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Background Tattooing is a widespread phenomenon, with an estimated prevalence of 10-30% in Western populations. For psoriasis patients, current recommendations are to avoid having a tattoo if the disease is active and they are receiving immunosuppressive treatments. Although scientific data supporting these recommendations are lacking, dermatologists are often reluctant to advocate tattooing in psoriasis patients. Objective We aimed to evaluate the frequency of tattoo complications in patients with psoriasis and determine whether the occurrence of complications was associated with psoriasis status and treatments received at the time of tattooing. Methods We performed a multicentre cross-sectional study. Adults with psoriasis were consecutively included and classified as tattooed or non-tattooed. Prevalence of complications associated with tattoos was then evaluated according to psoriasis onset and treatments. The study was divided into three parts, in which data were collected through a series of questionnaires filled in by the dermatologist. Complications included pruritus, oedema, allergic reaction/eczema, infection/superinfection, granuloma, lichenification, photosensitivity, Koebner phenomenon and psoriasis flare after tattooing. Diagnosis of complications was made retrospectively. Results We included 2053 psoriatic patients, 20.2% had 894 tattoos. Amongst non-tattooed patients, 15.4% had wished to be tattooed, with psoriasis being stated as a reason for not having a tattoo by 44.0% and 5.7% indicating that they planned to have a tattoo in the future. Local complications, such as oedema, pruritus, allergy and Koebner phenomenon, were reported in tattoos in 6.6%, most frequently in patients with psoriasis requiring treatment at the time of tattooing (P

CLOVES syndrome (Congenital Lipomatous asymmetric Overgrowth of the trunk with lymphatic, capillary, venous, and combined-type Vascular malformations, Epidermal nevi, Skeletal anomalies) is a sporadic malformational syndrome that has recently been described (mutation of PIK3CA), with asymmetric body hypertrophy, lipomatous hamartoma of the trunk and numerous malformations.We report a case of CLOVES syndrome initially diagnosed as Proteus syndrome, revealed by infection of a dorsal lipomatous hamartoma. The patient presented with both right lower limb hypertrophy and capillary and venous-lymphatic malformations, associated with dorsal capillary malformations, left cervico-facial hypertrophy, and cervical epidermal hamartoma, all of which are consistent with Proteus syndrome. Imaging of the dorsal lipomatous hamartoma associated with capillary as well as underlying venous-lymphatic malformations and syringomyelia resulted in subsequent correction of the earlier diagnosis of Proteus syndrome to that of CLOVES syndrome.Several malformational syndromes are associated with tissue hypertrophy, hamartoma and vascular malformations. Diagnosis of CLOVES syndrome may be delayed due to its fairly close phenotypic similarity to Proteus syndrome. Nevertheless, the prognosis and complications differ. Our case underlines the importance of considering a diagnosis of CLOVES syndrome in the presence of lipomatous hamartoma with hemi-hypertrophy and epidermal hamartoma, in order to enable adequate follow-up with specific monitoring for the possible complications associated with this disease.

The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.; International audience; Operationally tolerant patients (TOL) display a higher number of blood B cells and transcriptional B cell signature. As they rarely develop an allo-immune response, they could display an abnormal B cell differentiation. We used an in vitro culture system to explore T-dependent differentiation of B cells into plasma cells. B cell phenotype, apoptosis, proliferation, cytokine, immunoglobulin production and markers of differentiation were followed in blood of these patients. Tolerant recipients show a higher frequency of CD20(+) CD24(hi) CD38(hi) transitional and CD20(+) CD38(lo) CD24(lo) naïve B cells compared to patients with stable graft function, correlating with a decreased frequency of CD20(-) CD38(+) CD138(+) differentiated plasma cells, suggestive of abnormal B cell differentiation. B cells from TOL proliferate normally but produce more IL-10. In addition, B cells from tolerant recipients exhibit a defective expression of factors of the end step of differentiation into plasma cells and show a higher propensity for cell death apoptosis compared to patients with stable graft function. This in vitro profile is consistent with down-regulation of B cell differentiation genes and anti-apoptotic B cell genes in these patients in vivo. These data suggest that a balance between B cells producing IL-10 and a deficiency in plasma cells may encourage an environment favorable to the tolerance maintenance.

By decreasing plasminogen binding to fibrin surface, the thrombin activatable fibrinolysis inhibitor (TAFI) has been hypothesized to constitute an early marker for atherothrombotic diseases. Previous studies have shown that plasma TAFI levels exhibit a high interindividual variability that is only poorly explained by lifestyle factors. Several polymorphisms of the TAFI gene have been described, and a combination of a C+1542G substitution in the 3′ untranslated region and an Ala147Thr amino acid change has been shown to explain 60% of TAFI variability in a sample of unrelated individuals. A segregation-linkage analysis was performed to determine whether these polymorphisms are directly involved in the genetic regulation of TAFI levels, or whether they are only markers in linkage disequilibrium (LD) with unmeasured TAFI-linked quantitative trait loci (QTLs). The sample consisted of 97 healthy nuclear families from the Stanislas Cohort. The C+1542G and Ala147Thr polymorphisms were in complete negative LD, with minor allele frequencies of 0.27 and 0.28, respectively. Results of the segregation-linkage analysis provided evidence of two TAFI-linked QTLs in LD with the two measured polymorphisms, which would explain 78% of the TAFI variance, as compared with 55% explained by the C+1542G and the Ala147Thr polymorphisms combined. The two putative QTLs would have minor allele frequencies of 0.45 and 0.32, respectively. The hypothesis that one of the measured polymorphisms is one of the QTLs was rejected. The putative QTLs also did not seem compatible with the other TAFI gene polymorphisms that we have previously described. More extensive sequencing of the TAFI gene is necessary to identify the functional variants.

In January 1990 a registry for cases of breast cancer occurring in the Bouches-du-Rhone area was set up in conjunction with a screening programme for women over 50 years of age. The aim of this study was to compare histoprognostic findings of unscreened patients (A) with a palpable lesion, screened patients (B) with or without a palpable lesion and self screened patients (C) registered for clinically occult mammary carcinoma. The histoprognostic criteria studied were: histological type, tumor size, prognostic grade and axillary lymph node involvement. Of the 2,478 surgical procedures registered, 1,125 involved women over 50 years of age including 47% with malignant disease. Only 3.7% of screened patients presented intraductal carcinoma compared with 1.17% to 18.2% of unscreened A or self-screened C patients. The incidence of minimal infiltrating breast cancer smaller than 10 mm varied widely from 17.3% in A patients to 33.7% in B patients and 51.4% in C patients (P0.001). The incidence of histoprognostic grade III tumors ranged from 17.9% in A patients to 10% in B patients and 4.3% in C patients (P0.007). Lymph node involvement decreases from 41% in A to 28% in B patients and 23% in C patients (P = 0.01). Based on our data, 41.9% of screened patients were in the most favorable prognostic category, ie intraductal carcinoma or infiltrating carcinoma less than 10 mm or grade I and no lymph node involvement, versus only 26.1% of A patients and 60.9% of C patients (P0.0001). Information of the incidence, pathology of interval tumors in previously screened women will be evaluated in the future. This first study underscores the necessity for this kind of registry to evaluate the histoprognostic profile year by year of a breast cancer screening campaign.

Long term corticosteroid therapy has multiple effects on the endocrine system. These include adrenocortical suppression in high doses, alteration of gonadotropic and gonadal secretion, slowing down of long bone growth and bone maturation in children, osteoporosis in adults, alteration of the thyrotropic function and changes in thyroxine peripheral metabolism, diabetogenic effect. The list is not exhaustive, and there are more complex effects on the secretion of prolactin, pancreatic peptides, VIP, etc. Because of these various effects, the pros and cons of long term corticosteroid therapy must be carefully weighted, and if it is necessary steroids should be prescribed in such a way as to limit their side-effects: at best one dose taken in the morning every other day, together with the prescription of calcium, of a salt-free diet and, in some cases, of androgens or oestrogens. Weaning must be carried out with caution, to avoid rebound of the disease treated, and with substitution of hydrocortisone when the corticosteroid dosage reaches 5 mg per day of prednisone or equivalent and can be interrupted. The functional soundness or alteration of the corticotropic and adrenal functions must then be evaluated by testing corticotropic and adrenal functions must then be evaluated by testing the adrenocortical response to tetracosactrin, or even better by measuring early morning concentrations of blood cortisol. Depending on the results obtained, hydrocortisone can be withdrawn and limited to episodes of stress, or continued until ACTH and endogenous cortisol levels have returned to normal values.

Hematomas developed in the small bowel of 6 patients receiving long-term anticoagulant therapy with antivitamins K. As the report by Chapuis and Mercier during the 81st French Congress of Surgery has fully covered this subject, the authors present their cases to illustrate their clinical features, while emphasizing certain particular characteristics: 1 - Associated hemorrhagic lesions were frequently observed. 2 - Early diagnostic follow-through barium meal examinations of the small intestine could be conducted without any particular problem. 3 - Laparotomy was necessary in two patients because of shock or local signs on examination. 4 - Small bowel lesions can vary in severity, sometimes in the same patient (case no 1). Some hematomas heal spontaneously after discontinuation of anticoagulant treatment, while others can, theoretically, develop necrotic reactions. Small bowel resection was necessary in two patients. 5 - A frequent occurrence was the association of lesions in the right colic and ileal regions. 6 - Finally, anticoagulant treatment can often be reduced, discontinued, or replaced by other therapy.

In a controlled double-blind study the effect of muzolimine (20 mg o.d.) and acebutolol (400 mg o.d.) were investigated in outpatients suffering from moderate essential hypertension. After a three week placebo run-in period, 49 patients were recruited and followed by a cooperative group of general practitioners over a period of 3 months. Blood pressure decreased to the same extent in both groups. With regard to clinical and biological tolerance, no differences appeared between the two drugs.

Mixed cryoglobulinemia associated with liver disease is well known, but its mechanism and signification still have to be elucidated. The purpose of this study was to identify and to characterize hepatic disease by their immunochemical features among 60 patients presenting with mixed cryoglobulinemia. Thirteen cases of alcoholic liver disease and 8 of virus B hepatitis out of 40 cases in all of hepatic disease in this group were studied. A higher frequency of type III immunochemical features of cryoglobulinemia in alcoholic disease (83 p. 100), no matter how severe, as well as a higher frequency of type II in virus B hepatitis (62 p. 100) was demonstrated. There was no relationship between virus B hepatitis and cryoglobulinemia in our population. Therefore, the responsibility of virus B hepatitis in essential mixed cryoglobulinemia genesis has to be clarified. The localization of cryoglobulin in the Kupffer cell in two patients with chronic hepatitis confirms the essential role of the reticuloendothelial system in blood clearance of circulating immune complexes.