The informed consent for surgery. Update for Belgium in 2008.

Until the no-fault law in Belgium (15/05/2007) comes in action on 01/01/2009 it will be a system of fault to prove. Therefore the informed consent stays a mean or not liability progress. At this moment it stays a problem for the surgeon when he has not given any information about informed consent to the patient. If an operative intervention is unlawful. Then the signature of the patient does not remove the unlawful character of this intervention. Also the decline in standard forms with no personal contact and loss of individual adaptation cannot give a good result of information. The consequences of informed consent and how to prove the informed consent in medico legal setting are important for the surgeon's behavior. For the surgeons it will be a duty to make good informed consent brochures and forms that are adapted to the needs of the individual patients. First an oral and personal explanation between the surgeon and the patient has to be done during the first consultation. Secondly a form has to be handed over to the patient. Thirdly the patient must have the possibility to read it. Fourth the patient has to give his oral and written informed consent to the surgeon before being operated on by that same surgeon or any member of his staff. There is always a risk for sanctions in several procedures like criminal law and civil law until the no-fault system comes into action on 01/01/2009.

Parotid mass as first symptom of a malignant lymphoma.

BACKGROUND AND OBJECTIVES: Primary malignant lymphoma in the parotid gland is rare and seldom described in the literature. We studied the medical history and outcome of seven patients with a primary malignant parotid lymphoma. We looked for prognostic variables and for different behavior of these lymphomas in comparison to lymphomas in the usual sites. METHODS: Between 1985 and 1995, we conducted a retrospective study of the medical histories of malignant parotid tumors operated at our hospital. There were 18 malignancies, of which 7 were primary malignant lymphomas. We classified them according to Rosenberg et al. [Blood 1994;84: 1359-1392]. Outcome and survival time were compared with malignant lymphomas in usual sites. Further we looked for possible prognostic factors. RESULTS: We found an unusually high percentage of primary malignant lymphomas in the parotid gland in our series: 38% of all malignancies. Histological workup showed one Hodgkin lymphoma, two marginal zone B-cell non-Hodgkin lymphomas, two lymphoplasmocytoid non-Hodgkin lymphomas, and two follicular non-Hodgkin lymphomas. The clinical course of these lymphomas is comparable to that in lymphomas in the usual sites. CONCLUSIONS: Primary malignant lymphomas in the parotid gland have no different behavior compared to lymphomas in usual sites. There are no prognostic variables that distinguish a malignant lymphoma in the parotid gland. The only difference is a rather difficult operation to obtain a histologic specimen.