Really Matter?

It seems to be presumed by many that the simple multiplicationof international organizations (IOs) weakens the unity and integrityof international law. There is, in reality, nothing obviousin this assumption. First, there needs to be evidence of duplicationor overlaps in the various competences of IOs. Second, it needsto be proven that, in the instances in which the activitiesof IOs do overlap, such overlap translates into competition,divergence or conflict. Last, and most importantly, rival orcompeting activities must be of normative significance. Thisessay proposes to address the preliminary question which, infact, precedes and underpins all the others as regards the multiplicationof IOs and international legal unity: how do IOs matter in themaking of international law? IOs, we argue, are more shapersthan makers of international law and their multiplication istherefore not a source of increased chaos in the internationalnormative puzzle.     

Radicalization as a reaction to failure: An economic model of Islamic extremism

This paper views Islamist radicals as self-interested political revolutionaries and builds on a general model of political extremism developed in a previous paper (Ferrero, 2002). Extremism is modelled as a production factor whose effect on expected revenue is initially positive and then turns negative, and whose level is optimally chosen by a revolutionary organization. The organization is bound by a free-access constraint and hence uses the degree of extremism as a means of indirectly controlling its level of membership with the aim of maximizing expected per capita income of its members, like a producer co-operative. The gist of the argument is that radicalization may be an optimal reaction to perceived failure (a widespread perception in the Muslim world) when political activists are, at the margin, relatively strongly averse to effort but not so averse to extremism. This configuration is at odds with secular, Western-style revolutionary politics but seems to capture well the essence of Islamic revolutionary politics, embedded as it is in a doctrinal framework.