[Patients of other cultures and somatization]. / Quand la parole ne fonctionne plus. Patients d'autres cultures et troubles somatoformes.

This work concerns my personal clinical experience with people of other cultures presenting somatization. I analyse different ways of understanding this apparent lack of words in some of these patients, and a clinical approach based on the conviction that words are necessary to alleviate suffering of our patients.

[Victims of violence: importance of medical testimony for the practitioner]. / Victimes de violences: L'importance du constat médical pour le praticien.

Physicians may be asked to provide care to victims of violence. Adequate diagnostic and therapeutic management must be provided. Establishing a detailed medical testimony can substantially influence the judiciary or administrative procedure's outcome. This paper provides guidelines for writing a medical testimony and describes the criteria that physicians need to consider in order to serve at best the interests of their patient within a mutually trustful relationship.

[The health of asylum seekers: from communicable disease screening to post-traumatic disorders]. / La santé des demandeurs d'asile: du dépistage des maladies transmissibles à celui des séquelles post-traumatiques.

As the end of this century approaches, the pressure of migration is increasing. It is difficult to limit with restrictive measures the number of refugees and persons seeking asylum in Europe in each country, medical screening programs are organised for arriving refugees and asylum seekers. In Switzerland, they are screened for tuberculosis and hepatitis B. They are offered standard vaccinations and immunized for hepatitis B according to screening results. The prevalence of tuberculosis in asylum seekers is 414 per 100,000, 227 per 100,000 of bacteriologically active tuberculosis. Anti-HBc antibody is present in 22% of women and 39% of men. The frequency increases with age and varies greatly according to origin. Initially, refugees were screened for intestinal parasites. Over a quarter were carriers, a large majority asymptomatic. Increasing numbers of asylum seekers come from countries affected by war and insecurity. Systematic screening carried out in Geneva for previous exposure to violence revealed that 61% reported major trauma, 18% reported torture and 37% complained of symptoms such as nightmares, insomnia, flashbacks, etc. The authors discuss issues related to medical screening programs, and their relative usefulness in an increasingly mobile world where the distinction between travellers and migrants is not always clear.

Effect of factors inhibiting HLA-DR antibodies before transplantation on kidney graft survival.

Blood transfusions administered before renal allografts are known to enhance graft survival. Among alternative hypotheses proposed to explain this effect, one of the most attractive is the possible induction of antiidiotypic antibodies directed against the specific antigen-binding site of donor-specific antibodies. In order to determine if such blocking antibodies are generated after blood transfusions, serial serum samples obtained before transplantation from 44 kidney recipients were analyzed for the development of HLA-DR alloantisera inhibitory activity by a microcytotoxicity inhibition assay. A significant correlation was found between the presence of inhibitory factors before transplantation and prolonged graft survival. However a clear relation between the development of inhibitory factors and the administration of transfusions could not be established. In addition the sera of 36 patients were studied for the presence of circulating immune complexes (CIC) before grafting. The presence of CIC was clearly associated with that of inhibitory factors, and with a prolonged graft survival. Thus these studies provide support for the development of blocking (possibly antiidiotypic) antibodies to anti-MHC in human renal graft recipients.