Chemical submission: results of 4-year French inquiry.

Psychoactive substances may be administered without the knowledge of a victim in order to induce incapacitation and thus facilitate criminal actions. The characteristics of the victims and the drugs used in such suspected chemical submissions (CS) were analyzed in 309 cases collected from October 2003 to December 2007 through a national survey. Out of 309 cases, 158 met all criteria of CS. The victims were mostly female (n = 89, 56%). The type of aggression was mostly sexual assault (in 79 cases 50%). Benzodiazepines and related drugs were detected in 129 victims (82%) and were mostly clonazepam, zolpidem, and bromazepam whereas flunitrazepam and gamma hydroxybutyrate, well known for their use in CS, were identified in 11 (7%) and five (3%) of the 158 victims. CS is not an anecdotal phenomenon in France. Information for health professionals and workers in forensic structures as well as education of the general population associated with preventive measures such as drug dosage form changes should contribute to improved care management of victims and decreased risk.

Focal neurological complications of handcuff application.

The application of handcuffs may result in compression neuropathies at the wrist. The frequency of these complications is unknown. Twelve of 190 (6.3%) consecutive subjects kept in police custody presented distal neurological symptoms possibly related to handcuff application. The duration of handcuffing was significantly longer in patients with neurological symptoms than in patients without neurological symptoms (mean +/- SD: 3.7+/-5.2 h vs. 1.8+/-2.6 h, P = 0.02). A long duration of handcuff application and, possibly, the existence of somnolence or acute alcohol intoxication could be predisposing factors to handcuff neuropathy. A prospective study of clinical and electrophysiological detection and follow up is needed.

[Jaundice with free bilirubin following preventive anti-retroviral therapy after sexual aggression]. / Ictère à bilirubine libre au cours d'un traitement prophylactique antirétroviral après agression sexuelle.

BACKGROUND: Interest has recently focused on anti-HIV prophylaxis in case of sexual exposure. A circular from the French Ministry of Health (DGS/DH n(o) 97/560, 12 August 1997) envisages such treatment in certain risk situations such as sexual aggression. The toxic risk of prescribing a tritherapy or a bitherapy, even for a short period of a few weeks must be considered. CASE REPORT: A 20-year-old rape victim with an uneventful medical history was given a prophylactic regimen including zidovudine, laminovudine and indinavir. Three months later, she developed free-bilirubin jaundice with biological signs of hemolysis. DISCUSSION: We draw attention to the risk of severe adverse effects of short-duration anti-HIV prophylaxis in apparently healthy subjects. The protocol must included careful patient information and rigorous surveillance.

[Anaphylactic shock. From prevention to treatment]. / Choc anaphylactique. De la prévention au traitement.

Anaphylactic shock is a severe condition resulting from circulatory failure induced by a foreign agent introduced into the organism. True anaphylactic shock, with an immunological component, should be distinguished from anaphylactic shock and anaphylactoid shock related to non-specific release of mediators. There is a large spectrum of clinical manifestations, but the sudden onset, the potential gravity and the extreme sensitivity to epinephrine comprise the three main characteristics of circulatory collapse. Search for the responsible agent is essential when faced with an episode of anaphylactic shock in order to take effective preventive measures.