Many faces of the dual-role dilemma in psychiatric ethics

OBJECTIVE: To identify the various potential manifestations of the dual-role dilemma in the psychiatric ethics literature. METHOD: The terms 'dual role', 'dual agency', 'overlapping roles', and 'double agency' were searched on the electronic databases PubMed, Medline, Embase and PsychInfo. Classic papers in the field of psychiatric ethics and their references were manually searched. Papers were selected for relevance to the topic of the dual-role dilemma in relation to psychiatry. RESULTS: The dual-role dilemma is most explicitly addressed in the literature on forensic psychiatry and military psychiatry. Review of the ethics literature in other fields of psychiatry indicates many instances of the dilemma of psychiatrists facing conflicting obligations akin to the dual-role problem identified in the literature on forensic psychiatry. Many of these dilemmas are characterized by the presence of a powerful third party to whom the psychiatrist has some perceived obligations. CONCLUSIONS: In psychiatric ethics, the dual-role dilemma refers to the tension between psychiatrists' obligations of beneficence towards their patients, and conflicting obligations to the community, third parties, other health-care workers, or the pursuit of knowledge in the field. These conflicting obligations transcend a conflict of interest in that the expectations of the psychiatrist, other than the patient's best interests, are so compelling. This tension illustrates how the discourse in psychiatric ethics is embedded in the social and cultural context of the situations encountered. It appears that as society changes in its approach to the value of liberal autonomy and the 'collective good', psychiatrists may also need to change.     

Facet joint orientation in spondylolysis and isthmic spondylolisthesis

STUDY DESIGN: The orientation of facet joints (FJs) in a normal population and isthmic spondylolisthesis (IS) population was assessed using magnetic resonance imaging in the lumbar spine. OBJECTIVE: To document the difference in FJ orientation (FJO) between a normal population and a population with spondylolysis of L5 and IS. SUMMARY OF BACKGROUND [corrected] DATA: Spondylolysis and IS have both a familial and mechanical etiology, yet the phenotypic expression of the familial etiology is unknown except for the observation of spinal bifida occulta. Other posterior element abnormalities are unrecognized, and any FJO abnormality below the pars defect has been ignored because of presumed previous mechanical defunctioning by the development of that pars defect at an earlier age. The recognition of multilevel sagittal FJO in L4/5 degenerative spondylolisthesis (DS), raises the possibility that more proximal segment examination may reveal FJ variations in IS. METHODS: Magnetic resonance imaging scans were used to measure the orientation of the FJ at L3/4, L4/5, and L5/S1 in 30 individuals with normal scans, and 30 patients with IS. The angular measurement recorded was in relation to the coronal plane. Repeated measurements confirmed the validity of the method. RESULTS: Mean measurement of axial FJO at L3/4 and L4/5 was 51.1 and 42.5 degrees in the controls, and 45.2 and 35.0 degrees in IS. The more coronal angulation at the levels above a pars defect in IS was highly statistically significant (P = <0.001 at L3/4 and P = <0.0001 at L4/5). At L5/S1, orientations were the same (39 degrees) in each group. CONCLUSIONS: Relative coronal FJO in the lumbar spine may be the phenotypic expression of the familial etiology of IS. This may result in increased stress concentration in the pars between or below coronally oriented FJs. These more coronal FJOs in IS may also explain the common observation of retrolisthesis at L4/5 above IS when the L4/5 disc degenerates, lateral overhang of the L4/5 FJ to the L5 pedicle entry point above an IS, and the rare combination of DS at L4/5 and IS at L5/S1 when both disorders are separately common. This latter observation can be explained by the observation that DS occurs in those individual with sagittal lumbar facets, and that IS occurs in those with more coronal FJs.     

Phenomenology of obsessive compulsive disorder in patients with temporal lobe epilepsy or tourette syndrome

Phenomenology of comorbid obsessive-compulsive disorder was compared in nine patients with temporal lobe epilepsy and 15 with Tourette syndrome. Content of obsessive-compulsive themes focuses on sexuality and impulsiveness in Tourette syndrome and existential thoughts in temporal lobe epilepsy.     

Serum epidermal growth factor receptor and HER2 expression in primary and metastatic breast cancer patients

Background  

Breast tissue expression of the ERBB proto-oncogene family has been extensively studied. It was recently shown that expression of epidermal growth factor receptor (EGFR; c-erbB-1) and epidermal growth factor receptor (HER)2 (c-erbB-2) can be detected in the serum of breast cancer patients. The clinical relevance of this has not been fully established.     

Using array-comparative genomic hybridization to define molecular portraits of primary breast cancers

We analysed 148 primary breast cancers using BAC-arrays containing 287 clones representing cancer-related gene/loci to obtain genomic molecular portraits. Gains were detected in 136 tumors (91.9%) and losses in 123 tumors (83.1%). Eight tumors (5.4%) did not have any genomic aberrations in the 281 clones analysed. Common (more than 15% of the samples) gains were observed at 8q11-qtel, 1q21-qtel, 17q11-q12 and 11q13, whereas common losses were observed at 16q12-qtel, 11ptel-p15.5, 1p36-ptel, 17p11.2-p12 and 8ptel-p22. Patients with tumors registering either less than 5% (median value) or less than 11% (third quartile) total copy number changes had a better overall survival (log-rank test: P=0.0417 and P=0.0375, respectively). Unsupervised hierarchical clustering based on copy number changes identified four clusters. Women with tumors from the cluster with amplification of three regions containing known breast oncogenes (11q13, 17q12 and 20q13) had a worse prognosis. The good prognosis group (Nottingham Prognostic Index (NPI) 相似文献