[The calcipotriol-betamethasone dipropionate association]. / Le medicament du mois. L'association calcipotriol-dipropionate de bétaméthasone (dovobet).

The topical treatment of psoriasis benefits from the alternate use of dermocorticosteroids and vitamin D3 analogues. A new galenic formulation allows to combine them in a single application. Dovobet (LEO Pharma) ointment is the association of calcipotriol 50 microg/g with betamethasone dipoprionate 0.5 mg/g. This formulation boosts the therapeutic activity of calcipotriol. It also decreases the irritative inflammatory reaction due to calcipotriol without increasing the atrophogenic risk of the dermocorticoid.

[Relativity of the management of skin cancers. A plea for synergy between general practitioners and the dermatologist-oncologist]. / Relativité de la prise en charge des cancers cutanés. Plaidoyer pour la synergie entre le médecin généraliste et le dermatologue-oncologue.

The clinical diagnosis and treatment of cutaneous cancers represent a frequent situation in cancerology. About one third of all human cancers take their origin from the skin. The general practitioner and the dermatologist-oncologist play the key role in that field of health care.

[Perimenstrual dermatoses: a comment fact of chronobiology]. / Les dermatoses cataméniales: une facette fréquente de la chronobiologie.

More than 15 common or specific dermatoses may be worsened during the premenstrual phase. Acne, herpes simplex and the autoimmune progesterone dermatitis represent typical examples.

[Cutaneous melanomas, a spectrum of emerging cancers in women of Wallonia. Outlook by the Mosan Study Group of Pigmented Neoplasms]. / Les mélanomes cutanés, un spectre de cancers émergents chez la femme en région Wallonne. Un regard porté par le Groupe Mosan d'Etude des Tumeurs Pigmentaires.

The Mosan Study Group of Pigmented Neoplasms was founded about 15 years ago. It has collected more than 20,000 cutaneous malignancies including melanomas and basal and squamous cell carcinomas. The incidence of these cancers is on the rise in Wallonia. In particular, malignant melanomas represent a spectrum of emerging cancers characterized by a proteiform biological outcome. They mostly affect young women. The major risk factor appears to be iterative and unwise ultraviolet exposures. The prevention of melanomas is basically founded on such a dogma and accordingly relies on sunscreens. However, controversies about their beneficial effects are rife and fueled by axiomas and contradictory sophisms. At the exception of surgery, the therapeutic options for the diverse types of melanomas do not yet fulfill the scope of evidence-based medicine.

The scheduler, the register and the monthly report card.

PIP: The scheduler, the consultation register, and the monthly report card as basic management tools for statistical data collection for health care personnel are described in terms of their method of use, functions, and statistical objective. 1) The scheduler is a file care maintenance system for tracking the number of women protected by method, the number of women dropping out by method, and the number of withdrawals by method. Monthly aggregation can be done and forwarded to regional or central supervisory officers. The visit card is filled out at the end of each consultation and dated. The function is archival, statistical, and operational. 2) The consultation register functions as a quantitative and qualitative assessment and permits rapid inventory of the number of consultations and consultants. The recommended standard format is date of visit, number of the visit for the current month, number of the patient's card (new patient, prior patient), type of method used, patient status as new or previous, and data of appointment. Monthly summaries provide totals of the number of women seen, the number of previous cases, the number of new patients, and cases by method used. Programs must set their own unified standards for defining new and previous cases. For example, new cases includes any visit for whom a new visit card is begun, the first time for a consultation, the first time at this center but with prior attendance at another center and without a card, and use of a contraceptive or discontinuation. Previous cases include those with a visit card and regular return visits. 3) The monthly report card provides contraceptive usage incidence and prevalence statistics for a specific health center and usage by method. Data are obtained from the scheduler and the consultation register. Future articles will discuss the use of a commercially available software package to provide statistical tabulations: GEDOSTA (management of statistical data in family planning).^ieng

Method selection made easy.

PIP: The Togolese National Family Welfare Programme introduced a visit card system for method selection in 1989 developed several years earlier in Burundi. Thereby the health worker is aided in choosing the best contraceptive method for each client on the basis of personal data, medical history, and a general and gynecological examination. the card is also used makes the selection by taking into account contraindications and considering them in conjunction with the client's individual profile. At this stage the innovative aspect of the visit card is that the contraindications are grouped together under 3 headings; those identified by asking questions (e.g., a mother breast feeding for less than 6 weeks),those identified by looking at the client's history (e.g., a recent liver ailment), and those revealed by the general and gynecological examination (e.g., a blood pressure of more than 14/10). The 2nd part of the card concerns the search for the recommended contraceptive method. It includes a list of the methods: rhythm, barrier, IUD, combination pill, low-dose progestogen pill, and injection. A plus sign indicates that the method is recommended, a minus sign indicates that the method is not recommended, and a double minus sign indicates that the method is relatively recommended. A relative contraindication becomes an absolute contraindication if associated with another relative contraindication. After the acceptance of the method, the health worker prescribes it, and advises the client about the follow-up program, any possible side effects, and any warning signs which necessitate another appointment.^ieng

Measurement of mechanical forces generated by skin fibroblasts embedded in a three-dimensional collagen gel.

Mechanical activities developed by cells play a significant role in the embryogenesis, development, and physiopathology of pluricellular organisms. A technique is described to measure in vitro the traction force developed by cells seeded into a three-dimensional polymeric collagen lattice. It is based on the use of strain gauges generating an electrical signal upon tension that is amplified and recorded. The intensity of the signal depends on the number and type of cells, cytoskeleton integrity, concentration of collagen in the lattice support, and fetal calf serum in the culture medium. Skin fibroblasts from humans and animals produce traction forces ranging from 100 to 1000 mg per million cells. In the gel under tension, the cells are in mechanical dynamic equilibrium with their support. It is suggested that the mechanical activity of fibroblasts and the control of the tension that they operate on the lattice support participate in the structural organization of the dermis and in its physiologic tension.

Cyanoacrylate skin surface stripping: an improved approach for distinguishing dysplastic nevi from malignant melanomas.

We present a novel approach for improving the management of patients with pigmented neoplasms including malignant melanomas and dysplastic nevi. A cohort of 215 dysplastic nevi and malignant melanomas was studied by cyanoacrylate skin surface stripping (CSSS) and conventional histology. Presence of atypical melanocytes was found in the stratum corneum in more than 95% of malignant melanomas and was always absent in dysplastic nevi. We conclude that this non-invasive technique is rapid, easy to perform, and inexpensive. Its specificity and sensitivity are high enough to be considered by clinicians as an aid for distinguishing dysplastic nevi from malignant melanomas. We recommend this ancillary technique as a screening procedure though not as a substitute for conservative excisional biopsy, when doubt persists in the diagnosis of atypical pigmented neoplasms.

Fibroblasts induce the assembly of the macromolecules of the basement membrane.

The mechanism regulating the deposition of basement membrane components (BMCs) in a polymeric structure at the junction with the connective tissues is not yet understood. Cultures and cocultures of epithelial BMC-producing cells (L2 or PER cells) and fibroblasts were prepared in several experimental conditions and the organization of BMCs was studied by immunofluorescence. The pattern of BMCs in pure cultures of L2 or pulmonary epithelial rat (PER) cells consisted of intra- and extracellular granular deposits. At very high density, the cell contours were also underlined by a disrupted network of BMC deposits. A different fibrillar plexus--containing laminin, collagen type IV, and heparan-sulfate proteoglycan resistant to deoxycholate treatment and distant from the cell membrane--was observed in cocultures of L2 or PER cells with fibroblasts. Fibrils of fibronectin and/or collagen type I were most often dissociated from this plexus of BMCs. Similar results were obtained by adding a conditioned medium of L2 or PER cells to confluent fibroblasts, even when the cells were killed. Pure laminin also bound to the fibroblast layer. A coated film of fibronectin or polymeric collagen type I was unable to bind BMC provided by a conditioned medium. It is suggested that molecule(s) synthesized by fibroblasts and deposited in the pericellular matrix are involved in the assembly of BMCs.

Contraction of collagen lattices by fibroblasts from patients and animals with heritable disorders of connective tissue.

Fibroblasts derived from patients and animals presenting various heritable connective tissue disorders were investigated for the ability to retract a reconstituted collagen matrix. When seeded into gels, dermatosparactic calf and sheep fibroblasts did not exhibit the elongated shape of normal fibroblasts and did not contract the collagen lattice to the same extent as control fibroblasts. In contrast, several cell strains obtained from patients with Ehlers-Danlos syndrome type VII displayed contractile properties for collagen gels similar to controls. Delayed contraction was noted by two strains of fibroblasts from patients with Ehlers-Danlos syndrome type IV, whereas fibroblasts from patients with osteogenesis imperfecta, Marfan syndrome and cutis laxa had normal retraction properties.

Epidemiology of pregnancies with unknown last menstrual period.

A group of women with unknown last menstrual period was studied representing 16% of a total of 22 404 pregnant women recorded using a common perinatal form. Unknown menstrual period is associated with high rates of low birth weight and with low socioeconomic and sociodemographic status. Such characteristics are also associated with a high rate of preterm deliveries. Thus any possible bias introduced in studies of prematurity by ignoring the group of women with unknown last menstrual period should be carefully checked.

The capacity of retracting a collagen matrix is lost by dermatosparactic skin fibroblasts.

When cultivated within a matrix made of reconstituted collagen fibers, fibroblasts derived from skin, tendon, vena cava, and aorta of a normal (N) calf retract the lattice. This effect progresses with time and is related to the density of the cells included in the lattice. Under similar conditions, fibroblasts derived from the skin of 2 dermatosparactic (D) calves do not contract the lattice. Fibroblasts from D tendon and cells from D vena cava and aorta contract the lattice at the same rate and to the same extent as do their normal counterparts. In the lattice, N skin fibroblasts are elongated along the collagen fibers while D skin fibroblasts remain round and develop little cell processes. N skin fibroblasts do not multiply in the lattice while D skin fibroblasts increase in number by a factor of 3 in 5 days. The addition of N skin fibroblasts, in an amount insufficient to retract the lattice, to D skin fibroblasts does not correct their defective capacity. It is suggested that the disturbed relationship between the D skin fibroblasts and collagen fibers is responsible for the lack of architectural organization of the bundles of collagen polymers in the D skin.

Hyperprolactinaemia during prolonged lactation: evidence for anovulatory cycles and inadequate corpus luteum.

Serum progesterone and prolactin were measured in single blood samples collected from 176 mothers during a lactation period of 2 years and from fifty-six non-lactating, non-pregnant and regularly menstruating women from the Kivu region (Zaïre). On the basis of serum progesterone levels, evidence of corpus luteum activity was obtained in 61% of non-lactating women; but only 20% of non-amenorrhoeic lactating mothers. This suggests an increased incidence of anovulatory cycles and/or cycles with short luteal phases among nursing mothers. The incidence of corpus luteum activity was 8% in amenorrhoeic lactating mothers. In this 8% recurrence of ovulation preceded return of menstruation. Mean serum progesterone was significantly higher and serum prolactin significantly lower in the non-lactating women than in the nursing mothers. This suggests that although ovulation occurs, corpus luteum activity is inadequate in hyperprolactinaemic nursing mothers.

Serum prolactin, gonadotropins, and estradiol in menstruating and amenorrheic mothers during two years' lactation.

Serum prolactin, LH, FSH, and estradiol were measured in single blood samples collected from 465 nursing mothers in Central Africa (Kivu, Zaïre) during the first 2 postpartum years. Lactating mothers were hyperprolactinemic during 15 to 18 postpartum months. Both serum prolactin and FSH were higher in amenorrheic than in menstruating nursing mothers; the difference was more apparent during the first than during the second year. Mean serum LH and estradiol were significantly higher in menstruating then in amenorrheic nursing mothers during the second postpartum year but not during the first. There was a significant association of hyperprolactinemia with amenorrhea. Furthermore, postpartum, the incidence of amenorrhea declined parallel to that of hyperprolactinemia.

PIP: Serum prolactin, luteinizing hormone (LH), follicle stimulating hormone (FSH), and estradiol were measured in single blood samples collected from 465 nursing mothers in Kivu, Zaire, during the first 2 postpartum years. Lactating mothers were hyperprolactinemic during 15-18 postpartum months. Both serum prolactin and FSH were higher in amenorrheic than in menstruating nursing mothers; the difference was more apparent during the 1st than during the 2nd year. Mean serum LH and estradiol were significantly higher in menstruating than in amenorrheic nursing mothers during the 2nd postpartum year, but not during the 1st. There was a significant association of hyperprolactinemia with amenorrhea. Furthermore, the incidence of postpartum amenorrhea declined parallel to that of hyperprolactinemia.

The influence of the frequency of nursing and of previous lactation experience on serum prolactin in lactating mothers.

PIP: Serum prolactin levels were measured for 97 women from Zaire for 22 months postpartum. These 97 women were divided into 3 groups according to how frequently they breast-fed their children. These results were compared with the prolactin levels of 25 nonlactating, nonpregnant women. The prolactin levels increased with the frequency of breast-feeding. The postpartum decrease in serum prolactin is quicker among women who breast-feed less frequently; the serum prolactin levels returned to normal ranges within 6 months postpartum among women who breast-fed their children 1-3 times/day. No correlation could be found between previous breast-feeding or the parity of women and prolactin levels during subsequent pregnancies.^ieng