Common Offenders Research Articles

Metastasis to nervous system: spinal epidural and intramedullary metastases

Spinal cord epidural metastasis (SEM) is a common complication of systemic cancer with an increasing incidence. Prostate, breast and lung cancer are the most common offenders. Metastasis usually arises in the posterior aspect of vertebral body with later invasion of epidural space. Pathophysiologically, vascular insufficiency is more important than direct spinal cord compression. The most common complaint is pain, and two thirds of patients with SEM have motor signs at initial diagnosis. Currently magnetic resonance imaging is the most sensitive diagnostic tool. The optimal management of SEM is still arguable, but recent advances in surgical management of SEM and higher complication rate of surgery following radiotherapy should persuade clinicians to consider de novo surgery where possible. Radiotherapy has an important role, particularly in treatment of radiosensitive tumors and in patients who are not candidates for surgery. Novel approaches such as stereotactic radiosurgery are promising; however, response to chemotherapy depends on inherent properties of primary tumor. Recurrent SEM is a substantial problem for which surgery or repeat radiotherapy may be options. Intramedullary metastasis is rare but should be considered in patients with systemic malignancy and asymmetrical presentation of myelopathic symptoms. The prognosis is usually poor and preferred modality of treatment is radiotherapy.

Thrombocytopenia Associated with Intravenous Ciprofloxacin

A variety of disease states, disorders, hereditary conditions, environmental toxins, and drugs may cause thrombocytopenia. Fluoroquinolones, however, are not thought to be common offenders. We report the case of a 72-year-old woman who was receiving intravenous ciprofloxacin for a urinary tract infection and developed thrombocytopenia during her hospital stay. Her platelet count dropped from 147 x 10(3)/mm3 on admission to as low as 21 x 10(3)/mm3 . On discontinuation of the drug, her platelet counts began to return to normal. After discharge, the patient continued to improve clinically. Four days after discharge, her platelet count was 197 x 10(3)/mm3 . In the primary literature, we found two case reports on thrombocytopenia associated with ciprofloxacin and one case report with alatrofloxacin. In addition, six additional case reports were found in non-English journals that describe fluoroquinolone-associated thrombocytopenia. Clinicians should be aware of the possible relationship between thrombocytopenia and fluoroquinolones, and platelet counts should monitored accordingly.

Pill Esophagitis Is a Distinct Endoscopic Entity vs Reflux Esophagitis - a Case Control Study

Pill esophagitis is caused by topical mucosal injury of improperly swallowed medications. It can be difficult to diagnose by history particularly in older pats with poor recall and multiple medications, and it can be confused with GERD. Its endoscopic findings have not been compared with reflux esophagitis. STUDY AIMS: Retrospective case-control study of 28 pts with pill induced esophagitis (PILL), and 41 controls with reflux esophagitis referred for endoscopy (GERD). MATERIALS AND METHODS: Retrospective review of symptoms: chest pain, odynophagia, dysphagia, heartburn, dyspepsia; and endoscopic findings: distal esophagitis (LA classification), discontinuous ulcers, whitish exudate (candida negative), mucosal necrosis in the 2 groups. Statistical analysis: InStat v3.0. RESULTS: The PILL group was signficantly older (χ66±16yo) vs GERD controls (χ58±10 yo; p<0.006), with similar % women (60%PILL vs 57%PILL;p=NS). At endoscopy chest pain was present in 50% of PILL pts vs 3% of GERD pts*, odynophagia in 57% of PILL pts vs 0% of GERD*, dysphagia 78% of PILL pts vs 8% of GERD pts*. Heartburn was present in 43% of PILL pts vs 92% of GERD pts*. All values were significant (*p<0.001). Endoscopic findings: distal esophagitis LA grade A 14% PILL vs 63% GERD pts*, LA grade B 14% PILL vs 20% GERD (p=NS); LA grade C 29% PILL vs 12% GERD*. Discontinuous ulcers present in 71% of PILL pts and 0% of GERD pts*; whitish exudate present 78% of PILL pts vs 2% of GERD pts, mucosal necrosis in 25% of PILL pts vs 0% GERD pts. Pills/pill fragments present at EGD in 25% of PILL pts. Offending medications in PILL group: NSAID/ASA-50%, alendronate 17%, vitamin C 10%, niacin 3%, no specified 7%. CONCLUSIONS: Pill esophagitis is a specific endoscopic entity with findings distinct from GERD. Discontinuous ulcers, whitish candida negative exudate and mucosal necrosis very specifically separate it out from GERD at EGD. NSAIDs/ASA were the most common offenders. *p<0.001; data χmean ± SD.

Offender profiling and investigative psychology

AbstractThe origins of ‘Offender Profiling’ in the advice given by police medical advisors and other experts to criminal investigations are briefly outlined. The spread of such advice to police enquiries across the United States in the early 1970s, culminating in its uptake by Special Agents of the FBI in the mid‐1970s and the widespread promotion of their services through the fictional writings of Thomas Harris and others is noted.The development beyond the early application to serial killer investigations, and the focus on psychopathological explanations, to cover the full gamut of crime from, for instance, arson and burglary to terrorism, is briefly reviewed. The consideration of the social psychological processes inherent in criminality as well as the characteristics of individual offenders also broadens out the concerns of the field. The linking of crimes to a common offender as well as predicting their future actions further widens the range of issues to be dealt with.The many psychological and practical questions raised by these ‘profiling’ activities are summarised. These include questions of inference and prediction, about criminals and their crimes, both about their characteristics and about the spatial patterns of their activities. Related topics concerning the sources of information for both investigators and research are also summarised. These cover the full range from interviewing witnesses to the management of informants. The complexity of information management and inference derivation points to the need to understand investigative decision‐making and how it can be supported.These other issues, beyond those inherent in ‘profiling’, such as data integrity and investigative decision support, taken with the central ‘profiling’ questions leads to the identification of a new domain of applied psychology, ‘Investigative Psychology’. It is argued that the core topic of this domain, as in any emerging science, is how to appropriately describe and classify the central matters under consideration, i.e. criminals and their activities. The difficulties in setting up reliable, robust and valid classification schemes are discussed and approaches to overcoming these difficulties considered. It is emphasised that although many researchers have found Multi‐Dimensional Scaling procedures to be productive they are only one of many fruitful sets of approaches that are possible.The increasing variety of areas, for which Investigative Psychology is relevant, from tax evasion to peace keeping, and from evidence in court to organisational threat management, is briefly reviewed. In conclusion it is noted that Investigative Psychology can be considered as a general approach to problem solving relevant far beyond criminal investigations. This new Journal of Investigative Psychology and Offender Profiling therefore has rich and wide‐ranging potential. Copyright © 2004 John Wiley &amp; Sons, Ltd.

The approach to the patient with anaphylaxis

Anaphylaxis is an acute, life-threatening, multisystem response to a variety of triggers. Anaphylaxis affects multiple organ systems including the cutaneous, pulmonary, cardiovascular, and gastrointestinal systems. In 1949, the first case of fatal anaphylaxis to penicillin was reported. Antibiotics remain the most common cause. Other drugs implicated include non-steroidal anti-inflammatory drugs. Hymenoptera stings represent the second most common cause of anaphylaxis. Food is also a common offender. The clinical manifestations of anaphylaxis are the end result of a complex cascade involving multiple cell lines and chemical mediators. The final common pathway in anaphylaxis is the activation of mast cells and circulating basophils with subsequent degranulation and release of preformed mediators. The earliest cell mediator to be recognized was histamine. While it is important to note the signs and symptoms of anaphylaxis vary from patient to patient, one of the hallmarks of anaphylaxis is the rapidity of onset of symptoms. Cutaneous manifestations include urticaria and angioedema. The more serious aspects involve the pulmonary and cardiovascular systems. Prompt recognition and initiation of treatment is crucial. Respiratory failure and cardiovascular collapse can occur in a matter of minutes. Initial management should be directed at protecting the airway and maintaining cardiovascular function. Pharmacological measures should be based on the severity of symptoms as well as the clinical presentation. As with all allergic diseases, avoidance and prevention are the mainstays of therapy.

Diagnostic Evaluation

The diagnosis and management of adverse food reactions is a challenge for pediatricians and other primary care providers. Children of all ages may present with a variety of symptoms that parents have attributed to constituents of the diet. An approach has been devised to aid pediatricians in the evaluation of these children. The process begins with a detailed history. This history may be used to classify the problem into categories of symptoms and possible mechanisms. When common food offenders are suspected of causing symptoms, it is reasonable to obtain in vitro tests that may then be used to decide whether elimination of certain foods is indicated and whether a referral to an allergist is needed. Using this approach, the physician may be able to identify children who are experiencing food-allergic symptoms and aid frustrated families in dealing with problems that have not had apparent solutions. The application of specific testing and the assessment of the results are discussed. Also reviewed are the techniques used by allergists so that pediatricians may help families understand procedures that will be recommended and performed.

Linking commercial burglaries by modus operandi: tests using regression and ROC analysis.

This paper uses statistical models to test directly the police practice of utilising modus operandi to link crimes to a common offender. Data from 86 solved commercial burglaries committed by 43 offenders are analysed using logistic regression analysis to identify behavioural features that reliably distinguish between linked and unlinked crime pairs. Receiver operating characteristic analysis is then used to assign each behavioural feature an overall level of predictive accuracy. The results indicate that certain features, in particular the distances between burglary locations, lead to high levels of predictive accuracy. This study therefore reveals some of the important consistencies in commercial burglary behaviour. These have theoretical value in helping to explain criminal activity. They also have practical value by providing the basis for a diagnostic tool that could be used in comparative case analysis.

The Aggression Questionnaire: a validation study in student samples.

The goal of this study was to examine the psychometric properties of the Aggression Questionnaire (AQ) in Spain. The AQ is a 29-item instrument designed to measure the different dimensions of the hostility/anger/aggression construct. It consists of 4 subscales that assess: (a) anger, (b) hostility, (c) verbal aggression, and (d) physical aggression. In Study 1, reliability, construct validity, and convergent validity were evaluated in a group of 384 male and female university students. Test-retest reliability was evaluated using a group of 154 male and female university students. The results of the factor analysis were similar to the scale structure claimed for this instrument. The subscales also showed internal consistency and stability over time. The AQ and its subscales were also compared with the scales and subscales of the Spielberger State-Trait Anger Expression Inventory (STAXI), the Cook-Medley Hostility Scale (Ho), the Buss-Durkee Hostility Inventory (BDHI), and the Jenkins Activity Survey-Form H (JASE-H). The results show that the AQ evaluates some aspects of anger, such as Anger-Trait and Anger-Out, rather than other elements, such as Anger-In or Anger-State. In Study 2, two new male groups were used to evaluate the criterion validity of the AQ: 57 prison inmates and 93 university students, finding that this instrument discriminated between the scores obtained by common offenders and university students.

Etiology of spontaneous perirenal hemorrhage: a meta-analysis.

We determine the most common etiology of spontaneous perirenal hemorrhage. A MEDLINE search of the English language literature from 1985 to 1999 revealed 47 publications and 165 cases of spontaneous renal hemorrhage meeting our study entry criteria. These criteria were presentation of raw data including imaging modality, pathological confirmation (123 cases) or long-term (greater than 2 years) (42) imaging and/or clinical followup and no history of recent trauma, anticoagulant use, dialysis or renal transplant. Meta-analysis was performed using analysis of counts derived from contingency tables and pooled and stratified analysis. Hemorrhage was identified by ultrasound in 56 of 100 cases (56%) and by computerized tomography (CT) in all 135 cases assessed (100%). Etiology was correctly identified with an overall sensitivity and specificity of 0.11 and 0.33 for ultrasound and 0.57 and 0.82 for CT. Angiography in 81 cases revealed active bleeding in 11. The most common etiology of spontaneous renal hemorrhage was benign or malignant neoplasm (101 cases, 61%) with angiomyolipoma being predominant (48) followed closely by renal cell carcinoma (43). Vascular disease was the next most common offender (28 cases, 17%) with polyarteritis nodosa occurring most frequently (20). The most common cause of spontaneous perirenal hemorrhage is renal neoplasm and approximately 50% of such neoplasms are malignant. CT is the method of choice for evaluation of perirenal hemorrhage, although its sensitivity for detection of underlying etiology is only moderate.

Etiology Of Spontaneous Perirenal Hemorrhage: A Meta-Analysis

Etiology Of Spontaneous Perirenal Hemorrhage: A Meta-Analysis

Catheter thrombosis.

Catheter malfunction due to poor flow is a common problem. When it occurs early, the cause is generally technical. Late occurrences are most often related to thrombus formation. Several types of thrombus may be seen, differing by location and supposed mechanism of formation. The most common offender, however, is the fibrin sheath thrombus. Prevention of catheter malfunction is an endeavor that continues to beg many questions. Catheter malfunction should be treated early to avoid inadequate dialysis. In the past, urokinase was a highly valuable aid to the nephrologist in managing this problem. Since this agent became unavailable a suitable alternative has not emerged. Recombinant tissue plasminogen activator (tPA) seems to be the most likely candidate for this role; however, it is not currently available in a packaging form that is optimal for this purpose. Currently, catheter exchange appears to be the best available alternative for this problem, which cannot yet be resolved by simpler means.

DRUG-INDUCED AUTOIMMUNE DISORDERS

Drug-induced autoimmune disorders have been recognized for over 50 years. In 1945, Hoffman 60 reported drug-induced lupus (DIL) in a 19-year-old man receiving sulfadiazine who developed fever, skin rash, myalgia, nephritis, and an elevated sedimentation rate. Since then, over 70 drugs have been reported to cause a lupus-like illness. Recognition of the development of drug-induced autoimmune disorders and the development of alternative drugs to replace common offenders, such as procainamide and hydralazine, have resulted in a reduction of the incidence of DIL. With increasing use of agents that target cytokine and other immunologic pathways, however, it is possible that we may see more drug-induced autoimmune disorders in the future. This article discusses the common nonhematologic, drug-induced autoimmune disorders, including DIL, and some of the newer descriptions of autoimmune disorders believed to be related to the use of some biological agents.

Index of Suspicion

Index of Suspicion

Drug related involvement of specific sites in fixed eruptions: a statistical evaluation.

Different drugs produce fixed eruptions over different parts of the body. However, the significance of preferential site involvement in fixed eruptions due to specific drugs has not been statistically evaluated. One hundred and twenty five patients of fixed drug eruption (FDE) were studied to examine this question. Different sites affected by individual drugs were classified as lips alone, genitalia alone, lips and genitalia together, trunk alone, trunk and limbs together, and generalized. Statistical analysis was carried out for 7 common drugs causing FDE in 5 or more patients. Cotrimoxazole, a combination of sulfamethoxazole and trimethoprim, was the most common offender for FDE (32.8%), followed by analgin (12%), tetracycline (8%), pyrazolones (8%), metronidazole (6.4%), ciprofloxacin (5.6%), and phenytoin sodium (4%). Major sites involved by FDE were trunk and limbs (24%), lips alone (20.8%), genitalia alone (20%), generalised (14.4%), lips and genitalia together (11.2%), and trunk alone (8.8%). Seventy-two (57.6%) patients had multiple lesions; 33 (42.4%) had single lesions. Involvement of mucocutaneous junctions of lips and genitalia by FDE was frequently caused by cotrimoxazole and tetracycline; trunk and limbs, by analgin and pyrazolones. Generalised eruptions were commonly caused by cotrimoxazole and phenytoin. The present statistical analysis confirms the clinical impression that genitalia alone are frequently involved in FDE due to tetracyclines (p < 0.001). FDE over trunk and limbs was significantly associated with analgin (p < 0.001), and generalised eruptions, with phenytoin sodium (p < 0.001). The association of FDE over lips with cotrimoxazole was statistically not significant.

ABC of Rheumatology: PAIN IN NECK, SHOULDER, AND ARM

Pain in the neck is a common clinical presentation in primary care and rheumatological practice. It has been estimated that half of the population will have an episode of neck pain during their lifetime. Up to a third of patients attending general practices with neck pain will have had symptoms lasting more than six months or recurring in bouts. Symptoms arising in the neck are often poorly localised, and there may be difficulty making a precise anatomical diagnosis, particularly as the clinical signs of neck disorders are neither sensitive nor specific. However, certain features of a patient's history and examination help to distinguish common mechanical disorders from more sinister systemic disease. A full history and physical examination are therefore essential for anything other than trivial neck pain. Normal cervical lordosis, which is often lost in neck disorders. Acute spasm of the neck muscles (spasmodic torticollis) is a common phenomenon. The exact cause of the spasm is uncertain but often appears to be due to bad posture. Examples include poor positioning of a computer screen, inappropriate seating, and sleeping without adequate neck support. Another common offender is carrying unbalanced loads, such as a heavy briefcase or shopping bag. A careful history is often required to identify such factors. Degenerative changes in the cervical spine (cervical spondylosis) may be associated with neck pain but usually only when the degenerative changes are severe. Mild or moderate degenerative changes are often seen in asymptomatic individuals. In general the pain of mechanical disorders is intermittent and related to use. At least partial relief may be gained by supporting the head and neck. Poor sleeping posture is a common cause of neck pain. Pain referred to the arm may indicate irritation or entrapment of a nerve root. Common causes are a prolapsed cervical disc or degenerative …

Dermatoglyphics in Individuals with Asocial Behaviour

The patterns of fingertip prints (dermatoglyphics) in Swedish series of sexual offenders of law compared with common offenders of law and normal individuals were analysed. The dermatoglyphic patterns in common offenders of law did not differ from those in normal individuals. The group of sexual offenders of law showed statistically significant differences (p < 0.001) in the dermatoglyphic patterns compared to the samples of common criminals and normals.

Are White-Collar and Common Offenders the Same? An Empirical and Theoretical Critique of a Recently Proposed General Theory of Crime

This article addresses two propositions on white-collar crime derived from a general theory of crime recently proposed by Gottfredson and Hirschi. This theory predicts that white-collar offenders are (a) as criminally versatile and (b) as prone to deviance as common offenders. To assess the validity of these propositions, the authors investigate the criminal records of white-collar and common offenders and their respective levels of participation in deviant activities. As the general theory predicts, some white-collar offenders are involved in crime and deviance to much the same degree as typical street criminals. A large majority differ significantly from street criminals in these regards, contradicting the theory and limiting its generality. The authors argue that the theory's rejection of motives as important causal forces is misguided and that a more complex causal structure is needed to account for patterns of white-collar offending.

When Laboratory Tests Are Abnormal and the Patient Feels Fine

With routine biochemical screens, the problem is often with the tests, not with the patient. Nine of the most common offenders, which provide little if any useful information in the absence of clinical manifestations, are reviewed.

Social control and imprisonment during the American revolution: Newgate of Connecticut

During the period immediately before the American Revolution, Connecticut colonists became increasingly concerned with citizens who retained sympathies for the British Crown. The possession of such sympathies by Loyalists became the occasion for escalating informal and formal efforts to contain this newly troubling form of deviance. This paper details briefly the origins of the fractionalization of Connecticut society into patriot and loyalist factions and then presents a case study of the use of Newgate Prison of Connecticut as a tool for the suppression of such deviance. Newgate Prison, it may be argued, was the first true colonial prison for the long-term punishment of serious offenders. Although the prison was designed for conventional offenders, the war transformed the mission of the facility so that it confined common and political offenders simultaneously in a nonsegregated institutional environment. The wartime experience of the prison is described, the use of incarceration in Newgate is considere...

Disseminated Coccidioidomycosis Detected by Percutaneous Liver Biopsy in a Liver Transplant Recipient

The authors report the first case, to their knowledge, of disseminated coccidioidomycosis occurring in a liver transplant recipient. The case is also interesting in that the diagnosis of disseminated coccidioidomycosis was made fortuitously, only after finding the characteristic endosporulating spherules on a percutaneous liver biopsy. In addition, the authors reviewed the literature on post-transplant infection with particular emphasis on fungal pathogens. All studies concurred that Candida species was the most prevalent infecting fungal organism when both localized and disseminated forms of infection are included. Aspergillus was the second most common offender, and disseminated infection was associated with a very grave prognosis for the transplant recipient. Rare infections with Mucor and Cryptococcus neoformans are described in the literature.