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Biomedical subjects

F Truchetet

Publications and source records attributed to F Truchetet.

At least 19 recordsLinked to original sources

[Nail abnormalities and scleroderma-like lesions on the face associated with systemic amyloidosis].

INTRODUCTION: Mucocutaneous involvement in systemic amyloidosis occurs in 29 to 40 p. 100 of cases. Nail abnormalities are infrequent in AL amyloidosis. We report an original case of AL amyloidosis associated with cutaneous and integument alterations and scleroderma-like infiltration of the face. CASE REPORT: A 73 year-old woman was hospitalized because of weight loss and asthenia. She had been treated 4 years earlier with chemotherapy for a IgG-type multiple myeloma with complete resolution of the underlying monoclonal gammapathy. Cutaneous examination showed nail dystrophy of all fingernails associated with scleroderma-like skin changes on the chin and lips. Histopathologic study of a chin biopsy confirmed the presence of amyloid deposits in the dermis. Laboratory data were normal, without signs of recurrence of multiple myeloma. DISCUSSION: We report an original case of a patient who developed two unusual cutaneous manifestations associated with AL amyloidosis. Moreover, there was no correlation between the severity of the cutaneous lesions and the extent of the underlying hematological disease.

Aged↗

Study to determine the efficacy of topical morphine on painful chronic skin ulcers.

OBJECTIVE: To assess the efficacy of the topical application of morphine on painful chronic skin ulcers. METHOD: A prospective bi-centric controlled double-blind randomised study was conducted involving 24 patients with painful chronic skin ulcers using topically applied morphine versus placebo. Ten milligrams of morphine hydrochloride with Intrasite Gel or Intrasite Gel with placebo were applied daily for five days. All patients were treated with a level II analgesic treatment. A numeric pain scale lower than 4/10 and no need for a 'rescue' treatment (morphine sulphate) indicated that the treatment was successful. Local and systemic tolerance of the treatments was analysed daily. RESULTS: Twenty-four patients were included in the study, but only 18 started the protocol. Only 2/11 patients were completely relieved in the morphine group compared with 1/7 in the placebo group. Local and general tolerance of morphine was good. The peripheral efficacy of morphine is under discussion. CONCLUSION: The results suggest that topical morphine cannot be an alternative to morphine administered by other routes (subcutaneously or orally) in painful chronic skin ulcers. Stimulation of peripheral morphine receptors by systemic morphine could explain the difference between these results and those of previous studies.

Administration, Cutaneous↗

[Effect of smoking on the effectiveness of antimalarial drugs for cutaneous lesions of patients with lupus: assessment in a prospective study].

PURPOSE: Smoking has been involved in the failure of antimalarial therapy in patient with chronic or subacute erythematosus lupus. METHODS: We report a prospective study of 26 patients with chronic, subacute or systemic erythematosus lupus who were treated with antimalarials. Several variables including smoking are compared in responders and non-responders. RESULTS: Despite the reduced number of patients study that does not permit to allow significative results, it seems that among responders and non-responders, in other respects comparables, there is no difference in the presence of smoking, its quantity or its duration. CONCLUSION: The significance of molecular interactions between some components of tobacco and antimalarials have still to be established.

Adult↗

[The common wart].

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Diagnosis, Differential↗

[Lethal neurological involvement during incontinentia pigmenti].

INTRODUCTION: We present a case of incontinentia pigmenti associated with lethal neurological involvement. CASE REPORT: A newborn, three day-old female child presented with an erythromatous vesicular eruption and epileptic seizures secondary to extensive necrosis of the brain tissue. She died at 13 days of age following a seizure. The genetic analysis concluded in a sporadic case of incontinentia pigmenti. DISCUSSION: Thirty-eight cases of incontinentia pigmenti, associated with severe brain damage have been reported in the literature. The neurological manifestations appear rapidly after birth in the form of epilepsy. The seizures can lead to severe psychomotor retardation and, in most cases, precede the installation of motor deficiency. The lesions observed on imaging are hypodensity of varying localization and which do not correspond to any vascularization pattern. Autopsy reveals areas of brain tissue destruction. Recent genetic data suggest two physiopathological hypotheses, which both rely on NF-Kb dysfunction. The cutaneous cells expressing muted chromosome x exhibit a reduced rate of free NF-kB and are more sensitive to the apoptotic signals. Like the cutaneous cells, the brain tissue cells expressing muted chromosome x may be eliminated when becoming apoptotic. Furthermore, NF-kB is one of the links of the transduction system of the messages received by the VEGF receptor, the endothelial growth factor. A perturbation of the transmission of this message might alter cerebral microvascularization.

Brain Diseases↗

[Pseudoainhum in lamellar ichthyosis].

INTRODUCTION: Pseudoainhum is an affection characterized by the appearance of a constricting band around a digit or limb which may lead to spontaneous amputation. There are various etiologies which can be either congenital or resulting from a concomitant disease. We report herein an original case which occurred during lamellar ichthyosis. CASE-REPORT: We present the case of a thirty-year-old woman affected by a severe form of lamellar ichthyosis who, in a few months, developed a pseudoainhum of the third left finger. Biological results were normal. X-rays of this finger showed distal resorption of the bone. The painful evolution and the absence of any conservative treatment compelled us to propose amputation of the third phalanx. DISCUSSION: Other cases of pseudoainhum have been observed in many disease responsible for vascular or neurological abnormalities. They can also result in physical traumatisms or be associated with many dermatoses, such as hereditary palmar and plantar keratodermas. As far as we know, this lesion has never been described during lamellar ichthyosis but could result in the keratinization disorders observed in this congenital ichthyosis.

Adult↗

[Hamartoma oligemicus].

BACKGROUND: Naevus oligemicus is a rare affection caused by selective vasoconstriction of the deeper vessels ("thermal" skin blood flow), with respect of the superficial vascular plexus ("nutrient" blood flow). We report the fourth case. CASE REPORT: A 45 year-old man presented erythematocyanotic lesions with sensation of coolness on the abdomen and the thighs. These lesions had first been noted by the patient 3 years earlier. Physical examination and laboratory investigations were normal. Histology of a lesion revealed a non-specific superficial dermatitis. Result of skin surface thermometry of both areas showed that the surface temperature of the involved skin was up to 2 degrees C lower than the surrounding control skin. DISCUSSION: We don't know why there is a selective vasoconstriction of the deeper vessels and not of the superficial vascular plexus. Naevus oligemicus belongs to the pharmacological naevus group because of the absence of any histologic vascular abnormality. The functional abnormality has not been identified. This could be explained either by increased sympathetic vasoconstrictor tone in the autonomic sympathetic vasoconstrictor nerves supplying the deeper thermoregulatory vasculature in the affected skin, or by increased sensitivity of these vessels to vasoconstrictor catecholamines.

Diagnosis, Differential↗

Sunscreen use and intentional exposure to ultraviolet A and B radiation: a double blind randomized trial using personal dosimeters.

A previous randomized trial found that sunscreen use could extend intentional sun exposure, thereby possibly increasing the risk of cutaneous melanoma. In a similarly designed trial, we examined the effect of the use of sunscreens having different sun protection factor (SPF) on actual exposure to ultraviolet B (UVB) and ultraviolet A (UVA) radiation. In June 1998, 58 European participants 18-24 years old were randomized to receive a SPF 10 or 30 sunscreens and were asked to complete daily records of their sun exposure during their summer holidays of whom 44 utilized a personal UVA and UVB dosimeter in a standard way during their sunbathing sessions. The median daily sunbathing duration was 2.4 hours in the SPF 10 group and 3.0 hours in the SPF 30 group (P = 0.054). The increase in daily sunbathing duration was paralleled by an increase in daily UVB exposure, but not by changes in UVA or UVB accumulated over all sunbathing sessions, or in daily UVA exposure. Of all participants, those who used the SPF 30 sunscreen and had no sunburn spent the highest number of hours in sunbathing activities. Differences between the two SPF groups in total number of sunbathing hours, daily sunbathing duration, and daily UVB exposure were largest among participants without sunburn during holidays. Among those with sunburn, the differences between the two groups tended to reduce. In conclusion, sunscreens used during sunbathing tended to increase the duration of exposures to doses of ultraviolet radiation below the sunburn threshold.

Adolescent↗

[Large crusted ulceration of the scalp: first manifestation of cryptococcosis in an AIDS patient].

BACKGROUND: Cryptococcosis is an infection caused by the yeast-like fungus Cryptococcus neoformans. It primarily occurs in immunocompromised hosts. Crytptococcosis is usually a systemic disease and may be serious if the lungs or the central nervous system are involved. CASE REPORT: We describe a case of cutaneous cryptococcosis without systemic involvement occurring as the first manifestation of AIDS. The skin lesion in our patient consisted of a large crusted ulceration on the scalp. Fluconazole was successful. DISCUSSION: This case is a new observation of primary cutaneous cryptococcosis in a patient with AIDS. Clinical appearance may be misleading; skin lesions may be the primary sign in immunocompromised patients. Rapid treatment and secondary prophylaxis are required.

AIDS-Related Opportunistic Infections↗