Radiation-induced bullous pemphigoid after surgery for soft tissue sarcoma: About a rare case.

INTRODUCTION: Radiation therapy may cause a range of side effects of the skin within the irradiated area. Not of all the reactive effects of the skin induced by radiation therapy have to be related to some forms of radiodermatitis, and when non-standard clinical presentations overcome, it may be necessary to undertake appropriate diagnostic tools to not be in trap of wrong diagnosis. CLINICAL CASE DESCRIPTION: A 76 years-old man undertook resection surgery after a neoadjuvant radiation therapy for a soft tissue sarcoma of his groin region. After surgery, he developed an acute skin reaction comparable with a severe form of radiodermatitis. Despite cares, his clinical status got worse. Only skin biopsies guided us to the right diagnosis: it was a form of a bullous pemphigoid induced by radiation therapy. The consequent appropriate treatment was finally resolute. CONCLUSION: These forms have to be recognized in time, to undertake skin biopsies as soon as an evocative clinical presentation appears. The appropriate treatment, which consists in local or systemic corticotherapy, is resolute in most cases.

[Voriconazole-induced lentigines on photo-exposed skin: A little-known complication]. / Lentigines des zones photo-exposées induites par le voriconazole : une complication mal connue.

BACKGROUND: The appearance of diffuse lentigines in children is rare and a genetic syndrome should initially be envisaged. Another little-known cause of photo-distributed lentigines is use of voriconazole. We present a new case in which the original feature is the very short time of onset. PATIENTS AND METHODS: A 9-year-old immunosuppressed girl treated with voriconazole for 3 months presented lentigines in exposed areas after only 4 weeks of exposure. DISCUSSION: The literature contains only around ten cases of photo-distributed lentigines under voriconazole in children. The condition can appear very early, as in our case. Voriconazole also appears to induce cutaneous squamous cell carcinomas and even melanoma. The benefit-risk ratio of prescribing this drug must therefore be carefully evaluated, and close clinical monitoring and photoprotection must be instituted.

[An original reconstruction technique for double upper white lip defect]. / Une technique originale de réparation d'une double perte de substance de l'hémilèvre supérieure blanche.

INTRODUCTION: Herein we report a case of a surgical repair of double substance loss along the nasolabial groove by means of a double superior advancement flap from the cheek to the upper lip that we have here called the "double jigsaw puzzle" flap. OBSERVATION: A 58-year-old man underwent surgery for 2 basal cell carcinomas located in the right white upper lip. The two lesions were first removed and the two defects were then carried over to the cheek symmetrically along the nasolabial groove. Two triangular "lugs" were excised on both sides to allow horizontal advancement of the cheek to the upper lip to fill the 2 gaps from the upper lip excisions like 2 pieces of a puzzle. The nasolabial groove was then recreated by deep anchoring stitches, with suturing comprising superficial stitches. DISCUSSION: This surgical flap can be created quickly and easily and yields good aesthetic results in the immediate postoperative period and in the longer term, and the scar is totally masked within the nasolabial fold. The only limitation to a good aesthetic outcome is the presence of a small area of hairless skin within what constitutes an area of hair growth in male subjects.

[Impact of the obstructive sleep hypopnea-apnea syndrom treated on employment for military employment]. / Impact du syndrome d'apnées-hypopnées obstructives du sommeil appareillé sur le maintien dans l'emploi chez les militaires d'active.

INTRODUCTION: The diurnal hypersomnia associated with obstructive sleep apnea (OSA) affects soldier employment and deployability. In this study, we examined the impact of OSA on the employment of soldiers on continuous positive airways pressure (CPAP) therapy by measuring several items: work absenteeism using the Work Productivity and Activity Impairment (WPAI) questionnaire, diurnal hypersomnia, and career advancement. METHODS: A questionnaire was sent by regular mail to 940 soldiers with OSA on CPAP therapy who are insured by the French Military Healthcare Fund (Caisse Nationale Militaire de Sécurité Sociale). RESULTS: Questionnaires were returned by 439 soldiers: mean age 47 years; mean body mass index 29.8kg/m2. Absenteeism reached 0.45%, and work productivity impairment 8.7%. Hypersomnia was reported by 15.4% and was severe for 9.7%. The average daily working time was 6.5hours. Quality of life was improved for 91.1%. The military practitioner had diagnosed OSA in 19.6% of these soldiers and had prescribed treatment in 14.9%. DISCUSSION: Residual OSA in these soldiers on CPAP therapy had little impact on work productivity impairment that was less than observed in populations with chronic diseases. In our study population, hypersomnia was less common than observed in the general population. An impact on career advancement could not be clearly demonstrated. Close medical follow-up is warranted in certain populations due to the persistence of severe somnolence in a significant number of patients.