Verapamil toxicity: an unusual case report and review of the literature

Verapamil blocks the rapid influx of calcium into the cardiac myocytes of the cardiac conduction system and smooth muscle of the vasculature, resulting in decreased myocardial contractility, prolonged conduction time, and vascular relaxation. A sustained-release form, verapamil SR (or ER), is available that contains higher levels of medication and requires only once-daily dosing. The majority of reported fatal cases of verapamil toxicity are due to massive, intentional overdoses. Herein, we present an unusual case of fatal verapamil SR toxicity in a 57-year-old female that resulted from accidental overdose of only 3 tablets (720 mg), as witnessed by the decedent's daughter. In spite of the low dose ingested, the postmortem cardiac blood verapamil level was clearly toxic (6000 ng/mL, or 6 mg/L). Her preexisting medical conditions included hypercholesterolemia, hypertension, iron deficiency anemia, diabetes mellitus, and associated mild chronic renal failure. Complicating factors, which likely include the decedent's preexisting renal and cardiac disease, and a review of the available literature will be discussed.     

Acute deaths in nonpregnant adults due to invasive streptococcal infections

Streptococcal organisms, part of the normal human bacterial flora, occasionally become infectious pathogens responsible for a wide array of clinical syndromes, ranging from mild pharyngitis to death. Notably, infections due to group A and group B beta-hemolytic strains are well known for causing invasive disease leading to death. These deaths, while often suspected clinically, occasionally are not diagnosed until autopsy. We present 3 rapid deaths, with very different presentations, due to streptococcal infection. Two decedents experienced sudden deaths due to pneumonia and severe meningoencephalitis caused by group B beta-hemolytic streptococcal infection, a common cause of neonatal meningitis but only rarely reported in nonpregnant adults. The final case involves a 69-year-old male who presented to the emergency room with a complaint of shoulder pain but over the next several hours developed signs of necrotizing fasciitis, became septic, and died. While antemortem cultures were negative, owing to antibiotic administration, postmortem cultures of bone and deep soft tissue were positive for group A beta-hemolytic Streptococcus sp. Acute and sudden deaths due to infectious etiology represent an uncommon yet well-documented occurrence. The importance of appropriate postmortem cultures in these situations and a review of the literature will be discussed.     

Justice: Plain Old and Distributive: Rejoinder to Charles Taylor

This paper argues that the views of Charles Taylor on justice in income and wealth distribution are fallacious, especially in regard to issues such as private property rights, justice, human rights, and theft. As to this last point, Taylor maintains it is possible, under certain circumstances, to “legitimately steal.” We regard this as a philosophical howler of the first order. We also demur from his contention that equity and equality can be used as synonyms.

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Informative Committees and Legislative Performance in the American States

The information theory of legislative organization suggests that legislative committees are designed to provide their parent chamber with necessary information to legislate. Despite empirical evidence for various aspects of the theory, we have limited knowledge of committees’ influence on legislative outputs. I argue that informative committees are more than information providers, that they also substantively impact legislative outcomes. With supportive evidence from the US state legislatures, this article shows that the presence of an informative committee system not only lowers the number of bills introduced to the legislature but also enhances the chamber's efficiency in transforming legislative proposals into laws.     

Explaining Canada–US differences in attitudes toward the role of government: a test of S.M. Lipset’s ‘Continental Divide’

For decades scholars have engaged in a lively debate about the distinctiveness of Canadian and American value systems. Lipset (1990) argues that divergent responses to the American Revolution led Canada to embrace Tory values of ‘peace, order, and good government’ while Americans pursued classical liberal values of ‘life, liberty, and the pursuit of happiness’. Other scholars question the extent, or even the existence, of the differences Lipset describes. Using surveys of students from Canadian and American universities close to the Canada–US border, we identify compelling support for Lipset’s hypothesised differences on the role of government in the least likely setting imaginable.     

Policy transfer and reversal: customary land registration from Africa to Melanesia

Ideas and laws about land titling were transferred from East Africa to Melanesia in the 1950s and 1960s. There they provoked a nationalist reaction, and new sources of ideas became influential: from other South Pacific countries in the 1970s, from economic theory in the 1980s, and from the World Bank in the 1990s. Research has cast doubt on the effectiveness of earlier schemes, though little has emerged in Melanesia to take their place. This article analyses the process as one of failed ‘policy transfer’ in which the beneficiaries of the policy may see it quite differently from the government and donors who promote it. Copyright © 2002 John Wiley & Sons, Ltd.