Benefits of Avène thermal hydrotherapy in chronic skin diseases and dermatological conditions: an overview.

The beneficial effects of Avène Thermal Spring Water (TSW), a low mineral content spring water, on chronic skin diseases have been recognized for more than two centuries. This article provides a brief overview of efficacy and tolerance data for Avène TSW from clinical studies conducted at the Avène Hydrotherapy Center in patients with chronic inflammatory skin diseases or temporary skin injuries. Avène TSW hydrotherapy is effective as adjuvant management for chronic skin diseases and dermatological conditions, relieving subjective and physical symptoms with excellent tolerance.

Toxicités dermatologiques après prise en charge d'un cancer du sein : intérêt d'une cure thermale en soins oncologiques de support: Long lasting cutaneous adverse events after breast cancer and evaluation of hydrotherapy as supportive care.

Dermatological toxicities (affecting the skin, mucous membranes, nails or hair) are frequently associated with cancer treatments. They can represent a real burden for patients, with physical, social and psychological repercussions. These dermatological adverse events can also persist long after the treatment has ended, especially after treatment with cytotoxic chemotherapeutic agents such as taxanes. There is a clear need for the development of suitable supportive care measures to help manage these toxicities. The place of a hydrotherapy treatment in this context remains to be clarified. This article summarizes the main data available on the quality of life, and more specifically the dermatological quality of life, of patients for whom hydrotherapy was proposed after breast cancer. © 2020 Elsevier Masson SAS. All rights reserved.

Dermatology today and tomorrow: from symptom control to targeted therapy.

For many decades and until recently, medical approach to dermatologic diseases has been based on the physician's ability to recognize and treat symptoms. Nowadays, advances in the understanding of the biology of diseases and in technologies for intervening against them have allowed physicians to diagnose and treat underlying disease processes rather than simply addressing the symptoms. This means that rather than addressing 'the disease in humans', physicians can now address the particular pathologic (biologic, molecular) disturbance as it presents in the individual patient, i.e., physicians now can practice something much closer to 'personalized medicine', leading to greater benefits for the patients and the health of society in general. The deeper understanding of ultraviolet radiation, the importance of photoprotection and increased knowledge about signalling pathways of melanoma and carcinoma have led to more complete care for the dermatologic patient. The current popularity for excessive exposure to the sun, without adequate application of the appropriate photoprotection remedies, is the origin of melanoma, but also for the weakening of the structure and functions of the skin. Indeed, fragility of the skin can affect humans around the world. In the senior population, this skin fragility is accompanied by pruritus, whereas atopic dermatitis is an inflammatory disease with highest prevalence in children and adolescents. Acne, the number one reason for dermatologic consultations worldwide, increases its prevalence in adolescents and in females. Senescent alopecia affects humans after menopause and andropause. The articles in this publication present an overview of the current advanced understanding of the diagnosis and therapeutic approaches in 6 fields of dermatology - dermatopaediatry and gerontodermatology, oncodermatology, hair loss, atopic dermatitis, photoprotection and acne - and thereby serve as a useful compendium of updated information and references for all healthcare professionals who see patients with presentations of the symptoms of these diseases.

A simple self-diagnosis tool to assess the prevalence of dermatoporosis in France.

IMPORTANCE: The term dermatoporosis has been proposed to describe clinical signs and functional consequences of age-related extreme skin fragility. OBJECTIVE: To create a simple dermatoporosis self-diagnosis tool (IDA: Index Dermatoporosis Assessment) and to use this tool to estimate the prevalence of dermatoporosis in France. DESIGN, SETTING AND PARTICIPANTS: A specific dermatoporosis questionnaire was developed with the help of senior dermatologists and survey experts. This questionnaire was submitted to consecutive individuals aged ≥65 years who consulted a dermatologist. At the end of the consultation, the dermatologist was asked to assess 'whether or not' dermatoporosis was present. In a second step, the final questionnaire was mailed to a representative sample of the French population aged ≥65 years in order to estimate the prevalence of dermatoporosis. RESULTS: The initial questionnaire, consisting of two modules (24 questions), was validated in 173 individuals aged ≥65 years) during a dermatologist consultation. Dermatologists diagnosed 46% of the individuals with dermatoporosis. The final validated questionnaire consisted of 14 items, 12 consisting in presence or absence of clinical signs and two items consisting of the self-assessment by individuals of skin ageing on neckline and hands (none/moderate/significant/very significant). A scoring system was generated to quote quantitatively dermatoporosis (from 0 if no sign of dermatoporosis to 20 maximal dermatoporosis). The area under the receiver operator curve was 0.8535, indicating a very good ability of the questionnaire to differentiate between individuals. A cut-off value of 11 was linked to positive and negative predictive values of 0.78 and 0.81, respectively. In a second step, using the questionnaire in a representative sample of the French population (n = 533), the estimated overall prevalence of dermatoporosis was 37.5% in French subjects aged ≥65 years [27.5% (males) vs. 43.9% (females); P < 0.05]. The estimated prevalence of dermatoporosis was twice higher in subjects with eczema or atopic dermatitis during childhood than in the population without dermatoporosis (60.6% vs. 33.4%, P < 0.001). Individuals with dermatoporosis also reported a higher prevalence of itching, long-term corticosteroid use, anticoagulant use and prior sun exposure. CONCLUSIONS AND RELEVANCE: Using a new simple dermatoporosis self-diagnosis tool, this study provides a previously unprecedented insight into the high prevalence of dermatoporosis in elderly individuals. IDA questionnaire is a short (14-item) and easy to use tool for evaluating dermatoporosis in adults and may allow an easy evaluation of each subject.

Study regarding the survival of patients suffering a traumatic cardiac arrest.

Severe trauma is the most frequent cause of death in young people, in civilized countries with major social and vital costs. The speed of diagnostic decision making and the precocity of treatment approaches are both essential and depend on the specialists' colaboration. The present study aims to emphasize the actual situation of medical interventions in case of cardiorespiratory arrest due to trauma. 1387 patients who suffered a cardio respiratory arrest both traumatic and non-traumatic were included in order to point out the place of traumatic arrest. Resuscitation of such patients is considered useless and resource consumer by many trauma practitioners who are reporting survival rates of 0%-3.5%. As the determinant of lesions, trauma etiology was as it follows car accidents - 43%, high falls - 30%, suicidal attempts - 3%, domestic violence - 3%, other causes - 21%. Hypovolemia remains the major cause of cardiac arrest and death and that is why the efforts of emergency providers (trauma team) must be oriented towards "hidden death" in order to avoid it. This condition could be revealed and solved easier with minimal diagnostic and therapeutic maneuvers in the emergency department.

The place of thoracic abdominal ultrasound influencing survival of patients in traumatic cardiac arrest imminence.

Severe trauma has become the most frequent cause of death in industrialized countries and, for this reason, the fastness of a diagnostic approach and the precocity of the proper treatment are both essential and best influenced by the trauma team collaboration and the existence of a specific algorithm in which each specialist has a definite place and role. In the first stage time of a proposed specific algorithm, the vital stage, which covers the primary survey, the trauma team has not more than 5 min. (ideally) to complete airway, breathing, circulation lesions with vital potential. The ultrasound exam is placed in this stage, which is nothing more than a completion of the primary survey maneuvers, which are exclusively clinical. Two groups of patients were compared in our study; one which was named A, represented by severe traumatized patients admitted between January 2003 and December 2006 and the other one which was named B, with severe traumatized patients admitted between January 2007 and December 2012. The second group was treated by using the modified algorithm. Although the differences were not statistically significant because of the small number of survivors, the modified algorithm was evidently superior in patients with and without cardiac arrest. If we take into account that 48 of the 261 patients survived a cardiac arrest event (although only 9 of them were discharged), the advantages of this type of algorithm are even more obvious. In lot A, 21 patients survived a cardiac arrest, of whom only 4 were discharged. Performing an ultrasound examination during the first step of the algorithm used in the study is essential regardless of trauma causes, particularly hypovolemia. For both groups of patients with and without cardiac arrest, the percentage of patients who received ultrasound increased in the group that received a modified algorithm.

[Multiple skin and mouth squamous cell carcinomas related to long-term treatment with hydroxyurea]. / Carcinomes cutanés et buccaux multiples après traitement par l'hydroxyurée.

INTRODUCTION: Cutaneous side-effects of hydroxyurea treatment are frequently observed. Squamous cell carcinomas are the most severe among them. We report a patient with skin and mouth carcinomas after hydroxyurea treatment. To the best of our knowledge, this is the first case reported. OBSERVATION: A 83-year-old woman had been treated with hydroxyurea from 1985 to 1998 for polycythemia vera. She was referred to our institution in 1998 for painful erosions of both hands. Clinical examination revealed a squamous cell carcinoma leading to amputation of a finger. Hydroxyurea was stopped at this time, and the patient underwent treatment with pipobroman. From May 1998 to March 2000, the patient developed numerous skin keratoses and four squamous cell carcinomas on both hands. In September 2000 and October 2000, two additional skin carcinomas and two mouth carcinomas were diagnosed. DISCUSSION: Cutaneous carcinomas are severe side effects of hydroxyurea therapy. They usually occur after several years of treatment and their outcome may be lethal. The chronology and clinical signs are in favour of implicating hydroxyurea in the development of skin and mouth carcinomas. Despite a bibliographic research using Medline and Embase data bases, we could not find another case-report with simultaneous occurrence of skin and mouth carcinomas after hydroxyurea therapy. This observation emphasizes the need of a long term follow-up in patients receiving hydroxyurea.

[Digital purpura revealing septicaemical rat-bite fever]. / Purpura digital isolé révélant une streptobacillose septicémique après morsure de rat.

INTRODUCTION: Infection with Streptobacillus moniliformis is an uncommon illness which can lead to death if untreated. We report the case in which initially cutaneous signs permitted diagnosis and further identification of the organism. CASE REPORT: A 42 year-old woman presented with a three-day history of acrally distributed purpuric macules on her fingers. Two days later, she was admitted for arthritis of the knees and wrists. There were two large pustules on the left elbow and the right knee. Laboratory studies showed inflammatory changes. The diagnosis of streptobacillary rat-bite fever was made after isolation of Gram-negative bacilli from a blood-culture and from cutaneous lesions. Finally identification of the organism was made by molecular biology analysis. The patient received intravenous ofloxacin and imipenem with complete resolution of arthritis and the cutaneous lesions. DISCUSSION: Streptobacillary rat-bite fever is a systemic infectious disease. It is caused by Streptobacillus moniliformis, organism found in the oropharyngeal flora of small rodents, especially rats. The illness is uncommon in urban settings. It starts by fever, followed by arthritis and rash. Septicaemical rat-bite fever may start only with cutaneous involvement such as acral purpura, like in our case. This clinical manifestation must be recognized by the dermatologist, because the illness can lead to death if untreated.

["Sunshine at school": a network for training on sun exposure. Assessment of knowledge among 683 children]. / Le soleil à l'école: réseau d'éducation à l'exposition solaire. Evaluation des connaissances chez 683 enfants de CM1 et CM2.

INTRODUCTION: The protection of children from sun exposure appears inadequate. We assessed the knowledge of pre-teenagers, before and after they attended a training session on sun exposure. This investigation was carried out in Orléans and in 5 surrounding cities, from September 2000 to April 2002. MATERIAL AND METHODS: A didactic slide show on sun exposure and photoprotection was presented to 683 children in grade 4 and 5 by a nurse and a dermatologist during 30 informative sessions. The children filled in questionnaires at each training session and then one month later. The questionnaires contained 10 closed questions involving 32 cognitive and behavioral items. RESULTS: Forty-five percent of the children claimed that they were exposed to the sun more than one hour a day during holidays, 14 p. 100 more than 3 hours a day; 26 p. 100 declared they had never been sunburnt; 46 p. 100 said they had been less than 5 times, 15 p. 100 from 5 to 10 times and 12 p. 100 more than 10 times; 74 p. 100 of the children claimed they enjoyed getting sun-tanned; 80 p. 100 knew that sun exposure could lead to serious diseases, while 73 p. 100 realized that contracting sunburns during childhood increases the risk of subsequent skin cancers; 89 p. 100 knew of the necessity of sun-screen use prior to exposure, 94 p. 100 knew that they help to protect the skin whereas 78 p. 100 knew it must be applied on a regular basis; 77 p. 100 of the children had been informed of the importance of sun protection factor; 92 p. 100 of them were aware of the relevance of a cap and sunglasses for protection from the sun, whereas only 45 p. 100 knew of the need for a tee-shirt. DISCUSSION: Our study showed that children are generally aware of the dangers of sun exposure. This might be the result of previously initiated information and prevention campaigns on skin cancers. This study suggests the efficiency of such projects, and the lasting effects of the information received within one month. However, large numbers of children are still overexposed and subsequently suffer from traumas. The appeal of sun embellishment appears to go back to childhood, and should be taken into account from the early stages of childhood in future preventive actions. An efficient policy of education on sun exposure - including teaching tools relevant to each age--still has to be developed.

Traumatic cardiac arrest in the emergency department - Overview upon primary causes.

RATIONALE: Trauma is the leading cause of death for patients aged less than 40 years. Trauma patients with cardiac arrest have low survival rates, the resuscitation being often considered futile and consumptive of medical and human resources. OBJECTIVE: The aim of this study is to describe the main characteristics in cases of patients critically traumatized, who were admitted in our emergency department. METHODS AND RESULTS: The study is based on a retrospective analysis of cases of major trauma admitted in an Emergency Department between 2004 and 2008. There were 201 cases of critically traumatized patients, who received cardiopulmonary resuscitation. The patients were aged between 16 and 79, mostly men (67.16%), with a range of ISS between 30 and 75. Regarding the type of mechanism that produced the injury we noted a predominance of blunt trauma (87,2% of cases) and hypovolemia as a direct cause that led to the cardiac arrest. The first monitored rhythm was non-shockable for over 90% of the cases. In our group, 4 patients were discharged alive (2% of all cardiac arrest cases). The mechanism of cardiac arrest for those 4 cases were hypoxia through massive facial trauma in one case and tension pneumothorax through severe thoracic trauma in three cases. DISCUSSION: Given the low survival figures, all the efforts that could be achieved by an emergency team in the face of severe trauma had to be oriented towards the maintaining of the vital functions or, when needed, towards restoring life in order to enrich the operation theatre for the definitive care.

An Utstein style based on a reporting system of the emergency department's cardiopulmonary resuscitation in an emergency hospital in Romania.

RATIONALE: Different Utstein based reporting systems are used for research purpose in resuscitative medicine worldwide and resuscitation attempts data are available from different countries. In Romania, the only data available has been from the previous work in the Emergency Department of "Sf. Pantelimon" Emergency Hospital, since 2006. OBJECTIVE: This study was conducted to describe the characteristics of the cardiac arrest event in our Emergency Department (ED) and to identify factors associated with the outcome and the event itself. METHODS AND RESULTS: This descriptive study refers to the resuscitation attempts performed in the ED of our hospital between January 1st 2011 and December 31st 2011, following the Guidelines of the European Resuscitation Council 2010. The data used were gathered from the observational sheets. The reporting form used is Utstein-based, referring to the patient characteristics, event and outcome. A number of 81 cases have been analyzed; in 33 cases (40.74%), the cardiac arrest occurred out of the hospital. The return of the spontaneous circulation (ROSC) occurred in 25 patients (30.86%), with 12% discharged alive. The most common cause of arrest was the myocardial infarction. The first rhythm monitored was non-shockable in 92.59% of the cases. However, 24 patients developed a shockable rhythm at some point during the resuscitation and 37.5% of these experienced ROSC. DISCUSSION: The Utstein- based reporting system used provides a standardized, comprehensive method for data collection. Further research is needed in order to obtain valuable data with statistic relevance. Conclusions related to the aspects of the population in the area the hospital serves can be drawn.

Necrotropic protective effect of Ca-Mg gluconolactate on allyl alcohol-induced liver necrosis in rats.

The prevention of liver damage in rats intoxicated with allyl alcohol was attempted with 5 per cent Ca--Mg gluconolactate in reiterated doses. This preparation prevented or reduced liver necrosis only in the presence of spleen: splenectomy annihilated the effect of Ca--Mg gluconolactate.