Arterial-esophageal fistulae in patients requiring nasogastric esophageal intubation

A rare and potentially fatal cause of hematemesis is fistula formation between the esophagus and the vascular system. A case report of a 39-year-old woman with congenital aortic arch anomalies hospitalized for treatment of head injuries demonstrates the potential for iatrogenic esophageal trauma to initiate fistula formation between the esophagus and an anomalous arterial system. A literature review revealed 6 other cases of vascular-esophageal fistulae caused by nasogastric esophageal intubation. It is concluded that aortic arch anomalies increase the risk of esophageal injury and subsequent fistula formation from nasogastric esophageal intubation. In addition, the clinical features and pathologic findings of vascular-esophageal fistulae are reviewed.     

Unexpected childhood death due to hemolytic uremic syndrome

Two cases of unexpected childhood death due to hemolytic uremic syndrome are reported. A 21-month-old girl who was discovered dead in bed following a short illness was found at autopsy to have overwhelming sepsis resulting from transmural colitis. Escherichia coli serotype 0157A was isolated from the intestine, and renal changes of hemolytic uremic syndrome were found. A 4-year-old girl died suddenly in hospital from intracranial hemorrhage while being treated for hemolytic uremic syndrome-related renal failure. Culture of urine and feces grew verocytotoxin producing E. coli. These cases demonstrate that hemolytic uremic syndrome may be a rare cause of unexpected childhood death and that the diagnosis may not be established prior to autopsy. Postmortem culture of tissues and fluids in cases of suspected sepsis in children may be essential in establishing this diagnosis, because histologic evaluation may be compromised by profound sepsis and tissue putrefaction. Accuracy in diagnosis may have significant public health and medicolegal consequences.     

Compensating Plaintiffs and Punishing Defendants: Is Bifurcation Necessary?

Critics of the civil jury have proposed several procedural reforms to address the concern that damage awards are capricious and unpredictable. One such reform is the bifurcation or separation of various phases of a trial that involves multiple claims for damages. The purpose of this study was to assess the effects of bifurcating the compensatory and punitive damages phases of a civil tort trial. We manipulated the wealth of the defendant and the reprehensibility of the defendant's conduct (both sets of evidence theoretically related to punitive but not to compensatory damages) across three cases in a jury analog study. We wondered whether jurors would misuse the punitive damages evidence in fixing compensatory damages and whether bifurcation would effectively undo this practice. Our findings indicated that mock jurors did not improperly consider punitive damages evidence in their decisions about compensation. Moreover, bifurcation had the unexpected effect of augmenting punitive damage awards. These findings raise questions about the merits of bifurcation in cases that involve multiple claims for damages.     

Stereolithography: a potential new tool in forensic medicine

Stereolithography is a computer-mediated method that can be used to quickly create anatomically correct three-dimensional epoxy and acrylic resin models from various types of medical data. Multiple imaging modalities can be exploited, including computed tomography and magnetic resonance imaging. The technology was first developed and used in 1986 to overcome limitations in previous computer-aided manufacturing/milling techniques. Stereolithography is presently used to accurately reproduce both the external and internal anatomy of body structures. Current medical uses of stereolithography include preoperative planning of orthopedic and maxillofacial surgeries, the fabrication of custom prosthetic devices; and the assessment of the degree of bony and soft-tissue injury caused by trauma. We propose that there is a useful, as yet untapped, potential for this technology in forensic medicine.     

Genetic enhancement technologies and the new society

So long as procreation continues to remain a central driving force in a marital relationship, and the family the very core of progressive society, efforts will be undertaken to expand the period of fecundity and combat infertility. Genetic planning and eugenic programming are more rational and humane alternatives to population regulation than death by famine and war. Genetic enhancement technologies and the scientific research undertaken to advance them should be viewed as not only aiding (or, sometimes resolving) the tragedy of infertility in family planning, but as a tool for enhancing the health of a Nation's citizens by engineering man's genetic weaknesses out of the line of inheritance. Put simply, healthier and genetically sound individuals have a much better opportunity for pursuing and achieving the "good life" and making a significant contribution to society's greater well being.     

Interpersonal trust and disaffected high school youth

The study consisted of two parts. First, a new scale of interpersonal trust for adolescents was constructed using a representative sample of 70 students from a community high school. Second, the hypothesis was tested that disaffected youth compared to the more conventional would show less interpersonal trust. Two matched groups of 57 students each were employed for the second part of the study. Results indicate that the new scale is a reliable and valid measure. Correlates of the scale disclose that trust is associated with interpersonal distance, certain developmental factors, and the quality of parent-adolescent relations. Results from the second part of the study tend to confirm the hypothesis in that greater trust scores were found among students with more conventional beliefs.This study was partly supported by NIMH Grant No. MH9210, Ford Foundation Grant No. 69-0264B, and the Jessie and C. Clement Stone Foundation.Received his Ph.D. from the University of Kansas. Currently working on personality and clinical problems of adolescents and adults.Recieved his Ph.D. from the University of Michigan. Plans to continue his work of program development in the area of affect education in secondary schools.Received his Ph.D. from Harvard University. Current work is in the area of community mental health.     

The judiciary and post-election conflict resolution and democratic consolidation in Ghana’s Fourth Republic

ABSTRACT

In recent times most elections in Africa have been fraught with post-elections conflicts that have had dire consequences on citizens. Kenya, Ivory Coast and Zimbabwe are few of these cases. This makes post-election conflict resolution a very important aspect of the electoral process deserving enormous attention. However, extant literature has not accorded it the needed attention. It is as a result of this, that this study investigates the nature of post-election conflict resolution in Ghana’s Fourth Republic. The study, based on a qualitative case study approach, found among others that, the Courts have been instrumental in consolidating democracy in Ghana, and stakeholders are devotedly operating within the legal framework governing elections, despite logistical, law enforcement and justice delivery challenges. The study being conscious of the progress made over the years concludes that, where democratic institutions are consolidating, the use of unconventional means to resolve conflicts is usually not an option.