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Purpose: Children increasingly participate in horseback riding, especially young girls, with more and more accidents during this activity. The severity of the injuries caused by horses seems to be higher than in other sports., Methods: In a retrospective study, we reviewed 303 accidents of children younger than 15 years of age during the past 13 years. Our study only investigated children who were hospitalized after their accident., Results: Eighty-two percent of the injured children were girls, but there was no difference between girls and boys in terms of severity. In most cases, children were hurt by falling from the horse (87 %). In the other cases, they were kicked or bitten by the animal. The most frequent trauma sustained was fracture (50 %). The upper extremity was injured in 40 % of the traumas followed by the head (32 %). The lower limbs, the abdomen, the spine, or the thorax were injured in less than 10 % of the incidents. The severity of the accidents was studied with the Injury Severity Score and we compared groups of children. Children younger than 11 years old were more severely injured than older children (P=0.0002)., Conclusion: The youngest horseback riders should be supervised carefully to avoid severe injuries during this activity., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Background: Dermatofibrosarcoma protuberans (DFSP) is a rare malignant tumour of the skin, with an estimated incidence of 0.8 to five cases per 1 million people per year., Objective: To study epidemiological, immunohistochemical and clinical features, delay in diagnosis, type of treatment and outcome of DFSP from 1982 to 2002., Methods: Using data from the population-based cancer registry, 66 patients with pathologically proved DFSP were included (fibrosarcomatous DFSP were excluded). Each patient lived in one of the four departments of Franche-Comté (overall population of 1 million people) at the time of diagnosis. The main data sources came from public and private pathology laboratories and medical records. The rules of the International Agency for Research on Cancer were applied., Results: The estimated incidence of DFSP in Franche-Comté was about three new cases per 1 million people per year. Male patients were affected 1.2 times as often as female patients were. The trunk (45%) followed by the proximal extremities (38%) were the most frequent locations. DFSP occurred mainly in young adults between 20 and 39 years of age. Mean age at diagnosis was 43 years, and the mean delay in diagnosis was 10.08 years. Our 66 patients initially underwent a radical local excision. Among them, 27% experienced one or more local recurrences during 9.6 years of follow-up. There was one regional lymph node recurrence without visceral metastases. These recurrences were significantly related to the initial peripheral resection margins. We observed a local recurrence rate of 47% for margins less than 3 cm, vs. only 7% for margins ranging from 3 to 5 cm [P=0.004; OR=0.229 (95%, CI=0.103-0.510)]. The mean time to a first local recurrence was 2.65 years. Nevertheless, there was no death due to the DFSP course at the end of the follow-up, and the final outcome was favourable., Conclusion: Our study emphasizes the importance of wide local excision with margins of at least 3 cm in order to prevent local recurrence. However, the recent development of inhibitors of signal transduction by the PDGFB pathway should soon modify the surgical strategy, which is often too mutilating.

High risk human papillomaviruses (HPVs) have emerged as risk factors for anal carcinoma, of which incidence is higher in HIV-positive patients than in the general population. The aim of our study was to investigate the prevalence and risk factors for anal HPV infections in HIV-positive patients with or without history of anal intercourse. Fifty HIV 1-infected patients (36 men and 14 women) were tested at entry and followed-up every 3 months for one year for the presence of anal HPV DNA by the Hybrid Capture II trade mark assay. A series of 50 HIV-negative subjects matched for age and sex served as controls. At enrollment, anal HPV DNA was present in 29/50 HIV-positive patients (58 %) and in 3/50 control subjects (6 %). High risk (HR) HPV genotypes were detected in 20/50 HIV-positive patients (40 %) with no difference in homosexual men and other HIV-positive patients. Risk factors for HPV infection were CD4 + cell counts less than 500/microL (RR: 2.13 [95 % CI: 1.0-4.7]) and history of anogenital warts (RR: 2.36 [95 % CI: 1.2-4.6]). The HPV load was higher in patients with CD4+ < or = 500/microL than in patients with CD4 + > 500/microL (p < 0.04). During the follow-up, anal HR HPV DNA was repeatedly identified at high levels in 5 HIV-positive patients. There is some convincing evidence that HIV-positive patients with low CD4+ cells, whatever the routes of HIV transmission, have a high rate of anal HPV infection and might be at increased risk of developing anal neoplastic lesions. Identifying HR HPV infection might be warranted in immunosuppressed patients.

The currently observed increased prevalence of syphilis in subjects with human immunodeficiency virus (HIV) infection could be an expression of an increase in sex-related risks or could result from facilitated viral transmission via ulcerations of the genital organs. In addition, viral-immunological interactions related to HIV infection could affect the natural history of syphilis suggesting that the clinical pictures of the past may be making a comeback due to modified response to syphilis infection. These observations would suggest revising a certain number of the classical diagnostic and therapeutic criteria for syphilis in HIV positive patients. The consequence of these interactions on response to treatment may be the key to the increased number of unsuccessful treatments observed recently and to the increased frequency of early neurological and ocular manifestations of syphilis. Clinicians should revise their therapeutic schemes which have become unadapted to the new situation caused by HIV infection.