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Biomedical subjects

F Pierre

Publications and source records attributed to F Pierre.

At least 145 records · Page 8Linked to original sources
PubMed1988

[Importance of the initial examination after a rape in considering the criminal penalty and indemnification of the victim in a civil suit. Review of the documents from one Court of Assizes over 11 years].

The gynaecologist-obstetrician may be the medical witness who has to give evidence about the extent of the initial trauma after the presumption of a sexual assault on a victim who comes to consult him, or as an expert witness. The certificate that he gives at the time of the first consultation is an essential document for the examining magistrates who have to decide whether there has been an offence. It is also a very great help to support the brief for the lawyers in a civil action taken by the victim, who is claiming damages as compensation for physical or psychological damage resulting from the sexual abuse. The authors reported it useful to look through 64 case documents that were considered in 11 years. They studied the differences in the penalties that were awarded for criminal offences and the sums of money for indemnity that were awarded in civil cases. These were before the new law concerning rape was passed on the 23rd December 1980, and after this law had been applied. It tends to improve the position for the victim in civil cases and increases the sentences that can be passed for aggravated rape (as on a minor by an adult, or in particular somebody who has a position of responsibility to the child). The authors point out especially how important it is to take note of sexual precocity and to have a detailed account of the first investigations carried out after the sexual assault. These can be used to make the sentences differ and to make it possible to increase and widen the awards given to compensate the victims. As far as civil action is concerned, as there is usually a fixed scale for every regional Court of Assizes according to a definite formula, it is advisable according to the authors that the initial expert assessment presented by the magistrates should establish in its conclusions the details of the indemnity to be considered by professional judges of the Assize juries. They should take particular notice of added injuries that are not physical and are often not considered, such as pain and suffering, loss of pleasure and the aesthetic, the sexual, the obstetrical and the moral as well as the juvenile points of view. In certain cases ad full medical assessment presented before the end of the case will help the professional judges of the jury of Assizes who have to give judgment in a civil action by giving them information that will support the true interests of the victim.

Expert Testimony↗
PubMed1988

[Refusal of blood because of being Jehovah's witnesses or for fear of AIDS. Deontologic and legal aspects].

Difficult new medical and professional ethical problems have arisen by an increase in the number of patients refusing blood transfusion or the use of blood derivatives because of religious convictions. In particular Jehovah's Witnesses and patients frightened of catching AIDS and other diseases transmitted by blood are involved. Because of this it is necessary to consider how to prevent legal actions which may be brought under the heading of "death by negligence or by failing to give correct treatment for a patient in danger", particularly when the case is of death that could be connected with failure to resuscitate a patient where the basic treatment would be giving blood. The authors have analysed article by article of the Code of Medical Deontology of 1975 and have found ambiguities, not to say apparent contradictions, in the recommendations given to doctors who find themselves confronted by patients who have refused in this way needed treatment for haemorrhagic shock, as can occur particularly in obstetrics and gynaecology. The law is extremely weak in this matter because the Appeal Court has never taken a clear position in regard to the responsibility the doctor has when he finds himself with a patient who has refused the correct treatment. The authors have been driven to research through a large bibliography of medico-legal works to find out what doctors should do when they are confronted by patients who refuse the correct treatment by they adults or infants or mentally incapacitated. The practical advice that ends this analysis should make it possible for the readers to adopt a compromise way of dealing with these situations that at the same time accords with the normal medical contract between patients and doctor and the dignity that should be afforded to the patient but also the safety of the patient. This is done by avoiding on the one hand total rejection of the legitimate personal convictions of the patient but also on the other hand not accepting too readily these convictions, which could lead to being held responsible for failure to carry out one's obligations to patients or to just leaving the patient to her circle, stepping aside from caring for her.(ABSTRACT TRUNCATED AT 400 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1988

Determination of manganese in biological materials by electrothermal atomic absorption spectrometry: a review.

The great diversity of methods for measuring manganese in biological materials (serum, plasma, whole blood, urine, spinal fluid, and hair) reflects the difficulty in measuring extremely small quantities of this element. Detailed examination of these methods demonstrates that the one most used is flameless atomic absorption spectrometry. In this review we report the different instrument settings for wavelength, slit width, protection gases, graphite furnaces, type of background correction, amounts measured, and thermal programs. We give detailed recommendations by various authors for collecting samples. A thorough description of the preliminary steps and the handling of the specimen samples is also included: direct determination with or without dilution, addition of a matrix modifier or determination after ashing, with or without chelation-extraction steps. The preparation of the standards, procedures used, analytical criteria (accuracy, precision, specificity, detection limit, linearity), problems (interferences, matrix effects), and reference values and their physiological variations are also described. We give a consensus of recommendations concerning the choice of a method.

Female↗
PubMed1988

[Non-assistance or malicious avoidance of treating patients in obstetrics and neonatology. Analysis of its jurisprudence].

1947 was the date of the first prosecution for failure to assist a person in danger at the time of delivery. Before coming back to it the authors define the constitutional elements of breaking the law as specified in article 63, paragraph 2 of the Penal Code in connection with applying articles 319 and 320 which concern homicide or involuntary bodily harm (or recklessness) which are the most often used in medicine. After that they present the court records of a number of cases which for the most part have not been published, from the Tribunals or the Appeal Courts of cases where prosecution could resulting up to 5 years of imprisonment or a fine of 20,000 F for general practitioners, specialists, gynaecologists and obstetricians or midwives who are indicted under these conditions. A series of 18 case histories which cover pregnancy, delivery and help for the newborn at risk in the first days of life, should lead to a good was of preventing this medico-legal risk, which is little known but very real. It requires great care by practitioners when called to urgent cases and a thorough and proper handling over to a colleague or to a team who are more able to give help, as well as good control of the conditions under which resuscitation is carried out and under which the newborn is monitored in the neonatal period. It is emphasized that the biggest risk run by the doctor who is responsible for the care of the pregnancy, of the delivery or resuscitation of the newborn is later not to be able to deny false information that may be given about the risks run by the victim, and to challenge the accusation that he was unwilling to give help. It is only by keeping good notes and by the evidence of witnesses that later provide indisputable proof against accusations of his failure, which characterize cases of failure to assist people in danger in medicine, can be fought. This risk is particularly strong in obstetrics and in neonatology.

Female↗
PubMed1987

[The female breast as an object of liability complaints. Analysis of relative jurisprudence].

The authors analyse the incidence of medico-legal actions that can follow surgical and irradiation treatment of tumours in the female breast under French jurisprudence, which is now well established. Also involved are cosmetic surgery and all reconstructive procedures on the breast. Attention is drawn to errors that should be avoided in order to minimise the risks of being sued. There has been according to the files that have been inspected, a drop in legal actions for surgery of the breast for growths because radical surgery has become less frequent and less extensive. On the other hand there have been more complications from irradiation or from chemotherapy that has not been well controlled and where the risks had not been properly explained to the patients before treatment started. The article brings to attention how important it is to obtain informed consent about all details including very rare complications, particularly when the indication for the operation is cosmetic or for comfort and not in order to cure disease. Finally, the authors discuss the problem of cancer eventually developing in a tumour of the breast which appears after trauma received by the breast from seat-belt compression injuries. In spite of the unclear pathological causes so far discovered, there may be cause and effect between traumatism and a tumour discovered after an interval. It is suggested that immediately after the injury a careful examination of both breasts should be undertaken using mammography and ultrasound, including the anterior wall of the thorax, so that early diagnosis is made of possible signs suggesting that a tumour would be likely to develop. This should be done in spite of the presence of a haematoma in or around the breast.

Breast↗
PubMed1986

[Pregnancy and unwanted children after failure of sterilization and voluntary termination of pregnancy. I. Disconcerting French and foreign jurisprudence].

Specialists who carry out abortions and male or females sterilizations which are legally controlled under the penal law in the category of voluntarily accepted assaults on the body can risk legal actions against the doctors as a result of parents seeking damages for detriment suffered following failure of legally performed terminations of pregnancy or of sterilisation, which had been considered as certain, resulting in preservation of fertility. The authors have looked through the western literature and found that there is both a moral and a financial detriment which plaintiffs can plead after the birth of a normal or a malformed child after an attempt at termination of pregnancy or at sterilisation. They take note of a list of cases of claims which have given rise to a whole body of jurisprudence in France since 1976 and which show that magistrates have some resistance to awarding damages for such detriment.

Abortion, Induced↗
PubMed1986

[Pregnancy and unexpected children following failed sterilization and voluntary pregnancy interruption. 2: Bases of civil responsibility in cases of failed induced abortion or sterilization and the prevention of medicolegal risks].

Bases for responsibility of the civil courts in cases where legal abortion or sterilisation has failed and which, as described in the previous article, have given rise to a disturbing amount of French and foreign jurisprudence have been analysed in order to demonstrate three elements: failure or carelessness in performing the procedure; the detriment that has really been suffered and the link between the causes of the first two elements. Practical advice is given which has been based on detailed analysis of the cases found both in the French and foreign jurisprudence to protect gynaecologists or surgeons from this new unexpected medico-legal risk. The decisions of the courts both for termination of pregnancy and for sterilisation have been reviewed in relationship to pregnancy or to the birth of a child resulting from the statistically acceptable chances of failure that must happen in procedures that are carried out thousands of times a year in France.

Abortion, Induced↗
PubMed1985

Lung function and clinical findings in a cross-sectional study of arc welders. An epidemiological study.

An epidemiological, cross-sectional study was conducted in order to assess non-neoplasic effects on the lung due to chronic exposure to arc welding fumes and gases. The study involved 346 arc welders and 214 control workers from a factory producing industrial vehicles. These workers (welders and controls) had never been exposed to asbestos. Respiratory impairments were evaluated by using a standardized questionnaire, a clinical examination, chest radiophotography and several lung function tests (spirometry, bronchial challenge test to acetylcholine, CO transfer tests according to the breath-holding and the steady-state methods, N2 washout test). The only significant differences between the welders overall compared to the controls were a slightly higher bronchial hyper-reactivity to acetylcholine and a lower lung diffusing capacity for CO in the welders. However, non-specific, radiologic abnormalities (reticulation, micronodulation) and obstructive signs were more frequent in the most exposed welders (welding inside tanks) than in welders working in well ventilated workplaces. The nature of the metal welded (mild-steel, stainless steel, aluminium) did not seem to have an influence on respiratory impairments. In the mild-steel welders, respiratory symptoms (dyspnoea, recurrent bronchitis) and obstructive signs were more frequent in the welders using a manual process than in the welders involved with the semi-automatic process (MIG). For all the workers (welders and controls), smoking had a markedly adverse effect on respiratory symptoms and lung function. Moreover, smoking seemed to interact with welding since CO lung transfer was more impaired in smoking welders than in smoking controls.

Adult↗
PubMed1985

[Effect of smoking on the concentration and activity of serum alpha-1 anti-protease according to Pi phenotype].

In an epidemiological study on the respiratory pathology of 1 100 iron miners, the alpha 1 protease inhibitor concentration (alpha 1 Pi) and the elastase inhibitory capacity (EIC) of serum were determined in 97 men with deficient Pi phenotype (73 MS, 24 MZ or S) compared with PiM non deficient men adjusted for age and tobacco consumption. There were differences in alpha 1 Pi concentration and in alpha 1 inhibitory capacity between phenotype groups in agreement with the results of other studies. Smoking produces an increase of serum alpha 1 Pi concentration and EIC in all Pi phenotype groups. This increase is more important (30%) in the MS group than in the others (MZ 20%, M 12%). This effect which appears to be related to smoking intensity does not seem to have a link with an alteration or a modification of the molecular function which is at a rate of 70% in all cases.

Adult↗
PubMed1985

[The court on tubal sterilization in 1985].

The gynaecologist and the surgeon undertake unknown risks because the law as far as sterilisation is concerned is poor in case history and for this reason more to be feared. There is, apart from Penal Code 309-310-316 on voluntary infliction of injury, on mutilation and on castration and on procedures that are sometimes dangerous to body and soul, silence in the low. This may appear to be favourable to the performance of male or female sterilisation for medical and social reasons. This approach clarifies the question of sterilisation which is more useful at a time when there is an increase in attempts to sue doctors for indemnity; and it is possible to fear that there will be an increase in cases of such legal action, because of the increase in the number of case histories that are referred for expert medical opinions in gynaecology and obstetrics, in case law and for the civil courts. It is not denied that there has been a tacit agreement to give indications for sterilisation during operations, and that this has been respected by the law because the medico-social situation of the patients is a very special one. On the other hand it is wise, and it will prevent medico-legal risks in cases where tubal or vas sterilisation has been carried out, if there are full medical and surgical notes prepared with detailed information and informed consent often given by the patient in writing and sometimes later, if necessary, the preparation of full defensive explanations of why the procedure was carried out. Paradoxically, this operation is not strictly legal in spite of the vague outlines of the concessions that have been made by the Conseil National de l'Ordre and by the National Academy of Medicine, whose attitude is still a very theoretical one. This is also the case with the European Commission, whose deliberations are so far no better than those that apply to French law.

Female↗