Presse Med
-
A bill about Patients' rights and the end of life was adopted unanimously by the National Assembly on November 30, 2004. Article 1 provides that the physician is not obligated to continue treatment "when the latter appears futile, disproportional and has no effect other than artificially maintaining the patient's life". Article 2 recognizes that painkillers administered at high doses to terminally ill patients may as a side effect "shorten the patient's life". ⋯ Article 9 makes clear that futile treatment of unconscious patients can be withheld or withdrawn. Article 7 specifies that adults may draw up advance directives to indicate their wishes for their end of life and their desires regarding the withholding or withdrawal of treatment. Withholding or withdrawing active treatment is authorized under 3 conditions: the consent from the patient, or if he or she is unconscious, the approval of the health-care proxy, or a family member or close friend if the patient is unconscious; the inclusion of the decision in the patient's medical file, and a group decision-making process.
-
Schizophrenia might appear to be an obstacle to the initiation of and especially compliance with antiretroviral therapy for HIV-infected patients. The aims of this study were to describe the clinical, immunologic and virologic course after initiation of antiretroviral therapy in 7 HIV patients with schizophrenia (according to DSM-IV-R criteria), and to analyse the possibilities of an adequate antiretroviral therapy for those patients. ⋯ Individuals with schizophrenia can respond well to antiretroviral treatment, although response may appear slow; they can adhere to complex treatment regimens as long as they receive well coordinated and sustained multidisciplinary support.
-
Traditionally described, severe Graves' acropachy and tibial myxoedema are now only encountered in certain severe forms of Graves' disease, where they can be difficult to diagnose and hence delay the initiation of treatment. ⋯ In supplement to the usual biopsies and X-rays, bone scintigraphy provides early diagnosis of acropachy. The severity of the immune disease, the episodes of hypothyroidism and cigarette smoking are the 3 main factors contributing to these extra-thyroid manifestations of Graves' disease. There is currently no treatment that can permanently resolve the functional and aesthetic problems of dermopathy and acropachy.