[Control of the legal practice of euthanasia in Belgium]. / Le contrôle de la pratique légale de I'euthanasie en Belgique.

The Belgian law legalizing euthanasia under strict conditions came into effect September 22, 2002. Any physician performing euthanasia has to complete a registration document and to send it within four days to a federal commission whose mission is to verify that the legal conditions were fulfilled. From September 22, 2002 to December 31, 2013, 8.767 documents have been registered and analyzed by this commission. They are described in six reports referred to Parliament. The present paper analyzes the work of this commission and answers the criticisms concerning its quality and its efficiency. The allegations that clandestine euthanasia's escaping any control are performed are also discussed. In conclusion, it appears that the legal obligations concerning the practice of euthanasia in Belgium are fully effective.

[Management of requests for euthanasia. Discussion of cases]. / Gestion des demandes d'euthanasie en première ligne. Discussion de cas.

Since September 2002, more than 2.000 legal euthanasia's were performed in Belgium. The present paper reviews the necessary steps to be followed by the physician for a correct achievement of the process initiated by the patient's demand to die. Interpretation of the legal conditions to be respected by the physician is discussed from reports of ten cases of requests for euthanasia.

[Depenalized practice of euthanasia in Belgium: evolution from 2002 to 2005 and interpretation of the differences between the north and the south of the country]. / La pratique dépénalisée de l'euthanasie en Belgique: évolution de 2002 à 2005 et interprétation des différences entre le Nord et le Sud du pays.

The euthanasia's performed, in accordance with the law of may 28, 2002, between September 22, 2002 and December 31, 2003 and between January 1, 2004 and December 31, 2005 are respectively analyzed in two successive reports of the federal commission for control and evaluation of euthanasia, based on the registration documents referred by the physicians to this commission. The present paper compares the data of those two reports and analyses the evolution of the application of the law. Apart from the number of euthanasia's per year, much greater in 2004-2005, the statistical data are very similar. The important difference in the number of registration documents written in French and in Dutch, already noted in the first report, is confirmed in 2004-2005. An interpretation is proposed.

[Two years of legal practice of euthanasia in Belgium: comparison with the Netherlands. First evaluation in a palliative care unit]. / Deux années d'euthanasie dépénalisée en Belgique: comparaison avec les Pays-Bas. Premier bilan d'une unité de soins palliatifs.

The Belgian law relative to euthanasia prescribes that a physician performing an euthanasia has to complete a registration document and to send it within 4 days to the federal commission for control and evaluation of euthanasia. The 259 first documents are described in the report of the commission referred to Parliament on September 17, 2004. The present paper analyses this report and compares its most important data with those published in the Netherlands: apart from the total number of euthanasia's, much smaller in Belgium, and apart from aspects which are specifically related to the Belgian law, the statistical data are very similar in both countries. The difference in the number of registration documents written in French and in Flemish is analyzed and discussed. A first evaluation of the application of the law in a supportive and palliative care unit is reported.

[Depenalized practice of euthanasia in Belgium]. / La pratique dépénalisée de l'euthanasie en Belgique. Analyse et interprétation du premier rapport de la Commission fédérale de contrôle et d'evaluation.

The first report of the federal commission of control and evaluation of euthanasia, transmitted to Parliament on September 17, 2004, gives interesting data concerning the practice of euthanasia in Belgium under the conditions specified by the law of May 28, 2002. The present paper analyses and comments upon this report.

Slip prevention: validation of duplicates reproducing industrial floor surface state microgeometry.

The present study falls within the scope of work on the prevention of slips occurring on industrial workplace floor surfaces. Floor microgeometry is a determining factor in anti-slip flooring. Industrial environment-based quantification of floor microgeometrical properties is more restricting than laboratory quantification. The aim of the present study was to develop a duplication technique allowing reproduction of in situ floor microgeometry so as to be able to quantify this microgeometry in the laboratory. Duplicates were produced from a sample of five industrial floors. Surface microgeometry was characterized for both industrial floors and associated duplicates in order to study their microgeometrical changes following the duplicating operation. The purpose of this process was to reach a conclusion on the "reliability" of the duplication technique, on which the use of such duplicates depends. Parameters established from digitalized surfaces reveal differences of less than 5% between duplicates and original floor and this enables us to conclude that these duplicates offer a high degree of reliability with respect to results dispersion.

[Terminal medical interventions: psychosocial, medical, ethical and legal aspects]. / Les interventions médicales de dernier recours: aspects psychosociaux, médicaux, éthiques et juridiques.

We give an overview of the available medical solutions to help a patient with refractory symptoms at the end of his life. Patient "competence" must first be evaluated and, even if their diagnosis is difficult, organic mental disorders and depression must be diagnosed and adequately treated to allow a real, personal and honest dialog. Administration of high doses of morphine is frequently used at the end of life not only to fully relieve pain but also to accelerate death, even if this is not clearly stated. This technique is not devoid of hypocrisy and high doses of morphine can have quite unpleasant side effects. Treatment withdrawal or withholding is generally not sufficient to allow a correct end of life. The arrest of ventilation, dialysis, artificial nutrition and even more hydration must often be coupled with techniques inducing unconsciousness, which makes imprecise the limits between such a "passive" ending of life and "active" euthanasia. The technique of terminal sedation, frequently based on the use of midazolam, has been more recently introduced in some palliative care units. Such a "controlled sedation" is supposed to allow a "natural" death by inducing a profound sleep. In opposition with active euthanasia, which allows a quiet and rapid death at a moment chosen by the patient himself, this technique of "sedation" has an undetermined duration, has legal implications which could be viewed as quite similar as the ones of euthanasia, and, moreover, this prolonged agony can be extremely stressful and distressing for the family. Medical-assisted suicide is allowed in The Netherlands under the same conditions as euthanasia. Death is generally obtained after a few hours but the technique is not always successful and the process of death can sometimes be prolonged and uncomfortable. This technique can nevertheless be preferred by some physicians and patients. As compared to active euthanasia, the proportion of medically-assisted suicides (1/6) is low in The Netherlands. Euthanasia is the only technique able to induce a peaceful and rapid death. The proportion of various techniques to actively induce death is probably quite similar in our country than in The Netherlands but, most of the time, these interventions occur at the very end of life when the patient is no longer able to participate in the decision process and thus occur without his explicit request. We think that, as for all medical decisions, the use of one or the other of these various techniques should be selected after a quiet and free discussion between the patient and his physician, preferably in advance and not in a situation of emergency and panic.

Electrophysiologic effects of intravenous xamoterol in patients with sinus node dysfunction.

The electrophysiologic effects of xamoterol were studied in ten patients with electrophysiologic evidence of sinus node dysfunction. A significant shortening of mean sinus cycle length, maximal corrected sinus-node recovery time, and the mean of the three longest corrected sinus-node recovery times was observed after intravenous administration of 0.1 mg/kg of xamoterol. The atrioventricular (AV) conduction time and the effective and functional refractory periods of the AV node were shortened as the effective refractory period of the atrium. These effects suggest that xamoterol could be tried safely for the treatment of patients with moderate symptoms due to sinus-node disease.

Relationships between catastrophic cognitions and body sensations in anxiety disordered, mixed diagnosis, and normal subjects.

Clark's (Behaviour Research and Therapy, 24, 461-470, 1986) cognitive model proposes that panic attacks result from the catastrophic misinterpretation of certain body sensations. The present study examined correlations between feared body sensations and catastrophic cognitions. It was hypothesized that regardless of diagnostic status meaningful correlations between sensations and cognitions would be obtained. Three groups--anxiety disordered patients (n = 33), nonanxiety disordered patients (n = 57), and normals (n = 60)--completed the Agoraphobic Cognitions Questionnaire and the Body Sensations Questionnaire. Results generally supported the hypothesis and the cognitive model of panic and anxiety. Limitations of the correlational methodology are discussed, and treatment implications are noted.

Ephedrine-induced thermogenesis as an adjunct to cognitive restructuring and covert conditioning: a proposal for treatment of obese individuals.

Experimental investigators have discussed the therapeutic potential of ephedrine as a thermogenic agent in the treatment of obese individuals. Because research into thermogenesis and the role of sympathetic nervous system stimulation in weight control primarily has emphasized pharmacological interventions, the authors suggest that cognitive restructuring and covert conditioning procedures could be valuable psychotherapeutic additions to a pharmacologically derived weight-loss regimen. Furthermore, it is concluded that additional clinical research is necessary to determine the efficacy of integrating ephedrine therapy and cognitive-behavioral psychotherapeutic procedures as adjuncts to a multidimensional program for treating obesity.

Anterior mitral valve aneurysm perforation secondary to aortic valve endocarditis detected by Doppler colour flow mapping.

We report a case of mitral valve aneurysm formation and perforation, secondary to Streptococcus sanguis endocarditis of the aortic valve. Aneurysm formation was documented by cross-sectional echocardiography and its perforation was established by Doppler colour flow mapping, and subsequently confirmed at surgery.

Diastolic function and modifications of left ventricular architecture in ultraendurance athletes.

Although diastolic function is altered in left ventricular hypertrophy due to aortic stenosis or systemic hypertension, it has been shown to be normal in athletes. To analyze the reason for this discrepancy, we have studied left ventricular masses and volumes and diastolic flow velocities in 13 ultraendurance athletes and in 8 sedentary subjects as a control group by M-mode (TM), two-dimensional (2D) and Doppler echocardiography. Significant differences in the measurements of mass and volume have been found depending upon the method used. Considering that two-dimensional echocardiography is more appropriate for estimations of LV mass and LV volume, especially when the shape of the left ventricle is modified, overestimation of LV mass and underestimation of LV volume in ultraendurance athletes by TM could be explained by an elongation of LV cavity in athletes. Doppler velocimetry showed similar results in athletes and control subjects. We suggest that those LV configurational changes partly explain the preservation of diastolic function in athletes by restoring in diastole the energy stored in systole.

Noninvasive imaging of left coronary arteriovenous fistula.

We investigated a patient with coronary arteriovenous fistula (CAVF) by two-dimensional echocardiography (2-DE), cardiac Doppler, cardiac catheterization and nuclear magnetic resonance (NMR). These investigations clearly showed the abnormal vascular structures. NMR is another valuable noninvasive and safe method of confirming the presence of a CAVF.

A study of the correlation between Doppler and cross-sectional echocardiography in the determination of the mitral valve area.

Fifty-five consecutive adult patients with mitral stenosis (MS) were investigated by Doppler echocardiography, to assess the severity of MS. The measurement of mitral valve area (MVA) by cross-sectional echocardiography (CSE) was considered as the reference method, because catheterization data are often inadequate when combined lesions are present. Doppler MVA was calculated from apical mitral flow using the pressure half-time method. Adequate Doppler recordings (52 on 55) were easier to obtain than adequate CSE images[47]. The correlation between both methods was excellent (r = 0.90, SEE: 0.42 cm2) despite systematic underestimation of MVA by Doppler versus CSE. From our data, the following regression equation could be drawn, providing MVA from Doppler measurements: MVA = 250 (pressure half-time)-1 +0.15, where the area is in cm2 and half-time in ms. Both severe and mild MS were identified by Doppler with enough accuracy for clinical use. Reproducibility, inter and intraobserver variability were better for Doppler than for CSE. We conclude that Doppler seems particularly suitable for noninvasive quantification of MS and for patient follow-up.

Type II collagen arthritis: identification of arthritogenic epitopes using fractionated anticollagen IgG.

Affinity-purified anticollagen IgG was fractionated on purified cyanogen bromide-derived collagen peptide Sepharose. The antibody fraction bound to the peptides was eluted and tested for its ability to induce passive arthritis in recipients. Anticollagen IgG bound to peptide 5 (alpha 1(II)-CB8-10 and alpha 1(II)CB11-8) and to peptide 6 (alpha 1(II)CB11) were active in inducing passive arthritis. Other peptide bound fractions were inactive. These observations suggest that the arthritogenic domain in Type II collagen is restricted to alpha 1(II)CB11.