[Duplication of the gallbladder with heterotopic mucosa: A case report and proposal for a classification for gastrointestinal duplications]. / Duplication de la vésicule biliaire avec hétérotopie : cas clinique et proposition de classification des duplications gastro-intestinales.

BACKGROUND: Gastrointestinal duplications are rare congenital malformations that can occur anywhere between the mouth and the anus, including the digestive annexes. Numerous classifications of these malformations exist, varying from one author to another. This study describes a rare case of gallbladder duplication and suggests a unified classification of gastrointestinal duplications in order to merge epidemiological and clinical considerations. CASE REPORT: A 13-year-old boy presented with acute abdominal pain. Investigations revealed a cystic structure located in the gallbladder combined with lithiasis. Following an elective laparoscopic cholecystectomy, the diagnosis of gallbladder duplication in association with heterotopic gastrointestinal mucosa and pancreatic micro-clusters was made. The patient is in excellent health 4 years after surgery. COMMENTARY AND CONCLUSION: This atypical duplication is rare and can most likely be explained by the proximity between the pancreas and gastrointestinal tract during their development: the intestinal metaplasia and the development of the gastric mucosa may further represent congenital lesions due to aberrant migration of normal tissue, or could be secondary to a chronic inflammatory response in the gallbladder. The revised standardized classification we propose is based on the accurate identification, precise location and detailed histology of the lesions.

Optimization of encoding specificity for the diagnosis of early AD: the RI-48 task.

The aim of this study was to evaluate the discriminant validity of the RI-48 test, a shorter French version of the Category Cued Recall portion of the Double Memory Test developed initially by Buschke and colleagues (1997), in the diagnosis of mild and very mild Alzheimer disease (AD). The distinctive feature of the RI-48 task is that encoding specificity was increased by adding an immediate cued recall stage at the encoding phase. The results show that the RI-48 task seems to be well adapted to the clinical context and to have good psychometric properties, in particular a lack of a ceiling effect. Moreover, this task appears to be especially well suited for the diagnosis of both mild and very mild AD (sensitivity of 93% and 83.8%). From a more theoretical point of view, this study confirms the importance of optimizing the encoding specificity for the diagnosis of very mild AD, since the more encoding specificity is accentuated, the more discriminating power is increased for the diagnosis of very mild AD.

[Neuropsychological rehabilitation in early stage Alzheimer's disease: principles, methods and perspectives]. / La revalidation neuropsychologique dans la maladie d'Alzheimer à un stade précoce: principes, méthodes et perspectives.

An increasing number of studies have demonstrated the efficiency of various neuropsychological interventions on individuals with early Alzheimer's disease. There are also some encouraging findings suggesting that the interventions can be successfully applied in less controlled real-world contexts and largely provided into caregiving systems. The interventions have to be directly focused on daily life situations and they should include the perspective of the patients by allowing them to retain a capacity to maximize their cognitive abilities, to state specific preferences and needs, and to make intervention-related decisions.

[Management of cognitive deficits in patients with Alzheimer's disease]. / Prise en charge des déficits cognitifs chez les patients atteints de maladie d'Alzheimer.

Recently, an increasing number of studies has shown that some aspects of cognitive functions in Alzheimer patients may be selectively affected by Alzheimer's disease (AD) while others are preserved. They have also demonstrated the heterogeneity of cognitive deficits within AD patients. Furthermore, several researches put into evidence optimizing factors for the cognitive performance of demented patients. Such a cognitive approach to AD has allowed a renewal of rehabilitation strategies, taking daily difficulties into consideration. It mainly consists of optimizing the patient functioning at every stage of the disease course, by exploiting preserved abilities and performance enhancing factors. For example, the clinical management of memory problems in AD patients could be centered on three directions: 1. Temporary facilitation of information encoding or retrieval by the use of optimizing factors shown during detailed cognitive examinations; 2. New knowledge teaching by the use of preserved memory abilities; 3. Arrangement of the patient surroundings with external cues and use of physical supports to compensate for defective functions (e.g. an external memory aid, such as a diary), so as to reduce the impact of cognitive deficits in daily living activities. Such a management of cognitive problems naturally implies the active participation of a caregiver both during the evaluation and the rehabilitation. The caregiver can be of help at different stages: arranging the patient daily environment according to his/her cognitive deficits, and removing sources of confusion; helping the patient with the use of external aids; favoring optimizing factors and preserved abilities utilization; interacting with the patient in good conditions, preventing the call to impaired capacities. Therefore, adapted structures should be put into place to allow these interventions and an enlightenment of caregiver burden, for example day care centers reproducing real life environment, where optimizing strategies could be specifically trained.

Memory Clinics in Switzerland. Collaborative Group of Swiss Memory Clinics.

Currently, eleven Memory Clinics (MC) in Switzerland offer their services to patients, caregivers and family doctors. Their primary goal is the early diagnosis and management of dementia in elderly outpatients. Special emphasis is put on the detection of reversible causes of dementing disorders. Diagnoses and medical, pharmacological, neuropsychological and social treatment recommendations are established in a multidisciplinary consensus conference and communicated back to the referring physicians. The psychosocial therapies and supportive activities include counseling, memory training for patients, neuropsychological rehabilitation, caregiver groups, relaxation and biofeedback training, day care centers, Alzheimer's Tanzcafé, and special vacations for dementia patients. These activities vary from MC to MC according to the availability of resources. Research activities are an integral part of all MCs and range from the attempt to identify preclinical markers of Alzheimer's disease to studies of neuropathological correlates of cognitive disturbances. Moreover, patients are encouraged to participate in studies investigating new medications. MCs play an important role in the education and training of health care professionals and in raising awareness and support in the general population.

[Non-drug alternatives in Alzheimer disease]. / Mesures non-médicamenteuses pour la maladie d'Alzheimer.

Profiles of cognitive deficits in Alzheimer patients are often heterogenous and can vary considerably from one patient to another. Studies published in the last 10 years have shown that improvement of cognitive functioning is possible in these patients. A detailed neuropsychological exam is necessary to evaluate not only disturbed functions but also preserved areas and factors which could help to improve performance. These elements, which are also part of the diagnostic procedure, are necessary to put the deficit into its context, and to propose specific methods of therapy. The aim of this therapy is to insure optimal performances at each stage of the disease. The strategies employed vary and have to be adapted to each patient and the therapy goals but they almost always make the involvement of a family member necessary, to ensure that the acquired strategies are used systematically in everyday life. In view of the importance of the social problems connected with dementia, more research is necessary to develop techniques of intervention which lead to an improvement of impaired cognitive functioning.