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International audience; ObjectivesWe aimed to investigate the first Omicron cases detected in France in order to assess case characteristics and provide supporting information on the possible impact of this variant on the healthcare system.MethodsA standardized questionnaire was used to collect information from confirmed and probable Omicron cases.ResultsMedian age of 468 investigated cases was 35 years, 376 were symptomatic (89%); 64% were vaccinated with two doses and 7% had received three doses. Loss of smell and taste were reported by 8.3% and 9% of cases, respectively. Seven cases were hospitalized, three of those were unvaccinated (including two with reported precondition). No admissions to intensive care and no deaths were reported.ConclusionsOur results confirm a mild clinical presentation among the first Omicron cases detected in France and highlight the importance for the national COVID-19 surveillance system to quickly detect and adapt to the emergence of a new variant.

Summary: This is a report of a case with Nocardial asteroides infection. The infection in this case is presented with cutaneous manifestations which are in keeping with the concept of primary cutaneous chancriform syndrome. To our knowledge, these forms of Nocardial infection are rare and the one which we are reporting may be the first to be reported from Israel. Zusammenfassung: Bericht uber einen Fall einer Nocardia asteroides-Infektion. Die Infektion trat in diesem Fall unter einem klinischen Bild auf, das dem Konzept des primaren schankriformen Syndroms entspricht. Nach unserer Kenntnis sind derartige Formen der Nocardia-Infektion selten. Der von uns mitgeteilte Fall durfte die erste Mitteilung aus Israel sein.

Summary: Five hundred eighty six samples of skin and nail scrapings or hair clinically suspected of superficial fungal infection were studied by direct smears and cultures. 366 (62.5%) of these samples were negative by both methods. Of the remaining 220 (37.5%) samples, 114 (51.8%) were positive by the direct KOH preparation, 6 (2.7%) by culture and 100 (45.5%) by both methods. Most (72.7%) of the 214 (97.3%) KOH positive smears showed a low to high hyphal content, and 4 (1.9%) of them were culturally negative although they possessed a very high amount of hyphae. Discrepancies between the direct microscopic examination and the subsequent culture are well known in the literature and therefore this study strongly suggests the necessity of both tests for the diagnosis of superficial mycoses. Zusammenfassung: 586 Proben von Hautschuppen, Nagelmaterial und Haaren, bei denen klinisch an eine oberflachliche Pilzinfektion gedacht worden war, wurden im Nativpraparat und mit der Pilzkultur untersucht. 366 (62,5%) von diesen Proben waren in beiden Untersuchungsgangen negativ. Von den restlichen 220 (37,5%) Proben waren 114 (51,8%) nur im Nativpraparat (KOH) positiv, 6 (2,7%) zeigten nur ein positives Kulturergebnis, wahrend 100 Proben (45,5%) bei beiden Methoden einen positiven Befund ergaben. Von den 214 (97,3%) positiven Nativpraparaten zeigten die meisten (72,7%) einen niedrigen bis hohen Gehalt an Pilzhyphen und 4 (1,9%) von ihnen waren in der Kultur negativ, obwohl sie einen sehr hohen Gehalt an Hyphen aufwiesen. Diskrepanzen zwischen den Ergebnissen des Nativpraparates und denen der Pilzkultur sind in der Literatur gut bekannt. Daher stellt auch diese Untersuchung einen starken Hinweis darauf dar, das beide Untersuchungsmethoden fur die Diagnosestellung von oberfflachlichen Mykosen benotigt werden.

Among inbred strains of rats, the Fischer 344 (F344) is commonly used in immunological and behavioral studies. However, little is known about patterns of sex hormones and corticosterone (CORT) secretion throughout the estrous cycle in this strain, which is characterized by a marked CORT response to stress and variable length of cycles. In the current study, using radioimmunoassays, we assessed serum levels of progesterone, estradiol, LH, testosterone, prolactin and CORT, at 1-h intervals throughout the estrous cycle in F344 female rats with 4- and 5-day cycles, as well as in males. Vaginal smears were obtained from 268 females for 15 consecutive days to determine individual length of the estrous cycle and the exact estrous phase upon blood withdrawal, which was conducted once in each rat on the 12th day of smearing. The results indicated that both 4- and 5-day cyclers have two distinct and marked surges of progesterone, one on proestrus day and the other on diestrous-1 day. Testosterone levels in 5-day cyclers peaked on diestrus-3, one day earlier than in 4-day cyclers. Daily peak levels of CORT gradually increased from estrus day to proestrous day, whereas daily nadir levels of CORT remained unchanged. To simulate the natural kinetics of specific sex hormones in ovariectomized females, different doses of estradiol, progesterone, testosterone, prolactin or CORT were injected s.c. or i.p., or 90-day sustained release pellets containing different doses of estradiol or progesterone were implanted. The findings indicated dose- and time-dependent effects, suggesting regimens for modeling the estrous cycle or replacement therapy.

Summary: The frequency of Pityrosporum orbiculare as a skin commensal among israeli population was studied. Out of 74 subjects studied 51 (68.9%) gave positive results. However, the frequency of positive cases was not equally shared by the different age groups studied. It was positive in 77.1% of people between 15 and 45 years, while the positive results among younger and older subjects were 50% and 64.2% respectively. No difference in frequency was observed between the two sex groups. Zusammenfassung: Untersuchung uber die Haufigkeit von P. orbiculare als kommensaler Hautkeim in einer israelischen Bevolkerungsgruppe. Von 74 untersuchten Personen zeigten 51 (68, 9%) ein positives Resultat. Die Verteilung der positiven Nachweise war in verschiedenen Altersgruppen ungleich. Am hochsten lagen die Werte in der Gruppe mit einem Alter zwischen 15 und 45 Jahren: 77, 1%. Jungere bzw. altere Probanden waren mit 50% hzw. 64, 2% seltener befallen. Zwischen den Geschlechtern bestand kein Unterschied in der Haufigkeit des Befalls.

Assessing bone metastases is often beyond the scope of plain - film radiography, and nuclear imaging in particular with bone scintigraphy has proved the mainstay for detection of bony disease for over 40 years. Bone scanning with 99mTechnetium - labeled diphosphonates relies on the detection of pathological osteoblastic response elicited from malignant cells. This technique offers the advantage of whole body examination, low cost, availability and high sensitivity. However, it suffers from relative low specificity. The addition of single-photon emission computed tomography (SPECT) to bone scintigraphy has markedly improved the diagnostic benefit. Although the accuracy of SPECT is significantly higher than that of planar scintigraphy, there is still room for improvement of anatomic localization and morphological characterization, a limitation that has currently been mainly overcome with the upcoming of combined SPECT-CT (computed tomography). Positron emission tomography (PET), a modality with higher spatial resolution than that of SPECT can be particularly helpful in detecting small lesions. Moreover, PET imaging using various specific radiotracers has the advantage of detecting malignant disease in both bone and soft tissues. It is highly sensitive mainly in detecting early bone marrow as well as for diagnosing lytic bony metastases and can be also reliably used to monitor therapy response. In this review, we present the current role of SPECT and PET in the imaging of skeletal metastases from prostate cancer.

Eosinophilic fasciitis is an additional clinical entity to many others manifested by sclerodermic changes in the skin. A case with this process is reported. It presents vast cutaneous sclerodermic changes associated with eosinophilia, signs of muscular exertion, and a massive inflammatory infiltrate involving the lower part of the dermis, subcutaneous tissue and the muscle fascia. Prednisone therapy was followed by rapid and marked improvement.

Aspects of lymphocyte function were investigated, in vitro, in nine patients with active Behçet’s disease. The rosette formation technique revealed a slight decrease in number of T lymphocytes and more so of B lymphocytes. In spite of their low number, the transformation of the T lymphocytes in response to mitogens did not show a significant difference from that of normal controls. This may indicate a hyperreactivity, and in two instances a spontaneous blastogenesis prior to addition of mitogens, was also noted. The immunoglobulins and complement levels in serum were within normal limits.

SUMMARY The mechanism of skin hyperreactivity (pathergy) in Behcet's disease is unknown. It has been suggested that the response is due to an Arthus-like reaction. In 18 patients with active Behcet's disease, pathergy was induced and the skin biopsied after 24 h. The histological reaction was that of mild to intense round cell infiltration, perivascular in type. Direct immunofluorescence failed in all 18 patients to demonstrate the local presence of immunoglobulins and complement at the site of lesion. A marked increase in the number of mast cells was observed at the site of reaction and scattered throughout the dermis, the role of which is to be further investigated. The study failed to demonstrate a humoral mechanism in the production of the cutaneous hyperreactivity.

This is a report of generalized familial benign chronic pemphigus in a Negro male. The rich staphylococcal and streptococcal flora detected on the skin of this patient may have been a factor in the generalization of the process.

The etiology and treatment of Behçet’s diseases are still undecided. There are three principal etiological hypotheses: viral, autoimmune and defective fibrinolytic activity. Accordingly, antiviral, immunosuppressive and fibrinolytic enhancing agents have been tried. Corticosteroids, however, still constitute conventional therapy. Follow-up of cases has so far revealed that none of the above therapeutic measures fundamentally alters the course of the disease, and serious complications may occur and progress during their administration.

A pronounced vitiliginous reaction developed at the sites of MER/BCG injections given as an adjuvant immunotherapy to a patient with malignant melanoma. To our knowledge, this is the third report on patients exhibiting vitiligo apparently induced by immunotherapy and the first in association with MER. This association may be a sign for an antimelanocytic effect and may offer a further confirmation for the autoimmune nature of vitiligo.

A 2-year-old girl suffered from continuous pyogenic inflammation in the anogenital region probably enhanced by neurological alterations. In one episode, the inflammatory process presented multiple moist papillomatous growths on the labia majora and along the anal margin which are thought to have been caused by gonococcal infection.

Histocompatibility antigens (HL-A) were studied in a family with Behçet’s disease (BD). All who had symptoms or signs of BD had either HL-A B5 or BW35, or both.

Familial koilonychia involving 7 members in 3 generations is reported, one of them was complicated with an episode of bacterial infection of all fingernails. The familial distribution of the process in this report suggests an autosomal dominant transmission with high degree of penetrance.

The systemic manifestations of Behçet disease were evaluated retrospectively in 45 patients. Twenty-seven patients underwent radiographic examination. Twenty-two examinations (64.7%) showed positive but nonspecific findings, most of them involving the vascular tree. The roentgen diagnosis of Behçet disease will be influenced by the dermatologic and ophthalmologic findings.

10 of 16 (62.5%) patients with granuloma annulare presented microangiopathic changes in the skin. The incidence in control groups was 100% in diabetic patients, 40% in old-age patients not known as diabetics and 0 in young victims of road accidents. The frequency of the vascular findings does not seem to be shared equally by the two types of granuloma annulare, the generalized and the localized type. In the first, as in the diabetic group, microangiopathy was observed in all patients examined. Whereas, in the second it was detected in only 2 of the 8 patients. It is concluded, therefore, that from the point of view of their relation to a diabetic state, the two forms of the disorder differ from each other.

Disseminated Intravascular coagulation may be an important and determining factor in the pathophysiology of some of the cutaneous vascular manifestations. The use of heparin in this condition seems to be the therapy of choice and sometimes it is life saving. Hence, the importance of being aware of the possibility and polymorphism of this phenomenon. Three cases are described where the presenting symptoms of the disease were mainly dermatological.

Our experience with pemphigus vulgaris consists of 35 cases. The majority are Jews of Eastern European origin, with an average age of 49.3 years. A daily 40–60 mg of prednisone was effective to initiate remission in most of the cases. Substitution of prednisone by an equivalent dose of triamcinolone avoided further increasing in the dose in 11 of 14 cases. Other regimens of treatment, such as alternate-day therapy, addition of estrogen and of methotrexate, were utilized in some of the patients. They were effective in only a part of the cases and after the disease has been held in remission by the conventional daily therapy. Our data shows that it is adviseable to make allowances for individual reactions on determining the level of initial dosages and when utilizing the other modalities of treatment.

Two cases with circumscribed calcinosis of skin are described. One is an obvious case with scleroderma, whereas the second is apparently idiopathic. However, a striking clinical similarity is seen in both. This together with other noncontributory clinical and laboratory findings observed in the second case seem suggestive that idiopathic type of calcinosis may present a preceeding or presenting symptom of a subclinical underlying disease.

IDIOPATHIC hypoparathyroidism has been known as a clinical entity for almost a generation; it is, however, surprising how few cases of this disease have been reported in the clinical literature (1–6). In most of these reports special emphasis is laid on the trophic ectodermal manifestation of the disease. Steinberg (6) in his review of the literature up to 1952 found that out of 52 cases recorded, 37 had some kind of trophic ectodermal change of varying character and severity. Nevertheless, there is only 1 publication (7) on the occurrence of exfoliative dermatitis as a manifestation of idiopathic hypoparathyroidism.1 This fact has induced us to present the following case report. CASE REPORT Mrs. A.S., a 35-year-old Iraqi married woman, mother of 3 healthy sons, had been under treatment and observation since 1951 because of pulmonary tuberculosis. Psoriatic lesions had developed in 1952. A month before admission to our hospital she was discharged from a tuberculosis sanatorium in a stable general conditio...

A 55-year-old male with lymphosarcoma developed cutaneous tuberculosis during an asymptomatic stage of his basic disease. The possible relationship between the two processes is discussed.

SUMMARY The carbohydrate tolerance was routinely investigated in fifty-two patients with granuloma annulare. Thirteen of the fifty-two cases presented the generalized type and the remaining thirty-nine had the localized form of the disorder. The results obtained in these patients were compared with those revealed in two control groups of patients. The same number of patients of the same sex, age and ethnic group with skin diseases other than granuloma annulare were similarly investigated as were 386 patients with conjunctival micro-aneurysms. Some degree of carbohydrate intolerance was detected in 36.5% of patients with both types of granuloma annulare. However, the incidence of this disturbance in patients with the localized form was no greater than in those with other skin diseases. The important finding in this study was the 76.9% incidence of carbohydrate intolerance in generalized granuloma annulare. This finding was supported by the histopathological changes in the small cutaneous blood vessels of these patients.

Leishmania tropica rarely involve the mucous membrane. The only presenting symptom in the reported case was a chronic macrocheilia simulating a granulomatous cheilitis.

A patient with Behçet's disease developed the rare complications of pericarditis and, two months later, superior vena caval obstruction. The latter complication was investigated by angiography to exclude other causes. As a result of this investigation the caval obstruction was managed conservatively, the symptoms and signs improving spontaneously.

Solcoderm was used in the management of various epidermal growths in 372 patients with 1,002 lesions, including condyloma acuminatum, verruca plana, basal cell epithelioma, intradermal nevus, seborrheic and solar keratosis. No antiseptic precautions or local anesthesia were used during the treatment. The results seem promising and suggest that Solcoderm is a simple, safe, and efficient method for the management of these tumors. Cosmetic results were excellent. It is especially recommended when the lesions are in difficult to manage locations for surgical or other known chemical or physical methods, when the patient is not fit for surgical procedures, and when local anesthesia is contraindicated.

A patient with a cyclic premenstrual eruption, clearing spontaneously with the menstrual flow, is reported. Hypersensitivity to endogenous progesterone in this case was confirmed by positive intradermal and leukocyte migration inhibition tests. Treatment with conjugated estrogens was followed by remission of symptoms. The importance of awareness to the possibility of progesterone autoimmune mechanisms is emphasized.

This is a report of three cases of associated tuberculous and neoplastic processes. The first is a case of lymphosarcoma complicated by cutaneous tuberculosis. The remaining two are cases of cutaneous tuberculosis complicated by squamouse cell carcinoma. Due to clinical similarity, the diagnosis of the secondary process in these cases was evoked by its failure to respond to treatment of the primary disease.

Both venous and arterial thrombosis can be a feature in some patients with Behcet’s Syndrome. The pathogenesis of the coagulopathy is as yet ill understood. We have examined platelet adhesion and platelet aggregation in 14 patients with proven Behcet’s Syndrome and compared them with matched controls. Platelet adhesion was measured by two techniques recently developed in our laboratory. In the first platelet adhesion is determined when platelet rich plasma is applied to a glass slide while applying a predefined centrifugal force. In the second method citrated whole blood is pumped through an inert silicone tube and applied to a glass slide in the form of a stagnation point flow field. The number of platelets adhering to the slide per unit area is determined. The conditions of blood flow through this system were similar to those prevailing in arteries of similar size. Adhesion is found to be significantly greater in Behcet’s patients by both methods. There was a 30% increase in platelet adhesion in the Behcet patients. Platelet aggregation was determined by the Born method. Platelet rich plasma was used and 5HT, epinephrine, ADP, and collagen were the aggregating agents. In our hands platelets from the Behcet’s patients are more sensitive to aggregation induced by epinephrine and ADP than platelets from our controls.It appears that disturbed platelet function may play an important role in the coagulopathy of Behcet’s Syndrome.

Vaccinia of the vulva in a 32-year-old married woman is described. The vaccination was apparently due to a heteroinoculation from her husband during sexual contact. Clinically it presented as an indurated ulcer with a few isolated umbilicated vesicles and was associated with an acute biological false-positive serological reactions.