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Biomedical subjects

B Cribier

Publications and source records attributed to B Cribier.

At least 145 records · Page 8Linked to original sources

[Multiple infundibuloma].

A 42-year-old man presented with multiple hypopigmented macules, 4 to 10 mm wide, irregularly shaped and symmetrically distributed on the neck and face, with a 10 years duration. Histological examinations showed a plate-like epithelial proliferation below the epidermis. The cells had a pale cytoplasm, with few PAS positive granules. In the lower part of the proliferation the peripheral cells were palisading and surrounded by a dense elastic network. Serial sections showed connections with the normal outer root sheath of the neighbour follicles, and with the epidermis. This pattern is very characteristic of Mehregan's tumor of follicular infundibulum. Four distinctive presentations of this tumor can be observed, in spite of its rarity: multiple macules of the upper chest or face (4 cases have previously been described), tumors of follicular infundibulum occurring in Cowden's disease or in the natural course of organoid nevi, and the most common solitary form of the face. With their striking clinical features, the eruptive or multiple forms of this tumor should be recognized as a distinctive clinical entity. Possible transformation into basal cell carcinoma has been described in one of these cases, and long time supervision should be recommended.

Adult↗

[Bazin's erythema induratum: obsolete concept and terminology].

In 1855 Ernest Bazin, who had noted hard, deep and violaceous nodules on the legs of young women, created his famous "erythema induratum" classified among the "erythematous benign scrofulides". Some forty years later, identical lesions were observed associated with tuberculosis; Colcott-Fox called them "érythème induré de Bazin", and ever since that time erythema induratum has been presumed to be of tuberculous origin. In 1900, Darier spoke of "tuberculids" for erythema induratum, and Bazin's "scrofulides" were abusively translated as "tuberculids". In the early 20th century many authors described such skin lesions without any evidence of tuberculosis and later on many papers tried to deny this "systematic" association, but the idea that erythema induratum is caused by tuberculosis still lingers on in 1990. There are many arguments against a tuberculous aetiology, but although very few cases in large series are really associated with tuberculosis many patients have been treated with specific antituberculous agents. For numerous authors, erythema induratum in "tuberculous by definition". In 1945 Montgomery et al. created the "nodular vasculitis" concept. The clinical features are very similar to those of erythema induratum but the disease is certainly not of tuberculous origin. This new pathology has been well developed by French and Spanish authors (Bureau, Duperrat, Vilanova). Despite repeated efforts to separate these two "entities" no clinical or histological data are available to distinguish between erythema induratum and nodular vasculitis. The real meaning of "erythema induratum" is far from being clear: in old publications and sometimes in recent textbooks one can find the same name followed by of Bazin, Whitfield or Hutchinson. Some authors call the disease tuberculids, and other believe it is a true cutaneous tuberculosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnosis, Differential↗

[Isolation of 503 strains of virus in meningeal syndromes. Virologic and epidemiologic study].

An epidemiological and virological study on meningitis in Alsace during the 13-year period 1968-1981 is reported. 503 viruses isolated were associated with the diagnosis of meningitis. The Echovirus type 30 accounted for 48 p. 100 of the cases, the mumps virus of 12 p. 100. The remarkable high incidence of Echo 30 virus-associated cases is related to three outbreaks which occurred in Alsace during the summers of 1968, 1975 and 1980. Children below 12 years of age are the most sensitive population and particularly boys who made up 2/3 of the number of cases.

Adolescent↗

Role of endogenous interferon in hepatitis C virus (HCV) infection and in coinfection by HIV and HCV.

Recombinant interferon alpha (IFN alpha), widely used in the treatment of chronic hepatitis C, can induce a major decrease in HCV viraemia in good responders. In order to evaluate the possible role of endogenous IFN, using a biological method, we measured the IFN levels in 74 patients infected by HCV and in 73 patients coinfected by HIV and HCV. IFN levels were much higher in the HCV+HIV+ group and were linked to HIV viraemia. In those patients with high IFN levels, the HCV viraemia was lower, but only in the HCV+ group. These data suggest that IFN can partly control the HCV viraemia, but in coinfection by HIV, the response of HCV to endogenous IFN could be lower.

AIDS-Related Opportunistic Infections↗

[Superficial granulomatous pyoderma].

INTRODUCTION: Superficial granulomatous pyoderma is a rare variant of pyoderma gangrenosum, which is often diagnosed at a late stage because of misleading clinical-histopathological features. We report a new case of this rare disease. CASE REPORT: A 67 year-old man presented with inflammatory lesions that had become ulcerated over the past 4 months despite prolonged antibiotic therapy. The histopathological aspect was initially suggestive of palisading granuloma annulare and subsequently a necrotizing granuloma compatible with a mycobacteriosis. The various supplementary examinations eliminated the possibility of an infectious or systemic disease. The lesions became painful and ulcerated. A second biopsy showed a neutrophilic dermatosis with dermal necrosis and a granuloma leading to the diagnosis of superficial granulomatous pyoderma. The lesions healed after 3 months of systemic corticosteroids at the dose of 1 mg/kg/day. DISCUSSION: The clinical features of superficial granulomatous pyoderma are similar to those of classical pyoderma gangrenosum. However, its histological profile is more superficial and is associated with dermal granulomas. The latter are unusual in neutrophilic dermatosis and would suggest an infectious disease. This explains the frequent diagnostic errors, with inappropriate anti-infectious treatments and notably unnecessary surgical exeresis.

Adrenal Cortex Hormones↗

[Granuloma annulare].

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Diagnosis, Differential↗

[Neutrophilic eccrine hidradenitis in a healthy patient].

BACKGROUND: Neutrophilic eccrine hidradenitis occurs mostly in patients receiving chemotherapy for acute myeloblastic leukemia, rarely in healthy patients. Histopathologic pattern is characteristic and includes selective necrosis of the eccrine glands with a local neutrophilic infiltrate. CASE REPORT: We report the case of a 41 year-old woman with no medical past-history who developed during 2 years successive papulous skin eruptions. The latter always resolved spontaneously. Skin biopsy led to the diagnosis showing typical features of neutrophilic eccrine hidradenitis. DISCUSSION: Our case is original because the neutrophilic eccrine hidradenitis had occurred in a healthy woman. Neither malignant hematologic disease nor visceral cancer was disclosed in this patient in the following 31 months.

Adult↗

Quantification of hepatitis C virus RNA in peripheral blood mononuclear cells: a comparison between patients chronically infected by HCV and patients coinfected by HIV.

In patients chronically infected by hepatitis C virus (HCV), peripheral blood mononuclear cells (PBMCs) were shown to be targets for virus replication and in those coinfected with HIV, HCV viraemia was considerably increased. The purpose of this study was to quantify HCV RNA in PBMCs from 25 patients infected by HCV and from 25 patients coinfected by HCV and HIV. We used the branched DNA assay after extraction of total RNA on 5 x 10(6) cells to quantify HCV RNA, and the Inno LiPA assay to determine the HCV genotype. HCV RNA in PBMCs could be quantified in 8/25 patients in each group, but the HCV RNA concentration was very low in comparison with viraemia, since the highest result was 8.1 x 10(4) Eq genome/10(6) cells. In 10 ml of total blood, there was approximately 100 to 5,000 times less HCV RNA in PBMCs than in the plasma. It is therefore likely that PBMCs play only a minor part in the viral load present in the plasma. There was no preferential genotype associated with quantifiable HCV RNA in the PBMCs. In the case of HIV coinfection, there was no increase in the HCV-RNA concentration in PBMCs that could explain the increased viraemia observed in these patients. On the contrary, HCV RNA could not even be detected by RT-PCR in some of our coinfected patients.

Adult↗

HIV increases hepatitis C viraemia irrespective of the hepatitis C virus genotype.

In case of coinfection with hepatitis C virus (HCV) and human immunodeficiency virus (HIV), HCV viraemia is increased. Because the HCV genotype 1 is associated with elevated viraemia, the increase in HCV viraemia observed and described in HIV+ patients could be attributed to the predominance of HCV genotype 1 in these patients. Therefore, the purpose of this study was to quantify HCV RNA in patients coinfected with HIV and HCV, according to the HCV genotype. The HCV genotype was thus determined in serum samples of 59 HIV+HCV+ patients and 51 HIV-HCV+ patients. HCV RNA was quantified using a branched DNA assay and the HCV genotype was determined using the "InnoLiPA" technique. The distribution of the HCV genotype was not significantly different in the two groups of patients, and there were even more patients infected by genotype 1 in the HIV-HCV+ group. The mean HCV viraemia of patients infected by HCV genotype 1 and by HCV genotype 3 was higher in patients coinfected by HIV than in HIV- patients (p < 10(-7) and p = 0.05, respectively). The increase in HCV viraemia observed in HIV+ patients was not the result of a specific distribution of HCV genotype in these patients. HIV infection was responsible for an increase in HCV viraemia irrespective of the HCV genotype.

Adult↗

Perianal striated muscle hamartoma associated with hemangioma.

Striated muscle hamartoma is a rare entity which was described only recently. It is a congenital malformation characterized by the presence of striated, mature muscle fibers in the reticular dermis and hypodermis. We describe a striated muscle hamartoma of the perianal region in a female infant associated with an hemangioma in the same area that regressed completely. Including the present patient, only 14 cases of striated muscle hamartomas have been reported, but this association with an hemangioma is unique. The lesion was polypoid and histopathologic examination showed numerous striated muscle fibers located within the dermis.

Anal Canal↗

[Oral ulcers induced by nicorandil: prevalence and clinicopathological aspects].

INTRODUCTION: The first observations of "giant buccal aphthosis" induced by nicorandil were published in 1996. Nicorandil is a potassium channel activator used in the treatment of angina pectoris, which seems to induce specific buccal ulcerations. The purpose of this study was to analyze the clinicopathologic data of patients with aphthosis induced by nicorandil and to study the prevalence of this side effect. PATIENTS AND METHODS: We have seen 3 patients who spontaneously consulted, and 5 patients who were addressed to us after a telephone survey. We have then examined 100 consecutive patients treated by nicorandil for at least 1 month, who were hospitalized in 3 departments of cardiology in Strasbourg, and 100 age- and sex-matched controls who were treated by other antianginal drugs. RESULTS: Our 8 patients suffered from large, chronic and painful ulcerations of a 4-week duration, located on the tongue, the gingiva and the cheeks despite various symptomatic treatments. In one case, histopathologic data were consistent with an eosinophilic ulcer. Prospective study: among 100 patients treated by nicorandil, 5 had unusual chronic buccal ulcerations, whereas none of the 100 controls had aphthosis (p = 0.03). The confidence interval (99 p. 100) of this side effect prevalence was therefore 1 p. 100 to 14 p. 100. DISCUSSION: Nicorandil can induce large and painful buccal ulcerations with severe dysphagia, weight loss, and depression. Dermatologists should be aware of this particular side-effect, since our study showed a high prevalence, and because lesions heal rapidly after withdrawal of nicorandil. Why nicorandil may be associated with mouth ulcers remains unanswered. A past history of aphthae could be a cofactor of this side-effect.

Aged↗

Expression of stromelysin 3 in basal cell carcinomas.

Stromelysin 3 is a member of the metalloproteinase family, which is expressed in various remodelling processes. The prognosis of breast cancers and squamous cell carcinomas is correlated to the level of expression of this protein. The purpose of the present work was to evaluate the expression of stromelysin 3 in the major types of basal cell carcinomas. We selected cases of primary tumours that were fully excised, without previous biopsy: 40 Pinkus tumors, 40 superficial, 40 nodular, 38 morpheiform basal cell carcinomas and 10 cases showing deep subcutaneous or muscular invasion. Immunohistochemistry was carried out using monoclonal anti-ST3 antibodies (MC Rio, IGBMC Strasbourg), and evaluated on a semi-quantitative scale from 0 to 3. Positively stained cells were restricted to the periphery of the epithelial cells, which, by contrast, never expressed stromelysin 3. The global rate of expression was 27% in Pinkus tumors, 65% in superficial, 72.5% in nodular, 87% in morpheiform and 100% in deeply invasive carcinomas. The rates of tumours showing the highest number of positively stained cells (class 2 or 3) were respectively 7.5%, 20%, 45%, 63% and 100%. This systematic study of stromelysin3 expression in basal cell carcinomas confirms that it is a marker of poor prognosis, because the rate of positive tumours was much higher in aggressive carcinomas. Moreover, the majority of tumours showing an intense expression (i.e. the highest number of positively stained cells in their stroma) were of the morpheiform and deeply invasive types, which are of poor prognosis. Altogether, the studies performed on cutaneous tumours are consistent with the theory of stromelysin 3 playing an active role in tumour progression.

Adult↗

[Painful edema of the feet revealing ankylosing spondylitis].

INTRODUCTION: Painful peripheral oligoarthritis can reveal ankylosing spondylitis. In some instances, an acral pitting edema can be the sign of this affection. CASE REPORT: A 39-year-old man, with no significant previous medical history, consulted in a dermatology department for acral pain and edema of both feet, which were exacerbated during the second part of the night. On examination, he had a pitting edema and a livedo of the distal part of the feet. Biological investigations revealed an inflammatory syndrome and the presence of the histocompatibility HLA-B27 antigen. Bone scintigraphy revealed distal hyperfixation on both feet. Diagnosis of ankylosing spondylitis was established. DISCUSSION: Late-onset ankylosing spondylitis, which appears in subjects older than 35 years, can manifest as peripheral arthritis with systemic signs, often in the absence of involvement of the axial skeleton. Peripheral pitting edema of lower limbs can be the presenting sign. Since cutaneous involvement can be the presenting sign, dermatologists should be aware of this entity.

Adult↗