Legal and ethical issues in robotic surgery.

AIM: With the rapid introduction of revolutionary technologies in surgical practice, such as computer-enhanced robotic surgery, the complexity in various aspects, including medical, legal and ethical, will increase exponentially. Our aim was to highlight important legal and ethical implications emerged from the application of robotic surgery. METHODS: Search of the pertinent medical and legal literature. RESULTS: Robotic surgery may open new avenues in the near future in surgical practice. However, in robotic surgery, special training and experience along with high quality assessment are required in order to provide normal conscientious care and state-of-the-art treatment. While the legal basis for professional liability remains exactly the same, litigation with the use of robotic surgery may be complex. In case of an undesirable outcome, in addition to physician and hospital, the manufacturer of the robotic system may be sued. In respect to ethical issues in robotic surgery, equipment safety and reliability, provision of adequate information, and maintenance of confidentiality are all of paramount importance. Also, the cost of robotic surgery and the lack of such systems in most of the public hospitals may restrict the majority from the benefits offered by the new technology. CONCLUSION: While surgical robotics will have a significant impact on surgical practice, it presents challenges so much in the realm of law and ethics as of medicine and health care.

Venous thromboembolism during air travel: does the existing evidence raise legal implications?

Venous thromboembolism associated with prolonged sitting during air travel has been reported in the medical literature. The aim of this article was to review whether the existing evidence can raise ethical concerns and grounds for legal implications. Review of the pertinent literature. Long duration air travel is linked with venous thromboembolism in susceptible individuals. However, the jurisdictions in countries that have adopted the Warsaw Convention 1929 and its amendment at Hague in 1955 have invariably based their approach on whether venous thromboembolism developed after air travel is an ''accident'' under the provision of article 17. Not only this has failed to be proven under various jurisdictions but also inaction, including not warning of the risk and not giving advice on the precautions that would minimise that risk have not been considered sufficient to rank venous thromboembolism as an ''accident''. While there is scientific evidence to support that long-haul flights may predispose to the development of venous thromboembolism in susceptible individuals, there is a clear trend in various jurisdictions that the airline carrier does not incur liability under the Warsaw convention. Nevertheless, the existing scientific evidence raises ethical concerns on the need for information and advice on prevention to those passengers at risk from the airline companies.

Medically assisted human reproduction: the Greek view.

Medically assisted human reproduction is a controversial issue that has attracted heated debate over the last two decades. In December 2002 the Greek Parliament passed a law with major social and scientific impact: the Medically Assisted Human Reproduction Act 3089/02. This law establishes the parameters of so-called surrogate motherhood, protects the anonymity of semen donors and sets the legal framework through which a woman's artificial fertilization after her husband's death is allowed. This article aims to discuss the legal ramifications of medically assisted human reproduction and especially the moral and social issues concerning the introduction of surrogate motherhood in Greece.

Malpractice issues in modern anaesthesiology.

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.

Corticotropin-releasing factor (CRF) and the urocortins differentially regulate catecholamine secretion in human and rat adrenals, in a CRF receptor type-specific manner.

Corticotropin-releasing factor (CRF) affects catecholamine production both centrally and peripherally. The aim of the present work was to examine the presence of CRF, its related peptides, and their receptors in the medulla of human and rat adrenals and their direct effect on catecholamine synthesis and secretion. CRF, urocortin I (UCN1), urocortin II (UCN2), and CRF receptor type 1 (CRF1) and 2 (CRF2) were present in human and rat adrenal medulla as well as the PC12 pheochromocytoma cells by immunocytochemistry, immunofluorescence, and RT-PCR. Exposure of dispersed human and rat adrenal chromaffin cells to CRF1 receptor agonists induced catecholamine secretion in a dose-dependent manner, an effect peaking at 30 min, whereas CRF2 receptor agonists suppressed catecholamine secretion. The respective effects were blocked by CRF1 and CRF2 antagonists. CRF peptides affected catecholamine secretion via changes of subplasmaliminal actin filament polymerization. CRF peptides also affected catecholamine synthesis. In rat chromaffin and PC12 cells, CRF1 and CRF2 agonists induced catecholamine synthesis via tyrosine hydroxylase. However, in human chromaffin cells, activation of CRF1 receptors induced tyrosine hydroxylase, whereas activation of CRF2 suppressed it. In conclusion, it appears that a complex intraadrenal CRF-UCN/CRF-receptor system exists in both human and rat adrenals controlling catecholamine secretion and synthesis.

The British Abortion Act (1967) and the interests of the foetus.

This article examines ethical issues on the rights and interests of the unborn foetus, an issue that remains highly contentious. Furthermore, it attempts to investigate how well the British legislation fits with the foetus and pregnant woman's rights and interests. "Pro-life" and "pro-choice" groups have provided extensive arguments for and against. One important theoretical issue rests on whether foetuses are human beings in the moral sense, in which all human beings have full and equal moral rights. What constitutes personhood is a matter of moral decision and is not one of scientific fact and thus it consists of all persons, rather than all genetically human entities. It is persons who invent moral rights and who are capable of respecting them. Legislators in Britain have sidestepped the ethical debate on abortion by opting for the pragmatic course of permitting abortion in a limited range of circumstances and thus the Abortion Act 1967 has failed to address the status of the foetus, or indeed the rights of any of the parties concerned. Thus, although the Act supports the interests of the foetus capable of free existence by lowering the foetal age to 24 weeks after which termination is not permissible, the legislators have accepted that the rights of the woman outweigh those of the foetus and if a woman's own life or health is in danger then even a late abortion is the best choice.

Alcohol and drug abuse among doctors.

Alcohol and drug abuse among physicians are important and persistent problems. The aim of this study was to highlight the magnitude of the problem and the factors related to alcohol and/or drug abuse, and to underline the importance of methods for prevention, early recognition, and treatment. The literature shows that the problem has a multifactorial origin. Occupational stress and ability to manage it play an important role. Easy access to drugs and the possibility of self-prescribing may have a contributory role. Anaesthesiologists, surgeons, and general practice physicians are the most vulnerable specialties, probably because of the stressful and competitive environment in which they work. The consequences may be devastating to users and their families, and may be life-threatening to their patients. Establishment of monitoring programmes may help define the magnitude of the problem, the contributory factors and prevention and early identification. Additionally, initiation of special education in medical schools about alcohol and drug use and management of the occupational stresses are all of paramount importance and may help thwart problems at earlier stages.

Forensic pathology--de profundis.

This review of the literature discusses the evolution of the professional role of the forensic pathologist. This role is defined as that of an expert who mainly assists the legal process of investigating suspicious or unexpected deaths. The forensic pathologist is independent, bringing his expertise to various parts of the judicial process. His role in the development of forensic investigation and promotion of human rights is important.

Y chromosomal haplogroup J as a signature of the post-neolithic colonization of Europe.

In order to attain a finer reconstruction of the peopling of southern and central-eastern Europe from the Levant, we determined the frequencies of eight lineages internal to the Y chromosomal haplogroup J, defined by biallelic markers, in 22 population samples obtained with a fine-grained sampling scheme. Our results partially resolve a major multifurcation of lineages within the haplogroup. Analyses of molecular variance show that the area covered by haplogroup J dispersal is characterized by a significant degree of molecular radiation for unique event polymorphisms within the haplogroup, with a higher incidence of the most derived sub-haplogroups on the northern Mediterranean coast, from Turkey westward; here, J diversity is not simply a subset of that present in the area in which this haplogroup first originated. Dating estimates, based on simple tandem repeat loci (STR) diversity within each lineage, confirmed the presence of a major population structuring at the time of spread of haplogroup J in Europe and a punctuation in the peopling of this continent in the post-Neolithic, compatible with the expansion of the Greek world. We also present here, for the first time, a novel method for comparative dating of lineages, free of assumptions of STR mutation rates.

Organ and tissue transplantation in Greece: the law and an insight into the social context.

Advances in biological sciences and medicine have revolutionized current practice and opened new horizons. Tissue and organ transplantation is a miracle and an action of love and sacrifice for the sake of fellow human beings. Organ transplantation has been commonplace over the last decade but Greece still remains the lowest numerically among European countries in this field because of the lack of organ donation although it is highest in traffic accidents. Despite this, the legal framework regulating transplantation was enacted late in comparison to other European countries, and was not the only obstacle to the development of organ donation. Several other factors such as philosophy, culture, traditional and religious attitudes, lack of public information and lack of the relevant social fabric, have all contributed to the current sad situation. This article aims to present a critical view on the evolution of the legal framework in the field of tissue and organ transplantation in Greece. Issues that still deter organ donation are discussed along with an insight into the current situation in the Greek social context in order to make a constructive contribution to future perspectives.

Clinal patterns of human Y chromosomal diversity in continental Italy and Greece are dominated by drift and founder effects.

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.

The importance of communication between physicians and patients. Special considerations in the era of endovascular therapy.

Most of the lawsuits in medical practice are the result of inadequate communication between doctors and patients and litigation has very little to do with errors. In the era of the technological development and the implementation of new techniques such as endovascular therapy, good communication between physicians and patients is essential. The purpose of this review is to elicit important considerations on challenging issues relating to the art of communication between physicians and patients and to provide information on what the vascular surgeon or interventionalist should bear in mind in obtaining an adequate informed consent from the patients.

A multistep process for the dispersal of a Y chromosomal lineage in the Mediterranean area.

In this work we focus on a microsatellite-defined Y-chromosomal lineage (network 1.2) identified by us and reported in previous studies, whose geographic distribution and antiquity appear to be compatible with the Neolithic spread of farmers. Here, we set network 1.2 in the Y-chromosomal phylogenetic tree, date it with respect to other lineages associated with the same movements by other authors, examine its diversity by means of tri- and tetranucleotide loci and discuss the implications in reconstructing the spread of this group of chromosomes in the Mediterranean area. Our results define a tripartite phylogeny within HG 9 (Rosser et al. 2000), with the deepest branching defined by alleles T (Haplogroup Eu10) or G (Haplogroup Eu9) at M172 (Semino et al. 2000), and a subsequent branching within Eu9 defined by network 1.2. Population distributions of HG 9 and network 1.2 show that their occurrence in the surveyed area is not due to the spread of people from a single parental population but, rather, to a process punctuated by at least two phases. Our data identify the wide area of the Balkans, Aegean and Anatolia as the possible homeland harbouring the largest variation within network 1.2. The use of recently proposed tests based on the stepwise mutation model suggests that its spread was associated to a population expansion, with a high rate of male gene flow in the Turkish-Greek area.

Prevalence of polyps and diverticulosis of the large bowel in the Cretan population. An autopsy study.

While a number of studies have been performed in the United States, northern Europe, and some other countries on the epidemiology of large bowel polyps and diverticulosis, information from southern Europe and especially Greece is very limited. Our autopsy study sought to determine the prevalence of large bowel polyps and diverticulosis in the population on Crete. Specimens of colon and rectum were obtained during forensic postmortem autopsies and examined for the presence of polypoid lesions and diverticulosis. Data were collected from a total of 502 autopsies (320 men, 182 women; median age 65 years (range 16-93). Polyps were found in 106 cases (21.1%). These were adenomas in 73 cases (14.5%), hyperplastic polyps in 25 (4.9%), and mucosal tags in 8 (1.5%). Diverticulosis of the large bowel was found in 115 (22.9%). The prevalence of adenomas and diverticulosis increased with advanced age. The prevalence of colonic diverticulosis in Crete is slightly lower than that which has been reported in most other studies in economically developed countries. The prevalence of colorectal adenomas in Crete is one of the lowest rates reported in Europe and is compatible to the known low incidence of colorectal cancer in Crete.

Sudden cardiac death and right ventricular dysplasia.

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.

Patterns of male-specific inter-population divergence in Europe, West Asia and North Africa.

We typed 1801 males from 55 locations for the Y-specific binary markers YAP, DYZ3, SRY10831 and the (CA)n microsatellites YCAII and DYS413. Phylogenetic relationships of chromosomes with the same binary haplotype were condensed in seven large one-step networks, which accounted for 95% of all chromosomes. Their coalescence ages were estimated based on microsatellite diversity. The three largest and oldest networks undergo sharp frequency changes in three areas. The more recent network 3.1A clearly discriminates between Western and Eastern European populations. Pairwise Fst showed an overall increment with increasing geographic distance but with a slope greatly reduced when compared to previous reports. By sectioning the entire data set according to geographic and linguistic criteria, we found higher Fst-on-distance slopes within Europe than in West Asia or across the two continents.

The position of the axillary nerve in the deltoid muscle. A cadaveric study.

In 134 deltoid preparations taken from 67 fresh cadavers we examined the position of the axillary nerve in relation to the upper border of the muscle. The vertical distances from the upper deltoid border to the nerve in 17 of 67 cadavers was less than 4 cm in both shoulders. The minimal distance, measured from the mid-middle portion of the deltoid to the axillary nerve, was 2 cm. There was a significant negative correlation between the deltoid ratio (width/length) and the vertical distance, measured in all examined sites. The shorter the deltoid length the greater the danger of damaging the nerve in the short distance during surgical splitting of the muscle.

Disposition of pesticides and toxicants in the human reproductive system in cases of acute poisoning.

The aim of this study was to estimate the penetration of some of the pesticides and toxicant substances in the human reproductive system. This knowledge is valuable because of the possible adverse influence of these substances on the human reproduction system and the development of the foetus during pregnancy. The existing data is mainly concerned with the results of experimental studies on animals or epidemiological studies. Here we report data concerning the disposition of several toxic xenobiotics (pesticides and solvents) in the tissues of the human reproductive system as well as in other organs and glands. Data was collected from cases of acute poisonings and derived mostly from autopsy materials. Xenobiotics were found to penetrate sampled tissues such as the testes, ovaries, epididymis, uterus, thyroid gland, as well as other human tissues. Further studies will clarify and confirm peculiarities of the penetration of a wide range of substances in various body tissues and will be the base of the estimation of the role of these toxicants in human reproductive ability and the outcome of pregnancy in humans.