[Oral verrucous carcinoma and human papillomavirus infection]. / Carcinome verruqueux buccal et infection à papillomavirus.

BACKGROUND: Verrucous carcinoma of the oral cavity is a clinical variant of squamous cell carcinoma. Infection with human papillomavirus (HPV) seems to be a significant risk factor in carcinogenesis, as illustrated in our case report. PATIENTS AND METHODS: A 72 year-old woman with a history of actinic cheilitis consulted for a bulky tumour of the lips and palate. Clinical examination revealed a highly infiltrated labial tumour vegetating and budding, with a thick edge. A bulky tumour and firm masses were seen on the hard and soft palates. Biopsy samples from both sites indicated well-differentiated veruccous epidermoid carcinoma with chorionic infiltration. The immunohistochemical study showed intestinal tumour containing HPV-16 virus. The central facial scan showed involvement of the nasal fossae, soft palate and lips with lysis of the upper maxilla arcade and the osseous palate. The patient died a few days before the start of preoperative chemotherapy following severe deterioration of her general state. DISCUSSION: Verrucous carcinoma is an authentic well-differentiated low-grade cancer. It appears as a wart-like exophytic lesion and progresses over several years. Diagnosis is based on histological examination. Management and treatment are not codified but surgery remains the treatment of choice and relapse is common in the case of locoregional involvement.

[Pseudoainhum and peripheral neuropathy]. / Pseudo-aïnhum et neuropathie axonale.

BACKGROUND: Pseudoainhum is a rare disease characterised by gradual fibrous constriction of the fingers and/or toes eventually resulting in their amputation. In this article, we report the first case seen in Morocco, highly unusual in terms of its severity. CASE REPORT: A 46-year-old woman with no toxic habits was hospitalised for spontaneous amputation of the fingers and toes. This condition began when the patient was 12 years old with the appearance of a circular constriction band at the base of the fifth toe, eventually resulting in its loss. The patient gradually lost all her other toes and fingers except for the first joint of her left index finger. There was no family history of any similar condition. Clinical examination also revealed perforating plantar disease in two of the stumps and peripheral neuropathy in all four limbs, comprising predominantly axonal disease responsive to electromyogram. Amputation of the index finger was completed and histological examination of the removed section showed nothing unusual, with no signs of diabetes. DISCUSSION: The peculiarity of our case resides in the exceptional severity of these amputations and their association with isolated polyneuropathy. Pseudoainhum has been described chiefly in patients with congenital keratoderma, certain systemic diseases, diabetes and alcohol dependence. A number of etiopathogenic hypotheses have been suggested: traumatic, infectious, vascular, neurological and genetic processes.

Liposome-incorporated dexamethasone palmitate inhibits in-vitro lymphocyte response to mitogen.

The use of liposomes for the pulmonary delivery of corticosteroid is an area that is under active investigation. We have recently developed a novel liposomal corticosteroid preparation based on the incorporation of dexamethasone palmitate (DMP) within the bilayer of small unilamellar vesicles (SUVs) made of egg yolk phosphatidylcholine (EPC) and cholesterol; molar ratio EPCC:cholesterol: DMP, 4:3:0.3. In the present study, the biological activity of DMP-SUVs was evaluated using the lymphocyte transformation test with peripheral blood mononuclear cells (PBMCs) and a gamma-interferon production assay. Results showed that DMP-SUVs (but not empty SUVs) inhibited [3H]thymidine uptake and gamma-interferon production by concanavalin A-stimulated PBMCs by 94 and 96%, respectively, at a concentration corresponding to 10(-6) M dexamethasone. The inhibition by DMP-SUVs was found to require a 24-h pre-incubation with unstimulated PBMCs, suggesting that interaction of SUVs with lymphocytes may be altered by mitogen stimulation. We conclude that our DMP liposomal preparation is biologically active and may be considered a promising alternative to conventional local glucocorticoid therapy.

Toxicity of bupivacaine encapsulated into liposomes and injected intravenously: comparison with plain solutions.

The acute central nervous system and cardiac toxicities of 0.25% bupivacaine, without adrenalin, encapsulated in multilamellar liposomes were compared with 0.25% plain solutions with and without adrenalin after intravenous infusion at a rate of 0.15 mg.kg-1 x min-1 with an increase of 0.036 mg.kg-1 x min-1 every 10 min. Three groups of six anesthetized, unventilated rabbits were studied. The doses of bupivacaine (in mg.kg-1) which produced seizure, ventricular tachycardia, and asystole were determined. The doses of bupivacaine inducing seizure and ventricular tachycardia were significantly higher for liposomal bupivacaine than for the two plain solutions. A statistical comparison of the cumulative lethal doses of bupivacaine 0.25% with adrenalin and of liposomal bupivacaine led to a P = 0.06. Adrenalin did not modify the systemic toxicity of the local anesthetic. This study showed a reduction of nervous and cardiac toxicity of bupivacaine encapsulated in multilamellar liposomes when infused intravascularly.