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Human mitochondrial DNA haplogroup U is among the initial maternal founders in Southwest Asia and Europe and one that best indicates matrilineal genetic continuity between late Pleistocene hunter-gatherer groups and present-day populations of Europe. While most haplogroup U subclades are older than 30 thousand years, the comparatively recent coalescence time of the extant variation of haplogroup U7 (∼16-19 thousand years ago) suggests that its current distribution is the consequence of more recent dispersal events, despite its wide geographical range across Europe, the Near East and South Asia. Here we report 267 new U7 mitogenomes that - analysed alongside 100 published ones - enable us to discern at least two distinct temporal phases of dispersal, both of which most likely emanated from the Near East. The earlier one began prior to the Holocene (∼11.5 thousand years ago) towards South Asia, while the later dispersal took place more recently towards Mediterranean Europe during the Neolithic (∼8 thousand years ago). These findings imply that the carriers of haplogroup U7 spread to South Asia and Europe before the suggested Bronze Age expansion of Indo-European languages from the Pontic-Caspian Steppe region., 0, SCOPUS: ar.j, info:eu-repo/semantics/published

Medical malpractice has been raised as an important problem in daily practice, while the media and public remain unforgiving to those perceived to have harmed the patients' life. This article highlights important legal issues related to medical malpractice and summarizes the sources and the nature of potential errors in anaesthesiology practice.

Purpose To investigate the individual and social profile of the adolescents seeking abortion in Greece. Procedures Questionnaires were distributed from the obstetricians practicing in the capital and two major cities in Greece to adolescent pregnant women who were seeking for abortion and collected anonymously. Main findings From 150 consecutive pregnant adolescents, 38 refused to participate and from 112 who accepted to participate only 74 (66%) replied. Most of the respondents lived in a city (65%), were unmarried (73%), 62% had sex first time after the age of 15, and the educational status of their parents was rarely at higher degree (father: 20%, mother: 16%). Among them, 74% declared that they had received information on contraception (64% from friends, 47% from doctors, 36% from the media). Overall, withdrawal (49%) and male condom (28.5%) were the popular contraceptive precautions. Abortion was adolescents' decision in 65%, while the partner's influence in the case of a shared decision was as high as 73%. Most adolescents (91%) knew about the potential risks of abortion mainly by their doctor (87%) and socio-economical reasons (89%) were mostly claimed. Their parents were rarely aware about their pregnancy (28%) and decision for abortion (28%). In most cases it was the first abortion (78%) and adolescents declared that were aware about the Greek Church's opposition (89%) and the existence of an abortion law (86%). Principal conclusion In Greece, the poor education on the issue of contraception still remains a major problem among teenagers contributing to the increased prevalence of undesired pregnancies and abortions.

It has been often stated that the overall pattern of human maternal lineages in Europe is largely uniform. Yet this uniformity may also result from an insufficient depth and width of the phylogenetic analysis, in particular of the predominant western Eurasian haplogroup H that comprises nearly a half of the European mitochondrial DNA (mtDNA) pool. Making use of the coding sequence information from 267 mtDNA haplogroup (Hg) H sequences, we have analyzed 830 mtDNA genomes, from 11 European, Near and Middle Eastern, Central Asian and Altaian populations. In addition to the seven previously specified sub-haplogroups, we define fifteen novel sub-clades of Hg H present in the extant human populations of western Eurasia. The refinement of the phylogenetic resolution has allowed us to resolve a large number of homoplasies in phylogenetic trees of Hg H based on the first hypervariable segment (HVS-I) of mtDNA. As many as 50 out of 125 polymorphic positions in HVS-I were found to be mutated in more than one sub-cluster of Hg H. The phylogeographic analysis revealed that sub-Hgs H1(*), H1b, H1f, H2a, H3, H6a, H6b and H8 demonstrate distinct phylogeographic patterns. The monophyletic sub-haplogroups of Hg H provide means for further progress in the understanding of the (pre)historic movements of women in Eurasia and for the understanding of the present-day genetic diversity of western Eurasians in general.

The authors of this article attempt to look at the manner in which the field of bioethics has emerged to represent an entirely new science. The article does this by first looking at various developments in the field of medicine and science. Specifically, the authors point to the developments in pharmacology, biology, and in genetics, as the stimuli for the field of bioethics. Since these three fields of study directly deal with human beings and their respective environment, new developments in these respective areas of science have questioned what society has traditionally held concerning these two concepts. In an effort to help answer such questions, the field of bioethics has emerged. The authors argue that bioethics represents more than just a theoretical field. Instead, bioethics, as an entirely new science in itself, has the ability to provide answers to the question, and moral dilemmas that new developments in other sciences raise. The article attempts to show that science/medicine has direct links to proper therapy and procedures. The authors do this by making a direct connection between ethics and medicine, as Hippocrates understood. For Hippocrates, medicine and science should be distinguished from religion, but not from proper ethos. Therefore, the authors argue that the field of bioethics has gained its status as a scientific enterprise since it provides the ability for scientists and physicians to conduct their work in an ethos that aims to protect the human person.

We explored the spatial distribution of human Y chromosomal diversity on a microgeographic scale, by typing 30 population samples from closely spaced locations in Italy and Greece for 9 haplogroups and their internal microsatellite variation. We confirm a significant difference in the composition of the Y chromosomal gene pools of the two countries. However, within each country, heterogeneity is not organized along the lines of clinal variation deduced from studies on larger spatial scales. Microsatellite data indicate that local increases of haplogroup frequencies can be often explained by a limited number of founders. We conclude that local founder or drift effects are the main determinants in shaping the microgeographic Y chromosomal diversity.

Purpose: The aims of this paper are to point out the importance of coherence in established guidelines in daily practice, highlight the value of signed patient informed consent forms and stress the value of a good understanding of the law, while focusing on issues related to malpractice in ophthalmology. Methods: Search of the current relevant literature. Results: The most common causes of medical litigation in ophthalmology are related to LASIK surgery, cataract surgery, glaucoma care, radial keratotomy for myopia reduction and failure to diagnose binocular vision anomalies in children and adults in a timely fashion. The litigation raised in most cases is driven by unfavourable outcomes and not by malpractice. Conclusion: Maintenance of high standards in daily practice, with continuous training and clear communication along with the appropriate documentation of any procedure carried out, may improve the professional safety of practising eye specialists in the event of medical litigation. Although the use of patient informed consent varies substantially among European countries, it may serve as useful evidence in the physician's defence.

Malpractice and medical liability have been introduced into Greek reality over the last decade. Forensic sciences hold a key role in the investigation of medical liability cases. Along these lines, the medical examiner stands between colleagues and lawyers, who have divergent intentions in the investigation of such cases. This article offers an overview of the rapidly changing reality in Greece and approaches medical liability from the doctor's viewpoint. The role of forensic science and the medical examiner is portrayed, along with the emerging difficulties in the investigation of medical liability cases. Also attempted is an interpretation of the crisis phenomena that are very often seen between doctors and lawyers. However, the intent of this article is to search for ways to turn competition and tension between medical and law professionals into cooperation and understanding for the best interest for both professions and, more importantly, for the community.

Right ventricular cardiomyopathy dysplasia, now a well-established clinical and morphologic entity, was first reported in the medical literature in 1982. The cases of sudden death of two young men are here reported, with macroscopic and histologic findings. The anatomical explanation of such death was a fibrotic, lipomatous, or fibrolipomatous replacement and infiltration of the myocardium of the right ventricle. It is suggested that death due to right ventricular cardiomyopathy seems to be the result of electrical instability of right ventricular myocardium. There were no congenital malformations such as septal defect or valvular deformity. The subjects' heart weights were normal. Signs of myocardial degeneration and necrosis with or without inflammatory infiltrates were not identified.

Extraction procedures and analytical methods are described for the quantitation of methomyl, a carbamate insecticide, in autopsy tissue and fluid samples. The analytical results from case work demonstrate the rapid metabolism of methomyl in the body.

We have examined from a legal perspective the father's role in the decision to abort a pregnancy in western society. Furthermore, we have taken a closer look into the inadequacies the Greek legal framework on this issue, from a legal and social point of view.Literature in the Greek and English language.One of abortion's many victims is the father of the child. In most European countries and the United States of America, the law does not give any rights to the father on the issue of an abortion. Quite simply, men have no legal rights when it comes to abortion. Legally, an abortion is a private matter between a woman and her doctor, even if she is married. Greece was one of the last countries in Europe to legalize abortion after a long debate in Parliament and the publication of numerous declarations by women's rights organizations. However, despite the liberalization of abortion, which followed the ratification of L 1609/86, the legal framework in which abortions are carried out is not entirely satisfactory. One of the areas that require clarification is the role of father. L 1609/86 does not specify men's rights in abortion. Post-abortion counseling services are dealing with an increasing number of men coming forward, grieving their aborted children.A more careful approach is required and a possible review of the law on abortion may be useful. Counselling for women and their male partners should be offered by state organisations. Clarity of thinking, sympathy and understanding are prerequisites in order for a solution respecting the personality of both the woman and her male partner to be reached.

Numerous product liability and toxic tort verdicts were arguably unjustly made on the basis of "junk science" threatening not only justice but the workings of the American economy. This problem was expected to be solved with the application of Daubert criteria, which require the courts to determine whether an expert's testimony reflects scientific knowledge, whether his/her findings are derived by the scientific method, and whether the work product is based on good science. Moreover, the Daubert criteria were expected to have an extraordinary impact on criminal litigation because there is rarely a criminal trial that does not rely on some form of expert testimony. However, there has been some debate on how such standards should be applied to cases involving relatively new product technologies, which only recently have been approved for a specific use, when an incident occurs and for which no published articles or other peer review summaries exist. Additionally, because most violent crimes are committed by the poor and their court appointed advocates, who are overworked and under-financed, are not up to the challenge. Therefore, with the Daubert standards for the admissibility of scientific evidence in the courts alone no significant improvement is expected. The presence of a system of effective representation in criminal cases along with efforts to educate judges and courts to understand ranges of scientific evidence and to recognise the reasonableness of scientific disagreements in civil and criminal cases are of paramount importance.

The experience from the scandals in hospitals at Liverpool and Bristol in the UK where retention of tissue and organs was undertaken without the consent of the parents and relatives raised serious concerns regarding the efficacy of the existing Human Tissue Act 1961, in England and the operation of the law by medical practitioners. In the aftermath of these damaging scandals a combination of public distrust and government overreaction has led to the enactment of new legislation, the Human Tissue Act 2004, which is aiming to prevent any further instances of the retention of organs and tissue from dead children or adults without their next of kin's consent or knowledge. However, scientists have expressed concerns that such changes might seriously endanger several medical research programmes, and also tissue and organ donation for transplantation. The aim of this article is to highlight important issues raised by existing practice in the post-mortem examinations in the UK and the lessons learnt from this and to discuss the benefits and the potential problems arising from the new Act.

The present study investigates the possible associations between coronary heart disease and histological prostate carcinoma in autopsy material.The material of our study, were 116 men between 55 years and 98 years of age, who died in the period of August 2002-January 2005. The initial segment of the aorta and the prostate glands of all cadavers were removed while the initial 30 mm of the left and right coronary arteries and the peripheral zone of the prostate gland underwent pathologic examination.Of all subjects examined 71.8% had pathological findings suggesting advanced coronary heart disease. Twenty out of 116 cadavers were found with histological carcinoma in their prostate specimen. Among subjects positive for prostate cancer, 12 had died of cardiovascular diseases, while 16 had macroscopic evidence of advanced coronary artery obstructive disease, a finding that was confirmed on pathologic examination. Although most of the subjects had atheromatous lesions on the coronary arteries, the percentage of men with prostate cancer, which had advanced atheromatosis, was greater when compared to those of subjects without prostate cancer. The relation between the coronary artery obstructive disease severity and the presence of latent prostate cancer was statistically significant (P = 0.02). No statistically significant correlation was obtained between body mass index and the presence of prostate cancer.Our results indicate that there could be an association between coronary artery obstructive disease and prostate cancer, however due to the relatively low sample further studies are needed in order to confirm such findings.

The possibility of using eggs from an aborted foetus in IVF treatment has recently arisen after researchers presented work in which they managed to keep alive in the laboratory ovarian tissue taken from second and third trimester aborted foetuses for several weeks. Several ethical concerns and arguments have been raised. Some of them are general anti-abortion arguments while others relate to the use of eggs or ovarian tissue of aborted female foetuses in infertility treatment. In this article we will argue that most of the arguments for prohibiting the use of ovarian tissue from aborted foetuses in fertility treatment are not sufficient to provide ethical grounds for banning such a practice.

Purpose To outline the most common sources of raising malpractice claims in screening mammography and to discuss the related medical litigation issues in the light of the evidence-based medicine. Methods and material Electronic and manual search of the relevant literature. Results The most common cause of malpractice is the delayed diagnosis of breast cancer. The plaintiff must establish that the radiologist was negligent and the delay in diagnosis caused injury to the patient. Literature shows that mammography does not always detect breast cancer, and even skilled radiologists may periodically miss malignant lesions. Also, delay in diagnosis does not always affect treatment and prognosis. Over-promotion of screening mammography has made disproportionately difficult for a defendant radiologist to prevail in a malpractice lawsuit. Thus, screening mammography is at stake, although it saves lives. The public and legal system should be educated about biological processes, medical practice, and the limitations of screening mammography. Conclusion If mammography is to survive medical litigation and continue to save lives a major reform in public perception, in the stance of the mass media, and in the ability of legal system to understand medicine is required. Physicians and medical associations have an important role to play.

Litigation in obstetric and gynecologic practice has arisen as an important issue. This article aims to highlight issues related to malpractice in obstetrics and gynecology in order to point out several important aspects of medical practice, which may offer adequate professional protection.Search of the current relevant literature.The four most common clinical causes of medical litigation in obstetrics and gynecology are cases involving fetal distress, uterine rupture after a vaginal birth in a woman with a previous Cesarean section, shoulder dystocia, and misdiagnosis of breast cancer. Litigation raised in most of the cases is driven by bad outcomes and not by malpractice. Additionally, both juries and the public often expect perfection as the natural result of pregnancy and any deviation from this expectation has to be the result of someone's negligence. For this reason it has become mandatory for doctors in hospitals and private practices to acquire a sufficient knowledge relating to modem management, to document carefully in writing their procedural and management plans and to become familiar with the legal aspects of medical practice. Adequate communication and a written patient's consent form are of paramount importance.Maintenance of high standards in daily practice with continuous training, clear communication and a signed Patient's Informed Consent Form along with the appropriate documentation of any procedure carried out may provide professional safety to practicing obstetricians and gynecologists in case of medical litigation.

Children are being abused in Greece at an alarming rate. This article aims to clarify the magnitude of the child abuse issue in Greece and to highlight medical and legal aspects that may play a contributory role in the existing defects in the revelation, prevention, and punishment of this type of crime.

This article aims to highlight issues related to malpractice in plastic surgery and to point out the importance of good understanding of the law and the value of a patient's written informed consent as measures of professional protection.Search of relevant literature from PubMed.The demand for cosmetic plastic surgery increases despite the increasing cost, in contrast to other traditional goods for which demand typically declines as price increases. Cosmetic plastic surgery has moved beyond the stage of being an exclusive privilege of the rich and famous. Nevertheless, cosmetic plastic surgery is one of the medical specialties exposed to a substantially high risk of malpractice claims. Most malpractice claims in cosmetic plastic surgery are not consequences of technical faults but because of inadequate patient selection criteria and lack of adequate communication between patient and surgeon. Proven efficient training, careful utilization of computer imaging techniques in association with the adoption of simple precautions and guidelines and adequate communication along with a completed patient's consent form are important essentials in case of medical litigation.In today's litigious society, maintenance of high standards in daily practice with continuous training and appropriate documentation of every procedure are all a sufficient defense of the plastic surgeon in case of medical litigation. Written patient's informed consent remains an integral part of the communication between physicians and patients, and importantly is facilitating professional protection.

In today's technological world, humanity continuously surpasses the limits set by previous achievements. Although evidence of such progress exists in several fields of study, one clearly sees this in the medical and biotechnological fields. Despite the countless opportunities for longer, more productive lives, medicine and science have regressed in their conception of the human person. In an effort to overcome any moral and legal ramifications that research and medical practices entail, physicians and researchers have come to reduce personhood to only a matter of biological qualities and functioning. This essay attempts to show, first of all, the classical Christian understanding of the person, currently held by the Orthodox Church. It then looks at three fields of bioethical discussion; namely, abortion, brain death, and human embryonic cloning, and shows how each issue reduces the human person to his or her biological components. The essay concludes by suggesting a return to an understanding of personhood based on personal and communal levels of relationships.

As medical abortion becomes more widely used and available in Greece, several issues are emerging and require clarification. Health care providers often face a dilemma when dealing with an adolescent requesting abortion. Parents' consent is mandatory before delivering any kind of treatment to minors. However, as it appears in the case presented here, the circumstances are not always straightforward. A critical review of the Greek legal framework in relation to the current social context is attempted through an interesting case aiming to elicit potential defects of the law that should be addressed by the legislator.

The aims of this paper are to point out the importance of coherence in established guidelines in daily practice, highlight the value of signed patient informed consent forms and stress the value of a good understanding of the law, while focusing on issues related to malpractice in ophthalmology.Search of the current relevant literature.The most common causes of medical litigation in ophthalmology are related to LASIK surgery, cataract surgery, glaucoma care, radial keratotomy for myopia reduction and failure to diagnose binocular vision anomalies in children and adults in a timely fashion. The litigation raised in most cases is driven by unfavourable outcomes and not by malpractice.Maintenance of high standards in daily practice, with continuous training and clear communication along with the appropriate documentation of any procedure carried out, may improve the professional safety of practising eye specialists in the event of medical litigation. Although the use of patient informed consent varies substantially among European countries, it may serve as useful evidence in the physician's defence.

The creation of Dolly, a cloned lamb from adult cells was a major scientific breakthrough, which opened new avenues for many research fields such as reproductive medicine, transplantation and biotechnology. However this achievement brought to public attention the theoretical possibility of human reproductive cloning. Inevitably heated debate occurred on several ethical and legal consequences of the prospect of human cloning. At the present time there is no legal framework in any country to respond to this challenge in a pragmatic way in order to protect human rights and at the same time to allow science to work for the best interests of mankind. Greece is a European Union country with its own traditions, history, culture and beliefs but without political and legislative experience in the handling of medical and biotechnological matters. This paper aims to discuss the legal issues likely to be raised by the prospect of human reproductive cloning in relation to the current state of the Greek legal system.

Introduction/objective: Modern practice in Radiology has rapidly changed over the last decades incorporating invasive techniques. Additionally, litigation in medical practice has arisen as an important issue. This article aims to highlight issues related to malpractice in interventional radiology and endovascular therapy in order to point out the importance of the written informed consent. Methods and material: Search of relevant literature from the Pubmed. Results: The role of radiologist has been greatly transformed over the last decades. He is not only entitled to participate in the diagnosis but also he undertakes therapeutic procedures, either alone or as a member of a team. Thus the radiologist is now more exposed to actions that maximize litigation risk. Adequate communication and a written consent form seem to be mandatory before any invasive radiological procedure. Patient should know in detail the benefits and the risks of the scheduled procedure and whether the proposed therapy is a new form of treatment or part of a randomized trial. Discussions and conclusion: Interventional radiologist or physician is exposed to high litigation risk. This certainly requires an urgent adaptation of his practice and attitude to the new reality. Written patient's informed consent remains an integral part of the communication between physicians and patients, and importantly is offering professional protection along these lines.

It is a doctor's duty to observe the rules of professional secrecy strictly by refraining from disclosing voluntarily to any third party information concerning a patient, that he has learned in the course of his professional practice. Greece is a European Union country with its own tradition, history, culture and beliefs but without political and legislative experience in the statutory handling of medical matters. This paper aims to give emphasis to the obligation of confidence in the area of medical practice and to discuss the legal issues likely to be raised in relation to the current state of Greek legal order.

Drugs and all medicinal products are in a special category. The manufacturing, marketing authorization and the distribution of them within the market, require fulfillment of particular conditions compared with other consumer goods. Additionally, the safety of drug use is an important issue for the public health, involving State and insurance authorities, physicians, pharmacists and drug companies. In today's health care environment, any authority involved in therapeutic interchange issues should be knowledgeable about the legal and medical issues associated with this practice. The aim of this study was to provide an analysis of Greek pharmacy legislation and an insight into the infrastructure of the Greek system that is responsible for the safety of the use of medicinal products from the Public Health Standpoint.

Our era is characterized by the globalization of crime. This poses to all democratic countries the urgent need to reform their systems to fight crime more effectively. Forensic sciences remain an integral part of the system against crime. This scientific field can also offer valuable knowledge regarding the causes of death. From an epidemiologic point of view, this can result in better organization of prevention measures for the best interests of the community. Harmonization and collaboration in the operation of the various forensic systems that presently exist around the world is of paramount importance if effective prevention of crime and other causes of death in contemporary reality is to be achieved. In addition, revision of training in forensic pathology and forensic sciences is essential if harmonizing the forensic systems is to succeed. This report provides an overview of the wide variation in the operation of forensic systems and training. Emphasis is given to the importance of their harmonization, and an attempt is made to explore principles that may contribute along these lines. Finally, the authors provide proposals for revision of the training system in forensic pathology in Greece.

Concussion of the heart (commotio cordis) occurs in traffic accidents in which blunt force impact over the precordial area occurs, even in the absence of multiple blunt force injuries. The functional dynamics of the heart, with ventricular arrythmias and conduction disturbances, serve as the pathophysiological basis of this condition. As a cause of death in vehicular accidents, it is less common than other causes. However, it should be considered in the differential diagnosis, especially in cases with minor or no apparent injuries.

Healthy subjects or patients volunteering to participate in trials expect that their privacy and autonomy will be protected. The aim of this article is to highlight issues related to confidentiality governing surgical research practice. A search of the current relevant literature was undertaken. Consent to the disclosure of any information should be sought wherever practicable, but disclosures should be kept to the minimum necessary. The data should be made anonymous where unidentifiable data serve the purpose. Where the previously described actions are not practicable for various reasons, data may be disclosed for research, provided participants have been given information about access to their records and about their right to object. Personal information may only be disclosed without individual's consent when it is for the protection of the public interest, but this has proved too ambiguous a rubric to be useful without proper clarification. Hampering of noncommercial medical research should also be avoided, as it may cause serious damage to public health. Confidentiality in research is an important issue in the protection of the participants' rights to privacy and autonomy, and it should be considered in the design of each study. Breach of confidentiality is legally justifiable for the sake of the public interest, but proper clarification of the law is required in order to avoid hampering noncommercial medical research that is vital for the public health.

In Crete, in southern Greece, a number of fatal carbamate poisonings were investigated over a period of 2 years, from 1991 to 1993. Five cases are reported, involving the fatal ingestion of methomyl (Lannate), a cholinesterase-inhibiting carbamate insecticide. Analysis of samples of blood plasma and serum showed more than 90% inhibition of cholinesterase. The blood methomyl concentrations had a mean value of 26.7 mg/l, and a range of 5.6-57.0 mg/l. These values are much higher than those previously reporter in similar cases (0.57-1.4 mg/l). Methomyl concentrations in organs and tissues were found to be significantly lower than those in blood and vitreous humour.

The Saami are regarded as extreme genetic outliers among European populations. In this study, a high-resolution phylogenetic analysis of Saami genetic heritage was undertaken in a comprehensive context, through use of maternally inherited mitochondrial DNA (mtDNA) and paternally inherited Y-chromosomal variation. DNA variants present in the Saami were compared with those found in Europe and Siberia, through use of both new and previously published data from 445 Saami and 17, 096 western Eurasian and Siberian mtDNA samples, as well as 127 Saami and 2, 840 western Eurasian and Siberian Y-chromosome samples. It was shown that the "Saami motif" variant of mtDNA haplogroup U5b is present in a large area outside Scandinavia. A detailed phylogeographic analysis of one of the predominant Saami mtDNA haplogroups, U5b1b, which also includes the lineages of the "Saami motif, " was undertaken in 31 populations. The results indicate that the origin of U5b1b, as for the other predominant Saami haplogroup, V, is most likely in western, rather than eastern, Europe. Furthermore, an additional haplogroup (H1) spread among the Saami was virtually absent in 781 Samoyed and Ob-Ugric Siberians but was present in western and central European populations. The Y-chromosomal variety in the Saami is also consistent with their European ancestry. It suggests that the large genetic separation of the Saami from other Europeans is best explained by assuming that the Saami are descendants of a narrow, distinctive subset of Europeans. In particular, no evidence of a significant directional gene flow from extant aboriginal Siberian populations into the haploid gene pools of the Saami was found.

The ethical issues faced by clinicians have never been more challenging than they are today. For surgeons, awareness of ethical questions is perhaps even greater as they are often involvedwith the introduction of new techniques or technologies. In a multicentre randomised control trial (RCT), upon the completion of recruitment and before publication of the results, there is always a period of uncertainty over the best treatment. The ethical dilemma that emerges for surgeons and their patients is what treatment should be offered during this period in view of the assumed equipoise between the conventional and new treatment. Two good examples are the EuropeanAsymptomatic Carotid Surgery Trial (ACST) and the Endovascular Aneurysm Repair (EVAR) Trial that will not publish their results for at least 1 year after recruitment ends.

Nitrogen narcosis can cause death among experienced scuba divers. Nitrogen under pressure affects the brain by acting as an anesthetic agent. Furthermore, the consumption of ethanol along with diving will cause the symptoms of nitrogen narcosis to occur at depths less than 30 m. Our case deals with an experienced diver who drank alcoholic beverages before diving and developed symptoms of nitrogen narcosis at a shallow depth. These two conditions contributed to his death by drowning.