Different degrees of ischaemic injury in the right and left ventricle in cases of severe, nonfatal, pulmonary embolism.

Pulmonary fat embolism (PFE) is a common complication of blunt force traumas with bone fractures. Severe forms cause impedance to right ventricular (RV) ejection, with eventual right heart ischaemia and failure. In a prospective study, we have investigated 220 consecutive autopsy cases (73 females, 147 males, mean age 52.1 years, min 14 years, max 91 years). PFE was detected in 52 cases that were divided into three groups according to the degree of PFE (1-3). A fourth group of cases of violent death without PFE was used for comparison. In each case, histology (H&E, Masson) and immunohistochemistry (fibronectin and C5b-9) were performed on six cardiac samples (anterior, lateral and posterior wall of both ventricles). The degree of cardiac damage was registered in each sample and the mean degree of damage was calculated in each case at the RV and left ventricle (LV). Moreover, a parameter ∆ that is the difference between the mean damage at the RV and the LV was calculated in each case. The results were compared within each group and between the groups. In the present study, we could not detect prevalent RV damage in cases of high degree PFE as we did in our previous investigation. In the group PFE3 the difference of the degree of damage between the RV and LV was higher than the one observed in the groups PFE0-2 with the antibody anti-fibronectin. Prevalent right ventricular stress in cases of severe PFE may explain this observation.

An extraordinary case of an intracranial foreign body after a gunshot to the head.

Intermediate targets (IT) can modify the morphology of an entrance wound, the trajectory of the bullet, and contaminate the path with fragments or material from the target. The penetration into the body of big fragments or even of an entire IT is exceptional and only rarely reported in the literature. The interpretation of a gunshot wound after contact of the bullet with IT can sometimes be very tricky as the classical morphology can be missing. The presented case is a rare example of atypical entrance wound and path due to a surprising intermediate target of a gunshot fired against the head.

[Positional asphyxia, a cause of death insufficiently known]. / Asphyxie positionnelle: une cause de décès insuffisamment connue.

Positional asphyxia (AP) is a fatal condition arising because of the adoption of particular body positions, causing mechanical interference. Consequences are important alveolar hypoventilation and cardiac hyperexcitability due to respiratory acidosis in combination with extensive liberation of catecholamine occurring in attracted individuals sustaining physical restrain. This syndrome can occur in various circumstances and is mostly observed in situations with physical restraint and in combination with excited delirium (ED). The diagnosis is essentially based on three criteria: body position obstructing normal breathable air exchange, impossibility to move to another position and exclusion of other causes of natural or violent death.

Justice and the justification of a social policy: the distribution of primary care physicians.

A just distribution of primary care physicians in the United States would be one based on patient need. Given the nature of primary care and the distribution of need for primary care, such a principle would yield a pattern of roughly equal distribution of primary care physicians. A justified policy of distribution must take into account not only considerations of justice but other moral, political and economic considerations. It is argued that in the case of primary care physicians a policy of egalitarian distribution is justified. Methods for implementing such a policy are considered. It is argued that a workable policy must include some restriction on physicians' choice of practice location. A method of implementation is suggested.

KIE: It is argued that a just geographic and demographic distribution of primary care physicians in the United States should be based on the principle of need and that the distribution pattern should be "egalitarian," i.e., aimed at providing a uniform per capita distribution while ensuring roughly equal geographic access. The author describes the nature of primary care, details present distribution inequities, and explains why need is the most relevant distribution principle. He considers the role of health care in assuring national security and economic productivity, as well as the contribution of primary care physicians to a sense of community. He refutes counterarguments, such as those based on objection to restrictions on a physician's liberty, and proposes an approach to implementing a public policy of equal geographic access to primary care.

Policondritis recidivante / Relapsing polychondritis

La policondritis recidivante, es una infrecuente enfermedad inflamatoria del tejido conjuntivo, de etiología desconocida. Se caracteriza por inflamación episódica y progresiva de tejido cartilaginoso, principalmente del pabellón auricular, nariz y árbol traqueo-bronquial. Se presenta el caso de una paciente femenina de 58 años, que consulta por enrojecimiento y dolor en pabellón auricular derecho, con episodios previos similares en ambos oídos y nariz, además de estudio por poliartritis simétrica. Al examen físico destaca: eritema, edema y dolor local en pabellón auricular, respetando lóbulo. Con exámenes complementarios normales y presencia de tres criterios característicos de McAdam, se diagnostica policondritis recividante, iniciando prednisona oral, con respuesta favorable. Pese a ser una enfermedad poco frecuente, es importante considerarla en casos recurrentes de eritema y dolor local en regiones cartilaginosas, principalmente en pabellón auricular y nariz, de tal forma de lograr un diagnóstico precoz, para suprimir las crisis y mejorar el pronóstico de estos pacientes.

Relapsing Polychondritis (RP) is a rare inflammatory connective tissue disease of unknown etiology. It is characterized by episodic and progressive inflammation of cartilage tissue, especially ear, nose and tracheobronchial tree. We report the case of 58 year old Chilean female patient, who consulted for redness and pain in the right ear, with similar previous episodes in both ears and nose; along with symmetric polyarthritis study it is presented. Physical examination highlighted erythema, edema and local pain in ear, respecting lobe. With normal complementary examinations and presence of three diagnostic criteria of McAdam y col. relapsing polychondritis diagnosed, initiating oral prednisone, with favorable response. Despite being a rare disease, it is important to consider in recurrent cases of erythema and local pain in cartilaginous regions, mainly in ear and nose, so to achieve early diagnosis, to suppress the crisis and improve the prognosis of these patients.

Binding of xenobiotics to hepatic estrogen receptor and plasma sex steroid binding protein in the teleost fish, the common carp (Cyprinus carpio).

Competitive receptor binding assays have been suggested as an in vitro screening tool for assessing the activity of alleged estrogenic substances. In this study, we determined the ability of steroidal and nonsteroidal substances to inhibit the binding of [(3)H]17 beta-estradiol (E2) to the hepatic estrogen receptor (ER) and the plasma sex steroid binding protein (SBP) of the teleost fish, the common carp (Cyprinus carpio). The objectives of the study were (1) to characterize ER binding in the liver cytosol of male and female carp, (2) to establish complete [(3)H]E2 displacement curves from carp ER for a range of natural and xenobiotic substances and to compare the ligand data of carp ER with published data from other vertebrate species to reveal possible species differences, and (3) to determine the interaction of natural and xenobiotic substances with the steroid binding site of SBP in carp plasma. The results indicate the presence of a single class of estrogen binding sites with high affinity and limited capacity in liver cytosol of carp. The various test agents showed partly quantitative differences in their binding affinities, with the xenobiotics generally showing limited ability to displace [(3)H]E2 from the hepatic ER or from plasma SBP of carp. However, we found no evidence that a compound is an ER ligand exclusively in one species. The findings of this study indicate that interspecies extrapolation of steroid receptor binding data is possible on a yes/no basis but not on a quantitative basis.