We report a midazolam-related death that occurred during endoscopic retrograde cholangiopancreatography (ERCP). The acute intoxication due to midazolam overdose was confirmed by high-pressure liquid chromatography (HPLC) analysis of the blood samples taken from the patient in the intensive care unit (2.8 microg/ml) and postmortem (2.4 microg/ml). The case strongly emphasizes the necessity of the precautions that should be taken when midazolam is intravenously administered.

Background: Research findings regarding the influence of psychopathology on cancer progression are not yet clear. This preliminary report investigates the severity of psychopathology assessed before biopsy in patients with invasive breast carcinoma (IBC) and its association with two follow-up outcomes: disease-free (to first recurrence) and survival periods. Method: The psychiatric assessment of 80 patients under 70 years old was established by means of an interview before biopsy. The DSM-IV criteria were used to establish the past and current psychiatric diagnoses. The Present State Examination (PSE)-Index of Definition (ID)-computer program (CATEGO) was used to define total PSE score, clusters of psychiatric symptoms (psychiatric syndromes) and current clinical severity (ID). The independent influence of biological prognostic factors and psychiatric variables on first recurrence or survival period was tested using Cox’s proportional hazards regression model. Results: After biopsy, 38 IBC patients were followed up for 3–8¹/₃ years. During this period, 8 patients died from IBC and 7 were alive with metastatic disease. Cox’s proportional hazards regression analyses showed that tumor diameter and low ID were independent significant predictors of early recurrence, whereas tumor diameter, negative estrogen receptors and low ID were independent significant predictors of survival. Conclusions: A low prebiopsy psychopathology score in IBC is a predictor of early recurrence and short survival.

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