Ulcus ventriculi und duodeni als Ursache des plötzlichen, unerwarteten Todes

A retrospective review of 6962 autopsies carried out at the Institute of Legal Medicine (University of Hamburg) during 1991–1997 was performed to identify previously unknown peptic ulcer disease as the cause of sudden, unexpected death. During this period 25 cases (58%) of fatal acute bleeding, 16 cases (37%) of fatal peptic ulcer perforation and 2 cases of coincident bleeding and perforation occurred. The following aspects are emphasized: as the cause of sudden, unexpected death peptic ulcer disease mainly affects elderly people (average of the afflicted in the reviewed autopsy series 62.2 y), members of social fringe groups and addicts (predominately alcoholics). In cases of absent or atypical symptoms, preceding false medical appraisal of the life-threatening severity of the disease and insufficient diagnoses can be frequently found.     

Der plötzliche Tod bei Asthma bronchiale

Asthma is a widespread disease with an increasing prevalence. In spite of improved therapeutic strategies some cases can still take a fatal course. A total of 21 cases of acute death in asthmatics were analysed ¶(12 females and 9 males, aged between ¶2 and 75 years old), whereby 18 cases happened at home (mostly at night), 1 in a hospital, 1 in a nursing-home and 1 in a prison. ¶A history of asthmatic attacks, chronic asthmatic lesions and signs of acute airway obstruction and right cardiac failure were characteristic for all cases. Forensic investigations included questions of external violence, intoxication or incorrect medical treatment.     

Operationszwang?

Ohne Zusammenfassung     

Vitamin K deficiency with erythromycin. Observation of a boy treated with valproate

A nine year old boy had been treated with valproic acid during one and a half years because of a grand mal epilepsy. Under an additional medication with erythromycin succinate syrup this patient developed a deficiency of prothrombin-complex, which was reversible immediately after oral intake of vitamin K. In this case it is assumed that the simultaneous application of both valproic acid and erythromycin succinate seems to suppress the vitamin K producing intestinal tract bacteria, which has not been reported in the literature so far.     

Transient synovitis of the hip in children: role of US

Transient synovitis of the hip remains a common diagnostic problem for the clinician. The physical signs are not pathognomonic of the condition, and the classic technical examinations are of little help. Therefore, the authors retrospectively studied the value of hip arthrosonography in 46 children with clinical symptoms suggesting pathologic hip conditions. In 20 of the 21 patients with a final diagnosis of transient synovitis, articular effusion was detected on ultrasound (US). Conventional radiography showed an increased medial joint space in only eight of these patients. Increased echogenicity of the articular fluid was found in both transient synovitis and septic arthritis. The high sensitivity of US in detecting intraarticular fluid was demonstrated by cadaver studies.     

Rural Health Research: Rural Hospitals and the Local Economy: A Needed Extension and Refinement of Existing Empirical Research

The relationship between the health care sector and the rural economy is of increasing importance. Much additional research is needed to fully understand this relationship and to address some of the limitations of the modest amount of research that already exists. In this study, data from Nebraska were used to create a four-part typology of rural hospitals. Input-output analysis was used to assess the economic effects of each type of hospital on the local economy and to simulate the effects of three different changes or scenarios: an increase or decrease in hospital utilization; the elimination of local purchases of nonlabor inputs; and a change in the mix or configuration of services provided. While the hospital is an important contributor to local economies, this contribution is not constant across hospital types. The total job-related effects ranged from 77 jobs for the smallest type of rural hospital to 1,332 for the largest type. Service and trade (retail plus wholesale) are the two sectors of the local economy most heavily influenced by the presence of a hospital. In today's changing and challenging environment, there is a great need for researchers to create and evaluate the economic effects of a variety of relevant and realistic scenarios (other than hospital closure).     

Renal artery stenosis: evaluation with intravenous digital subtraction angiography

The ability of diagnostic intravenous digital subtraction angiography (IVDSA) to demonstrate the degree of renal artery stenosis was compared with that of intraarterial angiography in 45 patients with 92 arteries. Stenotic lesions on both IVDSA and intraarterial studies were classified as normal (0% stenosis), minor (less than 50%), low grade (50%-80%), and high grade (80%-99%). There was agreement about the degree of stenosis in 90% of the cases. IVDSA grading was correct in 94% of atheromatous lesions and in 56% of the fibromuscular dysplastic lesions. In the high-grade atheromatous lesions, the degree of stenosis was slightly overestimated on IVDSA studies in 22.5% of the cases. In fibromuscular dysplasia, stenosis was underestimated in 33% of the cases.