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Background Despite the gold-standard approach for transaortic valve implantation (TAVI) remains transfemoral (TF), alternative approaches are needed in patients who present contraindications to transfemoral access. Case summary We report the case of a 79-year-old female with a symptomatic high-gradient severe aortic stenosis—mean gradient of 43 mmHg—and a significant supra-aortic trunk stenosis (left carotid artery: 90–99%; right carotid artery: 50–70%), and who was hospitalized for progressive dyspnoea New York Heart Association (NYHA) stage III. In this high-risk patient, it was decided to perform a TAVI. Because of a history of stenting of both common iliac arteries in a context of an arterial insufficiency of the lower limbs (Leriche classification stage III) and stenotic thoraco-abdominal aorta atheromatosis, an alternative approach to the transfemoral transaortic valve implantation (TF-TAVI) one was needed. It was decided to perform a combined transcarotid-TAVI (TC-TAVI) with EDWARDS S3 23 mm valve with a left endarteriectomy during the same operating time. Discussion Our case illustrates an alternative approach to perform a percutaneous aortic valve implantation, despite supra-aortic trunk stenosis, in a high-risk surgical patient contraindicated to a TF-TAVI. Transcarotid transaortic valve implantation remains a safe alternative when TF-TAVI is contraindicated, and the combined approach of carotid endarteriectomy and TC-TAVI offers a minimally invasive one-step treatment in high operative risk patients.

We describe the case of a 64 years old patient, known for an Enterococcus faecalis endocarditis on a 25 mm Edwards-Carpentier biological aortic valve in 2020, who was re-hospitalized one year later in cardiac surgery for a recurrence of Enterococcus faecalisbacteriemia. During hospitalization, the patient presented a cardiac arrest. The coronarography revealed an acute occlusion of the left coronary artery. The autopsy confirmed an Enterococcus faecalis thrombus on aortic valve and left coronary artery. Although systemic embolism is a common complication of infective endocarditis, septic embolism is an unsual cause of acute coronary syndrome and a very rare cause of cardiac arrest. Our case highlights a rare and potentially fatal complication of infective endocarditis: acute coronary syndrome on septic coronary embolism.

Trichoblastoma (TB) is an uncommon benign follicular tumour for which clinical data is limited since most reports originate from pathology studies.To describe the clinical aspects of TB.This is an ancillary study of a prospective multicentre cohort of 2710 clinically suspected basal cell carcinoma (BCC), including 935 nodular BCCs. Sixty-two cases were TB: they were analysed and compared to 935 nodular BCCs.TB mostly occurred in females (61% vs. 43% for BCC, P0.01) of mean age 63 years. They were located on the head and neck, mainly on the nose and forehead, in 87% of cases. The mean size was 8.1mm, 77% were10mm (55% of BCCs, P0.001), 8% were ulcerated (vs. 21% of BCCs, P0.02), and 47% persisted for more than 1 year (34% of BCCs, P0.05). Most cases had a clinical presentation similar to nodular BCC, except for 5 small, flat, white papules and 1 anfractuous plaque.Cases originated from a series of tumours clinically suspected as BCCs.Some 2.6% of tumours clinically diagnosed as BCC are in fact TB. TB occurs on the head, are more frequent in women, and are smaller and of longer duration than BCC. In most cases, clinical diagnosis on clinical grounds is difficult.

Background Postoperative intracranial hypotension-associated venous congestion (PIHV) is a rare event. The authors report the case of a patient presenting with PIHV after spinal surgery following the sudden loss of cerebrospinal fluid (CSF) induced by suction drainage. Methods A 69-year-old patient underwent uneventful revision surgery for wound dehiscence after lumbar surgery with placement of a subfascial suction drain. Results Postoperatively, the patient presented with fluctuating consciousness and a generalized tonic–clonic seizure. Computed tomography (CT) and serial magnetic resonance imaging (MRI) were performed showing convexity subarachnoid hemorrhages (SAHs), diffuse swelling of the brain and thalami and striatum bilaterally without diffusion restriction, and signs of intracranial hypertension resulting in pseudohypoxic brain swelling in PIHV. A dural leak at L3–L4 was treated with several CT-guided patches combining autologous blood and fibrin glue injections. The patient recovered without neurologic deficit and follow-up MRI revealed progressive complete reversal of brain swelling, and re-expansion of CSF spaces. Conclusion PIHV is a rare but potentially fatal entity. Awareness of PIHV after cranial or spinal surgery leads to early treatment of CSF hypovolemia and possibly better clinical outcome. Following acute CSF volume loss, an acute elevation of cerebral blood volume overcoming autoregulatory mechanisms seems a likely explanation for diffuse cerebral vasogenic edema and SAH in PIHV.

Resume Introduction La tuberculose cutanee est une infection due a Mycobacterium (M.) tuberculosis. Elle est rare en France. Les presentations cliniques sont variees, la demonstration causale de M. tuberculosis difficile, compliquant le diagnostic et une prise en charge therapeutique adaptee. Observation Un homme âge de 58 ans, ne au Maroc, consultait pour une ulceration de l’avant-pied droit evoluant depuis l’âge de 3 ans. Il avait deja consulte dans plusieurs services de dermatologie. Il avait eu de nombreuses biopsies cutanees et cultures bacteriologiques et mycobacteriologiques non contributives au diagnostic. Une lente extension et un suintement etaient observes au cours du temps, entrainant progressivement un handicap fonctionnel. Devant un aspect clinique evocateur et malgre une nouvelle recherche negative de mycobacteries, une quadritherapie antituberculeuse etait prescrite permettant la guerison complete de la lesion. Discussion Cette observation souligne la difficulte du diagnostic de tuberculose cutanee. Ce diagnostic doit etre suspecte cliniquement devant toute lesion cutanee destructrice ou verruqueuse evoluant sans guerison pendant une longue periode, meme en cas de culture negative et conduire a la prescription d’un traitement antituberculeux d’epreuve.

Resume Introduction Le trichoadenome est une tumeur folliculaire tres rare, mais dont l’aspect histopathologique est remarquable. Nous presentons dans cet article une serie de 12 cas de trichoadenome, ainsi que l’etude anatomoclinique et dermatoscopique d’un cas typique. Nous discutons ces resultats a la lumiere d’une recherche bibliographique exhaustive. Methodes Nous avons collecte 12 cas de trichoadenome de diagnostic incontestable, au laboratoire de dermatopathologie de la clinique dermatologique des hopitaux universitaires de Strasbourg, sur une periode de 30 ans (1989–2018). Resultats Les 12 cas concernaient 7 femmes et 5 hommes, d’âge moyen 58,9 ans, dont la majorite etaient localises sur l’extremite cephalique puis la fesse et la cuisse. L’examen histopathologique, similaire pour les 12 cas, montrait de multiples kystes de structure epidermoide contenant une keratine lamellaire eosinophile avec une paroi stratifiee, sans tige pilaire, situes dans le derme superficiel et moyen et semblant s’empiler les uns sur les autres. En immunohistochimie, les marqueurs de keratines large spectre etaient toujours positifs, le marqueur folliculaire Ber-EP4 faiblement exprime et PHLDA1 negatif. Pour le cas examine en dermatoscopie a lumiere polarisee, des petites aires arrondies blanc-jaune correspondant aux structures kystiques, entourees de vaisseaux lineaires irreguliers, etaient observees. Discussion Le trichoadenome est une tumeur rare de l’adulte d’âge moyen 45 ans, sans predominance de sexe. Il est asymptomatique, a croissance lente, de couleur variable, de taille infracentimetrique et localise le plus souvent au visage ou sur les fesses. Sur le plan histologique, la juxtaposition de multiples petites structures kystiques plaide pour une origine folliculaire. Le diagnostic differentiel se fait avec le trichoblastome qui exprime toujours intensement PHLDA1 et/ou Ber-EP4, le trichoepitheliome desmoplastique constitue de multiples travees beaucoup plus fines dans un stroma tres fibreux avec des vaisseaux arborescents bien nets sur un arriere-fond blanc-jaune ivoire en dermatoscopie, le carcinome microkystique qui a une extension plus profonde et le milium en plaque ou les kystes sont plus volumineux.

Inhibition of CYP450-mediated retinoic acid (RA) metabolism by RA metabolism blocking agents increases endogenous retinoids and is an alternative to retinoid therapy. Currently available RA metabolism blocking agents (i.e., liarozole and talarozole) tend to have fewer adverse effects than traditional retinoids but lack target specificity. Substrate-based inhibitor DX314 has enhanced selectivity for RA-metabolizing enzyme CYP26B1 and may offer an improved treatment option for keratinization disorders such as congenital ichthyosis and Darier disease. In this study, we used RT-qPCR, RNA sequencing, pathway, upstream regulator, and histological analyses to demonstrate that DX314 can potentiate the effects of all-trans-RA in healthy and diseased reconstructed human epidermis. We unexpectedly discovered that DX314, but not all-trans-RA or previous RA metabolism blocking agents, appears to protect epidermal barrier integrity. In addition, DX314-induced keratinization and epidermal proliferation effects are observed in a rhino mice model. Altogether, the results indicate that DX314 inhibits all-trans-RA metabolism with minimal off-target activity and shows therapeutic similarity to topical retinoids in vitro and in vivo. Findings of a barrier-protecting effect require further mechanistic study but may lead to a unique strategy in barrier-reinforcing therapies. DX314 is a promising candidate compound for further study and development in the context of keratinization disorders.

Introduction Androgen receptor (AR) immunohistochemistry is used in general pathology and in dermatopathology, particularly for sebaceous tumours. The goal of this study was to quantify AR expression in benign and malignant epidermal tumours and adnexal tumours. Methods We studied AR expression in 301 skin lesions using standard immunohistochemistry and compared 10 trichoblastomas, 10 sebaceomas and 10 hidradenomas using 5 markers (cytokeratin 7 and 8, PHLDA1, BerEp4 and AR). Results The rates of AR expression were: 22% in basal cell carcinomas, 3% in squamous cell carcinomas, 92% in sebaceous tumours, 10% in follicular tumours and 22% in sweat gland tumours. Benign sebaceous tumours were AR+ in 97% of cases. Only 12% of sebaceous carcinomas showed no AR staining. The immunohistochemical profiles of the comparative study were as follows: sebaceoma: AR+, CK7–, CK8–, PHLDA1–, BerEp4–; hidradenoma: AR–, CK7+, CK8+, PHLDA1+, BerEp4+; trichoblastoma: AR–, CK7–, CK8–, PHLDA1+, BerEp4+. Discussion AR staining was positive in 92% of sebaceous tumours, including sebaceomas, in some cases indicative of Muir–Torre syndrome. AR staining is therefore highly sensitive for the diagnosis of sebaceous tumours, but it is non-specific and is best used in combination with other antibodies, notably anti-CK8 and PHLDA1, particularly to distinguish sebaceoma from hidradenoma or trichoblastoma.

This manuscript illustrates an unusual cause of dyspnea. Cardiac tumor are uncommon, especially fusiform cells carcinoma.