[Irritant contact dermatitis caused by direct contact with oleander (Nerium oleander)]. / Dermatite irritative par contact direct avec du laurier rose (Nerium oleander).

BACKGROUND: Although the oleander plant is practically ubiquitous throughout the Mediterranean area, very few publications refer to its cutaneous toxicity. PATIENTS AND METHODS: Herein, we report two cases of irritant contact dermatitis caused by oleander. The patients in question were twins who had oleander leaves applied directly to their face for 20minutes. The initial lesions consisted of periorbital erythema, followed by the emergence of papules and macules. Vesicles and crusts appeared over the ensuing 24hours. Treatment included withdrawal of the toxic agent, prescription of oral antihistamines, and the topical application of dermocorticoids to the lesions for two weeks. The outcome on the 9th day was slightly hypochromic and atrophic. Complete restitutio ad integrum of the skin was observed after 30 days. DISCUSSION: In our patients, a joint effect of ultraviolet radiation (phytophotodermatitis) and chlorine from the swimming pool cannot be ruled out. Although the substances present in oleanders (irritant saponins and glycosides) can cause chemical irritant dermatitis, immunological reactions cannot be excluded. The lack of signs of systemic toxicity observed is the result of the factors governing transdermal diffusion of the toxic glycosides found in oleander. CONCLUSION: These two cases provide a timely reminder, both for the general public and for healthcare professionals, of the potential biohazards of oleander, not only because of its systemic toxicity but also because of the risks associated with cutaneous exposure.

Contrast-enhanced harmonic endoscopic ultrasound in solid lesions of the pancreas: results of a pilot study.

BACKGROUND AND STUDY AIMS: Distinguishing pancreatic adenocarcinoma from other pancreatic masses remains challenging with current imaging techniques. This prospective study aimed to evaluate the accuracy of a new procedure, imaging the microcirculation pattern of the pancreas by contrast-enhanced harmonic endoscopic ultrasound (CEH-EUS) with a new Olympus prototype echo endoscope. PATIENTS AND METHODS: 35 patients presenting with solid pancreatic lesions were prospectively enrolled. All patients had conventional B mode and power Doppler EUS. After an intravenous bolus injection of 2.4 ml of a second-generation ultrasound contrast agent (SonoVue) CEH-EUS was then performed with a new Olympus prototype echo endoscope (xGF-UCT 180). The microvascular pattern was compared with the final diagnosis based on the pathological examination of specimens from surgery or EUS-guided fine-needle aspiration (EUS-FNA) or on follow-up for at least 12 months. RESULTS: The final diagnoses were: 18 adenocarcinomas, 9 neuroendocrine tumors, 7 chronic pancreatitis, and 1 stromal tumor. Power Doppler failed to display microcirculation, whereas harmonic imaging demonstrated it in all cases. Out of 18 lesions with a hypointense signal on CEH-EUS, 16 were adenocarcinomas. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy of hypointensity for diagnosing pancreatic adenocarcinoma were 89 %, 88 %, 88 %, 89 %, and 88.5 %, compared with corresponding values of 72 %, 100 %, 77 %, 100 %, and 86 % for EUS-FNA. Of five adenocarcinomas with false-negative results at EUS-FNA, four had a hypointense echo signal at CEH-EUS. CONCLUSIONS: CEH-EUS with the new Olympus prototype device successfully visualizes the microvascular pattern in pancreatic solid lesions, and may be useful for distinguishing adenocarcinomas from other pancreatic masses.

Exposures associated with making or playing with viscoelastic polymer toys known as Slime: a retrospective case series from French Poison Control Centres.

Context: Slime is a slow-flowing material with viscoelastic properties which is attractive to children. Its preparation is based on the crosslinking of polyvinyl alcohol, polyvinyl acetate or starch with boric acid.Objectives: The goal of this study was to describe the adverse effects of Slime.Materials and methods: This is a descriptive retrospective study of cases of exposure reported to French Poison Control Centres between January 2014 and May 2018. The following parameters were used: age and sex, date and circumstances of exposure, symptoms and severity.Results: Two hundred and eight (208) cases of exposure were recorded, 93 cases happened in 2017, and 88 cases in the first four and a half months of 2018. The average age was of 8 years old; 190 patients were younger than 15. Fifty-seven percent (57%) were female. Regarding routes of exposure, 168 were oral, 30 cutaneous, eight ocular, one inhalation and one ear exposure. Eighty-two (82) patients were symptomatic, including 81 cases of low severity and one of average severity (keratitis). All cases lead to recovery.Conclusion: No significant adverse health effects are expected to develop if only small amounts are swallowed; making Slime with home ingredients is a potential cause of boric acid exposure that must be supervised by adults.

Poisoning by non-edible squash: retrospective series of 353 patients from French Poison Control Centers.

CONTEXT: Among the numerous varieties of squash that exist, some are edible while other bitter-tasting ones are not fit for human consumption. Cases of confusion seem to be multiplying and are characterized by digestive problems (diarrhea, vomiting, and abdominal pain). METHODS: This is a descriptive retrospective study of cases of exposure reported to French Poison Control Centers between 1 January 2012 and 12 December 2016. RESULTS: 353 patients were included, with 71.7% belonging to collective cases of poisoning. The male to female sex ratio was 0.75 for an average age of 38.2 ± 23.6 years. The circumstances of exposure were dietary for 337 patients (95.5%). The majority of the squash consumed was purchased at a store (55.8%) but some also came from the garden (25.5%). 204 patients (57.8%) mostly presented with diarrhea, vomiting, abdominal pain, sometimes with the consequent dehydration, hypotension, tachycardia, headaches, or vertigo. There were no deaths or severe (Poisoning Severity Score (PSS) 3) cases, but there were 14 patients (4.0%) of moderate severity, 190 patients (53.8%) of minor severity (PSS 1), and 149 patients (42.2%) without severity (PSS 0) but among which we include the bitter taste of the squash. The average age of PSS 2 patients was significantly (p = .003) older than that of the PSS <2 patients. CONCLUSION: As the first consequential series in Europe, our study shows that exposure to non-edible squash is frequent. Usually benign, poisoning could be the consequence of the irritating effect of certain cucurbits, the molecules responsible for the taste and toxicity of the fruits. In terms of prevention therefore, we recommend disposing of any squash with a bitter taste.

Rhabdomyolysis during envenomation by Physalia sp envenomation in New Caldonia.

We report the first case of rhabdomyolysis following envenomation by a Physalia sp in New Caledonia. Systemic envenomation by this marine hydrozoan is well known, including myalgia as a commonly reported clinical feature. Nonetheless, a related increase in muscle enzymes, featuring rhabdomyolysis, has not previously been described. In this case report, we describe a patient with rhabdomyolysis and acute renal failure. Rhabdomyolysis should be checked in case of systemic physalia envenomation.

Acute Methiopropamine Intoxication After "Synthacaine" Consumption.

Use of methiopropamine (MPA), a synthetic metamfetamine analog, has been detected since 2011 in Europe, but there is limited information on its acute toxicity. A 30-year-old man was admitted to the emergency department in a confused state, with paranoid delusion, auditory and visual hallucinatory experiences, and incoherent speech following the use of "synthacaine" (a slang term derived from "synthetic" and "cocaine"). Toxicological screening for pharmaceuticals and drugs of abuse by liquid chromatography-diode-array detector, gas chromatography-mass spectrometry and liquid chromatography-tandem mass spectrometry (LC-MS-MS) detected MPA, which was subsequently quantified by a specific LC-MS-MS method. Of note, 13 h after presentation to the emergency department, the plasma concentration of MPA was 14 ng/mL. This case report confirms the toxicity of MPA and the need for toxicological analysis to confirm the substance actually ingested by users of new psychoactive substances.

European viper envenomation recorded by French poison control centers: A clinical assessment and management study.

INTRODUCTION: Immunotherapy is the gold standard treatment for patients bitten by European vipers in France; it significantly decreases morbidity, frequency and severity of complications and length of stay. A national prospective study was performed by all Poison Control Centers (PCC) to validate the emergency protocol for viper envenomations. METHODS: This prospective study included all cases of viper bites in France, treated or not with Viperfav(®) in 2013. RESULTS: In 2013, 277 cases of viper bites were collected: ratio M/F 2.1; mean aged 43 years (<15 years 25% 15-65 63% > 65 12%). The final severity was divided into 68 grades 0, 58 grades I, 62 grades IIA, 71 grades IIB and 18 grades III. One death was reported. Five patients had neurological signs. For the 114 patients who received Viperfav(®), all systemic signs disappeared in 5 h and in 24 h for biological and neurological signs. No severe anaphylactic reaction with Viperfav(®) was reported. Late Viperfav(®) administration increased the risk of functional impairment 15 days after the bite (OR = 3.21 p = 0.043). The administration of Low Molecular Weight Heparin (LMWH) increased the frequency of functional impairment to 15 days after the bite (OR = 6.38 p = 0.064), although Viperfav(®) was given in the first 18 h. DISCUSSION: This study confirms the efficiency, safety and recommendation of an early administration of a single dose of Viperfav(®), LMWH should not be used. It also shows the extension of neurotoxic venom of vipers in France.

[Study of the enzymatic hydrolysis of a phosphonic ester using microcalorimetry]. / Etude de l'hydrolyse enzymatique d'un ester phosphonique par microcalorimétrie.

A "Batch" microcalorimeter is used at 30 degrees C for the study of the hydrolysis of 4-nitro-phenylphenylphosphonate with a calf-intestinal phosphonate esterase, in a tris buffer, pH 8. The yield of enzymatic hydrolysis is estimated by spectrophotometric determination of the p--nitrophenol evolved; we have then calculated the apparent molar enthalph of the reaction. (delta Happ = -72,2 kj. mol-1). Phenylphosphonic acid, the second reaction product, is not transphosphonylated on tris. The second acidity of phenylphosphonic acid was studied at 30 degrees C by sodium hydroxide electrotitration (pKa2 = 7,13) and by "Flow" microcalorimetry (delta Hionization = 19,8 kj.mol-1). In the same manner at 30 degrees C, we measured the heat of ionization of p-nitrophenol (delta Hionization = 26,75 kj.mol-1). These findings allow a calculation for the actual heat of hydrolysis of 4-nitro-phenyl-phenylphosphonate (delta Hrho = -29,7 kj.mol-1).

Percutaneous fine needle biopsy (P.F.N.B.) of intra-abdominal lesions.

Four hundred and seventeen percutaneous fine needle biopsies (P.F.N.B) have been performed in 405 patients. Two hundred and thirteen had a focal lesion of the liver, 116 a lesion of the pancreas, 74 an abdominal mass and 14 miscellaneous lesions. Real-time ultrasound has been used as a method of guidance in 90% of cases, fluoroscopy in 7% and computed tomography (CT) in 3%. The main indication for P.F.N.B. was detection of malignant lesions which represent 70% of the 338 proven cases. In these 338 cases, P.F.N.B. was successful in 310 (92%) and results were non-conclusive in 28 (8%). Sensitivity of P.F.N.B. in detection of malignancy of the liver, pancreas of abdominal masses was respectively 92%, 77% and 85%. Specificity was respectively 100%, 100% and 94%. Non-malignant lesions included benign solid tumours, cystic lesions or abscesses. Three symptomatic complications occurred in the 405 patients (0.75%). P.F.N.B. complements imaging procedures, especially real-time ultrasound, in obtaining a specific diagnosis of focal lesions within the abdomen.

Comparison of 2 clinical techniques for treatment of gingival recession.

BACKGROUND: In early case studies, use of a collagen barrier as a guided tissue regeneration (GTR) material has shown particular promise in procedures aimed at root coverage. The similarities between collagen membrane and subepithelial connective tissue graft (SCTG) have made collagen membrane an attractive and a possible alternative material for root coverage. The purpose of this randomized clinical trial was to compare these 2 techniques, SCTG versus a GTR-based procedure (GTRC), for root coverage/recession treatment. METHODS: Sixteen patients with bilateral Miller's Class I or II (gingival recession > or = 3.0 mm) recession defects were treated either with SCTG or GTRC using a newly designed collagen membrane. Clinical parameters monitored included recession depth (RD), clinical attachment level (CAL), probing depth (PD), width of keratinized gingiva (KG), attached gingiva (AG), and recession width (RW), each measured at the mid-buccal area to the nearest 0.5 mm. Measurements were taken at baseline and 6 months. A standard mucogingival surgical procedure was performed. Data were reported as means +/- SD and were analyzed using the paired t test for univariate analysis and restricted/residual maximal likelihood (REML)-based mixed effect model for multivariate analysis. RESULTS: No statistically significant differences were observed in RD, CAL, KG, and AG between test and control groups at either time period. However, SCTG showed significantly more residual PD and more RW gain when compared to GTRC at 6 months. Both treatments resulted in a statistically significant (P < 0.05) reduction of recession defects (2.5 mm and 2.8 mm), gain of CAL (2.8 mm and 2.3 mm), reduction of RW (1.9 mm and 2.7 mm), and increase of KG (0.7 mm and 1.1 mm) and AG (0.7 mm and 0.5 mm) for GTRC and SCTG, respectively, when comparing 6-month data to baseline. Mean root coverage of 73% (collagen membrane) and 84% (subepithelial connective tissue graft) was achieved. CONCLUSIONS: The 2 techniques are clinically comparable. Use of a modified collagen membrane to attain root coverage may alleviate the need for donor site procurement of connective tissue.

Percutaneous fine-needle aspiration biopsy of the pancreas.

Percutaneous fine needle aspiration biopsy of the pancreas allows to obtain without surgery a tissue proven diagnosis of focal lesions of the pancreas. Ultrasound (US), computed tomography (CT), or fluoroscopy are used to guide the positioning of the needle in the lesion. Various benign and malignant lesions can be diagnosed and the cytologic features of them are presented. The average sensitivity of the technique in the diagnosis of pancreatic carcinoma is 80.5% in the literature. The use of percutaneous fine needle biopsy of the pancreas decreases the number of investigations to be done in a patient with pancreatic disease.

[Determination of serum glycosylated proteins in normoglycemic patients with cancer]. / Dosage des protéines sériques glycosylées chez des malades normoglycemiques atteints de cancers.

The nitroblue tetrazolium "fructosamine" test was elaborated by Johnson et al. in 1982. It gives an easy evaluation of the degree of non enzymatic glycosylation of serum proteins. This degree, like the percentage of HbA1C, is a biochemical test of the average level of glycemia and so is useful in diabetic patient management. The authors test "fructosamine" with a Kone-Progress automated analyzer on blood collected without anticoagulant or antiglycolytic substances; if iodoacetate is added to the blood sample, they observed a partial inhibition of chemical reaction. The results of the tests carried on two groups of normoglycemic patients with localized and metastatic cancers don't show significant statistical difference with healthy subjects. The nitroblue tetrazolium test can be used to manage diabetics patients suffering from cancers; however for metastatic and cachectic patients, an accelerated turn-over of proteins might decrease the non enzymatic glycosylation degree.

[Possible value of variations in the serum alkaline DNAse activity in the prognosis of cancers of the upper respiratory-digestive tract treated by chemotherapy]. / Valeur prédictive des variations de l'activité sérique de la DNAse alcaline dans le pronostic des cancers des voies aérodigestives supérieures traités par chimiothérapie.

Variations in serum alkaline DNase activity before and repeatedly after standardized chemotherapy were examined in patients with head and neck carcinomas. The enzyme activity was measured by way of a modified spectrophotometric method. No variations of such activity observed in patients without therapeutic response or with minor response could be considered as a marker of primary or acquired resistance to chemotherapy. Distinct variations in serum alkaline DNase activity (a steep decrease after therapy followed a few weeks later by a regain of values higher than the initial value) correspond to complete or partial positive responses. Such observations of the variations in enzyme activity in relation to individual initial values measured before therapy could be considered as a reliable prognostic test for the therapy of many head and neck carcinomas.

[Angiomyolipomas of the liver. Diagnostic and therapeutic aspects in 4 cases and review of the literature]. / Angiomyolipomes du foie. Aspects diangostiques et thérapeutiques de 4 observations et revue de la littérature.

In four cases, angiomyolipoma of the liver was discovered incidentally by ultrasound investigation. Based on a review of 26 other previously reported cases and as was borne out in our series, the diagnosis is suggested by the demonstration of fatty material on CT-scan and confirmed by needle aspiration biopsy. Magnetic resonance may be contributive as well.

[Value of intraductal biopsies and intraductal cytology in the etiological diagnosis of biliary stenoses]. / Intérêt des biopsies et de la cytologie endocanalaires pour le diagnostic étiologique des sténoses biliaires.

Endobiliairy tissue specimens were obtained for cytologic and histologic examinations at the site of stenosis after percutaneous biliary drainage or endoscopic retrograde sphincterotomy in 49 patients with benign (10 cases) or malignant (39 cases) biliary stricture. Final etiologic diagnosis was obtained by surgery (18 cases), autopsy (one case), aspiration cytology of metastasis (2 cases), serology (2 cases), and in 26 cases, was determined by the course and outcome of the disease. As the sensitivity of each method, cytology and histology, was weak, it was necessary to associate them to improve results. Accurate etiologic diagnosis was achieved in 77 p. 100 of cases. The specificity of the method was satisfactory and specimen examination allowed to correct and confirm the initial etiologic diagnosis in 12 and 65 p. 100 of cases, respectively. The specificity of the method and its low morbidity prompt us to recommend it during transhepatic or retrograde therapeutic drainage as it can serve as a guide for later treatment. On the other hand, achievement of a transhepatic drainage or an endoscopic sphincterotomy only to obtain endobiliairy tissue specimens means taking into account the poor sensitivity of the method and the complications inherent to transhepatic drainage and endoscopic sphincterotomy. The practice of obtaining specimens by the retrograde technique without sphincterotomy or under cholangioscopy should be developed.

[Metastatic pancreatic endocrine tumor with elevation of alpha-fetoprotein]. / Tumeur endocrine pancréatique métastatique avec élévation de l'alpha-foetoprotéine.

Hepatoma was diagnosed in a 47 year old man presenting with multiple liver tumors and elevated alpha-fetoprotein concentration (460 micrograms/l). Liver biopsy showed a poorly differentiated carcinoma. The discovery of 2 hypervascular tumors in the splenic area at celiac arteriography led to challenge the diagnosis: ultrasound guided-aspiration biopsy showed endocrine cells at the level of the hepatic and pancreatic tumors. The diagnosis of pancreatic islet cell tumor with liver secondaries was confirmed by the pathology of the operative specimen. During the following months, alpha-fetoprotein concentration steadily increased. The patient died 5 months later from widespread metastases. At necropsy, no evidence of hepatoma was found. Immunocytochemical study with antibody raised against alpha-fetoprotein was negative both at the level of the tumoral cells and of the liver cells around the tumor. This case adds a new cause to abnormally high plasma alpha-fetoprotein. As hepatoma and endocrine tumor metastatic to the liver could be difficult to differentiate, this new cause could be clinically relevant.

[Real time ultrasonic guidance of percutaneous fine needle biopsies]. / Une technique simple de guidage des ponctions percutanées par l'échographie en temps réel.

Real time ultrasonic guidance of percutaneous fine needle biopsies with a standard transducer is described. This technique is simple, reliable, and cheap to obtain samples in focal liver and pancreatic lesions or abdominal masses.

[Determination of fructose in sperm: application in the monitoring of a male hormonal contraceptive]. / Dosage du fructose dans le sperme application a la surveillance d'une contraception hormonale masculine.

PIP: This work describes a simple and reproducible method of determining the fructose content of sperm in order to assess the impregnation of the genital tract with testosterone in men in whom spermatogenesis is blocked by a combination of progesterone and androgens. The colorimetric method of Karvonen and Malm was used with certain modification. The fructose content of sperm is colorimetrically determined by the indol in a concentrated chlorhydric milieu, after deproteinization by cadmium hydroxide. Instructions are given for preparation of the aqueous solution of indol, the sulfuric solution of cadmium sulfate and the fructose solution, as well as for the procedure itself and calculation of the fructose concentration. The method was designed to monitor men taking 20 mg/daily of medroxyprogesterone acetate and applying testosterone daily to the torso. The progesterone inhibits spermatogenesis in inhibiting follicle stimulating hormone and luteinizing hormone and also blocks testosterone secretion by the testicles. The addition of testosterone is designed to maintain a normal level of testosterone to avoid feminization.^ieng

Shiitake dermatitis recorded by French Poison Control Centers - new case series with clinical observations.

CONTEXT: Shiitake (Lentinula edodes) is an edible mushroom which was initially grown in Japan and China and is now sold on the European market. Flagellate erythema may arise following shiitake consumption and was first described in Japan in 1974. OBJECTIVE: This paper reports a French shiitake dermatitis case series. METHODS: The findings of retrospective study of shiitake dermatitis cases, reported to French Poison Control Centres (PCC) from January 2000 to December 2013, are reported. RESULTS: Among 32 exposed patients, 15 presented flagellate urticarial lesions after raw shiitake consumption. The first case of this series was reported in 2006 and the last nine cases were reported as of 2012. After shared meals, no symptoms were reported among guests, who preferred cooked shiitake to the raw mushroom. In this series, rashes appeared 12 h to 5 days (median: 24 h) after raw shiitake ingestion. Linear and itchy urticarial lesions formed on the trunk, arms, and legs within a few hours and persisted for 3-21 days. In four cases, rash and pruritus were either triggered or worsened by sun exposure. Eleven patients received corticosteroids, antihistamines, or both. All patients completely recovered. CONCLUSION: Due to the rapidly increasing consumption of exotic food in Western countries, it is no surprise that cases of shiitake dermatitis are now appearing in Europe. The mechanism of shiitake dermatitis is thought to be toxic and due to lentinan, a polysaccharide component of the mushroom. There is no specific validated treatment for shiitake dermatitis. Health professionals and the general population should be aware of both the risk associated with raw shiitake consumption and of the good prognosis of this very spectacular and uncomfortable toxic dermatitis.

Primary tumour of the round ligament of the liver: a case presentation.

A 40-year-old Caucasian female patient presented to the outpatient General Surgery ward in "V. I. Lenin" Teaching Hospital complaining of a recurrent mesogastric pain that had lasted for 3 months. Physical examination showed a palpable mass confined to that area. She was then admitted with diagnosis of an abdominal tumour. Diagnostic work-up revealed that the process involved the round ligament of the liver, which is an exceptional localization, which motivated us to publish this case after surgical treatment by excision, having also taken into account the results of histopathology which revealed a PEComa, confirmed by inmunohistochemistry. After reviewing the available literature, the low incidence of these lesions, as well as the unusual histological variety, makes the present case one of interest.