[Results of treating infections of the cervical mucosa with doxycycline polyphosphate in 53 infertile women]. / Résultats du traitement de l'infection de la glaire cervicale par le polyphosphate de doxycycline chez 53 femmes infertiles.

Our study was carried out on 53 women who had been infertile for more than a year and who had cervical mucus infection. In 13 cases (group A) there was no other known associated factor to cause the infertility. In 26 cases (group B) there was an obvious associated factor and in a further 14 cases there was a latent associated factor. The physical characteristics as well as the bacteriological appearances of the mucus (which included a systematic search for aerobic bacteria and for chlamydia trachomatis (CT) and for ureaplasma urealyticum (UU) were studied both before and 6-8 weeks after treatment with doxycycline polyphosphate given in doses of 100 mg twice daily. Before treatment the bacteria most often found were escherichia coli (20 cases) and enterococci (18 cases). CT was only found once and UU six times, usually in association with other bacteria. In 75.5% of cases the treatment made the affecting organism go; and cut down or removed entirely the number of leucocytes in the mucus in 73.5% of cases. But the physical characteristics of the mucus were only improved in 43% of cases, and in 18 cases a new infective organism was found in the mucus after treatment. However, it was in too low a concentration to determine its pathogenicity. There were nine pregnancies within 4 months of the start of treatment, which means that 30% in group A and 19% in group B became pregnant. Infection of the cervical mucus therefore does really seem to be a factor in lowered fertility in certain women CT and UU seem to be rarely the responsible organisms. Doxycycline phosphophate in an efficient and well tolerated treatment in these infections.

[Malignant melanoma in children and adolescents. 8 cases]. / Les mélanomes malins de l'enfant et de l'adolescent. Huit observations.

Eight cases of malignant melanoma developed during childhood have been recorded over a 35-year period. Treatment and course of the disease were extremely variable. Melanomas developed on giant pigmented naevi had a particularly somber prognosis: death occurred within 6, 7 and 3 months respectively in the 3 cases observed. In the 5 remaining cases, the course of the melanoma seemed to be about the same as in adults. The main difficulty resides in the clinical and histopathological diagnosis at that age: although most lesions are benign, uncertainty is not permissible, and in doubtful cases the tumour must be rapidly removed and examined.

[Genetics of hereditary cutaneous diseases associated with digestive tract involvement]. / Génétique des affections cutanées héréditaires associées a des lésions digestives.

Most of cutaneous hereditary diseases are associated with digestive symptoms but only four groups have a predominated digestive symptomatology: I. Hereditary disease with intestinal polyposis. II. Vascular dysplasias with intestinal haemorrhage. III. Connective tissue discover in hereditary diseases. IV. Acrodermatitis enteropathica with diarrhoea. Though very different with one another, Peutz-Jeghers syndrome and Gardner's syndrome are transmitted according to autosomal dominant trait. Only bi- or unigenic origin is still controversed. Rendu-Osler's disease and blue rubber bled naevus also transmit according to autosomal dominant trait. Pseudoxanthoma elasticum is very likely transmitted according to autosomal recessivity. But the main forms of Ehlers-Danlos disease are autosomal dominant conditions, the other form being either autosomal recessive or sex-linked (type V). Acrodermatitis enteropathica is transmitted according to autosomal recessivity but the gene has a very variable penetrance so that the mutations are very common.

[Congenital nodular fibromatosis: report of six personal cases (author's transl)]. / A propos de la fibromatose nodulaire congénitale (d'après 6 observations).

Six personal cases of nodular congenital fibromatosis are reported: one fibromatosis colli, two fibromas of the fingers one multiple fibromas of the toes and sole associated with osteoporosis and underlying bone lacunes, one recurrent plantar fibromatosis, one disseminated fibromatosis with multiple bone lesions. Such varieties of fibromatosis are very uncommon. Few are isolated such as fibromatosis colli or the fibroma of the fingers. The prognosis is generally good except for the generalized multinodular form which associates a very large visceral involvement. Aetiology is completely unknown. Only few arguments are in favour of an hereditary dominant autosomal transmission of the diffuse multinodular form.

[Study of the role of Candida albicans infection in different infant conditions including a diaper rash (64 cases)]. / Etude du role pathogéne de candida albicans au cours de diverses affections du nourrisson comprenant une dermite du siége

The pathogenic role of Candida albicans has been determined by performing: skin scrapings, mouth swabs, faecal specimens and serology from 64 infants and very young children affected with different conditions including a napkin dermatitis, divided into 4 groups. 1) 7 patients affected with true or presumed candidiasis, 2) 53 patients with different manifestations of diaper dermatitis, 3) 3 patients with papulo-erosive dermatitis of the diaper area, 4) 1 congenital ichthosiform erythrodermia. Candida albicans is the only responsible agent of the granulomatous candidiasis, it is constant but appeared lately in acropathia enteropathica. It is one of the major agents of the trichophytoid dermatitis (2 cases out of 4 cases). Candida albicans has been recovered from the skin of 33 infants out of 53 patients affected with all types of napkin eruption (62 p. 100) and from faecal specimens of 43 patients (81 p. 100). Though Candida albicans has often been considered as an opportunistic organism, even in infants, this percentage is greatly higher than that of the normal infant that is about 4p. 100, and consequently has a real pathogenic value. Species of yeasts different from Candida albicans have been recovered from faecal specimens of 3 infants affected with papulo-erosive dermatitis of the napkin area: parapsilosis, macedoniensis, deformans which are not generally considered as pathogenic agents. Serology is positive only in 3 infants or young children affected with a real chronical candidosis: 1 granulomatous candidosis, 1 acropathia enteropathia, 1 erythrodermia, the faecal specimen of whom contained a great nomber of Candida albicans.

[Cutaneous lesions of malignant histiocytosis. About five cases (author's transl)]. / Les manifestations cutanées de l'histiocytose maligne. A propos de 5 cas.

Five cases of malignant histiocytosis are reported. They associate specific cutaneous lesions with the other much more classical symptoms of the illness; fever, weight loss, lymphadenopathy, splenomegaly, hepatomegaly. The principal clinical and histological findings observed during the course of the illness in these patients are described. In a review of the literature concerning this rare but now well individualized illness, 34 cases of malignant histiocytosis associated with cutaneous lesions are found among which 24 were studied on a clinical and histological point of view. The principal characteristics of the cutaneous eruption are presented: clinical characteristics with the most frequent nodular aspect of the lesions, but also histological features with the relative specificity of the disposition of the infiltrate whose cytological features will not be forgotten to analize. Nevertheless, the diagnostic will often be established by the histological analysis of the lymph node biopsy or sometimes of biopsy of the other affected organs. These cutaneous lesions might also be in several cases of some prognostic interest.

[Atopic dermatitis: a histologic and radioautographic study (after 3H-thymidine labelling) of epidermal and dermal lesions (author's transl)]. / Dermatite atopique: étude histologique des lésions cutanées et historadioautographie après incorporation de thymidine tritiée.

Skin lesions of atopic dermatitis (A. D.) have been studied histologically and radioautographically after in vitro incorporation of tritiated thymidine. The histopathologic aspects of epidermis in the different types of skin lesions are reviewed. The dermal infiltrate is mononuclear and not very abundant in all types of lesions. An enlargement of the epidermal proliferative compartment has been noticed. Labelled cells are distributed as follows (mean +/- standard deviation) : 46 +/- p. 100 in the basal layer; 37 +/- 6 p. 100 in the epibasal layer; 16 +/- 7 p. 100 in the upper layers. The basal and epidermal labelling indices have been found significantly increased in exudative and lichenified lesions as compared to xerotic areas and normal epidermis. The labelling index of the "round" cell infiltrate in the dermis was significantly higher than in irritant patch test reactions (p less than 0.001) but significantly lower than in allergic positive patch test reactions (p less than 0.001). This increased cell proliferation in the dermal infiltrate does not allow definite conclusions about immunopathogenesis of the disease: indeed, a large number of mediators, involved in the inflammatory reactions of A. D. lesions, can modulate cell proliferation.

[Impotence with venous leakage. An extensive study of 49 cases detected by the artificial erection test]. / Impuissances avec fuite veineuse. Etude extensive de quarante-neuf cas détectés par l'épreuve d'érection artificielle.

Fourty nine men seeking advice for erectile impotence, in whom the serum flow rate necessary to maintain an artificial erection (MFR) exceeded the upper limit of the normal range proposed by most authors (75 ml/mn), underwent different investigations (including a study of their penile arteries, Nocturnal Penile Tumescence monitoring (NPT) and a papaverine test) in order to ascertain the organic basis of their impotence, and to define the diagnostic criteria for "venous incompetence". Several other types of treatments were attempted. Two thirds of the patients were found to have occlusions of their sexual arteries, and these were severe in one third of cases. Our overall results suggest that only cases of MFR exceeding 120 ml per mn. were due to a true organic abnormality (severe venous incompetence, SVI), able to induce impotence, and possibly warrant surgical treatment, on condition that the organic nature is confirmed by NPT. 40% of the cases of impotence with SVI start before the age of 40, and 15% are primary. 37.5% of the cases never achieve rigid erection, and 37.5% have only rigid erections of short duration. Very few plausible etiological factors were found, except fibrosis of the cavernous bodies in 5 cases. The prognosis of impotence with SVI seems very bad, since only 4 of the 35 patients were clearly improved by non surgical treatments, while only 1 out of the 10 patients who underwent a surgical ligation of the deep dorsal vein of the penis was improved.

[Cardio-cutaneous syndromes (apropos of 2 observations)]. / Síndromes cardio-cutáneos (a propósito de dos observaciones)

Two cases of lentiginosis with associated heart anomalies are described. A review of the different syndromes in which pigmentary disturbances (cafe au lait spots, lentiginosis) are associated with cardiopathy is made by the authors. They emphasize the importance of investigation on members of the patient's family.

[Microsurgical tubal desterilization: an efficient procedure. Evaluation of a 42 cases cohort according to Guzick's biparametric method]. / Déstérilisation tubaire microchirurgicale: une option efficace. Evaluation d'une série de 42 cas selon le modèle biparamétrique de Guzick.

OBJECTIVE: Tubal ligation tends to be a contraceptive method used by younger women. Regrets may then become more frequent. Although less tough today, microsurgical tubal reversal is a reliable technique and we report results taking into account exposure time and curing rate. PATIENTS AND METHODS: We studied 42 cases operated from 1990 and 1997. The patients were selected following the same protocol and operated according to the same surgical way. The results were analyzed by Guzick biparametric method, and comparison assessed by Log-rank test. We compared results depending on age, type of sterilization (mechanical and non mechanical), duration of laparotomic time, and interval between sterilization and reversal. RESULTS: There is an overall hope of 80% of pregnancy at 49 months. Even if there is no statistical difference between the different parameters studied, there is a trend to better reversal results after mechanical sterilization and intervention duration less than 90 minutes. DISCUSSION AND CONCLUSION: Microsurgical tubal reversal is a trustworthy technique, which may be offered to patients regretting their sterilization. Analyzing results by Guzick method is interesting, but insufficiently used although more precise to express a curing (= pregnancy) result than a simple Kaplan-Meier surviving curve. Microsurgical reversal may be proposed to carefully selected patients, even after 40 years.