Programme Hospitalier Recherche Clinique, Institut Pasteur, Inserm, French Public Health Agency.

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We conducted a prospective study to investigate access to treatment in hepatitis C in 268 prisoners. Hepatitis C positivity had been known for 182 prisoners previously and 19 reported previous attempts to treat (10%). In comparison, during our study, 86/268 prisoners (32%) started therapy (P < 0.0001). They represented 41% of 211 prisoners with a positive viral load. In the genotype 2 or 3 group, 46 prisoners (50%) started therapy versus 40 prisoners (33%) with other genotypes (P = 0.01). This difference was due to prisoners waiting for liver biopsy. On an intention to treat basis, 45 prisoners (52%) achieved sustained virological response 6 months after the end of therapy. We conclude that a stay in prison is an effective opportunity to treat a group of hepatitis C patients which otherwise have very limited access to therapy.

We present an unusual case of a liver abscess caused by a swallowed toothpick in a 43-year-old man. The abscess was first punctured under percutaneous ultrasound control and intraveneous administration of antibiotics whereas the diagnosis of the foreign body stuck in the sigmoid bowel wall was only made by a follow-up computed tomography since the patient had no complains indicating a colonic pathology. Even more, the patient did not remember ever having ingested a foreign body. The wooden toothpick was then successfully removed by endoscopy. The case report stresses the need for a search of the cause of unexplained liver abscesses and highlights the importance of computed tomography as the first imaging technique as the foreign body was missed on the ultrasound examination. Finally, the non-surgical treatment as first line management of liver abscesses will be discussed.

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