痔疮错误手术引起直肠阴道瘘1例

痔疮在人群中多发,临床上有多种疗法,但由于其位置的特殊性,如果方法不当,亦可引起严重后果.笔者在工作中遇到一例非法行医者对患者痔疮错误手术后引起患者直肠阴道瘘.     

痔疮错误手术引起直肠阴道瘘1例

痔疮在人群中多发,临床上有多种疗法,但由于其位置的特殊性,如果方法不当,亦可引起严重后果。笔者在工作中遇到一例非法行医者对患者痔疮错误手术后引起患者直肠阴道瘘。案例:某女,27岁,广东新丰县人,过去一直患有痔疮(混合痔)。由于痔疮经常发生嵌顿,1998年10月6日去一无证行医者处治疗,行医者用手术钳夹住痔疮根部剪除,未行缝合,仅用棉花压迫止血,当时患者即觉疼痛难忍,有大量鲜血流出,口服大黄片即回家休息。10天后患者小便时发现阴道内有血、脓及粪便流出,即去医院检查,经肛镜检查发现肛周已全部感染发炎,表面有脓性物,在直肠前壁距肛缘…     

Driving and the combined use of drugs and alcohol in The Netherlands

The extent and nature of the use of medicinal drugs by drivers who had undergone a blood test on suspicion of driving under the influence of alcohol was ascertained by analysing some 40,000 case records in which the suspect had been questioned about the use of drugs. No chemical analyses were performed. 9.7% of the road users indicated that they used drugs in combination with alcohol, and more than 50% of the drugs used must be considered to have a negative impact on driving performance. The influence of the combined use of benzodiazepines and alcohol on behaviour was also investigated. The finding here was that drivers using these drugs should be warned against the consumption of alcohol.     

Forensic cases involving the use of GHB in The Netherlands

In this study, forensic cases involving the use of Gamma Hydroxy Butyric acid (GHB) from the second half of 1999 through the second half of 2001 in The Netherlands (blood >5mg/l and urine >10mg/l) are described. GHB was analysed by GC-MS after lactone formation and using GHB-d6 as internal standard. The results are divided into three groups: cases of chemical submission, cases of driving under the influence and cases of unknown causes of death.GHB was found in six cases of possible chemical submission. In these cases, relatively low concentrations of GHB were found. The results show that in cases of chemical submission, urine should be analyzed, because GHB is present longer in urine than in blood. The police should collect the samples in containers that do not contain citrate as anticoagulant. Especially at low levels of GHB, the formation of GHB in these tubes hampers an interpretation of the results.GHB was found in 13 cases of driving under the influence. In contrast to the cases of chemical submission, high concentrations of GHB were found, corresponding with observations of extreme sleepiness or temporary loss of consciousness.GHB was found in 16 cases of unexplained death: the measured range of GHB concentrations in blood might correspond to effects such as drowsiness, but not to serious toxicity of GHB. In 4 of these 16 cases, the role of GHB could be excluded. In the remaining cases, the role of GHB remains unclear; more research into "background" concentrations of GHB in post-mortem material is required.The incidence of the use of GHB in The Netherlands cannot be derived from these toxicological data. As GHB is not routinely found during systematical toxicological analyses, these data may seriously underestimate the use of GHB. Therefore, information from the police to the forensic institute is essential.     

A case of death after ingestion of an agrochemical spreading agent

An agrochemical spreading agent was found near the slightly decomposed corpse of a deceased female. The appearance of the stomach contents suggested that ingestion of a surfactant had occurred before death. The spreading agent was found to contain nonionic nonylphenol ethoxylates (NPEO(n)) and anionic sulfonated naphthalene-formaldehyde condensates (SNFC(n)). A solid phase extraction cartridge containing a mixed reversed phase-weak anion exchange sorbent (Oasis WAX, Waters) was used to successfully extract both NPEO(n) and SNFC(n) from the blood. The cartridge was preconditioned with methanol and acetic acid (AcOH). After the dilute blood sample was applied to the cartridge, it was washed with AcOH, and then NPEO(n) and SNFC(n) were eluted with methanol/dichloromethane (7:3, v/v) and 5% NH(3)/80% methanol, respectively. The concentrations of NPEO(n=2-9) and SNFC(n=0) in the blood sample were 7.7μg/mL and 1.8mg/mL, respectively. It is possible that postmortem changes increased the concentration of SNFC(n=0) monomer by breaking down the polymer. However, the behavior of these compounds in the human body is unclear and further case studies are needed to investigate this result.     

The transnationalization of the extreme right and the use of the Internet

Like many other political actors, the extreme right is currently expanding beyond national borders, and, as with any civil society organization, the Internet is assuming a growing role in achieving this goal. To date, however, this topic is understudied. In this article, aiming to empirically filling this gap, we shall explore the new tactics of the extreme right in Europe and the USA in the context of transnational politics. Namely, we investigate the degree and forms of extreme right transnationalization (in terms of mobilization, issues, targets, action strategies, and organizational contacts) and the potential role of the Internet in these developments. The analysis combines qualitative and quantitative data derived from 54 interviews with representatives of extreme right organizations in six European countries (Austria, France, Germany, Great Britain, Italy, and Spain) and the USA with a formalized Web content analysis of 336 right-wing websites. We will compare different types of right-wing groups which compose the radical right family (from political parties to associations), underlining the main differences and similarities across groups and across countries.     

"Culture of death" in The Netherlands: Dutch perspectives

During the summer of 1999, extensive interviews with some of the leading authorities on euthanasia policy were conducted in the Netherlands. They were asked: Daniel Callahan argues that there is a 'culture of death' in the Netherlands. What do you think? The majority of interviewees disagreed with the statement. They said that the Netherlands is not fundamentally different than other countries. If at all, the Dutch culture is open and tolerant, welcomes debates and plurality of views, and physicians are decent people who wish to help their patients, not to kill them. A small minority acknowledged that there is some truth in Callahan's observations, arguing that the Dutch actually do not welcome critique and are quite conservative in their liberal attitude toward euthanasia.     

The use of seclusion in the Netherlands compared to countries in and outside Europe

The use of seclusion in psychiatric practice is a contentious issue in the Netherlands as well as other countries in and outside Europe. The aim of this study is to describe Dutch seclusion data and compare these with data on other countries, derived from the literature. An extensive search revealed only 11 articles containing seclusion rates of regions or whole countries either in Europe, Australia or the United States. Dutch seclusion rates were calculated from a governmental database and from a database covering twelve General Psychiatric Hospitals in the Netherlands. According to the hospitals database, on average one in four hospitalized patients experienced a seclusion episode. The mean duration according to the governmental database is a staggering 16 days. Both numbers seem much higher than comparable numbers in other countries. However, different definitions, inconsistent methods of registration, different methods of data collection and an inconsistent expression of the seclusion use in rates limit comparisons of the rates found in the reviewed studies with the data gathered in the current study. Suggestions are made to improve data collection, to enable better comparisons.     

The positioning of the Prosecution Service in the Netherlands and England and Wales: Lessons from one extreme to another

It has been widely acknowledged that the Crown Prosecution Service (CPS), has since it came into existence, had an unsteady start. Part of the problem relates to its relation and communication with its criminal justice partners, by which we mean courts, police and local and central government. A key issue in this respect appears to be striking a balance between independence and autonomy on the one hand, and close contact and the establishment of `partnership' on the other hand. This paper examine show this balance is struck in the Netherlands, where the Prosecution service (Openbaar Ministerie) is strikingly different in nature, but faces very similar problems. It will be argued that a slightly more relaxed attitude on the CPS's independence might open the door to more fruitful relationship with the criminal justice partners in the field. Several examples concerning this in the Netherlands will be presented and discussed. This revised version was published online in August 2006 with corrections to the Cover Date.     

眼手术后使用激素不当致死医疗纠纷1例

肾上腺皮质激素具有抗炎、免疫抑制、抗毒素等作用，在临床各科广泛使用。但大剂量或长期应用可能产生一些严重的副作用甚至导致死亡。在临床应用中应该严格掌握其使用指征，对其可能产生的副作用应严密观察和监控。笔者报道1例眼科因疏忽而违反肾上腺皮质激素使用原则，诱发肺结核发展为干酪性肺炎死亡的医疗纠纷。     

眼手术后使用激素不当致死医疗纠纷1例

肾上腺皮质激素具有抗炎、免疫抑制、抗毒素等作用,在临床各科广泛使用。但大剂量或长期应用可能产生一些严重的副作用甚至导致死亡。在临床应用中应该严格掌握其使用指征,对其可能产生的副作用应严密观察和监控。笔者报道1例眼科因疏忽而违反肾上腺皮质激素使用原则,诱发肺结核发展为干酪性肺炎死亡的医疗纠纷。案例某男,66岁。因“左眼网膜脱离术后4月”于某年11月18日入住某医院眼科。既往史:曾行“双眼白内障术”,4月前行“左眼网膜脱离术”。入院查体:一般情况可,BP150/90mmHg,心肺及腹部检查无异常。眼科检查:右眼盲,瞳孔上移不规则…     

Trafficking in human beings for labour exploitation. The case of the Netherlands

Exploitation of women in the sex industry is the best known but probably not the most common outcome of trafficking in human beings. Still, trafficking for labour exploitation gets less attention from policy makers, the police and researchers. The legal framework allows dealing with trafficking for labour exploitation, but the prosecution of such cases is still in its infancy. In this contribution we focus on labour exploitation. We first present the legal framework. Then we go into the lack of knowledge in this area, followed by what we do know about risk sectors, victims, and what makes them vulnerable for exploitation. Focussing on the Netherlands, we describe the perpetrators and the difficulties in investigating and prosecuting trafficing cases in general and labour exploitation in particular, rounding off with some general conclusions.     

A case of death from prothiophos poisoning

A 62-year-old male, a farmer, who had ingested prothiophos (Tokuthion), died after 21 h of intensive care. Prothiophos in the tissues of the victim was extracted and purified by Extrelut column extraction. A gas chromatograph equipped with a flame photometric detector, and a gas chromatograph-mass spectrometer were used to detect prothiophos. The concentration of prothiophos was 10.9 micrograms/g in the brain, 8.6 micrograms/g in the kidney, 418 micrograms/g in the liver, 2.96 mg/g in the gastric contents and 4.69 mg/g in the intestinal contents. The case history and the distribution of prothiophos indicated that the cause of death was acute prothiophos poisoning.     

Vertebral artery rupture in a sudden death case after mild trauma

We report a case of subarachnoid hemorrhage at the skull base with possible rupture of a vertebral artery, and we present a new method to investigate rupture of this artery. In this method, the brain stem and cerebrum are divided with ligation of the internal carotid artery and basilar artery, and milk is injected from the original part of the vessel to find the rupture. We show that this method is particularly useful for cases of subarachnoid hemorrhage at the skull base in which there may be rupture of a vertebral artery.     

The use of circular dichroism and spectrophotometric methods in establishing the time of death

Dynamics of destruction of metal-containing proteins in skeletal muscles depending on storage duration (up to 30 days) of cadaveric material was studied in vitro using spectra of circular dichroism and absorption in visible spectrum area. Dichroic absorption diminishes gradually with increase of storage duration of cadaveric material.     

The use of mental status in death certification of suicide

A 5-year study (1982-1986) illustrates the use of mental status in death certification of suicide in 182 consecutive cases from Marion County, Oregon, U.S.A. The presence of specific mental illness was documented in Part II of the filed death certificate whenever sufficient data supported such a diagnosis. This study represents, so far as we are aware, the first use of mental illness in the routine death certification of suicide. The study subjects were described in terms of sex; age group; the presence or absence of a suicide note; the anatomical cause of death (Part I of the death certificate); and the presence of mental illness, severe physical illness, or alcohol abuse (Part II of the death certificate) as contributive to the death. About half (97 of 182 = 53.30%) of the study group was diagnosed as suffering from a major affective disorder. Another portion (18 of 182 = 9.89%) was classified as schizophrenic. A subgroup of 18 men, all of whom were residents of state mental or correctional institutions at the time of death, was also briefly described.     

Disclosure of medical data to relatives after the patient's death: recent legal developments with respect to relatives' entitlements in the Netherlands

In the Netherlands the physician is still bound to professional confidentiality after the patient's death. However, in the legal doctrine and in case law some exceptions have been recognized, especially for circumstances where the relatives have a legitimate interest in the inspection of medical records of the deceased. Today developments as regards the Dutch proposal to new legislation on patients' rights, notably the proposed insertion of a provision stipulating the conditions under which the relatives have a right of access to medical records of the deceased, give cause for renewed consideration of this issue related to legal protection after death. This article explores whether the proposed provision corresponds to the prevailing principles regarding disclosure of medical data after death. It is concluded that there is a need to reconsider the provision's wording or to adhere to self-regulation of the Royal Dutch Medical Association in order to strike an appropriate balance between the various interests concerned.