Staging of primary cutaneous follicle centre B-cell lymphoma: bone marrow biopsy, CD10, BCL2 and t(14;18) are not relevant prognostic factors.

BACKGROUND: There is a certain degree of controversy as to whether bone marrow biopsy is required during the staging procedures for primary cutaneous follicle centre B-cell lymphoma (PCFCCL). OBJECTIVES: Firstly, to determine extra-cutaneous involvement at initial diagnosis, in particular, based on bone marrow biopsy, and secondly, evaluate the phenotypic features associated with extra-cutaneous involvement during follow-up (in particular, the predictive value of BCL2 and CD10 coexpression and identification of t[14;18] in skin lesions, as well as bone marrow biopsy involvement at initial staging) in a cohort of patients with PCFCCL. MATERIALS & METHODS: A bicentric retrospective study was established to investigate 75 cases of PCFCCL, for which 44 bone marrow biopsies were performed. RESULTS: Two of 44 (5%) patients had bone marrow involvement. These two patients had no relapse during follow-up, either cutaneous or extra-cutaneous. BCL2 staining in B cells was positive in 39/75 (52%) cases and CD10 was positive in 39/73 (53%). Only 4/26 (15%) cases showed t(14;18) based on fluorescence in situ hybridisation. CONCLUSIONS: Our study combined with data from the literature suggests that systematic bone marrow biopsy at initial staging for putative PCFCCL is not to be recommended. Moreover, BCL2 or CD10 expression does not currently represent a reliable basis to introduce significant changes in initial therapy or the follow-up strategy.

Compounded topical preparations in plaque psoriasis: Still a place for it in 2018?

Compounded topical preparations (CTP) were used to treat psoriasis until the last century and have disappeared from guidelines. The present authors report two severe psoriasis patients who were treated with CTP. A man had psoriasis with a PASI of 23 and a body surface area (BSA) of 43%. He had been using daily for several weeks a CTP including minoxidil, clobetasol propionate and hydroxyprogesterone formulated in an alcohol based vehicle. A woman suffered from psoriasis with an annular inflammatory pattern and a central healing. The PASI was 20 and the BSA was 30%. She had been using a CTP daily for 4 months including resorcinol, salicylic acid, 0.05% tretinoin cream, bethamethasone dipropionate cream. Until the 1970s, the dermatological textbooks recommended to treat severe psoriasis with CTP. Nowadays, CTP are considered outdated because of the large therapeutic armamentarium. The stability and benefit risks of the CTP used here were not documented. The use of CTP in psoriasis should be regulated and must be evidence based. Strict protocol and stability evaluation for preparations must be confirmed prior to compounding.

Early clindamycin for bacterial vaginosis in pregnancy (PREMEVA): a multicentre, double-blind, randomised controlled trial.

BACKGROUND: Preterm delivery during pregnancy (<37 weeks' gestation) is a leading cause of perinatal mortality and morbidity. Treating bacterial vaginosis during pregnancy can reduce poor outcomes, such as preterm birth. We aimed to investigate whether treatment of bacterial vaginosis decreases late miscarriages or spontaneous very preterm birth. METHODS: PREMEVA was a double-blind randomised controlled trial done in 40 French centres. Women aged 18 years or older with bacterial vaginosis and low-risk pregnancy were eligible for inclusion and were randomly assigned (2:1) to three parallel groups: single-course or triple-course 300 mg clindamycin twice-daily for 4 days, or placebo. Women with high-risk pregnancy outcomes were eligible for inclusion in a high-risk subtrial and were randomly assigned (1:1) to either single-course or triple-course clindamycin. The primary outcome was a composite of late miscarriage (16-21 weeks) or spontaneous very preterm birth (22-32 weeks), which we assessed in all patients with delivery data (modified intention to treat). Adverse events were systematically reported. This study is registered with ClinicalTrials.gov, number NCT00642980. FINDINGS: Between April 1, 2006, and June 30, 2011, we screened 84 530 pregnant women before 14 weeks' gestation. 5630 had bacterial vaginosis, of whom 3105 were randomly assigned to groups in the low-risk trial (n=943 to receive single-course clindamycin, n=968 to receive triple-course clindamycin, and n=958 to receive placebo) or high-risk subtrial (n=122 to receive single-course clindamycin and n=114 to receive triple-course clindamycin). In 2869 low-risk pregnancies, the primary outcome occurred in 22 (1·2%) of 1904 participants receiving clindamycin and 10 (1·0%) of 956 participants receiving placebo (relative risk [RR] 1·10, 95% CI 0·53-2·32; p=0·82). In 236 high-risk pregnancies, the primary outcome occurred in 5 (4·4%) participants in the triple-course clindamycin group and 8 (6·0%) participants in the single-course clindamycin group (RR 0·67, 95% CI 0·23-2·00; p=0·47). In the low-risk trial, adverse events were more common in the clindamycin groups than in the placebo group (58 [3·0%] of 1904 vs 12 [1·3%] of 956; p=0·0035). The most commonly reported adverse event was diarrhoea (30 [1·6%] in the clindamycin groups vs 4 [0·4%] in the placebo group; p=0·0071); abdominal pain was also observed in the clindamycin groups (9 [0·6%] participants) versus none in the placebo group (p=0·034). No severe adverse event was reported in any group. Adverse fetal and neonatal outcomes did not differ significantly between groups in the high-risk subtrial. INTERPRETATION: Systematic screening and subsequent treatment for bacterial vaginosis in women with low-risk pregnancies shows no evidence of risk reduction of late miscarriage or spontaneous very preterm birth. Use of antibiotics to prevent preterm delivery in this patient population should be reconsidered. FUNDING: French Ministry of Health.

Management of infertile women with pelvic endometriosis: a literature review.

INTRODUCTION: Endometriosis is a condition that affects women's fertility. Several mechanisms are involved in this process: anatomical changes, mechanical, immune or inflammatory factors, ovarian reserve alterations... There are different types of strategies to treat endometriosis-related infertility: medical treatment, surgical treatment and/or techniques of medically assisted procreation. EVIDENCE ACQUISITION: We tried to consider various therapeutic strategies depending on the stage of the disease in order to offer appropriate management to patients with endometriosis who wish to become pregnant: we reviewed 58 articles between 1985 to 2016 searching in medline using the key words «endometriosis and infertility¼ and «infertility and endometriosis treatment¼. And we divided the patients in subgroups mild and severe endometriosis, in vitro fertilization (IVF) versus surgery in deep infiltrating endometriosis (DIE) and others. EVIDENCE SYNTHESIS: Surgery appears to be the chief treatment for minimal to mild endometriosis in a context of infertility. Concerning deep infiltrating endometriosis, data in insufficient to decide on the best treatment although surgery associated with IVF seems to bring clinical benefit. CONCLUSIONS: Regarding optimal management of infertility - in case of stage III or IV endometriosis, there is yet no consensus. A multidisciplinary approach is essential in order to consider the various treatment options and provide optimum care and individualized to patients according to different parameters (patient age, degree of damage and location of DIE lesions, presence or absence of ovarian failure or other factors associated with subfertility, male infertility factors in the couple...). Indeed, optimal care of patients should be multidisciplinary and personalized.

Complete Penetrance and Absence of Intrafamilial Variability in a Large Family with Hereditary Leiomyomatosis and Renal Cell Carcinoma.

BACKGROUND: Hereditary leiomyomatosis and renal cell carcinoma (HLRCC) is an autosomal dominant familial disorder due to FH mutation. Despite a considerable increase in information about the genetic background, inter- and intrafamilial phenotypic variability/penetrance are not well documented. OBJECTIVE: To describe a large French HLRCC family and provide new data on penetrance and intrafamilial variability. MATERIALS AND METHODS: The whole family was contacted for clinical examination, skin biopsy, uterine and kidney imagery and molecular analysis. RESULTS: The family included 22 members in 3 generations. The second generation consisted of 13 members who were older than the expected age of onset of disease manifestations. Of the 12 available members of this second generation, 6 (1 man and 5 women, aged 44-57 years) had a novel FH mutation. All had the same mild phenotype with cutaneous asymptomatic leiomyomas, uterine fibroids (if women) and no kidney tumor. The other 6 members not bearing the familial mutation had normal clinical and radiological findings. In this second generation, the penetrance was therefore complete, and there was no intrafamilial variability in the clinical expression of the mutation. CONCLUSION: This study provides additional data on genotype/phenotype correlation, intrafamilial variability and penetrance that should help to improve prognosis and genetic counseling.

Rhenium complexes bearing phosphole-pyridine chelates: simple molecules with large chiroptical properties.

The synthesis and chiroptical properties of chiral rhenium complexes bearing mono- or di-topic phosphole ligands are described.