[Medical death certificate]. / Certificat médical de décès.

The death certificate is a complex diagnostic procedure for the first medical responders (or general practioners) and requires a complex intellectual process. This article provides a practical and critical approach to the death certificate (modèle IIIc) which must be completed in the best way. The authors strongly emphasized the differences between violent death and natural death, keystone of the medicolegal approach and as a possible starting point of criminal investigations.

[Ignored homicides]. / Homicides ignorés.

Forensic medicine is a fundamental science for a good evolution of the law and a serious protection of citizens. This science is also inextricably linked to public health. As basic discipline, we consider useful to revisit homicides which escape the investigators'sagacity and especially to know the reasons of this missing. Forensic high quality depends on respect of the crime scene, through specialized training and above all the recognition of this crucial discipline in our contemporary society.

[About medical accidents and their medicolegal implications. Information and consent]. / Réflexions sur l'accident médical et ses implications médico-légales. Le consentement eclairé.

Medical practice today is not simple because of various factors impinging on the doctor-patient relationship. The concept of consent arises from the ethical principle of patient autonomy and basic human rights. It is also the rule of law (Civil Code article 16-3) that guarantees the patient's right and freedom to decide what should or should not happen to his/her body and to gather information before undergoing a test/procedure/surgery. No one else has the right to coerce the patient to act in a particular way. The authors after a reflexion about medical accidents and their medicolegal implications, discuss the means to display in order to provide to the patients the adequate information about their disease and proposed treatment, therefore protecting the medical practitioner from the consequences of insufficient or ill information.

[Medico legal issues related to driving: the role of the general practitionner]. / Restrictions médico-légales a la conduite automobile rôle du médecin généraliste.

The Belgian law requires that the physician informs his/her patient when he diagnoses a medical reason that makes him/her unfit to drive a vehicle. This paper lists, as they appear in the official texts, the physical conditions and diseases which may be responsible for the inaptitude to drive. Thus are detailed the rules applied in the presence of neurological diseases, psychic disorders, epilepsia, pathological sleepiness, locomotive disorders, cardiovascular disease, rhythm or conduction disturbances, blood pressure abnormalities, coronary or myocardial disease, and hearing loss or vestibular problems. The reader will also find a summary of the rules related to visual ability, alcohol use, driving under the influence of psychotropic drugs, or medicines in general, renal or hepatic diseases, and to the patient who received an organ transplant or an artificial implant. The responsibility of the physician, primarily the general practionner, may be involved in these matters; this issue is discussed.

[Management of intrafamily violence issues by general practitioners]. / Gestion sur le terrain de la violence intra-familiale par le médecin généraliste.

General practitioners often come upon intrafamily abuse cases in their practice. They are either specifically consulted because of these instances of abuse or they discover them by accident. When this happens, they are often unsure of the appropriate procedure to follow, for fear of committing a medical fault or breaking the law. The aim of this short article is not to dwell on the diagnostic methodologies, but to provide a series of general guidelines to follow in everyday practice.

Fatal herpes simplex virus infection in Darier disease under corticotherapy.

A 67-year-old man is presented with longstanding and severe Darier disease treated by topical antiseptics and potent corticosteroids, in combination with oral glucocorticoids and etretinate. After cardiac bypass surgery in 1997, the patient experienced herpes simplex virus (HSV type-1) infection of the skin that was treated by intravenous aciclovir. In 2003, he presented a widespread atypical exacerbation of his Darier disease, involving the face, trunk, buttocks, intertriginous areas and arms. Initial clinical signs and bacteriological findings suggested a bacterial involvement by multiresistant Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and Proteus mirabilis. Despite antibiotherapy, the clinical presentation progressively worsened. A skin biopsy was performed and immunohistochemical examination identified a type-2 HSV infection. Although intravenous aciclovir was administered, the widespread cutaneous HSV infection was followed by systemic dissemination. A severe acute respiratory distress syndrome (ARDS) developed, leading to a fatal issue. At autopsy, a severe interstitial type-2 HSV pneumonitis with extensive necrotic areas was found, in association with gastro-intestinal involvement. This case represents, to the best of our knowledge, the first case of Darier disease presenting a fatal type-2 HSV infection. It underlines the importance of rapidly recognizing HSV infection in Darier disease and stresses the risk of lethal outcome. The different risk factors for HSV infection in this patient are reviewed.