Parricide and homicide NGRI offenders: How do they differ?

The aim of the present study was to provide a forensic psychiatric characterization of perpetrators of parricide who were found not guilty by reason of insanity (NGRI). We conducted a study involving 52 NGRI patients who had committed homicide or attempted homicide within the Department of Forensic Psychiatry in Thessaloniki, Greece, between January 2015 and 2020. Subjects were categorized into two groups: parricide (n = 21) and a control group (n = 31). Our findings revealed that in the parricide group, the majority of patients were unmarried males in their thirties, with a history of prior contact with mental health services and nonadherence to treatment. Additionally, they had a background of substance abuse and exhibited violent behavior before the index crime. A notable trend observed among parricide offenders was the tendency to seek hospitalization, possibly as a means of distancing themselves from stressful family environments, based on information obtained in the interviews conducted as a part of this research. All instances of parricide involved the use of sharp weapons, and the crimes were consistently committed in private settings. Symptomatology among parricide patients was assessed as moderate to severe, with a significant long-term risk observed following the crime. The primary differences identified between the two groups were the higher pre-crime voluntary admissions and the elevated estimated postcrime risk observed in the parricide group. Early intervention, comprehensive assessment of risk factors, family support, and assistance in resolving conflicts and reintegrating patients into society are emphasized as critical interventions that can potentially prevent future tragedies.

Prisoners' perceptions and satisfaction with telepsychiatry services in Greece.

Telepsychiatry is an effective tool to support and provide mental health services to prison inmates. In Greece, telepsychiatry was formally applied in two correctional facilities in 2018. The objective of this study was to compare inmates' perceptions and satisfaction with telepsychiatry versus face-to-face consultation. The sample consisted of 100 male inmates with a multicultural background and prior experience with both methods of services provision. The data were obtained through a Demographic Data Questionnaire, a Participant Satisfaction Questionnaire to assess satisfaction with face-to-face psychiatric services, and another Participant Satisfaction Questionnaire to assess satisfaction with telepsychiatric services. The results have shown a higher level of satisfaction with telepsychiatry compared to face-to-face care. Statistically significant improvements (all p-values <0.001) were noted in: waiting times, support for relapse prevention, follow up, quality of mental health care, quality of care in the management of psychiatric problems and related medication, behaviour of psychiatrists, duration of the assessment, sense of comfort, and confidentiality. Telepsychiatry has proved to be an acceptable way of approaching and supporting inmates in Greece, with most of the participants expressing high acceptance, satisfaction, and preference rates. Implications for additional research and further development of telepsychiatry are discussed.

Prisoners' Perceptions and Satisfaction with Telepsychiatry Services in Greece and the Effects of Its Use on the Coercion of Mental Healthcare.

BACKGROUND: Prisoners are often associated with mental health and substance use disorders. Coercive measures are widely used in prison settings. The objective of this study was to compare inmates' perceptions and satisfaction with telepsychiatry versus face-to-face consultation and the effects of telepsychiatry on the use of coercive measures. The sample consisted of 100 male inmates from various backgrounds who had experienced both approaches of services (face to face and telepsychiatry). METHOD: The data were obtained through an interview where the individuals completed a Demographic Data Questionnaire, a Participant Satisfaction Questionnaire to assess satisfaction with face-to-face psychiatric services, and a Participant Satisfaction Questionnaire to assess their satisfaction with services offered via telepsychiatry. Additionally, calculations of time spent waiting for a face-to-face psychiatric evaluation and time spent in handcuffs and in confined spaces were made before and after the introduction of telepsychiatry. RESULTS: Statistically significant improvements (all p-values < 0.001) were noted in waiting times, support for relapse prevention, follow up, quality of mental health care, quality of care in the management of psychiatric problems and related medication, behavior of psychiatrists, duration of the assessment, sense of comfort, and confidentiality. Telepsychiatry led to the elimination of time spent in handcuffs and in confined spaces (transport vehicles). CONCLUSION: According to the results of this study, telepsychiatry is an acceptable method of service delivery in correctional facilities and was associated with a reduction of coercive practices.

Ageism among dentists who are Facebook users in Greece.

The phenomenon of ageism in healthcare is a significant threat to elderly people's well-being. There is a literature gap regarding the topic of ageism among dental professionals in Greece. This study aims to contribute to filling this gap. A cross-sectional study was conducted using recently validated in Greece 15-item ageism 6-point Likert-scale. The scale has been previously validated in the environment of senior dental students. Purposive sampling was used to select participants. A total of 365 dentists responded to the questionnaire. As to the internal consistency of the scale, Cronbach's alpha found to be very low (α = 0.590) to support the reliability of a total of 15 Likert-type questions (items) of the scale. However, the factor analysis resulted in three factors that achieved high reliability towards validity. The demographic comparison with these factors and single items revealed statistically significant gender differences in ageism (with males being more ageist than females), and differences related to other socio-demographic factors, which however, were related to factors or items individually. The study revealed that the Greek version of the ageism scale for dental students had not further validity and reliability among dentists. However, some items were distributed into three factors that presented significant validity and reliability. This is of great importance for the ongoing research on the topic ″ageism in dental healthcare″.

The impact of meteorological factors on involuntary admission in Attica, Greece.

Few studies in the literature have examined the effect of meteorological factors, especially temperature, on psychiatric hospitalization and even less on their association with involuntary admission. This study aimed to investigate the potential association of meteorological factors with the involuntary psychiatric hospitalization in the region of Attica, Greece. The research was conducted at the Psychiatric Hospital of Attica "Dafni". This was a retrospective time series study of 8 consecutive years of data (2010 to 2017) and included 6887 involuntarily hospitalized patients. Data on daily meteorological parameters were provided from the National Observatory of Athens. Statistical analysis was based on Poisson or negative binomial regression models with adjusted standard errors. Analyses were initially based on univariable models for each meteorological factor separately. All meteorological factors were taken into account through factor analysis and then, through cluster analysis, an objective grouping of days with similar weather type was performed. The resulting types of days were examined for their effect on the daily number of involuntary hospitalizations. Increases in maximum temperature, in average wind speed and in minimum atmospheric pressure values were associated with an increase in the average number of involuntary hospitalizations per day. Increase of the maximum temperature above 23 °C at lag 6 days before admission did not affect significantly the frequency of involuntary hospitalizations. Low temperature and average relative humidity above 60% levels had a protective effect. The predominant day type at lag 1 to 5 days before admission showed the strongest correlation with the daily number of involuntary hospitalizations. The cold season day type, with lower temperatures and a small diurnal temperature range, northerly winds of moderate speed, high atmospheric pressure and almost no precipitation, was associated with the lowest frequency of involuntary hospitalizations, whereas the warm season day type, with low daily temperature and small daily temperature range during the warm season, high values of relative humidity and daily precipitation, moderate wind speed/gust and atmospheric pressure, was associated with the highest. As climate change increases the frequency of extreme weather events, it is necessary to develop a different organizational and administrative culture of mental health services.

Therapeutic Management and Prognostic Factors for Ovarian Malignant Tumours in Adolescents: A Comprehensive Review of Current Guidelines.

Background: Ovarian malignant tumours are rarely diagnosed in adolescents but may have a significant impact on their survival, future fertility and quality of life. The management of such cases is rather complex and requires expertise and careful planning according to scarce existing evidence and recommendations. Objective: The aim of this study was to review and compare recommendations from published guidelines regarding the diagnosis, prognosis and treatment of malignant ovarian tumours in adolescents. Evidence acquisition: A comparative descriptive/narrative review of guidelines issued by L'Observatoire des Tumeurs Malignes Rares Gynécologiques, the British Society for Paediatric & Adolescent Gynaecology, the European Society for Medical Oncology, the European Society of Gynecological Oncology-European Society for Paediatric Oncology and the European Cooperative Study Group for Pediatric Rare Tumors was conducted. Results: All guidelines recommend a thorough diagnostic work-up, consisting of both imaging tests and serum tumour marker measurement, as well as the use of immunohistochemical methods to confirm the diagnosis and complete surgical staging prior to constructing the treatment plan. There is a lack of recommendations regarding the assessment of prognostic factors, with only one guideline providing detailed information. Treatment strategies, as suggested by the majority of guidelines and with only a few discrepancies between them, should include both surgery and adjuvant therapies, mainly chemotherapy, with great emphasis on fertility preservation when it is considered oncologically safe and on the significance of regular and long-term follow-up. Conclusions: There is a significant degree of agreement among recommendations of existing guidelines. The reported differences, although limited, highlight the need for the adoption of an international consensus in order to further improve the management of adolescent ovarian cancer.

Evaluating the potential role of human papilloma virus infection in breast carcinogenesis via real-time polymerase chain reaction analyzes of breast fine needle aspiration samples from Greek patients.

BACKGROUND: Human papilloma virus (HPV), in addition to its known clinical contribution to cervical cancer is probably actively involved in the development of breast tumors in various populations worldwide. Predominant HPV types in breast cancer patients vary geographically. The present study further examines HPV incidence in Greece, based on molecular analysis of clinical cytological samples. METHODS: Greek patient fine needle aspiration (FNA) biopsy samples were examined using RT-PCR and immunohistological staining. FNA biopsy samples were collected from 114 female patients, diagnosed between the years 2018 and 2021, 57 with C5 diagnosed breast cancer lesions and 57 diagnosed with benign diseases. RESULTS: A total of three different HPV types were identified within the patient sample. HPV-39 was found only in the control group, in 1.8% of patients, while HPV-59 was present in both control and study groups in 1.8% and 3.5% respectively. HPV-16, on the other hand, was present only in the study group in 12.3% of cases. HPV type presence was statistically differentiated between histological groups. HPV-16 was exclusively in IDC, HPV-39 was present in one cyst diagnosed sample and HPV-59 was present in 3 samples that included fibroadenoma, IDC and LN diagnosis. CONCLUSION: More international comparative studies are required to investigate population differences and HPV genotype distribution to offer definite answers to the effect that certain HPV types might have a role in breast cancer, as this study also supports, albeit in a cofactory role.

Psychosis and conduct disorder in Greek forensic patients found not guilty by reason of insanity: Differences between patients with and those without a history of conduct disorder in childhood or adolescence.

Much epidemiological evidence converges in identifying distinct types of individuals suffering from schizophrenia who exhibit aggressive behavior: those with and those without a history of conduct disorder (CD) in childhood or adolescence. In this study a sample of Greek forensic patients suffering from psychotic disorders was examined regarding demographic, clinical, legal and psychometric characteristics. All patients had committed a crime and were found not guilty by reason of insanity (NGRIs) in a court of law. This study aims to clarify whether history of conduct disorder leads to greater violence or shapes the index offense in some way. It also aims to examine new parameters, such as psychopathology, personality traits, substance abuse and risk assessment, not included in the relevant literature so far, and whether they are relevant and why in this specific group of patients. The sample was divided in two groups depending on the history of CD or not, and subsequently statistically significant differences were explored between the groups. The research aimed to highlight specific characteristics of both groups with the ultimate goal of making more accurate prognosis regarding risk assessment, as well as determining different needs for treatment in each group (e.g. drug abuse). Overall, 78 forensic psychiatric records of NGRI offenders were identified throughout a five-year period in the Psychiatric Hospital of Thessaloniki (January 2015 to January 2020), who were divided into two groups depending on the history of conduct disorder in childhood or adolescence (N = 30) or not (N = 48). The two groups were compared regarding hostility and aggression (with the Hostility and Direction of Hostility Questionnaire-HDHQ and the Aggression Questionnaire), personality traits (with the Zuckerman- Kuhlman Personality Questionnaire-ZKPQ), dangerousness (with the Historical, Clinical and Risk Management 20- HCR-20 scale), addiction (with the Addiction Severity Index-ASI), previous violent behavior or convictions (with a semi-structured tool), and psychopathology current and at the time of the index (with the Positive And Negative Syndrome Scale-PANSS). Comparing the two groups (with CD history vs. without CD history) we found that patients with a history of conduct disorder had significantly higher compulsory hospitalization rates up to the time of the perpetration of the offense and a significantly higher rate of illicit drug use. While they were more likely to exhibit violent behavior before the index offense, it was noted that they committed fewer crimes against life. They were younger at the index offense and they presented with more severe positive symptomatology at the time of the research and a steadily high risk assessment score. Our findings underline the importance of diagnosing CD in early life and subsequently raising awareness when this individual develops schizophrenic disorder, thus emphasizing the need for appropriately targeted interventions in each case. Our research also illustrates that forensic patients with both schizophrenia and a history of conduct disorder before the age of 15 exhibit more severe psychopathology after the index crime even after long hospitalization and treatment. Our findings illustrate that the diagnosis of CD in psychotic offenders found not guilty by reason of insanity affects their dangerousness in general, but not the severity of the crimes committed.

Reliability of Greek version of the Toronto empathy questionnaire in medical students and associations with sociodemographic and lifestyle factors.

BACKGROUND: Empathy is an important key driver of any therapeutic relationship. It is beneficial for both physicians and patients. Enhancing physician's empathy should be an important goal of medical education. As there was a literature gap regarding the topic of empathy among medical students in Greece, this study aimed to contribute to filling this gap. METHODS: A cross-sectional study was conducted. A socio-demographic questionnaire and the 52-item Greek version of the Toronto composite empathy scale (TCES) for measuring the cognitive and emotional aspects of empathy in both personal and professional life was administered to all the medical students in the Aristotle University of Thessaloniki, in Greece. Descriptive statistics were displayed for demographics. The associations of the variables were quantified by Chi-2 independence tests and Pearson's Correlation Coefficient. The reliability and validity of the questionnaire was determined by Cronbach's α, Hotelling's T-Squared Test, and Pearson correlation. Paired and Independent Sample T-Tests and One-way ANOVAs indicated statistically significant mean differences among the variables or subgroups of the variables. RESULTS: The 52-item TCES, 26 for the personal (Per) setting and another 26 for professional (Pro) life, equally divided into cognitive (Cog) and emotional (Emo) empathy in each case. The overall reliability of the TCES questionnaire was found to be high (Cronbach's α = 0.895, significant positive correlations between the subscales). The mean total score of empathy showed that students had a moderately high empathy. Further, there was a statistically significant difference in means between the Per-Cog and Per-Emo settings (p < 0.001), the Pro-Cog and Pro-Emo (p < 0.001), the Per-Cog and Pro-Cog (p = 0.004), and the Per-Emo and Pro-Emo (p < 0.001). Females had significantly higher empathy scores (mean score 208.04) than males (192.5) on the Per-Cog, Per-Emo and Pro-Emo subscales. Furthermore, a positive correlation was found between empathy and factors such as love for animals, interest in medical ethics, belief in God, having an ill person in the family, class year or carrier intention. CONCLUSIONS: The TCES is applicable to medical students. For the most part our findings were consistent with previous literature. However, we identified some nuances that might draw researchers' attention. The results of this study may contribute to plan interventions in the curriculum to enhance empathy in the medical students.

Cerebrospinal Fluid Homeostasis and Hydrodynamics: A Review of Facts and Theories.

BACKGROUND AND PURPOSE: According to the classical hypothesis, the cerebrospinal fluid (CSF) is actively secreted inside the brain's ventricular system, predominantly by the choroid plexuses, before flowing unidirectionally in a cranio-caudal orientation toward the arachnoid granulations (AGs), where it is reabsorbed into the dural venous sinuses. This concept has been accepted as a doctrine for more than 100 years and was subjected only to minor modifications. Its inability to provide an adequate explanation to questions arising from the everyday clinical practice, in addition to the ever growing pool of experimental data contradicting it, has led to the identification of its limitations. Literature includes an increasing number of studies suggesting a more complex mechanism than that previously described. This review article summarizes the proposed mechanisms of CSF regulation, referring to the key clinical and experimental developments supporting or defying them. METHODS: A non-systematical literature search of the major databases was performed for studies on the mechanisms of CSF homeostasis. Gray literature was additionally assessed employing a hand-search technique. No restrictions were imposed regarding the time, language, or type of publication. CONCLUSION: CSF secretion and absorption are expected to take place throughout the entire brain's capillaries network under the regulation of hydrostatic and osmotic gradients. The unidirectional flow is defied, highlighting the possibility of its complete absence. The importance of AGs is brought into question, potentiating the significance of the lymphatic system as the primary site of reabsorption. However, the definition of hydrocephalus and its treatment strategies remain strongly associated with the classical hypothesis.

Modern bioethical issues: Euthanasia, physician assisted suicide and abortion. Comparative study of attitudes between physicians and law professionals.

We aimed to examine and compare the attitudes of physicians and law professionals on modern bioethical issues. Euthanasia, physician assisted suicide and abortion were selected for this study, as they underline the conflict between human life as a fundamental value, and the individual's right to self-determination. The demand of euthanasia and physician assisted suicide services reflects each person's right to decide on the way their life will end, while the legalization of abortion determines the individual's right to self-determination. These are complex issues with moral, religious and social implications, and as such tend to divide public opinion. In order to investigate their attitudes, physicians of all specialties, as well as law professionals from all over Greece, were invited to participate in the study. In total, 220 professionals responded to the call and participated in the survey. The professionals involved showed fairly high rates of agreement in all the issues studied, but a significant difference in results was found when the occupation of participants was set as a criterion, with physicians being more negative to euthanasia, physician assisted suicide and abortion than lawyers. Religiousness, age and male sex were negatively correlated with "positive" attitudes towards euthanasia, physician assisted suicide and abortion. Moreover, participants' attitudes towards euthanasia and physician assisted suicide were found to predict their attitudes towards abortion, indicating a single ideological direction of agreement or disagreement, accordingly. Individuals' attitudes and opinions are complicated issues, not easy to be categorized. However, it is of scientific interest to shape a legislative framework that is close to the social consensus, ideological evolution and moral needs. This study tried to pave the way for a modern approach to the issues of euthanasia, physician assisted suicide and abortion.

Dilatation and curettage in endometrial cancer. What is the correlation with hysterectomy histology? A 14 years retrospective cohort study.

PURPOSE: The aim of the present study is to evaluate the concordance between preoperative endometrial sampling histopathology performed by conventional dilatation and curettage (D&C) and final histopathological diagnosis after total hysterectomy concerning tumor grade and subtype in patients with endometrial cancer (EC). METHODS: In this comparative retrospective study, 203 women with endometrial cancer were included who underwent at first dilatation and curettage and then total hysterectomy. The preoperative histopathological report obtained by dilatation and curettage was compared with the final histopathology after total hysterectomy to assess the accuracy of endometrial sampling. RESULTS: Comparison of preoperative with postoperative histopathological results showed an overall 5.9% and 10.9% discordance regarding endometrial cancer histological subtype and grade, respectively. Six (4.9%) of the patients with preoperative grade 1 were grade 2 and 1 (0.8%) was found to be grade 3. Three (8.3%) of the patients with preoperative grade 2 were found to be grade 3 after hysterectomy. Discordance is higher for endometrioid endometrial cancer grade 2 (25%) compared with grade 1 (5.7%) and 3 (18.8%). CONCLUSION: Patients should be informed and consent for the potential discrepancy between the pre and postoperative histopathological features of malignancy. This discrepancy may result in either under or overtreatment. Thus, it should be accounted for when counseling for a major operation.

Medullary thyroid cancer: molecular factors, management and treatment.

Medullary thyroid cancer (MTC) is an infrequent neuroendocrine tumor, which amounts to 3-5% of all thyroid malignancies. Approximately 75-80% of MTCs are sporadic neoplasms. The rest of 20-25% are familial cases that belong to multiple endocrine neoplasia (MEN) syndromes, specifically MEN2 and MEN3. These cases of familial MTC are attributed to an activating germline mutation of a tyrosine kinase receptor gene, the rearranged during transfection (RET) proto-oncogene, located on chromosome 10q11.21. These mutations are also found in some cases of sporadic MTC. This review sets forth in summary the accepted guidelines and approaches regarding diagnosis, management, and treatment of MTC. Surgical resection is the standard care, and an early, prophylactic intervention is performed in genetic cases. Further investigation and understanding of the molecular pathways involved in the growth and advancement of MTC is required in order to provide efficient therapy in cases of progressive disease.

Cardiopulmonary resuscitation (CPR) complications encountered in forensic autopsy cases.

BACKGROUND: Cardiopulmonary resuscitation (CPR) provides a significant increase in survival rate, even if performed by bystanders. However, bystanders may refrain from performing CPR for fear of eventual malpractice litigation. Currently lack Guidelines specifying whether a particular CPR-related complication is in all likelihood unavoidable or not. To fulfill this gap a great number of studies is required to be published in the most relevant leading academic literature. This paper aims at making a contribution to addressing such a challenge. METHODS: A retrospective observational study based on forensic autopsy material aiming at recording injuries resulting from the application of CPR. The severity of injuries was forensically evaluated. RESULTS: Out of 88 cases autopsied, only 26.7% had rib fractures (only 20% of which were located in the 6 lower ribs), 17.4% had sternal fractures (85.7% of which were detected in the body of the sternum and 14.3% in the manubrium). The ratio of sternal fractures to rib fractures is similar to the ratio cited in other studies reported in the literature (2:3, approximately). The number of fractures was 7.86 (4.11 on the right side and 4.75 on the left side). 16% of the cases were found to be mild, 48% were moderate, and 35% of the cases were severe. When a physician was present, a (not statistically significant) trend towards more severe complications was found. CONCLUSION: The findings are in accordance with other similar studies reported in the literature referring to the classic external CPR. This study offers a proposal aiming at making a contribution to develop Guidelines specifying whether a particular CPR-related complication is in all likelihood unavoidable or not.

Purkinje cells pathology in schizophrenia. A morphometric approach.

OBJECTIVES: Schizophrenia is a brain disorder that affects more than 21 million people worldwide. Ventricle enlargement and reduction in the volume of the temporal lobe overall and in medial temporal structures constitutes the main macroscopic findings, whilst synaptic and spinal changes as well as gliosis in the hippocampal formation, the prefrontal and the entorhinal cortex stand among cardinal microscopic findings in the schizophrenic brains. In recent years, accumulated evidence comes to light about the role of cerebellum in the pathophysiology of schizophrenia. MATERIALS AND METHODS: The present study is based on the morphological analysis and 3D neuronal reconstruction of the Purkinje cells from 10 schizophrenic brains and 10 normal controls. RESULTS: Significant morphological alterations such as loss of distal and terminal dendritic branches and decrease of the density of the dendritic spines constitute the main morphological findings found in the present study. CONCLUSIONS: The present findings may be added to accumulated evidence on macroscopic and microscopic pathology of the cerebellum in schizophrenia. Morphological alterations of Purkinje cells seem to be a central feature of neuropathology of schizophrenia, reflecting to impairment of neuronal connectivity and functionality, and related to motor and cognitive symptoms.

Spinal Alterations of Reil Insula in Alzheimer's Disease.

Alzheimer's disease (AD) is a progressive neurodegenerative disease that involves numerous cellular and biochemical mechanisms resulting in synaptic alterations and extensive neuronal loss. It is primarily characterized by impairment of memory, associated frequently with mood disorders. Continuous studies have shown that insula may be an important target of AD, but neuropathological alterations have not been described extensively. In the present study, we attempted to describe the morphometric and morphological changes of the spines of Reil insula in AD in comparison with normal aging using a silver impregnation technique. We classified spines into 3 types: (1) long neck, (2) short stubby, and (3) other types; and we measured and correlated the length of them in normal controls and in individuals with AD using ImageJ application. Statistical analysis was based on the Student t test on the basis of 360 cells in SPSS v.17.0, and significance was taken as P < .05.

Burnout syndrome and job satisfaction in Greek residents: exploring differences between trainees inside and outside the country.

BACKGROUND: The purpose of this study is to investigate the levels of burnout among Greek residents, highlighting potential differences between those practicing at home and abroad, as well as to investigate correlations with demographic, individual and labor factors. METHODS: The research was conducted on a sample of 131 residents, using an anonymous questionnaire which included demographic, individual and labor characteristics, Maslach's Burnout Inventory, questions regarding job and life satisfaction levels, working conditions and the impacts of the economic recession. RESULTS: Fifty two point seven percent of the sample were training in the Greek National Health Service (N.H.S.), 27.5% in Germany and 19.8% in the United Kingdom. One out of three residents in the Greek system showed high levels of burnout in all three dimensions of the syndrome, while 51.1%, 72.2% and 30.8% of the Greek, British and German team, respectively, appeared burnt out simultaneously in two dimensions. Levels of job and life satisfactions ranged on average, while workload appeared heavy. CONCLUSIONS: The occurrence of burnout was associated with gender, specialty, employment characteristics (working hours, autonomy, support etc.), proneness to accidents, country, job satisfaction and quality of life, but was not associated with age or marital status. No correlation was found with susceptibility to medical errors.

Successful surgical treatment of a complicated esophageal perforation, by use of primary closure and lung parenchyma reinforcement.

Esophageal perforation (EP) is a medical condition which demands urgent confrontation with significant complications. The cause of the perforation may be common, spontaneous or iatrogenic, with conservative or surgical therapeutic strategy, which is needed in the majority of incidents, depending on the characteristics of the lesion. We report a case of a 68-year-old man, with the existence of an ulcerative lesion 31 cm approximately from the dental barrier, and a coexistent stenosis, diagnosed through esophagogastroduodenoscopy, which evolved to an extensive purulent necrotic mediastinitis, diagnosed through a thorax CT scan after the patient began to complain of asphyxiation during eating. A right posterolateral thoracotomy was performed along with intensive wide spectrum antibiotic therapy. Primary closure of the perforation as well as pulmonary tenting was used with satisfactory results. There was no evidence of leakage after a 12-month "follow-up" period. The early diagnosis of an EP combined with immediate surgical procedure and frequent "follow-up" of the patient, eliminate the risks for the patient's life and ensure a satisfactory outcome.

Percutaneous tracheostomy-beware of the thyroidea-ima artery.

Percutaneous tracheostomy is a minimally invasive operation performed in patients, in order to provide an air passage through the windpipe. A rare cause of severe bleeding during such operation is the injury of the thyroidea-ima artery. This case report presents a patient with hemorrhage after thyroidea-ima injury during percutaneous dilatational tracheostomy. Surgeons should always be aware of such anatomic variation, in order to prevent urgent sternotomy.

Potential use of pericardial cTnI, Mg2+ and Ca2+ in the forensic investigation of seawater drowning in Greece: An initial assessment.

The investigation of drowning constitutes one of the biggest problems in forensic practice. Elevated cardiac troponin I (cTnI) levels in biological fluids have been associated with myocardial damage, whereas increased Mg2+ and Ca2+ levels were found in cases of seawater drowning. The aim of this study was to examine the diagnostic utility of postmortem determination of cTnI, Mg2+ and Ca2+ in the pericardial fluid, in differentiating between cases of seawater drowning related to myocardial injury and those brought about by other causes. This study included 76 cases selected during a 2-year period from medicolegal autopsies. The cases were divided into three groups, according to the cause of death established based on macroscopic and microscopic evidence. The groups were: 1) seawater drowning (n=23), 2) seawater drowning with histological evidence of myocardial infarction (n=28), and 3) myocardial infarction unrelated to drowning (n=25). cTnI was determined with an enzyme immunoassay; Mg2+ and Ca2+ with standard colorimetric assays. Pericardial cTnI levels were significantly lower in group 1 compared to groups 2 and 3. In contrast, pericardial Mg2+ and Ca2+ levels were both significantly higher in groups 1 and 2 compared to group 3. Our results suggest that the postmortem determination of pericardial cTnI levels may be useful in detecting previous myocardial damage as a contributory factor in death from seawater drowning and provide independent confirmation of the usefulness of pericardial Mg2+ and Ca2+ levels for differentiating between seawater drowning and fatal acute myocardial injury unrelated to the former.