The lung of the severely premature infant: radiologic aspects

The iatrogenic pulmonary complications (interstitial emphysema, pneumothorax, atelectasis, broncho-pulmonary dysplasia) in 87 premature infants (less than 32 weeks gestational age, birth weight less than 1500 g) are analyzed. Also the predictive value of the radiologic pattern of the lung of the premature infant as seen at birth is evaluated (predictive value versus survival beyond the fifth day and versus the possible need of assisted ventilation).     

Dying with dignity: developments in the field of euthanasia in The Netherlands

The development of the debate on euthanasia in The Netherlands, the role of the courts and proposals for legislation are discussed. In foreign newspapers and other publications an erroneous picture of the Dutch situation on euthanasia is sometimes given. In Parliament two proposals for legislation are pending. The parliamentary debate is expected to be reopened in 1989.     

The role of the medical examiner in the euthanasia notification procedure in The Netherlands

The objective of the study was to provide an insight into the role of the medical examiner in the euthanasia notification procedure in The Netherlands. At the beginning of 1996 a representative group of 116 medical examiners was interviewed. The study found that there was a considerable variation in the way in which the medical examiners fulfilled their tasks. In all cases, after the physician-assisted death had taken place, the medical examiner investigated whether the attending physician had met the requirements for prudent practice, and in approximately 75% of the cases he reported his findings to the Public Prosecutor. In 78% of cases the attending physician was well known to the medical examiners, who were general practitioners, and in a third of the cases this influenced their assessment. Seventy-six per cent of the medical examiners, 61% of the members of the public prosecution and 47% of the physicians thought that it is the task to the medical examiner to review whether the requirements for prudent practice have been met by the attending physician. In conclusion further specification of the task of the medical examiner would appear to be beneficial to increase uniformity in the procedure. In particular, it should be determined whether it is the medical examiner's responsibility to review whether the requirements for prudent practice have been met. It should also be taken into consideration whether the position of the general practitioner medical examiner is sufficiently independent to make an objective report.     

The importance of the frequency of suicide attempts as a risk factor of suicide

The number of suicides in Japan has increased from approximately 22,000 per year in 1988-1997 to over 30,000 per year since then. The number has also increased in Mie Prefecture during this period. According to many reports, suicide attempts are one of the risk factors of suicide. In the present study, we investigated the incidences and circumstances of all suicide cases between 1996 and 2002, focusing in detail on the frequency of suicide attempts and general differences in the frequency of all suicide cases. During the 7 years, 1979 male and 969 female suicides were reported to Mie Prefectural Police Headquarters. During the test period, there were suicide attempts in 13.4% of all suicidal cases, 10.7% for men and 18.9% for women. The average age was 48.98 years (SD 17.68), 47.07 years (SD 16.32) for men, and 51.19 years (SD 18.89) for women. Among men, we discovered the risk factors of suicide attempts in completed suicides, which were "single time" of suicide attempts, "living with family" for the family constitution, and "visiting treatment" of the admission statuses. Among women, the risk factors were "living with family" and "visiting treatment". We must pay attention to those risk factors.     

The mechanics behind the image: foot and ankle pathology associated with gastrocnemius contracture

Contracture of the gastrocnemius musculature is a prevalent finding in the setting of foot and ankle pathology. Tightness of the posterior musculotendinous structures in the leg limits ankle range of motion and affects an equinus posture of the foot. Increased contact pressures are generated in the plantar foot with weightbearing. The resultant overload of the ligaments and the intrinsic muscles of the midfoot and forefoot is manifest in a variety of pathologic processes. The altered mechanics contributes to, among other conditions, ankle impingement, plantar fasciitis, midfoot arthritis, posterior tibial tendon dysfunction, forefoot overload, diabetic ulceration, and Charcot arthropathy. Effective management of these conditions includes addressing the underlying gastrocnemius contracture as well as the related foot and ankle pathology. Here we describe the underlying biomechanical abnormalities and radiographic findings in these pathological conditions of the foot and ankle associated with gastroequinus contracture. An awareness and understanding of the pathomechanics should enable the radiologist to better appreciate the form and function associated with the image.     

The suicide of General Emory Upton: a case report

On the evening of March 14, 1881, Emory Upton inexplicably and unexpectedly committed suicide. He was acknowledged as the United States Army's leading tactician of his day; his drill manual, A New System of Infantry Tactics, Double and Single Rank, had been officially adopted by the Army in 1867. The entire Army was stunned by the news. For the past century, a mystery has remained as to the medical factors that led to his suicide. This paper will examine the existing medical records and offer a probable modern diagnosis for this unique 109-year-old case report.     

The indicators associated with increasing suicide trends: Need for harmony in discussing suicide in legal medicine and other fields

Each year in Japan from 1990 to 1997, approx. 21,000–24,000 individuals committed suicide. In 1998, the number of suicides increased to >30,000, and a trend of high suicide numbers then persisted for >10 years. Although Japan’s annual number of suicides has recently been decreasing, it remains among the highest worldwide. Herein, we assessed the annual suicide data (numbers and rates) related to three economic and life indicators: (1) the difference between actual income and consumer spending of one average month per year in one household, (2) the annual difference between exports and imports, and (3) the annual total debt determined by statistical analyses for both sexes/males/females during the 40-year period from 1979 to 2018 in Japan. Our findings indicated that [1] total debt may be associated with both the number of suicides and the suicide rate for both sexes, for males, and for females, and [2] the difference between actual income and consumer spending may be associated with both the number of suicides and the suicide rate only in females. These findings revealed factors that are clearly suicide-related, and it is necessary to design suicide prevention strategies based on the factors. Relevant public and private entities should become aware of the involvement of both debt and the difference between income and spending in suicide trends as they plan suicide prevention measures. Further analyses of suicide data should be performed in a wide range of fields including legal medicine, toward a greater understanding of suicide risk factors.     

Assisted suicide in the care of mentally ill patients: The Lucio Magri's case

A year after Mario Monicelli's suicide, the death of another famous person in Italy, Lucio Magri, reawakened the Italian debate on social, ethical and juridical issues in end-of-life decisions. Unlike Monicelli, Lucio Magri decided to end his own life in Switzerland with the help of a physician because his mental illness rendered his life unbearable. Both Monicelli and Magri suffered from a severe depression. The authors analyze the ethical issues regarding the right to die for mentally ill patients and neurological disabled patients, discussing the decision-making autonomy in persons suffering from severe depression. The role of the psychiatry in the management of end-of-life decision requests is considered along with pros and cons of suicide prevention and rationale suicide.