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Background: Rupture of an abdominal aortic aneurysm (rAAA) is associated with a high mortality both before and after admission to hospital. In spite of the use of expensive intensive medical therapeutic interventions 30 - 50 % of the operated patients still die. The ASA score is one of the most used scores world-wide. Use of the Glasgow aneurysm score (GAS) and the Hardman index (HI) is frequently reported in the literature to predict survival after surgical management of rAAA. With regard to the comorbidity factor severity score (CSS) no evaluated data on the mortality in cases of rAAA are available. On the basis of our own patient collective we intended to assess to what extent the risk score could give an answer to the question of therapeutic options. Methods: In a retrospective study (7/1998 - 8/2007), 94 patients (m : f = 78 : 16) were assessed after operative management of rAAA. The validity of preoperative risk assessments on the basis of the ASA score, the CSS, the GAS and the HI with regard to intra- or postoperative death in the initial hospitalisation period was examined. Sensitivity and specificity of the score systems were determined by receiver operating characteristics (ROC) analyses. Results: The age of the patients was 72.3 +/- 9.5 years (mean +/- SD). Thirty-five (37.2%) patients died in the immediate postoperative period. The areas under the receiver operating characteristics curves for ASA, GAS, HI and CSS were 0.598, 0.787, 0.742 and 0.614, respectively. Conclusions: This study revealed clear differences in the prognostic predictions of the various scores. In accord with the literature, no score gave a 100% positive result with regard to mortality. Thus, an individual decision or, respectively, a therapeutic option cannot be reached with the help of the investigated scores. Further parameters need to be evaluated in order to make decisions about postoperative therapy.

Objectives: Several studies have documented a slight but significant deterioration of renal function after endovascular repair of abdominal aortic aneurysm (AAA) (EVAR). The aim of this retrospective study was therefore to investigate whether medication with statins may favourably affect perioperative renal function. Material and Methods: From January 2000 to January 2008, out of a total cohort of 287 elective patients receiving endovascular repair of their AAA or aortoiliac aneurysm, 127 patients were included in the present study, as their medication was reliably retrievable. Patients were divided according to whether their medication included statins (>3 months). Second, they were subdivided according to their supra- (SR) or infrarenal (IR) endograft fixation. Serum creatinine (SCr) and creatinine (CrCl) clearance were determined preoperatively, postoperatively, at 6 and 12 months. Patients with known pre-existing renal disease, with incorrect placement of the stent graft resulting in severe renal artery stenosis, and with occlusion or renal parenchymal infarction were excluded from the study. Results: Patients receiving an infrarenal fixation of their graft had no change in the renal function, regardless whether they were on statins or not. In patients with SR fixation not receiving statins, a deterioration in renal function was observed in the early postoperative period ((SCr) preoperative vs. SCr postoperative: 1.02 +/- 0.2 vs. 1.11 +/- 0.28, p < 0.001 and (Cr.Cl) preoperative vs. Cr.Cl postoperative: 74.1 +/- 21.4 vs. 68.0 +/- 21.4, p<0.001), whereas patients on statins experienced no change in renal function (SCr preoperative vs. SCr postoperative: 0.99 +/- 0.24 vs. 1.02 +/- 0.20 n.s. and Cr.Cl preop vs. Cr.Clpostop.: 76.4 +/- 19.1 vs. 74.28 +/- 20.50, n.s.). During follow-up, a constant worsening of renal function at 6 and 12 months was observed, irrespective of the medication with statins. Conclusions: The present study suggests a slight immediate deterior

A major issue to arise in the aftermath of the Black Saturday bushfires in Victoria in February 2009 concerned access by the media to the places destroyed. This issue arose in five main forms: media efforts to circumvent roadblocks; use of deception by media to get into areas that were open only to residents; use of private property by media, with and without the connivance of the authorities, as venues for gathering material; balancing residents' rights of access and property protection against the media's need to discharge their legitimate function of informing the community; and managing crime scenes and protecting survivors from the media. This article explores these issues from the perspective of 28 media professionals who covered the fires. It identifies and discusses the ethical dilemmas raised, and describes how the journalists concerned resolved them. It contains many lessons for the media, the authorities and the public. It lays bare the lack of an ethical consensus among media people. In doing so, it points up some exemplary decision-making by individual journalists and the weaknesses of their profession's institutional framework. It is argued that these matter because ethical lapses at disaster scenes can cause harm to victims and survivors, as well as placing the safety of media personnel at risk. Parallel ethical issues confronted the authorities too. These are canvassed as well, and the implications for public policy discussed – particularly in relation to the justification for controlling media access, and balancing justifiable restrictions against competing interests such as the public right to information and the autonomy of survivors in being able to make their own decisions about whether to speak to the media.