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Biomedical subjects

J M Bonnetblanc

Publications and source records attributed to J M Bonnetblanc.

At least 73 records · Page 4Linked to original sources
PubMed1996

[Cutaneous reactions to gold salts].

Gold salts are used for rheumatoid arthritis, and also in resistant corticosteroid dermatoses such as pemphigus. Gold salts inhibit the expression of endothelial cell adhesion molecules, but activity varies from one molecule to another; thiomalate alone gives the same effect. Patients given gold salts have as high risk of cutaneous reactions, and a provisional diagnosis of "gold dermatisis" is insufficient. The mechanisms of cutaneous reactions are unknown and vary according to the molecules. Smokers, HLA Bw35 patients and perhaps atopic states are more prone to gold drug reaction. Inflammation at the site of injections is frequent but with no consequence. Accumulation (chrysiasis) may be observed with long-term treatment. The main problem is its diagnosis as it may mimic numerous dermatoses. Immunological adverse events are the most frequently encountered. Pruritus is frequently observed, more often with oral salts. Exanthemas are common and may disclose an associated visceral disease. Drug hypersensitivity is rare, but severe. All these types necessitate drug interruption although prescription has been continued after development of pityriasis rosea-like and eczematous eruptions in some series without worsening. Lichenoid eruptions require withdrawal, but the skin disease may continue. Oral presentation is frequent, either as a taste abnormality, or as stomatitis. Contact dermatitis may flare in patients sensitized to gold. Rare non-immunological skin diseases have been also observed. Careful dermatological assessment correlated with an imputability method and search of visceral side-effects could lead to a better choice for the patient. Skin tests are not reliable.

Animals↗
PubMed1996

Binding of autoantibodies is not restricted to desmosomes in pemphigus vulgaris: comparison of 14 cases of pemphigus vulgaris and 10 cases of pemphigus foliaceus studied by western immunoblot and immunoelectron microscopy.

Pemphigus vulgaris (PV) and pemphigus foliaceus (PF) are autoimmune blistering diseases characterized by a loss of cell-cell adhesion and by autoantibodies directed against epidermal cadherins. PF antigen has been established as desmoglein I which is located strictly on the desmosome, whereas the precise ultrastructural localization of PV antigen remains unclear and controversial to date. To further investigate this question, we compared the location of immune deposits in 14 patients with PV and 10 patients with PF by both direct and indirect immunoelectron microscopy (IEM). Inclusion criteria were based upon clinical features, histological level of cleavage and characterization of circulating antibodies by Western blot on epithelial bovine tongue extracts. IEM was performed on unfixed 0.7-mm slices of skin for the direct technique or on normal skin for the indirect technique using peroxidase labelling. In PF, by both direct and indirect IEM, immune deposits were located on the extracellular part of desmosomes (desmoglea) in all the samples studied. In PV, by both direct and indirect IEM, deposits were situated on the desmoglea and along large portions of the keratinocyte membrane without desmosomal structures in 15 of the 18 samples studied and only on the desmoglea in 3 samples. These results suggest that, in contrast to PF, the target antigen in PV is not always restricted to desmosomes. As various types of adherens junctions have been reported to mediate cell adhesion in the epidermis, the PV antigen could be a component of desmosomes and of other focal adhesions.

Adult↗
PubMed1996

Thalidomide and recurrent aphthous stomatitis: a follow-up study.

BACKGROUND: Thalidomide is used for the symptomatic treatment of recurrent aphthous stomatitis (RAS). Some authors reported remissions, but this was not evaluated. OBJECTIVE: To evaluate the number of patients who could stop or reduce thalidomide treatment. METHODS: Twenty-five patients with RAS treated with thalidomide and followed during at least 1 year were retrospectively studied. RESULTS: Six patients could stop the treatment and further presented minor aphthae, 10 needed minimal daily doses of thalidomide and 7 did not respond to 100 mg daily. One patient was not evaluated because of an early side effect and one was lost to follow-up. CONCLUSION: This study showed that a minority of patients responded and could stop thalidomide therapy whereas another group of patients could be maintained in remission with low doses of thalidomide which may represent a means to reduce the potentially severe side effects.

Adult↗
PubMed1996

[Carriage of Staphylococcus aureus. A severity factor of erysipelas?].

INTRODUCTION: Occasional superinfection or co-infection with Staphylococcus aureus led us to search for S. aureus carriage prospectively in patients with non-necrotizing bacterial dermophypodermitis, in particular erysipelas. PATIENTS AND METHODS: This prospective study included immunocompetent patients with bacterial dermophypodermitis without signs of toxicity or local manifestations suggesting necrotizing fasciitis. Bacteriology tests included: 1) direct immunofluorescence for streptococcus (groups A, C, G) on skin biopsies taken on day 0, 2) samples from the nasal orifices, the intergluteal fold, and potential skin portals for bacteriology culture, and 3) assay of antistreptolysine O and antistreptodornase B on day 0 and 15. RESULTS: The study group included 42 patients (23 females, 19 males, mean age 64 +/- 3.5 yr). In 39 cases (93%) bacterial dermohypodermitis was located on the lower limb with a potential skin portal in 36 cases (86%). Sample culture, direct immunofluorescence or serology findings demonstrated presence of streptococci in 33 cases (79%). Nasal, intergluteal or potential portal were identified in 19 patients (45%) including 16 with demonstrated presence of streptococci. The rate of cure after oral pristinamycin did not vary significantly between carriers (79%) an non-carriers (91%) of Staphylococcus aureus. Drainage of a localized abscess was successful in 5 of 6 patients after initial failure of antibiotic treatment; 4 of them were carriers of S. aureus. CONCLUSION: This prospective study demonstrated that cutaneous-mucosal carriage of Staphylococcus aureus is frequent in patients with non-necrotizing dermohypodermitis. This carriage is not a factor of over-morbidity as shown in this group of infections largely dominated by erysipelas.

Anti-Bacterial Agents↗
PubMed1996

[Pristinamycin in the treatment of acute bacterial dermohypodermitis in adults. An open study of 42 patients].

INTRODUCTION: We recently demonstrated that oral roxithromycin is as effective as intravenous penicillin G in adults with erysipelas. We therefore evaluated the effectiveness of pristinamycin, an antibiotic which is very active on streptococci and Staphylococcus aureus, in non-necrotizing bacterial dermohypodermitis in adults. PATIENTS AND METHODS: This prospective open study was conducted in one center and included immunocompetent patients with bacterial dermophypodermitis without signs of toxicity or local manifestations suggesting necrotizing fasciitis. Bacteriology tests included direct immunofluorescence for streptococcus (groups A, C, G) on skin biopsies of the lesion before treatment. Patients were treated with pristinamycin (Pyostacine 500, 3 g/day until 10 days after apyrexia), and evaluated clinically on day 0, 2, 6, 8, and 15. Overall treatment effect was assessed on day 15. RESULTS: The study group included 42 adults (23 woman and 19 men; mean age 64 +/- 3.5 yr). In 39 cases (93%), the bacterial dermohypodermitis was localized on the lower limb. The inflammatory lesion was well delimited, a characteristic feature of erysipelas, in 32 cases (76%). Sample culture, direct immunofluorescence or serology findings demonstrated presence of streptococci in 33 cases (79%). A single treatment with pristinamycin was successful in 36 patients, giving an overall rate of 86%. Drainage of a localized abscess was successful in 5 of 6 patients after initial failure of antibiotic treatment. CONCLUSION: This prospective study demonstrated the effectiveness of pristinamycin in non-necrotizing bacterial dermohypodermitis in the adult, especially in erysipelas. Overall effectiveness was comparable with that reported for penicillin G or macrolides in erysipelas.

Adult↗
PubMed1996

[Multicentric histiocytosis with hematological involvement].

INTRODUCTION: The aim of this work was to present a case of multicentric histiocytosis with haematologic involvement. CASE REPORT: A 68-year-old man presented with poor general health and a nodular eruption of the skin and larynx. On clinical examination there was an enlarged spleen and laboratory results revealed an inflammatory syndrome, platelet count 60,000 and myelemia with 10 p. 100 immature elements in a white cell count of 14,000. Pathology and ultrastructure examinations led to the diagnosis of multicentric histiocytosis. Bone marrow aspiration was normal. Pancytopenia then developed with bone marrow hypoplasia without infiltration. Corticosteroids then cyclophosphamide were uneffective for either the skin disease or the hematologic disorder. The patient developed severe buccal aphthosis which responded well to thalidomide. This treatment reduced the size and the number of skin nodules. Finally, renal failure of unknown origin was observed. DISCUSSION: Electron microscopy is essential for positive and differential diagnosis of atypical multicentric histiocytosis. Hematological disorders associated with multicentric histiocytosis may either be specific or totally independent.

Aged↗
PubMed1996

[Treatment of accidental extravasation of antitumor agents with dimethylsulfoxide and alpha-tocopherol].

INTRODUCTION: The aim of this study was to test topical applications of dimethylsulfoxide and alpha-tocopherol for the prevention of ulcerations after antimitotic extravasation. METHODS: An open prospective study was conducted in 10 patients in 4 different chemotherapy wards who had experienced infusion accidents leading to phlebitis (4 cases) or cellulitis (8 cases) including 2 at implant sites. Topical application of the dimethylsulfoxide alpha-tocopherol combination was initiated within the first hours and continued for 3 to 15 days. One patient was given dimethylsulfoxide alone. RESULTS: Necrosis was never observed. The implant sites were preserved and remained functional. CONCLUSION: The absence of secondary ulcerations and the preservation of the implant sites are clear advantages of this topical combination which should be used as first line treatment. Favorable results have been reported in the literature while other techniques used depend on the antimitotic agent and give variable results.

Administration, Topical↗
PubMed1995

Evidence of chromosomal instability in the lymphocytes of Gorlin basal-cell carcinoma patients.

The Gorlin syndrome, or naevoid basal-cell carcinoma syndrome (NBCS) is an autosomal dominant disease. It has been suspected for long that this cancer prone disease (multiple basal-cell carcinomas; other malignant or benign proliferations) is a chromosome instability syndrome. We previously reported a lengthening in the cell cycle of lymphocytes from two patients with NBCS. With a larger sample (n = 7), we confirm this disease to be a chromosome instability syndrome, although clearly, expression of this characteristic can vary between patients: (1) spontaneous chromatid breaks occurred more often in a subset of the patients; (2) spontaneous micronuclei were found more frequently in NBCS than in the controls; (3) we confirm the cell cycle to be affected in this disease. As these results were obtained on lymphocytes--a cell lineage not affected in NBCS manifestations--the chromosome instability we found would appear to be part of the general condition of this syndrome.

Adult↗
PubMed1995

Treatment of verrucous carcinoma with recombinant alfa-interferon.

BACKGROUND: Verrucous carcinoma is an uncommon neoplasm whose medical treatment is not well defined. OBJECTIVE: We report the clinical effects of recombinant alpha-interferon (IFN) with varying dispensing routes on the tumor size in 3 patients exhibiting three different subtypes of verrucous carcinoma. OBSERVATIONS: In case 1, an oral florid papillomatosis of the upper gingiva, a stabilization of the lesion size was observed after the administration of a cumulative dose of 45 million IU of IFN alfa-2b. The patient died after discontinuation of the treatment due to hepatic toxicity. In case 2, a giant condyloma acuminatum of the penis, treatment with a cumulative dose of 522 million IU of IFN alfa-2a first resulted in stabilization of the disease, and no evidence of recurrence was observed after surgical treatment. In case 3, a verrucous carcinoma of the leg, a mild decrease in lesion size was observed after the administration of a cumulative dose of 174 million IU. Surgery was finally required. CONCLUSION: In reducing the growth of the tumor, treatment by IFN appears to be an adjuvant therapy of verrucous carcinoma, but it never prevents surgery or death.

Aged↗
PubMed1995

Crossover study of thalidomide vs placebo in Jessner's lymphocytic infiltration of the skin.

BACKGROUND AND DESIGN: An effective therapy is still unavailable for Jessner-Kanof lymphocytic infiltration of the skin. Thalidomide's efficacy was suggested in an open study. Twenty-eight patients were randomly assigned to receive thalidomide (100 mg/d) or placebo over a period of 2 months and were then switched to the other treatment. RESULTS: After the first period, 11 of 13 patients treated with thalidomide were in complete remission (CR), and there were two failures. There was no CR in the patients who received placebo (chi y2 = 17.5; P < .0001). After the second period, nine of 14 patients who had received thalidomide were in CR. Eleven of the 13 patients who had received thalidomide during the first period were given placebo (two were unavailable for follow-up). Ten of them were in CR: four were still free of lesions at the end of the second period, and six experienced a relapse of their lesions after a mean duration of 26 +/- 10 (SD) days. A total of 25 patients participated in the two study periods; CR was observed in 19 (76%) after thalidomide therapy and in four (16%) after treatment with placebo (chi y2 = 11.1; P < .001). Of 27 patients who received thalidomide, 16 (59%) were in CR after 1 month and 20 (74%) were in CR after 2 months. Two patients treated with thalidomide experienced neurologic changes that were not consistent with typical thalidomide-induced neuropathy. CONCLUSIONS: A therapeutic regimen of thalidomide administered at a dosage of 100 mg/d for 2 months is able to suppress the clinical symptoms of Jessner-Kanof lymphocytic infiltration of the skin. The long-term risk-benefit has still to be evaluated.

Adult↗