Effect of zopiclone and midazolam on sleep and EEG spectra in a phase-advanced sleep schedule.

Midazolam (15 mg), a benzodiazepine (BDZ) hypnotic, and zopiclone (7.5 mg), a non-BDZ hypnotic, were administered to young, healthy subjects prior to bedtime. They went to bed at 2300 hours after taking placebo (PL-23), and then on three occasions at 1900 hour after taking placebo (PL-19) or one of the hypnotics. Advancing bedtime by 4 hour increased the combined value of waking, stage 1, and movement time. Compared to PL-19, both drugs reduced sleep latency and stage 3, and increased stage 2. Spectral analysis of the EEG in non-rapid-eye-movement sleep revealed a declining trend of power density in the low-frequency range in the course of the night. Activity in the 1 to 10 Hz range was markedly depressed by the two hypnotics, whereas activity in the spindle range (11 to 14 Hz) was augmented. The former changes persisted throughout the 12-hour recording period. The fact that both hypnotics bind to BDZ receptors could be responsible for the similar effects on the EEG spectra.

Crossover study of thalidomide vs placebo in severe recurrent aphthous stomatitis.

A multicentric crossover randomized trial of 100 mg of thalidomide vs placebo each for 2 months was conducted in patients with severe aphthous stomatitis of more than 6 months' duration. Seventy-three patients were included. Complete remission was obtained in 32 patients who received thalidomide and in 6 patients who received placebo. The confidence interval of the difference between the two treatments ranged from 25% to 53%. Most of the patients who did not achieve a complete remission had a dramatic improvement with regard to the number of aphthae when they were receiving thalidomide. Thirteen of 17 patients who had a complete remission while they were receiving thalidomide had a recurrence with placebo, 19 +/- 9 (mean +/- SD) days after stopping this drug. Side effects were significantly more frequent with thalidomide, especially drowsiness and constipation. We concluded that thalidomide in a dosage of 100 mg/d is an effective treatment of severe aphthous stomatitis but is not without some risk.

[Immediate treatment of bullous pemphigus with a corticosteroid-cyclophosphamide combination]. / L'association corticostéroïdes-cyclophosphamide d'emblée dans le traitement de la pemphigoïde bulleuse.

Optimal management of the patient with generalized bullous pemphigoid (BP) should both control the disease rapidly to avoid fluid losses and superinfection, and have minimal side-effects. Although their initial dosage is subject to some controversy, corticosteroids (CS) provide currently the basis of therapy. Immunosuppressants have been advocated to decrease CS dosages more rapidly and to reduce potential hazards of long-term systemic steroid therapy, because of their sparing effect on cumulated CS doses. They have a delayed activity ranging from three to six weeks after beginning of therapy. Chloraminophene has been used in most previous studies. The aim of this study was to assess retrospectively a combined CS-cyclophosphamide (CP) regimen. Ten patients with generalized BP were treated. In nine, dexamethasone sodium phosphate was given intravenously (mean: 1.56 mg/kg/day in prednisone equivalents; range: 1 to 1.90 mg/kg/day) at onset of treatment. Prednisolone was given orally when complete control--absence of any new lesion--was achieved. CP was given d'emblée at a daily dosage of 100 mg for at least 6 months when feasible (mean: 4 months; range 9 days to 15 months). Patients characteristics are summarized in table I. Results are shown in tables II and III. In brief, three deaths occurred following major side-effects of the drugs during the first three months of treatment. Further non lethal untoward effects included bone marrow toxicity due to CP and septicemia (4 patients). At the end of follow-up, 5 patients were in remission without treatment for 22 +/- 6 months and one was controlled with prednisolone alone.(ABSTRACT TRUNCATED AT 250 WORDS)

["Saber-cut" scleroderma and Parry-Romberg facial hemiatrophy. Nosologic problems. Neurologic complications]. / Sclérodermie "en coup de sabre" et hémi-atrophie faciale de Parry-Romberg. Problème nosologique. Complication neurologique.

We report two cases of gradual facial hemiatrophy (Parry-Romberg syndrome). The first patient, an adolescent girl under treatment for hypothyroidism, presented with a very severe form combining advanced facial hemiatrophy, epilepsy with hemi-generalized seizures and hemiatrophy of the brain. The second patient was a girl who presented with localized scleroderma resembling a saber injury, homolateral cerebral atrophy and contralateral hemiparesis. Our two cases are evidence in support of a close relationship between saber injury-like scleroderma and the Parry-Romberg syndrome.

[Lichenoid pityriasis (parapsoriasis guttata) in children. Report of 17 cases]. / Pityriasis lichénoïde (parapsoriasis en gouttes) de l'enfant. A propos de dix-sept cas.

Seventeen cases of pityriasis lichenoides diagnosed over a nine-year period in children under 15 years of age are reported. Patients with this benign disease develop papular skin lesions covered with thick, coherent scales which detach in a single piece (reminiscent of sealing wax). Pruritus is not marked. Lesions may be necrotic (Mucha Habermann's small pox-like form, n = 6) or mild (leukodermic form, n = 2). Half of the patients studied developed several episodes and total duration of the disease exceeded two years in one third of cases. Recovery occurred after one or two episodes in half the children. Scars developed in some patients with severely necrotic lesions. None of the patients developed lymphoma. All patients with lymphomatoid papulosis progressing to lymphoma reported in the literature were adults. Pathogenesis of pityriasis lichenoides remains unknown but may involve lymphocytic vasculitis. No truly effective therapy is available. However, oral macrolides can be used especially in patients with early manifestations suggesting an infectious disease. Emollients, heliotherapy and ultraviolet therapy may also be recommended.

[Acute infectious cellulitis. Apropos of 28 cases]. / Les cellulites infectieuses aiguës. A propos de vingt-huit observations.

Acute infectious cellulitis is a common condition in pediatric patients. We retrospectively studied 28 cases seen over the last four years. Average age of patients was four years. Fever and a decline in general health were often found. Streptococcus pyogenes and Staphylococcus aureus were the most common organisms in our series. Outcome was favorable under early antimicrobial therapy selected according to age and clinical features. Before three months of age, cellulitis suggests a streptococcus B infection and should be treated by ampicillin or parenteral penicillin, combined with an aminoglycoside if called for. Between 4 months and 2 years of age, Haemophilus influenzae b or a pneumococcus are the most likely organisms; Haemophilus cellulitis should be treated by a third generation cephalosporin for ten days or longer, followed by ampicillin or ampicillin-clavulanic acid per os for ten or 15 days. Beyond 2-3 years of age, all organisms may be the cause of cellulitis, but the most likely are Streptococcus pyogenes and Staphylococcus aureus, treatment consists in administration of either a penicillin M or a macrolide, the route being selected according to the general condition and site of the cellulitis.