[Evaluation of injunction to care practices: A study of 119 cases]. / Évaluation des pratiques de l'injonction de soins : étude sur 119 sujets.

INTRODUCTION: The injunction to care (IC) is a new compulsory treatment created by the Act of June 17, 1998. Initially, this judicial tool concerned mainly sex offenders, but then the number of overall crimes requiring an IC began to dramatically rise. The judge can order this measure only if a psychiatric expertise has concluded to its potential opportunity. Then the convict must undergo a psychiatric follow-up after having served the sentence. The creation of a court-ordered treatment is based on the premise that many offenders are affected by psychiatric disorders. For the lawmaker, the aim is to lower the risk of recidivism. PURPOSES: The main purpose of this study is to assess the convicts concerned by the IC describing their sociodemographic characteristics, psychiatric diagnostics and criminal characteristics. The second purpose is to assess the efficiency of this measure regarding re-offending and specifically legal recidivism. METHODS: This is a retrospective and descriptive study concerning 119 subjects followed-up by two "coordinating doctors" in the department of Sarthe who could assess their psychiatric diagnostics and sociodemographic characteristics. They could also compare medical data with the judicial data for 78 of the subjects. RESULTS: The population was composed of 117 men (98.3%) aged 45 years old on average. They had a job in 37% of cases (n=44) and were single in 56.3% of cases (n=67). According to the DSM-IV-TR, only 29 subjects (24.4%) had an axis I disorder and 37.8% of the population had a pathological personality trait (non DSM-IV-TR categorized disorder). Furthermore, 51.3% (n=61) of the subjects were addicted (mainly alcohol). The medical follow-up was carried out by a psychiatrist in 83.2% of cases (n=99). The average duration of follow-up was five years. Among the 78 subjects for whom there was access to juridical data, 13 (16.7%) had committed a new offense during follow-up. Among them, seven had recidivated six of whom were initially sentenced for sexual offense. CONCLUSIONS: Most of the subjects in injunction to care had no axis I disorder but addictions and/or pathological personality traits. Nevertheless, the expert concluded the need of an IC. Personality and behavior disorders do not always require psychiatric care, and the management must be multidisciplinary. In France, the psychiatrist remains at the center of injunction to care measure. The addictology care is not developed whereas it is a population at risk and there is a lack of interactions between professionals (medical, social and judicial professionals). The IC is a measure that needs to be improved by means of better communication among the different professionals and a better global assessment of the subjects. Medical care must be a possible option but not a systematic treatment.

Herpes simplex virus delivery to orthotopic rectal carcinoma results in an efficient and selective antitumor effect.

Cancer of the rectum poses a complex therapeutic challenge because of its proximity to adjacent organs and anal sphincters. The addition of radiotherapy before surgical resection has been shown to confer good survival rates while preserving sphincter function. Nevertheless, radiation is associated with significant side effects. On the basis of our previous work showing that herpes simplex virus type-1 (HSV-1) preferentially infects human colon cancer, we set out to examine the oncolytic effect of HSV-1 on orthotopic rectal tumors in mice. Two vectors were compared for oncolytic activity, HSV-1(Gbeta) with wild-type replication and an attenuated HSV-1 vector (HSV-G47Delta). Intratumoral injection of HSV-1(Gbeta) and HSV-G47Delta resulted in a significant reduction or disappearance of the tumors and increased survival of mice. Although the use of HSV-1(Gbeta) was associated with systemic toxicity, HSV-G47Delta appears to possess a selective oncolytic activity. Moreover, infection with HSV-G47Delta resulted in the activation of the double-stranded RNA-dependent protein kinase (PKR) pathway. A significant improvement in viral replication and the antitumor effect was observed when the PKR inhibitor 2-aminopurine was coadministered with HSV-G47Delta to the tumor. In conclusion, the efficacy of local delivery of HSV-G47Delta combined with a specific chemical inhibitor of antiviral activity points to a novel therapeutic modality for rectal cancer and other solid tumors.

Defective internalization of low density lipoprotein in epidermoid cervical cancer cells.

Cells of an epidermoid cancer cell line of human uterine cervix, which possessed a high-affinity, specific receptor for low density lipoprotein (LDL), internalized and degraded [125I]iodo-LDL at a very low rate. In these cells, LDL did not stimulate cholesteryl ester synthesis, nor did it suppress 3-hydroxy-3-methylglutaryl coenzyme A reductase to the same extent as in the control cells. The binding of [125I]iodo-LDL by these cells was not decreased by preincubation of the cells in medium containing LDL. Using ferritin-labeled LDL (F-LDL) and electron microscopy, it was determined that at 4 degrees C the cells bound F-LDL in the same way as other cancer cell lines that did not have a defect in internalization. When these cells were warmed to 37 degrees C the F-LDL remained on the surface, whereas in cells from control cancer cell lines the F-LDL was internalized and was no longer observed on the cell surface. On the basis of the results of these studies it is concluded that cells of this epidermoid cancer cell line have a defective ability to internalize LDL.

Percutaneous arterial gene transfer in a rabbit model. Efficiency in normal and balloon-dilated atherosclerotic arteries.

The possibility of using an exclusively percutaneous strategy to deliver foreign DNA to normal and balloon-dilated atherosclerotic arteries was studied by analysis of transfection efficiency in a rabbit model. A total of 22 external iliac arteries from 22 rabbits (10 normal and 12 atherosclerotic) were transfected with a solution of luciferase expression vector plasmid and liposome, using a dual balloon-catheter system. Analysis of the transfected segments revealed luciferase activity in 10 of the 22 arteries (4/10 normal vs 6/12 balloon-injured atherosclerotic, P = NS); no activity could be detected in the contralateral limb arterial segments used as controls. Luciferase activity levels in successfully transfected segments measured 4.10 +/- 1.19 (m +/- SEM) Turner light units (TLU), with 3.03 +/- 1.16 TLU found in normals vs 4.81 +/- 1.87 TLU in balloon-injured atherosclerotic arteries (P = NS). In situ hybridization of successfully transfected atherosclerotic sections showed expression of the luciferase gene mRNA from rare cells (less than 1/1,000) limited to the neointimal lesion. Thus, expression of new genetic material may be achieved in both normal and balloon-dilated atherosclerotic arteries following an exclusively percutaneous approach. The low efficiency of the current delivery strategy, however, represents a potential limitation that must be improved if this strategy is to be applied as a therapeutic approach to human vascular disease.

Mesenchyme-epithelial interactions in human endometrium. Prostaglandin synthesis in separated cell types.

Glandular epithelium and stromal cells of human endometrium were separated and maintained in monolayer culture. At the time the cells became confluent, cell suspensions were prepared and incubated with [14C]arachidonic acid. Radiolabeled prostaglandin E2 and, to a lesser extent, prostaglandin F2 alpha and metabolites of these prostaglandins, were formed principally in stromal cells. There was considerably less prostaglandin formation in endometrial glands either after maintenance in monolayer culture or in freshly separated glands. In stromal cells of endometrium prostaglandin formation was linear with time of incubation for 2.5 min and with [14C]arachidonic acid concentrations up to 8 microM. When stromal cells and epithelial cells were combined, all prostaglandin formation could be accounted for by that produced in stromal cells. Little or no prostaglandin formation was detected in stromal cells from human adipose tissue or in fibroblasts from human genital or abdominal skin or human fallopian tube.

Increased gene expression after liposome-mediated arterial gene transfer associated with intimal smooth muscle cell proliferation. In vitro and in vivo findings in a rabbit model of vascular injury.

Arterial gene transfer represents a novel strategy that is potentially applicable to a variety of cardiovascular disorders. Attempts to perform arterial gene transfer using nonviral vectors have been compromised by a low transfection efficiency. We investigated the hypothesis that cellular proliferation induced by arterial injury could augment gene expression after liposome-mediated gene transfer. Nondenuded and denuded rabbit arterial strips were maintained in culture for up to 21 d, after which transfection was performed with a mixture of the plasmid encoding firefly luciferase and cationic liposomes. In non-denuded arteries, the culture interval before transfection did not affect the gene expression. In contrast, denuded arteries cultured for 3-14 d before transfection yielded 7-13-fold higher expression (vs. day 0; P < 0.005). Transfection was then performed percutaneously to the iliac arteries of live rabbits with or without antecedent angioplasty. Gene expression increased when transfection was performed 3-7 d postangioplasty (P < 0.05). Proliferative activity of neointimal cells assessed in vitro by [3H]thymidine incorporation, and in vivo by immunostaining for proliferating cell nuclear antigen, increased and declined in parallel with gene expression. These findings thus indicate that the expression of liposome-mediated arterial gene transfer may be augmented in presence of ongoing cellular proliferation.

Natural origins of off-flavours in fish related to feeding habits.

The objective of our study was to survey the accumulated 2-methylisoborneol (MIB) and geosmin (GSM) in fillets of five important farmed fish species in Hungarian aquaculture in relation to MIB and GSM concentrations in water and sediment in the aquatic systems where they were raised: (the planktivorous silver carp (Hypophthalmichthys molitrix), the herbivorous grass carp (Ctenopharyngodon idella), the bottom-feeding omnivorous common carp (Cyprinus carpio), the omnivorous tilapia (Oreochromis niloticus) and the carnivorous African catfish (Clarias gariepinus)). Water, sediment and fish samples were collected from different experimental aquatic systems which included a combined aquaculture-algae (CAA) system, effluent-fed fishponds, a pond recycling system and a traditional fishpond. MIB and GSM contents were extracted with distillation-headspace solid-phase-microextraction (SPME) and extracts analysed by GC-MS. Results showed that off-flavour contents in fish fillets were related to the feeding habits of the studied fish species. Higher GSM concentrations were found in the fillet of bottom-feeding common carp than in the silver carp or African catfish in all studied aquatic systems. Usually, low GSM concentrations were detected in the water of fishponds but sometimes the levels of this odour compound in carp fillet were well above the limits of human detection. This suggests that the off-flavour tainting of common carp may originate from the sediment or benthic algallactinomycete sources. Negligible MIB levels were found in all samples in all of the studied aquatic systems.

Nicotinamide adenine dinucleotide-dependent 15-hydroxyprostaglandin dehydrogenase activity in hydatidiform mole tissue and choriocarcinoma cells.

Prostaglandins may occupy an important role in viral and chemical carcinogen-induced neoplasia. To evaluate the possible role of prostaglandin catabolism in neoplastic cells, we measured nicotinamide adenine dinucleotide-dependent 15-hydroxyprostaglandin dehydrogenase activity in hydatidiform mole tissue and in choriocarcinoma cells maintained in monolayer culture. The specific activity of nicotinamide adenine dinucleotide-dependent 15-hydroxyprostaglandin dehydrogenase in hydatidiform mole tissue (0 to 1.2 nmol 15-ketoprostaglandin E2 formed x min-1 x mg-1 cytosolic protein) and in choriocarcinoma cells (1.0 nmol 15-ketoprostaglandin E2 x min-1 x mg-1 protein) was strikingly less than that found in normal placental tissue [11.4 +/- 2.3 (S.E.) nmol 15-ketoprostaglandin x min-1 x mg-1 protein].

Effect of cell density and confluency on cholesterol metabolism in cancer cells in monolayer culture.

Cholesterol metabolism in four gynecological cancer cell lines in monolayer culture was evaluated as a function of cell density. The rate of uptake and degradation of [125I]iodinated low-density lipoprotein increased during the first 24 to 48 hr of culture, but decreased thereafter. Once the cells became confluent, the rate of metabolism of [125I]iodinated low-density lipoprotein was only one-tenth that in cells which were in the preconfluent state. The specific activity of 3-hydroxy-3-methylglutaryl coenzyme reductase increased during the first 24 to 48 hr of culture and subsequently declined, reaching a nadir after confluency was attained. The rate of incorporation of [14C]oleate into cholesteryl esters was low when the cells were in the log-exponential phase of replication but increased gradually as cell density increased. The highest specific activity of acylcoenzyme A: cholesterol acyltransferase was attained after the cells became confluent. Generally speaking, there was an inverse relationship between the specific activity of 3-hydroxy-3-methylglutaryl coenzyme A reductase, on the one hand, and the rate of [125I]iodinated low-density lipoprotein metabolism and cholesteryl ester synthesis, on the other. It is concluded that cholesterol metabolism in cancer cells in monolayer culture is regulated, in part, by the rate of cell division. In the cancer cells utilized in this study, it is apparent that cholesterol metabolism was subject to the same regulatory mechanisms as are present in nonneoplastic cells.

Isolation of a novel gene, TSP50, by a hypomethylated DNA fragment in human breast cancer.

A novel gene, testes-specific protease 50 (TSP50), was isolated from a human testes cDNA library by using a genomic DNA probe, BR50. BR50 was isolated by a modified representational difference analysis (RDA) technique due to its hypomethylated feature in a breast cancer biopsy. This altered DNA methylation status was also detected by BR50 in other breast and some ovarian cancer tissues. The TSP50 gene product is a homologue to several human proteases, which indicates that it may encode a protease-like protein. Northern analysis of 16 different types of normal human tissues suggests that TSP50 was highly and specifically expressed in human testes, which indicates that it might possess a unique biological function(s) in that organ. Methylation status analysis in normal human testes and other tissues showed a correlation between DNA methylation and gene expression. Most importantly, reverse transcription-PCR analysis of 18 paired breast cancer tissues found that in 28% of the cancer samples, the TSP50 gene was differentially expressed. The possibility that TSP50 may be an oncogene is presently under investigation.

Effect of argon laser irradiation on rabbit aortic smooth muscle: evidence for endothelium independent contraction and relaxation.

To study the effect of argon laser irradiation on vascular smooth muscle reactivity, ring segments of rabbit thoracic aorta were mounted isometrically in Krebs bicarbonate buffer. Laser irradiation was performed via a 200-micron core optical fibre interfaced with an argon ion gas laser. Laser irradiation at powers greater than 1.0 watt (W) (n = 34) produced contraction in each case, regardless of the duration of exposure. Conversely, irradiation at powers less than 0.1 W (n = 41) consistently produced relaxation. When the power employed ranged from 0.1 to 1.0 W (n = 100), the typical response consisted of a combination of low amplitude contraction and relaxation. At each power level, the responses observed were independent of the presence or absence of intact endothelium, assessed functionally by the response to acetylcholine and anatomically by scanning electron microscopy. Recordings of tissue temperature profiles performed during continuous-wave laser irradiation suggest that the findings observed in this study may be explained by a combination of heat induced contraction and light induced relaxation. At powers greater than 1.0 W, heat generated by laser irradiation is predominant, causing contraction. At powers less than 0.1 W, light predominates over heat, causing relaxation. When the power range is intermediate between these values, the heterogeneous response recorded reflects the combination of light and heat. In all cases, contraction and relaxation are endothelium independent.

Cholesterol metabolism in human cancer cells in monolayer culture. V. The effect of progesterone on the regulation of 3-hydroxy-3-methylglutaryl coenzyme A reductase activity by low density lipoprotein.

The effect of progesterone on the regulation of 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase activity by low density lipoprotein (LDL) was studied in eight gynecological cancer cell lines maintained in monolayer culture. In the absence of LDL and progesterone, the specific activity of HMG CoA reductase varied widely from one cell line to another (range, 200-2500 pmol mg microsomal protein-1 min-1). As in noncancerous cells, LDL suppressed the activity of HMG CoA reductase in all cell lines. Progesterone (40 microM) attenuated or abolished the decrease in specific enzyme activity normally brought about by LDL. Progesterone, in the absence of LDL, stimulated HMG CoA reductase activity in some of these cell lines. Other steroids (cortisol and estradiol) had no effect on the specific activity of HMG CoA reductase. The mechanism by which progesterone stimulates HMG CoA reductase activity is not clear, but since progesterone receptors were not detectable in these cells a mechanism independent of the classic hormone receptor-mediated phenomenon is likely to be involved.

Burkholderia pseudomallei virulence: definition, stability and association with clonality.

Clinical presentations of melioidosis, caused by Burkholderia pseudomallei are protean, but the mechanisms underlying development of the different forms of disease remain poorly understood. In murine melioidosis, the level of virulence of B. pseudomallei is important in disease pathogenesis and progression. In this study, we used B. pseudomallei-susceptible BALB/c mice to determine the virulence of a library of clinical and environmental B. pseudomallei isolates from Australia and Papua New Guinea. Among 42 non-arabinose-assimilating (ara(-)) isolates, LD(50) ranged from 10 to > 10(6) CFU. There were numerous correlations between virulence and disease presentation in patients; however, this was not a consistent observation. Virulence did not correlate with isolate origin (i.e. clinical vs environmental), since numerous ara(-) environmental isolates were highly virulent. The least virulent isolate was a soil isolate from Papua New Guinea, which was arabinose assimilating (ara(+)). Stability of B. pseudomallei virulence was investigated by in vivo passage of isolates through mice and repetitive in vitro subculture. Virulence increased following in vivo exposure in only one of eight isolates tested. In vitro subculture on ferric citrate-containing medium caused attenuation of virulence, and this correlated with changes in colony morphology. Pulsed-field gel electrophoresis and randomly amplified polymorphic DNA typing demonstrated that selected epidemiologically related isolates that had variable clinical outcomes and different in vivo virulence were clonal strains. No molecular changes were observed in isolates after in vivo or in vitro exposure despite changes in virulence. These results indicate that virulence of selected B. pseudomallei isolates is variable, being dependent on factors such as iron bioavailability. They also support the importance of other variables such as inoculum size and host risk factors in determining the clinical severity of melioidosis.

Hormonal therapy for lesions of the endometrium.

Megestrol acetate, 20 to 40 mg/d, was given continuously to 70 postmenopausal women with a variety of endometrial hyperplastic changes. All patients were followed up with periodic endometrial biopsies. The study was conducted for 14 years with mean patient follow-up of more than 5 years. In 65 patients (93%), surgery was avoided due to this protocol. No patient developed endometrial carcinoma, and there were no major side effects. This regimen proved to be most effective in preventing hysterectomy in postmenopausal patients who presented with surgical risk factors and endometrial hyperplasia.

Pelvic control following external beam radiation for surgical stage I endometrial adenocarcinoma.

PURPOSE: To determine if postoperative external pelvic radiation (EBRT), without vaginal brachytherapy, is sufficient to prevent vaginal cuff and pelvic recurrences in patients with surgical Stage I endometrial adenocarcinoma (ACA). METHODS AND MATERIALS: The records of 122 patients with surgical Stage I endometrial cancer were reviewed. There were 87 patients with ACA who received EBRT alone and are the subject of this study. Their radiation records were reviewed. All patients underwent exploration, total abdominal hysterectomy, and bilateral salpingo-oophorectomy (TAH BSO), and pelvic and paraaortic lymph node sampling. They were staged according to the FIGO 1988 surgical staging system recommendations. Postoperatively, pelvic EBRT was administered by megavoltage equipment using four fields, to a total dose of 45 to 50.4 Gy. Actuarial survival and disease free survival were calculated according to Kaplan-Meier Method. RESULTS: Twenty-seven patients with Stage IA Grade 1 or 2 ACA with less than one-third myometrial invasion, who did not receive EBRT, and eight patients with histology other than adenocarcinoma (i.e., serous papillary, mucinous, etc.) were not included in the study. For the remaining 87 patients who are in the study group, the median follow-up was 52 months (range: 12-82 months). The 5-year overall survival for these 87 patients was 92%, with a disease-free survival of 83%. There were no tumor recurrences in the upper vagina or in the pelvis. Two patients developed small bowel obstruction (no surgery required), and one patient developed chronic enteritis. CONCLUSION: Adjuvant external pelvic radiation, without vaginal brachytherapy, prevents pelvic and vaginal cuff recurrences in surgical Stage I endometrial ACA.

Effect of radiation on prostaglandin production by human bowel in vitro.

The effect of gamma irradiation on the production of prostaglandins by human colon was investigated. Squares of tissue in organ culture dishes were irradiated with 500, 1000, or 2500 rad in single applications. Tissues that were not irradiated served as controls. After treatment the tissues were superfused and prostaglandin concentrations in the effluent fluid were determined. The rates of production of prostaglandins E2 and F2 alpha by irradiated tissues were significantly lower (p less than 0.05) than those of nonirradiated tissues. Neither the release of lactate dehydrogenase nor the rate of production of 13,14-dihydro-15-keto-prostaglandin F2 alpha were increased in the irradiated samples, suggesting that neither decreased cell viability nor increased prostaglandin metabolism accounted for the decreased prostaglandin production rates. We conclude that irradiation of the human colon in vitro results in an acute inhibition of prostaglandin synthesis. The cytoprotective nature of prostaglandins is discussed with regard to the possible pathophysiological significance of these findings.

Keloid scars as a result of CO2 laser for molluscum contagiosum.

Molluscum contagiosum is an infectious disease of the skin, found primarily on the thighs and genitalia. It is a sexually transmitted disease of increasing prevalence. The traditional treatment of this condition is surgical ablation, although CO2 laser has been advocated recently as an alternative mode of therapy. Six patients with molluscum contagiosum were treated by either continuous or intermittent CO2 laser. Four of the six have developed severe keloid scars. Removal of lesions by cold knife, however, was not followed by keloid scars. In the same patient, areas affected by human papillomavirus that were treated with CO2 laser did not develop keloid scars. Our results question the use of CO2 laser therapy for molluscum contagiosum.

Silicone band technique for laparoscopic tubal sterilization in the gravid and nongravid patient.

Laparoscopic tubal sterilization by the Falope ring technique was performed on 196 patients. Sixty-four patients underwent laparoscopic tubal sterilization at the time of gestation termination. One hundred thirty-two patients underwent interval laparoscopic sterilization. The complication and failure rates in the group that had both laparoscopic tubal sterilization and gestation termination was lower than in the group that had laparoscopic tubal sterilization alone. The Falope ring sterilization technique is a safe method when combined with gestation termination, and spares the patient the inconvenience and increased hazard of 2 separate procedures.

A cinefluoroscopic study of ureteral function following radical hysterectomy.

Twenty patients were studied with static and cinefluoroscopic intravenous pyelograms to quantitate the morphologic and physiologic ureteral alterations following radical hysterectomy and pelvic lymphadenectomy. More than 87% of the patients in the 48-hour study had ureteral dilatation, which persisted for 7 days in most patients, proximal to the site of pelvic dissection. By 6 weeks after surgery, the dilatation had regressed and pyelograms returned to normal. Transit time from renal pelvis to bladder was doubled at 7 days. An alteration in the character of peristalsis was noted on the cinefluoroscopic studies at 48 hours and at 7 days. The distal ureter appeared as a rigid conduit, and the peristaltic activity was replaced by bolus emptying.

Transmissibility and treatment failures of different types of human papillomavirus.

In order to evaluate the transmissibility and treatment failures of different types of human papillomavirus (HPV), we obtained biopsy specimens from genital lesions related to HPV in 113 women prior to laser therapy. Sixty-eight had condylomata acuminata, 14 had flat condyloma, and 31 had cervical intraepithelial neoplasia with or without condylomata. Of 76 male sexual partners examined colposcopically, 58 (76%) had HPV-related lesions. All biopsy specimens were analyzed for specific type of HPV DNA by Southern blot hybridization with probes for HPVs 6, 11, 16, and 18. Sixty-one women had HPV 6 or 11 (6/11), 40 had HPV 16 or 18 (16/18), and in 12 the analysis was negative for these types of viral DNA. Deoxyribonucleic acid analysis of biopsy specimens from recurrent lesions showed the same type of viral DNA as in the primary lesion. Significantly more male partners (28 of 47) with the same HPV type were found among women with HPV 6/11 than among women with HPV 16/18 (P less than .005). Patients with HPV 16/18 had significantly more recurrences (14 of 40) after laser therapy than patients with HPV 6/11 (six of 60) (P less than .001).