[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.

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.

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.

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.

Serum prolactin levels during the menstrual cycle.

Serum prolactin has been measured in blood samples collected daily during 51 menstrual cycles using an homologous human radioimmunoassay for 17 cycles and an homologous ovine radioimmunoassay for 34 cycles. There was a progressive and significant increase in serum prolactin during the late follicular phase, with a maximal value concomitant to the LH peak. Serum prolactin levels were also significantly higher during the luteal phase than during early follicular phase. In some 70% of the individual cycles, the highest serum prolactin level was found at mid-cycle. Similar patterns were obtained with both radioimmunoassays. However, when using the same laboratory serum standard, the average serum prolactin level calculated for the entire cycle was 1.6 times higher with the homologous ovine assay than with the homologous human assay. The overall pattern of serum prolactin during the menstrual cycle resembles that reported for circulating 17beta-estradiol.

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.

[Prevention of the malignant form of trophoblastic disease after a hydatidiform mole: systematic or selective chemotherapy]. / Prévention des formes malignes de la maladie trophoblastique après une môle hydatiforme: Chimiothérapie systématique ou chimiothérapie sélective

After a mole has been evacuated there are two ways of treating the condition: routine chemotherapy from the beginning or chemotherapy reserved for selected cases. They offer the same chances of cure. Seeing that the risk of malignancy in our country is 5 per cent and that selective chemotherapy only exposes a small number of patients to the risk of such treatment, we have adopted the scheme of follow-up suggested by Bagshawe and recommended by OERTC. The follow-up is based on radio-immune assay for HCG carried out at regular intervals for two years. Only cases where the level of HCG is higher than 25,000 international units per litre, one month after curettage, or cases where the rise in HCG is associated with metastases, are treated with chemotherapy. In our experience, which is based on 20 cases, we acknowledge the value of radio-immune assaying. It is superior to immunological tests used for pregnancy diagnosis in sensitivity. It also appears to us that systematic treatment routinely administered and treatment based on raised levels of HCG two months after evacuation of a mole are useless. Only 3 cases were treated with chemotherapy out of the 20 cases that were followed up. We have had no malignancy after 2 and 3 years of checking back on the patients. Treatment given routinely from the start would have been unnecessary exposure to the risks of chemotherapy for 17 patients. Had we taken into account the abnormal rise in HCG after 8 weeks we would still have treated 7 patients instead of 3 with the same results as far as cure. We have worked out a graph for the drop in the levels of HCG after a mole has been evacuated. This may serve as a base for criteria for treatment in the future. Cases where the levels of HCG are above the 95 percentile are considered as at risk to evolve into malignant forms of disease. Consequently earlier treatment can be started (before the 6th month) without altering the number of patients who are going to be treated.

[Clinical evolution of LH-RH reactivity in gynecology (author's transl)]. / Evaluation clinique du test au LH-RH en gynécologie

Impaired LH response to LH-RH has been found in 2/4 cases of primary amenorrhoea, in 2/8 cases of psychogenic secondary amenorrhoea, in 2/4 cases of secondary amenorrhoea associated to a pituitary tumour and in 1/5 cases of iatrogenic secondary amenorrhoea post hormonal contraception. Therefore, this test appears not to differentiate these pathologic conditions.

PIP: Responses to luteinizing hormone-releasing hormone (LH-RH) 100 mcg iv in 25 women with 5 different gynecologic disorders and in 12 controls aged 18-28 in the luteal phase were compared. Impaired LH release occurred in 2 of 4 women with primary amenorrhea, in 3 of 8 women with psychogenic amenorrhea, in 1 of 5 women with iatrogenic amenorrhea afterstopping oral contraceptives, in 2 of 4 women with pituitary tumors, and in none of 4 women with isolated galactorrhea. The results did not permit differential diagnosis of these disorders, with the exception of those with intact hypothalmus-pituitary function.

[Autoimmune hemolytic anemia during pregnancy. Apropos of 1 case]. / Anémie hémolytique auto-immune au cours de la grossesse

A case of auto-immune haemolytic anaemia during pregnancy is described. The different tests carried out on the patient make the diagnosis of idiopathie auto-immune haemolytic anaemic haemolytic anaemia in this case. Several theories have been reviewed in order to try and explain the possible role of pregnancy in the appearance of worsening of this kind of anaemia. The theory most likely to be true is that it is a slowly evolving process of auto-immunisation in which the haemolytic effect was accelerated by the pregnancy and showed itself clinically because of the haemodynamic factors occurring at the placental site.

[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.

[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.

[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