Forcible medication for courtroom competence--the case of Charles Sell.
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Helmholtz is usually credited with demonstrating the relationship between the perception of visual direction and eye muscle activity: he said that directional judgements resulted from the effort of will involved in altering the position of the eyes. However, Bell reached the same conclusion many years earlier, primarily on the basis of experiments with afterimages: an afterimage appeared to move with voluntary movement of the eye, but it appeared stationary when the eye was moved passively.
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The pathological findings in a retrospective review of 100 consecutive intracranial stereotactic biopsies are presented. Definite diagnosis could be established in the majority (89) of cases and included 85 neoplasms (69 primary cerebral tumors, 10 non-Hodgkin's lymphomas and 6 metastases) and 4 non-neoplastic processes. In the remaining 11 samples the findings were non-diagnostic; 2 consisted of normal glial tissue, while the remainder variously showed changes of necrosis, hematoma, histiocytic reaction or astrocytic proliferations of uncertain nature. Verification of the stereotactic diagnosis by examination of lesional tissue obtained at subsequent craniotomy or postmortem was possible in 7 of 10 cases. Two broad categories of diagnostic difficulty were identified in interpreting stereotactic biopsies: (1) accurate tumor typing and grading, and (2) the distinction between reactive and neoplastic astrocytic proliferations. Two essential components in the diagnostic process are: (1) careful correlation with the clinical and radiological findings; and (2) use of intraoperative smear and/or frozen section preparations to confirm specimen adequacy. By adhering to these principles accurate intraoperative diagnosis can usually be established, particularly for high grade astrocytoma, lymphoma and metastasis. Tumor typing is aided by the use of immunohistochemistry and ultrastructural examination and the examination of serial sections is of value in grading.
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A telephone interview was held in November of 2004 with Mr. Jeffrey Bronfman, representative mestre for the União do Vegetal Church in the United States, which utilizes ayahuasca as a religious sacrament. At the time of this writing, the U.S. Supreme Court has agreed to hear a case in which a large quantity of the ayahuasca tea was seized in the U.S. destined for sacramental use in church ritual. Mr. Bronfman discusses his church's attempt to seek remediation in the courts on this freedom of religion issue, in conflict with current drug legislation outlawing the ayahuasca tea as a scheduled drug.
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