Are prescribed medications effective in the treatment of insomnia complaints?

Although frequently investigated in the general population, the epidemiology of insomnia complaints and their treatment have received little attention in general practice. This study recruited patients > or =15 years of age, consecutively, from 127 general practitioners in France. The physicians collected data from 11,810 of their patients, of whom 55.

Soft tissue tumors following traumatic injury: two observations of interest for the medicolegal causality.

Two cases of tumors of the soft tissues developing at the site of a previous traumatic injury occurring a few years earlier are reported. One was finally diagnosed as aggressive fibromatosis and the other as low-grade fibrosarcoma. Among the pathogenic mechanisms and the etiologic factors involved in such tumors, the posttraumatic causality is discussed, and in addition to the initial trauma, the role of iterative surgery in the first case and mineral muscular inclusions in the second case are examined.

Brain electrical activity mapping in the study of visual development and amblyopia in young children.

Brain electrical activity mapping (BEAM) allows the study of electrical visual reactivity on a computerized electroencephalogram (EEG). We carried out 150 BEAM studies on 120 infants to evaluate the usefulness and reliability of this noninvasive technique in the assessment of vision in very young children, compared with other methods (clinical testing, preferential looking, and visual evoked potentials). BEAM demonstrated amblyopia at a cortical level and showed specific electrical signs of amblyopia.

Questions raised by artificial prolongation of life of the aged patient.

The existence of treatments which now make it possible to prolong life beyond the point when it would previously have ended, gives rise to particular questions in the context of the care of aged patients: the distinction between curative and palliative treatment, the evaluation of incurability, the right to refuse treatment, competence to make such a decision and the use of the limited objective and pure objective tests in the event of incompetence. The natural role of the physician as protector adds a further ethical dimension to what is also a medicolegal question.

Radiographic identification of human remains through deformities and anomalies of post-cranial bones: a report of two cases.

Human remains can be identified radiographically by anomalies and deformities of the post-cranial bones when there are no old fractures and the cranium and extremities are not available. These anomalies and deformities of the sternum, vertebrae, sacrum and innominate bone are often protected from damage by scavengers. We report their use to exclude a proposed identity in one case and to confirm identity in another case.

[Drowsiness and traffic accidents. Importance of diagnosis].

"Tiredness", often cited in civil and penal responsibilities secondary to car accidents, hides neurophysiological phenomena which must now be taken into account. The problems of watchfulness in car-driving, is sleepiness, are indeed linked to a genuine disorder in the sleep-wake rythm and attention should be drawn to them in medico-legal cases. Investigations and clinical examinations concerning 110 experts' reports confirm the role played by sleep' disorders in the occurrence of car accidents.

[Development of jurisprudence concerning the medical contract in esthetic surgery].

The authors report a study of 60 years of French Jurisprudence in relation to the medical contract in cosmetic surgery. Although the obligation can only be in the form of means in the case of surgery of living tissues, a special obligation nevertheless applies when the operation is not performed as a therapeutic procedure but at the patient's wishes. It is an obligation of caution and diligence, respecting the role of proportionality in the indications and the means applied to obtain the desired objective and the safety of the patient.

[Chronobiologic organization of sleep].

Interrelations between sleep and chronobiology as been studied in isolated experimental situations. A succession of hormonal regulations has been described to explain these mechanisms. Some disruptions of these regulations might be at the beginning of a lot of sleep pathologies (jet lag syndrome, burn out syndrome, insomnia.

[Comparison of the effects of zopiclone and triazolam on the sleep of normal subjects].

Zopiclone 7.5 mg and triazolam 0.50 mg have been compared in a double-blind randomized cross-over sleep laboratory study.

Amyotrophic lateral sclerosis presenting with sleep hypopnea syndrome.

Described is a 67-year-old man whose initial symptoms evoked an obesity-hypoventilation syndrome. Polysomnography showed hypopneas associated with O2 desaturation episodes, and no apnea; maximal changes were noted during REM sleep. A few months later, in spite of marked weight loss, acute alveolar hypoventilation occurred and necessitated mechanical ventilatory support.

[Urinary stress incontinence in women: contribution of electromyography of the striated urethral sphincter].

Fourteen women within their menopausal period and suffering from stress urinary incontinence were studied. Electromyographic studies show that sphincter weakness is almost constant (9/14), usually associated with a bladder instability and/or a lack in abdominal urethral transmission, both conditions being known as possible causes of urinary stress incontinence. However, neurological causes at the origin of urinary stress incontinence, such as neurogenous sphincter, may be found (3/14).

[Somatotropin secretion during sleep. Application to partial somatotropin deficiency in the child].

The authors studied somatotropic secretion during sleep in 122 children who had a backward growth of at last 2 standard deviations from the mean growth. Diurnal pharmacological tests showed 73 normal responses, 49 intermediate or dissociated responses orienting toward a partial deficit of STH secretion. The study of sleep secretion shows, among normal children, a secretory response superior to those pharmacological tests with a late secretory response in 20% of cases.

[Somatotropin secretion during sleep in 60 cases of growth retardation in children].

A study of nocturnal somatotropic secretion with sleep polygraphic recording was performed in 60 children, aged 1 to 18 years and presenting with growth retardation greater than or equal to -2SD. GH secretion was analysed according to the peak value, the number of peaks greater than 5 ng/ml and the integrated concentration (surface under the curve divided by the duration of the test). The children were studied in four groups according to the responses to pharmacologic stimulation tests: a normal group (n = 7), a group with complete somatotropic deficiency (n = 4), a group with partial somatotropic deficiency (n = 39) and a group with dissociated responses (n = 12).