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Objective To examine the epidemiologic data of closed medical claims from Taiwanese civil courts against obstetric departments and identify high-risk diseases. Design A retrospective descriptive study. Setting/study participants The verdicts from the national database of the Taiwan judicial system that pertained to obstetric departments were reviewed. Between 2003 and 2012, a total of 79 closed medical claims were included. Main outcome measures The epidemiologic data of litigations including the results of adjudication and the disease and outcome of the alleged injury. Results A majority of the disputes (65.9%) were fetus-related. Four disease categories accounted for 78.5% of all claims including (i) perinatal maternal complications (25.3%); (ii) errors in antenatal screening or ultrasound diagnoses (21.5%); (iii) fetal hypoxemic-ischemia encephalopathy (16.5%); and (iv) brachial plexus injury (15.2%). Six cases (7.6%) resulted in an indemnity payment with a mean amount of $109 205. Fifty-one cases (64.6%) were closed in the district court. The mean incident-to-litigation closure time was 52.9 ± 29.3 months. All cases with indemnity payments were deemed negligent or were at least determined to be controversial by a medical appraisal, while all defendants whose care was judged as appropriate by a medical appraisal won their lawsuits. Conclusions Almost 93% of clinicians win their cases but spend 4.5 years waiting for final adjudication. The court ruled against the clinician only if there was no appropriate response during a complication or if there was no follow-up or further testing for potential critical diseases.

This article describes a 49-year-old man with lower gum cancer who received tumor ablation by an otolaryngologist and immediate reconstruction with microsurgical free tissue transfer. The thrombosis occurred at the arterial anastomotic site at least twice during operation by an experienced microsurgeon and progressed to skin paddle necrosis following surgery. The thalidomide-induced recipient vessel thrombosis is highly suspected after excluding other hypercoagulation problems and technique errors. While thalidomide is increasingly used as an adjuvant therapy agent in head and neck cancer treatment, its potential adverse effect resulting in recipient vessel thrombosis is worth consideration in microsurgery. Prophylatic antithrombosis agents are thus recommended to prevent this potential side effect.

Killip classification is a valuable prognostic stratification for patients with acute myocardial infarction. Patients with high initial glucose levels also have adverse outcomes. We hypothesize that an increase in the Killip classification rank of patients with acute myocardial infarction might be associated with increase in initial glucose levels.In a retrospective cohort study, patients receiving percutaneous coronary angiography after an acute myocardial infarction were enrolled. Patients were accorded Killip classifications, and the data were compared using the χ(2) and 1-way analysis of variance tests.The study was conducted on 246 eligible subjects. Higher initial glucose levels were associated with higher rate of hospitalization within 1 year as well as mortality (P.05). Glucose levels among the 4 Killip classes were different (P.05).Patients ranked in the higher Killip classes had higher glucose levels than those ranked in the lower classes.