Fistulotomy-First Approach is Safe and Effective in Endoscopic Retrograde Cholangiography: Results of a Prospective Case Series

Abstract Background and Aims The aim of this study was to assess the safety and efficacy of using needle-knife fistulotomy (NKF) as a primary cannulation technique in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) with a native papilla. Patients and Methods This prospective feasibility study enrolled 50 patients between December 2018 and June 2019. The procedure was performed by two expert endoscopists (R.B. and L.H.). The primary outcome was the incidence of post-ERCP pancreatitis. Other variables assessed included the success rate of cannulation of the common bile duct (CBD), time to successful cannulation, and incidence of adverse events. Results Between December 2018 and June 2019, 50 patients enrolled in the study. The mean age was 63.4 years (standard deviation 18.1), and there were 26 females. Indications included biliary obstruction secondary to malignancy (n = 14) and choledocholithiasis (n = 36). Successful cannulation of the CBD through the fistulotomy occurred in 49/50 cases. The time to successful cannulation was 5.1 minutes (range 0.5 to 23 minutes). Mild acute pancreatitis occurred in two cases (4%). Post-ERCP bleeding occurred in three patients (6%) Conclusions In this pilot study, NKF was used as the primary biliary access technique and it was demonstrated that it appears to be at least as safe as the traditional access technique with a sphinctertome. However, its role as a primary cannulation technique requires further investigation with multicenter, randomized control studies.

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Proximal Rotational Metatarsal Osteotomy for Hallux Valgus (PROMO)

Foot & Ankle Orthopaedics ◽

10.1177/2473011418790071 ◽

2018 ◽

Vol 3 (3) ◽

pp. 247301141879007 ◽

Cited By ~ 1

Author(s):

Pablo Wagner ◽

Emilio Wagner

Keyword(s):

Hallux Valgus ◽

Case Series ◽

Valgus Deformity ◽

Metatarsal Osteotomy ◽

Level Of Evidence ◽

Reliable Technique ◽

Intermetatarsal Angle ◽

Hallux Valgus Deformity ◽

The Mean ◽

Prospective Case Series

Background: Hallux valgus deformity consists of a lateral deviation of the great toe, metatarsus varus, and pronation of the first metatarsal. Most osteotomies only correct varus, but not the pronation of the metatarsal. Persistent postoperative pronation has been shown to increase deformity recurrence and have worse functional outcomes. The proximal rotational metatarsal osteotomy (PROMO) technique reliably corrects pronation and varus through a stable osteotomy, avoiding fusing any healthy joints. The objective of this research is to show a prospective series of the PROMO technique. Methods: Twenty-five patients (30 feet) were operated with the PROMO technique. The sample included 22 women and 3 men, average age 46 years (range 22-59), for a mean prospective follow-up of 1 year (range 9-14 months). Inclusion criteria included symptomatic hallux valgus deformities, absence of severe joint arthritis, or inflammatory arthropathies, with a metatarsal malrotation of 10 degrees or more, with no tarsometatarsal subluxation or arthritis on the anteroposterior or lateral foot radiograph views. The mean preoperative and postoperative Lower Extremity Functional Scale (LEFS) score, metatarsophalangeal angle, intermetatarsal angle, metatarsal malrotation, complications, satisfaction, and recurrence were recorded. Results: The mean preoperative and postoperative LEFS scores were 56 and 73. The median pre-/postoperative metatarsophalangeal angle was 32.5/4 degrees and the intermetatarsal angle 15.5/5 degrees. The metatarsal rotation was satisfactorily corrected in 24 of 25 patients. An Akin osteotomy was needed in 27 of 30 feet. All patients were satisfied with the surgery, and no recurrence or complications were found. Conclusions: PROMO is a reliable technique, with good short-term results in terms of angular correction, satisfaction, and recurrence. Long-term studies are needed to determine if a lower hallux recurrence rate occurs with the correction of metatarsal rotation in comparison with conventional osteotomies. Level of evidence: IV, prospective case series.

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Kingella kingae septic arthritis

The Bone & Joint Journal ◽

10.1302/0301-620x.103b3.bjj-2020-0800.r1 ◽

2021 ◽

Vol 103-B (3) ◽

pp. 584-588

Author(s):

Mohammed Khattak ◽

Sujith Vellathussery Chakkalakumbil ◽

Robert A. Stevenson ◽

David J. Bryson ◽

Michael J. Reidy ◽

...

Keyword(s):

Septic Arthritis ◽

Young Patients ◽

Case Series ◽

Blood Parameters ◽

Pcr Analysis ◽

Kingella Kingae ◽

Patient Demographics ◽

The Mean ◽

Polymerase Chain ◽

Prospective Case Series

Aims The aim of this study was to determine the extent to which patient demographics, clinical presentation, and blood parameters vary in Kingella kingae septic arthritis when compared with those of other organisms, and whether this difference needs to be considered when assessing children in whom a diagnosis of septic arthritis is suspected. Methods A prospective case series was undertaken at a single UK paediatric institution between October 2012 and November 2018 of all patients referred with suspected septic arthritis. We recorded the clinical, biochemical, and microbiological findings in all patients. Results A total of 160 patients underwent arthrotomy for a presumed septic arthritis. Of these, no organism was identified in 61 and only 25 of these were both culture- and polymerase chain reaction (PCR)-negative. A total of 36 patients did not undergo PCR analysis. Of the remaining 99 culture- and PCR-positive patients, K. kingae was the most commonly isolated organism (42%, n = 42). The knee (n = 21), shoulder (n = 9), and hip (n = 5) were the three most commonly affected joints. A total of 28 cases (66%) of K. kingae infection were detected only on PCR. The mean age of K. kingae-positive cases (16.1 months) was significantly lower than that of those whose septic arthitis was due to other organisms (49.4 months; p < 0.001). The mean CRP was significantly lower in the K. kingae group than in the other organism group (p < 0.001). The mean ESR/CRP ratio was significantly higher in K. kingae (2.84) than in other infections (1.55; p < 0.008). The mean ESR and ESR/CRP were not significantly different from those in the 'no organism identified' group. Conclusion K. kingae was the most commonly isolated organism from paediatric culture- and/or PCR-positive confirmed septic arthritis, with only one third of cases detected on routine cultures. It is important to develop and maintain a clinical suspicion for K. kingae infection in young patients presenting atypically. Routine PCR testing is recommended in these patients. Cite this article: Bone Joint J 2021;103-B(3):584–588.

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Positive Intraoperative Cholangiography during Laparoscopic Cholecystectomy: Is Laparoscopic Common Bile Duct Exploration Necessary?

The American Surgeon ◽

10.1177/000313480507100911 ◽

2005 ◽

Vol 71 (9) ◽

pp. 750-753

Author(s):

Gabriel Akopian ◽

James Blitz ◽

Thomas Vander Laan

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Common Bile Duct ◽

Case Series ◽

Common Bile Duct Stones ◽

Common Bile Duct Exploration ◽

Bile Duct Stones ◽

Endoscopic Retrograde ◽

Technical Problems ◽

The Common

The treatment of choledocholithiasis discovered incidentally during laparoscopic cholecystectomy is not yet standardized. Options include laparoscopic common bile duct exploration (LCBDE), postoperative endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy (ERCP-ES), and no intervention. We undertook a review of our case series to determine whether LCBDE is obligatory and which LCBDE method is unsuccessful. During the 6-year study period, 91 patients with choledocholithiasis were identified. Fifty-six patients (62%) underwent LCBDE. Thirteen (23%) of these 56 patients subsequently required ERCP. Balloon sweeping of the common bile duct failed in 10 of 21 patients (48% failure) compared to any other combination of techniques with a failure rate of 1/33 (3%; P < 0.001). Two patients did not undergo complete duct exploration because of technical problems. Thirty-five patients (38%) did not undergo LCBDE. Nine of these patients (26%) did not have ERCP-ES. None of the patients who underwent postoperative ERCP-ES required additional procedures or surgery. LCBDE can successfully treat common bile duct stones, with minimal to no morbidity, but is not mandatory for safely treating choledocholithiasis. Additionally, advanced techniques for clearing the common bile duct are more successful. Surgeons should be proficient at performing these techniques.

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Comparison of visual outcomes after implantation of AtLisa tri 839 MP and Symfony intraocular lenses

International Ophthalmology ◽

10.1007/s10792-020-01435-z ◽

2020 ◽

Vol 40 (10) ◽

pp. 2553-2562

Author(s):

Wojciech Lubiński ◽

Karolina Podborączyńska-Jodko ◽

Marta Kirkiewicz ◽

Maciej Mularczyk ◽

Michał Post

Keyword(s):

Case Series ◽

Cataract Extraction ◽

Intraocular Lenses ◽

Group Differences ◽

Difficult Situation ◽

Iol Implantation ◽

Visual Outcomes ◽

Defocus Curve ◽

The Mean ◽

Prospective Case Series

Abstract Purpose To compare visual outcomes after implantation of AtLisa tri 839 MP and Symfony intraocular lenses (IOLs). Methods All subjects underwent sequential bilateral cataract extraction with AtLisa tri 839 MP or Symfony IOL implantation. The design is prospective case series. Each group consists of 20 patients (40 eyes). At 1 year postoperatively, the following parameters were analysed: binocular uncorrected visual acuity (log MAR): for distance (UDVA) at 4 m, for intermediate distances (UIVA) at 60, 70, 80 cm and for near (UNVA) at 40 cm, defocus curve, mesopic and photopic contrast sensitivities (CSs), spectacle independence, visual function test questionnaire modified VFQ-25), photopic phenomena and postoperative complications. Results In the AtLisa tri 839 MP group, the mean binocular UNVA and UIVA were significantly better than in the Symfony group (UNVA: − 0.01 ± 0.04 vs. 0.21 ± 0.15; p = 0.000; 60 cm UIVA: − 0.01 ± 0.04 vs. 0.09 ± 0.09, p = 0.001; 70 cm UIVA − 0.05 ± 0.06 vs. 0.11 ± 0.08, p = 0.002; 80 cm UIVA − 0.01 ± 0.06 vs. 0.15 ± 0.08, p = 0.019). There were no significant between-group differences in the mean binocular UDVA and CS, with one exception: the mean binocular distance CS (18 cpd) under mesopic conditions was significantly better in the Symfony group than in the AtLisa tri 839 MP group (1.39 ± 0.22 vs. 1.17 ± 0.27; p = 0.015). The defocus curve analysis revealed significant between-group differences at vergences of 2.0 to − 4.0 D (p < 0.05), except for 2.0, 1.0, 0 and − 1.5. All subjects in AtLisa tri 839 MP group and 18 subjects (90%) in Symfony group were spectacle independent. Patients from both groups highly rated their overall vision quality in the VFQ-25 (1.67 ± 0.47 vs. 1.85 ± 0.5 in the Symfony and AtLisa tri 839 MP group, respectively, p = NS). The scores for daytime driving (1.00 ± 0.00 vs. 1.21 ± 0.36; p = 0.002), night driving (1.57 ± 0.55 vs. 2.13 ± 1.15; p = 0.027) and difficult situation driving (1.14 ± 0.31 vs. 1.53 ± 0.56; p = 0.049) were significantly better in the AtLisa tri 839 MP group than in the Symfony group. The incidence and perception level of halo and glare were significantly reduced (p = 0.00) in the Symfony group as compared to the AtLisa tri 839 MP group. The postoperative course was uneventful in all subjects. Conclusions Visual outcomes achieved with both IOLs are comparable. In both groups, 90% of patients achieved spectacle independence. Whereas the AtLisa tri 839 MP IOL implantation was associated with slightly better intermediate distance VA and significantly better near VA, photic phenomena were less perceived by patients with Symfony IOLs.

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Corneal biomechanical outcome of collagen cross-linking in keratoconic patients evaluated by Corvis ST

European Journal of Ophthalmology ◽

10.1177/1120672120944798 ◽

2020 ◽

pp. 112067212094479

Author(s):

Mahmoud Jabbarvand ◽

Zahra Moravvej ◽

Kianoush Shahraki ◽

Hessam Hashemian ◽

Hamed Ghasemi ◽

...

Keyword(s):

Amplitude Ratio ◽

Corneal Thickness ◽

Case Series ◽

Cross Linking ◽

Corvis St ◽

Significant Difference ◽

Biomechanical Changes ◽

The Mean ◽

Prospective Case Series ◽

Collagen Cross Linking

Purpose: A 6-month evaluation of the topographic and biomechanical changes induced by corneal collagen cross-linking (CXL) in keratoconic eyes using Pentacam and Corvis ST. Design: Longitudinal prospective case series. Methods: In this study, 67 eyes of 67 patients with progressive keratoconus (KCN) treated with “Epithelium-off” CXL were evaluated. Patients with stages 1 or 2 of KCN and a corneal thickness of at least 400 μm at the thinnest point were included. Standard ophthalmologic examinations were carried out for all patients. The topographic and biomechanical measurements of the cornea were obtained by Pentacam (Oculus Optikgeräte GmbH, Wetzlar, Germany) and Corvis ST (Oculus Optikgeräte GmbH, Wetzlar, Germany) preoperatively and 6-month postoperatively. Results: The mean age of the participants was 21.68 ± 4.23 years. There was significant difference in mean spherical equivalent (SE) before and 6 months after CXL. Uncorrected and best corrected visual acuity improved postoperatively, although not statistically significant. The mean and maximum keratometry showed a significant decrease 6 months after CXL (0.93 ± 0.38 D and 1.43 ± 0.62 D, respectively p < 0.001). Among Corvis ST parameters, first applanation length and velocity (AL1 and AV1) showed statistically significant changes. The radius at highest concavity changed significantly (0.13 ± 0.37 mm mean increase after CXL; p < 0.001). A significant increase was observed in stiffness parameter A1 (SP-A1; p < 0.001) and significant decreases were noted in integrated radius (IR) and deformation amplitude ratio (DAR; p < 0.001). Conclusion: Analyzing biomechanical changes after corneal cross-linking can provide basis for efficient KCN treatment. Corvis ST parameters demonstrated changes in corneal biomechanical characteristics indicative of stiffing after CXL.

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The Safety and Effectiveness of the Percutaneous Flexor Tenotomy in Healing Neuropathic Apical Toe Ulcers in the Outpatient Setting

Foot & Ankle Specialist ◽

10.1177/1938640019843314 ◽

2019 ◽

Vol 13 (2) ◽

pp. 123-131

Author(s):

Simon E. Smith ◽

Julie Miller

Keyword(s):

Patient Satisfaction ◽

Ulcer Healing ◽

Case Series ◽

Outpatient Setting ◽

The Mean ◽

Prospective Case Series ◽

Protective Sensation ◽

Loss Of Protective Sensation ◽

Mean Time ◽

Flexor Tenotomy

Percutaneous flexor tenotomy is a minimally invasive procedure that involves cutting one or both flexor digitorum tendons underneath the toe. It is an alternative to open surgical procedures performed in an operating theatre. This project is a prospective case series investigating the utility, effectiveness, and participant satisfaction of the percutaneous flexor tenotomy when performed in the outpatient setting. People with diabetes, digital flexion deformity, and loss of protective sensation with an apical ulcer or preulcerative lesion presenting to the Austin Health Foot Ulcer Specialist Outpatient Clinic were enrolled in the study. The procedure was performed under sterile technique with an 18-gauge needle or fine scalpel blade. Participants were reviewed weekly until the incision and/ or ulcer healed. Participants were then followed up at 3 and 6 months. Time to ulcer healing, reulceration rate, frequency of complications, and patient satisfaction were recorded. There were 11 toe ulcers and 41 preulcerative lesions. A total of 76 tenotomy procedures were performed on the 23 participants across 35 episodes of care. The mean time to ulcer healing following tenotomy was 10.2 ± 4.3 days. There were no recurrences of ulceration. The infection rate per episode of care was 2.8%. There were 11 toes (14.5%) that sustained a transfer lesion post the index procedure. The mean time to development of a transfer lesion was 95.5 ± 98.1 days. All participants strongly agreed that they were satisfied with the outcome of the procedure. The flexor tenotomy is an effective procedure to expedite the healing of apical toe ulcers in people with loss of protective sensation and flexion digital deformity. It has a low infection rate and high patient satisfaction rate when performed in the outpatient setting. There is a moderate risk of transfer preulcerative lesions to an adjacent digit. Levels of Evidence: Level IV: Prospective case series

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Laparoscopic management of liver echinococcal cyst at B.P.Koirala Institute of Health Sciences Dharan, Nepal an institutional review

Health Renaissance ◽

10.3126/hren.v13i1.17952 ◽

2017 ◽

Vol 13 (1) ◽

pp. 86-94

Author(s):

Suresh Prasad Sah ◽

S Adhikary ◽

CS Agrawal ◽

R Gupta ◽

A Ghimire

Keyword(s):

Hydatid Disease ◽

Case Series ◽

Laparoscopic Approach ◽

Laparoscopic Management ◽

Hepatic Hydatid Disease ◽

Case Series Study ◽

The Mean ◽

Prospective Case Series ◽

Upper Abdominal ◽

Hepatic Hydatid

Background: Hydatid disease is an endemic disease in several parts of the world. Surgeons and physicians in the non-endemic areas may encounter the disease. Surgery remains the mainstay of therapy. Recently, laparoscopic treatment of hepatic hydatid disease has been increasingly popular and has undergone a revolutionary parallel to the progress in laparoscopic surgery. It is a new and encouraging approach with minimum morbidity and mortality.Objective: To assess the outcome of laparoscopic management of hydatid cyst.Methods: A retrospective & prospective case series study included all patients of hydatid liver cysts who were managed laparoscopically from 1st January 2008- 31st June 2013 (five & half yrs). Patients with deep intraparenchymal location of the cyst, more than 3 cysts and cysts with calcified walls were excluded.Results: Thirty two patients were included in this study to know the results of the laparoscopic management of hepatic hydatid cyst disease. Majority of patients in the age group of 21-40 years. The mean age was of 38± 5.25 with range being 19-65 years. The commonest presentation of dull aching pain in right upper quadrant was seen in 21(62.5%) patients followed by hepatomegaly in 12 (37.5%) patients & right upper abdominal lump in 8 (25%) patients. Twenty seven (84.3%) patients had single cyst & 5 (15.6%) patients had two cysts. The mean diameter of the cyst was 9.2±2.72 cm in size. The mean operative time was (65.42±12.67min) with range being 45-125 mins.Conclusion: The laparoscopic approach is safe & feasible in selected patients. The treatment choices of hydatid disease of the liver have increased in the last 2 decades including medical treatment, percutaneous drainage, or a combination.Health Renaissance 2015;13 (1): 86-94

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Femtosecond Laser Implantation of a 355-Degree Intrastromal Corneal Ring Segment in Keratoconus: A Three-Year Follow-Up

Journal of Ophthalmology ◽

10.1155/2019/6783181 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7

Author(s):

Marwa Mahmoud Abdellah ◽

Hatem Gamal Ammar

Keyword(s):

Femtosecond Laser ◽

Case Series ◽

Corneal Neovascularization ◽

High Rate ◽

Spherical Equivalent ◽

Clinical Trial Registry ◽

Link Type ◽

The Mean ◽

Prospective Case Series

Purpose. To evaluate the outcomes of femtosecond laser-assisted implantation of a 355-degree intracorneal ring (ICR) (Keraring) in patients with keratoconus in the three-year follow-up. Setting. Future Femtolaser Center, Sohag, Egypt. Design. Prospective interventional case series. Patients and Methods. A prospective case series of 38 eyes of 26 patients with keratoconus had implantation of the 355-degree ICR keraring after tunnel creation with a femtosecond laser. The uncorrected visual acuities (UCVA) and best-corrected visual acuities (BCVA), sphere, cylinder, and manifest refraction spherical equivalent (SE), and mean keratometry (K), K max, and K min were evaluated preoperatively and 3, 6, 12, 24, and 36 months postoperatively, and all complications were reported. Results. 38 eyes of 26 patients with mean age 25.92 ± 5.44 years were enrolled in the study, 11 were males (42.3%). The mean UCVA improved from 0.93 ± 0.21 to 0.63 ± 0.21 logMAR (P≤0.001) and the mean BCVA from 0.67 ± 0.22 to 0.43 ± 0.26 logMAR (P<0.001). The mean sphere, cylinder, and spherical equivalent have been changed dramatically from preoperative to 3 month postoperative, which is statistically significant (P≤0.001), and the changes between 1 and 2 years and 2 and 3 years are also considerable and statistically significant; the K max and K min and K mean improved and the changes were statistically significant (P≤0.001), and the changes between one, two, and three years were also statistically significant. The safety and efficacy indices were changed through the three-year follow-up. The complications were corneal neovascularization (36.84%), corneal melting (26.3%), and ring extrusion (31.5%) at the end of the study. Conclusions. Implantation of a 355-degree intracorneal keraring using femtosecond laser improved the visual, refractive, and topographic parameters in keratoconus patients, with a high rate of ICR extrusion and instability. The study has been registered for the Pan African Clinical Trial Registry (http://www.pactr.org) database within No: PACTR201810796878908 on 29 October 2018.

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Impact of a Novel Oblique-Tip Papillotome for Biliary Cannulation during ERCP: A Nonrandomized Coarsened Exact Matching Study

Gastroenterology Research and Practice ◽

10.1155/2020/2417841 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Hiroo Imazu ◽

Shiaw-Hooi Ho ◽

Shoryoku Hino ◽

Khean-Lee Goh ◽

Mitsuhiko Moriyama ◽

...

Keyword(s):

University Hospital ◽

Exact Matching ◽

Endoscopic Retrograde ◽

Biliary Cannulation ◽

Coarsened Exact Matching ◽

Patient Allocation ◽

Cannulation Technique ◽

The Mean ◽

A Prospective Study ◽

The University

Background. We developed a novel oblique-tip papillotome (OT-papillotome) to facilitate biliary cannulation during endoscopic retrograde cholangiopancreatography (ERCP). This study was performed to evaluate the utility of the OT-papillotome for contrast-guided cannulation (CGC) and wire-guided cannulation (WGC) during ERCP, compared with standard cannulation by WGC using a standard-tip papillotome (ST-papillotome). Methods. A prospective study was performed at two centers. CGC with the OT-papillotome (OT-CGC group) was performed at Jikei University Hospital, while WGC was done with the OT-papillotome and ST-papillotome (OT-WGC and ST-WGC groups, respectively) at the University of Malaya Medical Centre. The results of the OT-CGC and OT-WGC groups were compared with those of the ST-WGC group after performing coarsened exact matching (CEM) to reduce bias due to nonrandomized and center-based patient allocation. Results. Eighty patients were enrolled in each of the OT-CGC, OT-WGC, and ST-WGC groups. After CEM, the successful biliary cannulation rate was significantly higher in the OT-CGC and OT-WGC groups than in the ST-WGC group, while rescue cannulation was reduced. The mean number of unintended pancreatic access events in the OT-WGC and OT-CGC groups was similar to the ST-WGC group. However, it was significantly lower in the OT-WGC group than in the OT-CGC group. Multivariate analysis revealed that the OT-papillotome was independently associated with less frequent rescue cannulation and a higher successful biliary cannulation rate. Conclusions. Although use of the OT-papillotome in biliary cannulation did not reduce unintended pancreatic access events or PEP compared to the ST-papillotome, the OT-papillotome increased the successful biliary cannulation rate, while reducing the frequency of rescue cannulation procedures. Combining the OT-papillotome with WGC might be the best cannulation technique for minimizing unintended pancreatic access.

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Parasuicidal poisoning treated in a Greek medical ward: epidemiology and clinical experience

Human & Experimental Toxicology ◽

10.1191/096032701718890595 ◽

2001 ◽

Vol 20 (12) ◽

pp. 611-617 ◽

Cited By ~ 28

Author(s):

A I Hatzitolios ◽

M L Sion ◽

N P Eleftheriadis ◽

E Toulis ◽

G Efstratiadis ◽

...

Keyword(s):

Rural Areas ◽

Urban Areas ◽

Previous History ◽

Case Series ◽

Acute Poisoning ◽

Northern Europe ◽

Female Ratio ◽

History Of ◽

The Mean ◽

Prospective Case Series

Objective: To study the epidemiology of acute poisoning patients presenting to an acute medical service ward in a Greek hospital between January 1998 and December 2000. Design: Prospective case series. Results: A total of 273 patients with self-poisoning were included in the study. This represented 3.8% of the overall admissions to the unit. The mean age of patients was 33, the most frequent age group being that aged 20–30 years (36.2% of total) with a male-to-female ratio of 1:1.97. Sixty per cent of patients was admitted within 4 h. Those from urban areas comprised 76.2% and 23.8% from rural areas. The most frequently ingested agents were psychopharmaceuticals (37.4%) and analgesics/anti-rheumatics (32.6%). Pesticides (7.7% of total) were most frequently used by patients coming from rural areas (32.3% of patients from rural areas). Alcohol was included in the overdose in 8.4%. Of the patients, 16.2% had a previous history of overdose. In this case series, psychiatric assessment suggested that 52% of the patients had a formal psychotic diagnosis, 21% had personality disorder and 27% had taken an overdose in response to stress. The most frequently documented precipitating factors were family problems and disputes (37%). Unusually, the seasonal distribution in these patients suggested a peak in summer (37.5% of presentations) with lower numbers in spring (30.2%), autumn (17.7%) and winter (14.6%). Of the patients, 23.7% presented in July. A total of 73.5% of patients was conscious, 16.4% was somnolent, 4.5% was in precoma and 5.6% was in coma (GCS <8). Patients who received antidotal therapy comprised 17.9%. Evidence of hepatic dysfunction was observed in 8.9% of patients and renal dysfunction in 3.6%. Extracorporeal techniques for drug removal (hemodialysis and hemoperfusion) were used in 2.2% of patients. Intensive care therapy was required in 11.4% of patients. The mean overall hospitalization time was 3.3 days. The mortality rate was 2.9%. Conclusions: This study shows that the epidemiology of self-harm by overdose in Greece is significantly different in terms of the seasonal presentation from other parts of Europe. The agents ingested and other features are similar to northern Europe. Psychiatric diagnoses are more common in our group than in those reported from northern Europe.

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