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Resume Les neuroleptiques sont souvent prescrits chez les patients âges presentant des troubles du comportement. Ces molecules ont cependant de nombreux effets indesirables. L’objectif de cette etude etait d’evaluer l’impact a huit jours de la diminution des neuroleptiques sur l’intensite des troubles du comportement de patients âges hospitalises. Une etude prospective observationnelle multicentrique (5 hopitaux du groupe hospitalo-universitaire Paris Nord Val-de-Seine) incluant des patients de plus de 70 ans, hospitalises, souffrant de troubles du comportement et traites par neuroleptiques a ete conduite. Les participants ont ete classes en 2 groupes a j0 selon l’avis des medecins referents des patients et l’importance des troubles evaluee par le score de l’inventaire neuropsychiatrique–equipes soignantes (NPI-ES) : « groupe 1 : patients pour lesquels le traitement neuroleptique a ete maintenu a l’identique » et « groupe 2 : patients pour lesquels les neuroleptiques ont ete diminues ». L’evolution des troubles du comportement a ete mesuree a j8 par le score NPI-ES. L’impression clinique globale selon l’equipe medicale (ICG medecin) et paramedicale (ICG soignant) a egalement ete recueillie a j8. Soixante-dix-huit patients (81,5 + 5,7 ans) presentant une maladie soit psychiatrique (15,4 %), soit dementielle (84,6 %) avec des troubles du comportement (NPI-ES (moyenne ± ET) : 26,06 + 23,31/144) ont ete inclus : 40 dans le « groupe 1 » et 38 dans la « groupe 2 ». La baisse des neuroleptiques etait associee a une diminution significative de la severite des troubles du comportement dans le groupe ayant beneficie d’une diminution de doses de neuroleptiques (groupe 2) a j8 par rapport aux troubles du comportement des patients ayant conserve la meme dose de neuroleptiques (groupe 1) apres ajustement sur la severite des troubles a j0 (ΔNPI-ES : groupe 1 vs groupe 2 = −0,13 vs −0,34, p = 0,003). L’ICG etait concordant entre l’equipe medicale et paramedicale et variait dans le meme sens que la ΔNPI-ES. Ainsi, cette etude met en evidence une association entre la diminution des doses de neuroleptiques et la diminution des troubles du comportement dans cette population selon la NPI-ES. Ces resultats renforcent les recommandations concernant la revision systematique de la prescription de neuroleptiques.

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.

In order to interpret the low-H peak and the particular form of M ( H ) curves of pure YBa 2 Cu 3 O 7− δ (YBCO) nanoparticles, many pellets of YBa 2 Cu 3 O 7− δ /Y 3 Fe 5 O 12 (YBCO/YIG) with different proportions of added YIG were prepared by pressing nanoparticles into disks of 5 mm diameter and 0.5 mm thickness and high temperature sintering. The crystal structure and phase composition of YBa 2 Cu 3 O 7− δ and Y 3 Fe 5 O 12 were characterized by X-ray diffraction (XRD) with CoK α radiation. Magnetization measurements vs. temperature T and applied field H were performed with a conventional magnetometer in the temperature range 4.2–110 K and in magnetic fields up to 10 T. The field was applied parallel to the pellet axis. Our results reveal that the application of a strong field leads to a phase transition: for H less than a threshold field H ⁎ , the superconducting nano-domains are prevalent in the sample. When the field increases beyond H ⁎ , superconducting nano-domains spins line up along the applied field direction to create a ferromagnetic phase. Phase diagrams are proposed. Field dependence of the critical current J C in YBCO pellet has revealed the existence of two pinning mechanisms: a pinning at low fields and a pinning at higher fields.

Pure YBa 2 Cu 3 O 7− δ (YBCO) pellet and many pellets of YBa 2 Cu 3 O 7− δ /Y 3 Fe 5 O 12 (YBCO/YIG) of different concentrations of YIG were prepared by pressing nanoparticles into disks of 5 mm of diameter and 0.5 mm of thickness. X-ray diffraction (XRD) with CoK α radiation was used to check the phase formation and to determine the mean crystallite sizes from the half-width X-ray peaks using the Scherrer relation. Magnetization measurements vs. temperature T and applied field H were performed using a conventional magnetometer within the temperature range 4.2–110 K and in magnetic fields up to 10 T. The field was applied parallel to the pellet axis. Our results confirm the superconductivity and ferromagnetism coexistence in nanoparticles of YBCO at 4.2 K. For H less than a threshold field H ⁎ , the superconducting nano-domains are prevalent in the sample. When the field increases beyond H ⁎ , the spins of the superconducting nano-domains line up along the direction of the applied field to create a ferromagnetism phase that reinforces the ferromagnetic nano-domains. The present experimental findings corroborate Kopp et al.'s claims that superconductivity and ferromagnetism in singlet superconductors such as cuprates do not exist uniformly but are phase-separated in nano-domains.

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.

The blending of magnetic elements or compounds into a superconducting matrix has a direct effect on the physical properties of the latter and provides precious information on the superconductivity mechanisms, the spin/vortex interaction and the vortex pinning. To our knowledge, no study of the addition of nanoparticles of yttrium iron garnet Y3Fe5O12 (called commonly YIG) in the yttrium, barium and copper oxide YBa2Cu3O7−δ (well known under the YBCO appellation) nanometrical matrix has been performed up to the present time. The YBCO and YIG powders have been elaborated by a conventional ceramic process. The obtained products have been characterized by magnetization measurements, X-ray diffraction and optical microscopy. The used ways to reduce their grain sizes below 50 nm and to mix them avoiding the formation of grain crowds have been explained. Their nanometrical sizes have been confirmed by atomic force microscope analysis. Eight pellets have been elaborated. The thermal variations of zero field cooled magnetizations, in a residual field of 44 G, have shown that the introduction of 5 and 9% in weight of a non-superconductor material (YIG) into a superconducting matrix (YBCO) has reduced the TC only by 1 K for a ybcoyig5% pellet and 1.57 K for a ybcoyig9% one, comparatively with the ybcopur reference pellet’s TC. In another way, our results have shown that the incorporation of YIG in very low quantities, between 0 and 0.5% in weight of YIG, increases the value of the critical current JC of a ybcopur pellet (and, so, the vortex pinning). By fitting our experimental points starting from 0.5% in weight of YIG, an empirical law of the JC variation versus added YIG percentage is suggested.

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.

The nested PCR was used to estimate its inputs in malaria diagnosis and in the performance of the microscope operators involved in the surveillance of malaria in remote areas of South Algeria. For the period 2010 to 2015, 112 patients (93 febrile and 19 asymptomatic) coming from sub-Saharan Africa were tested for malaria in the hospital of Tamanrasset. One part of the blood taken from fingertip was used for blood smears and the second part was absorbed in filter paper for molecular diagnosis. Overall, the infection was detected by nested PCR in 63 samples versus 53 by direct examination. In addition, 11 mixed infections and 6 positive asymptomatic cases not detected by microscopy were diagnosed by PCR. Moreover, two negative samples in nested PCR were tested positive by direct examination. The molecular tool is more sensitive than the direct examination in detecting infra-microscopic parasitaemia and mixed infections...

Resume Afin d'evaluer le potentiel en eau thermale du secteur de Haddage, Tunisie, une etude hydrogeothermique multidisciplinaire—comportant la geologie, la geophysique, l'hydrochimie, la geothermometrie et l'hydrogeologie—a ete menee dans le bassin de Maknassy. Cette approche est capitale pour determiner les differents facies chimiques des eaux thermales, et les relier a leurs reservoirs d'origine. Elle constitue un outil adequat pour la delimitation des bassins hydrogeothermiques. En effet, le traitement integre de toutes les donnees existantes ou nouvellement acquises confirme bien que l'eau thermale de la region de Haddage est d'origine meteorique. Elle s'est infiltree profondement dans les sables et gres du Cretace inferieur (formation Boudinar) et a atteint une temperature elevee (60°C) avant de resurgir au niveau de la source par un drainage vertical en suivant les dysharmonies tectoniques. En outre, il a ete possible d'esquisser un modele conceptuel de fonctionnement hydrogeothermique du systeme a...

The Hmeima–Boujabeur zone is considered as an important geothermal province for Tunisia. The reef limestone, characterized by intense fracturation and important karstification, confers them the property to be a regional thermal aquifer. A geophysical study based on two complementary geoelectrical methods, the Electrical Sounding (ES) and Magneto-Telluric Sounding (MTS), turned out to be very efficient to provide a complete electrical image of the underground until about 1-km depth. The synthetic approach integrating all data allowed us to delimit the favourable area for thermal water exploitation. To cite this article: M. Gouasmia et al., C. R. Geoscience 338 (2006).

Resume La plaine d'El Mida, qui fait partie de la region de Gabes-Nord (Tunisie meridionale), est caracterisee par des unites profondes, a fort potentiel aquifere, dans les series greseuses du Continental intercalaire (CI) ou carbonatees du Senonien inferieur. Une etude geophysique par sondages electriques (SE) a ete menee pour mieux reconnaitre le sous-sol de cette plaine et, par consequent, ses potentialites hydriques. L'analyse de l'ensemble des resultats montre que la zone prospectee est caracterisee par la succession de plusieurs terrains a resistivites contrastees et souvent affectes par des failles la subdivisant en deux structures essentielles, a savoir le graben d'El Mida et le horst de Draa Oudhref. Du point de vue hydrogeologique, deux niveaux geoelectriques peuvent constituer deux aquiferes. Le niveau tres conducteur dans le graben d'El Mida pourrait contenir une nappe salee et le substratum resistant du horst de Draa Oudhref pourrait contenir une eau de meilleure qualite. La forte salinite de la nappe d'El Mida pourrait provenir du nord a partir des terrains saliferes de Zemlet El Beida par drainance verticale et laterale a travers la faille bordiere du graben, et du sud-ouest a partir de Sebkhet El Hamma. Pour citer cet article : A. Mhamdi et al., C. R. Geoscience 338 (2006).

The Hmeima region (Central–Western Tunisia) is characterized by numerous Aptian anticlines associated with Triassic outcrops. These Aptian reefal limestones, characterized by intense fracturing and important karstification, constitute a regional thermal aquifer. The aim of this multidisciplinary study is to evaluate the hydrothermal potential of this aquifer. Geophysical prospecting based on the electrical method allowed the lateral evolution and the structure at depth of the reefal limestones to be followed. Furthermore, the dataset obtained permitted a fair understanding of the structural geology of the region. Hydrochemical characterization of the sampled water, with temperature ranging between 29 and 39.3 °C, shows that it is of Na–Cl type with enrichment in Ca and HCO 3 . This water is undersaturated with respect to gypsum but oversaturated or close to equilibrium with respect to calcite. The synthetic approach integrating all data gave a clear picture of the water flow-path at depth. It is clear that the thermal groundwater in the region flows in the Aptian limestone and dissolves evaporitic Triassic deposits.

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.

Les auteurs se proposent d'etudier les aquiferes, c'est-a-dire les formations geologiques susceptibles de repondre aux besoins en eaux souterraines pour les agglomerations rurales de la plaine de Mech et pour l'Office des Terres Domaniales dans la plaine de Sned sud en Tunisie centrale. La campagne geophysique par sondages electriques de type Schlumberger (SE) couplee a l'analyse structurale et stratigraphique montre dans les deux plaines que la nappe superficielle se situe dans la couverture heterogene d'âge mio-plio-quaternaire. La nappe profonde dont le residu sec est inferieur a 2 g/l, se situe dans des termes carbonates d'âge Cretace superieur (Zebbag). Le contexte structural de la plaine de Mech est celui du flanc Nord de l'anticlinal E-W de Bouhedma, traverse a l'Est par la faille de Mech d'orientation NW-SE. Le contexte structural de la plaine de Sned sud est celui d'un graben majeur borde par un couloir de failles conjuguees a d'autres fractures transversales et basculant des blocs effondres de moindre importance. Les traces de ces accidents sont suivis par les lits des oueds dont le plus important est celui d'Oued Drag. Des aires favorables a l'exploitation par forages des nappes superficielles et profondes dans les deux plaines sont delimitees.

The area of study, located in the northern part of Gabes (South of Tunisia), remains other slightly unknown as far as its deep water table is concerned. The sole existing witness is the 'El Hicha' drilling, dug more than 20 years ago, reaching the water table having a salinity of 5.6 g/l at a depth exceeding 100 m. On the other hand, 15 km North West of this point, another drilling 'Sbih' has reached a water table, with a salinity of 17 g/l at a depth exceeding 150 m. A geophysics study undertaken by VES is deemed necessary in order to know the limits of this deep water table at 'El Hicha' area. To reach this objective, a measuring study was done in collaboration with CRDA-Gabes. Results have allowed to locate the deep water table in three suitable zones to plant new drilling for exploration.

At Sidi Abdel Hamid (Sousse-Tunisia), after having discovered an artesian superficial water-table, we undertook 31 V.E.S. of geophysical measurements. The underground is made of at least five beds. The artesian acquifer is wedged between two impermeable levels. Two faults (F1 and F2) cross the prospected zone. F1 has basculed down the South-East compartment. It represents a barrier between two parallel ground-water flows from West to East. The flow at the north of F1 may cross the sediments of Sebket-Sousse, and that could explain the high sulfure concentration at the level of P1 well (more than 40 mg/l). Geoelectric sections and maps of the acquifer have been made in order to better understand its general structure. Finally, we have made some recommandations and proposed the emplacement of a mechanical boring prospection.

Orai1 calcium channels in the plasma membrane are activated by stromal interaction molecule-1 (STIM1), an endoplasmic reticulum calcium sensor, to mediate store-operated calcium entry (SOCE). The cytosolic region of STIM1 contains a long putative coiled-coil (CC)1 segment and shorter CC2 and CC3 domains. Here we present solution nuclear magnetic resonance structures of a trypsin-resistant CC1–CC2 fragment in the apo and Orai1-bound states. Each CC1–CC2 subunit forms a U-shaped structure that homodimerizes through antiparallel interactions between equivalent α-helices. The CC2:CC2′ helix pair clamps two identical acidic Orai1 C-terminal helices at opposite ends of a hydrophobic/basic STIM–Orai association pocket. STIM1 mutants disrupting CC1:CC1′ interactions attenuate, while variants promoting CC1 stability spontaneously activate Orai1 currents. CC2 mutations cause remarkable variability in Orai1 activation because of a dual function in binding Orai1 and autoinhibiting STIM1 oligomerization via interactions with CC3. We conclude that SOCE is activated through dynamic interplay between STIM1 and Orai1 helices., When endoplasmic reticulum calcium levels are low, STIM1 binds to and opens Orai1 channels in the plasma membrane to replenish calcium stores. Stathopulos et al. present solution structures of the STIM1 coiled-coil domain in the presence and absence of Orai1, revealing the structural basis for this interaction.

Esophageal perforation is uncommon and often iatrogenic.To report a neonatal case of esophageal perforation.A premature newborn boy was admitted with a diagnosis of oesophageal atresia after several unsuccessful attempts to insert an orogastric tube. A chest x-ray showed a "high pouch" with a gasless intestine. At operation, no atresia was found and a large traumatic perforation of the lower cervical segment was identified, requiring cervicotomy and primary closure. Oral feeding was started after 3 weeks. As a result, nosocomial sepsis occurred, causing death in the third month after surgical treatment.Oesophageal perforation in the neonate is often iatrogenic and may mimic oesophageal atresia. The authors highlight the importance of early diagnosis and management.

L’echographie endo-anorectale est devenue la technique de reference dans l’evaluation des ruptures sphincteriennes responsables d’incontinence ou bien dans l’exploration des suppurations ano-perineales (abces ou fistules) ou des affections tumorales du canal anal. L’exploration a l’aide d’une sonde lineaire permet une approche plus anatomique du canal anal. Les coupes de type lineaire permettent de mieux suivre les sphincters ou les fistules le long de l’axe du canal anal, tandis que les coupes de type radial permettent une meilleure evaluation des angles de rupture des sphincters.

Thanks to the malaria eradication campaign launched in Algeria in 1968, the number of malaria cases fell down significantly from 95,424 cases in 1960 to 30 cases in 1978. At that time the northern part of the country was declared free of Plasmodium falciparum. Only few cases belonging to P. vivax persisted in residual foci in the middle part of the country. In the beginning of the eighties, the south of the country was marked by an increase of imported malaria cases. The resurgence of the disease in the oases coincided with the opening of the Trans-Saharan road and the booming trade with the neighbouring southern countries. Several authors insisted on the risk of introduction of malaria or its exotic potential vectors in Algeria via this new road. Now, the totality of malaria autochthonous cases in Algeria are located in the south of the country where 300 cases were declared during the period (1980-2007). The recent outbreak recorded in 2007 at the borders with Mall and the introduction of Anopheles gambiae into the Algerian territory show the vulnerability of this area to malaria which is probably emphasized by the local environmental changes. The authors assess the evolution of malaria in the Sahara region and draw up the distribution of the anopheles in this area.

Hydatid cyst disease is still a significant clinical problem in endemic regions. The lungs and the liver are most often involved in the child. A mediastinal localisation is rare and represents 0.1 to 4% of all cases of hydatidosis. The authors reports on two cases and provides a review of the literature. In a retrospective review of the last 12 years, the authors treated two cases with a mediastinal localisation out of total of 235 intrathoracic hydatid cysts arising in 222 patients (0.85%). Two girls, one 12 and the other 13 years old, were admitted with a previous history of chest pain. The chest x-ray revealed an homogenous opacity of 150 mm in the first case and 50 mm in the second. Computed tomography in the second case revealed a cyst in the posterior mediastinum. The abdominal ultrasound was normal in both cases. The patients were approached through a posterolateral thoracotomy and the diagnosis was confirmed macroscopically. The cysts were intact and located on the left side of the posterior mediastinum. The operative field was isolated and protected with hypertonic saline solution. Hydatid fluid was aspirated, followed by the extraction of the hydatid membrane and subtotal excision of the residual cavity in both cases. The postoperative course was uneventful without any relapse or other organ involvement during four and three years, respectively. The authors notes that hydatidosis should be considered in the differential diagnosis of a mediastinal cyst mass. Because of the benign nature of the disease, they emphasize that surgical treatment must be conservative.

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.

Why is feline immunodeficiency virus (FIV) such an appealing candidate for gene therapy vector development? Phylogenetic analysis suggests FIV is only distantly related to the primate lentiviruses, and despite repeated exposure, neither seroconversion nor other detectable evidence of human infection occurs. FIV naturally infects diverse Felidae worldwide, including the domestic cat. Here, the disease progression parallels the immunodeficiency caused by HIV, and for that reason, FIV and the cat provide an excellent model for anti-virals and AIDS vaccine research. Simple genome organization also facilitates vector development and analysis: FIV has only three accessory/regulatory proteins. To overcome FIV's cat-specific tropism, feline vectors are equipped with hybrid LTRs, since the FIV LTR shows low activity in human cells. Recombinant FIV vectors generate titers comparable to other lentiviral systems, are capable of incorporating heterologous envelopes and efficiently transduce dividing and nondividing cells in the presence and absence of the accessory proteins in vitro. Compared to HIV vectors, FIV vector development is still in its infancy, but initial in vivo data in various species and tissues indicate long-term gene expression at therapeutic levels, and thus FIV vectors hold great promise. Future efficacy studies in animal models and primates will determine the FIV vectors' suitability for gene therapy. The design of recombinant FIV vectors incorporates safety features described for primate lentiviral vectors with the benefit that biosafety testing of FIV vectors can occur in the natural host. Currently, FIV vectors are generated in a transient fashion, but the availability of a stable producer system amenable to better characterization and scale-up will considerably increase the potential for use of FIV vectors in the clinic.

Zidovudine treatment of human immunodeficiency virus (HIV) infection induces drug-resistant viral strains harbouring specific amino acid substitutions in the reverse transcriptase (RT). To investigate whether this phenomenon could be observed in the case of human T lymphotropic virus type I (HTLV-I) infection, we analysed the HTLV-I RT proviral gene sequence in five HTLV-I/HIV-1 co-infected patients treated with zidovudine for HIV-1 infection and in one untreated co-infected subject. In the 816 bp of HTLV-I pol gene sequence determined, no particular nucleotide mutation associated with zidovudine therapy could be identified in the treated subjects. Moreover, the dominant HTLV-1 deduced amino acid sequences determined in treated subjects were identical to that from the untreated subject. Our data show that in the co-infected patients already presenting well-defined mutations associated with zidovudine resistance in HIV-1, no mutations were observed in a part of the pol gene coding for the RT activity of HTLV-I.

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.

Segdoud is an oasis situated at 70 km south-ouest of Gafsa, south Tunisia (Fig. 1) downwards small colluvial fans produced by quaternary wadis, descending from cretaceous Jebel el Negueb. This material, interbedded with mio-pliocene clays and marls, and ancient terrases of oued Mit is rich in gypsum and magnesium salts.