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171.
Hyperosmolarity Induces Armanni‐Ebstein‐like Renal Tubular Epithelial Swelling and Cytoplasmic Vacuolization
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Chong Zhou M.B.B.S. Robert Vink D.Sc. Roger W. Byard M.D. 《Journal of forensic sciences》2017,62(1):229-232
Armanni–Ebstein lesions have been considered pathognomonic for diabetes mellitus and appear as markedly swollen renal tubular epithelial cells with cytoplasmic clearing and glycogen accumulation. However, the extent to which hyperosmolarity contributes to the Armanni–Ebstein phenotype is unclear. Ten sheep were injected intravenously with 20% mannitol at 11 mOsm/kg, and subsequent histological evaluation of the kidneys showed variable degrees of osmotic nephrosis and cytoplasmic clearing of renal tubular epithelial cells similar to that seen with Armanni–Ebstein lesions. However, although morphological changes similar to Armanni–Ebstein lesions could be produced, no intracytoplasmic glycogen was demonstrated with periodic Acid–Schiff (PAS) stain. This suggests that while hyperosmolarity may contribute to the development of an Armanni–Ebstein phenotype, glycogen accumulation may result from the more complex metabolic effects of glucose on renal tubular epithelial cells. Thus, when Armanni/Ebstein‐like vacuolizations are seen at autopsy, a confirmatory PAS stain is recommended because of the potential effect of hyperosmolar states. 相似文献
172.
Roger W. Byard M.D. 《Journal of forensic sciences》2017,62(4):934-936
Deaths due to buffalo attack have not been well described. A 72‐year‐old man was trampled by a water buffalo (Bubalus bubalis) while attempting to move the animal within an enclosed area at an abattoir. At autopsy, there were numerous injuries involving the chest, head, neck, and left upper arm. Blunt force injury had resulted in multiple rib fractures with a flail chest and fracture/dislocation of the mid‐cervical vertebrae caused either by physical crushing by the animal against the walls of the enclosure or by stomping. There was also evidence of crush asphyxia with bilateral conjunctival hemorrhages and petechial hemorrhages. In addition, there was a deep degloving injury of the upper left arm compatible with goring by one of the buffalo horns. While large animal attacks may result in death from multiple injuries, careful dissection and examination of specific injuries at autopsy may clarify the complex interaction of lethal mechanisms. 相似文献
173.
Chong Zhou M.B.B.S. Andrea J. Yool Ph.D. Roger W. Byard M.D. 《Journal of forensic sciences》2017,62(4):921-925
Armanni–Ebstein lesions (AEL) occur in deaths related to uncontrolled diabetes mellitus. To investigate the relationship between AEL and terminal hyperglycemia, we retrospectively reviewed 71 cases with vitreous glucose levels ≥11.1 mmol/L; 27 (38%) cases had AEL (vitreous glucose 14.0–77.3 mmol/L); and 44 cases (62%) did not (vitreous glucose 11.1–91.9 mmol/L). There was no significant difference (p = 0.271) in vitreous glucose levels between the cases with AEL (mean 39.2, SD 16.7 mmol/L) and those without (mean 34.2, SD 19.8 mmol/L). Similarly, there was no difference in the degree of dehydration, renal failure, or osmolality. However, there was a significantly higher level of β‐hydroxybutyrate among the cases with AEL compared to those without (p = 0.007), suggesting that ketoacidosis may facilitate the development of AEL. Given the possible synergistic role of β‐hydroxybutyrate, the correlation between AEL and terminal hyperglycemia in animal studies may not be applicable to humans. AEL may also possibly occur with sublethal elevations in glucose. 相似文献
174.
Roger W. Byard M.D. 《Journal of forensic sciences》2017,62(4):926-929
Given the potential significance of mutilation of the external genitalia in medicolegal fatalities, a review of the literature was undertaken to identify subcategories. Such mutilations may have been sustained sometime before death, around the time of death, or after death. The most common type of ante mortem genital mutilations involves cultural practices such as male circumcision. Less common male mutilations such as subincisions are tribally based. Female genital mutilation is found particularly in African, Middle Eastern, or Asian populations. Self‐inflicted genital injuries are most common in males and may be related to attempts at suicide, or to self‐harming practices. The latter have a strong association with psychiatric illnesses. Postmortem injuries may arise from animal predation or deliberate mutilation of a corpse. The latter may be associated with ante mortem genital injuries in sadistic homicides. The range of possible causes of genital mutilations in forensic cases necessitates extremely careful evaluation. 相似文献
175.
Kimberley J. Omond M.B. B.S. Neil E. I. Langlois M.D. Roger W. Byard M.D. 《Journal of forensic sciences》2017,62(4):930-933
The body mass indexes (BMIs) of 100 randomly selected homicide cases from the files of Forensic Science SA were compared to the Australian and South Australian populations. There were 70 males and 30 females (M:F = 2.3:1; age range 18–84 years; mean 42.3 years). There was a substantially lower proportion of obese individuals in the homicide population compared to the general Australian and South Australian populations (19% [vs.] 27.9% and 30%, respectively). A second group of 144 randomly selected autopsy cases where the BMI was ≥40 kg/m2 was analyzed. There were 77 males and 67 females (M:F = 1.2:1; age range 23–78 years; mean 46.7 years). The majority of deaths were natural (N = 108), with no homicides. A negative association between obesity and homicide has, therefore, been demonstrated. Reasons for the lower numbers of obese/morbidly obese individuals among homicide victims are unclear, but may include physical protection afforded by fat padding from sharp force injuries, and relative sociodemographic isolation. 相似文献
176.
Basal Vacuolization in Renal Tubular Epithelial Cells at Autopsy and Their Relation to Ketoacidosis
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Chong Zhou M.B.B.S. Andrea J. Yool Ph.D. Roger W. Byard M.D. 《Journal of forensic sciences》2017,62(3):681-685
Basal vacuolization of renal tubular epithelial cells is a useful postmortem marker for ketoacidosis. To investigate its incidence and relationship to the severity of ketoacidosis, 158 autopsy cases with elevated β‐hydroxybutyrate (>1 mmol/L) over a 7‐year‐period were retrospectively reviewed. Sixty‐eight cases (43%) exhibited basal vacuolizations (vitreous β‐hydroxybutyrate: 1.16–29.35 mmol/L, mean 10.28 mmol/L), and 90 cases (57%) did not (vitreous β‐hydroxybutyrate: 1.03–13.7 mmol/L, mean 2.84 mmol/L). Quantitative analysis revealed on average a fourfold elevation in β‐hydroxybutyrate in cases with basal vacuolizations compared to those without; 10.3% of cases with β‐hydroxybutyrate concentrations between 1.01 and 2.00 mmol/L had basal vacuolizations, and this incidence increased to 33.3% with concentrations between 4.01 and 6.00 mmol/L. A marked increase in incidence to >70% was observed with concentrations >6.00 mmol/L, and basal vacuoles were invariably present (100%) with concentrations >14.01 mmol/L. This study demonstrates that basal vacuolizations are a sensitive marker for significant ketoacidosis and reaffirms its use as an indicator for likely cases of fatal ketoacidosis at autopsy. 相似文献
177.
178.
Richard E. Levy 《European Journal of Law and Economics》2017,43(3):441-473
This article, prepared for an issue devoted to the work of Judge Richard A. Posner, considers the implications of law and economics for the structure of supranational organizations, with particular attention to the application of collective action theory to the relationships among states in the EU. After discussing the connections between this approach and Judge Posner’s work, the article describes collective action theory and its implications for our understanding of the state and of relationships among states. From this perspective, supranational organizations such as the EU can be understood as institutional structures that facilitate collective action among states by reducing the transactions and enforcement costs of making and implementing collective decisions. At the same time, the delegation of authority to supranational institutions creates agency costs for states and their peoples because the interests of the state and its people diverge from the interests of the collective in some instances. Viewed in this perspective, the institutional structure of the EU—like that of other supranational organizations or federal nation states—reflects an effort to strike a balance between collective decision making and local control so as to maximize the collective gains and minimize the resulting agency costs. Understood in these terms, various features of the EU’s institutional design make sense. The ordinary legislative process permits the EU to act without the unanimous consent of member states, thus reducing transactions costs in those areas where collective action is necessary, particularly in relation to the creation and regulation of the internal market. The EU reduces enforcement costs through principles of direct applicability or effects and the supremacy of EU law, which are effective legal restraints in states governed by the rule of law. The institutional structure of the EU also incorporates a representative and deliberative process for collective action that helps control the resulting agency costs for member states and their peoples through supermajority and co-decisional requirements. The collective action perspective also illuminates the function of the subsidiarity principle and the enhanced role of national parliaments in its enforcement. 相似文献
179.
Roger O'Keefe 《Cambridge Review of International Affairs》2011,24(3):335-355
The article outlines US dissatisfaction with the International Criminal Court (ICC), before assessing the strengths and weaknesses of US objections from the point of view of international law. It concludes that most of the concerns expressed by the United States are either overstated or legally flawed but that there is good reason to object to the abrogation, for the purposes of trial before the ICC, of the immunities conferred by international law on at least certain US personnel. 相似文献
180.