Imagerie des transformations kystiques des acini du pancréas (comparaison aux TIPMP)

PARIS7-Xavier Bichat (751182101) / SudocSudocFranceF

Rapport BCSF (2014) - Séisme de Barcelonnette (Alpes-de-Haute-Provence) du 7 avril 2014

This report is based on data provided by the services responsible for seismic monitoring in France (RéNaSS for the CNRS and the Universities, the ISTerre and Géoazur laboratories for the Universe Science Observatories, LDG for the CEA).The earthquake of April 7, 2014 occurred at 19:27 UT (21:26:59 local time) in the Alpes-de-Haute-Provence. Its epicentre is located approximately 6 km west southwest of the commune of Saint-Paul-sur-Ubaye and 11 km north of Barcelonnette, near the border of the departments of Alpes-de-Haute-Provence and Hautes-Alpes (Figure 1). The initiation of the rupture (hypocentre) is estimated at a depth of 11km below sea level (about 13km below the surface).This earthquake had an impact on the south-eastern quarter of France, i.e. 18 departments plus the Principality of Monaco. It has been noted by many residents as the strongest felt in the region in many years. At La Motte-en-Champsaur (yet 55 km from the epicentre) or Puy-Saint-Eusebe (22km) all the inhabitants went out to the village square to comment on this event, also fearing a more important replica.The mission of the French Central Seismological Office is to collect data on earthquakes felt in France, to collect useful information and to facilitate its dissemination to stakeholders concerned by seismic risk or conducting studies or research requiring the use of these observations.Ce rapport s'appuie sur les données communiquées par les services chargés de la surveillance sismique du territoire français (RéNaSS pour le CNRS et les Universités, les laboratoires ISTerre et Géoazur pour les observatoires des Sciences de l’Univers, LDG pour le CEA).Le séisme du 7 avril 2014 s’est produit à 19h27 TU (21h 26min 59sec heure locale) dans les Alpes- de-Haute-Provence. Son épicentre est situé à environ 6 km à l’Ouest Sud-Ouest de la commune de Saint-Paul-sur-Ubaye et 11km au Nord de Barcelonnette, à proximité de la limite des départements des Alpes-de-Haute-Provence et des Hautes-Alpes (figure 1). L’initiation de la rupture (hypocentre) est estimée à une profondeur de 11km sous le niveau de la mer (environ à 13 km de profondeur sous la surface du sol).Ce séisme a impacté par ses effets le quart sud-est de la France, soit 18 départements plus la Principauté de Monaco. Il a été noté par de nombreux habitant comme étant le plus fort jamais ressenti dans la région depuis de nombreuses années. À La Motte-en-Champsaur (pourtant à 55 km de l’épicentre) ou encore à Puy-Saint-Eusebe (22km) l’ensemble des habitants est sorti sur la place du village pour commenter cet événement, craignant aussi une réplique plus importante.Le Bureau Central Sismologique Français a pour mission de collecter les données sur les séismes ressentis en France, de rassembler les informations utiles et de faciliter leur diffusion vers les acteurs concernés par le risque sismique ou menant des études ou recherches nécessitant l’usage de ces observations

Imaging of human neurolisteriosis: a prospective study of 71 cases

International audienceBackground: Neurolisteriosis ranks among the most severe neurological infections. Its radiological features have not been thoroughly studied. We describe here the neuroradiological features of neurolisteriosis and assess their prognostic value.Methods:Patients with microbiologically proven neurolisteriosis were enrolled from November 2009 to October 2013 in MONALISA study. Magnetic resonance and computed tomography images were studied by 2 independent neuroradiologists. Predictors of 3-month mortality were determined using logistic regression.Results:Seventy-one patients were included; 42 were men (59%). Mean age was 64 years. Sixty patients (85%) reported signs of encephalitis, with clinical brainstem involvement in 16 (23%). Images were abnormal in 87% of cases (62/71). Main neuroradiological images were meningeal enhancement (25/71, 35%), abscess(es), or nodular image(s) evocative of abscess (10/71, 14%), hemorrhages (11/71, 15%), contrast-enhancing ventricles, or hydrocephalus (7/71, 10%). White-matter images (42/71, 59%), dilated Virchow-Robin spaces (22/71, 31%), and cerebral atrophy were also reported (34/71, 48%). Brainstem involvement (meningeal enhancement, abscess) was reported in only 7/71 cases (10%). Three-month survival was lower in patients with hydrocephalus or contrast-enhancing ventricles (1/7 [14%] than without [47/64, 73%], P = .005) and in patients with parenchymal images (abscess[es], nodule[s]\, or white matter images; 25/46 [54%] vs 23/25 without [92%], P = .004). Parenchymal images were associated with lower 3-month survival in the multivariable model (odds ratio 5.60, 95% confidence interval [1.42-29.6], P = .02).Conclusions:Neurolisteriosis presents as a combination of neuroradiological images, none being specific. Radiological signs of rhombencephalitis are uncommon, whereas, unexpectedly, hemorrhagic images are frequent. The negative prognostic value of parenchymal neuroradiological images was evidencedClinical Trials Registration: NCT01520597

Percutaneous Thermal Ablation for Renal Tumors in Patients with Birt–Hogg–Dubé Syndrome

BHD syndrome is characterized by an increased risk of bilateral and multifocal renal cell carcinoma (RCCs), but is rarely metastatic. Our report aims to analyze the outcome of patients with BHD syndrome who underwent percutaneous thermal ablation (TA). The present report included six BHD syndrome patients (five men) with a mean age of 66 ± 11 (SD) years who had a proven germline FLCN gene mutation and underwent TA for a renal tumor. Nineteen renal tumors (median two tumors per patient; range: 1–3), including seven chromophobe RCCs, five clear-cell RCCs, four papillary RCCs, two clear-cell papillary RCC, and one hybrid oncocytic/chromophobe tumor were treated in 14 ablation sessions. The mean size of the tumors was 21 ± 11 (SD) mm (median: 20 mm; interquartile range (IQR): 14–25 mm) for a mean volume of 7 ± 11 (SD) mL (median: 3; IQR: 1–5 mL). Technical success was achieved in all ablation sessions (primary success rate, 100%). The procedure was well tolerated under conscious sedation with no significant Clavien–Dindo complication (grade 2, 3, 4). All patients were alive with no distant metastasis during a median follow-up period of 74 months (range: 33–83 months). No local tumor progression was observed. The mean decrease in estimated glomerular filtration rate was 8 mL/min/1.73 m2. No patients required dialysis or renal transplantation. In this case series, percutaneous TA appeared as a safe and efficient nephron-sparing treatment for treating RCCs associated with BHD syndrome, even in the case of advanced chronic kidney disease

Clinical Assessment of a Nocardia PCR-Based Assay for Diagnosis of Nocardiosis

International audienceThe diagnosis of nocardiosis, a severe opportunistic infection, is challenging. We assessed the specificity and sensitivity of a 16S rRNA Nocardia PCR-based assay performed on clinical samples. In this multicenter study (January 2014 to April 2015), patients who were admitted to three hospitals and had an underlying condition favoring nocardiosis, clinical and radiological signs consistent with nocardiosis, and a Nocardia PCR assay result for a clinical sample were included. Patients were classified as negative control (NC) (negative Nocardia culture results and proven alternative diagnosis or improvement at 6 months without anti-Nocardia treatment), positive control (PC) (positive Nocardia culture results), or probable nocardiosis (positive Nocardia PCR results, negative Nocardia culture results, and no alternative diagnosis). Sixty-eight patients were included; 47 were classified as NC, 8 as PC, and 13 as probable nocardiosis. PCR results were negative for 35/47 NC patients (74%). For the 12 NC patients with positive PCR results, the PCR assay had been performed with respiratory samples. These NC patients had chronic bronchopulmonary disease more frequently than did the NC patients with negative PCR results (8/12 patients [67%] versus 11/35 patients [31 %]; P = 0.044). PCR results were positive for 7/8 PC patients (88%). There were 13 cases of probable nocardiosis, diagnosed solely using the PCR results; 9 of those patients (69%) had lung involvement (consolidation or nodule). Nocardia PCR testing had a specificity of 74% and a sensitivity of 88% for the diagnosis of nocardiosis. Nocardia PCR testing may be helpful for the diagnosis of nocardiosis in immunocompromised patients but interpretation of PCR results from respiratory samples is difficult, because the PCR assay may also detect colonization

Progressive Multifocal Leukoencephalopathy in Primary Immunodeficiencies

International audiencePurpose:Progressive multifocal leukoencephalopathy (PML) is a rare but severe demyelinating disease caused by the polyoma-virus JC (JCV) in immunocompromised patients. We report a series of patients with primary immune deficiencies (PIDs) who developed PML. Methods:Retrospective observational study including PID patients with PML. Clinical, immunological, imaging features, and outcome are provided for each patient. Results:Eleven unrelated patients with PIDs developed PML. PIDs were characterized by a wide range of syndromic or genetically defined defects, mostly with combined B and T cell impairment. Genetic diagnosis was made in 7 patients. Before the development of PML, 10 patients had recurrent infections, 7 had autoimmune and/or inflammatory manifestations, and 3 had a history of malignancies. Immunologic investigations showed CD4 + lymphopenia (median 265, range 50-344) in all cases. Six patients received immunosuppressive therapy in the year before PML onset, including prolonged steroid therapy in 3 cases, rituximab in 5 cases, anti-TNF-α therapy, and azathioprine in 1 case each. Despite various treatments, all but 1 patient died after a median of 8 months following PML diagnosis. Conclusion: PML is a rare but fatal complication of PIDs. Many cases are secondary to immunosuppressive therapy warranting careful evaluation before initiation subsequent immunosuppression during PIDs

Low incidence of SARS-CoV-2, risk factors of mortality and the course of illness in the French national cohort of dialysis patients

International audienceThe aim of this study was to estimate the incidence of COVID-19 disease in the French national population of dialysis patients, their course of illness and to identify the risk factors associated with mortality. Our study included all patients on dialysis recorded in the French REIN Registry in April 2020. Clinical characteristics at last follow-up and the evolution of COVID-19 illness severity over time were recorded for diagnosed cases (either suspicious clinical symptoms, characteristic signs on the chest scan or a positive reverse transcription polymerase chain reaction) for SARS-CoV-2. A total of 1,621 infected patients were reported on the REIN registry from March 16th, 2020 to May 4th, 2020. Of these, 344 died. The prevalence of COVID-19 patients varied from less than 1% to 10% between regions. The probability of being a case was higher in males, patients with diabetes, those in need of assistance for transfer or treated at a self-care unit. Dialysis at home was associated with a lower probability of being infected as was being a smoker, a former smoker, having an active malignancy, or peripheral vascular disease. Mortality in diagnosed cases (21%) was associated with the same causes as in the general population. Higher age, hypoalbuminemia and the presence of an ischemic heart disease were statistically independently associated with a higher risk of death. Being treated at a selfcare unit was associated with a lower risk. Thus, our study showed a relatively low frequency of COVID-19 among dialysis patients contrary to what might have been assumed