Faculty Bibliography

Case histories of proposed life insurance are presented to introduce the topic of cardiac valvular tumors. Using fibroelastoma as the prototypical cardiac tumor, pathology, diagnosis, echocardiographic findings and clinical course are reviewed, based on available clinical literature. Although the natural history of benign cardiac tumors is uncertain, because of the risk of adverse outcomes, cases must be underwritten on an individual basis until long-term studies become available

Ofri reviews Sloan-Kettering by Abba Kovner and translated by Eddie Levenston

Torture and ill-treatment are reportedly widespread in Mexico. Little is known, however, about the quality of forensic investigations and documentation of evidence of these human rights violations. To determine the integrity of the documentation and the presence, quality, and frequency of both physical and psychological evaluations, analyses were conducted on 103 medical evaluations identified in 33 cases of alleged torture and/or ill-treatment that the Mexican National Commission for Human Rights (CNDH) investigated between January 2000 and July 2002. Findings suggest that forensic medical evaluations in CNDH cases have been conducted promptly after alleged occurrences of torture and/or ill-treatment, and the results of such evaluations have often been introduced as evidence in legal investigations. Inadequate documentation in most forensic medical evaluations reinforces the need for effective training, monitoring, and accountability strategies.

BACKGROUND: 'Chasing the dragon' involves placing heroin on aluminum foil, heating it from below with a flame, and inhaling the pyrolysate through a straw. It has rarely been associated with the development of a progressive spongiform leukoencephalopathy. CASE REPORT: A 43-year-old woman presented with 2 weeks of bizarre behavior, forgetfulness, and slowed speech and movements. Serum, cerebrospinal fluid, and head computed tomography (CT) scan were normal. The patient progressed to coma and expired during week 4 of hospital admission. The family confirmed that she 'chased the dragon.' Cause of death at post mortem examination was spongiform leukoencephalopathy. CONCLUSION: The diagnosis of heroin pyrolysate-induced spongiform leukoencephalopathy should be considered in a patient with a history of 'chasing the dragon' and neurobehavioral changes, including confusion, apathy, cerebellar signs, and motor restlessness