Two cases of secondary AA amyloidosis involving the skin and chronic kidney infection with a nephrotic syndrome in a high-income country

We present two French cases of amyloid-associated (AA) amyloidosis secondary to chronic infections. Patient 1, a 51-year-old heroin addict, was hospitalised for chest pain and anasarca. During hospitalisation, a nephrotic syndrome with an inflammatory condition was discovered along with a chronic skin ulcer on his arm. Salivary gland and kidney biopsies confirmed the diagnosis of AA amyloidosis. Renal function quickly declined and haemodialysis was initiated 6 months later. Patient 2, a 55-year-old woman, was hospitalised for obstructive pyelonephritis secondary to coraliform lithiasis. Renal insufficiency with an impure nephrotic syndrome was found. After nephrectomy due to chronic pyelonephritis and an atrophic cortex on the abdominal scan, the histology revealed AA amyloidosis. Despite treatment with ACE inhibitors and control of inflammation, the nephrotic syndrome persisted with rapid decline of the kidney function.

An Unusual Case of Gas Gangrene in Intravenous Heroin Addict

BACKGROUND: Gas gangrene is a clostridium infection primarily of muscle tissue, most commonly caused by C. perfringens. Clinical diagnosis is usually made by local inspection of the wound: the infected tissue shows characteristic signs of tissue inflammation with blistered changes. The disease can starts suddenly, 4-6 hours after the injury, but most commonly the incubation period lasts 2-4 days. Without proper medical intervention, death occurs in 4-24 hours after the development of the first symptoms, but even with timely and adequate therapy, the lethality is very high (around 12%). Due to its fulminant course, in all cases with fatal outcomes, a forensic autopsy is an obligatory procedure. However, discovering the entrance gate and source of infection is not an easy task, especially in the absence of a traumatic injury. CASE PRESENTATION: Male, 27 years old, an intravenous heroin addict for about 10 years, injured his left leg in a traffic accident. He only visited the doctor after 5 days. Upon examination, it was determined that there were no externally visible injuries and no fracture, and he was given a splint immobilization for an ankle luxation. Twelve days after the accident (or 7 days after the immobilization) his mother found him unconscious. CONCLUSION: From medicolegal aspects, it’s important to have in mind even the less frequent paths of infection, in order to give an expert professional opinion on origin and cause of death.

Knowledge

This chapter begins with United States v. Moore, a case from the United States Court of Appeals for the District of Columbia involving a heroin addict charged with drug possession. It describes in more detail what the actus reus and mens rea requirements entail when applied to a defendant who realized he was committing a crime. It discusses, in relation to actus reus, free will as the capacity to choose otherwise, proposes a test to help determine if a defendant lacked the capacity to choose otherwise (the Stephen test), and compares the actus reus requirement to the existing defense of insanity. In relation to mens rea, the chapter explains how the Jekyll test (introduced in Chapter 2) applies to defendants who realized there were committing a crime, and then compares mens rea to the existing defenses of duress and provocation, as well as to the problem of the “willing addict.” It concludes with a discussion of the circumstances under which the state can legitimately ascribe guilt to a defendant who lacked actus reus or mens rea at the time of the crime but whose guilt can nonetheless be traced to a prior guilty act or omission.

Stalled

This chapter relates how CBS Cinema Center Films agreed to make Two-Lane Blacktop and Monte Hellman chose cinematographer Gregory Sandor to shoot the film using wide-screen Techniscope. Over the objections of casting director Fred Roos, who brought in dozens of young, trained actors, Hellman chose rock stars for the two lead roles.: James Taylor, then a heroin addict who nevertheless was not using during the shoot, would play the Driver and Dennis Wilson, the Beach Boys’ drummer, a juvenile, drug-taking, erratic young man who had befriended the cult murderer Charles Manson, would play the Mechanic. Hellman’s girlfriend Laurie Bird would play the Girl, and Warren Oates would portray GTO. Hellman and associate producer Gary Kurtztravelled across the country scouting locations that they would use with minimal set dressing, since they had only a $1 million budget and no production designer. Then CBS dropped the film.

Sexual In-betweener/Industry In-betweener: The Career and Films of Lisa Cholodenko

This chapter claims that Lisa Cholodenko’s work exemplifies the sort of ‘in-betweenness’ that resists and challenges established categories. Identified with the lesbian branch of the New Queer Cinema of the early 1990s, evoking both praise and divisive reactions, Cholodenko’s High Art (1998), about the professional and sexual relationship between a young straight female art critic and journalist and a brilliant lesbian artist/heroin addict, was controversial at a time when lesbian indies were usually lo-fi romances. Likewise, her more mainstream lesbian family drama The Kids Are All Right (2010) has been accused of compromise with heteronormative patriarchal values. San Filippo argues that rather than ‘betraying’ lesbian cinema, her characters and films traverse boundaries and resist sexual, ideological and industrial categories.