Saccular posterior cerebral artery aneurysm encased within a lipoma.

We present a case of a man in his 80s with an incidental posterior cerebral artery aneurysm encased within a lipoma. The literature surrounding the incidence and intricate relationship of lipomas to cerebral aneurysms is reviewed. Lipomas are proposed to be derived from maldifferentiated subarachnoid space. For this reason, lipomas are often associated with vascular malformations and may develop in conjunction with vascular malformations such as cerebral aneurysms. Hypothesised theories include the impediment of smooth muscle nutrient diffusion and the secretion of factors that weaken the arterial wall thereby predisposing to aneurysm formation. When lipomas neighbour cerebral vasculature, careful evaluation of the adjacent vessels should be conducted.

Assessment of accuracy of Australian health service death data: implications for the audits of surgical mortality.

BACKGROUND: The Victorian Audit of Surgical Mortality (VASM) investigates all surgically related deaths in Victoria, Australia, as a surgical educational activity aimed to make surgery safer. Whilst data collected within the audit are regularly reviewed for accuracy, there has never been a review of the data provided from health services. METHODS: Two-year death data provided by one Victorian health service were reviewed. Hospital notes for 4 months of each year were analysed to assess patients dying under surgical care. These data were compared to referrals to the VASM over the same period. RESULTS: Of the 3907 patient deaths recorded, 35.1% were reviewed. During their final admission, 178 (13%) patients underwent a procedure (93 medical and 85 surgical). Only 29.2% of these were recorded in the health service data set. Eighteen patients died under the care of a surgeon without a procedure, meaning that 103 deaths should have been reported to the VASM of which only 55.3% (57/103) were reported. CONCLUSION: There were major errors in the health service database resulting in under-reporting of deaths to the VASM which could have education and policy repercussions. For improvements to the safety and quality of health services, it is critical that all deaths are accurately recorded by health services and reported to the relevant bodies with internal verification processes.