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1.
Ann Dermatol Venereol ; 144(6-7): 423-425, 2017.
Artículo en Francés | MEDLINE | ID: mdl-28242093

RESUMEN

BACKGROUND: Acute generalized exanthematous pustulosis (AGEP) is a severe drug eruption. We report herein the first case of AGEP induced by phloroglucinol (Spasfon®). PATIENTS AND METHODS: A 27-year-old pregnant woman developed a febrile exanthematous pustulosis eruption three days after treatment with intravenous phloroglucinol and paracetamol for nephritic colic. She had no previous history of psoriasis. The laboratory workup showed hyperleukocytosis with neutrophilia. A cytobacteriological sample of the pustules was negative. Skin biopsy revealed marked neutrophilic and leukocytoclastic vasculitis. Reintroduction of phloroglucinol after delivery resulted in the same clinical symptoms within a few hours of intake. A diagnosis of phloroglucinol-induced AGEP was made on the basis of intrinsic imputability of I4 (S3 C3) using the imputability criteria of Begaud et al. The outcome was favorable after withdrawal of the drug. DISCUSSION: To the best of our knowledge, this is the first case of phloroglucinol-induced AGEP confirmed by reintroduction of the drug.


Asunto(s)
Pustulosis Exantematosa Generalizada Aguda/diagnóstico , Pustulosis Exantematosa Generalizada Aguda/etiología , Indicadores y Reactivos/efectos adversos , Floroglucinol/efectos adversos , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/etiología , Acetaminofén/administración & dosificación , Antipiréticos/administración & dosificación , Biopsia , Femenino , Humanos , Embarazo , Cólico Renal/tratamiento farmacológico , Piel/patología
2.
Ann Oncol ; 27(5): 914-9, 2016 05.
Artículo en Inglés | MEDLINE | ID: mdl-26811346

RESUMEN

BACKGROUND: Sentinel lymph-node (LN) biopsy (SLNB) is a valuable tool to assess the regional LN status in Merkel cell carcinoma (MCC). However, its prognostic value is still debated. This study was undertaken to assess SLNB usefulness for MCC management and to determine the impact of SLNB status on disease-free survival (DFS) and overall survival (OS) by comparing SLNB-positive versus -negative patients according to demographic, clinical and treatment characteristics. PATIENTS AND METHODS: In this retrospective, multicenter observational study, SLNB was proposed to all patients referred for clinically N0 MCC. Treatment schedule consisted of wide-margin surgical resection of primary MCC followed by adjuvant radiation therapy (aRT) to the primary site and, for SLNB-positive patients, radical LN dissection followed by regional aRT. Univariate and multivariate analyses determined factors associated with DFS and OS. RESULTS: Among 87 patients with successful SLNB, 21 (24.1%) were SLNB-positive. Median follow-up for the entire series was 39 months; respective 3-year DFS and OS rates were 73% and 81.4%, respectively. Univariate analysis (all patients) identified SLNB-negativity as being associated with prolonged OS (P = 0.013) and aRT (all sites considered) was associated with longer DFS (P = 0.004) and OS (P = 0.018). Multivariate analysis (all patients) retained SLNB status and aRT (all sites considered) as being associated with improved DFS (P = 0.014 and 0.0008) and OS (P = 0.0020 and 0.0019). Moreover, for SLNB-negative patients, tumor-bed irradiation was also significantly associated with prolonged DFS (P = 0.006) and OS (P = 0.014). CONCLUSIONS: The present study demonstrates that SLNB-negativity is a strong predictor of longer DFS and OS in stage I and II MCC patients. The similar benefit for aRT on tumor bed observed in this study has to be confirmed by a prospective study. The results advocate for SLNB being considered to all MCC patients.


Asunto(s)
Carcinoma de Células de Merkel/radioterapia , Pronóstico , Radioterapia Adyuvante , Biopsia del Ganglio Linfático Centinela , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células de Merkel/patología , Carcinoma de Células de Merkel/cirugía , Supervivencia sin Enfermedad , Femenino , Humanos , Escisión del Ganglio Linfático , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios Retrospectivos , Ganglio Linfático Centinela/patología , Ganglio Linfático Centinela/cirugía , Resultado del Tratamiento
3.
Ann Dermatol Venereol ; 142(5): 350-5, 2015 May.
Artículo en Francés | MEDLINE | ID: mdl-25683011

RESUMEN

BACKGROUND: Lymphedema induced by mTOR inhibitors is a side-effect rarely reported to date. PATIENTS AND METHODS: Long-lasting bilateral lower-limb lymphedema with left predominance developed in a 71-year-old stable renal transplant recipient after 40 months of sirolimus treatment. Although no change in lymphedema was observed after 21 months despite dosage reduced, it improved markedly after changeover to tacrolimus. DISCUSSION: Regardless of the individual drug, mTOR inhibitors can cause lymphedema. This effect may be countered through substitution with tacrolimus. CONCLUSION: Physicians should be aware of lymphedema as a side-effect of mTOR inhibitors. It can be improved by substitution with tacrolimus. However, early withdrawal of mTOR inhibitors is recommended before irreversible lymphedema occurs.


Asunto(s)
Inmunosupresores/efectos adversos , Linfedema/inducido químicamente , Sirolimus/efectos adversos , Tacrolimus/uso terapéutico , Anciano , Femenino , Humanos , Trasplante de Riñón , Sirolimus/uso terapéutico , Receptores de Trasplantes
4.
Br J Dermatol ; 171(4): 895-8, 2014 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-24773172

RESUMEN

We report a case of drug reaction with eosinophilia and systemic symptoms (DRESS) in a patient with HIV receiving antitoxoplasmic drugs (adiazine and pyrimethamine) and levetiracetam along with highly active antiretroviral therapy (tenofovir-emtricitabine, darunavir and ritonavir). Cytomegalovirus (CMV) infection was reactivated in the 7 weeks before the development of DRESS but was successfully treated with ganciclovir and corticosteroids. DRESS flare was concomitant with another CMV reactivation after the withdrawal of ganciclovir. This case report is an example of DRESS that may be considered real DRESS or virus reactivation with eosinophilia and systemic symptoms (VRESS) as a manifestation of immune reconstitution inflammatory syndrome. The case confirms that herpesvirus reactivation precedes DRESS or VRESS, and suggests the need to monitor herpesvirus infection in patients at risk for the infection or after the initiation of culprit drugs.


Asunto(s)
Síndrome de Hipersensibilidad a Medicamentos/diagnóstico , Síndrome Inflamatorio de Reconstitución Inmune/complicaciones , Antiprotozoarios/efectos adversos , Terapia Antirretroviral Altamente Activa/efectos adversos , Infecciones por Citomegalovirus/inducido químicamente , Diagnóstico Diferencial , Síndrome de Hipersensibilidad a Medicamentos/etiología , Eosinofilia/inducido químicamente , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Persona de Mediana Edad , Toxoplasmosis Cerebral/tratamiento farmacológico , Activación Viral
5.
J Eur Acad Dermatol Venereol ; 27(9): 1138-42, 2013 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-22913528

RESUMEN

BACKGROUND: Most dermatological conditions can be evaluated using validate clinical scores, no such tool is available for irritant contact dermatitis (ICD). OBJECTIVE: To create and validate a grid-based ICD severity score. METHODS: Three dermatologists developed the SCOre de REparation de l'EPIderme (SCOREPI) grid. Two studies were conducted to validate the SCOREPI. A cross-sectional study assessed the intra- and inter-observer error associated with using the SCOREPI. Each investigator received 15 min of training on proper use of the SCOREPI. A computer displayed a series of 20 photos of ICD, each of which were repeated three times in a randomized order. The prospective study assessed the correlation between SCOREPI with the severity of clinical symptoms as well as the sensitivity of the score to changes in ICD in response to topical treatment. RESULTS: The SCOREPI took an average of 35 ± 5 s to be completed and was characterized by an excellent intra-observer and moderate inter-observer reproducibility (intra-class correlation coefficient = 0.93 and 0.74, respectively). Significant divergence was observed between the physicians' assessment of estimated surface (P = 0.04), the presence of erythema (P < 0.0001) and the number of deep cracks (P = 0.0008). In the prospective analysis of patients, SCOREPI was correlated with tightness (r = 0.45; P < 0.0001), pain (r = 0.45; P < 0.0001), burning (r = 0.42; P < 0.0001), and pruritus (r = 0.28; P = 0.0055). SCOREPI decreased considerably during follow-up from 10.45 ± 4.61 to 4.82 ± 4.15 (P < 0.0001). CONCLUSION: The SCOREPI is easy to use, sensitive to change, and characterized by high intra- and moderate inter-observer reliability.


Asunto(s)
Dermatitis Irritante/diagnóstico , Índice de Severidad de la Enfermedad , Adolescente , Adulto , Anciano , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Adulto Joven
7.
Ann Dermatol Venereol ; 140(2): 112-5, 2013 Feb.
Artículo en Francés | MEDLINE | ID: mdl-23395492

RESUMEN

BACKGROUND: Primary EBV infection mainly affects children and young adults. Most patients present the characteristic triad of fever, pharyngitis and lymphadenopathy. Symptoms may include a morbilliform eruption, occasionally induced by amoxicillin. We report a case of Stevens-Johnson syndrome concurrent with EBV infection. CASE REPORT: A 17-year-old boy consulted for an eruption suggestive of Stevens-Johnson syndrome, which was supported by the histopathology results. The patient had taken no medication during the previous weeks. Laboratory examinations showed atypical activated T lymphocytes. Serological tests and PCR results confirmed the diagnosis of primary EBV infection. The outcome was spontaneously favorable with only symptomatic treatment being required. DISCUSSION: Stevens-Johnson syndrome is characterized by "target" lesions and profuse mucous membrane involvement. Stevens-Johnson syndrome is frequently drug-induced, being due less frequently to infections. Stevens-Johnson syndrome is very rarely a manifestation of infectious mononucleosis, with only one case being reported in the literature. When confronted with Stevens-Johnson syndrome without any imputable medication, complete screening for infection should be performed, in particular for primary EBV infection.


Asunto(s)
Mononucleosis Infecciosa/complicaciones , Síndrome de Stevens-Johnson/etiología , Adolescente , Anticuerpos Antivirales/sangre , Herpesvirus Humano 4/inmunología , Humanos , Masculino , Síndrome de Stevens-Johnson/patología , Linfocitos T/patología
8.
Ann Dermatol Venereol ; 140(2): 83-90, 2013 Feb.
Artículo en Francés | MEDLINE | ID: mdl-23395488

RESUMEN

BACKGROUND: Rosai-Dorfman disease (RDD) is a benign form of non-Langerhans-cell histiocytosis. It is identified by a particular histological profile first observed in febrile lymph nodes. Extranodal sites are frequent. The most common site is the skin, which can reveal the disease despite a difficult and delayed diagnosis. Seven cases of cutaneous revelation of RDD were studied retrospectively in order to delineate the clinical characteristics and facilitate diagnosis and treatment of this extremely rare disease. PATIENTS AND METHODS: Six cases of RDD from 1990 to 2011 were identified in the photographic and histopathological records of the Saint-Louis Hospital and one case came from a Bichat Hospital consultation. The diagnosis was based in all cases on histopathology results. RESULTS: Patients consisted of four men and three women aged between 31 and 69 years. Cutaneous lesions (3 to 20) revealed the disease in all of them and the time from disease onset to diagnosis ranged from six months to five years. The clinical presentation was erythematous or orange popular nodules or plaques, usually on the face. Microscopically, a dense dermal infiltration was observed, in some cases extending into the subcutaneous tissue, with pale histiocytic cells characterised by emperipolesis, plasma cells, lymphocytes, some neutrophils and variable fibrosis. The diagnosis, initially erroneous in 4 cases, was rectified by a second reading of histopathology slides, and immunohistochemical studies showed expression of S-100 protein in histiocytes but not CD1a. Three patients had pure cutaneous RDD. Two neurological sites and one nasal site were also found, with one ENT site and sequelae of previous uveitis in one patient. All extra-cutaneous sites were identified by clinical examination. Different treatments were proposed according to the sites and impact of the disease. In one case, the lesions regressed spontaneously after 18 months. COMMENTS: Few RDD series have been published and they mainly concern Asian patients. The ethnic origin of our patients was varied. The main findings were: 1) common clinical findings (orange or erythematous papules or nodules, mostly on the upper body), which should alert the dermatologist and histopathologist to the possible diagnosis of RRD; 2) the possibility, already mentioned in the literature, of spontaneous regression and a good prognosis; 3) the need for thorough evaluation by thoracic, abdominal and cerebral CT (computed tomography) or more a PET (positron emission tomography) scan to screen for potentially dangerous visceral sites, and also clinical follow up.


Asunto(s)
Histiocitosis Sinusal/diagnóstico , Piel/patología , Adulto , Anciano , Antígenos CD1/análisis , Biomarcadores , Encéfalo/patología , Diagnóstico Tardío , Errores Diagnósticos , Emperipolesis , Dermatosis Facial/diagnóstico , Dermatosis Facial/patología , Femenino , Glucocorticoides/uso terapéutico , Histiocitos/química , Histiocitos/ultraestructura , Histiocitosis Sinusal/complicaciones , Histiocitosis Sinusal/tratamiento farmacológico , Histiocitosis Sinusal/patología , Histiocitosis Sinusal/cirugía , Humanos , Masculino , Metotrexato/uso terapéutico , Persona de Mediana Edad , Obstrucción Nasal/etiología , Remisión Espontánea , Estudios Retrospectivos , Proteínas S100/análisis , Convulsiones/etiología
10.
Br J Dermatol ; 162(4): 743-50, 2010 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-19886889

RESUMEN

BACKGROUND: Fine analysis of antiskin autoantibodies can contribute to the differential diagnosis of autoimmune bullous dermatoses. OBJECTIVES: To develop a high-performance immunoblotting method using human amniotic membrane as the antigen source, and to compare it with current laboratory methods. METHODS: Sera from 113 patients were tested by immunoblotting (IB), rat and monkey oesophagus and salt-split skin indirect immunofluorescence (IIF), and enzyme-linked immunosorbent assay (ELISA) quantification of anti-BP180-NC16a and anti-BP230, or antidesmoglein (Dsg) 1 and 3 antibodies. There were 56 cases of bullous pemphigoid (BP), 22 cases of mucous membrane pemphigoid (MMP), eight cases of epidermolysis bullosa acquisita (EBA), two cases of bullous systemic lupus erythematosus (BSLE), 17 cases of pemphigus vulgaris (PV), and four cases each of pemphigus foliaceus (PF) and paraneoplastic pemphigus (PNP). RESULTS: In BP, the three methods had similar sensitivity (84-89%) for both anti-BP180-NC16a and anti-BP230 antibody detection. In MMP, autoantibodies (mainly directed against BP180 or laminin 332 subunits) were detected in 77% of patients by IB, compared with only 9% by IIF on rat and monkey oesophagus and 36% on salt-split skin, and 14% by anti-BP180-NC16a and anti-BP230 ELISA. In patients with pemphigus, ELISA had 92% sensitivity for anti-Dsg1 and 3, but IB and rat bladder IIF were necessary to confirm PNP by revealing specific and rare patterns (antidesmoplakin I/II, antienvoplakin and antiperiplakin antibodies). IB also revealed anticollagen VII antibodies in 60% of patients with EBA and BSLE, and antibodies to BP180, BP230 and Dsg3 in a few patients who were negative using the other two techniques. CONCLUSION: Amniotic membrane immunoblotting is an interesting diagnostic tool for bullous diseases, as the entire panel of autoantibodies can be detected with a single extract. This method improves the identification of complex and heterogeneous autoimmune processes in conjunction with IIF and ELISA, and is particularly useful for MMP characterization.


Asunto(s)
Amnios/inmunología , Autoanticuerpos/inmunología , Immunoblotting/métodos , Enfermedades Cutáneas Vesiculoampollosas/diagnóstico , Animales , Biomarcadores , Estudios de Casos y Controles , Ensayo de Inmunoadsorción Enzimática/métodos , Técnica del Anticuerpo Fluorescente/métodos , Haplorrinos , Humanos , Ratas , Enfermedades Cutáneas Vesiculoampollosas/inmunología
11.
Ann Dermatol Venereol ; 137(12): 769-74, 2010 Dec.
Artículo en Francés | MEDLINE | ID: mdl-21134578

RESUMEN

BACKGROUND: a clinical study of 14 patients presenting both malignant melanoma and HIV infection, and analysis of the literature to determine the frequency and specific features of this association. PATIENTS AND METHODS: ten men and four women of median age 43 years were included. In 50% of cases, the primary melanoma consisted of spreading superficial melanoma with a mean Breslow thickness of 2.83 mm. In two cases, regional lymph node metastasis was discovered but with no primary melanoma being identified. HIV infection was already documented on diagnosis of melanoma in 11 cases, and it was discovered in three cases at the time of surgery for melanoma (treatment of the primary melanoma in two cases, and in one case, regional lymph node dissection two years after the initial diagnosis). Eight patients died within a mean period of 39 months, with melanoma being the cause of death in six cases. Following relapse of melanoma, the course of the disease was severe, with mean stage IV survival of 3.6 months. No response to chemotherapy was observed where such treatment was feasible. DISCUSSION: the presence of HIV appears to be an aggravating factor for the outcome of metastatic melanoma. CONCLUSION: our study suggests the importance of clinical examination of pigmented lesions in HIV patients in order to ensure early identification of melanoma.


Asunto(s)
Seropositividad para VIH/diagnóstico , Melanoma/diagnóstico , Neoplasias Cutáneas/diagnóstico , Adulto , Causas de Muerte , Diagnóstico Precoz , Femenino , Seropositividad para VIH/mortalidad , Seropositividad para VIH/patología , Humanos , Metástasis Linfática/patología , Masculino , Melanoma/mortalidad , Melanoma/patología , Melanoma/cirugía , Persona de Mediana Edad , Recurrencia Local de Neoplasia/diagnóstico , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/cirugía , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Neoplasias Cutáneas/mortalidad , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/cirugía , Tasa de Supervivencia
12.
Ann Dermatol Venereol ; 136(11): 806-10, 2009 Nov.
Artículo en Francés | MEDLINE | ID: mdl-19917434

RESUMEN

BACKGROUND: The increasing use of anti-TNFalpha exposes patients to emerging risks, particularly that of infection. We report a case of severe cutaneous Mycobacterium marinum infection in a patient treated with infliximab and we discuss therapeutic options. PATIENTS AND METHODS: A man treated with infliximab for Crohn's disease developed a severe cutaneous infection with M. marinum. Despite withdrawal of infliximab and the introduction of triple antibiotic therapy, the patient's lesions worsened and surgical treatment was required. DISCUSSION: The worsening experienced by our patient 1 week after the beginning of the treatment is comparable with the immune reconstitution syndrome occasionally observed in tuberculosis in immunocompromised hosts, thus raising the question of the potential value of continuing infliximab treatment. Recommendations are needed concerning the prevention and treatment of M. marinum infections in patients on anti-TNFalpha biotherapies.


Asunto(s)
Anticuerpos Monoclonales/uso terapéutico , Enfermedad de Crohn/tratamiento farmacológico , Fármacos Gastrointestinales/uso terapéutico , Infecciones por Mycobacterium no Tuberculosas/inducido químicamente , Infecciones por Mycobacterium no Tuberculosas/tratamiento farmacológico , Antibacterianos/uso terapéutico , Anticuerpos Monoclonales/efectos adversos , Fármacos Gastrointestinales/efectos adversos , Humanos , Infliximab , Masculino , Persona de Mediana Edad , Infecciones por Mycobacterium no Tuberculosas/patología , Infecciones por Mycobacterium no Tuberculosas/cirugía , Mycobacterium marinum , Necrosis , Enfermedades Cutáneas Bacterianas/inducido químicamente , Enfermedades Cutáneas Bacterianas/tratamiento farmacológico , Enfermedades Cutáneas Bacterianas/cirugía , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores
13.
Ann Dermatol Venereol ; 136(11): 800-5, 2009 Nov.
Artículo en Francés | MEDLINE | ID: mdl-19917433

RESUMEN

BACKGROUND: Mycosis fungoides during large cell transformation to lymphoma has a poor prognosis with mean survival of 36 months. Autologous stem cell transplantation is rarely proposed in this indication. We report the case of a young man still in complete remission for transformed mycosis fungoides 14 years after autologous stem cell transplantation. CASE REPORT: A 25-year-old man presenting eczema-like patches since childhood was treated by chemotherapy for multiple lymphadenopathies considered as Hodgkin's lymphoma. He was referred with diffuse skin tumours and infiltrated patches. Histology of tumour samples revealed atypical T-cell infiltrate with epidermotropism and presence of more than 25% of large CD30-positive cells. Non-infiltrated patches showed small T-cell lymphoma with epidermotropism. Histological verification of a previous lymphadenopathy confirmed the diagnosis of transformed mycosis fungoides. Despite multiple courses of chemotherapy, the disease progressed, with neurological involvement in particular. Because of tumour aggressiveness, autologous stem cell transplantation was performed and resulted in rapid regression of the tumours, lymphadenopathy and neurological symptoms. Non-transformed mycosis fungoides patches persisted but were controlled with topical mechlorethamine. This patient is still in complete remission for tumour and extracutaneous lesions 14 years after the autograft. DISCUSSION: This was probably a case of juvenile mycosis fungoides diagnosed and transformed in adult age. Neurological involvement by mycosis fungoides is rare and usually carries a drastic prognosis. To our knowledge, this is the longest remission of transformed mycosis fungoides seen after autograft. It highlights the value of this method in aggressive transformed mycosis fungoides, especially in patients ineligible for allograft.


Asunto(s)
Micosis Fungoide/patología , Micosis Fungoide/cirugía , Trasplante de Células Madre , Adolescente , Adulto , Biopsia , Humanos , Pierna/patología , Masculino , Piel/patología , Trasplante Autólogo , Resultado del Tratamiento
14.
Ann Dermatol Venereol ; 136(1): 46-9, 2009 Jan.
Artículo en Francés | MEDLINE | ID: mdl-19171230

RESUMEN

BACKGROUND: Pyoderma gangrenosum is a neutrophilic dermatosis in which systemic involvement is rare. It may be associated with systemic disease. We report a case of pyoderma gangrenosum in the spleen. CASE REPORT: A 68-year-old man presenting pyoderma gangrenosum with pustules and stage I multiple myeloma was admitted for asthenia and abdominal pain. There were no skin lesions. Laboratory tests showed inflammatory syndrome with polynuclear leucocytes of 25,000/mm(3). CAT scans and abdominal ultrasound revealed a splenic abscess. A spleen biopsy was performed and histological examination showed polynuclear leukocyte infiltration, while cultures were negatives. Diagnosis of pyoderma gangrenosum with splenic involvement was made. Increased systemic corticosteroid therapy produced a successful outcome. Haematological findings remained unchanged. DISCUSSION: Spleen involvement in pyoderma gangrenosum is very rare and can mimic an infectious process. In such cases, routine screening is essential for associated diseases, particularly haematological malignancies.


Asunto(s)
Absceso/complicaciones , Piodermia Gangrenosa/complicaciones , Enfermedades del Bazo/complicaciones , Anciano , Mano/patología , Humanos , Recuento de Leucocitos , Masculino
15.
Ann Dermatol Venereol ; 136(6-7): 530-5, 2009.
Artículo en Francés | MEDLINE | ID: mdl-19560616

RESUMEN

BACKGROUND: The antimalarial compounds chloroquine and hydroxychloroquine are widely used in the treatment of connective tissue diseases and are usually well tolerated. We report two cases of chloroquine cardiotoxicity. PATIENTS AND METHODS: Two women (aged 43 and 48 years) were treated for 5 years for lupus. They developed severe conduction disturbances requiring a pacemaker. Plasma chloroquine concentrations were abnormally high in both cases. In one case, a genetic polymorphism modulating the activity of a cytochrome involved in chloroquine metabolism (CYP2C8) was identified. DISCUSSION: Since 1965, 60 cases of occasionally severe cardiotoxicity have been reported following long-term treatment with chloroquine in most cases, but also with hydroxychloroquine. This toxicity must be detected early and close cardiac assessment is required.


Asunto(s)
Antirreumáticos/efectos adversos , Bloqueo Atrioventricular/inducido químicamente , Cloroquina/efectos adversos , Disfunción Ventricular/inducido químicamente , Adulto , Antirreumáticos/administración & dosificación , Bloqueo Atrioventricular/terapia , Cloroquina/administración & dosificación , Electrocardiografía , Femenino , Humanos , Lupus Eritematoso Cutáneo/complicaciones , Lupus Eritematoso Cutáneo/tratamiento farmacológico , Lupus Eritematoso Sistémico/complicaciones , Lupus Eritematoso Sistémico/tratamiento farmacológico , Persona de Mediana Edad , Marcapaso Artificial , Síndrome de Sjögren/complicaciones , Síndrome de Sjögren/tratamiento farmacológico , Disfunción Ventricular/terapia
16.
Ann Dermatol Venereol ; 135(1 Pt 2): 1S70-2, 2008 Jan.
Artículo en Francés | MEDLINE | ID: mdl-18442667

RESUMEN

Within the French Agency for Health Products (AFFSSAPS), there is a section for evaluating medical devices, separate from drug and biological product monitoring. Medical devices vigilance monitors incidents or incident hazards that may result from use of medical devices after they have been put on the market. Anyone, manufacturer, user, or third party who observes or knows of voluntary accident(s) or risk(s) or incidents caused by a medical device, should immediately report to the agency. The dermatologist, for example, is concerned as much by small instrumentation such as lasers and sterilizers, but also implantable medical devices. Each type of report indicates the capacity of the informant, the name of the medical device, as well as its batch and series number, and specifies the incident (date, consequences, and measures taken).


Asunto(s)
Equipos y Suministros , Vigilancia de Productos Comercializados/métodos , Materiales Biocompatibles , Dermatología , Francia , Humanos , Prótesis e Implantes
17.
Ann Dermatol Venereol ; 135(1 Pt 2): 1S66-9, 2008 Jan.
Artículo en Francés | MEDLINE | ID: mdl-18442666

RESUMEN

Medical devices have been individualized to include a category of implantable medical devices, "designed to be totally implanted in the human body or to replace an epithelial surface or a surface of the eye, through surgery, and remain in place after the intervention" (directive 93/42/CEE and decree of 20 April 206). Each implantable medical device has a common name and a commercial name for precise identification of the model (type/references). The users' service and the implanting physician should be clearly identified. There are a number of rules concerning health traceability to rapidly identify patients exposed to risks in which the implantable medical devices of a particular batch or series were used and to monitor the consequences. The traceability data should be preserved 10 years and the patient's medical file for 20 years.


Asunto(s)
Prótesis e Implantes , Francia , Sector de Atención de Salud/legislación & jurisprudencia , Humanos , Legislación Médica , Registros Médicos/legislación & jurisprudencia , Médicos/legislación & jurisprudencia , Vigilancia de Productos Comercializados/métodos , Prótesis e Implantes/clasificación , Registros/legislación & jurisprudencia , Terminología como Asunto
18.
Ann Dermatol Venereol ; 135(1): 48-52, 2008 Jan.
Artículo en Francés | MEDLINE | ID: mdl-18342074

RESUMEN

BACKGROUND: Diagnosis of naevus lesions may be complex where they contain little or no pigmentation. Naevus spilus (or naevus on naevus) is, generally, readily identified by the difference in pigmentation between overlying and underlying naevi and healthy skin. Malignant transformation of naevus spilus is rare. We report two cases of melanoma in which surgical procedures revealed underlying melanocyte lesions, diagnosed at histology but undetectable on clinical examination. PATIENTS AND METHODS: Two patients were operated for melanoma in which surgery, at a site remote from the melanoma, suggested incomplete relapse despite the fact that previous clinical examination had indicated healthy skin. A diagnosis was made of melanoma in invisible naevus spilus. DISCUSSION: Diagnosis of melanoma in invisible naevus spilus may be suspected where several naevi are found together in a specific area. The main problem is the therapeutic stance to be adopted since complete excision of the underlying naevi is difficult in practice. Wood's light examination may be helpful.


Asunto(s)
Melanoma/patología , Neoplasias Primarias Múltiples/patología , Nevo Pigmentado/patología , Neoplasias Cutáneas/patología , Humanos , Masculino , Melanoma/cirugía , Persona de Mediana Edad , Neoplasias Primarias Múltiples/cirugía , Nevo Pigmentado/cirugía , Neoplasias Cutáneas/cirugía
19.
Ann Dermatol Venereol ; 135(6-7): 499-502, 2008.
Artículo en Francés | MEDLINE | ID: mdl-18598802

RESUMEN

BACKGROUND: Extraskeletal osteosarcoma is a rare mesenchymatous tumour occurring in adults aged over 50 years and is located mainly in the limbs or retroperitoneum. We report a case of metastatic extraskeletal osteosarcoma revealed by a cutaneous occipital tumour site. CASE-REPORT: A 53-year-old woman was admitted for dyspnea and weight loss. An occipital tumour, noticed for one year by the patient, was discovered. It was freely movable on the bone, of hard consistency and responsible for alopecia. In addition to left-sided pleural effusion, a chest CAT revealed a large mass in the left lung, including areas of necrosis and calcifications with intracardiac extension. Histological examination of biopsies of the skin and of pulmonary and intracardiac lumps showed an osteosarcomatous proliferation. No primary osteosarcoma was found in the bones. A diagnosis was made of metastatic extraskeletal osteosarcoma. Intravenous chemotherapy was given followed by radiotherapy. After a six-month stabilization period, the disease progressed. DISCUSSION: Extraskeletal cutaneous locations of osteosarcoma are extremely rare. They may comprise either the primary tumour or a metastatic lesion. In this patient, the immediately metastatic nature of the disease was a poor prognostic factor for this high-grade sarcoma.


Asunto(s)
Neoplasias de Cabeza y Cuello/secundario , Osteosarcoma/secundario , Cuero Cabelludo , Neoplasias Cutáneas/secundario , Alopecia/etiología , Biopsia , Progresión de la Enfermedad , Femenino , Neoplasias de Cabeza y Cuello/complicaciones , Humanos , Inmunohistoquímica , Pulmón/patología , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/secundario , Imagen por Resonancia Magnética , Persona de Mediana Edad , Osteosarcoma/complicaciones , Osteosarcoma/diagnóstico , Osteosarcoma/patología , Pronóstico , Radiografía Torácica , Piel/patología , Neoplasias Cutáneas/complicaciones , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/patología , Tomografía Computarizada por Rayos X
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