[The alliance of the parent, child and the nurse to challenge medical error]. / L'alliance parents-enfant-soignants à l'épreuve de l'erreur médicale.

A group composed of parents, nurses, and physicians involved in pediatric cancerology has reflected on medical errors within the Espace Éthique de l'Assistance publique-Hôpitaux de Paris. Based on narratives and qualitative analysis of histories and testimonies, this discussion aimed at exploring the causes, circumstances, and impacts of medical errors on the relations between these individuals. The study demonstrated that some circumstances actually promote medical errors, such as hard working conditions, mistrust, unreliable control procedures, not listening to parents, and caring for children in extreme situations of pain and suffering. Errors almost always result from the accumulation of several shortcomings. The tensions raised by a medical error can be overcome, provided that parents and caregivers trust each other from the onset of disease and that the medical errors are disclosed in a sincere way, whatever the medical consequences. The feelings raised by the painful experience of a medical error do not solely depend on the severity of the consequences, since seemingly benign errors may lead to long-term trauma, whereas severe errors, even those leading to death, do not necessarily breach trust. The keyword here is permanent vigilance. The capacity of caregivers to question their practice, from both a technical and ethical point of view, will determine their ability to learn from an error for the future. The depth and quality of this questioning, in the best of times encouraged by the institution, may also help children affected by a medical error and their family to move forward in their personal history, beyond such painful experiences.

Insight and schizophrenia.

Few clinical attributes, if any, have such a profound impact on the management of schizophrenia as that associated with lack of insight. Yet, despite its importance, the clinical correlates of lack of insight are poorly understood. In one present study of long-stay patients at a state facility, lack of insight showed modest associations with positive and negative symptoms and with diminished executive function on cognitive testing. Insight did not differ between patients receiving typical and atypical antipsychotic medications.

If patients with schizophrenia have small brains, why don't they have small heads?

Although patients with schizophrenia have reduced brain size, there is no conclusive evidence that they have reduced head size. This begs the question: 'What is the precise relationship between head size and brain size?' We used a unique osteological collection to explore the relationship between external head measures and cranial capacity. The external measures accounted for, at most, 60% of the variance in cranial capacity - a value low enough to question the oft-assumed tight relationship between head measures and brain size. Obviously, various tissues and spaces [skull, sinus, muscle (frontalis, temporalis and occipitalis), subcutaneous fat and epidermal layers] contribute to head size without contributing to brain volume. The contribution of these other tissues and spaces tends to decrease the signal and increase the noise in the estimation of brain volume. Thus, it is understandable that patients with schizophrenia can have reduced cranial capacity and not reduced head size.

Variant petrotympanic fissure as possible cause of an otologic complication during TMJ arthroscopy. A case report.

In this reported case, a variant petrotympanic fissure--opening at the height of the orifice of the Eustachian tube into the hypotympanon--was identified by high resolution computed tomography (CT) as the possible cause of a tympanic membrane perforation. Inner ear function was preserved by an otosclerotic stapes which prevented destruction of the labyrinth. The perforation was closed by a myringoplasty and was to be followed by a stapedectomy after six months to restore normal hearing. Surgeons performing temporomandibular joint arthroscopy should be aware that in a small percentage of patients a variant anatomy of the tympanic plate exists and, therefore, great care must be exercised in the manipulation of instruments near this structure. A preoperative high resolution CT with thin slices of the temporal bone might allow identification of these high risk patients.

The sedimentation potential and the boycott effect.

The sedimentation potential or the Dorn effect occurs when heavy particles fall in a liquid. An electrode near the bottom of the vessel acquires a potential difference with respect to another identical electrode placed near the upper surface of the solution. The Boycott phenomenon enhances the sedimentation in inclined vessels. In this investigation, fixed erythrocytes at 2-3% concentration were studied. The shapes include discs, oblate spheroids, spheres and spindles. From the sedimentation potentials, the zeta potentials were calculated and compared with those determined by laser Doppler velocity. By using a technique of reduced variables, it is shown that all of the data could be placed on a single curve, combining particle flexibility, shape, concentration and angle of inclination.

Somatostatin reduces the release of colony-stimulating activity (CSA) from PHA-activated mouse spleen lymphocytes.

PHA-activated lymphocytes release colony-stimulating activity (CSA) for macrophage-granulocyte precursor cells (colony forming units, CFUc) in the culture medium. Somatostatin, known to interfer with ribosomal protein synthesis, was demonstrated to reduce the release of CSA from PHA-treated mouse spleen lymphocytes.

[Multiple-stage treatment of malignant melanoma (author's transl)]. / 78. Die Mehrschritt-Therapie des Melanomalignoms

The paper reports on 11 patients with very advanced melanoma, who were treated with a modified version of multiple-stage cancer therapy. No improvement in the course of the illness resulted, but survival may have been slightly prolonged.