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The severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) pandemic has become a major public health issue worldwide. Developing and evaluating rapid and easy‐to‐perform diagnostic tests is a high priority. The current study was designed to assess the diagnostic performance of an antigen‐based rapid detection test (COVID‐VIRO®) in a real‐life setting. Two nasopharyngeal specimens of symptomatic or asymptomatic adult patients hospitalized in the Infectious Diseases Department or voluntarily accessing the COVID‐19 Screening Department of the Regional Hospital of Orléans, France, were concurrently collected. The diagnostic specificity and sensitivity of COVID VIRO® results were compared to those of real‐time reverse‐transcriptase quantitative polymerase chain reaction (RT‐qPCR) results. A subset of patients underwent an additional oropharyngeal and/or saliva swab for rapid testing. A total of 121 patients confirmed to be infected and 127 patients having no evidence of recent or ongoing infection were enrolled for a total of 248 nasopharyngeal swab specimens. Overall, the COVID‐VIRO® sensitivity was 96.7% (CI, 93.5%–99.9%). In asymptomatic patients, symptomatic patients having symptoms for more than 4 days and those with an RT‐qPCR cycle threshold value ≥ 32, the sensitivities were 100%, 95.8%, and 91.9%, respectively. The concordance between RT‐qPCR and COVID VIRO® rapid test results was 100% for the 127 patients with no SARS‐CoV‐2 infection. The COVID‐VIRO® test had 100% specificity and sensitivity greater than 95%, which are better than the recommendations set forth by the WHO (specificity ≥ 97%–100%, sensitivity ≥ 80%). These rapid tests may be particularly useful for large‐scale screening in emergency departments, low‐resource settings, and airports.

International audience; To develop a rapid and sensitive method to quantify viable Legionella spp. in cooling tower water samples. A rapid, culture-based method capable of quantifying as few as 600 Legionella microcolonies per litre within 2 days in industrial waters was developed. The method combines a short cultivation step of microcolonies on GVPC agar plate, specific detection of Legionella cells by a fluorescent in situ hybridization (FISH) approach, and a sensitive enumeration using a solid-phase cytometer. Following optimization of the cultivation conditions, the qualitative and quantitative performance of the method was assessed and the method was applied to 262 nuclear power plant cooling water samples. The performance of this method was in accordance with the culture method (NF-T 90-431) for Legionella enumeration. The rapid detection of viable Legionella in water is a major concern to the effective monitoring of this pathogenic bacterium in the main water sources involved in the transmission of legionellosis infection (Legionnaires' disease). The new method proposed here appears to be a robust, efficient and innovative means for rapidly quantifying cultivable Legionella in cooling tower water samples within 48 h.

The Ca 2+ cation effect on the antihypertensive molecule binding on human serum albumin (HSA) was studied by biochromatography. The thermodynamic parameters corresponding to this binding were determined for a wide range of Ca 2+ concentration ( x ). For the two antihypertensive molecules under study, their binding to HSA can be divided into two Ca 2+ cation concentration regions due to a HSA phase transition. This result was confirmed by an enthalpy-entropy investigation. For a low x value (below x c =1.6 mmol l −1 ), the HSA cavity was in an ordered solid-like state leading to an increase in the interactions between the antihypertensive drugs and the HSA cavity and consequently, a solute–HSA affinity increase. For x above x c , the HSA cavity was in a disordered solid-like state, implying a decrease in the antihypertensive drug–HSA binding.

Aortic oesophageal Doppler (ODM) allows continuous non-invasive haemodynamic monitoring. We tested to confirm if residents and nurses were able to reposition oesophageal probe (OP), obtain aortic blood flow of good quality and so perform reliable static and dynamic haemodynamic assessments.Prospective observational study assessing ODM measurements were obtained by six residents and three nurses after they have participated in training. Measured (aortic diameter) and calculated haemodynamic data [indexed stroke volume (SVI), cardiac index] were directly obtained from ODM, after residents and nurses repositioned the OP. In a second group of patients, we tested the ability of residents and nurses to detect rapid haemodynamic changes after a passive leg raising. SVI comparison was the primary end point. Statistical analysis was performed using the method of Bland and Altman.Sixty-six haemodynamic measurements were performed on 42 patients. Mean bias for SVI between the skilled physician and residents, and between the skilled physician and nurses were -0.9 ± 5.2 ml/m(2) (P = 0.15), with a percentage error of 31%, and 0.9 ± 5.1 ml/m(2) (P = 0.14), with a percentage error of 33%, respectively. There was an excellent correlation for SVI between the physician and residents (r = 0.9; P0.0001) and between the physician and nurses (r = 0.9; P0.0001). Induced changes in SVI measured by residents and nurses strongly followed those of our skilled physician.Residents and nurses get reliable static and dynamic haemodynamic assessments with ODM compared to our skilled physician.

Folliculosebaceous cystic hamartoma (FSCH) is a relatively recently described malformation with follicular and sebaceous components and a particular type of stroma with adipocytes. We conducted an anatomo-clinical study in order to clarify the clinical and histological characteristics of FSCH.We included all cases of FSCH diagnosed between 1985 and February 2011 at our dermatopathology laboratory. Clinical information was obtained from medical records and requests for histological examination.We studied 25 cases of FSCH in 25 patients of mean age 51 years. The sex ratio was 1.3. The mean disease duration was 9 years. Lesions were described mainly as flesh-colored, occasionally pedunculated nodules and were found primarily on the face (60%). The diagnosis of FSCH had never been mentioned by the clinician. Histological examination revealed in all cases one or more follicular cystic structures surrounded by sebaceous glands in a stroma containing adipocytes. A number of variants were identified, such as the presence of a mucinous stroma, a neuroid component with protein S 100 expression, and rudimentary hair follicles in adjacent dermis. One case involved a proliferating cyst while another was on the scalp in the area of pre-existing radiodermatitis. Only one relapse was noted, 5 years after the initial excision.FSCH is a benign, underdiagnosed lesion, localized on the face, particularly on the nose. It is dome-shaped or pedunculated and grows slowly. Differential diagnoses include nevus lipomatosus superficialis and "sebaceous" trichofolliculoma. FSCH can be readily identified by the presence of adipocytes and a fibrous stroma. One case was unique in its appearance of a large pedunculated nodule with a proliferating cyst. Prior to the invidualization of this entity, such cases were interpreted as nevus lipomatosus superficialis or "sebaceous" trichofolliculoma, although their histological appearance was inconsistent with such a diagnosis.

Objective: Cast nephropathy, due to free light chain (FLC) toxicity, is the main cause of acute kidney injury in multiple myeloma, with about 10% of patients requiring dialysis. In these patients, in addition to chemotherapy that prevents FLC production, daily hemodialysis using high cutoff or adsorptive membranes, showed promising results by decreasing quickly toxic serum FLC concentrations. Case history: We report here the case of 2 patients presenting with acute kidney injury and high FLC serum concentration and M-components one with IgG Kappa and the other with IgD lambda. Both were treated with bortezomib and dexamethasone and received a 24-h continuous hemodialysis using a high and sharp cutoff (around 35,000 Daltons) polysulfone membrane (ultraflux ® HD 1000, Fresenius Medical Care GmbH, Bad Homburg, Germany) with citrate regional anticoagulation using a safe and dedicated device (multi filtrate Ci-Ca ® ). Conclusion: Despite similar range of depuration, serum plasma FLC decreased importantly in the patient with the kappa type who recovered but was unchanged in the lambda type patient who remained under maintenance dialysis. Further studies are needed to confirm this new approach therapy.

Blaschko-linear psoriasis is a rare disease about which only a few publications have appeared in the literature. This form of psoriasis poses problems of differential diagnosis with regard to other forms of inflammatory Blaschko-linear dermatoses. Herein, we report an original case, the linear nature of which was revealed by treatment with infliximab.A 29-year-old man presented chronic psoriasis present for 17 years and resistant to various forms of systemic therapy. Treatment with infliximab 5mg/kg given on D1, D15 and two-monthly, thereafter resulted in practically complete resolution of all skin lesions after the fourth infusion. The only remaining lesions were psoriatic erythematous-squamous, non-pustular lesions with a Blaschko-linear pattern, limited to one side, on the left arm and left leg. These lesions persisted after 10 courses of infliximab, although no other lesions reappeared.This case was original in terms of the revelation of Blaschko-linear lesions during treatment with infliximab, despite the complete disappearance of diffuse psoriatic plaques, thus suggesting the existence in this patient of two cell populations, each having a different response to biotherapy.

A biochromatographic approach is developed to measure for the first time thermodynamic data and magnesium (Mg(2+)) effect for the binding of testosterone (TT) to sex hormone-binding globulin (SHBG) in a wide temperature range. For this, the SHBG was immobilized on a chromatographic support. It was established that this novel SHBG column was stable during an extended period of time. The affinity of TT to SHBG is high and changes slightly with the Mg(2+) concentration because the number of Mg(2+) linked to binding is low. The determination of the testosterone retention with the steroid hormone at different Mg(2+) concentrations and temperatures demonstrated that the Mg(2+) binding heat effect associated with this Mg(2+) release or uptake during this binding was in magnitude around 17kJ/mol corresponding to the model describing the electrostatic attraction that occurs between the negatively charged non specific areas of SHBG and the positively charged of magnesium. At all the magnesium concentrations studied, the DeltaH values were negative due to van der Waals interactions and hydrogen bonding which are engaged at the complex interface confirming strong TT-SHBG hydrogen bond networks. As well, the DeltaS values were all positive due to hydrophobic forces in the testosterone-SHBG complex formation. In addition our results suggest that adaptive conformational transitions contribute to the specific testosterone-SHBG complex formation. As well, in the biological Mg(2+) concentration domain, it was clearly demonstrated that there was an uncompetitive inhibition of Mg(2+) on TT-SHBG binding which led an enhancement of bioavailable TT. Our work indicated that our biochromatographic approach could soon become very attractive for study other SHBG-steroid (or phytoestrogen) binding.

Annular elastolytic giant cell granuloma (AEGCG) is a rare form of granulomatous dermatosis. It is characterised histologically by phagocytosis of elastic fibres by multinucleated cells. We report a favourable outcome in a case of AEGCG following PUVA therapy and treatment with synthetic antimalarials.A 67-year-old retired wine grower presented with highly pruritic annular lesions with raised borders on the shoulders and trunk that had been present for several months. Histological examination of a biopsy sample from the erythematous border was characteristic of AEGCG. Various topical treatments proved ineffective and systemic corticosteroids attenuated the patient's pruritus but had no effect on the skin lesions. PUVA therapy resulted in regression of lesions on the trunk, but the rash spread to the patient's arms and was covered with epidermal microcysts. PUVA therapy was discontinued and treatment with a synthetic antimalarial (hydroxychloroquine 400mg/d) was initiated, resulting in complete regression of the lesions.AEGC was isolated in 1979 by Hanke et al. on the basis of five cases seen in females. This is a rare form of dermatosis with some 30 cases being reported in the English literature. The clinical aspect is fairly evocative, with erythematous papular lesions, either alone or in groups, with a raised border and a lighter centre tending towards atrophy. In most cases, the lesions are found predominantly in areas exposed to sunlight. The histological appearance is characteristic, with an image of giant cell elastophagic granuloma from which the name of the disease is taken. This appearance allows the disease to be differentiated from a number of other granulomatous diseases. The aetiology is unknown and treatment is empirical. Spontaneous cure can occur and consistent results have not been obtained with any treatments. In our case, PUVA was partly successful, and the synthetic antimalarials resulted in complete regression of residual lesions.

Subcutaneous T-cell lymphoma is a rare disease and diagnosis is often difficult. We report two cases of subcutaneous T-cell lymphoma simulating panniculitis and initially treated with systemic steroids.Case No. 1. A 75-year-old woman, otherwise asymptomatic, presented with plaques and nodules of the legs present for 4 months. Histological and immunohistochemical analysis revealed subcutaneous T-cell lymphoma of CD4- CD8+ CD56- phenotype. Improvement was observed with systemic steroids followed by radiotherapy. Case No. 2. A 53-year-old woman presented with a 10-year history of recurrent infiltrated plaques. Lupus panniculitis was evoked but not confirmed. In the context of new panniculitis lesions, histological examination showed a dense lymphocytic infiltrate involving the fat lobules. Lymphocyte immunophenotyping and genotyping led to a diagnosis of subcutaneous T-cell lymphoma of CD4- CD8+ CD56- phenotype. Molecular analysis showed T-cell monoclonality (alpha beta). The lesions improved after few months of systemic corticosteroids. Although new nodular lesions appeared from time to time, further therapy was not deemed necessary.A distinction is currently made between two types of subcutaneous T-cell lymphomas and the prognosis and therapeutic consequences differ widely. In our two patients, subcutaneous CD8+ T-cell lymphoma was diagnosed. The clinical course was indolent in both cases. Differential diagnosis with regard to lupus panniculitis can be difficult because of its slow progression. In such cases of low-grade lymphomas, first-line therapy may be limited to systemic corticosteroids.

A double blind, placebo-controlled trial was performed to test the efficacy of prevention of nosocomial infections by selective digestive decontamination. Placebo or tobramycin (80 mg) and colistin (100 mg) was given four times daily via the gastric tube. Amphotericin B (500 mg/6 h) was administered to all patients. As our ICU is divided into two separate subunits, intestinal decontamination or placebo was administered alternatively to patients of the two subunits during two 3-month periods, separated by a 2-month period without prevention. The decontamination (n = 97) and placebo groups (n = 84) were similar with respect to age, sex, severity score and diagnostic categories on admission. Intestinal decontamination alone failed to significantly reduce the number of infected patients (26% vs 34.5%, p = 0.20), but was effective on ICU-acquired infections (0.33 vs 0.60, p = 0.02) especially gram-negative infection rates (0.17 vs 0.43, p = 0.01). The onset of the first ICU-acquired infection was delayed (9 vs 13 days, p less than 0.001) and incidence of pneumonia (2 vs 13 cases, p less than 0.01) including bacterial pneumonia (0 vs 8 cases, p less than 0.01) was significantly decreased. However, mean ICU stay and mortality were not significantly modified by intestinal decontamination.

In this work, the interaction of a series of acetylcholinesterase inhibitors (AChEIs; donepezil, galanthamine, huperzine and neostigmine) with human serum albumin (HSA) immobilized on porous silica particles was studied using a biochromatographic approach. For all the tested AChEI molecules, linear retention plots were observed at all temperatures. An analysis of the thermodynamics (i.e. enthalpy (DeltaH degrees ), entropy ((S degrees *)) of the interaction of the AChEI molecules with the immobilized human serum albumin was also carried out. The (H degrees and (S degrees * values for donepezil, galanthamine and neostigmine, were negative due to van der Waals interactions and hydrogen bonding which govern this association with albumin. Whereas the positive values of (H degrees and (S degrees * of huperzine binding on HSA indicated a predominance of hydrophobic interactions. The association of AChEIs with HSA was increased linearly with pH. A comparative thermodynamic study with benzodiazepine molecules was also done to determine the potential binding site of these drugs on HSA.

We carried out a survey to assess the prevalence of various therapeutic approaches for chronic wounds in 14 primary care and rehabilitation units (SSR) and long-term care units (SLD) in the Haut-Rhin department of France, and we attempted to gauge the interest of doctors and nursing staff in the creation of a Mobile Wound and Healing Unit (EMPC).Our anonymous transversal survey was based on the results of two questionnaires, one concerning patients and the other concerning medical and nursing staff.96 of the 1 163 patients hospitalised at the time of our survey met the inclusion criteria. The global prevalence of sores was 8.3%, while that of bedsores was 6.4% and that of leg ulcers was 1.6%. There were no cases of wounds on diabetic feet. The study population was characterised by a M/F sex-ratio of 0.37, with mean age of 86 years for women and 76 years for men. The mean duration of bedsores was 6 months, compared with 14 months for leg ulcers and a relapse rate of 36% for bedsores and 52.6% for leg ulcers. In more than half of all cases the aetiology of the ulcers was not stated. Bacteriological samples were obtained in 7 cases. Wounds were generally cleansed using soap and physiological saline, with mechanical debridement being used in 4 cases. Hydrocolloids were the dressings used most widely for bedsores, while interfaces were most commonly used in leg ulcers. No topical antibiotics were prescribed. A pain evaluation scale was used in only 18 cases and topical anaesthetics were administered in one case prior to debridement of a leg ulcer. A bedsore risk evaluation scale was completed for 27 of the 75 of the patients presenting bedsores and special preventive mattresses were used for two-thirds of these patients. Twelve of 19 patients with leg ulcers had compression bandaging that was changed daily. Most doctors considered their knowledge of chronic wounds to be good, in contrast with nursing staff, 72% of whom judged their knowledge mediocre or insufficient. All the nursing staff and 11 of the 13 doctors expressed interest in the use of a specialised team for difficult cases.The main practices consistent with the recommendations were use of modern dressings, although the latter appeared to be changed too frequently, anecdotal use of antiseptic solutions, abandonment of use of topical antibiotics and nutrition management plans. Two-thirds of patients with leg ulcers wore compression bandages. However, improvements remain to be made concerning the use of topical anaesthetics, manual debridement, use of pain evaluation and bedsore risk scales, and assessment of the aetiology of leg ulcers.This survey, conducted prior to the creation of a mobile wound and healing unit based at the Colmar General Hospital, showed that doctors and nursing staff are extremely keen on the idea of specific training and practical advice concerning chronic wound management. It provided a clearer vision of the training requirements of SSR and SLD establishments in terms of chronic wound management.

In this paper, we present an automatic, robust and reliable process to quantify liver steatosis. The degree of steatosis is a useful marker of steatohepatitis. This degree is routinely assessed visually by an expert and then lacks of accuracy and robustness. The process that we have developed is divided in two steps. A fuzzy classification first merges into classes pixels according to their intensity. We use a generalized objective function that allows to detect micro and blurredness vacuoles of steatosis. Then, regions with inhomogeneous texture and irregular shape were eliminated with compactness and standard deviation parameters. The obtained results are good correlated with expert graduation (in five levels). A better correlation is obtained with a more precise grading.

Fluindione (Previscan) is an oral anticoagulant belonging to the vitamin K antagonist class and is very widely used in France. While bleeding is a common complication, severe immunoallergic reactions are less frequent. The authors report a case of drug-induced hypersensitivity syndrome.A 75 year-old woman was hospitalized for diffuse erythematous papular rash associated with facial oedema. These symptoms appeared 3 weeks after the beginning of treatment with fluindione, allopurinol and perindopril. Laboratory tests showed hyperleukocytosis, mixed hepatitis and moderate renal failure, with the entire picture being evocative of drug-induced hypersensitivity reaction. The eruption was associated with eosinophilia, hepatic cytolysis with cholestasis, and acute renale failure. While allopurinol and perindopril were stopped definitively, fluindione was only suspended temporarily following overdosage. On reintroduction, rapid recurrence of clinical and biologic signs was observed with increased severity. The skin rash resolved completely on withdrawal of the drug. Patch tests performed later were positive for fluindione and negative for allopurinol and perindopril.These manifestations were consistent with the diagnosis of drug-induced hypersensitivity syndrome due to fluindione. Very few cases have been described with fluindione despite widespread prescription of the treatment is in France. While there may be no skin involvement, immunoallergic signs such as fever, hepatitis and acute tubular interstitial nephritis have been described with fluindione and these may be related to this syndrome (DRESS - Drug Reaction with Eosinophilia and Systemic Symptoms). Skin patch testing, which is easily performed, can be extremely helpful in determining a causal relationship with medication.

Purpuric allergic contact dermatitis is a rare and poorly understood condition.A 27-year-old male patient with a personal history of atopic dermatitis since childhood consulted for chronic papular-purpuric rash present for 7 years. Moderate pruritus was seen. Profuse lesions were observed on the palms and soles and on the upper and lower limbs, with sparing of the trunk. These lesions consisted of purpuric papules, in some cases with crusts, forming large plaques. The clinical picture was initially suggestive of vasculitis, but this diagnosis was ruled out by histological examination and laboratory tests. Skin patch tests were evocative of chromium-induced contact dermatitis. Retrospective directed history-taking confirmed the relevance of the latter test since it revealed regular wearing of leather clothing. Lasting cure was achieved following eradication of the allergen.Reports of contact purpuric dermatitis are rare. This condition has been described principally for allergens consisting of rubber or dyes used in clothing. Our case was notable on account of the severity of the lesions, mimicking vasculitis, as well as the novelty of the incriminated allergen, chromium, found in leather garments. It underlines the value of routine skin patch tests in the event of chronic non-specific dermatitis. To our knowledge, this is the first reported case of chromium-induced purpuric allergic contact dermatitis.

Dermatologists frequently provide training for general practitioners, but such training is not systematic and evaluation is rare.A training campaign for general practitioners and occupational physicians in melanoma screening was carried out in the Haut-Rhin Department of France in 2004. The 630 general practitioners and 120 occupational physicians in this geographic department received repeated mail together with materials (posters and booklets) for their waiting rooms, and they were invited to attend medical training sessions. The sessions consisted of 10 photographs for initial evaluation, provision of epidemiological information, training in identification of subjects at risk and diagnosis of pigmented lesions, with a further 10 photographs for evaluation at the end. The 20 evaluation photographs were randomly selected for each session from 40 photographs comprising 18 cases of melanomas, 14 of nevi, 4 of basal cell carcinomas and 4 of seborrheic keratoses. At the end of each session, the physicians returned 2 anonymous questionnaires containing their overall assessment of the campaign (Q1) and their answers concerning the 20 evaluation photographs (proposed diagnosis and management strategy) (Q2). The questionnaires were then analyzed. The 40 evaluation photographs were also tested on 47 dermatologists.Three hundred and fifty physicians - 278/630 general practitioners (44%) and 72/120 occupational physicians (60%) - attended 18 medical training sessions. Response levels for questionnaires Q1 and Q2 were 88% and 90% respectively. Almost all of the physicians involved considered the campaign to be warranted. At the end of the training sessions, 96% felt they were better equipped to identify subjects at risk for melanoma and 53% (58% of general practitioners and 39% of occupational physicians, p=0.03) felt they had greatly improved their ability to diagnose pigmented lesions. The median number of correct replies concerning the evaluation photographs increased from 6/10 to 7/10 between the initial evaluation photographs and the final evaluation photographs (p0.0001), with no difference being seen between the general practitioners and occupational physicians. The median number of correct replies from the 47 dermatologists was 35/40 (8.75/10). The most striking improvement noted during the campaign concerned the ability to identify melanomas. The figure rose from an initial 59% at the start of the session (initial evaluation photographs) (versus 86% for the dermatologists) to 84% by the end of the session (final evaluation photographs) (p0.0001). The management strategy proposed for photographs of melanoma (irrespective of the proposed diagnosis) was judged "appropriate" in 86% of cases at the start of the session versus 94% at the end of the session (p0.001). Seborrheic keratosis was correctly identified in 43% of cases by the general practitioners/occupational physicians versus 75% by the dermatologists, and was confused with melanoma in 22% of cases by the general practitioners/occupational physicians versus 5% by the dermatologists. No improvement was seen during the training session in terms of the ability of the general practitioners/occupational physicians to correctly identify seborrheic keratosis. The majority of participants indicated their willingness to participate in the screening program and asked to receive information on melanoma on a regular basis.This initial study shows the immediate impact of medical training sessions on general practitioners/occupational physicians to be important in terms of sensitization and moderate but significant in terms of improved diagnosis of pigmented lesions. The longer term impact, as well as the impact of the campaign on physicians not taking part in the medical training sessions, remains unknown. This study militates in favor of the involvement of general practitioners and occupational physicians in mass screening for melanoma in collaboration with dermatologists. The 2004 campaign in the Haut-Rhin Department also included information for the general public. The primary evaluation criterion of the campaign will be change in incidence of thick melanomas recorded by the departmental cancer registry.

Bacteremic pasteurellosis is an uncommon form of Pasteurella multocida infection, usually involved in local infections. This systemic infection often occurs in immuno-compromised patient such as cirrhotic or alcoholic patients, with a high mortality rate (up to 60%). Septic shock may occur and neurological disorders or coma are frequent. We report such a case. Treatment associated local care, antibiotics (beta-lactam antibiotics plus fluoroquinolone) during 14 days and resuscitation of septic shock. Owing these therapies, septic shock was successfully treated without complications.

The binding constants (K) of a series of anticoagulant rodenticides with the main soil organic component, humic acid (HA), were determined using frontal analysis approach. The order of the binding constants was identical as the one obtained in a previous paper [J. Chromatogr. B 813 (2004) 295], i.e. bromadiolone > brodifacoum > difenacoum > chlorophacinone > diphacinone, confirming the power of this frontal analysis approach for the determination of binding constants. Moreover, and for the first time, the concentration of unbound rodenticide to HAs could be determined. Thanks this approach, we could clearly demonstrate that HA acid protected the human hepatoma cell line HepG2 against the cytotoxicity of all the rodenticides tested and that the toxicity of rodenticides was directly linked to the free rodenticide fraction in the medium (i.e. unbound rodenticide to HA).

European borreliosis, known to the general public as 'Lyme disease' in analogy with the American form, which it differs from in many points, is endemic in the area of Alsace and is a public health problem. The level of knowledge and prevention of the population with regard to the disease has never been assessed in France.A survey was conducted in all the national health examination centers in Alsace using a self-applied questionnaire. The data collected concerned the socio-demographical characteristics, knowledge on the disease, history of tick bites, fear the disease creates, frequency of visits to the forest, prevention habits when visiting the forest and the attitude adopted in the case of a tick bite.Out of the 600 persons included, 99 (16.5 p.cent) had been bitten by ticks once or more over the past year. The existence of Lyme's disease was known to 74 p.cent of the consultants, 63 p.cent claimed they were worried by the disease and 43 p.cent knew that the first manifestation is redness spreading over the skin. Twenty-seven percent wore trousers and long sleeves when visiting the forest and 19 p.cent inspected their body carefully on their return. The persons least well informed were also those who did little to protect themselves against tick bites. They often were under 30 years old, lived in urban settings and had few diplomas. Those who had frequent spare time in forest and those who had a history of tick bites were the best informed and protected themselves better. The fear of the disease was associated with better knowledge and more appropriate behaviour.This study shows that a large percent of the population in Alsace is exposed to tick bites. Tick bite borreliosis is relatively well known, but protection remains insufficient. Better knowledge of the disease is related to better prevention. Information and teaching campaigns for the general public could specifically target the young people, urban dwellers and those with few diplomas. Specific messages of prevention could be delivered to the most exposed at-risk subjects (i.e. those bitten by ticks or having leisure in forest) at the places of their leisure or medical consultations.

Clinical features and extent of bullous pemphigoid lesions differed widely among patients. The pathogenic role of anti-BPAG2 antibodies has been recently demonstrated. The aim of this study was to analyze the relationship between clinical features of bullous pemphigoid patients and the antigens recognized by their serum.One hundred and twelve bullous pemphigoid patients were included in this prospective multicenter study. Inclusion criteria were the following: 1) diagnosis of bullous pemphigoid established on the presence of 3 of the 4 clinical features of bullous pemphigoid, histological picture of bullous pemphigoid and positive direct immunofluorescence; 2) serum available for immunoblotting studies. The clinical and biological findings were prospectively recorded on standard forms. Sera were collected and analyzed using indirect immunofluorescence and immunoblotting on human epidermal extracts.Analysis of patient's clinical features depending on the antigens recognized by their serum showed that patients whose serum contained anti-BPAG1 antibodies had more frequently pruritus, blisters on the lower limbs and a positive indirect immunofluorescence. Patients whose serum contained anti-BPAG2 antibodies had blisters more frequently localized on the head, and a more frequently negative indirect immunofluorescence. Patients whose serum was negative by immunoblotting had less frequently urticarial and/or eczematous lesions, bullae less frequently localized on the lower part of the trunk, abdomen and lower limbs, lower eosinophilia and a more frequently negative indirect immunofluorescence.Patients with circulating anti-BPAG1 antibodies exhibited the most typical, clinical and biological features of bullous pemphigoid.

Data collected in free anonymous HIV screening centers (Centre d'Information et de Dépistage Anonyme et Gratuit du VIH, CIdAG) are numerous but poorly exploited. The characteristics of the consultants, their risk factors and their behavior were rarely analyzed previously.Data of 3995 patients attending the CIdAG of Colmar between January 93 and February 99 were prospectively analyzed. Two 18-month periods at the beginning and end of the study were compared.The activity of the center was stable. Nine HIV infections were detected (2 p. 1000 consulting). The male/female ratio was 1.2 and the mean age was 26 years. The proportion of very young patients (20 years) was 30 p. 100 and increased significantly between the two periods. Six per cent of the consultants were male homo/bisexuals and 2 p. 100 used intravenous drugs. A regular use of condoms when having occasional sexual relations was reported by 40 p. 100 of consultants before 20 years of age, but this proportion decreased regularly as the age increased. It was minimal among intravenous drug users (19 p. 100), and greater among male homo/bisexuals (46 p. 100) than among male heterosexuals (37 p. 100) and women (33 p. 100). This proportion increased significantly during the study period in heterosexual men and women but not in male homo/bisexuals. The number of sexual partners did not vary but the knowledge of the partners'status for HIV infection and drug addiction progressed significantly. Some subjects who attended the centre several times were identified anonymously. They differed from the other consultants by an older age (mean: 31), a higher proportion of male homo/bisexuals (14 p. 100) and a less regular use of condom (26 p. 100).In some French anonymous HIV screening centers, information and prevention currently appears to prevail over detecting new HIV infections. Modifying at-risk behaviour is difficult. Current messages for prevention must be improved.

This study aimed at measuring the medico-economic interest of a care management programme established for asthmatic patients in the Amiens region ("Action Asthma Amieris") by using and comparing different evaluation tools. Three tools were used in parallel: 1) a questionnaire for collecting information on healthcare received was completed monthly by 305 patients recruited by 73 physicians between November 1998 and January 1999; 2) data issued by the national insurance fund for the years 1998 and 1999, for those patients included after January 1999; and 3) data on all hospitalisations for 1998 and 1999 in the University Hospital Centre obtained from the French hospital information database (PMSI). Data from the national insurance fund and from the PMSI are essential to evaluate costs, since the patients' statements proved to under-estimate the amount of healthcare administered and received. Following the implementation of this asthma care management programme, an increase of pharmaceutical expenses and a decrease in the number of hospitalisations for asthmatic patients were observed.

International audience; The retention of 8-methoxypsoralen (8-MOP) on an immobilised hydroxypropyl-beta-cyclodextrin (HP-beta-CD) column was analysed in HPLC by the determination of its Langmuir distribution isotherm. A such method was used to confirm the potential drug complexing role of this cyclodextrin. The 8-MOP/HP-beta-CD association constant (K) was equal to 29.5 and 18.7 M-1, respectively, at a temperature equal to 5 and 25 degrees C, respectively. These association constant values were used to determine the cytotoxicity profile of human keratinocyte cell line (HaCaT) in relation to the complex concentration. It was showed through these data that HP-beta-CD had a cytoprotective since a reverse effect of HP-beta-CD on 8-MOP cytotoxicity was observed.

The mechanisms of (i) the binding of two sex-hormones (i.e. progesterone and beta-estradiol) to human serum albumin (HSA) and (ii) the progesterone displacement of its HSA binding cavity by beta-estradiol were studied by biochromatography using three different methods. In the first time, zonal elution method was used to prove the direct competition effect between the two sex-hormone. In the second time, the competition effect between beta-estradiol and progesterone to bound on the same HSA site was analysed by the competitive bi-Langmuir approach. Finally, the thermodynamic data of these two binding processes were studied. The Gibbs free energy value (Delta(approximately)G degrees) of the displacement equilibrium was negative demonstrating that beta-estradiol displaced progesterone of its HSA binding cavity. Moreover, the effect of two chloride modifiers (i.e. Na(+), Mg(2+)) on these two binding processes were analysed. Results showed that in the salt biological concentration ranges, the Mg(2+) cation enhanced strongly the bioavailable progesterone, whereas the Na(+) cation interacted slowly on the progesterone displacement of its HSA binding site by beta-estradiol. This study showed that it must be useful to carry out more in vivo test on the magnesium supplementation effect for women who suffer from estrogen dominance syndrome.

In this paper, a new and efficient method for synthesis of phloroglucinol with an overall yield of 60% was described. As well, the phloroglucinol association on an immobilized human serum albumin (HSA) column was analyzed in biochromatography by the determination of its Langmuir distribution isotherms. The role of the magnesium cation Mg2+ on the phloroglucinol-HSA binding process was as well analyzed. The results showed that in the Mg2+ concentration range (0.7-2 mM) (including its biological concentration range, i.e. 0.75-0.90 mM), increasing the Mg2+ concentration increased the fraction of free phloroglucinol (not linked with HSA) and thus its biological effect.

Increased level of homocysteine has been shown to be associated with atherosclerotic disease and venous thrombosis. There are only exceptional reports of cutaneous disease due hyperhomocysteinemia.A 71-year-old man presented with an acral purpura mainly located under the nail plates and resulting in onycholysis. Histologic examination of a skin biopsy specimen showed thromboses of dermal vessels without vasculitis. Laboratory tests revealed highly elevated homocysteinemia due to a mutation in the methylene-tetra-hydrofolate-reductase gene. No other cause of purpura or thrombophilia was found. When oral folic acid was given, both homocysteinemia and cutaneous lesions were controlled. However, a biological and clinical recurrence occurred when therapy was discontinued.Hyperhomocysteinemia has probably a causal role in this original case of acral purpura. Since treatment is effective, the detection of hyperhomocysteinemia should be proposed in patients with cutaneous lesions secondary to distal vascular thromboses.

Allergic contact dermatitis is frequent in patients with chronic leg ulcers. However, it rarely occurs with modern wound dressings and is exceptional with hydrocolloids.A 66-year-old woman was treated for a leg ulcer with the Comfeel plus(R) transparent hydrocolloid dressing for two months. She developed a pruriginous, erythematous and vesiculous dermatitis under the hydrocolloid plaques. Patch tests for the Comfeel plus(R) transparent hydrocolloid, the Comfeel plus(R) hydrocolloid, balsam of Peru and epoxy resin were positive. Only the positive test for the Comfeel plus(R) transparent hydrocolloid was clinically pertinent. The histological examination of the positive test was suggestive of eczema.To our knowledge, allergic contact dermatitis to Comfeel plus(R) hydrocolloid dressings has not been reported. Most previous studies which included systematic patch-testings in patients with leg ulcers showed high sensitization rates for various allergens, but no allergy to hydrocolloids. Only isolated cases of allergic contact dermatitis to another hydrocolloid (Duoderm E(R)) have been reported. Our case report shows that allergic contact dermatitis is a possible side-effect of Comfeel plus(R) hydrocolloid dressings. However, it seems exceptional. Since the patch-tests failed to identify the constituent responsible for this allergy in our observation, comprehensive allergologic investigations should be repeated in further cases.

General treatments for immunocompetent individuals with herpes simplex infections are based on the use of antiviral agents which constitute the only treatment with proven efficacy. Antivirals were developed in the 1980s with aciclovir (ACV) as the leading compound and have greatly changed management. However, once the virus has penetrated the organism, it cannot be eradicated, neither by the immune system nor by antiviral agents. This viral resistance is basically related to its capacity to maintain itself in a latent form in the sensorial ganglions. ACV is the first line treatment, used since the 1980s; other antiviral agents are also available.

Fractal geometry has provided a mathematical formalism for describing complex and dynamical structures. It has been applied successfully in a variety of areas such as astronomy, economics and biology. Because of its success in such a variety of areas it is natural to develop fractal application in separative sciences.

Histological examination of a biopsy of a lesion of the glans penis revealed blood capillaries within the malpighian epithelium.A 66 year-old man exhibited two circumscribed red plaques of the glans penis following posthectomy. Their histological examination revealed blood capillaries within the epithelium without basal membrane and pericytes between the endothelial cells and keratinocytes. Further evolution was towards lichen planus of the genital mucous membranes. In spite of a verrucous carcinoma which had been surgically removed, the evolution within a follow-up time of 6 years was favorable.Blood capillaries ascending in the epithelium of the genital mucous membranes have been observed in a special variant of Zoon's balanitis, the lichenoid, telangiectatic and purpuric balanitis described by Jonquières in 1971. In our patient exhibiting a lichen planus of the glans penis, the occurrence of blood vessels in the malpighian layer of the epithelium may be interpreted as the consequence of an unusual epithelial and vascular regeneration of an erosive lichenoid lesion. It may also be interpreted as an original neoplasia, and could therefore be considered as a genital intraepithelial capillary hemangioma.

Recommendations on chronic wound management have greatly evolved during the last years. Practice in the medical units of the Civil Hospital of Colmar (France) appears to controversy these recommendations. Since nurses have a central place in such cares, we conducted a management audit among those working in different departments, before organising an educational program.One hundred and ten nurses (20 p. 100), randomly selected among the 546 concerned by chronic wounds working in the hospital were invited to participate in this audit composed of 23 questions.Participation rate was 72 p. 100. Response rates were higher than 80 p. 100 for 18 of 23 questions. The percentages below are those of the expressed answers. For 58 p. 100 of nurses executing the care after medical prescription, 31 p. 100 did so without medical advice and 11 p. 100 in collaboration with a doctor. Five and 14 p. 100 respectively knew all the classical clinical characteristics of venous and arterial leg ulcers. Some important risk factors for pressure sores were not well known, and only 15 p. 100 of nurses regularly used an evaluation scale of this risk. The massage-kneading of a stage I pressure ulcer was practiced by 49 p. 100 of nurses. Depending on the questions, 64 to 82 p. 100 of them routinely used antiseptics, and 82 p. 100 thought it was more important than compression for the healing of a venous leg ulcer. In more than one third of the answers, the dressing of a chronic wound was described as sterile. Finally, if an average knowledge of hydrocolloids was observed, there was little on alginates, foams and hydrogels, with a majority of nurses avoiding to answer these questions.Although important is the management of chronic wounds, basic knowledge was insufficient to hope for the nurses' collaboration. Prevention policy of pressure sores was not optimal. There were discrepancies between local practices and actual knowledge. Knowledge of new dressings was inadequate, and there was a risk for limited clinical benefit. We believe the results would have been similar if the audit had conducted among the doctors. Hense, a vast educational program has been initiated.

The occurrence of acne in dialysed renal failure patients has rarely been reported and the clinical characteristics and therapeutic issues rarely studied in these patients.Two men and two women, 33 to 56 years-old, with chronic renal failure and no past history of acne, developed severe acne under dialysis. The acne was excoriated in all cases and associated with prurigo-like lesions and intense pruritus, which made diagnosis difficult. Acne was profuse on the face and the trunk, but also on the neck (1 case) and the upper limbs (2 cases). No patient was taking acne-inducing substances. Various to therapies attempting to control pruritus were ineffective. However, anti-acne treatments (cyclines associated with local tretinoin in 1 case and oral isotreninoin in 3 cases) led to complete regression of the acne, pruritus and the prurigo-like lesions without relapse after a follow-up time of 4 months to 2 years.Pruritus is frequent during renal failure. However, the occurrence of unexplained acne has only rarely been reported. Our patients' clinical picture was original, characterized by the late development, under dialysis, of severe and pruriginous acne, the pathogenesis of which is unknown. Because of the clinical and therapeutic implications (impaired quality of life, pigmentation or scarring and remarkable efficacy of oral isotretinoin) this clinical picture merits more attention, and the modalities for the prescription of isotretinoin in this context should be defined.

Ethnicity, when it is used to mean shared genetic inheritance within a group, has become one of the most important factors in determining prostate carcinoma risk. Genetic polymorphisms were hypothesized to be the probable explanation for differences in risk among ethnic groups. The authors evaluated the association between polymorphisms in genes involved in the androgen biosynthesis and metabolism pathway and the risk of prostate carcinoma.Two hundred twenty-six patients with the pathologic diagnosis of sporadic prostate tumor and 156 healthy matched (age, ethnic group) male controls from a large epidemiologic cohort were genotyped for previously described polymorphisms in the androgen receptor (AR), 5alpha-reductase type II (SRD5A2), p450c17 (CYP17), and aromatase (CYP19) genes. The different polymorphisms in prostate carcinoma patients also were analyzed according to age of onset, preoperative prostate-specific antigen level, tumor stage, and tumor grade.The distribution of the tetranucleotide simple tandem repeat polymorphism (STRP) in intron 4 of CYP19 was significantly different in control and cancer patients (P = 0.012). The 171 allele and the 187 allele were associated with prostate carcinoma risk (P = 0.05 and P = 0.045, respectively). Conversely, no association was observed between prostate carcinoma risk and the other polymorphisms studied as follow: the CAG repeat in exon 1 of AR, the (TA)n dinucleotide repeat polymorphism in the 3' untranslated region, and the A49T or V89L substitutions in SDR5A2, the single base pair (bp) (a T to C transition) polymorphism that creates an additional Sp1-type (CCACC box) promoter site in CYP17. In prostate carcinoma patients, CAG repeats of AR, and TA repeats of SDR5A2 are associated with age of onset (P = 0.05 and P0.001, respectively).The association between the 171-bp allele of CYP19 and prostate carcinoma risk suggests that aromatase could be used as a new indicator for prostate carcinoma prevention in men of White French ethnogeographic origin. Conversely, it is possible that an individual carries both a high- and a low-risk marker (e.g., CYP17 A2 allele and V89L in SRD5A2) resulting in no overall difference in risk observed across the population. For these reasons, the development of a polygenic model, incorporating multiple loci from the individual genes may maximize the chance of identifying individuals with high-risk genotypes.

Since 1994, health care in French prisons is managed by the public hospital system. The hospitals created ambulatory consultation units for prisons and detention centers. Skin problems rapidly became a frequent reason for consultation. This is the first systematic assessment of needs concerning dermatological consultation in prisons.A monthly dermatology consultation was established at the Colmar detention center in May 1996. We reviewed the files of all prisoners who attended between May 1996 and May 1999. Data collected concerned motivation for the consultation, drug use and serology for HIV and hepatitic C virus.There were 280 consultations for 180 prisoners. All were men, mean age 30 years, who represented 16% of the total prisoner population. Most consulted for one or more benign skin conditions. The two most frequent conditions were acne (29%) and mycoses (13%). Drug use was found in 36% of the consulting prisoners (64/180). One was HIV-positive. Hepatitis C virus serology was positive in 19% of those tested (28/149), and in 39% of the drug users and 2% of the non-drug users. Motivation for consultation did not differ between drug users and non users, neither between seropositive and seronegative patients for hepatitis C virus.This survey confirms the demand for dermatology consultation in the prison population and points out the frequency of hepatitis C virus in prisoners. A monthly specialized consultation was able to meet the basic demands concerning dermatology. Adapted management of hepatitis C virus in the prison population setting remains a difficult challenge.

Sarcoidosis or granulomatous reactions have rarely been reported in association with malignant melanoma (MM). We describe seven patients who presented with both granulomatous disease and MM, and discuss the physiopathological and prognostic significance of this association. In three patients, the granulomatosis was diagnosed as true sarcoidosis and in one patient, as tumour-associated granuloma. In three cases, designated here as atypical tumour-associated granulomatoses, the presence of clear-cut pulmonary granulomatous nodules was typical neither for sarcoidosis nor for tumour-associated granuloma and was highly suggestive of melanoma metastases. Mediastinal lymphadenopathy was present in every patient. In all seven patients, the question of mediastinal or pulmonary involvement or relapse of the MM was raised, but could be confirmed in only one patient. MM can be associated with granulomatous disease. Knowledge of this association has implications in the management of patients with MM.

Basal cell carcinomas (BCCs) are very frequent cutaneous cancers, often located on the face. Cure rates with surgery and radiotherapy are high, but these treatments have never been compared prospectively. A randomized trial was initiated in 1982 to compare surgery and radiotherapy in the treatment of primary BCC of the face measuring less than 4 cm. The primary end point was the failure rate (persistent or recurrent disease) after 4 years of follow-up. The secondary end point was the cosmetic results assessed by the patient, the dermatologist and three persons not involved in the trial. In the course of the trial, 347 patients were treated. Of the 174 patients in the surgery group, 71% had local anaesthesia and 91% frozen section examination. Of the 173 patients in the radiotherapy group, 55% were treated with interstitial brachytherapy, 33% with contactherapy and 12% with conventional radiotherapy. The 4-year actuarial failure rate (95% CI) was 0.7% (0.1-3.9%) in the surgery group compared with 7.5% (4.2-13.1%) in the radiotherapy group (log-rank P = 0.003). The cosmetic results assessed by four of the five judges were significantly better after surgery than after radiotherapy. Eighty-seven per cent of the surgery-treated patients and 69% of the radiation-treated patients considered the cosmetic result as good (P < 0.01). Thus, in the treatment of BCC of the face of less than 4 cm in diameter, surgery should be preferred to radiotherapy.

Sporadic observations would suggest that certain drugs play a role in the development of pemphigoid. A recent case-control study on long-term drug use associated with pemphigoid was unable to confirm the suspected role of these drugs, but did demonstrate a significant association between the development of pemphigoid and use of spironolactone.An 82-year-old patient had bullous erythematous lesions on the left thigh suggestive of pemphigoid. Histology and direct cutaneous immunofluorescence confirmed the diagnosis. The patient had been taking alimemazine, adrafinil, flunarizine, spironolactone and furosemide as long-term treatment. Spironolactone alone was withdrawn. The cutaneous lesions regressed and have not recurred during the 18-month follow-up.The causal effect of spironolactone in this case of pemphigoid is quite plausible. This hypothesis is favored by the agreement with epidemiological data. Other observations are however required before the causal role of spironolactone in development of pemphigoid can be confirmed.

Only few studies focus on ocular motor paralyses in herpes zoster ophtalmicus. We report 2 cases of complete ptosis resulting from paralysis of the superior lid levator, appearing at day 6 and 7 of an ophtalmic herpes zoster under treatment with acyclovir.Case 1: A 68 year old woman presented an history of ophtalmic herpes zoster with kerato-conjunctivitis and uveitis treated with acyclovir. At the third day of the treatment and 7th day of the ophtalmic zoster, an incomplete paralysis of the oculomotor nerve appeared resulting in a complete ptosis. The treatment was carried on until the 21st day without improvement. Four months later, all symptoms had completely cleared. CASE 2: A 66 year old woman was treated with acyclovir for an ophtalmic herpes zoster without ocular involvement. At the 4th day of the treatment and 6th day of the onset of the ophtalmic zoster, a paralytic ptosis and a acute epithelial keratitis appeared. Acyclovir treatment was continued for 10 days. The ptosis resolved gradually during 2 months.The manifestation of a complete ptosis with paralysis of the oculomotor nerve or of one of its branch is rarely seen in ophtalmic herpes zoster. However minor symptoms are often detected when patients were carefully examined with regard to external ocular movements. The physiopathological mechanism are discussed about. The possible action of an early antiviral treatment on the prevention of these complications is not known. In our two cases, a paralytic ptosis broke out suddenly, even under treatment with acyclovir for respectively 3 and 4 days. For future prospective studies about antiviral drugs for ophtalmic herpes zoster, a systematic evaluation of these neurological symptoms would be interesting.

Mercury exanthem can be considered as a systemic contact dermatitis following exposure to mercury vapor in patients with a prior sensitization to mercurials. It is characterized by a symmetrically distributed erythematous eruption appearing predominantly in the major flexural areas, in the neck, the lower portion of the abdomen and the upper anteromedial part of the thighs. In some cases, small pustules develop over the erythematous surfaces. We report our observations of two patients with mercury exanthem after exposure to mercury vapor caused by a broken thermometer. One of these patients presented with an unusual bullous form of mercury exanthem. Although diagnosis of mercury exanthem can be essentially based on clinical features, confirmation of the patient's exposure to mercury should be obtained. Cutaneous patch tests often prove the sensitization to mercurials.