Transient protection by peripheral benzodiazepine receptors during the early events of ultraviolet light-induced apoptosis.

The peripheral benzodiazepine receptor (PBR) is a mitochondrial protein involved in the formation of mitochondrial permeability transition (PT) pores which play a critical role during the early events of apoptosis. PBRs are located in many tissues and are strongly expressed in the superficial layers of human epidermis. PBRs play a protective role against free radical damage and PBR ligands modulate apoptosis. To investigate the role of PBR during the early events of ultraviolet (UV)-mediated apoptosis we compared the effects of UVB on PBR-transfected Jurkat cells and their wild type counterparts devoid of any PBR expression. Results indicate that early after UVB exposure (up to 4 h), PBR-transfected cells were more resistant to apoptosis and exhibited a delayed mitochondrial transmembrane potential drop, a diminished superoxide anions production, and a reduced caspase-3 activation. Taken together these findings suggest that PBR may regulate early death signals leading to UV induced apoptosis.

[Narrow band UVB phototherapy in the treatment of widespread lichen planus]. / Photothérapie à spectre étroit dans le traitement du lichen plan cutané disséminé.

INTRODUCTION: UVA phototherapy, acitretin and oral corticosteroids are currently the front-line treatment of disseminated cutaneous lichen planus. We studied the efficacy of narrow band UVB therapy in this indication. PATIENTS AND METHODS: We retrospectively studied the dossiers of patients suffering from disseminated cutaneous lichen planus, treated with narrow band phototherapy in the Phototherapy Unit of the University hospital in Montpellier, from May to November of the year 2001. Disseminated lichen planus was defined as lichen involving at least 20p. 100 of the skin surface. Twenty patients were included. UVB were applied thrice weekly using a Philips TL01 cubicle (311-313 nm). The protocol was that used for the treatment of psoriasis. We defined 4 types of response: complete response (disappearance of more than 90p. 100 of the lesions), partial response (disappearance of at least 50p. 100) poor response (improvement in 20 to 50p. 100) and failure (less than 20p. 100 reduction in the lesions). Assessment of relapses in the long term was made using a telephone survey among the patients treated or their physicians. RESULTS: Complete response was obtained in 11 out of the 20 patients (55p. 100) and partial response in 4 (20p. 100), corresponding to 75p. 100 of the responders. Response was obtained with a median delay of 3 months, ranging from 2 to 6 months, following a median of 30 sessions (12 to 50) and accumulated dose of UVB of 36 +/- 4.8 joules/cm2. The phototype, gender, age and duration of evolution before treatment did not influence the response. The relapse rate was and estimated 18p. 100 (2/11) 42 months after treatment had been stopped. DISCUSSION: In our opinion, these results underline the efficacy of narrow band UVB in the treatment of disseminated cutaneous lichen planus. They confirm those of earlier studies and are superimposable with those of oral UVA phototherapy.

Intrathecal somatostatin in terminally ill patients. A report of two cases.

Intrathecal morphine has been shown to be reliable in producing analgesia in patients with intractable cancer pain. Recently, we have demonstrated that intrathecal somatostatin is as effective in the treatment of cancer pain as intrathecal morphine. This report presents 2 cases in whom analgesia could be maintained for 60 and 25 days, respectively, under continuous intrathecal infusion of somatostatin by means of infusion devices.

The pharmacological basis for the treatment of photodermatoses.

The pharmacological basis for the treatment of photosensitivity diseases is poorly understood. The supposed pathogenesis of photosensitivity reactions is reviewed, and the mechanism of action of drugs known to be efficient in this type of reaction (antimalarials, beta-carotene, thalidomide, PUVA therapy) discussed.

Dapsone as initial treatment in superficial pemphigus. Report of nine cases.

Nine cases of superficial pemphigus that were treated by dapsone as the initial mode of therapy are reported. Five patients, all having low or negative serum anti-intercellular cement substance antibody titers, responded dramatically, while the other four patients, showing high titers of anti-intercellular cement substance antibodies, did not respond to this treatment. Complications of therapy were observed in three cases.

Vascular access for intravenous chemotherapy: totally implanted systems.

This is a prospective study conducted in order to evaluate totally implanted venous access systems. The report concerning 42 patients is presented. The follow-up is 5 to 17 months (median 9 months). A variety of antineoplastic agents were administered through the device. Complications rarely occur and after utilization all patients are still treated in this way. Physician-, nurse- and patient-acceptance were excellent and this system appears to improve the quality of life style of cancer patients.

Uptake enhancement of platinum in the dog kidney by microencapsulation of cisplatin and local injection.

Microcapsules containing cisplatin were administered into the renal artery of mongrel dogs. Significant increase of the platinum tissue concentration in the kidney was observed 17 days after administration compared to injection of cisplatin only. The highest drug tissue levels were obtained when the renal artery was ligated after microcapsule injection. In addition the decrease in plasma levels indicated that microencapsulation causes, at least, a 100-fold enhancement of the ratio: exposure of infused tissue to the drug over total body exposure. On the contrary, no major change in drug urine excretion could be related to microencapsulation.

Neutrophil chemotaxis in psoriasis before and after PUVA therapy.

Chemokinesis and chemotaxis of neutrophil leucocytes were studied by migration under agarose in 35 patients with psoriasis and compared with 35 healthy controls. Eschericheae coli filtrate and lipopolysaccharide were used as chemo-attractants. Of these patients, 14 were tested before and after photochemotherapy. The chemotactic capacities of psoriatic serum before and after PUVA therapy were also investigated. The increase in the chemotactic activity of psoriatic polymorphonuclear leucocytes (PMNs) was not significant and remained unchanged after PUVA therapy. The activated psoriatic serum showed a slight increase in chemotactic activity when compared with normal activated serum. These results do not support an intrinsic abnormality of psoriatic PMNs, and their migration into psoriatic lesions could be chiefly due to the presence of chemotactic factors in involved epidermis.

Immunofluorescence in psoriasis: studies of immunoglobulins, complement deposits, and three membrane markers.

Sixteen psoriatic patients and 11 control subjects were investigated by immunofluorescence for skin immunoglobulins (IG) and complement (c) deposits and for keratinocyte membrane markers with anti beta 2 microglobulin (beta 2 m) antibodies (Ab), Con A, and pemphigus Ab. IG and/or c deposits were almost constant in involved epidermis. Three patterns were associated: (1) parakeratotic nuclear (dots-dashes), (2) stratum corneum (SC) intercellular (lamellar pattern), (3) vascular (granular or linear deposits in papillary dermal vessels). In uninvolved epidermis nuclear or vascular deposits could occasionally be present but intercellular pattern was never found in SC. Control specimens were always negative. The three surface markers investigated (beta 2 m, Con A receptor, Pemphigus antigen) could be demonstrated on psoriatic keratinocytes with only slight differences in distribution when compared with controls. Thus, by this methodology no important abnormality could be found in psoriatic keratinocyte membrane antigens.

Somatostatin treatment of psoriasis.

Somatostatin treatment was administered to 20 psoriatic patients according to the following protocol: Continuous infusion (250 micrograms/h) for at least 2 days followed either by short infusions (1 h) at 8 A.M. and 8 P.M. (12 cases) or by repeating the initial 2-day infusion (eight patients). Before treatment (day 0) and on day 6, biopsy specimens were taken for routine examination (12 patients) and for ultrastructure (seven patients). In vitro immunological studies were carried out on peripheral blood lymphocytes (six patients) on day 0 and day 8. In two patients, somatostatin was stopped because of serious side effects. Thus, clinical results were evaluated in 18 patients, on day 30. In ten of them no improvement whatsoever occurred, two had a partial clearing and an almost complete remission was achieved in six others. Ultrastructural studies showed, on day 6, enlargement of the intercellular spaces with deposits of granular material of glucidic composition, associated with features of cellular damage. Percentages of T and B cells were unmodified but a significant depression of mitogenic stimulation by PHA and ConA was clearly observed on day 8. Even if somatostatin treatment may have a beneficial effect in some patients it seems much less valid than other well-known therapies for psoriasis.

Efficacy and safety study of two zinc gluconate regimens in the treatment of inflammatory acne.

This double-blind study was conducted on 67 patients with inflammatory acne who received one of two zinc gluconate regimens (Rubozinc) for three months. One was a constant-dose regimen and the other included an initial three-week loading dose, but both regimens provided the same cumulative dose at three months. The primary assessment criteria was the change with respect to baseline in the total number of superficial inflammatory lesions (papules and pustules). The two treatment groups were not statistically significantly different, with respect to this criteria, after three, five, seven or thirteen weeks of treatment. Therefore, the regimen that included a loading-dose provided no additional benefit. The results of this study are in favor of the conventional therapeutic regimen of two capsules daily for three months, as defined in the marketing authorization.

A comparison of the efficacy and safety of lymecycline and minocycline in patients with moderately severe acne vulgaris.

A multicentre, randomised, double-blind and double-dummy study was conducted to compare the efficacy and safety of lymecycline (n = 71) with that of minocycline (n = 73) in 144 patients with moderately severe acne vulgaris. Patients with an acne score of 1-5 on the Leeds scale received oral lymecycline, 300 mg/day for 2 weeks, then 150 mg/day for 10 weeks or oral minocycline, 100 mg/day for 2 weeks then 100 mg every other day for 10 weeks. Inflammatory, non-inflammatory and total lesion counts were determined at baseline (week 0) and after 4, 8 and 12 weeks' treatment, and global efficacy and safety assessments were made by the patient and investigator at the end of the study. Both treatments were equally effective at reducing differential lesion counts and improving acne condition and severity, with no significant differences between treatments. Inflammatory lesions were reduced by 50.6% and 52.2% with lymecycline and minocycline, respectively, and non-inflammatory lesions by 40.6% and 32.2%. Acne severity was reduced by 42.4% with lymecycline and by 47.9% with minocycline. A total of 4.3% of lymecycline recipients and 4.1% of minocycline recipients experienced treatment-related adverse events, the majority of which were mild in nature. Lymecycline was as effective as minocycline for the treatment of moderately severe acne vulgaris. Both treatments were well tolerated, although there were slightly fewer adverse gastrointestinal and dermatological effects with lymecycline.

Tongue necrosis provoked by ergotamine tartrate and disclosing a giant cell arteritis.

A case of tongue necrosis induced by ergotamine tartrate is reported in a patient who was suffering from an unknown giant cell arteritis (GCA). The role of ergotamine in provoking tongue necrosis in temporal arteritis has only infrequently been considered. The hypothesis concerning ergotamine-induced vasospasm potentially being able to trigger a tongue necrosis in GCA is supported by the present case. This unusual complication warns us against uncritical prescription of this drug for elderly people suffering from migraine without considering GCA.

Angiosarcoma of the scalp and face: failure of an interferon alpha treatment.

Angiosarcoma of the scalp and face is a rare malignant endothelial tumor arising in elderly people. Treatment is disappointing and prognosis remains poor. We report two cases of angiosarcoma of the scalp and face relapsing after classical therapy with surgery and radiotherapy and treated with interferon alpha. The tolerance was poor and the disease progressed 2 and 5 months after the onset of the treatment. When used alone, interferon alpha does not appear as an effective treatment in this kind of angiosarcoma.

[Drug therapy of pain in oncology: keep it simple!]. / Le traitement médicamenteux de la douleur en cancérologie: restez simple!

Pain is the most common symptom in patients suffering from cancer, in particular for advanced diseases. Unfortunately, one third of the patient do not benefit from optimal pain control. One must stress the importance of defining the etiology of pain and subsequently its pathophysiology. This thorough evaluation can help to formulate a proper strategy for a treatment of pain that could be adapted to the disease evolution. A multidisciplinary approach with respect to the WHO prescribing criteria is the most appropriate way to control severe cancer pain syndromes.

[The use of the pectoralis major myocutaneous flap in cervicofacial and particularly buccopharyngeal, surgery. Apropos of 42 cases]. / L'apport du lambeau musculo-cutané de grand pectoral en chirurgie cervico-faciale et notamment bucco-pharyngée. A propos de 42 cas.

During the last two years, we have used a pectoralis major myocutaneous flap in 42 cases (28 after radiotherapy). The immediate post-operative periods were very simple and the flap reliability was remarkable: only three partial necrosis and no total necrosis were observed. This technique seems to be an important contribution in the field of buccopharyngeal surgery, especially in the case of extensive tumors involving the tongue. In that case, initial radiotherapy followed by extensive surgery with myocutaneous flap reconstruction seems to be the best therapeutic strategy. It is the authors' feelings that local control will probably be better but long term results will be still poor. Effectively, in case of extended tumors general prognosis has to be taken in account as well as local prognosis.

[Lichen planus and hepatitis C virus. Apropos of 5 new cases]. / Lichen plan et virus de l'hépatite C. A propos de 5 nouveaux cas.

Lichen planus is an immunologically mediated skin or mucous disease, which has recently been described in some patients with hepatitis C virus-related liver disease. We report 5 new cases of the association of hepatitis C with lichen planus, to be added to the 15 cases published in the literature. The sex ratio (female/male) was of 1.2. Lichen planus occurred more frequently in chronic active hepatitis (2/3 of cases) than in cirrhosis (1/3 of cases). Lichen planus manifestations were only mucous (30%), only cutaneous (40%) or both (30%). Mucous lesions were mainly observed in patients with cirrhosis (3/4 of cases). The onset of skin and hepatic manifestations was variable, with liver disease as the most frequent revealing symptom (60%). The influence of interferon remains unclear. However, it seemed to trigger more than to relieve lichen planus.

[Pyoderma gangrenosum. 14 personal observations and review of the literature]. / Pyoderma gangrenosum. Quatorze observations personnelles et revue de la littérature.

Fourteen cases of pyoderma gangrenosum are reported. Twelve were associated with various diseases: ulcerative colitis, Crohn disease, colic tumor, rheumatoid arthritis, chronic myeloid leukemia, agammaglobulinemia, respiratory infections (2 cases) and post surgical intervention. In 2 cases pyoderma gangrenosum appeared to be primary. The clinical characteristics of the affection make it a very particular type of ulcer: pustular onset, frequent localization to other than leg, rapid eccentric spread, frequent associated morbidity (mainly digestive and hematologic). The pathogenesis is still unknown and the treatment is not well codified.

[Study of demographic, environmental and congenital factors in the development of nevi in children between three and fifteen years old. Early results]. / Etude des facteurs démographiques, environnementaux et congénitaux de développement des naevi chez l'enfant entre 3 et 15 ans. Premiers résultats.

A survey of benign melanocytic naevi was conducted among school children in Montpellier (France) in 1993 with the aim to assess the evolution with age of the number of naevi and the factors influencing their number. Children in different age groups (3, 6, 9, 12 and 15 years) attending randomly selected public schools where included in the study. Dermatologists examined 651 children and recorded the number of naevi of more than 2 mm of diameter. Analysis was restricted to 565 children whose parents responded to a historical questionnaire of exposure and sociodemographic data. Among these children the number of naevi per unit of area increased progressively with age although the number of naevi per unit of skin area reached a plateau at about 11 years of age for the girls and around 15 years of age for the boys. Puberty is a regulative factor for the number of naevi and the number of naevi per unit of area. Children whose parents were born in Europe were most likely to have naevi. Susceptibility to burns were also associated with few number of naevi and number of naevi per unit of skin area. The cumulative exposure to sun since birth and the cumulative exposure during the holidays increased the number of naevi and the number of naevi per unit of area but these variables are the last introduced into the logistic model. A prospective questionnaire can be used to assess the exposures and protection variables allowing a better estimation of the skin reaction to sun.

[An intercenter study of the validity of nutritional evaluation]. / Etude intercentre de la validité d'un bilan nutritionnel.

Malnutrition is one of the most frequent consequences of neoplastic disease. During specific therapies, in order to improve the quality of life of cancer patients, it is necessary to correct their bad nutritional status, allowing thus a better quality of response to the treatment and a better survival. Therefore, it may be needful to realize repetitive nutritional evaluations. The authors have tested the validity of a nutritional assessment in patients with head and neck cancer undergoing radiotherapy, and known to have a progressive impairment of pre-existent nutritional alterations during this therapy. Results show the interest of ponderal curve and serum prealbumin level monitoring, associated with a quantified evaluation of alimentary practice of the patients ("Nutritional Status Index") during cancer therapy. Those investigations are cheap and easy to realize, and could be done often and regularly, giving thus essential data for nutritional status evaluation; the consequence is the possibility of improving the correction of malnutrition.