[Pregnant, addicted prostitutes: compulsory admission is sometimes necessary in the interests of the child]. / Zwangere, verslaafde prostituees: soms gedwongen opname in het belang van het kind.

Three drug-addicted prostitutes, who were 37, 27 and 25 weeks pregnant respectively, were admitted to a psychiatric department under court order. After the birth, the children were placed in foster families. The mothers withdrew from further treatment. In Rotterdam, The Netherlands, there is a city network made up of doctors and social workers; in the case of addicted pregnant prostitutes they advise the Child Protection Agency of the Ministry of Justice about the care of the child after its birth. The combination of heavy addiction and prostitution in a pregnancy without any prenatal care can be considered a psychiatric disorder. Consequently, an addicted woman can be compulsorily admitted because of the threat she forms to her unborn child. In these cases the mother's right to self-determination must be limited in the interest of the child.

[Post mortem semen acquisition: not without 'informed consent']. / Semenafname post mortem: niet zonder 'informed consent'.

Recently, two requests for post-mortem semen acquisition were evaluated and rejected. The first request was from the wife of a man who died after the wedding night. In the second case, the wife requested that electroejaculation be done on a man who was brain dead because of a gunshot wound in the head. In both cases, the fact that there was no written consent from the men involved before they died was the deciding reason not to grant the requests. Written consent is legally and ethically seen as the final episode of a period in which persons have considered the consequences of the acquisition, storage and use of semen after the death of the husband.

Legal protection or legal threat? Ethical conflicts in the process of medical decision making.

Children have a fundamental right to good health care. It seems natural that they should be treated according to their age and intellectual capacity. However, this is more complicated than it seems at first and causes ethical conflicts. This article discusses whether Dutch and European law can solve these ethical conflicts and points out that solutions are not always to be found through legal interference, which may lead to judicial paternalism.

[Technetium TC 99m pyrophosphate myocardial scintigraphy in amyloidosis. Correlations with Doppler echocardiography]. / La scintigraphie myocardique au pyrophosphate technétié dans l'amylose. Corrélations avec l'échographie doppler cardiaque.

Technetium 99m cardiac scintigraphy as practiced at present for diagnosing amyloisodid only provides a visual semi-quantitative assessment of uptake of the isotope. To improve the diagnostic accuracy of the method, the authors evaluated prospectively a personal technique of scintigraphy quantification based on early images obtained at the 20th minute in 15 patients with neuropathic amyloidosis. Doppler echocardiographic studies indicated that 9 patients had cardiac involvement whilst 6 were free of cardiac amyloidosis. The index of isotopic uptake (ratio of cardiac/abdominal uptake) was 0.44 to 1.58 in the first group and 0.09 to 0.31 in the second group. The correlation between the scintigraphic index and interventricular septal or posterior wall thickness measured by echocardiography was poor. These results obtained in 15 patients with neuropathic amyloidosis suggest that the scintigraphic index measured at the 20th minute is discriminatory and allows identification of those patients with cardiac involvement. On the other hand, the correlations with echocardiographic wall thickness are poor. Technetium 99m cardiac scintigraphy with this technique of quantification is a useful tool for diagnosing cardiac amyloidosis, especially when echocardiography is difficult to interpret.

[Coronary spasm and diffuse coronary vasoconstriction responsible for transient left ventricular insufficiency]. / Spasmes coronaires et vasoconstriction coronaire diffuse responsables d'une insuffisance ventriculaire gauche transitoire.

A 52 year old patient presenting with spontaneous anginal chest pain for 4 days was admitted to hospital for a more intense and prolonged chest pain associated with signs of left ventricular failure (gallop, pulmonary crepitations, hypoxemia). Coronary angiography showed marked septal hypokinesia and spontaneous localised spasm of the left anterior descending and marginal arteries with a variable degree of luminal narrowing of the other segments of these two arteries and of the right coronary artery. These changes regressed after intracoronary injection of molsidomine. The signs of left ventricular failure disappeared in 48 hours. The wall motion abnormality, monitored by 2D echocardiography, regressed slowly over 3 days. On the other hand, the electrocardiogram, which showed anterior wall subendocardial ischaemia with prolongation of the QTc interval during the spasm, remained abnormal for a long time. Therefore, in the absence of organic heart disease, coronary spasms associated with vasoconstriction can induce a sufficiently severe and durable alteration of left ventricular function to create clinical signs of cardiac failure and profound and prolonged ST-T wave changes on the electrocardiogram.

Genetic and molecular analysis of six tumor suppressor genes in Drosophila melanogaster.

Six Drosophila melanogaster tumor suppressor genes causing malignant or benign tumors in specific cell types are described. The wild-type alleles of these genes are instrumental in the differentiation of particular cell types. In the homozygous state, recessive mutations in the genes interrupt the differentiation of the cells and thus cause their uncontrolled, autonomous, lethal proliferation. The tumors show all major characteristics of malignant and benign neoplastic growth. Genomic sequences of four of the genes have been identified and are currently being characterized.

Comparison of the efficacy of propranolol and amiodarone in suppressing ventricular arrhythmias following myocardial infarction.

The purpose of this prospective randomized trial was to compare the efficacy of propranolol and amiodarone in suppressing ventricular arrhythmias during the first 6 months following myocardial infarction (MI). 97 patients were treated with either amiodarone (n = 48) or propranolol (n = 49) starting on the 9th day following MI. Holter monitoring was carried out on four occasions: on D7, D21, D90 and D180. There was no statistical difference in the incidence of 'major' arrhythmias (an average of at least 10 ventricular premature complexes (VPCs) h-1, multiform or paired VPCs or runs) between the two groups on D7. A significant difference in favour of amiodarone became apparent at D180 (P = 0.04). Patients were also classified according to whether treatment failed or was successful. 'Success' was recorded when arrhythmias remained minor or became minor (less than 10 uniform VPCs h-1) and 'failure' when arrhythmias remained major or became major, or when patients were withdrawn because of side-effects, or lost to follow-up. The difference remained in favour of amiodarone (P = 0.03 at D21; P = 0.05 at D90; P = 0.06 at D180). Evaluation of the percentage reduction in the number of VPCs at D21, D90 or D180 compared with D7 showed superiority of amiodarone at D90 (P less than 0.01) and D180 (P less than 0.04). In this study, the overall effect of amiodarone on ventricular arrhythmias following MI was shown to be superior to that of propranolol.

[Cardiac toxicity of 5-fluorouracil]. / Toxicité cardiaque du 5-fluoro-uracile.

A 67 year-old patient receives 5-fluorouracil for vocal chord cancer. During the perfusion, atypical angina pain occurs, accompanied with offset of ST above the baseline in standard leads and in V4 through V6. The pain subsides spontaneously in 45 minutes. These ECG alterations are followed 48 hours later by diffuse inverted T waves with lengthened QT. Cardiac ultrasonography and isotopic angiography do not show any abnormality of the left ventricular function, but myocardial tomoscintigraphy with labelled thallium show a lower hypofixation on exertion. The cardiac toxicity of 5-fluorouracil is in frequent. It is usually believed that it involves a coronary spasm, as suggested by the ECG tracing in the reported cases. The incident, which may be painful or painless, may result in a myocardial infarction or even sudden death during the perfusion. Therefore, it is advisable to discontinue the treatment as soon as an angina-type pain occurs.

[Comparative efficacy of amiodarone and propranolol on ventricular arrhythmia in the post-infarction period]. / Efficacité comparée de l'amiodarone et du propranolol sur les arythmies ventriculaires dans les suites d'infarctus du myocarde.

Beta-blockers are known to be effective against post-infarction ventricular arrhythmias and amiodarone has recently been shown to have this property. The purpose of this prospective randomized study was to compare the effects of beta-blockers and amiodarone during the first 6 months following infarction. Nine days after the onset of myocardial infarction, 97 patients were put on either amiodarone (48) or propranolol (49). Holter monitoring was performed on four occasions: on the 7th post-infarction day (baseline), then on the 21st, 90th and 180th days (under treatment). On D7 the two groups were similar in age, sex, risk factors, medical history, characteristics of the infarction and type of arrhythmia. For result analysis purposes the patients were divided into two categories depending on whether their arrhythmia was "moderate" (less than 10 monomorphous and isolated ventricular extrasystoles per hour) or "severe" (at least 10 ventricular extrasystoles per hour, or polymorphous or repetitive ventricular extrasystoles). Concerning the frequency of "severe" arrhythmia, there was no statistical difference between the two treatment groups on D7 (p = 0.53), but differences in favour of amiodarone became increasingly important during the study (p = 0.08 on D21; p = 0.07 on D90; p = 0.04 on D180).(ABSTRACT TRUNCATED AT 250 WORDS)

[Intermediate-term trial treatment of arrhythmia in hypertrophic myocardiopathy with sotalol]. / Essai de traitement à moyen terme des troubles du rythme de la myocardiopathie hypertrophique par le sotalol.

Unlike amiodarone, beta-blockers have proved ineffective in the treatment of severe ventricular rhythm disorders encountered in hypertrophic myocardiopathy. We tried to evaluate the efficacy of sotalol, a betablocker with anti-arhythmic properties, like amiodarone, on the supraventricular and ventricular rhythm disorders of this disease. 13 patients (6 men and 7 women, mean age 53.5 +/- 26.5 years) were evaluated with a 48 hours electrocardiographic recording, before and 8 and 120 days after a sotalol treatment at a mean dose of 290 mg/day (160 to 640 mg). The diagnosis of hypertrophic myocardiopathy was established on standard clinical, phonomecanographic (13 cases), sonocardiographic (13 cases) and haemodynamic (9 cases) criteria. Five patients presented bursts of supraventricular tachycardia on DO. Their number decreased to 4 on D8 and to 3 to D120. Six patients presented Lown's class III or IV ventricular rhythm disorders on DO. Their number went from 2 on D8 to 4 on D120. Therefore, in this short series, sotalol has shown a non-negligible efficacy on the rhythm disorders encountered in hypertrophic myocardiopathy.

[Uncommon aspect of electrocardiographic ischemia. Correlations with coronarography]. / Aspect insolite de l'ischémie électrocardiographique. Corrélations avec la coronarographie.

It has long been known that the morphology of ventricular repolarization is extremely sensitive to acute or chronic myocardial anoxia. In patients with coronary disease, we are used to observe a wide variety of ST segment, T wave and sometimes U wave abnormalities. The classical description of "lesions" or "ischaemia", as well as their anatomical locations called, perhaps rather arbitrarily, "subendocardial" or "subepicardial" account for ST segment displacements and T wave inversions the patterns of which are well known to all of us. It may happen, however, that repolarization takes a frankly unusual appearance very different from the conventional images. On several occasions we were surprised to find, in a situation of acute or subacute coronary obstruction, a highly atypical and characteristically very transient repolarization pattern with considerable lengthening of QT and broad and deep inversion of T wave which, to our knowledge, have never been described in the literature. A systematic search for such unusual ECG patterns, conducted over the last 4 years in the Cardiology department of the Bicêtre Hospital on patients with ischaemic heart disease, has yielded 16 cases which are reported in the present study.

[Sinusal dysfunction secondary to the ingestion of diltiazem, cured by the administration of intravenous calcium]. / Dysfonction sinusale secondaire à la prise de diltiazem corrigée par administration de calcium intraveineux.

An elderly patient, receiving long-term oral diltiazem at the usual dosage, presented a sudden attack of junctional bradycardia at 35 b X min-1; this was badly tolerated by the patient. The diltiazem blood level was normal. After recovery, nodal investigations were also normal. The treatment of this accident due to a calcium-blocker is stressed: the intravenous injection of a calcium salt only was sufficient, with a return to near-normal sinus function, so avoiding the necessity of pacing.

Serum selenium deficiency in myocardial infarction and congestive cardiomyopathy.

Serum selenium concentration was prospectively measured using the method of thermoelectric atomic absorption spectrophotometry in 129 study participants distributed as follows in three groups: control group (n = 48) volunteers without known cardiac or lung disease; group I: patients with congestive cardiomyopathy (n = 48), group II: patients with myocardial infarction (n = 31). Serum selenium level was 84.73 +/- 1.79 micrograms.l-1 (m +/- sem) in the control group, 68.53 +/- 2.26 micrograms.l-1 in group I and 73.55 +/- 2.33 micrograms.l-1 in group II. The difference between group I and group II versus the control group was significant (p less than 0.01). There was no significant difference between group I and II.

[Decrease of the serum level of selenium in chronic alcoholics with or without dilated cardiomyopathy]. / Baisse du taux sérique de sélénium chez les alcooliques chroniques avec ou sans cardiomyopathie dilatée.

Serum selenium concentrations were measured by electrothermal atomic absorption spectrophotometry in 31 controls and 101 patients with the following results (mean +/- s.e.m; microgram . l-1: controls: 86.27 +/- 2.26; 24 chronic alcoholics without denutrition: 63.29 +/- 3.19; 38 patients with denutrition (64.75 +/- 3.68) divided into chronic alcoholics (n = 27); 65.24 +/- 3.49 and non-alcoholics (n = 11): 63.55 +/- 4.15; 39 patients with cardiomyopathy (68.89 +/- 3.43) divided into chronic alcoholics (n = 21): 67.61 +/- 3.10 and non-alcoholics (n = 18): 72.56 +/- 3.82. Compared with values in the control group, the fall in mean serum selenium concentrations was statistically significant (P less than 0.001) in all groups of patients. In contrast, there was no significant difference in mean serum selenium concentrations between patients with cardiomyopathy and those with denutrition, alcoholic or not. Chronic alcoholism and denutrition are accompanied by a fall in blood selenium level. The decrease of serum selenium concentrations in alcoholic and non-alcoholic patients of the third group suggests that congestive cardiomyopathy is associated with selenium deficiency. These findings indicate that patients with congestive cardiomyopathy should be evaluated not only for alcoholism, but also for their nutritional status.

[Complete left branch block and electrocardiographic diagnosis of left ventricular hypertrophy]. / Bloc complet de la branche gauche et diagnostic électrocardiographique de l'hypertrophie ventriculaire gauche.

The electrocardiogrammes of 71 patients (39 men and 32 women) with transient or intermittent complete left bundle branch block (LBBB) were studied. Two tracings, one with and the other without LBBB were analysed in each case. The interval between the two recordings was less than 90 days in all cases (average 10 days). The diagnosis of left ventricular hypertrophy (LVH) was established from the ECG without LBBB. The sensitivity and specificity of the classical criteria or indices of LVA and of different associations of indices of LVH were assessed on the ECGs with LBBB. The best criteria of LVH in the presence of LBBB were the SV2 + RV6 greater than or equal to 32 mm (sensitivity 80%; specificity 81%), Sokolow's index greater than or equal to 33 mm (sensitivity 78%, specificity 81%); followed by SV1 greater than or equal to 23 mm (sensitivity 73%, specificity 86%), SV1 + SV2 + RV6 + RV7 greater than or equal to 65 mm (sensitivity 88%, specificity 63%), SV1 + SV2 greater than or equal to 54 mm (sensitivity 73%, specificity 74%). These six parameters allow correct diagnosis of LVH in 81%, 79%, 78%, 79% and 73% of cases, respectively. The SV1 + SV2 + RV5 + RV7 and the SV1 + SV2 + RV6 + RV7 greater than or equal to 65 mm indices are the most stable (same sensitivity and specificity for several consecutive threshold values, i.e. 62 to 67 mm and 64 to 66 mm respectively); the results obtained with these two indices are therefore more likely to be reproducible than those of the other indices as they seem less dependent on the sampling. The indices of LVH based on the QRS amplitude in the precordial leads remain valid in the presence of LBBB and are sufficiently reliable for the diagnosis of LVH to be clinically useful.