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Biomedical subjects

B Cribier

Publications and source records attributed to B Cribier.

At least 91 records · Page 5Linked to original sources

[Cutaneous eruptions of streptococcal and staphylococcal origin].

Scarlet fever consists in a diffuse exanthem associated with mucous changes. Classical scarlet fever is rare now, but other severe streptococcal infections have become more frequent, such as streptococcal toxic shock syndrome. The scarlatiniform exanthem and the shock observed in this disease are due to a streptococcal pyrogenic exotoxin. Exfoliative toxins secreted by Staphylococcus aureus are responsible for the tender erythema and cutaneous scaling characteristic of staphylococcal scalded skin syndrome of infancy. The so-called staphylococcal scarlet fever is probably an attenuated variant of this disease. Toxic shock syndrome toxin 1 (TSST1) is another staphylococcal toxin implied in the staphylococcal toxic shock syndrome. This disease is characterized by general symptoms and a scarlatiniform exanthem which are due to the effects of TSST1, acting as a superantigen.

Child↗

Nail abnormalities in rheumatoid arthritis.

Many nail abnormalities have traditionally been described in association with rheumatoid arthritis (RA), but their specificity has never been assessed in a controlled study. Our purpose was to evaluate the frequency and the specificity of nail changes associated with RA in a case-controlled study including 50 patients suffering from RA and 50 controls. For each patient, a general skin examination was performed and the 20 nails were examined. The nail features were noted and classified. A chi 2 test or a Fisher test was used to compare the two groups. The only nail abnormalities significantly associated with RA were longitudinal ridging on nine or 10 finger nails (29 patients in the RA group vs. three in the controls, chi 2: P < 0.001) and clubbing on at least one nail (24 patients vs. 10, chi 2: P < 0.01). Other nail changes were noticed but were not frequent enough to be significant. The presence of longitudinal ridging on the finger nails was significantly associated with RA.

Adolescent↗

[Lichen].

Explore the source record for details and available documents.

Adrenal Cortex Hormones↗

[Primary cutaneous monomelic B-cell lymphoma].

BACKGROUND: Cutaneous B cell lymphomas, especially when appearing as a monomelic papulonodular eruption, are rare. PATIENT: Ms H. 87-year-old, consulted for a papulonodular eruption of the left lower limb which developed during the past 5 months. This limb had been the site of a lymphedema since a traumatism 8 years ago. Histopathological analysis and immunostaining of a nodule showed that it was a large cell lymphoma of follicular stem cells. There was no extracutaneous involvement and the patient was successfully treated with radiotherapy. Two months after the completed radiotherapy a cutaneous relapse on the trunk and the upper limbs was treated with cyclophosphamide-vincristine-prednisone chemotherapy. DISCUSSION: Lymphedema probably played a role in the genesis of this lymphoma presumably by reducing the local immune response. It may have harmed endothelial cells and maintained an antigenic stimulation leading first to lymphocyte hyperplasia and eventually to a true lymphoma, in the same way this has been proved for some MALT lymphomas.

Aged↗

[Rilmenidine in rosacea: a double-blind study versus placebo].

INTRODUCTION: The usual treatments of rosacea (cyclines and metronidazole) are mainly effective on reducing the number of papules and pustules. Clonidine only was employed in order to treat flushes observed in rosacea. Rilmenidine is a central hypotensive drug which acts more specifically than clonidine on imidazoline receptors and which has no sedative side effects. The purpose of this study was to evaluate the efficacy of rilmenidine 1 mg/d in the treatment of rosacea. PATIENTS AND METHODS: A total of 41 patients suffering from typical rosacea were selected in this randomised double blind study rilmenidine versus placebo. The study comprised an 1-month observation period without treatment followed by 3 months of treatment. The major assessment criteria was the proportion of responders at the end of the treatment period. Responders were defined as patients showing a decrease of more than 50 p. 100 in the count of papules and pustules. Minor criterias were the variation of the number of flushes, self-evaluated by the patient and the variation of the redness of the face, noted by the investigator on a scale from 0 to 5. RESULTS: Fifteen patients treated by rilmenidine (R) and 19 patients receiving the placebo (P) were evaluated. The proportion of responders was 69.2 p. 100 in group R and 57.1 p. 100 in group P (p = 0.69). The variations of the number of papules and pustules and of the redness of the face were not significantly different in the two groups. The decrease in the number of flushes was higher in group R (around -13) than in group P (around -5), but the difference was not really significant (p = 0.076). Arterial pressure decreased in 3 patients in group R and in 2 patients in group P. Minor side effects were noted in a similar proportion of patients in the two groups. DISCUSSION: Rilmenidine is not efficient in reducing the number of papules and pustules but could decrease the number of flushes. Nevertheless, many patients were lost for follow-up and because of a major placebo effect, the conclusions of this study are not strong enough. Another study including more patients and using evaluation criteria based on the vascular components of rosacea could perhaps confirm this hypothesis.

Adrenergic alpha-Agonists↗

[Erysipelas and impetigo].

Erysipela is a dermal or hypodermal infection of the skin, which predominantly involves the leg and is associated with high fever. Erysipela is most often caused by Streptococcus pyogenes. Venous insufficiency or lymphoedema are important local factors for the development of this infection which spreads from intertrigo, local wound or leg ulcer. Treatment is essentially based on parenteral penicillin G. Impetigo is a superficial infection of the skin due to Staphylococcus aureus or to Streptococcus pyogenes, and is frequent in children. Classical impetigo is made of yellow-brown crusts located around the mouth and nose, whereas bullous impetigo involves frequently the trunk and limbs. Secondary impetigo occurring in pediculosis or scabiosis is frequent. It is a contagious disease which is more frequent in patients with poor hygiene. It can be treated by general antibiotics, mainly macrolides, penicillin M or cephalosporins.

Adult↗

Recurrent annular erythema with purpura: a new variant of leucocytoclastic vasculitis responsive to dapsone.

Annular lesions are rarely reported in the clinical spectrum of leucocytoclastic vasculitis, except in the acute haemorrhagic oedema of the skin. We report three patients who suffered from an extraordinary recurrent annular dermatitis, for 4 years in one case and for decades in the other two. The eruption was characterized by purpuric lesions that had a centrifugal evolution, creating target- or polycyclic patches disseminated on the limbs and trunk. The patients' general condition remained excellent during the attacks. All lesions spontaneously disappeared within 2 weeks, but recurred monthly. In all three cases, the histological changes were consistent with leucocytoclastic vasculitis. One patient had ulcerative colitis and another had a benign immunoglobulin A (IgA) monoclonal gammopathy. These two patients showed a good response to dapsone therapy. This dermatosis probably represents a new and rare variant of leucocytoclastic vasculitis.

Dapsone↗

Changes in sexual behaviour of patients attending an HIV testing centre: a prospective study 1988-1994.

OBJECTIVE: To evaluate the sexual behaviour changes in patients attending HIV testing during the period July 1988 to June 1994. DESIGN: In a prospective study, 6824 face-to-face interviews were carried out before the HIV test was performed. The frequency of condom use and the number of sexual partners during the 6 previous months were recorded annually from July to June. The data were analysed according to gender, age class and sexual orientation. SETTING: Strasbourg, Bas-Rhin, France. SUBJECTS: Patients attending the HIV testing centre of Strasbourg. RESULTS: There was a striking increase in the number of attenders of this centre from 358 patients in 1988/89 to 2421 in 1993/94. We observed a significant decrease of homosexuals having more than five partners (p < 0.05) whereas multipartner sex remained unchanged in heterosexuals. There was no change in the proportion of patients having only one partner, except a slight raise in patients under 20 years. All groups showed a very significant increase in condom use, which was especially marked in young heterosexuals aged under 30 years. Nevertheless, condom use remained higher in homosexuals than in heterosexuals in 1993/94. In addition, there was a striking fall of past sexually transmitted disease in heterosexual patients under 20 years during the study period, and a fall in the HIV positivity rate from 1.96% to 0.42%. CONCLUSIONS: A major increase was noted in condom use in all groups and a reduction of multipartner sex in some patients. These data are encouraging in the younger patients, but prevention efforts should also be concentrated on middle aged patients who did not show major sexual changes, although having important risk factors for HIV infection.

Adult↗

[Porphyria cutanea tarda and hepatitis C virus infection. Clinical and virological study].

INTRODUCTION: The role of hepatitis C virus (HCV) infection in porphyria cutanea tarda (PCT) is probable since the global antibody prevalence among PCT patients is about 70 p. 100. The purpose of this study was to evaluate the virological characteristics in 12 patients with sporadic PCT and one with familial PCT. METHODS: Anti-HCV antibodies were detected by enzyme-linked immunosorbent assay and confirmed by recombinant immunoblot assay. Hepatitis B virus (HBV) and anti-human immunodeficiency virus (HIV) markers were also determined. The polymerase chain reaction (PCR) was performed in order to detect: 1) both positive and minus HCV strands, 2) HCV RNA titer and 3) HCV RNA genotype. RESULTS: Seven of the 12 patients with sporadic PCT were HCV positive and the patient with familial PCT was HCV negative. The age of onset of PCT was significantly lower in HCV positive patients than in HCV negative patients (p < 0.02). The HCV RNA was detected in all patients who had HCV antibodies, and the replicative intermediate of HCV was detected in 3 of them. The positive RNA titer ranged from 1/10 to 1/10(6). Four patients were infected by HCV genotype I, 2 by genotype II and 1 patient was coinfected by type I and type II. Three of the 7 HCV positive patients also had HBV antibodies, but HBV DNA was never detected. All patients were HIV negative. DISCUSSION: The HCV infection rate was high in this series (58 p. 100), and all HCV infected patients had HCV RNA, reflecting an active replication of the virus. The young age of onset of PCT suggests that HCV is a major triggering factor of PCT. Nevertheless, the clinical changes of PCT were not related to the virological findings, suggesting an indirect role of HCV.

Adult↗

Examination of cutaneous macroglobulinosis by immunoelectron microscopy.

Cutaneous macroglobulinosis is a rare cutaneous manifestation of Waldenström's disease. Lesions are though to result from accumulation of macroglobulin in the dermis and are therefore called IgM storage papules. Ultrastructural findings in the previously reported cases were contradictory and the nature of the deposits was not established by electron microscopy. The purpose of this study was to analyse such deposits by the use of immunoelectron microscopy. A 60-year-old woman had multiple erythematous papules for 1 year. The histopathological changes consisted of plasmocytic infiltration of the dermis and eosinophilic deposits. The skin changes and other investigations led to a diagnosis of Waldenström's disease. Samples from normal and diseased skin were analysed by electron microscopy and by immunogold labelling with anti-IgM antibodies, after Lowicryl K4M embedding. An extracellular electron dense granular and filamentous material was observed in the mid- and upper dermis, between and within the collagen bundles. No periodicity was noted and no deposits were seen at the dermoepidermal junction. Immunoelectron microscopy showed a positive labelling located only on these deposits, in both normal-appearing skin and in lesions. In this patient, immunoelectron microscopy clearly demonstrated the presence of large amounts of IgM in the dermis, which were found in the lesions of cutaneous macroglobulinosis and in normal skin. These results suggest that the IgM storage papules result from a greater density of deposits rather than a site-specific accumulation.

Female↗

Abnormal urinary coproporphyrin levels in patients infected by hepatitis C virus with or without human immunodeficiency virus. A study of 177 patients.

OBJECTIVE: Many cases of porphyria cutanea tarda have been described in association with human immunodeficiency virus (HIV) infection in young individuals. The link between hepatitis C virus (HCV) and porphyria cutanea tarda is even stronger as more than 50% of patients who have this diagnosis in Italy, France, or Spain are also infected by HCV. To study the role of viral infections on the metabolism of porphyrins, we measured the urinary porphyrin levels in patients with HIV and HCV infections. DESIGN: Survey; prospective study. SETTING: University Hospital of Strasbourg, France. PATIENTS: Sixty-one HIV-positive patients, 56 HCV-positive patients, 60 HIV- and HCV-positive patients, and 51 HIV- and HCV-negative control subjects were randomly selected. None had clinical signs of porphyria or a familial history of porphyria. MAIN OUTCOME MEASURES: The porphyrin-excretion profile was determined by high-performance liquid chromatography on fresh urine samples. The HIV and HCV viremias were quantified in the serum by the branched DNA assay. Measures were planned before data collection began. RESULTS: The porphyrin-excretion profile typical of porphyria cutanea tarda was found in only 1 of 177 patients. In the remaining 176 patients, the mean coproporphyrin level was significantly raised in HCV-positive patients and even higher in patients who were HIV- and HCV-positive. The coproporphyrin level was not correlated to the alanine aminotransferase level, the CD4+ cell count, or the HCV and HIV viremias. CONCLUSIONS: In cases of infection with HIV, HCV, or both, the development of a porphyria cutanea tarda urinary profile is a rare event (0.56% in this study), but coproporphyrin excretion is increased. This could be related to hepatic changes induced by the viruses. Our results do not support the hypothesis of a direct viral effect on the porphyrin metabolism. Infection with HIV, HCV, or both may be a major triggering factor, but is not sufficient to induce porphyria.

Adolescent↗