Suitability of microwave drying for mealworms (Tenebrio molitor) as alternative to freeze drying: Impact on nutritional quality and colour.

Freeze drying represents the current practice to stabilize mealworms, even though it is an energy demanding technique. Therefore, it was examined in the present study whether microwave drying could be a proper alternative. To this end, the impact of both drying techniques on the proximate composition, vitamin B12 content, fatty acid profile, oxidation status and colour parameters of mealworms was investigated. Furthermore, the influence of the application of vacuum during microwave drying was studied. The different drying technologies resulted in small differences in the proximate composition, while the vitamin B12 content was only reduced by microwave drying. The fat fraction of freeze dried mealworms showed a higher oxidation status than the fat of microwave dried mealworms. Application of a vacuum during the microwave drying process did not appear to offer advantages. This research shows that for mealworms microwave drying can be a proper alternative to freeze drying.

[Pediatric psychiatry: evolution and developments]. / La psychiatrie infanto-juvénile evolution et développements.

Since 1986, the field of the child and adolescent clinics in the University Children Hospital Queen Fabiola is much developed. It is divided in five areas: the ambulatory sector, the medical psycho-psychiatry field, the day unit, the psychiatric hospitalisation and the ward. The population consists in babies (not yet born and born), children, adolescents. The clinical approach is multi and transdisciplinary including the child, his family and his life systems, caring staff included. Clinical research is centered on four axes: medical psychology, prevention, therapy and child psychiatry, somatic aspects included.

The clinical use of deproteinized bovine bone mineral on bone regeneration in conjunction with immediate implant installation.

Twenty-one c.p. titanium screw-shaped implants were immediately installed after extraction and thorough curettage of the alveoli in 15 patients. Granules of deproteinized bovine bone of 0.25-1.0 mm diameter were used to fill the remaining defect when the distance of the defect wall to the implant surface was > 3 mm. Dimensional measurements of the defect height and width were made with a pocket probe. Fourteen sites in the upper jaw and 7 sites in the lower jaw were thus treated. The mean defect depth varied between 7 mm vestibularly and 10 mm mesially. The mucoperiosteal flaps were hermetically closed. At re-entry, the particles were packed and firmly attached but still distinguishable from the surrounding bone. Of the 21 sites treated, 5 sites had an exposure of the implant cover screw during the healing period. An exposure of the granular material occurred in 4 sites, but loss of granules in only 3. Even in these sites no signs of infection or inflammation of the soft tissues were observed. At re-entry after 6 months, 10 sites were completely and 9 partially filled. For the partial fills, the mean remaining defect height was 1.6 mm (range: 0.6-3.0 mm). Two sites showed an increased defect of respectively 2.4 and 4.8 mm. No fixtures were lost. The present results indicate that deproteinized bovine bone is a safe filling material to fill remaining defects around implants installed in fresh extraction sockets.

[Prevention of vitamin D deficiency in the child and adolescent. I. Proposal and arguments for use of a decision tree]. / Prévention de la carence en vitamine D chez l'enfant et l'adolescent. I. Proposition et argumentaire pour l'utilisation d'un abaque décisionnel.

A decision-making table, using three questionnaires, is proposed to determine the vitamin D status in children and adolescents. The first questionnaire assesses the vitamin D endogenous synthesis, taking into account the sunlight exposure and the time interval out of the sun. The second questionnaire quantifies the vitamin D dietary intake within three levels: optimal, medium or low. In case of a medium dietary score, a third questionnaire evaluates the daily calcium intake, taking into account the fact that vitamin D metabolism is increased by a low calcium intake (under 400 mg/day). This decision-making table should enable the detection of children and adolescents at risk of vitamin D deficiency and requiring an adapted prophylaxis. Its accuracy will be assessed in prospective surveys.

[D-penicillamine-induced pemphigus, polymyositis and myasthenia]. / Pemphigus, polymyosite et myasthénie induits par la D-pénicillamine.

BACKGROUND: D-penicillamine can induce autoimmune disease, particularly in patients with associated immune disorders. CASE REPORT: A 67-year old woman who had been taking D-penicillamine for 15 months for rheumatoid arthritis was hospitalized due to the development of a bullous eruption and proximal muscle deficiency. Search for intercellular antisubstance antibodies in serum was negative. The skin biopsy histology revealed intra-epidermal cleavage in the mucosal body and direct immunofluorescence revealed epidermal frame-marking with anti-IgG and anti-C3 antibodies. Other tests revealed muscular cytolysis, and anti-acetylcholine receptor antibodies. The electromyogram showed neuromuscular block without muscle deficiency and muscle biopsy showed moderate myositis. D-penicillamine was interrupted and was followed by cure of the pemphigus and aggravation of the myositis, requiring high-dose systemic corticosteroid therapy. DISCUSSION: This patient developed D-penicillamine induced pemphigus, a rather frequent observation. The desmoglein immunolabelling favored drug-induced pemphigus and the course was rapidly favorable after withdrawal. Pemphigus had developed simultaneously with signs of myasthenia and polymyositis. Polymyositis and myasthenia are also known complications of D-penicillamine therapy. The association of these three complications suggests that D-penicillamine can unmask certain antigens or have an immunomodulator effect.

[Acquired tufted angioma in an adult: failure of pulsed dye laser therapy]. / Angiome en touffes acquis de l'adulte: échec du traitement par laser à colorant pulsé.

BACKGROUND: Tufted angioma, described by Wilson Jones in 1976, is a benign acquired vascular tumor occurring in children or young adults, usually located on the neck or the upper part of the thorax. Pathology examination confirms the diagnosis showing well-limited lobules in the dermis composed of tight clusters of capillaries without atypical cells. CASE REPORT: An 81-year-old woman consulted for a large extensive angiomatous lesion involving the neck and shoulder which had developed over two years. Histopathology reported tufted angioma. Treatment with pulsed dye laser was unsuccessful. DISCUSSION: Different treatments have been proposed for tufted angiomas: surgery, cryotherapy, interferon, argon laser and pulsed dye laser. This is a second cases of unsuccessful treatment, perhaps due to deep extension of the angioma.

[High resolution ultrasound imaging: value in treatment of basocellular carcinoma by cryosurgery]. / Imagerie ultrasonore haute résolution: utilité pour le traitement des carcinomes basocellulaires par cryochirurgie.

OBJECTIVE: We conducted a prospective evaluation of the contribution of high-resolution ultrasound imaging prior to cryosurgery for basocellular carcinoma and in search for recurrence. PATIENTS AND METHODS: All patients seen between 1992 and 1994 at the skin tumor clinic and treated by cryosurgery were included. Ultrasound imaging using 20 MHz prototype was performed prior to cryosurgery and 2 months later. RESULTS: Among 101 patients treated, 112 basocellular carcinomas were treated by cryosurgery. Ultrasound imaging provided good visualization of the tumor limits in all cases. The ultrasound aspect was anechogenic, often with rare areas of highly dense echoes. The tumor limits described by ultrasound imaging were larger than the clinical limits in 32% of the cases. In 8 of the 16 cases of recurrent tumors, the ultrasound examination revealed the recurrence first. In the other 8 cases, clinical manifestations were confirmed by ultrasonography. In our series, recurrence of basocellular carcinoma was statistically more frequent when the depth of the tumor was 3 mm (ultrasonographic measurement) or when the lateral limits established by ultrasound assessment were greater than the clinical evaluation. DISCUSSION: These findings demonstrate that high-resolution ultrasound imaging of basocellular carcinomas prior to cryosurgery: 1) visualizes tumor limits allowing adapted cryosurgery, 2) identifies factors with predictive value for recurrence, 3) can identify recurrences early. Ultrasound imaging of the skin is a useful non-invasive technique for pre- and post-therapeutic assessment of skin tumors and could be a particularly useful tool for "blind" cryosurgery destruction of skin tumors.

[Parvovirus B19 primo-infection and cold agglutinins]. / Primo-infection à parvovirus B19 et agglutinines froides.

INTRODUCTION: Parvovirus B19 infection is frequent. Primary infection leads to diverse skin manifestations including the recently described gloves-and-socks papulopurpura. CASE REPORT: A patient presented with a papulopurpuric eruption on the nose, hands, feet and perineum with cheilitis and high-grade fever. Parvovirus B19 serology showed characteristic IgG on the 15th day after the initial eruption demonstrating the seroconversion. Cold agglutinins were positive during the eruption and negative after regression. DISCUSSION: The gloves-and-socks papulopurpura syndrome was initially described in 1990. Since that time 20 cases have been reported. In 7 cases, primary parvovirus B19 infection was proven and viral infections were suspected in the others (measles, coxsackie B6, hepatitis B, Epstein-Barr virus). Our case evidenced here to undescribed skin manifestations and the development of cold agglutinins. The presence of cold agglutinins at eruption could explain the acral localizations observed in this syndrome.

[Study of early postoperative lactitol versus paraffin following anal surgery in 110 adult patients]. / Etude du lactitol comparé à la paraffine chez 110 adultes, en postopératoire précoce d'une chirurgie anale.

The aim of this open and randomised clinical trial was to compare, in terms of efficacy, lactitol with petroleum jelly, regarding the time before recovery of intestinal transit in patients having undergone anal surgery. Efficacy, comfort and tolerability were assessed on day 4 and 7, the convenience of treatments at the end of the period. The main criterion for efficacy was the time taken to obtain the first stool after surgery. Lactitol appears to be more effective than petroleum in terms of recovery of intestinal transit: the first postoperative stool was obtained 13 hours earlier with lactitol. This difference is statistically significant whatever the comparison: survival analysis (p = 0.0018) or t test on means (p = 0.0014). The secondary criteria for efficacy are consistent with this first result: the mean number of stools per day was significantly higher with lactitol (p = 0.046), the daily dose could be-reduced for more patients under lactitol on day 4 (p = 0.004) and, also on day 4, the general efficacy assessment was significantly in favour of lactitol (p = 0.033). The separate analysis of the items included in the comfort score shows that stools are more often "normal or soft" in the petroleum group and that pain on defecation is frequently less severe in the lactitol group. This led to a significantly higher comfort score in the petroleum group from D1 to D4 but not from D1 to D7. Tolerance was rated "good" by 97% of patients on day 7, and no statistically significant difference was observed for any of the tolerability criteria. Lactitol therefore appears to be an interesting choice, with a high benefit/risk ratio, in the treatment of the transitory constipation frequently observed immediately after anal surgery.

Does hormonal skin aging exist? A study of the influence of different hormone therapy regimens on the skin of postmenopausal women using non-invasive measurement techniques.

BACKGROUND AND DESIGN: The skin properties of 98 postmenopausal women with hormone replacement therapy (oestradiol gel or patches) or without hormone replacement therapy were studied using non-invasive techniques: skin thickness with skin echography, skin hydration with a dryness score and measurement of capacitance, skin surface lipids with a Sebumeter and microtopography with image analysis of cutaneous replicas. RESULTS: In this open study we demonstrated an increase in skin thickness and sebum in the treated group in comparison to the untreated group (7-15% according to area for skin thickness, 35% for sebum). Hydration and microtopography were not different in the two groups. CONCLUSIONS: Postmenopausal women who were receiving hormonal substitution have a greater thickness and casual level than untreated women. We therefore suggest that hormonal aging exists and that cutaneous atrophy can be prevented with hormone replacement therapy.

[Agranulocytosis induced by dapsone prescribed for dermatitis herpetiformis]. / Agranulocytose induite par la dapsone prescrite pour une dermatite herpétiforme.

INTRODUCTION: Dapsone is a drug widely prescribed in dermatology. It can lead to undesirable side effects including hematologic disorders. CASE REPORT: A patient with dermatitis herpetiformis was treated with dapsone. Agranulocytosis developed 6 weeks later and was revealed by fever and pneumonia which resolved under antibiotics. The agranulocytosis regressed without specific treatment after drug withdrawal. Blood counts returned to normal 2 weeks later. DISCUSSION: Dapsone-induced agranulocytosis is in common (1/10,000 to 1/20,000). The drug is widely prescribed, particularly for leprosy. Nevertheless, when dapsone is prescribed for dermatitis herpetiformis, the risk of agranulocytosis increases 25-fold reaching 1/400. The indication for dapsone must always made carefully, with surveillance of the blood counts every 15 days during the first 3 months of treatment for dermatitis herpetiformis.

[Hormone replacement treatment and skin aging]. / Traitement hormonal substitutif et vieillissement cutané.

Ageing of the skin results from the synergistic effects of intrinsic ageing (due to age and genetic factors), photoageing (due to ultraviolet radiation) and, for women, hormonal ageing (due to oestrogen deficiency in postmenopausal women). Oestrogens receptors and metabolism or inactivation of oestradiol have been demonstrated in the skin, and the pilosebaceous unit is a target for sexual steroids. Could hormonal replacement therapy (HRT) be a treatment for the symptoms of skin ageing (dryness, roughness, burning and atrophy of the skin, itching, cold intolerance, wrinkles, hyperpilosity, alopecia)? In some experimental studies oestrogens increase the activity of fibroblasts and water, hyaluronic acid and collagen dermal contents. Some studies have demonstrated that oestrogen treatment increases skin thickness, mitotic activity of keratinocytes, and dermal collagen content in postmenopausal women. Thus HRT could theoretically treat skin ageing. It has been shown that HRT alleviates some symptoms of skin ageing (dryness of hair and skin) and that flushes disappear. We demonstrated that non-invasive measurements of physical parameters of the skin can reveal increase in skin thickness (+10 to +20 per cent) in women treated by HRT vs non treated, especially in the application area of oestrogen and in the non-sun-exposed areas. In our study HRT alleviated the hyposeborrhoea usually seen after menopause and could contribute to the amelioration of some complaints of post menopausal women such as roughness or dehydrated skin. Hormonal ageing is quantitatively less than actinic ageing, but its treatment is easier. Moreover HRT increases skin thickness, contributing to the prevention of atrophy (with fragile and fading skin) due to intrinsic ageing, and it limits the masculinization of facial hair and skin experienced by women as a sign of ageing. In conclusion HRT treats oestrogen deficiency and can be used to treat skin ageing.

[Elastosis perforans serpiginosa with vitamin A deficiency in a child with trisomy 21]. / Elastome perforant serpigineux avec hypovitaminose A chez une enfant ayant une trisomie 21.

INTRODUCTION: Elastosis perforans serpiginosa frequently occurs in trisomy 21. Usually no cause is found. We report a case in which vitamin deficiency may have contributed to the development of skin lesions. CASE REPORT: A 11-year-old girl with trisomy 21 developed papulokeratosic eruptions with a linear serpiginous distribution, predominantly involving the lower limbs. On ultrastructure examination, numerous elastic fibers penetrated the epiderma and the baseline membrane had disappeared. The patient also had a totally patent atrioventricular canal with hypoplasia of the left ventricle and cardiac liver. Serum vitamin A level was low (0.56 mumol/l, normal > 1.55). Acitretine was prescribed at the dose of 0.5 mg/kg/day but had to be stopped 2 months later due to elevated liver enzyme levels despite a clear clinical improvement. DISCUSSION: This association between elastosis perforans serpiginosa and vitamin A deficiency, observed here in a child with trisomy 21, has never been reported by others. Vitamin A deficiency might aggravate the skin lesions. In our case, there was probably a relationship between the vitamin A deficiency and the cardiogenic liver disease. The keratoregulatory effect of vitamin A on elastic tissue is less well known. Treatment with retinoids provided clinical improvement but had to be stopped due to hepatotoxicity. Parenteral vitamin A would be an interesting alternative but the risk of side effects would theoretically be greater than with oral retinoids.

Treatment of fenestration and dehiscence bone defects around oral implants using the guided tissue regeneration technique: a prospective multicenter study.

Four clinical centers, using the Brånemark System and with personnel trained in the use of Gore-Tex Augmentation Material (GTAM), participated in a prospective study of 45 patients 18 to 83 years of age. A total of 55 implants were placed with membranes because of local bony defects (fenestration or dehiscence). Dehiscence and fenestration defects were evaluated as one group. The mean initial defect height was 4.7 mm (SD = 3.0). After healing, the remaining defect height was reduced to 1.1 mm (SD = 2.3). The decrease in surface exposure was significant. Complications were primarily attributed to exposure of six membranes during the early healing period. The cumulative survival rate was 84.7% in maxillae and 95.0% in mandibles after 2 years of follow-up. The surgical application of GTAM to produce bone in localized bony defects around oral implants seems to be a predictable method that may reduce the need for extensive augmentation surgery in patients with insufficient jaw bone volume.

Ultrasound imaging of psoriatic skin: a noninvasive technique to evaluate treatment of psoriasis.

BACKGROUND: The aim of our study was to image psoriasis plaques by ultrasound to assess the changes in psoriasis and to measure and quantify them objectively. MATERIALS AND METHODS: Thirty-one psoriasis plaques were studied in 19 patients. Measurements of skin thickness were obtained with a high resolution B-mode echographic system. RESULTS: Some changes were seen in psoriatic skin. A new structural element was observed: a wide subepidermal nonechogenic band. The other changes were a decrease in dermal echoes that were less intense and less dense, and an increase in the epidermal and dermal skin thicknesses. The skin thickness was increased in all psoriasis plaques as compared to apparently normal skin (P < 0.001). The average increase was 67% for whole skin and 200% for epidermis. CONCLUSIONS: Ultrasound imaging of psoriatic skin allowed the identification of different skin changes induced by psoriasis, and particularly, the differentiation between epidermal and dermal alterations. We presume that epidermal thickness reflects epidermal proliferation and desquamation, and the increase in the dermal and whole skin thickness reflects infiltration. We feel that ultrasound imaging of psoriatic skin is a quantitative method that is as easy and noninvasive as the psoriasis area and severity index (PASI). It could be used for following up patients with psoriasis and could achieve widespread use, especially in research protocols.

Localized atypical pemphigoid on lymphoedema following radiotherapy.

Autoimmune bullous diseases have been reported associated with different causal factors: drugs, mechanical trauma and physical trauma, particularly ultraviolet light and radiotherapy. In these cases different hypotheses regarding the pathogenesis of blister formation can be supported. In this observation, we report a localized cicatricial pemphigoid with unusual clinical presentation. Moreover, it appeared 9 years after radiotherapy for breast carcinoma and it was preferentially localized on an upper limb lymphoedema. Because of the long time between the treatment of carcinoma with radiotherapy and the onset of pemphigoid, we assume that lymphoedema played a major etiological role in this particular cicatricial pemphigoid.

Clinical evaluation of a constant force electronic probe.

This study aimed to compare, in vivo, a conventional pocket probe with an automatic, computerized, constant force, electronic probe with a discrimination ability up to 0.1 mm. Sixteen adults with moderate chronic periodontitis and free of supra- and subgingival calculus participated in this study. Eight patients were examined by 2 investigators who used both the conventional and the automatic probes, for a total of 4 probings per subject. The remaining 8 patients were examined 4 times by investigator 1, twice with each probe. For each patient the Ramfjord teeth were examined and 6 sites were considered per tooth. Although the pocket depth measurements recorded by the manual probe were consistently deeper than those of the electronic probe, a good correlation was found between both recordings. Moreover, intra- and inter-examiner comparisons showed comparable standard deviations for both probes and small differences in absolute scores. The conventional probe was slightly more reproducible whereas the automated probe had the advantage of automatic registration. The results indicate that both probes can be considered as valuable in clinical practice.