[French plastic surgeons and humanitarian missions, does a French touch exist?]. / Chirurgie humanitaire, implication des plasticiens français et particularités. Recherche d'une spécificité française ?

France like many other countries has long since been committed to Humanitarian Medicine within the framework of evangelical and territorial expansion. As prodigies of the Age of Enlightenment and the universalisation of Human Rights, French surgeons have successfully exported these inherited values through The Rights of Indigenous Peoples and the creation of nongovernmental organisations recognised worldwide. In addition to the finely acquired medical skills that French surgeons share with other prestigious countries, the "French Touch" appears to be found in their transfer of this knowledge along with their will and commitment to return to the same places as often as possible in order to cultivate local self sustainability.

Human papillomavirus infections in nonmelanoma skin cancers from renal transplant recipients and nonimmunosuppressed patients.

BACKGROUND: Nonmelanoma carcinomas of the skin represent the most frequent cancers among the Caucasian population worldwide. They occur with high frequency in renal allograft recipient patients after prolonged immunosuppression. PURPOSE: We analyzed tumors obtained from both immunosuppressed and nonimmunosuppressed patients for human papillomavirus (HPV) DNA. METHODS: Twenty-nine specimens of nonmelanoma carcinomas of the skin were obtained from 19 renal allograft recipient patients; these included 20 specimens of squamous cell carcinoma (SCC) from 11 patients, five specimens of basal cell carcinoma (BCC) from four patients, and four specimens of carcinoma in situ (CIS) from four patients. Forty-one specimens of nonmelanoma carcinomas of the skin were obtained from 32 nonimmunosuppressed patients; these included 26 SCC specimens from 19 patients, 11 BCC specimens from nine patients, and four keratoacanthoma (benign epithelial tumor) specimens from four patients. A polymerase chain reaction method involving use of degenerate oligonucleotide primers, in which the conserved region of the open reading frame of the HPV L1 (major capsid protein) gene is amplified, was used to amplify total cellular DNA purified from individual tumors. The DNA of each specimen was subjected to 16 different amplification reactions; different primer combinations were used in order to increase the sensitivity and specificity of HPV detection. Resulting products were probed with a radioactively labeled, degenerate oligonucleotide. HPV-specific DNA was either sequenced directly after elution from the gel or amplified with semi-nested, degenerate primers, after which the products were cloned and sequenced. Sequences were compared with all known papillomavirus sequences. RESULTS: Thirteen (65%) of the 20 SCC specimens and three of the five BCC specimens from immunosuppressed (renal allograft recipient) patients contained identifiable HPV-related sequences, among them 13 putative novel HPV genomes. In addition, all other malignant tumor specimens from this patient group revealed faint signals upon amplification and hybridization; the origin of these signals has not been identified in the present study. In nonimmunosuppressed patients, eight (31%) of 26 SCC specimens and four (36%) of 11 BCC specimens contained sequences of HPV types. Two putative novel HPV sequences could be identified in this group. Faint signals of yet undetermined origin were observed in eight of the SCC specimens and in two of the BCC specimens. Two of four keratoacanthoma specimens contained sequences of known HPV type. (Keratoacanthoma is a nonmalignant lesion for which the natural history has not been defined.) The spectrum of HPV types in both groups of patients differed substantially. CONCLUSIONS: These data point to the frequent presence of HPV sequences in SCCs and BCCs of the skin. The etiologic relationship of these infections to the respective malignant tumors remains to be evaluated. IMPLICATIONS: The presence of HPV DNA in a large percentage of specimens of nonmelanoma carcinomas of the skin from immunosuppressed patients, as well as from nonimmmunosuppressed patients, renders a papillomavirus infection as a possible factor in the etiology of this disease.

Human papillomaviruses are commonly found in normal skin of immunocompetent hosts.

We have previously demonstrated, by the combined application of two degenerate polymerase chain reaction primer sets, the presence of human papillomavirus (HPV) DNA in 91% of cutaneous squamous cell cancers from renal allograft recipients, with multiple types being present in one-third of these tumors. Five HPV types--HPV 20, HPV 23, HPV 38, DL40, and DL267--accounted for 73% of positive results. These HPV types are all related to the epidermodysplasia verruciformis group, and HPV 38 was originally isolated from a melanoma. The aims of this study were to determine: (i) whether HPV DNA could readily be demonstrated in skin tumors, as well as in perilesional skin, of immunocompetent patients using two polymerase chain reaction primer sets; (ii) the prevalence of infections in normal skin; and (iii) the prevalence of HPV 38 or HPV 38 related viruses in melanoma. The HPV types detected in lesions from renal allograft recipient were present not only in the perilesional skin and tumors of immunocompetent patients, but also in 35% of normal skin biopsies. HPV DNA was present in 13% of the melanoma samples, but none harbored HPV 38 DNA. We identified four putatively new HPV types. Infections with different types of human papillomavirus are widespread and often occur in clinically normal skin. In vitro studies are required to determine the specific molecular mechanisms by which these HPV types may be involved in the etiology of nonmelanoma skin cancer.

Stereoselective synthesis of iso-dolaproine via dynamic kinetic resolution.

[see reaction]. An efficient multigram-scale synthesis of optically pure Boc-(2S,3R,4S)-iso-dolaproine is reported using dynamic kinetic resolution (DKR). The catalytic asymmetric hydrogenation of ethyl (4S)-3-(2'-pyrrolidinyl)-3-oxo-2-methyl propanoate hydrochloride using in situ generated Ru[(S)-MeO-BIPHEP]Br2 catalyst affords the anti beta-hydroxy alpha-methyl ester quantitatively. The two new stereogenic centers are simultaneously controlled with high diastereoselectivity.

Papillomavirus in esophageal papillomas and carcinomas.

Human papillomavirus (HPV) has been implicated as a possible etiological factor in the development of squamous-cell carcinoma of the esophagus. Published data demonstrating HPV DNA in these lesions have been conflicting, varying between failure to detect HPV DNA to detection of up to 60% to 70% of the biopsies harboring HPV DNA, mainly HPV 16 and HPV 18. We have analyzed esophageal carcinoma samples from 2 high-risk areas, China and South Africa, using a degenerate PCR approach. All amplified products were cloned and sequenced. A broad spectrum of HPV types was demonstrated in 10/29 samples from China and 9/34 samples from South Africa. HPV types detected included mucosal types HPV 6, 18, 51, 52 and 57; cutaneous types HPV 9, 20, 24 and 25; and the putative new HPV types DL231, DL428 and DL436, with HPV 6/51, 6/57, 20/9 and 20/DL231 occurring as double infections. HPV 6 predominated (4 samples) in 11 esophageal papillomas originating from patients in Europe and tested for HPV DNA. Other HPV types present included HPV 20, DL284 and DL436. Another putative new HPV type, DL416, was identified in a dysplastic lesion of the esophagus.

The limitation of primary excision of cicatricial alopecia: a report of 63 patients.

This 11-year retrospective study (1985-1996) of 63 patients demonstrates that cicatricial alopecia is almost always distressing for the patient and is considered as a social handicap, which makes repair a necessity. Two major therapeutic methods for remedying this condition were used in the study: suture excision and tissue expansion. The optimal use and limitations of each method are defined on the basis of treatment quality, as evaluated by the patient and the surgeon. Suture excision often ends with disappointing results for the surgeon as well as the patient and seems limited to alopecias no greater than 10 mm in width. Tissue expansion is considered generally satisfactory, but has the problem of scar enlargement, which reduces the quality of the result.

Prevailing papillomavirus types in non-melanoma carcinomas of the skin in renal allograft recipients.

The role of human papillomavirus (HPV) in the aetiology of in situ and invasive carcinoma of the genital tract is well established. In the rare disorder epidermodysplasia verruciformis (EV), in which patients develop extensive warts of unusual types and multiple cutaneous squamous cancers on light-exposed skin, current evidence suggests a probable role for a specific group of EV HPVs in the carcinogenic process. Determination of the possible role of HPV in the aetiology of non-melanoma skin cancers (NMSCs), which occur frequently in immunosuppressed organ allograft recipients, has been limited, until recently, by the lack of availability of a sensitive detection system for a wide range of cutaneous HPV types. We have used a combination of 2 sets of PCR primers to examine 68 benign and malignant tumours collected over a 12-year period from 25 renal allograft recipients. Cloning and sequencing of the PCR products were carried out to distinguish HPV DNA from cellular sequences. A combination of these techniques revealed HPV DNA in all viral warts, 65% of keratoses, 91% of intra-epidermal cancers and 91% of invasive squamous cancers. Both cutaneous and EV HPV types were detected, including 18 novel types. In 4 patients with multiple cancers, the most prevalent types were in the EV group: HPV 20, 23, 38 and 2 novel types, DL40 and DL267 (related to HPV 10 and 38, respectively). These 5 HPV types were present in a total of 73% of all malignant lesions tested. The technique described represents a reliable method of HPV DNA detection in NMSC. The EV group of HPVs predominate in the cancers, but the multiplicity of HPV types detected with double infection in some lesions suggests virus/virus in addition to virus/host interaction in the carcinogenic process.

Corn phosphoglycolate phosphatase: Modulation of activity by pyridine nucleotides and adenylate energy charge.

The activity of corn phosphoglycolate phosphatase (EC 3.1.3.18), a bundle sheath chloroplastic enzyme, is modulated, in vitro, both by NADP(H) and adenylate energy charge. The Vmax of the enzyme is increased by NADP (25%) and NADPH (16%) whatever the pH used, 7.0 or 7.9 respective pH of the stroma in the dark and in the light. At both pH, the adenylate energy charge alone has a positive effect with two peaks of activation, characteristics for this enzyme, at 0.2 and a maximum at 0.8 accentuated under nonsaturating concentration of phosphoglycolate. At low energy charge, NADP(H) increased the activation with an additive effect most particularly observed at pH 7.9 under saturating phosphoglycolate concentration; at high energy charge, NADP(H) had a positive or negative effect on the activation, depending on the pH value and the concentrations of substrate and NADP(H).The ferredoxin-thioredoxin system does not regulate the activity since i) DTT addition do not have any effect, ii) the light-reconstituted system containing ferredoxin, ferredoxin-thioredoxin reductase, thioredoxins and thylakoids is not effective either. However, light-dark experiments indicate that phosphophycolate phosphatase can be subjected to a fine tuning of its activity.All these data suggest that light cannot induce a modification of the protein but could exert a tight control of its activity by the intermediate of Mg(2+) and substrate concentrations and the levels of metabolites such as NADP(H), ATP, ADP, AMP. So, the regulation of the activity shown, in vitro, by energy charge and NADP(H) might be of physiological significance.

[Necrotizing fasciitis of the upper limb. Apropos of a case]. / Fasciite nécrosante du membre supérieur. A propos d'un cas.

Necrotizing fasciitis is a rare infection, serious because of its risk of functional sequelae and mortality. The first clinical and histological descriptions of acute Streptococcal infection of the fascia were published in 1924 by Meleney, who referred to this condition as "Streptococcal haemolytic gangrene". However, since Meleney, numerous authors have reported cases of necrotizing fasciitis due to a wide range of bacteria. The authors report a case of necrotizing fasciitis of the upper limb in a 45 year old man following a superficial lesion of the dorsum of the hand. Despite the use of antibiotics, the morbidity and mortality of this disease are still high. Treatment is surgical and must be performed urgently. A review of the literature groups together the published cases and analyses the various aetiologies and risk factors.

[Dermoid cyst of the scalp. Apropos of a case]. / Kyste dermoïde du cuir chevelu. A propos d'un cas.

A subgaleal dermoid cyst of a 32 years old white adult is reported. The lesion appeared at the age of several years and ten regularly. Clinical examination, complementary exams as well as the result of the operation are reported. Embryology, histological classification and the main clinical, laboratory and histological characteristics of such lesions are defined by the review of the literature. Subgaleal dermoid cyst is rare in childhood and exceptionally occurs in adults. Only six cases of subgaleal dermoid cyst of adult are mentioned in the literature. Most of the time, the lesion is situated on the anterior fontanelle. The treatment is surgical and the prognosis is excellent.

An interlaboratory study to determine the presence of human papillomavirus DNA in esophageal carcinoma from China.

Esophageal-carcinoma samples originating from the high-incidence area of China were tested in 2 different laboratories, each using a different degenerate PCR approach. Results confirmed the notion that none of the PCR approaches available for HPV-DNA detection today, is optimal for detecting all known HPV types at equal sensitivity and specificity. In combining results obtained in both laboratories, HPV DNA was demonstrated in 20/117 (17.1%) esophageal-carcinoma samples analyzed. HPV DNA was detected in 3/70 (4.3%) diagnostic biopsies, 7/23 (30.4%) surgical specimen and 10/24 (41.6%) cytological scrapings originating from the entire surface of the esophagus. Mucosotropic HPV types were present in 7/117 (6%) samples, only 3 being of the high-risk types (HPV 16, 18, 33). Other mucosal types found were HPV 6, 11, 13, 53 and 54. Cutaneous HPV types were present in 14/117 (12.0%) samples. HPVs 20 and 38 were present in 3 (2.6%) of the total samples and, in each case, together with another HPV type within one lesion. Two putative new HPV types, DL347 and DL 369, were identified.

Bundle-sheath thylakoids from NADP-malic enzyme-type C4 plants require an exogenous electron donor for enzyme light activation.

Light activation of either NADP-malate dehydrogenase (EC 1.1.1.82) or fructose-1,6-bisphosphate phosphatase (EC 3.1.3.11) was assayed in a reconstituted chloroplastic, system comprising the isolated proteins of the ferredoxin-thioredoxin light-activation system and thylakoids from either mesophyll or bundle-sheath tissues of different C4 plants. While C4-plant thylakoids functionned almost equally well with C3-or C4-plant proteins, the photosyntem-II-deficient bundle-sheath thylakoids from the NADP-malic enzyme type, were unable to perform enzyme photoactivation unless supplemented with an electron donor to photosystem I. Bundle-sheath thylakoids isolated from plants showing no photosystem-II deficiency did not require such an addition. The results are discussed with respect to a possible requirement for a physiological reductant of ferredoxin for enzyme light activation in bundle-sheath, tissues.

Immunological detection of potential signal-transduction proteins expressed during wheat somatic tissue culture.

An immunochemical approach was used to detect the expression of putative guanine nucleotide-binding proteins (G-proteins), arrestin, and nucleoside diphosphate kinases during wheat (Triticum aestivum) tissue culture initiated from immature embryos. Both the soluble and membrane extracts from the immature embryos revealed bands of 58, 40, and 16 kD with antibodies to G-protein (alpha subunit), arrestin, and nucleoside diphosphate kinase, respectively. These proteins were overexpressed in vitro in both nonembryogenic callus and embryogenic cultures. An additional soluble protein (32 kD) was detected by anti-G alpha antibodies in cultured tissues but not in immature embryos, suggesting a possible function in cell multiplication. Moreover, somatic embryogenesis was associated with the appearance of a 29-kD protein reactive with anti-arrstin antibodies, both in soluble and membrane fractions. Tissue-cultured genetic stocks of Chinese Spring wheat, including the disomic, 36 ditelosomic, and 6 nullisomic-tetrasomic wheat lines, were used to ascertain the chromosomal location of the genes encoding the 29-kD arrestin-like protein. The lack of a signal with the nonembryogenic ditelosomic 3 D short chromosome arm line suggests that the 3 D long chromosome arm possesses at least one gene involved in the expression of the 29-kD protein. The putative role of the 29-kD protein in signal-transduction regulating embryogenesis is discussed.

[Paraffinomas: history, clinical features and treatment. A case report]. / Les paraffinomes: historique, aspects cliniques et traitement. A propos d'une observation.

One case of paraffinoma is reported on a 60 years old man following injections of paraffin fourty years ago. The authors recalled with this observation history of paraffin, clinical aspect and surgical treatment of the paraffinoma.

[Cover of trochanter pressure sores by V-Y musculocutaneous flap of the fascia lata]. / Couverture des escarres trochantériennes par lambeau musculo-cutané de fascia lata en V-Y.

Authors report their experience with the V-Y advancement flap in the coverage of trochanteric pressure sores. Nine flaps have been performed concerning 7 patients. Trochanteric sores in paraplegia or tetraplegia may lead to suppurative arthritis of the hip, with a risk of anaerobic infection and acute septicaemia. The treatment has to be as complete as possible. The trochanteric sore is debrided, with special attention given to removing all necrotic material, the surrounding bursa, and the bony prominence of the greater trochanter. The debrided trochanteric region is then covered by a well-vascularized and thick tissue. We observed only one complication at the donor site which can be closed primarily by this technique. The V-Y advancement technique is a new, simple and safe design of tensor fasciae latae flap. The defect is covered by the thicker and the best vascularized portion of the musculo-cutaneous flap. It allows preservation of other donor sites of the gluteal region to cover other sores, which are often associated.