Autolytic and putrefactive processes can cause considerable alterations to soft tissues and internal organs that may complicate forensic assessments. An overview was undertaken of the range of taphonomonic changes and processes that may result from postmortem putrefactive gas accumulation. The most commonly encountered phenomenon was purging of putrefactive fluids from the nose and mouth that was on occasion confused with bleeding from antemortem trauma. Much less common was putrefactive \'rigor mortis\' where the limbs extend due to the accumulation of soft tissue and subcutaneous gas. This may sometimes be associated with alteration of the position of a body suggesting that it had been deliberately moved. Distension and stretching of the skin and subcutaneous tissues may cause recently sutured surgical incisions to dehisce, raising the possibility of inflicted incised wounds. Raised intra-abdominal pressures may cause diaphragmatic herniation of small intestine and has been associated with so-called \'coffin birth\' where a fetus is expelled from the uterus after death due to pressure on the fundus. Gas accumulation on postmortem computed tomography examination may be confused with air embolism or the effects of trauma. All of these changes are the result of anaerobic bacterial action generating gases such as methane, carbon dioxide and hydrogen sulphide resulting in pressure gradients.

Corroborative evidence for discectomy in pediatric or adolescent patients remains scarce, with this single-arm meta-analysis investigating discectomy for lumbar disc herniation (LDH) within this population. PubMed, Embase (Elsevier), CiNAHL, Cochrane Library, Scopus, and Web of Science were searched. Eligible studies reported pediatric patients under 21 years of age with a diagnosis of LDH that was treated surgically with discectomy. This review was registered in PROSPERO (ID: CRD42023463358). Twenty-two studies met the eligibility criteria (n=1182). Visual analog scale (VAS) scores for back pain at baseline were 5.34 (95% CI: 4.48, 6.20, I2=98.9%). Postoperative VAS back pain scores after 12 months were 0.88 (95% CI: 0.57, 1.19, I2=95.6%). VAS scores for leg pain at baseline were 7.03 (95% CI: 6.63, 7.43, I2=93.5%). Postoperative VAS leg pain scores after 12 months were 1.02 (95% CI: 0.68, 1.36, I2=97.0%). Oswestry disability index (ODI) scores at baseline were 55.46 (95% CI: 43.69, 67.24, I2=99.9%). Postoperative ODI scores after 12 months were 7.82 (95% CI: 4.95, 10.69, I2=99.4%). VAS back, VAS leg and ODI scores demonstrated a minimum clinically important difference (MCID) at all postoperative points. Perioperative outcomes demonstrated operative time as 85.71 mins (95% CI: 73.96, 97.46, I2=99.4%) and hospital length of stay as 3.81 days (95% CI: 3.20, 4.41, I2=98.5%). The postoperative reoperation rate at the same level was 0.01 (95% CI: <0.00, 0.02, I2=0%). Discectomy appears safe and effective in pediatric and adolescent patients suffering from LDH. The findings here provide groundwork for future randomized control trials against conservative measures to elaborate on optimal management and elucidate long-term outcomes.

OBJECTIVE: To report a case of delayed death after initial successful treatment of severe bromethalin intoxication in a cat.
METHODS: A 2-year-old neutered male domestic shorthair cat presented as a referral for bromethalin toxicosis and progressive neurological decline. At the time of referral, the cat was nonambulatory tetraparetic with minimal motor function in all 4 limbs and exhibited a dull mentation. Within the first 4 hours of hospitalization, the cat\'s neurological status continued to rapidly decline, and osmotherapy, corticosteroids, and intralipids were administered. The treatment regimen also included levetiracetam, thiamine, cholestyramine, vitamin E, and gingko biloba. Six days after bromethalin ingestion, the cat displayed marked neurological improvement with near normal mentation and mild tetraparesis and was discharged. The cat continued to do well at home with improving neurological status and function. Nine days after discharge, the cat was presented dead on arrival. Postmortem examination revealed transforaminal brain herniation secondary to spongy degeneration of the white matter and increased intracranial pressure as the cause of death.
UNASSIGNED: To the authors\' knowledge, this is the first report of a cat that suffered delayed death despite initial neurological improvement after being treated for severe bromethalin toxicosis.

UNASSIGNED: Back pain in pregnancy is common, but pain from lumbar disk herniations in pregnancy is rare. This systematic review aims to comprehensively analyse literature on lumbar disk herniation in pregnancy, focusing on risk factors, incidence, clinical presentation, and management.
UNASSIGNED: We conducted a literature review using PubMed and Web of Science databases, including studies from January 1, 1950, to August 1, 2023. The Critical Appraisal Skills Programme (CASP) checklist for cohort studies and the Joanna Briggs Institute Critical Appraisal Checklist for case-control studies were utilised to assess risk of bias. The review protocol was not previously published.
UNASSIGNED: A total of 41 studies were reviewed, with 6 addressing incidence and risk factors and 35 focusing on clinical presentation and management. Symptomatic lumbar disk herniation during pregnancy was found to be uncommon, with no significant predisposition noted during pregnancy as per magnetic resonance imaging (MRI) findings. However, patients with MRI-detected herniations were more likely to report back pain. Non-surgical management resulted in higher rates of complete symptom resolution (69% vs. 50%) and lower rates of cesarean section (57% vs. 70%) compared to surgical management. Among surgically treated patients, microdiscectomy showed higher symptom resolution (59%) compared to laminectomy (17%) or a combined approach (33%).
UNASSIGNED: While pregnancy does not inherently increase the risk of herniated lumbar disks, the presence of a prolapsed disk can predispose to back pain during pregnancy. There is poor quality evidence that should be interpreted cautiously. Non-surgical management, in the absence of red-flag symptoms including bowel and bladder dysfunction may be trialled and yield comparatively better symptom resolution. Additionally, surgical management if necessitated has no clear link to pregnancy complications within the scope of this study.

UNASSIGNED: The aims of this study are to determine the incidence and more frequent localizations of orbital fat tissue herniation accompanying dehiscences in the medial orbital wall and to investigate the relationship between orbital fat tissue herniations and the anterior and posterior ethmoidal foramina.
UNASSIGNED: One thousand two hundred patients who had undergone computed tomography with a preliminary diagnosis of sinusitis and who had no previous facial, orbital, paranasal sinus surgeries or history of trauma were retrospectively analyzed. The localization of the ethmoidal foramina and orbital fat tissue herniations were marked. In patients with orbital fat tissue herniation, the relationship between the localization of orbital fat tissue herniation and the anterior and posterior ethmoidal foramina was investigated.
UNASSIGNED: The incidence of orbital adipose tissue herniation in our study was 7.9%. Of the 98 herniations on the bilateral medial orbital wall, 60 were in zone 3, and the most common herniation site was zone 3. A statistically significant difference was noted between the localization zone of the anterior ethmoidal foramen and the localization zones of orbital fat tissue herniations (Fisher\'s exact test, p < 0.001).
UNASSIGNED: Zone 3 is the weakest area of the medial orbital wall, and zone 3 is the most prone to herniation of fat tissue. The association of orbital fat tissue herniations with the anterior ethmoidal foramen is extremely common. Being cognizant of this finding may help a surgeon better estimate the anatomical view to be met before functional endoscopic sinus surgery as well as to minimize the risk of possible orbital complications, especially anterior ethmoidal artery injury.

UNASSIGNED: Minimally invasive esophagectomy has emerged as the established standard for treating esophageal cancer. The gastric graft is usually placed in the posterior mediastinum or the retrosternal tunnel for reconstruction. Hiatal hernia occurrence is more common in the posterior mediastinal reconstruction and is more frequently observed in laparoscopic compared to open approach. On the other hand, retrosternal hernia is a rare complication that deserves greater attention, considering the increasing popularity of retrosternal reconstruction in esophageal cancer treatment.
METHODS: We present the case of a 55-year-old male patient who underwent minimally invasive esophagectomy with retrosternal reconstruction using gastric conduit and cervical anastomosis. After four years, the patient experienced symptoms, including dyspnea and chest pain. CT scan revealed transverse colon herniation into the retrosternal tunnel.
UNASSIGNED: Our diagnosis was retrosternal herniation of the transverse colon. Although there was no sign of obstruction, the abundant colon in the retrosternal space caused mass effect symptoms. For that reason, we performed laparoscopic surgery to release the herniated organ and close the hernia hole. Postoperatively, the patient had a satisfactory recovery, and a follow-up CT scan confirmed the absence of any remaining herniated organs.
CONCLUSIONS: While hiatal hernia is a well-known complication in minimally invasive esophagectomy, retrosternal hernia is a lesser-known entity. Surgical intervention is necessary to alleviate symptoms caused by herniation or address complications such as strangulation. The occurrence of retrosternal hernia warrants further attention and research in the future.

The buccal fat pad (BFP) is a specialized encapsulated adipose tissue, located intimately between the buccinator muscle and oral mucous membrane. A small perforation of buccinator muscle can lead to herniation of BFP into the oral cavity, which can be readily mistaken with a pathological entity. In general, the size of herniated BFP is larger than the perforation. The treatment options for BFP are excision or repositioning in its anatomical position if noticed early. This article reports two such cases presenting with herniation of the BFP, following trauma to buccal mucosa and its surgical management.

UNASSIGNED: Drainage tubes are commonly used to remove unwanted fluid after surgery. However, they are not indicated in all situations, and there is no evidence to support their common utilization.
METHODS: A 31-year-old woman at 38 weeks of gestation with a history of five cesarean sections presented with lower abdominal pain following a tonic-clonic epileptic seizure. Emergency surgery was performed due to fetal distress, and the uterus was found to be ruptured. After delivering the baby and closing the uterus, a drainage tube was inserted into the pouch of Douglas. Two days after surgery, the right ampulla and infundibulum were eviscerated from the drain site during the drainage tube removal. A second surgery was performed to reduce the herniated uterine tube.
UNASSIGNED: Drainage tubes are typically easily removed without complications. Some reported complications related to drainage tube removal include herniation, anchoring and suctioning of the uterine tube to the drainage tube, knotting with the colonic epiploica, and fracturing and retraction of the drainage tube due to adhesions. To the best of our knowledge, this is the first reported case of uterine tube evisceration during drainage tube removal.
CONCLUSIONS: Evisceration after drainage tube removal is very rare. We believe that this is the first report of immediate evisceration after the removal process. Such complications can be avoided with more restricted instructions for the use of drainage tubes and more researches on the reasons for these complications.

OBJECTIVE: To compare the performance of multiple international guidelines in selecting patients for head CT prior to lumbar puncture (LP) in suspected meningitis, focusing on identification of potential contraindications to immediate LP.
METHODS: Retrospective study of 196 patients with suspected meningitis presenting to an emergency department between March 2013 and March 2023 and undergoing head CT prior to LP. UK Joint Specialist Society Guidelines (UK), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Infectious Diseases Society of America (IDSA) guidelines were evaluated by cross-referencing imaging criteria with clinical characteristics present at time of presentation. Sensitivity of each guideline for recommending neuroimaging in cases with brain shift on CT was evaluated, along with the number of normal studies and incidental or spurious findings.
RESULTS: 2/196 (1%) patients had abnormal CTs with evidence of brain shift, while 14/196 (7%) had other abnormalities on CT without brain shift. UK, ESCMID and IDSA guidelines recommended imaging in 10%, 14% and 33% of cases respectively. All three guidelines recommended imaging pre-LP in 2/2 (100%) cases with brain shift. IDSA guidelines recommended more CT studies with normal findings (59 vs 16 and 24 for UK and ESCMID guidelines respectively) and CT abnormalities without brain shift (4 vs 1 and 2 respectively) than the other guidelines.
CONCLUSIONS: UK, ESCMID and IDSA guidelines are all effective at identifying the small cohort of patients who benefit from a head CT prior to LP. Following the more selective UK/ESCMID guidelines limits the number of normal studies and incidental or spurious CT findings.

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