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The concept of addiction has gained recognition in French semantics, standing for a pathological condition that was formerly designated solely on the basis of specific drug abuse. We questioned 90 patients followed at there Parisian outpatient units about their understanding of the term "addiction". We also looked for signs that this term is used to federate notions since it is supposed to describe a general condition involving a large number of singular phenomena. One part of our questionnaire focused on treatment modes (several practitioners for several addictions, one institution for all addictions, specialized consultations with a practitioner other than the usual primary care physician). Our findings would illustrated areas where further details are needed in order to consider patient expectations when designing specialized care for outpatients or inpatients.

We report three personal cases of hydrocarbide aspiration pneumonia. High-viscosity non-volatile hydrocarbides (paraffin oil, for instance) cause often pseudotumoral exogenous fat-aspiration lung disease. Low-viscosity volatile hydrocarbides (petroleum, gasoline, white spirit, for instance) cause acute pseudo-infectious lung disease with dyspnea and fever which usually resolves within a few weeks but which may also be life-threatening. Purely symptomatic treatment has greatly progressed with advances in intensive ventilatory assistance. Gastric emptying with emetic agents or lavage procedures is dangerous and must be avoided except for exceptional cases. When required, the airways must be protected with tracheal intubation. Volatile hydrocarbides should be stored in protected areas in containers with safety stoppers which children cannot open.

Abstract This study evaluated the concordance of concomitant urinalysis and clinical assessments of drug abusers included in a methadone maintenance programme. The agreement between a clinical subjective score and an objective biological score, both measuring the evolution of illicit substance consumption over 12 months, was analysed. The clinical score, established by physicians and applied during patient interviews, was determined at entry into the programme and re-evaluated after 6 and 12 months. Forty-one patients were evaluated. The urinalysis score was based on regular screening of urine samples with the EMIT method. Agreement between the two scores was determined by using the kappa coefficient for each substance (opiates, benzodiazepines and cocaine) for each time-point. The calculated kappa coefficients showed poor agreement between the two scores, but could indicate the complementarity of these clinical and biological appraisals. Indeed, the urinalysis objectively detected change in drug use before the clinician. Thus, urinalysis monitoring should be considered as an additional and complementary biological procedure for patient follow-up by physicians.

Early February 1999, the French Ministère de la Jeunesse et des Sports (Youth and Sports Ministry) sponsored three different studies, aiming to prevent harmful behavior in the area of sport practices among youth. Two years earlier, our health care team working with drug users published reports on the meaningfulness of intensive sports activities in the history of our patients. The present work was performed to highlight the midterm results of one of these studies, to better understand and quantify the importance of physical training in the history of a group of outpatients seen for addictive disorders and comorbid pathologies. For 20 consecutive weeks, 3,040 self-administered questionnaires were available for persons consulting 20 health centers, 2 self-help groups and a general practitioner network working in the field of alcohol or heroine abuse. One thousand one hundred and eleven questionnaires were filled out (36.1%) and returned by mail for complete analysis: 86% of the answering persons had practiced at least one sports activity or participated in physical training, 10.5% had participated in a national or international level competition, and 10.6% reported stress fractures. In the intensive sports group, 36% had used illicit drugs intravenously and 16.4% said they had already used doping substances. Only 28.4% said they experienced dependence during their period of intensive sports activities compared with 15.2% before this time, and a majority (56.4%) thereafter. Intensive sports or physical training should not be seen as a protective factor nor as a way of improving addictive behaviors. More studies are needed to evaluate individual vulnerability factors and specific harm of overtraining and to determine the exact periods when men and women participating in sports activities are likely to abuse drugs, especially at the end of their career.

The aim of this study was to analyze information concerning multiple drug addiction, illicit behaviors and use of the venous route by maintenance treatment patients included in the October 1998 survey of the OPPIDUM program. Among 1,462 observations, 71% of the subjects were taking maintenance treatments (60% high-dose buprenorphine and 40% methadone). High-dose buprenorphine was taken without medical supervision in 10% of cases. Indicators of abuse were high in this case: multiple drug addiction and intravenous use of buprenorphine (28%). Patients maintained by methadone were older and living in better socio-economic conditions than patients maintained by high-dose buprenorphine. However, in the two groups, the percentage of patients using the intravenous route was the same (15% and 21%). More cocaine was used by the methadone group (16% versus 7%). Thirty-seven percent of the subjects maintained on high-dose buprenorphine were followed by a general practitioner. They appeared to be more unbalanced and in more precarious condition than subjects treated in specialized care centers but they were not representative of the patients maintained by buprenorphine. It would be important to determine why these subjects consult a specialized care center.

To define the medical characteristics of intravascular drug users in Ho Chi Minh City, Vietnam, we examined 280 men, of whom 235 were infected with human immunodeficiency virus (HIV), being treated in a rehabilitation center. The patients used mainly opium, often in shooting galleries (50%). The prevalence of oral candidiasis (58%) and zoster infection (20%) was high in HIV-seropositive patients, whereas oral hairy leukoplasia and Kaposi's sarcoma were absent. The prevalence of acquired immunodeficiency syndrome was 24%. More than 80% of the patients had infections with hepatitis C virus, hepatitis B virus, cytomegalovirus, or human T cell lymphotropic virus type-1. The CD4+ cell counts correlated well with viral load. Only HIV-1 subtype E was detected in the 30 patients tested. A cohort study of HIV-infected subjects in this population seems feasible, and would permit introduction of anti-retroviral therapy The large number of HIV-seronegative subjects sharing the same at-risk practices as the HIV-infected subjects raises the possibility of natural protection in this population.

A rapid gas-liquid chromatographic assay is developed for the quantification of methadone (Mtd) and its major metabolite, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), in biological fluids of opiate addicts. After alkaline extraction from samples with lidocaine hydrochloride as internal standard, Mtd and EDDP are separated on SP-2250 column at 220 degrees C and detected with a thermionic detector. The chromatographic time is about 6 min. The relative standard deviations (R.S.D.) of Mtd and EDDP standards are between 1.5 and 5.5%. Most drugs of abuse (morphine, codeine, narcotine, cocaine, benzoylecgonine, cocaethylene, dextropropoxyphene etc) are shown not to interfere with this technique. The method has been applied to study the levels of Mtd and EDDP metabolite in serum, saliva and urine of patients under maintenance treatment for opiate dependence. EDDP levels were found higher than those of Mtd in urine samples from four treated patients, but lower in serum and undetectable in saliva. However, Mtd concentrations were higher in saliva than in serum.

Adequate dosage of sublingual buprenorphine is now recommended for substitution treatment of severe opioid dependance. We report two cases of acute discomfort, probably linked to withdrawal syndrome, after an IV injection of high doses of buprenorphine in opiate dependant patients. Data on the pharmacokinetics and neurobiochemical aspects of buprenorphine are compared with those of other opiates. A major issue of this work is a guideline for inducing substitution treatment with this "unique" partial agonist/antagonist of endorphinic receptors.

Sutton's disease is characterized by giant necrotizing ulcers around minor salivary glands and is of unknown cause. We report a case, review the medical literature, and discuss the treatment of this affliction.

Emergencies during HIV infection consist mainly in opportunistic infections. They are varied and the physician should keep an "internist's eye" on the condition; they also require emergency complementary examinations for confirmation of diagnosis. If such diagnostic tests cannot be rapidly made, treatment should be started on the basis of presumption and frequency. In France, the most frequently observed opportunistic infections are: pneumocystosis, cerebral toxoplasmosis and candidiasis. Tuberculosis is a major concern of those responsible for public health care. Surgical complications following infections or opportunistic tumours, are rare and of poor prognosis. Iatrogenic complications (haematologic, cutaneous and infectious) are also reasons for emergency care.

In this retrospective study 141 HIV positive subjects were included. Allergy was studied by a specific questionnaire and the Phadia Top Test, an in vitro screening test for specific IgE. Both were related to the patients' history, clinical symptoms and the treatment used. Allergy was studied in reference to HIV negative controls and in relation to the clinical and biological subgroups of HIV patients. The statistical analysis (x 2 test) demonstrated a relationship between allergy and HIV infection and the clinical stage of AIDS-IKEL among patients with CD4 > 300 microliters, which may suggest that allergy contributes to the functional deficiency of these cells. We also demonstrated a high frequency of hypersensitivity reactions (75%) in HIV asymptomatic patients with CD4 < 300 microliters, which indicates that allergy could contribute to the early destruction of these cells. The allergic patients declared to be hypersensitive before contamination. Both mechanisms, functional deficiency and destruction of CD4 T-lymphocytes could be the result of the mediators, cytokines and enzymes released from the mast cells during IgE allergic reaction. Thus this study demonstrated that allergy could be a predisposing factor for the contamination and a polyvalent co-factor for the clinical and biologic evolution of HIV infection.

In AIDS patients an acalculous cholecystitis may be responsible for abdominal pain subsiding after cholecystectomy. But the indications for cholecystectomy are not clear: cholecystitis is usually associated with diffuse cholangitis and this might cause the symptoms. Since 1985, 8 AIDS patients have undergone cholecystectomy for acute cholecystitis. Ultrasonography revealed a 5 to 12 mm thickening of the gallbladder wall in all of them and gallbladder stones in two; four patients had cholangitis. The decision to operate was based on persistent pain associated with fever, poor general condition and muscular rigidity at palpation. Four patients had septic shock at the time of surgery; one died in the immediate postoperative period. In all other patients pain and septic syndrome subsided. Two patients died of AIDS complications 20 days after surgery; the remaining five died of AIDS 6, 9, 10, 12 and 14 months respectively after surgery; in two of them cholestasis had reappeared due to cholangitis. To summarize, in the 8 AIDS patients studied cholecystectomy was performed for clinical deterioration. Gallbladder pathology was responsible for the abdominal pain and the febrile general condition which was relieved by cholecystectomy.

This multicenter retrospective study concerns 594 cases of HIV-1 positive patients. The majority were asymptomatic. Some had Aids-related complex and some had AIDS. They were all seen in seven hospitals of the western outskirts of Paris and in one Paris hospital between 1983 and 1988. There was a predominance of homosexuals and of cases of AIDS in the center of Paris. Intravenous (IV) drug users and asymptomatic cases were more numerous in the city outskirts, a reflection of the populations at risk around each hospital. The proportion of cases of AIDS was lower among IV drug users than among homosexuals or bisexuals probably due to the fact that the viral infection was discovered at an earlier stage in a population contaminated at a later date or to the tendency to ask for the test "systematically" in drug addicts. 22% of the cases were women with a sex ratio of 3.5. HIV infection was attributed to use of intravenous drugs in 51% and to heterosexual transmission in 18% of the women. But the incidence of heterosexual transmission increased significantly, essentially in women. Overall, the incidence of infection by the HIV 1 has decreased since 1986. A number of recent publications seem to indicate the same tendency. But this fundamental observation remains to be validated by further studies. The yearly incidence of AIDS increases. The 5 year calculated actuarial rate of probability of remaining asymptomatic decreased to 40% in 385 initially asymptomatic patients.

Sixteen patients with Churg-Strauss syndrome (CSS), a disorder characterized by hypereosinophilia and systemic vasculities which complicate preexisting asthma, were analyzed. The mean duration of asthma before CSS was 8 years; peripheral blood eosinophilia was always greater than 1,900/microliters and exceeded 5,000/microliters in 14 cases. The clinical manifestations were the following: 16 in generally poor condition with fever; 12 peripheral neuropathies; 11 cutaneous lesions; 9 pericardial or myocardial involvement; 9 digestive disorders; 9 muscular or articular diseases; 5 renal involvement, all associated with the vasculitis; 7 upper respiratory tract disorders. Chest radiographs showed pleuropulmonary or cardiac anomalies in 11 patients. The diagnosis was confirmed histologically in 11 cases, however, no clinical, biological or evolutive differences were observed between these patients and those with negative biopsies (5). Follow-up for 6.35 +/- 5.55 years was characterized by relapses always preceded by increased eosinophilia. Fourteen patients were successfully treated with corticosteroids, associated with cyclophosphamide in 7 of them. Five-year survival was 87%. Four deaths occurred, all CSS-associated, two because of a poorly adapted therapeutic regimen. The need for rapid and effective treatment must be stressed. The diagnosis can be made based on clinical manifestations alone before histological confirmation can be obtained.

We determined the relative value of the free erythrocyte protoporphyrin (FEP) assay compared to those of total iron-binding capacity (TIBC) and serum ferritin in the diagnosis of iron deficiency in a population of elderly anemic subjects. One hundred and three patients, 65 to 98 years old (mean +/- SD: 81.5 +/- 8.8), with hemoglobin levels of less than 110 milligrams (mean +/- SD: 97 +/- 12, range 53-109) were included in the study. In the patients with iron-deficiency anemia due solely to chronic bleeding, mean values for the three parameters were highly different from those in patients without chronic bleeding. In the patients with anemia due to an association of chronic bleeding and chronic inflammation, the mean FEP value was very significantly different (p less than 0.001) from that in the patients with chronic inflammation but without bleeding, whereas this was not the case for TIBC or serum ferritin. The sensitivity of FEP in the diagnosis of iron deficiency due to chronic bleeding in this population of anemic subjects was 60% (specificity 90%), compared to 13% (specificity 96%) for TIBC and 20% (specificity 100%) for serum ferritin. The FEP assay thus emerges as being highly suitable for the diagnosis of iron-deficiency anemia in the elderly subject, particularly when bone marrow is not examined.

Numerous abdominal manifestations were noted among 600 patients undergoing treatment at Hospital Laennec for various stages of infection by the acquired immunodeficiency virus. These included violent abdominal pain in 30% of cases, the development of abdominal lymphoma, and occasionally alarming pseudo-surgical syndromes. Diagnosis is difficult, all the more so since authentic emergencies may be aggravated by the immunodeficiency state. 18 cases were collected in 3 years and included 6 cases of acute cholecystitis and 2 of appendicitis. The gangrenous and extensive nature of infection was generally noted and required appropriate antibiotic therapy.

Cough is a well recognised though undesirable side effect during the course of treatment with angiotensin converting enzyme inhibitors (IEC). With the help of two examples we have tried to show that this cough does not have an immunological origin but rather pharmacological. Cough was suppressed by non steroidal anti-inflammatory drugs. Stemming from these observations and from two studies in the literature a patho-physiological mechanism for the cough is proposed in which treatment with IEC leads to a connection with prostaglandins, notably bronchial PGE2.

The hour of day of primary ventricular tachycardia (VT) in the acute phase of myocardial infarction was studied in 63 consecutive patients without cardiac failure or antiarrhythmic therapy, admitted to hospital less than 6 hours after the onset of chest pain. There were 19 women and 44 men, with an average age of 63 years. The site of infarction was anterior in 23 cases, posterior in 34 cases and circumferential in 6 cases. The cardiac rhythm was analysed from the 6th hour following the onset of chest pain for 4 days, using a HP 98220 A computerised analyser CPK levels were measured daily. Ventricular tachycardia occurred in 73% of cases with no significant difference between daytime (18 patients) and night time (28 patients). The patients developing VT did not differ from the remainder with respect to age, sex, or site of ECG changes, but peak CPK levels were significantly higher than in patients without VT. The risk of VT decreased slowly as the interval from the onset of chest pain increased and fell practically to zero after the 40th hour. Diurnal and nocturnal VT were independent of age, sex or site of infarct. However, nocturnal VT correlated independently of the time of onset of chest pain to high values of CPK. There was no difference with respect to age, sex, location of infarct or incidence of ventricular tachycardia between infarcts with pain starting during the day, and infarcts with pain starting at night. However, when the pain started during the day, the peak CPK was significantly higher and there were significantly more attacks of nocturnal ventricular tachycardia.(ABSTRACT TRUNCATED AT 250 WORDS)

Cyclosporin (7.5 mg/kg daily) was given to 8 AIDS patients for 17-66 days and to 25 HIV-seropositive non-AIDS patients, 15 with stage II (T4 cells/microliter greater than or equal to 300, less than 600) and 10 with stage III (T4/microliter less than 300), for 3-6 months with the hypothesis that the drug could inhibit both HIV replication and the potential autoimmune component of HIV disease. A sustained increase over 600 T4/microliter occurred in 7 patients with stage II and 1 with stage III. T8 cells significantly decreased in most patients and lymphadenopathy disappeared in 14/16. After cyclosporin withdrawal T4 and T8 cells as well as lymphadenopathy returned to pretreatment status. Cyclosporin side effects (hypertension, creatinine increase, and anemia) were moderate and reversible. These results might stimulate biological research as well as clinical trials with cyclosporin in selected groups of HIV-seropositive subjects with the aim of delaying or preventing AIDS occurrence.

The authors report the results of a one year study carried out in the Department of Internal Medicine at Laennec Hospital. Out of a total of 1334 hospitalisation, 95 had drug side effects (7.1 p. 100) and 3.5 p. 100 of admissions were directly related to a iatrogenic complication. These complications were more common in women and elderly patients. Sixty-two drugs were implicated: antibiotics (32.6 p. 100), cardiovascular drugs (20 p. 100) including the diuretics (8.4 p. 100), antiinflammatory and antalgic drugs (16.8 p. 100), anticoagulants (8.4 p. 100), neuropsychiatric drugs (7.4 p. 100), oral hypoglycaemic agents (6.3 p. 100)..., 101 side effects were observed: gastro-intestinal (35.6 p. 100) dermato-anaphylactic (19.8 p. 100), cardiovascular (12.9 p. 100), endocrine or metabolic (11.8 p. 100), neuropsychiatric (10.9 p. 100), haematological (5.9 p. 100) and renal (4.2 p. 100). Iatrogenic complications were responsible for the admission to hospital of 47 patients and for 390 days of hospitalisation, costing approximately 380.000 FF.

Erythrocyte protoporphyrin (EP) measurement is useful for the diagnosis of protoporphyrin, iron deficiency or lead poisoning. The authors described a manual procedure for the spectrofluorimetric determination of EP. Erythrocytes were used, instead of whole blood. The following steps were performed: treatment with celite suspension, extraction using ethylacetate/acetic acid, estimation of the fluorescence of protoporphyrin IX extracted in HCl. Analytical results are following: a low detection limit (0.045 mumol/l), a linear response up to 2 mumol/l, within run and day-to-day precision respectively better than 3.5 p. cent and 5.8 p. cent. The procedure with predilution led to no significant difference with the spectrophotometric reference method (student t-test, t: 0.85) up to 42 mumol/l. Concentrations of EP according to age were studied for children (0.0470-1.000 mumol/l), middle-aged subjects (0.390-0.880) and elderly subjects (0.340-1.040). The proposed method is accurate, rapid and available for routine measurements.