Medico-Legal Journal最新文献

Fatal choking due to aspiration of roundworm during laparoscopic cholecystectomy. 腹腔镜胆囊切除术中吸入蛔虫导致致命窒息。

Medico-Legal Journal Pub Date : 2025-03-28 DOI: 10.1177/00258172241304737

Shinto Devassy, Ravi Rautji, Asit R Mridha, Chittaranjan Behera

引用次数: 0

Fatal ruptured unrecognised aortic aneurysm. 致命的未被识别的破裂主动脉瘤。

Medico-Legal Journal Pub Date : 2025-03-28 DOI: 10.1177/00258172251315552

Dubravko Habek

{"title":"Fatal ruptured unrecognised aortic aneurysm.","authors":"Dubravko Habek","doi":"10.1177/00258172251315552","DOIUrl":"https://doi.org/10.1177/00258172251315552","url":null,"abstract":"Thirty years ago, a 24-year-old teacher attended hospital, suffering from persistent stomach pains, more pronounced around the navel, along with nausea; she vomited several times with several diarrhoeal stools. When admitted to the emergency room, she had normal vital normal laboratory findings, and the basic X-ray image of the abdomen did not indicate intra-abdominal perforation and ileus. On palpation, her abdomen was continuously diffusely painful, and the elastic wall had no defence musculature; there was no back pain. Given the clinical picture of a \"pseudoacute abdomen\", the patient was examined by an internist, surgeon and gynaecologist. Three hours after admission, during examination, the patient suffered a fatal cardiorespiratory arrest which did not respond to resuscitation procedures which were applied immediately and for one hour. At autopsy, an infraceliac complete asymmetrical ruptured abdominal aortal aneurysm of the posterolateral wall, 9 cm in length, was found with massive coagulum and fresh blood filling the entire retroperitoneum. Pathohistologically, a typical lesion of abdominal aortal aneurysm dissection into media with intimal fragmentation, intramural haematoma and mild atherosclerotic plaques was proven. The cause of sudden death was declared to be unknown, spontaneous, non-traumatic ruptured abdominal aortal aneurysm with massive retroperitoneal bleeding and ireversible haemorrhagic shock.","PeriodicalId":35529,"journal":{"name":"Medico-Legal Journal","volume":" ","pages":"258172251315552"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A military medico-legal medley. 军事医学和法律的混合。

Medico-Legal Journal Pub Date : 2025-03-28 DOI: 10.1177/00258172241304557

Sarah Galbraith

引用次数: 0

Delusional disorder and criminal responsibility: A systematic review to help improve Iranian judicial perspectives. 妄想障碍与刑事责任：有助于改善伊朗司法观点的系统回顾。

Medico-Legal Journal Pub Date : 2025-03-28 DOI: 10.1177/00258172251314974

Seyed M Saberi, Reza H Manouchehri, Hoda B Ardestani, Seyed A Mahdavi, Elham Bazmi

引用次数: 0

Malpractice outcomes of perioperative ischaemic optic neuropathy after nonocular surgery. 非眼手术后缺血性视神经病变围手术期的医疗事故结局。

Medico-Legal Journal Pub Date : 2025-03-28 DOI: 10.1177/00258172251314742

Daniel Zhu, Paras P Shah, Hannah Yoo, Rebecca L Kellner, Helena M Li, Amanda Wong, Jonathan Guevara, Howard D Pomeranz

{"title":"Malpractice outcomes of perioperative ischaemic optic neuropathy after nonocular surgery.","authors":"Daniel Zhu, Paras P Shah, Hannah Yoo, Rebecca L Kellner, Helena M Li, Amanda Wong, Jonathan Guevara, Howard D Pomeranz","doi":"10.1177/00258172251314742","DOIUrl":"https://doi.org/10.1177/00258172251314742","url":null,"abstract":"BackgroundPerioperative vision loss following nonocular surgery is a rare but devastating complication. It typically occurs following spinal, cardiac, or head and neck procedures with ischaemic optic neuropathy being the primary cause. Despite increased understanding of potential risk factors, such as prolonged prone positioning, anaemia and hypotension, the legal implications remain underexplored. This study investigates malpractice litigation outcomes related to perioperative ischaemic optic neuropathy in the US.MethodsWe conducted a retrospective analysis of US malpractice cases involving perioperative ischaemic optic neuropathy following nonocular surgeries using the Westlaw Database. Cases included only those with jury verdicts and settlements. Relevant data, including patient demographics, surgery performed, defendant specialties, verdicts and monetary awards were collected and analysed.Results12 cases were included. Most affected patients were males (83.3%) with a mean age of 52 years. Spinal surgery (50%) was the most common procedure, and anaesthesiology (75%) was the most commonly litigated specialty. In 75% of cases, the defence was successful; however, in 16.7% of cases, the plaintiff won, with an average inflation-adjusted award of US$4.8 million (in 2024 dollars).ConclusionMalpractice claims related to perioperative ischaemic optic neuropathy predominantly favour defendants, suggesting that this complication is often viewed as unpreventable. However, proactive risk mitigation strategies, such as optimised positioning and thorough informed consent procedures, remain crucial to improving patient care and minimising litigation risks.","PeriodicalId":35529,"journal":{"name":"Medico-Legal Journal","volume":" ","pages":"258172251314742"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Capacity and the exercise of patient autonomy. 能力和病人自主权的行使。

Medico-Legal Journal Pub Date : 2025-03-27 DOI: 10.1177/00258172241304559

Benjamin Andoh

引用次数: 0

Heat, drought and death - communal responsibility? 炎热、干旱和死亡——共同的责任？

Medico-Legal Journal Pub Date : 2025-03-27 DOI: 10.1177/00258172251323740

Diana Brahams, Eleanor Jane Turner

引用次数: 0

Who should be an expert in endoscopy? 谁应该是内窥镜专家？

Medico-Legal Journal Pub Date : 2025-03-27 DOI: 10.1177/00258172241311344

John F Mayberry, Affifa Farrukh

引用次数: 0

Distal femoral metaphyseal fractures in children: A systematic review and meta-analysis of their significance in the context of child abuse. 儿童股骨远端干骺端骨折：系统回顾和荟萃分析其在儿童虐待背景下的意义。

Medico-Legal Journal Pub Date : 2025-03-27 DOI: 10.1177/00258172241293885

Shrayash Khare

{"title":"Distal femoral metaphyseal fractures in children: A systematic review and meta-analysis of their significance in the context of child abuse.","authors":"Shrayash Khare","doi":"10.1177/00258172241293885","DOIUrl":"https://doi.org/10.1177/00258172241293885","url":null,"abstract":"BackgroundDistal femoral metaphyseal fractures in children pose diagnostic challenges due to potential accidental and non-accidental aetiologies. This review aims to critically analyse the evidence on the association between distal femoral metaphyseal fractures and child abuse, as well as fracture patterns aiding in distinguishing inflicted injuries from accidental injuries.MethodsA systematic review of studies involving children with distal femoral metaphyseal fractures was conducted, examining the reported associations with child abuse, fracture patterns and proposed mechanisms.ResultsThe review revealed a significant association between distal femoral metaphyseal fractures and child abuse, particularly in non-ambulatory infants. However, some fractures may occur accidentally, often from short falls with direct impact on the knee. Certain fracture patterns, such as transverse or oblique configurations, suggest abuse, while spiral or buckle patterns are more likely accidental. Case series and retrospective studies reported varying findings, with some studies supporting a strong association with abuse and others highlighting the potential for accidental mechanisms.ConclusionsA comprehensive evaluation, including history, physical examination, skeletal survey and multidisciplinary collaboration, is crucial for accurate diagnosis and management. Healthcare professionals should maintain a high index of suspicion for child abuse while recognising accidental mechanisms. Specific recommendations for healthcare professionals and future research directions are provided.","PeriodicalId":35529,"journal":{"name":"Medico-Legal Journal","volume":" ","pages":"258172241293885"},"PeriodicalIF":0.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Pendulums in medical practice. 医学实践中的钟摆

Medico-Legal Journal Pub Date : 2025-03-27 DOI: 10.1177/00258172241304558

Mathias E Kant

{"title":"Pendulums in medical practice.","authors":"Mathias E Kant","doi":"10.1177/00258172241304558","DOIUrl":"https://doi.org/10.1177/00258172241304558","url":null,"abstract":"Medicine is taught as a science, but in reality, as with other areas that undergo much public scrutiny, it is often more of an art than a science. Particularly when dealing with controversial areas, physicians often attempt to employ the \"standard of care\" as a guide to practising medicine, and to protect themselves. However, the standard of care itself is often a reactive and temporary construct. A number of practices serve as good examples of accepted patient care that has swung completely from one extreme to another. The history of opiate prescribing in this country exemplifies a complete swing in practice fundamentals among US physicians, where opiates have been repeatedly embraced, and then vilified. Numerous other practices demonstrating this phenomenon can be cited, including the use of electroconvulsive therapy for depression, and hormone replacement for postmenopausal women. Research funding itself has been subject to pendulum swings, such as occurred during the recent pandemic. Currently, there are a number of similar, very active issues of debate, such as marijuana for widespread medical use, and the employment of hallucinogens for addiction and other mental health disorders. Considerable harm has occurred to some patients when extremes of these pendulum swings have impacted their medical care. It is urged that in practising medicine, physicians consider the entire body of medical evidence accumulated during these pendulum swings, and then have the courage and wisdom to represent the best interests of their patients.","PeriodicalId":35529,"journal":{"name":"Medico-Legal Journal","volume":" ","pages":"258172241304558"},"PeriodicalIF":0.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0