Rape as a legal indication for abortion: implications and consequences of the medical examination requirement

A number of countries adopt abortion laws recognizing rape as a legal ground for access to safe abortion service. As rape is a crime, these abortion laws carry with them criminal and health care elements that in turn result in the involvement of legal and medical expertise. The most common objective of the laws should be providing safe abortion services to women survivors of rape. Depending on purposes of a given abortion law, the laws usually require women to undergo a medical examination to qualify for a legal abortion. Some abortion laws are so vague as to result in uncertainties regarding the steps health personnel must follow in conducting medical examination. Another group of abortion laws do not leave room for regulation and remain too rigid to respond to changing socio-economic circumstances. Still others require medical examination as a prerequisite for abortion. As a result, a number of abortion laws remain on the books. The paper attempts to analyze legal and practical issues related to medical examination in rape cases.     

Interventional breast imaging: current procedures and assessing for concordance with pathology

Minimally invasive breast biopsy procedures performed for suspicious imaging findings have expanded the role of breast imaging in the management of breast diseases. The first portion of this article reviews the current procedures for performing a core-needle biopsy under stereotactic, ultrasound, and MR imaging guidance. The second portion of the article addresses the management of the patient after the biopsy, including assessment for concordance of radiology and pathology findings and potential underestimation of disease.     

France and the United States: the legal and ethical differences in assisted reproductive technology (ART)

In this paper, we will look at the development and the current status of the laws in France (and to some extent other EU nations) and the United States. In doing so, many differences will emerge about the views and values of assisted reproductive technology in the two countries. We will try to articulate some of those underlying moral, political, and legal differences.     

Illicit drugs, testing, prevention and work in France: ethical and legal issues

The use of illicit drugs in the workplace raises issues pertaining to prevention and safety and the responsibility of the various members of staff. It also brings into question the interface between work and private life. If employees are in theory responsible for their own safety and risk heavy penalties in the event of the consumption of illicit drugs in the workplace, such behaviour has to be proved. In reality, the worker can only be partially and marginally held liable, given the fact that the employer is prohibited from infringing on their rights and liberties (restrictions on the searching of their personal belongings and lockers as well as on the carrying out of breath testing and saliva testing under restrictive conditions). Employers have for their part a broader range of responsibilities and, above all, an absolute obligation to achieve specific goals in terms of health and safety resulting in the need to take action. In accordance with the International Labour Organization recommendations, European and national legislation, the employer has to implement a suitable preventive policy. However, where is the balance between prevention and repression? Very few studies have raised these issues and our aim is to precisely situate the place of drug testing in the employer's repressive arsenal in France and to try to answer the legal and ethical issues raised. Thus, for example, repression can only be acceptable when it deals with moderate and non-addicted users, or it could be tantamount to discrimination.     

水化疗法预防对比剂肾病临床实践现况调查分析

目的了解目前临床采用水化疗法预防对比剂肾病(CIN)实施现况,为进一步规范水化治疗方案提供参考依据。方法通过文献分析和专家会议设计调查问卷,面向介入病房护士展开网络调查。采用非概率抽样法,调查全国292家医院介入围手术期水化治疗实施现况。结果76.4%调查对象介入临床工作年限>5年,超过85.0%了解介入水化基本概念,但不到45.0%了解水化相关指南。约70.0%科室评估CIN发生风险,但评估内容和方法不一。目前74.4%科室采用静脉联合口服水化治疗,但水化时间自术前24 h至术后72 h不等,静脉水化输液速度波动在1~4 mL·kg^-1·h^-1,口服水化量和速度更是无统一标准,与相关临床指南推荐不同,且80.1%科室无具体水化方案。结论水化疗法是预防CIN公认的最有效方法。但受调查医院科室临床水化方式、时机、总量、速度及效果观察方法等仍缺乏规范性,广大医护人员需要进一步加强学习和落实相关指南,以规范临床实践。     

Pulmonary fitness for underwater pressure exposure: a review of current procedures and standards

The PFT SOPs developed by the DD&HM provide a standardised framework by which individuals requiring PFTs for service occupational reasons receive co-ordinated administration, consistent medical opinion and the opportunity to provide feedback. The SOPs have built in audit standards to ensure clinical governance is maintained.     

Arthroscopic surgery of the hip: current status

Arthroscopy of the hip is now recognised as a valuable diagnostic and therapeutic procedure [23]. It is still relatively new and remains largely in the hands of a few specialist centres, but orthopaedic surgeons are increasingly willing to provide it as part of their own service. This article outlines its background and details its clinical and technical application.     

Intraoperative sonography in spinal surgery: current state of the art

Summary Intraoperative spinal sonography (IOSS) has significant impact on the surgical management of spinal lesions. This paper describes the techniques involved, illustrates the sonographic anatomy of the spinal canal and its contents and discusses the role of IOSS in the surgical management of spinal trauma, spinal tumors, spinal stenosis and congenital anomalies.     

Continent urinary diversions: review of current surgical procedures and radiologic imaging

Continent urinary diversions are currently gaining wide acceptance as alternatives to the ileal conduit following cystectomy for neoplasm or bladder dysfunction. Clean, intermittent catheterization of the reservoir (pouch) at regular intervals obviates the inconvenience of wearing an external stomal appliance. A variety of surgical techniques have been described for continent pouches. These techniques make use of the small bowel alone (Camey and Kock techniques) or a combination of cecum and terminal ileum (Indiana, Mainz, Penn, and King techniques). The optimum pouch protects the upper tracts by prevention of reflux, provides urinary continence, and has sufficient capacity to require catheterization no more frequently than every 3-6 hours. Simplified construction techniques for the commonly encountered pouches are graphically presented, and a method is suggested for the study of continent diversions.     

Iodine deficiency in Europe and its consequences: an update

This paper updates the information on the prevalence of the disorders induced by iodine deficiency (IDD) in Europe. Thirty-two European countries were still affected by mild to severe iodine deficiency in the late 1990s. The most severely affected countries were in Eastern Europe, including Central Asia, but Western Europe was also still affected. National surveys recently conducted in 11 of these countries show that, with the exception of the Netherlands, none has yet reached a state of iodine sufficiency, though very significant improvement in the situation has been evidenced in many of them, e.g. Poland, Bulgaria and Macedonia. The consequences of persisting iodine deficiency are goitre, hyperavidity of the thyroid for iodide (which increases the risk of thyroid irradiation in the event of a nuclear accident) and subclinical hypothyroidism during pregnancy and early infant (with a concomitant risk of minor brain damage and irreversible impairment of the neuropsychointellectual development of offspring). Access to iodised salt at the household level in European countries affected by IDD increased from 5%-10% in 1990 to 28% in 1999. This constitutes encouraging progress. However, in terms of access of iodine-deficient countries to iodised salt, Europe remains the worst region in the world, as shown by the fact that the mean figure worldwide in 1999 was 68%. In Latin America it even reached 90%. Salt iodisation has to be further implemented in Europe. Until that goal is achieved, iodine supplementation in those groups most sensitive to the effects of iodine deficiency (pregnant and lactating women and young infants) will have to be considered in the most severely affected areas.     

A grid overlay framework for analysis of medical images and its application to the measurement of stroke lesions

Objectives  

To create and evaluate an interactive software tool for measuring imaging data in situations where hand-drawn region-of-interest measurements are unfeasible, for example, when the structure of interest is patchy with ill-defined boundaries.     

Radiographic imaging procedures in the diagnosis of the major central neuropathological consequences of alcohol abuse

Excessive consumption of alcohol is well recognized to have specific neurologic sequelae. The MRI and CT findings in these syndromes is presented and correlated with pathological findings and suspected pathogenesis. The role of imaging in both the diagnosis and monitoring of patients is discussed.     

The Chernobyl accident and its consequences: update at the millennium

A marked increase in the incidence of papillary thyroid cancer in children has been documented in regions of the former Soviet Union most heavily contaminated by radioactive fallout from the Chernobyl nuclear power plant accident in April 1986. Accumulation of radioactive iodines by normal iodine trapping mechanisms resulted in significant radiation doses to the thyroid gland. Although it has long been known that thyroidal radiation resulted in nuclear and chromosomal abnormalities visible by light microscopy, modern molecular biology techniques are beginning to identify much smaller alterations in chromosomal coding sequences that are associated with malignant transformation. Although stable chromosomal abnormalities can be detected in Chernobyl-associated thyroid cancers, they are much less prevalent than in thyroid cancers developing after external beam irradiation. However, several unique chromosomal breakpoints have been described in radiation-associated thyroid cancers that are not commonly found in spontaneously occurring thyroid cancer. Furthermore, activation of specific subtypes of the ret/PTC tyrosine kinase oncogene appears to be more common in radiation-associated thyroid cancers than in spontaneous thyroid cancers. In summary, thyroid cancers developing in the aftermath of the Chernobyl accident provide a unique opportunity to search for chromosomal abnormalities that may be specific for radiation-induced thyroid cancer.     

微波消融治疗结直肠癌根治术后肝转移患者的疗效分析

目的 评价微波消融(MWA)在结直肠癌根治术后肝转移治疗中的作用,评估局部疗效及各因素对远期预后的影响.方法 回顾性统计2010年1月至2011年12月接受超声引导下MWA术治疗的106例结直肠癌根治术后肝转移患者的临床资料.观察术后完全消融率、并发症和局部肿瘤进展,计算术后总体生存率和无瘤生存率,并行生存率相关影响因素分析.结果 106例患者共消融215枚肿瘤,首次消融后209枚达到完全消融(97.2％);严重并发症发生率2.8％(3/106).截至随访结束,局部肿瘤进展率6.6％ (7/106);术后中位生存时间35个月;1、3、5年总体生存率和无瘤生存率分别为87.7％ 、50.0％、33.0％和55.7％、21.7％、5.7％.亚组分析显示,肿瘤最大直径≤3 cm的患者5年生存率为35.1％,＞3 cm的患者5年总生存率为27.3％,差异无统计学意义(P=0.077),化疗组5年生存率为38.9％,显著高于未化疗组的10.0％(P=0.003),肝内单发转移瘤患者5年生存率为50.9％,显著高于多发转移瘤患者的16.8％ (P=0.000).结论 MWA在直径≤6 cm肝转移瘤的治疗中,即使肿瘤直径较大,在完全消融后也能得到与直径较小的肿瘤相似的局部疗效和远期预后;MWA联合化疗能提高结直肠癌肝转移患者的远期预后,效果优于仅接受MWA;是否接受化疗、肝转移瘤数量及原发病灶手术切除时的Dukes分期是生存率的独立危险因素.     

影像引导下射频消融治疗的现状与进展

影像引导下射频消融(RFA)治疗是一种安全、近期疗效肯定、并发症少的微创介入治疗方法.现已广泛应用于肝癌、肺癌、肾上腺恶性肿瘤、骨肿瘤及脾功能亢进的治疗.RFA与动脉栓塞化疗、化学消融或经皮穿刺椎体成形术等联合应用,是一种新型的综合性介入治疗肿瘤的方法,将会进一步提高肿瘤治疗的疗效.     

The surgery of the rheumatoid wrist: postoperative appearances and complications of the more common procedures

There is considerable orthopedic interest in the surgical management of rheumatoid arthritis involving the wrist. Surgery is being used more frequently in treating this condition, and many surgical options are available. The biomechanical basis, indications, postoperative appearances, and complications of these many operations should be known to the radiologist involved in preoperative care and postoperative follow-up. Some of the more frequent procedures are presented, and the complications are discussed.     

Nonconventional uses of the rocket-propelled grenade and its consequences

Operation Iraqi Freedom and Operation Enduring Freedom have forced U.S. and allied medical personnel caring for wounded soldiers to reassess nonconventional uses of the rocket-propelled grenade. The effects can be devastating when this device is used as an antipersonnel weapon, producing large blast injuries that are limb and life threatening. A classic case presentation followed by a short historical perspective on the rocket-propelled grenade and a proposed algorithm for initial care of these wounds is presented.     

Radiosensitivity of the developing haemopoietic system in mammals and its adult consequences: animal studies

The haemopoietic system in the developing mammal is very sensitive to the damaging effects of ionizing radiation. Epidemiological studies have established a strong association between obstetric exposure to diagnostic radiation and an increase in the incidence of childhood leukaemia and between low dose gamma irradiation during the early fetal period and mental retardation in children. It has been suggested that insufficient oxygen supply to the developing brain due to radiation induced damage to fetal haemopoietic tissue has a role in inducing the severe mental retardation observed in the Japanese children exposed to atom bomb radiation in utero. Experimental studies have shown that X- and gamma irradiation of pregnant mice with <1 Gy during the late organogenesis or fetal period caused chromosome damage and significant depletion in the fetal haemopoietic progenitor cells and led to haematological disorders in the adults. The present paper reviews the experimental findings on the effect of pre-natal irradiation on the fetal haemopoietic system and its long-term consequences.