Lymphatic spread in an immunocompetent adult.

Cutaneous tuberculosis with lymphatic spread is rarely described. We report the case of a woman aged 38, immunocompetent, working in a fruit sorting center, who consulted us for ulceration of the left third finger that had persisted for four months, following a prick from a prickly pear. Physical examination revealed a nodular, erythematous, and ulcerative lesion of the left third finger, associated with inflammatory subcutaneous nodules arranged in a line along the ipsilateral upper extremity and an ipsilateral axillary lymph node. Laboratory tests and chest X-ray were normal. Pathological examination revealed granulomatous chronic inflammation without necrosis. PCR detected DNA from Mycobacterium tuberculosis. No extracutaneous tuberculosis locations were detected. A tuberculous chancre by direct inoculation was therefore diagnosed. The patient received quadruple therapy (rifampicin + isoniazid + pyrazinamide + ethambutol) for 2 months, followed by a combination therapy based on isoniazid and rifampicin for 6 months. Marked regression of the cutaneous lesions occurred after 1 month of first-line therapy. A tuberculous chancre is a rare form of cutaneous tuberculosis, with possible lymphatic spread, in immunocompromised patients but also in immunocompetent children and young adults.

[Chronic vulvar lymphedema revealing Crohn disease in a teenage girl]. / Lymphœdème vulvaire chronique révélant une maladie de Crohn.

INTRODUCTION: Cutaneous Crohn disease is a rare cutaneous manifestation of Crohn disease in children. Herein is reported a case of persistent vulvar lymphedema revealing Crohn disease in a teenage girl. CASE REPORT: A 14-year-old girl presented with an 8-month history of persistent vulvar swelling associated with chronic macrocheilia. Dermatologic examination showed an inflammatory vulvar lymphedema, associated with perianal fissures and hypertrophic gingivitis. Vulvar skin biopsy revealed non-necrotizing granulomatous inflammation. Gastrointestinal endoscopy yielded no significant findings. The diagnosis of Crohn disease presenting as vulvar lymphedema was established. Oral metronidazole therapy resulted in partial improvement of cutaneous lesions beginning the 1st week. CONCLUSION: The originality of this case lies in the presentation of chronic macrocheilia with persistent vulvar lymphedema in a child, revealing Crohn disease without gastrointestinal involvement.

[Thrombotic skin gangrene: A rare extra-intestinal manifestation of ulcerative colitis]. / La gangrène cutanée thrombotique : une manifestation extradigestive rare de la rectocolite hémorragique.

BACKGROUND: Thrombotic cutaneous gangrene is a rare extra-intestinal manifestation of ulcerative colitis with a severe prognosis. CASE REPORT: A 35-year-old woman with a 7-year history of ulcerative colitis presented with extensive ecchymotic lesions that began a few hours earlier. On examination, she was febrile with multiple necrotic lesions. Skin biopsy showed multiple microthrombi in the dermal vessels. A diagnosis of thrombotic cutaneous gangrene was established. The patient was treated with heparin and systemic corticosteroids. The majority of cutaneous lesions showed improvement after 1 month. Thrombophlebitis of the left lower limb occurred subsequently. CONCLUSION: Thrombotic cutaneous gangrene is attributed to microvascular thrombosis, which arises from the hypercoagulability observed in ulcerative colitis. Complete blood and coagulation tests must be performed and early anticoagulation with heparin must be considered in order to prevent the progression of cutaneous infarction.

[Bowel-associated dermatosis-arthritis syndrome during ulcerative colitis: A rare extra-intestinal sign of inflammatory bowel disease]. / Syndrome arthro-cutané lors d'une rectocolite ulcéro-hémorragique : une manifestation extra-intestinale rare des maladies inflammatoires de l'intestin.

INTRODUCTION: Bowel-associated dermatosis-arthritis syndrome (BADAS) is characterized by combined pustular skin eruption and arthralgia. It may be associated with inflammatory bowel disease or bowel bypass surgery. We report a case of BADAS in a patient with ulcerative colitis. CASE REPORT: A 39-year-old woman was being treated for a severe flare-up of ulcerative colitis present over the preceding 2 months and treated with prednisone, azathioprine and cyclosporine. She was also presenting a cutaneous eruption and arthralgia that had begun three days earlier. Dermatological examination revealed profuse vesicular and pustular lesions. Biopsy specimens showed mature neutrophilic infiltrate within the dermis. A diagnosis of BADAS was made and the same treatment was maintained. Systemic symptoms were resolved but the vesicular lesions were superseded by hypertrophic scars. DISCUSSION: Bowel-associated dermatosis-arthritis syndrome consists of a vesiculopustular eruption associated with arthralgia and/or arthritis and fever, as was the case in our patient. The histological picture is characterized by abundant neutrophilic infiltrate in the superficial dermis. The clinical and histological features and the course of BADAS allow this entity to be classified within the spectrum of neutrophilic dermatoses. Treatment chiefly involves systemic corticosteroids.

Periodic variation of the water use efficiency in durum wheat.

Water Use Efficiency (WUF) of five durum wheat varieties (Khiar, Karim, Nasr, Razzak and Sobirano) cultivated in Tunisia was investigated. The experiment was conducted under rainfed field conditions, irrigated pots and test tubes at ESA Kef experiment station during the cropping season of 2010-2011. Under rainfed conditions, Khiar has the highest grain yield with 29.35 q ha(-1). Biological WUE ranged from 1.72-1.49 mg dry matter per g of water for Razzak and Nasr, respectively. The WUE of grain ranged.from 0.81-0.48 mg grain per g of water for Khiar and Sobirano, respectively. Biological WUE showed positive correlation to grain yield and stomatal density and negatively correlated with leaf area. Periodic water use efficiency in pot and test tube trials indicated variation of wheat genotypes according to stage periods and how the experiment was conducted. Test tubes trials showed high, accurate and maximum value of water use. Therefore, we can consider that Khiar has a high WUE in the first period; germination-early tillering (6.70 mg dry matter per g water). Nasr and Sobirano valorise well had got water use during the second period; tillering (9.16 and 10.20 mg dry matter per g of water). Razzak shows a high WUE for the third period; booting-early heading (9.06 mg dry matter per g of water). Finally, Karim cultivar has the highest WUE during for the fourth period; heading-physiological maturity (22.13 mg dry matter per g of water). Periods of high WUE can be targeted for appropriate time of wheat cultivar irrigation.

[Analysis of 18 Tunisian cases of mycetoma at the Sousse hospital (1974-2010)]. / Analyse d'une série tunisienne de 18 cas de mycétomes à l'hôpital de Sousse (1974-2010).

Mycetoma are inflammatory pseudotumors, due to infection by bacterial (Actinomycetoma) or fungal (Eumycetoma) agent. A retrospective study was conducted during 34 years. Our aim was to study epidemiologic, clinic, therapeutic and microbiologic characteristics. Eighteen patients were assessed. Sex-ratio H/F was 2. The mean age was 43.6 years. Principal localization was the feet. Our study was characterized by majority of actinomycetoma found in 15 cases (Actinomadura madurae in 14 cases and Nocardia sp. in one case). Eumycetoma were diagnosed in 3 cases (Madurella mycetomatis in two cases and Pseudallesheria in one case). All patients received medical treatment associated with surgical treatment in 11 cases.

The role of van der Waals interactions in the adsorption of noble gases on metal surfaces.

Adsorption of noble gases on metal surfaces is determined by weak interactions. We applied two versions of the nonlocal van der Waals density functional (vdW-DF) to compute adsorption energies of Ar, Kr, and Xe on Pt(111), Pd(111), Cu(111), and Cu(110) metal surfaces. We compared our results with data obtained using other density functional approaches, including the semiempirical vdW-corrected DFT-D2. The vdW-DF results show considerable improvements in the description of adsorption energies and equilibrium distances over other DFT based methods, giving good agreement with experiments. We also calculated perpendicular vibrational energies for noble gases on the metal surfaces using vdW-DF data and found excellent agreement with available experimental results. Our vdW-DF calculations show that adsorption of noble gases on low-coordination sites is energetically favored over high-coordination sites, but only by a few meV. Analysis of the two-dimensional potential energy surface shows that the high-coordination sites are local maxima on the two-dimensional potential energy surface and therefore unlikely to be observed in experiments; this provides an explanation of the experimental observations. The DFT-D2 approach with the standard parameterization was found to overestimate the dispersion interactions, and to give the wrong adsorption site preference for four of the nine systems we studied.

Resonance Raman spectra of TNT and RDX using vibronic theory, excited-state gradient, and complex polarizability approximations.

Geometries, UV absorption bands, and resonance Raman (RR) cross sections of TNT and RDX are investigated using density functional theory (DFT) in conjunction with the Coulomb attenuated B3LYP exchange-correlation functional. The absorption and RR spectra are determined with use of vibronic (VB) theory, excited-state gradient, and complex polarizability (CPP) approximations. We examined low-energy isomers (two for TNT and four for RDX) whose energies differ by less than 1 kcal/mol, such that they would appreciably be populated at room temperature. The two TNT isomers differ by an internal rotation of the methyl group, while the four conformers of RDX differ by the arrangements of the nitro group relative to the ring. Our theoretical optical properties of the TNT and RDX isomers are in excellent agreement with experimental and recent CCSD-EOM results, respectively. For the two TNT isomers, the ultraviolet RR (UVRR) spectra are similar and in good agreement with recently measured experimental results. Additionally, the UVRR spectra computed using the excited-state and CPP approaches compare favorably with the VB theory results. On the other hand, the RR spectra of the RDX conformers differ from one another, reflecting the importance of the positioning of the NO2 groups with respect to the ring. In the gas phase or in solution, RDX would give a spectrum associated with a conformationally averaged structure. It is encouraging that the computed spectra of the conformers show similarities to recent measured RDX spectra in acetonitrile solution, and reproduce the 10-fold decrease in the absolute Raman cross sections of RDX compared to TNT for the observed 229 nm excitation. We show that in TNT and RDX vibrational bands that couple to NO2 or the ring are particularly resonance enhanced. Finally, the computed RDX spectra of the conformers present a benchmark for understanding the RR spectra of the solid-phase polymorphs of RDX.

An Assessment of the vdW-TS Method for Extended Systems.

The Tkatchenko-Scheffler vdW-TS method [Phys. Rev. Lett.2009, 102, 073005] has been implemented in a plane-wave DFT code and used to characterize several dispersion-dominated systems, including layered materials, noble-gas solids, and molecular crystals. Full optimizations of the structures, including relaxation of the stresses on the unit cells, were carried out. Internal geometrical parameters, lattice constants, bulk moduli, and cohesive energies are reported and compared to experimental results.

Adsorption of polyvinylpyrrolidone on Ag surfaces: insight into a structure-directing agent.

We use density functional theory to resolve the role of polyvinylpyrrolidone (PVP) in the shape-selective synthesis of Ag nanostructures. At the segment level, PVP binds more strongly to Ag(100) than Ag(111) because of a surface-sensitive balance between direct binding and van der Waals attraction. At the chain level, correlated segment binding leads to a strong preference for PVP bind to Ag(100). Our study underscores differences between small-molecule and polymeric structure-directing agents.

Bilateral idiopathic hyperkeratosis of the nipple and areola.

Hyperkeratosis of the nipple and areola (HNA) is an unusual dermatosis that Levy-Franckel classified into three variants (1). This rare condition occurs primarily in young women and represents a cosmetic problem. Furthermore, its management is a therapeutic challenge. We report on the rare case of a 32-year-old woman with idiopathic bilateral HNA, which belongs to the third Levy-Franckel classification.

[Annular lipoatrophy of the ankles]. / Lipoatrophie annulaire des chevilles.

BACKGROUND: Annular lipoatrophy of the ankles (ALA) is an extremely rare form of localized lipoatrophy characterized by atrophy of subcutaneous fat. We report a case of annular atrophy of the ankles associated with a history of diabetes and Graves' disease. PATIENTS AND METHODS: A 22-year-old woman with a history of Graves' disease and diabetes consulted for annular lesions of ankles which had appeared three years earlier. She had suddenly developed erythematous annular plaques on the right ankle. One week later, the plaques had evolved towards progressive atrophic bands involving the lower third of the legs. The overlying skin was normal and muscle involvement was absent. Laboratory studies revealed an antinuclear antibody (ANA) titre of 1/640 while a skin biopsy specimen showed diffuse lobular lymphohistiocytic panniculitis rich in lymphocytes and lipophages foam cells without any evidence of vasculitis. A direct immunofluorescence microscopy study was negative. Lipoatrophy was still present after six months of chloroquine treatment (300mg per day). DISCUSSION: ALA is a rare and poorly understood condition. Based on the ten or so case reports in the literature, we attempted to define the clinical and histological profile of the disease as well as its course and its relationship with other forms of atrophic panniculitis. In particular, the onset of LAC in our patient presenting several autoimmune diseases underlines its close relationship to the condition described as "connective tissue panniculitis".

[Childhood cutaneous Abrikossoff tumor]. / Tumeur d'Abrikossoff purement cutanée chez 2 enfants.

INTRODUCTION: Granular cell tumor (GCT), also known as Abrikossoff tumor, is a rare and benign neoplasm that more commonly affects the oral cavity in adults. We report here 2 childhood cases of a cutaneous granular cell tumor. CASE REPORTS: An 8- and a 12-year-old girl, with no past medical history, presented with pigmented nodular lesions located, respectively, in the left scapular region and the left iliac crest. Histological examination showed sheets and clusters of infiltrating tumor cells with morphologic and immunohistochemical features consistent with granular cell tumor. In both cases, the lesions were excised with 2-cm margins. The patients are presently being reviewed at 6-month and 2-month intervals to evaluate for recurrence and any malignant transformation. They were in good health with no signs of further tumor development. DISCUSSION: GCT is a relatively uncommon benign neoplasm probably of neural origin derived from Schwann cells. The tongue and buccal mucosa are commonly affected. It develops between the second and sixth decades of life, more frequently among women and blacks. It can also occur in childhood, but this is rare. The cutaneous forms, as in the present observations, are exceptional. Benign granular cell tumours are generally seen as a solitary asymptomatic nodule less than 3 cm in size involving the subcutaneous or submucosal tissues. Histologically, the tumor is not encapsulated but is well circumscribed. The tumor cells may show a degree of infiltration of the surrounding connective tissue. The cells are polygonal, have abundant cytoplasm, are granular and weakly eosinophilic. The nuclei are small, vesicular, and highly chromatic. Mitotic figures are rare. A key element for the histological diagnosis is the expression of S100 protein, neuron specific enolase (NSE), and vimentin on immunohistochemistry. The treatment of choice is a conservative surgical excision of the lesion. However, as the GCT has a poorly defined margin, it is suggested that the tumor should be excised along with portions of adjacent tissue. A low rate of recurrence of the lesion has been reported. CONCLUSION: The specific value of these rare cases is the occurrence in 2 children and the cutaneous location.

Density functional theory study of pyrophyllite and M-montmorillonites (M = Li, Na, K, Mg, and Ca): role of dispersion interactions.

The stacking parameters, lattice constants, bond lengths, and bulk moduli of pyrophyllite and montmorillonites (MMTs), with alkali and alkali earth metal ions, are investigated using density functional theory with and without dispersion corrections. For pyrophyllite, it is found that the inclusion of the dispersion corrections significantly improves the agreement of the calculated values of the lattice parameters and bulk modulus with the experimental values. For the MMTs, the calculations predict that the interlayer spacing varies approximately linearly with the cation radius. The inclusion of dispersion corrections leads to sizable shifts of the interlayer spacings to shorter values. In Li-MMT, compaction of the interlayer distance triggers migration of the Li ion into the tetrahedral sheet and close coordination with basal oxygen atoms. Analysis of electron density distributions shows that the isomorphic octahedral Al(3+)/Mg(2+) substitution in MMT causes an increase of electron density on the basal oxygen atoms of the tetrahedral sheets.

Evaluation of theoretical approaches for describing the interaction of water with linear acenes.

The interaction of a water monomer with a series of linear acenes (benzene, anthracene, pentacene, heptacene, and nonacene) is investigated using a wide range of electronic structure methods, including several "dispersion"-corrected density functional theory (DFT) methods, several variants of the random phase approximation (RPA), DFT-based symmetry-adapted perturbation theory with density fitting (DF-DFT-SAPT), MP2, and coupled-cluster methods. The DF-DFT-SAPT calculations are used to monitor the evolution of the electrostatics, exchange-repulsion, induction, and dispersion contributions to the interaction energies with increasing acene size and also provide the benchmark data against which the other methods are assessed.