Minerva

doi:10.1136/bmj.327.7408.238

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Only a third of death certificates issued in the accident and emergency department of a Scottish district general hospital were supported by strong evidence. The study reviewed all cases where a death certificate had been issued over two years. Among the 24 deaths, nine had good evidence in the case notes of what had caused death, and in eight deaths the patient had a history or other identifiable evidence that could support the cause of death given. The cause of death of seven was not supported by the available evidence (Emergency Medicine Journal 2003;20: 349-51.

A 73 year old man was known to have had coronary artery disease since 1986, when saphenous vein bypasses had been grafted to the left anterior descending, the second marginal branch and the distal right coronary artery (RCA). Angiography from 1986 had revealed patent grafts. A very small aneurysm of the RCA vein bypass had been observed first in 1996 before mitral valve replacement was done. At the current admission the pseudoaneurysm was enlarged to about 15x8 mm. A covered stent graft successfully occluded the entrance. Control angiography six months later showed a still sufficient occlusion.

Peter Alter, physician for internal medicine, Matthias Herzum, cardiologist, Bernhard Maisch, professor of cardiology, department of internal medicine, Phillips University …