Death-related gastric necrosis after laparoscopic adjustable gastric banding in the early post-operative period

We report a case of a rare complication of laparoscopic adjustable gastric banding (LAGB) as a cause of death in the immediate post-operative period. The number of relevant reports and postmortem images presented in the literature is extremely restricted. Gastric necrosis may constitute a cause of death after LAGB in the early post-operative period. Postmortem examination reveals the extension of gastric ischemia and necrosis, responsible for the lethal outcome. To date, only one case of gastric necrosis after LAGB in the immediate post-operative period leading to death has been reported, according to authors' knowledge. The diagnosis of this complication may be delayed on the grounds of its rarity. In our opinion, surgeons should be aware of the clinical state implying gastric ischemia early after LAGB, so as to recognize and, in turn, to treat it promptly.Diagn Patho

Unilateral elongated styloid process: a case report

An unusual case of a unilaterally elongated styloid process with a length of 5.8 cm was found on a dry skull of a male cadaver. During his life the subject was complaining for reported ipsilateral otalgia presumably due to nerve compression from the elongated styloid process. The symptomatology appeared by such an anatomical variant as well as relative literature is discussed in this paper

Status and perspectives of hospital mortality in a public urban Hellenic hospital, based on a five-year review

<p>Abstract</p> <p>Background</p> <p>Analysis of hospital mortality helps to assess the standards of health-care delivery.</p> <p>Methods</p> <p>This is a retrospective cohort study evaluating the causes of deaths which occurred during the years 1995–1999 in a single hospital. The causes of death were classified according to the International Statistical Classification of Diseases (ICD-10).</p> <p>Results</p> <p>Of the 149,896 patients who were discharged the 5836 (3.4%) died. Males constituted 55% and females 45%. The median age was 75.1 years (1 day – 100 years).</p> <p>The seven most common ICD-10 chapters IX, II, IV, XI, XX, X, XIV included 92% of the total 5836 deaths.</p> <p>The most common contributors of non-neoplasmatic causes of death were cerebrovascular diseases (I60–I69) at 15.8%, ischemic heart disease (I20–I25) at 10.3%, cardiac failure (I50.0–I50.9) at 7.9%, diseases of the digestive system (K00–K93) at 6.7%, diabetes mellitus (E10–E14) at 6.6%, external causes of morbidity and mortality (V01–Y98) at 6.2%, renal failure (N17–N19) at 4.5%, influenza and pneumonia (J10–J18) at 4.1% and certain infectious and parasitic diseases (A00–B99) at 3.2%, accounting for 65.3% of the total 5836 deaths.</p> <p>Neoplasms (C00–D48) caused 17.7% (n = 1027) of the total 5836 deaths, with leading forms being the malignant neoplasms of bronchus and lung (C34) at 3.5% and the malignant neoplasms of large intestine (C18–21.2) at 1.5%. The highest death rates occurred in the intensive care unit (23.3%), general medicine (10.7%), cardiology (6.5%) and nephrology (5.5%).</p> <p>Key problems related to certification of death were identified. Nearly half of the deaths (49.3%: n = 2879) occurred by the completion of the third day, which indicates the time limits for investigation and treatment. On the other hand, 6% (n = 356) died between the 29^thand 262^nddays after admission.</p> <p>Inadequacies of the emergency care service, infection control, medical oncology, rehabilitation, chronic and terminal care facilities, as well as lack of regional targets for reducing mortality related to diabetes, recruitment of organ donors, provision for the aging population and lack of prevention programs were substantiated.</p> <p>Conclusion</p> <p>Several important issues were raised. Disease specific characteristics, as well as functional and infrastructural inadequacies were identified and provided evidence for defining priorities and strategies for improving the standards of care. Effective transformation can promise better prospects.</p

Fatal drug poisonings in a Swedish general population

ABSTRACT: BACKGROUND: Pharmaceutical drug poisonings have previously been reported using single sources of information, either hospital data or forensic data, which might not reveal the true incidence. We therefore aimed to estimate the incidence of suspected fatal drug poisonings, defined as poisonings by pharmaceutical agents, by using all relevant case records from various sources in a Swedish population. METHODS: Every seventh randomly selected deceased in three counties in southeastern Sweden during a one-year period was identified in the Cause of Death Register. Relevant case records (death certificates, files from hospitals and/or primary care centres and medico-legal files) were reviewed for all study subjects. RESULTS: Of 1574 deceased study subjects, 12 cases were classified as pharmaceutical drug poisonings according to the death certificates and 10 according to the medico-legal files. When reviewing all available data sources, 9 subjects (0.57%; 95% confidence interval: 0.20-0.94%) were classified as drug poisonings, corresponding to an incidence of 6.5 (95% confidence interval: 2.3-10.7) per 100 000 person-years in the general population. The drug groups most often implicated were benzodiazepines (33%), antihistamines (33%) and analgesics (22%). CONCLUSIONS: Fatal drug poisonings is a relatively common cause of death in Sweden. By using multiple sources of information when investigating the proportion of fatal poisonings in a population, more accurate estimates may be obtained.Original Publication:Anna Jonsson, Olav Spigset, Micaela Tjäderborn, Henrik Druid and Staffan Hägg, Fatal drug poisonings in a Swedish general population., 2009, BMC clinical pharmacology, (9), 7, 1-5.http://dx.doi.org/10.1186/1472-6904-9-7Licensee: BioMed Centralhttp://www.biomedcentral.com

The global distribution of fatal pesticide self-poisoning: Systematic review

<p>Abstract</p> <p>Background</p> <p>Evidence is accumulating that pesticide self-poisoning is one of the most commonly used methods of suicide worldwide, but the magnitude of the problem and the global distribution of these deaths is unknown.</p> <p>Methods</p> <p>We have systematically reviewed the worldwide literature to estimate the number of pesticide suicides in each of the World Health Organisation's six regions and the global burden of fatal self-poisoning with pesticides. We used the following data sources: Medline, EMBASE and psycINFO (1990–2007), papers cited in publications retrieved, the worldwide web (using Google) and our personal collections of papers and books. Our aim was to identify papers enabling us to estimate the proportion of a country's suicides due to pesticide self-poisoning.</p> <p>Results</p> <p>We conservatively estimate that there are 258,234 (plausible range 233,997 to 325,907) deaths from pesticide self-poisoning worldwide each year, accounting for 30% (range 27% to 37%) of suicides globally. Official data from India probably underestimate the incidence of suicides; applying evidence-based corrections to India's official data, our estimate for world suicides using pesticides increases to 371,594 (range 347,357 to 439,267). The proportion of all suicides using pesticides varies from 4% in the European Region to over 50% in the Western Pacific Region but this proportion is not concordant with the volume of pesticides sold in each region; it is the pattern of pesticide use and the toxicity of the products, not the quantity used, that influences the likelihood they will be used in acts of fatal self-harm.</p> <p>Conclusion</p> <p>Pesticide self-poisoning accounts for about one-third of the world's suicides. Epidemiological and toxicological data suggest that many of these deaths might be prevented if (a) the use of pesticides most toxic to humans was restricted, (b) pesticides could be safely stored in rural communities, and (c) the accessibility and quality of care for poisoning could be improved.</p

Forensic and criminologic aspects of murder in North-West (Epirus) Greece

Little information is presenting in Greek literature regarding forensic and criminological aspects of homicide in North-West Greece. Autopsy reports and the prosecution authorities' files were respectively analyzed with regard to individual characteristics of perpetrators and victims, circumstances, and mode of commitment in order to comprehensively characterize relevant forensic and criminologic aspects. In the 8-year period from January 1998 to May 2005, 26 homicide cases were autopsied in the Department of Forensic Medicine and Toxicology, University of Ioannina, Greece. Twenty-nine homicide victims (18 males, 11 females; mean age 47 years) and 26 offenders were involved--20 single, 4 multiple-offenders and 2 were not known (24 males, 2 females; mean age 35 years). The most common method used for homicide was gunshot trauma (41.4%). Head injuries and multiple trauma were the most common cause of fatal injuries. Most homicides took place outside in a deserted area or close to agricultural side (n=12). Fifty percent (n=13) of all cases the offender and the victim were known to each other (acquaintances). Twenty-three cases were categorized as "single" homicides and 3 as "multiple" and the victims were classified; 20 as murder-physical injury with fatal outcome, 2 homicide-suicide, 1 infanticide, 4 matricide, and 2 as patricide.J Clin Forensic Me

Sudden cardiac death: an 11-year postmortem analysis in the region of Epirus, Greece

The aim of the study was to determine the rate of sudden cardiac death in people aged between 1 and 80 years, and to investigate its etiology. All autopsies performed during an 11-year period were reviewed. Circumstances of death, individual's information, and post-mortem findings were determined. Among 1254 sudden death autopsies performed during the study period, 688 cases were recognized as sudden cardiac death (79.8% males). The estimated annual frequency of sudden cardiac death in the region of Epirus was 18.6/100,000. The major cause of death was ischemic heart disease (82%), and in 2.6%, death was unexplained. Among our study's total population, 4.1% were <35 years old. The estimated annual rate of sudden cardiac death in the population 1-35 years old was 1.78/100,000. The most common etiology in that age group was atherosclerosis (17.8%), myocarditis (10.7%), and cardiomyopathies (10.7%), whereas 39.3% exhibited structurally normal heart. Although ischemic heart disease accounts for most of sudden cardiac death episodes, many other causes contribute. Most sudden deaths in the young were "unascertained". The likely cause of death in these cases might be a primary arrhythmogenic disorder. Correct identification of such cases at autopsy will enable an appropriate clinical screening of surviving relatives.Pathol Res Prac

Children, adolescents and young adults suicide data from Epirus, northwestern Greece

The aim of this study was to evaluate suicide trends among individuals or = 19 years involved firearms, and for those aged 16 years. Suicides by self-shooting were more often related to drinking than suicides by other methods. Children and adolescents (aged up to 15 years), older adolescents (15-18 years) and young adults (19-24 years) had suicide rates of 0.05/100,000, 0.10/100,000 and 0.39/100,000 inhabitants per year, respectively. These suicide rates are the lowest reported so far in Europe. The main reason for this may be the traditional lifestyle of the local population and the strong family ties that protect against suicide, especially for the young.Forensic Sci Med Patho