[Involuntary hospitalization: A survey of liberty and custody judges]. / Soins psychiatriques sans consentement : une enquête auprès des juges des libertés et de la détention.

The procedure of involuntary hospitalization in France has been recently modified by the law of 5 July 2011. Since that time, a liberty and custody judge has been appointed to guarantee the rights of psychiatric inpatients and to prevent abusive hospitalizations. Currently, for one involuntary hospitalization in ten a release is decided by the liberty and custody judge although psychiatrists consider that psychiatric care is necessary. In order to improve our understanding of the role of liberty and custody judges, and how they make their decisions, we conducted a qualitative survey of liberty and custody judges in the Tribunal de Grande Instance of Lille. Three judges were questioned, based on a semi-structured interview. Judges' responses have highlighted the need for psychiatrists to strictly respect the legal procedures and to accurately describe the clinical signs and symptoms that justify the procedure of involuntary hospitalization in the medical certificates. The intervention of liberty and custody judges for patients with psychiatric disorders represents a breakthrough for patients' rights in France, reflecting that they are considered as citizens, with the same rights as others. Nonetheless, this new mission needs a progressive learning, based on mutual exchanges with doctors and caregivers.

Hashimoto's encephalopathy masquerading as acute psychosis.

Hashimoto's encephalopathy (HE) is a relapsing, but exquisitely corticosteroid-responsive encephalopathy associated with autoimmune thyroiditis. Although a rare disease, with just over 100 cases reported, it may be under-recognised. Its presentation can be protean with prominent neuropsychiatric features, stroke-like episodes, seizures and myoclonic jerks. Prompt corticosteroid treatment usually leads to rapid recovery. Here we report a patient with HE, initially presenting with florid neuropsychiatric symptoms. Recent developments in the understanding of this condition are discussed.

Ictus emeticus: further evidence of nondominant temporal involvement.

We report two cases of ictal vomiting in patients who had left temporal lobe epilepsy. In one patient, vomiting developed when the discharge spread to the right temporal lobe as seen during depth electrode recording. In the second patient, ictal vomiting occurred with a restricted left temporal discharge, but the patient was left-handed and had right-hemisphere language dominance. These cases provide additional evidence of the involvement of the nondominant temporal lobe in ictus emeticus.

13-cis retinoic acid and murine pulmonary adenomas: a preliminary report.

The inhibitory effect of 13-cis-retinoic acid was tested in conjunction with ethyl carbamate (urethane) induced murine pulmonary adenomas. Continuous feeding of the retinoic acid for 20 weeks did not significantly reduce the number of surface adenomas. No physical evidence of toxicity due to the vitamin A analog was observed in any of the mice. All mice showed a steady weight gain during the 20-week period, and there was no evidence of eye lesions, hemorrhage, bone fractures, fur changes or lethargy.

Protracted form of encephalitis with good outcome.

OBJECTIVE: To present four patients seen over a five-year period who developed severe protracted encephalitic illnesses but whose outcomes were favourable. CLINICAL FEATURES: Of the four patients, aged 18, 22, 34 and 19, three presented with acute psychosis, and all had a prolonged clinical course requiring intensive care management. One patient had residual generalised seizures and the other three recovered fully. No infective or toxic agent could be identified but viral encephalitis was considered most likely. OUTCOME: Despite the protracted courses, the outcomes were favourable. This is in contrast to the generally poor outcomes in encephalitis caused by established infective agents such as herpes simplex type 1. CONCLUSIONS: When the aetiology and hence the natural history of the encephalitis is unknown, long-term intensive support is appropriate.

Adult T-cell leukaemia lymphoma in an aborigine.

A 44-year-old Aborigine with Adult T-cell Leukaemia/Lymphoma (ATLL) due to HTLV-I is reported. He presented with transverse myelitis of subacute onset, and subsequently developed frank T-cell leukaemia complicated by splenomegaly and hypercalcaemia. Cell surface marker studies showed a phenotype of CD3+ CD4+ CD8- CD25+, and serological and molecular studies confirmed HTLV-I infection. This is the first report of ATLL in an Australian Aborigine.

Factors influencing referral decisions in physiatry.

As the population ages and more emphasis is placed on patient management than on curative exercise, physical medicine gains an important place in medical specialties. This study investigates the referral behavior in physiatry and compares it with referrals to other specialties. From a sample of 159 primary care physicians in the St. Louis metropolitan area who have a high probability of using physical medicine and rehabilitation, a referral model in physiatry was constructed. The results indicate that while the traditional determinants of referral decision play a significant role in influencing the referral behavior in physiatry, there also is a group of variables in physiatry that are significantly different from those of other subspecialties in determining referral process.

Do Foreign Medical Graduates (FMGs) Have Different Attitudes Toward Health Care Management?

A sample study of 216 physicians in the St. Louis Metropolitan area reveals a statistically significant difference in dealing with important issues in patient management between Foreign Medical and U.S. Medical graduates. Using the prospective payment systems (PPS) as a test case, this study shows that attitude toward patient management is significantly different in three controversial areas: consumer benefit, inclusion of physician's fee into the PPS, and quality of care. This study raises important questions in health care policy.

A clinical and pathological study of progressive supranuclear palsy.

The clinical features of 26 patients diagnosed as progressive supranuclear palsy are reviewed. The atypical findings were the relatively low frequency of visual complaints (23%) and of significant dementia (20%). As well, the characteristic eye signs, supranuclear ophthalmoplegia of vertical gaze, occurred some years after the onset of the initial symptoms in a small but substantial number (31%), which significantly delayed the diagnosis, in one case by as long as 18 years. The pathological studies on 2 of the clinical cases and an additional 6 cases showed the characteristic pattern of involvement of particular subcortical and brainstem nuclei. In particular, significant degeneration of the pedunculopontine tegmental nucleus was confirmed. Degeneration of the pedunculopontine tegmental nucleus may well play an important role in the motor disability in progressive supranuclear palsy.

Adenomatous lesions of the large bowel: an autopsy survey.

A comprehensive autopsy survey of the large bowel showed that adenomas were very common lesions occurring in about one-half of the 518 cases studied. The great majority were small adenomatous polyps (tubular adenomas), 86.7% measuring less than 10 mm in diameter. Adenomas with a more complex tubulovillous pattern were larger with a mean diameter of 19.0 mm. There was no apparent incresae in mean size of adenomas with age. Nineteen clinically unsuspected cancers were discovered. Fourteen (8 in situ and 6 invasive) cancers had areas of residual benign adenoma. Five invasive cancers had no residual benign component. No in situ carcinomas or small (less than 10 mm) invasive cancers not containing residual adenoma were found. The results suggest that, although adenomas of the large bowel are very common, the vast majority are simple adenomatous polyps which do not undergo progressive growth and malignant change. Conversely, it appears that cancers may arise from benign adenomas which have the characteristics of large size and a more complex villous architecture.

A comparison of World Health Organization (WHO) classification of lung tumors by light and electron microscopy.

Forty-nine cases of lung tumor were initially classified according to the World Health Organization (WHO) system by light microscopy. Additional study by electron microscopy using only a minimum of ultrastructural features as criteria for each type made more precise classification of some of the poorly differentiated or undifferentiated tumors possible. Most significant was the finding of evidence of a second tumor type in nine of the 35 tumors previously classified as moderately to well differentiated thus reclassifying them as mixed tumors. Sixteen of the 49 tumors were reclassified and a more precise classification was made in five others. Only two cases of undifferentiated small cell tumors were available and no unequivocal neurosecretory granules could be found in either. Correlation of the more precise typing of lung tumors by electron microscopy with the clinical data and modes of therapy will provide necessary information for determining the usefulness of the WHO classification.

Morphologic alterations induced by short-term cigarette smoking.

Pulmonary fibrosis and emphysema were produced in beagle dogs by their direct inhalation of cigarette smoke over a relatively short period of time (2-7 cigarettes daily for 2-4 months). One dog was sacrificed after having smoked 172 cigarettes, one after 282 cigarettes, and the others after 480 and 534 cigarettes, respectively. Examination of the lungs by scanning and transmission electron microscopy showed a range of response from the presence of numerous smoker's macrophages to extensive alterations, including destruction and enlargement of alveolar ducts and varying degrees of enlargement of alveolar spaces. Interalveolar pores were enlarged, and marked fenestration leading to destruction of the alveolar walls became apparent. These features were accompanied by interstitial fibrosis of the interalveolar septa. Light- and electron-microscopic examination showed no evidence of bronchitis and/or bronchiolitis or of physical obstruction to the terminal airways in the early development of fibrosis and emphysema.

AUStralian study of titration to effect profile of safety (AUS-STEPS): high-dose gabapentin (neurontin) in partial seizures.

PURPOSE: To evaluate the safety, tolerability, efficacy, and impact on quality of life of gabapentin (Neurontin; GBP) as adjunctive therapy in patients with refractory partial seizures. METHODS: AUS-STEPS was an open-label, multicenter, prospective study in patients experiencing partial seizures who were inadequately controlled with one to three concurrent antiepileptic drugs (AEDs). GBP treatment was titrated to a maximum of 4,800 mg/day, over a treatment period of 24 weeks, to achieve an efficacious and tolerable dosage. Efficacy was assessed by seizure-frequency data. Quality of life was evaluated by using the QOLIE-10 questionnaire, and safety was assessed by adverse-event reports and clinical laboratory findings. RESULTS: A total of 176 patients received treatment with GBP, with 174 evaluable for intention-to-treat (ITT) efficacy analysis. A reduction of >50% in overall seizure frequency was observed in 93 patients (53%). There was a small (4.6%) overall improvement in QOLIE-10 score. The most frequent adverse events were dizziness (31%), fatigue (29%), somnolence (27%), headache (21%), and ataxia (20%), with no major increase seen in adverse events necessitating discontinuation as the dose of GBP was titrated upward. CONCLUSIONS: This study indicates that patients with partial epilepsy may be effectively treated with GBP at dosages of < or =4,800 mg/day, without altering the safety profile of the drug.