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BACKGROUND: French prisoners have health problems that have been inadequately treated before imprisonment. This population has insufficient access to the healthcare system. Addictive behaviours, particularly smoking, are widespread. The aim of the study is to evaluate the prevalence of airflow limitation by using a primary care screening method adapted for the correctional facility and its inmates. METHOD: The screening of airflow limitation using a mobile spirometer is carried out in inmates consulting the primary care unit (UCSA) of Amiens prison. Patients consulting the UCSA between 16 August and 17 October 2006 and providing their consent are included in the study. The criteria for exclusion are: a counter-indication for spirometry, poor compliance with the effort of forced expiry after eight efforts, as well as refusal to take part in the study. The descriptive statistical analysis includes all of the quantitative and qualitative variables. RESULTS: Among the 210 patients included in the sample, only five patients refused to take part in the study. Their mean age was 37 (range: 16-65) and 90% were men. Ninety percent of this population were active smokers. Sixty percent of these smokers would like to quit. The spirometry detected 11% undiagnosed airflow limitation: 11 prisoners suffered from chronic obstructive lung disease and 13 prisoners suffered from asthma. DISCUSSION: Given the relative youth and high risk nature of these diagnosed patients, the potential for the long or short term aggravation, and a growing recognition of the seriousness of exposure to tobacco, the authors suggest that the systematic screening of inmates for airflow limitation may be used to assist in detecting serious health issues. Along with new French antismoking legislation, this screening may enable primary care workers to better reduce smoking habits in prisons.

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Benzo[a]pyrene is a cigarette smoke component that is metabolized in the human body to the diol-epoxide derivative benzo[a]pyrene-trans- 7,8-dihydrodiol-9,10-epoxide (BPDE-I), which is the final carcinogen. BPDE-I binds covalently to DNA, producing BPDE-I-DNA adducts. A competitive immunoenzymetric assay was used to measure BPDE-I-DNA adducts in blood samples from 58 heavy smokers, 32 men and 26 women, attending a smoking cessation clinic. Cigarette consumption was evaluated based on urinary continine levels. None of the subjects worked in jobs involving exposure to polycyclic aromatic hydrocarbons (e.g., benzo[a]pyrene). Concentrations of BPDE-I-DNA adducts varied with cigarette consumption, ranging from 10.00 to 28.20 fmol/50 micrograms of DNA.

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The measurement of transcutaneous PtcO2 in eight normal adults prove a comparable efficacy of 50 l.min-1 O2 through facial "small mask" (61.5 kPa; 463 mmHg) and 20 l.min-1 O2 through head tent (65.1 kPa; 490 mmHg). First procedure, inexpensive, is very simple to use.

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The study has been carried out on 476 epidural deliveries. 69 per cent of the patients were satisfied. Amongst the 31 per cent of unsatisfied, most claimed that the analgesia was not sufficient, mainly due to delayed re-injections. Instead of a continuous administration, the authors prefer the use of a bolus which is better adapted to the different times of labour. 80 per cent of the patients who had a caesarian delivery under epidural anaesthetic were very satisfied. The efficacy of the re-injection for post-operative analgesia is also to be noted (92 per cent success). Finally, whatever the stage of perfection of the epidural technique, it is always better to associate the latter with a good psychoprophylaxis.

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Tuberous sclerosis or Bourneville's disease is a phakomatosis with common but paucisymptomatic bone localisations. Some osseous lesions, of osteosclerotic type, can be radiologically diagnosed as primary or secondary malignant disorders. We describe a case of Bourneville's disease with bone involvement, radiologically characterized by osteosclerosis areas of the spine and the pelvis. Interestingly, bone scintiscan was normal. The absence of primary malignancy, the stability of control bone X-ray films, the clinical status and the family history, together with the pathognomonic radiological feature of the hands support the diagnosis of tuberous sclerosis with bone involvement.

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Hydatid cysts located in the thymus are extremely rare. Only 8 cases were reported in a recent publication, and all concerned patients from endemic areas. The case presented here is original in that it concerns a patient living in Picardy.

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27 patients (17 F, 10 M) with a mean age of 65 +/- 11 years and suffering from recurrent pleural effusions were treated with locally administered Doxycycline by lavage-drainage to achieve pleural symphysis (17 adeno-carcinomas, 3 large cell carcinomas; 3 epidermoid cancers; 3 non-Hodgkin's lymphoma; 1 small cell carcinoma). The solution used was a dilution of 50 ml doxycycline in 250 cc of isotonic saline. 22 of the 27 patients could be evaluated long term, 5 were lost to follow up, of whom two had recurred straight away despite local treatment. An immediate response was obtained in 23 out of the 28 patients (85%). Later the absence of recurrence was seen in 90% of the patients evaluated. The incidence of antimitotic therapy did not seem to be the determining factor in the 7 patients who received this in parallel. The duration of drainage was 11 +/- 6 days, the local treatment was well tolerated in the majority of cases. The use of the technique of lavage-drainage of doxycycline could be an alternative in those patients with a malignant pleural effusion whose general condition contra-indicates a symphysis under pleuroscopy.

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Intracranial hypertension and acute renal failure are frequent complications in polytraumatized patients with head trauma. This paper deals with the evolution of intracranial pressure during haemodialysis in two cases of traumatic coma. Significant changes in intracranial pressure were noted. Increase of intracranial pressure during haemodialysis was 7.6 mmHg for the first patient and 4.6 mmHg for the second patient. Prophylactic measures are discussed.

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From 1967 to 1978, home assisted ventilation (HAD) was applied to 74 severe chronic respiratory insufficient patients (67 COPD-7 restrictive). These patients used volume generators through mouth piece, except 3 of them who had a tracheostomy. The main results of this study are a highly statistically significant decrement (P less than 0,001) of the hospitalization durations and of the frequency of ARF, as well as an improvement of the survival duration in front of a non-tested group, and a significant decrease of haematocrit (less than 0,05) and P.V.R. (P less than 0,01). But blood gases and functional tests are not statistically different. Age (greater than 55 years) and delay after first ARF (greater than 2 years) when starting HAD are considered as pejorative factors.

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The authors studied 24 patients with chronic respiratory insufficiency divided in 2 groups, one of them subjected to long lasting oxygen therapy. They studied the correlations between the variations of hemodynamic and non dynamic parameters registered during a previous assay of oxygen therapy and those observed during the evolution so as to deduct criteria of prescription of a long lasting oxygen therapy. They stress the importance of microcatheterism at the beginning. On the other hand if it suggests the indication for a controlable oxygenation, the ponctual assays of oxygen therapy, such as defined, present no interest where the appreciation of later successes of a long term oxygen therapy is concerned.

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