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Background The few studies that have focused on Time between Onset of Signs and Symptoms and Referral (TOSR) for dementia to a memory center suggest a substantial delay of 1–3 years. This delay has a negative impact on both patients’ and their caregivers’ quality of life. Objective This study aimed to evaluate this delay and the factors associated with it in a cohort of community-dwelling elderly people attending a memory clinic, as well as assess the impact of the Third French National Alzheimer Plan (2008–2012). Methods All patients referred to the Bretonneau Memory Clinic for the first time between January 2006 (the clinic has maintained a specific database since then) and March 2016 were included in the study. Results Of the 8543 patients attending our Memory Clinic during the study period, 3353 attending for the first time and with complete data were included. Briefly, their ages were 82 ± 7 years, and 67.2% were female; MMSE score was 21.2 ± 6.6, IADL was 4.06 ± 0.78 and the social-needs category of the Groupes Iso Ressources (GIR); Iso-Resource Group (IRG) scale was 4.04 ± 0.37. The TOSR was, on average, 35.4 ± 30.24 months, and increased after implementation of the Third French National Alzheimer Plan, from 26.68 ± 26.28 months before 2009 to 40.08 ± 31.2 months after 2009. Age and MMSE were associated with TOSR, but not the type of dementia, household composition and social characteristics. Also, there was a shorter TOSR for mild cognitive impairment than for dementia patients. Conclusion Our results emphasize the need for more education and information among the general public about the early signs of cognitive impairment, especially in elderly people.

La PCR nichee a ete utilisee pour evaluer son apport et ses limites dans le diagnostic du paludisme et pour evaluer la performance des microscopistes dans la surveillance de la maladie dans le Sud de l’Algerie. Durant la periode de 2010-2015, 112 patients dont 93 febriles et 19 asymptomatiques originaires d’Afrique subsaharienne ont ete adresses au laboratoire de l’hopital de la wilaya de Tamanrasset pour le diagnostic du paludisme. Une partie du sang preleve a la pulpe du doigt a servi pour la confection de frottis et de goutte epaisse et l’autre partie a ete absorbee dans du papier filtre pour le diagnostic moleculaire. La PCR nichee a permis de detecter le parasite dans 63 echantillons contre 53 a l’examen microscopique, de mettre en evidence 11 infections mixtes et de diagnostiquer 6 cas positifs non detectes a la microscopie. Deux echantillons negatifs a la PCR nichee avaient ete declares positifs a l’examen direct. La PCR nichee est plus sensible que l’examen direct dans la detection des parasitemies infra microscopiques et les infections mixtes.

Objective To assess the accuracy of pre‐operative staging in patients with peripheral pancreatic cystic neoplasms (pPCNs). Methods From 2005 to 2011, 148 patients underwent a pancreatectomy for pPCNs. The pre‐operative examination methods of computed tomography (CT), magnetic resonance imaging (MRI), endoscopic ultrasonography (EUS) were compared for their ability to predict the suggested diagnosis accurately, and the definitive diagnosis was affirmed by pathological examination. Results A mural nodule was detected in 34 patients (23%): only 1 patient (3%) had an invasive pPCN at the final histological examination. A biopsy was performed in 79 patients (53%) during EUS: in 55 patients (70%), the biopsy could not conclude a diagnosis; the biopsy provided the correct and wrong diagnosis in 19 patients (24%) and 5 patients (6%), respectively. A correct diagnosis was affirmed by CT, EUS and pancreatic MRI in 60 (41%), 103 (74%) and 80 (86%) patients (when comparing EUS and MRI; P = 0.03), respectively. The positive predictive values (PPVs) of CT, EUS and MRI were 70%, 75% and 87%, respectively. Conclusions Pancreatic MRI appears to be the most appropriate examination to diagnose pPCNs accurately. EUS alone had a poor PPV. Mural nodules in a PCN should not be considered an indisputable sign of pPCN invasiveness.

Resume Le kyste hydatique constitue un probleme de sante publique dans les pays d’endemie. Chez l’enfant, il siege au niveau du poumon puis du foie. Sa localisation mediastinale est rare, representant 0,1 a 4 % des cas. Entre janvier 1996 et decembre 2007, 222 patients presentant 235 kystes hydatiques intra-thoraciques ont ete colliges, parmi lesquels deux ont ete de siege mediastinal (0,85 %). Deux patientes, âgees de 12 et 13 ans, ont ete hospitalisees pour des douleurs thoraciques evoluant depuis un an. La radiographie du thorax a montre une opacite arrondie, homogene, de tonalite hydrique, mesurant respectivement 150 et 50 mm de diametre. La tomodensitometrie realisee dans le second cas a objective une formation kystique, bien limitee, a paroi propre, siegeant au niveau du mediastin posterieur et ne se rehaussant pas apres injection du produit de contraste. L’echographie abdominale a ete normale. Par une thoracotomie posterolaterale, un kyste hydatique sain, de siege mediastinal posterieur a ete retrouve dans les deux cas. Apres protection du champ operatoire par du serum sale hypertonique, une ponction-aspiration du kyste avec ablation de sa membrane proligere ont ete realisees, suivies d’une perikystectomie sub-totale. Les suites operatoires ont ete simples avec un recul respectif de quatre ans et de trois ans sans recidive ni reinfestation. Les auteurs soulignent la rarete de la localisation mediastinale et rappellent que toute masse kystique du mediastin doit faire discuter sa nature hydatique. Du fait de la benignite de la maladie, le traitement chirurgical doit rester conservateur.

Human T-lymphotropic virus type I (HTLV-I) is endemic in the Caribbean region, south-western Japan and Africa, and is associated with tropical spastic paraparesis and adult T-cell leukaemia/lymphoma (ATLL). Cutaneous forms of ATLL are sometimes indistinguishable from other cutaneous T-cell lymphomas (CTCL). We report a woman living in a non-endemic area for HTLV-I, with no risk factors for viral infection, who developed mycosis fungoides-like ATLL. The findings underline the usefulness of molecular biological techniques in distinguishing between mycosis fungoides and ATLL. We emphasize the need to establish the HTLV-I status of patients with CTCL, even in HTLV-I non-endemic areas, not only to establish a preventive policy in these countries, but also to further our knowledge of the lymphoproliferation spectrum associated with human retroviruses.

L'apparition de la ponction dirigee sous echoendoscopie, a completement transforme la prise en charge des maladies neoplasiques et en particulier la prise en charge des tumeurs du pancreas. En effet, le pancreas est un organe difficile a prelever sur un plan histologique. Le risque d'essaimage sur le trajet de l'aiguille, au cours des ponctions guidees sous echographie ou sous scanner, a egalement contribue au developpement des ponctions sous echoendoscopie. Si l'on veut repondre a la question « faut-il toujours ponctionner? », il faut d'abord evaluer les raisons qui doivent conduire a la ponction et les elements decisionnels de la ponction sous echoendoscopie.

Summary Background : Injecting fibrin glue has proved to be an effective means of treating anal fistulas (AF). There has been some debate, however, as to whether this technique should be used on the AF often involved in Crohn's disease (CD). Aim : To assess the effectiveness of injecting heterologous fibrin glue as a means of treating AF refractory to immunosuppressive treatment in patients with CD. Methods : Fourteen CD patients (five men and nine women, average age 42 years) presenting with refractory AFs were included in this study. Heterologous fibrin glue was injected into the fistula tract under general anaesthesia under continuous endosonographic monitoring using a 7.5-MHz blind linear probe. The patients were followed up clinically and ultrasonographically for 3 months after the procedure, and then at regular intervals. Results : Three months after the fibrin glue injection, the fistulas had completely dried up in 10 patients (71%), the leakage had decreased in one patient (7%), and no improvement was observed in the other three patients (21%). Endosonographic findings showed that the fistula tract had completely disappeared in two cases (14%). The fistula tract was found to be non-permeable in eight cases (57%), and no change in the fistula was observed in four patients (29%). At the end of the follow-up period [average 23.4 months (12–26 months)], the leakage had completely dried up in eight of the 14 patients (57%). No side effects were observed. Conclusion : Nearly 2 years after the use of a heterologous fibrin glue to treat an AF, over half of the patients with CD showed clinical signs of remission. Because it is easy to use and harmless as well as being effective, this method provides a good alternative to classical methods of surgical treatment.

BACKGROUND: Transfusion of human T-lymphotropic virus type I (HTLV-I) contaminated blood is sometimes linked with the rapid onset of HTLV-I- associated myelopathy/tropical spastic paraparesis (HAM/TSP) in immunocompromised recipients. STUDY DESIGN AND METHODS: This study addressed the question of whether HTLV-I variants could emerge in an immunocompromised patient who developed HAM/ TSP after the transfusion of blood from an asymptomatic HTLV-I carrier. Base pairs (n = 2327) of the HTLV-I genome located in the LTR U3 region and parts of the env and tax genes were sequenced and compared to the isolated identified in the asymptomatic blood donor and to well-known ATK-1 and H5 strains. The same analysis was performed on another set of samples from an asymptomatic HTLV-I-positive blood donor and a similar blood recipient. RESULTS: No critical changes in nucleotide sequences were identified in the immunosuppressed HAM/TSP patient when compared with the nucleotide sequences of the corresponding blood donor, the other asymptomatic blood donor and recipient or the ATK-1 and H5 strains. CONCLUSION: Immunosuppression does not seem to favor the emergence of particular nucleotide sequences in the genome located in the LTR U3 region or in parts of the env and tax genes in transfused patients who develop HAM/TSP.

Congenital diaphragmatic hernia (CDH) is a severe disorder in neonates. The prognosis has been improved in the past 10 years by a combination of HFO ventilation, sedation and analgesia, nitric oxide and delayed surgery. Extracorporeal oxygenation (ECMO) has been proposed by certain teams. A decrease in mortality from 70% to approximately 40% has recently been reported [1,2]. However, little is known about the outcome of such patients. We report the outcome of a group of patients after 10 years' follow-up.