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Biomedical subjects

B Guillot

Publications and source records attributed to B Guillot.

At least 91 records · Page 5Linked to original sources
PubMed2000

Eruptive pseudoangiomatosis arising in adulthood: 9 cases.

Eruptive pseudoangiomatosis has only been reported in children up till now. The purpose of this study is to present the clinical characteristics of eruptive pseudoangiomatosis in adulthood and to discuss the potential role of infectious agents. A retrospective study concerning nine cases of eruptive pseudoangiomatosis observed over a ten year period was undertaken, concerning clinical, histological and epidemiological aspects of the disease. The patients, 8 women and one man had an acute eruption of numerous papules measuring 2-5 mm in diameter, disseminated on the face, limbs and trunk. The papules were erythematous and telangiectatic, surrounded by a white halo. The lesions blanched completely with pressure and refilled from the center on release. Histological examination was performed on 4 patients, showing dilated blood vessels with plump endothelial cells but no evidence of an increased number of vessels. Epidemiological data revealed the onset of the disease during hospitalisation for treatment of cancer or asthma in four patients and among the five remaining patients, two were hospitalized in a retirement home and one was a nurse in a psychiatric hospital. These data suggest that the eruption could be linked with a infectious disease despite the negativity of some serological investigations. We report for the first time cases of pseudoangiomatosis arising in adulthood.

Adult↗
PubMed2000

[Raltitrexed-induced skin reaction].

BACKGROUND: Raltitrexed (Tomudex(R)) is a thymine synthetase inhibitor used for first line treatment of metastatic colorectal cancer. Skin reactions were reported in the preclinical trials but have never been documented in clinical practice. We report the first two cases. CASE REPORTS: Two patients, aged 75 and 65 years, were given raltitrexed for adenocarcinoma of the rectum for the first case and of the sigmoid for the second. Both developed a skin reaction 5 and 7 days after onset of treatment. These patients had erythromatous edematous and purpuric skin reactions associated with asthenia, diarrhea and moderate fever. The skin lesions were painful and pseudo-cellulitic. They were generalized in the first case and localized on the legs in the second. The reactions subsided in both cases 15 days after drug withdrawal after a desquamation phase. CONCLUSION: We report the first two cases of raltitrexed-induced pseudo-cellulitic skin reactions.

Aged↗
PubMed1999

Melanoma and tumor thickness: challenges of early diagnosis.

OBJECTIVE: To test the basic assumption of campaigns for early diagnosis of melanoma, ie, prognosis is correlated with the delay in the diagnosis. DESIGN: Prospective study of the correlation between delays to diagnosis, assessed using a questionnaire, and the Breslow thickness as a prognosis marker. SETTING: Dermatology departments in France. PATIENTS: Five hundred ninety consecutive patients, referred within 12 weeks after resection of cutaneous melanoma. MAIN OUTCOME MEASURES: Assessment of 5 successive time intervals from the first time the patients realized that they had a lesion until the resection of the melanoma, and results of the correlation between each time interval and tumor thickness (Breslow). RESULTS: There is a positive but weak correlation between tumor thickness and the delay to identify a lesion as suspicious (r = 0.17; P = .009). However, this delay tends to be short for the thickest tumors. There is a negative correlation between tumor thickness and the delay to seek medical attention (r = -0.20; P<.001). This delay was shorter for nodular melanoma. No correlation is found between melanoma thickness and physicians' delays. CONCLUSIONS: Poor prognosis can be accounted for by aggressive rapidly growing tumors rather than by delays. In well-informed populations, campaigns for early diagnosis of melanoma may thus no longer have a major impact on prognosis, unless they are focused on subgroups less accessible to information and medical care.

Female↗
PubMed1999

Leg ulcers and hydroxyurea: forty-one cases.

BACKGROUND: Hydroxyurea is an antitumor agent used to treat chronic myeloproliferative disorders. Leg ulcerations have been reported in patients undergoing long-term hydroxyurea therapy for myeloproliferative diseases. To better define this dermatological adverse effect of hydroxyurea therapy and to try to understand the pathophysiological process of this disease, we collected medical information for such patients in a multicenter retrospective study. OBSERVATIONS: Forty-one patients (mean age, 67 years) developed leg ulcerations while undergoing hydroxyurea therapy (mean therapy duration, 5 years). The sex ratio was 1, and there was no underlying vascular disease. Hematologic abnormalities were identified. Complete recovery from the ulcerations occurred quickly after withdrawal of treatment in 33 (80%) of the cases. CONCLUSIONS: This longest-reported series of patients confirms the role of hydroxyurea therapy in the onset of leg ulcerations. Healing or improvement requires cessation of treatment. Cutaneous atrophy and impaired wound healing may explain the relationship between hydroxyurea and leg ulcers. In addition, the megaloblastic erythrocytes resulting from the presence of hydroxyurea may circulate poorly through the capillary network. A prospective study in hematologic centers would be valuable.

Adult↗
PubMed1999

EMLA cream as a topical anesthetic for the repeated mechanical debridement of venous leg ulcers: a double-blind, placebo-controlled study.

BACKGROUND: A granulating surface is important for skin grafting and healing of leg ulcers. Mechanical debridement to remove necrotic tissue often must be stopped before completion because of pain. OBJECTIVE: Our purpose was to assess the effect of EMLA cream on the number of debridements required to obtain a clean ulcer and on pain during debridement and to determine its safety after repeated doses. METHODS: In this randomized double-blind, placebo-controlled study, 69 patients with venous leg ulcers received cream before debridement until a clean ulcer was obtained (or a maximum of 15 debridements). RESULTS: EMLA decreased the median number of debridements required for a clean ulcer (EMLA 11.5, placebo >15; P = .019) and decreased pain by 50% (P = .003). Plasma levels of lidocaine, prilocaine, and their main metabolites were low without any apparent accumulation. CONCLUSION: EMLA produces effective pain relief for the debridement of leg ulcers and shortens the time to a clean ulcer.

Administration, Cutaneous↗
PubMed1999

[Secondary radiodermatitis caused by endovascular explorations: 5 cases].

BACKGROUND: Fluoroscopically guided interventional procedures expose patients to high doses of ionizing radiation. OBSERVATIONS: We describe 5 patients in whom radiodermatitis developed following vascular catheterization: cardiac catheterization and coronary angioplasty in 4 cases and renal artery catheterization and angioplasty in 1 case. All patients were men. The endovascular procedures have been repeated or prolonged in all cases excepted one. The clinical aspects were those of a chronic radiodermatitis (4 cases) and acute radiodermatitis (1 case). An extensive and painful ulceration was observed in 3 patients for which surgical excision was proposed. In one case lesions were bilateral. Delay of onset after the last exploration varied from a few weeks to 3 years. Biopsy specimen was suggestive of chronic radiodermatitis but, in 2 cases, was not contributive in the absence of clinical proposal. DISCUSSION: About 20 cases of radiodermatitis following coronary angioplasty have been reported in the literature since 1996. The cumulative radiation doses to which the patients were exposed are compatible with the occurrence of radiodermatitis. Coronary angiography using fluoroscopy and cineradiography delivers notably higher radiation doses than any other routine procedure. Even higher levels of radiation may result from percutaneous transluminal angioplasty, which is a more complicated and lengthier procedure frequently repeated. Radiodermatitis have been described during many other vascular procedures like radiofrequency catheter ablation, renal angioplasty, interventional neuroradiologic and hepato-biliary procedures. Medical facilities and physicians performing interventional procedures should be aware of these sides effects and implement measures to reduce the potential for radiation skin injuries.

Aged↗
PubMed1999

[Dubreuilh melanoma: and epidemiologic and prognostic study].

BACKGROUND: Lentigo maligna melanoma is a specific histoclinical type of melanoma. We studied the epidemiologic features of lentigo maligna melanoma (Dubreuilh's melanoma) and compared prognosis with other types of melanoma. PATIENTS AND METHODS: A retrospective review of 516 cases of cutaneous melanomas, seen from 1985 to 1997, identified 29 cases of lentigo maligna melanoma. Epidemiologic, clinical and prognostic data were collected using a common scoring system for all patients. The chi-squared test, univariate log rank analysis, Cox multiple regression model for multivariate analysis, and actuarial survival curves were applied. RESULTS: The 29 cases of lentigo maligna melanoma (16 women, 13 men) accounted for 5.9 p. 100 of all melanomas. Mean age at diagnosis was 73 years compared with 54 years for others melanomas. Predominant localization was head and neck. There was no prior history of nevi compared with 50 p. 100. Mean delay to diagnosis was 4 years versus 1 year. All patients have had an occupation with to sun exposure. Mean tumoral thickness was 2 mm. Survival was the same as for extensive superficial melanomas and better than for nodular melanomas. Multivariate analysis showed that prognosis was not better in case of lentigo maligna melanoma. Tumoral thickness was the main prognosis factor. DISCUSSION: Our findings confirmed the specific nature of lentigo maligna melanoma and suggested that sun exposure plays an important role. Multivariate analysis did not show that prognosis was any better in case of lentigo maligna melanoma than in other types of melanoma. The thickness of the tumor must be taken into account as for other melanomas.

Actuarial Analysis↗
PubMed1998

Randomised trial of interferon alpha-2a as adjuvant therapy in resected primary melanoma thicker than 1.5 mm without clinically detectable node metastases. French Cooperative Group on Melanoma.

BACKGROUND: Owing to the limited efficacy of therapy on melanoma at the stage of distant metastases, a well-tolerated adjuvant therapy is needed for patients with high-risk primary melanoma. Our hypothesis was that an adjuvant treatment with low doses of interferon alpha could be effective in patients with localised melanoma. METHODS: After resection of a primary cutaneous melanoma thicker than 1.5 mm, patients without clinically detectable node metastases were randomly assigned to receive either 3x10(6) IU interferon alpha-2a, three-times weekly for 18 months, or no treatment. The primary endpoint was the relapse-free interval. FINDINGS: 499 patients were enrolled, of whom 489 were eligible. When used as part of a sequential procedure, interferon alpha-2a was of significant benefit for relapse-free interval (p=0.038). A long-term analysis, after a median follow-up of 5 years, showed a significant extension of relapse-free interval (p=0.035) and a clear trend towards an increase in overall survival (p=0.059) in interferon alpha-2a-treated patients compared with controls. There were 100 relapses and 59 deaths among the 244 interferon alpha-2a-treated patients compared with 119 relapses and 76 deaths among the 245 controls. The estimated 3-year-relapse rates were 32% in the interferon alpha-2a group and 44% in controls; the 3-year death rates were 15% and 21%, respectively. Only 10% of patients experienced WHO grade 3 or 4 adverse events. Treatment was compatible with normal daily life. INTERPRETATION: Adjuvant therapy of high-risk melanoma with low doses of interferon alpha-2a for 18 months is safe and is beneficial when started before clinically detectable node metastases develop.

Antineoplastic Agents↗
PubMed1998

Subcutaneous interleukin-2 and interferon-alpha therapy associated with cisplatin monochemotherapy in the treatment of metastatic melanoma.

The anti-tumoral activity of interleukin-2 (IL-2) is well-documented. Although the response rate with this cytokine is low, it appears to be improved when associated with interferon-alpha (INF-alpha) and/or cytotoxic drugs. Aim of this work was to study the efficacy and tolerance of an ambulatory treatment using subcutaneous, low-dose IL-2 with subcutaneous INF-alpha and chemotherapy. We report a multicenter study of ambulatory treatment combining subcutaneous (SC) low-dose IL-2 (9 x 10(6) IU) with SC INF-alpha-2a (3 x 10(6) IU) and cisplatin (100 mg/m2) in 33 patients (13 women and 20 men, 22 to 66 years of age) with metastatic malignant melanoma. Metastases were mainly nodal (54.5%) and pulmonary (51.5%). For 81.8% of patients, this therapy constituted the firstline treatment. The overall response rate at the end of the first maintenance course was 30.3% (3 complete responses and 7 partial responses). Adverse effects were observed in 28 patients (84.8%), but were most often minor (grade 1 or 2 on the WHO toxicity scale). The results confirmed the good tolerance to SC IL-2 and its suitability for ambulatory therapy, as well as the potential benefit of associating IL-2 with cisplatin in the treatment of metastatic melanoma (a possibility considered in two previous studies).

Adult↗
PubMed1998

[Multiple congenital smooth-muscle hamartomas].

BACKGROUND: Smooth muscle hamartoma is an uncommon lesion. Diagnosis is usually made at birth in infants presenting a plaque with minimal or no infiltration and covered with long dark hairs. Congenital forms with multiple plaques are rarely reported. CASE REPORT: A 5-day-old infant (normal pregnancy and delivery) had plaques localized on the buttocks, the left thigh, leg and shoulder and the right ankle. The plaques were minimally infiltrative and covered with long black hairs. Histology examination showed hyperplastic smooth muscle bundles with varying orientation. The diagnosis was smooth muscle hamartoma. The rest of the clinical examination was normal. CONCLUSION: This case of congenital smooth muscle hamartoma showed a particular form with partially regressive multiple plaques.

Biopsy↗
PubMed1998

[Bullous lichen sclerosus after radiotherapy].

BACKGROUND: Bullous lichen sclerosus is an uncommon observation after radiotherapy and can be misdiagnosed as a radiodermitis or recurrence of the neoplasia. CASE REPORT: Two women developed bullous lichen sclerosus after radiotherapy. The delay after radiotherapy was 4 months and 10 years respectively. Irradiation dose was 60 and 64 grays. The lesions covered more than the irradiated zone in one case. Stabilization or regression of the lesions was obtained with cases I topical corticosteroids, with acitretine in one case. DISCUSSION: These cases, and similar cases reported in the literature, underline the fact that the condition has only been reported in women. This is probably because of the nature of the neoplasias treated (breast cancer in 20 cases and cervical cancer in 1). The delay to onset of the skin lesions are quite variable. Lichen sclerosus or morphea may be observed in the irradiated zone but may also appear at a distance. These lesions are not associated with recurrence of the initial cancer. As no association between breast cancer and localized sclerodermia has been found, the causal role is probably played by radiotherapy, producing a Koebner phenomena in predisposed tissue.

Administration, Topical↗
PubMed1997

Benefit of a 2-month treatment with a micronized, purified flavonoidic fraction on venous ulcer healing. A randomized, double-blind, controlled versus placebo trial.

OBJECTIVE: To assess the efficacy of a micronized purified flavonoid fraction (Daflon 500 mg = Dios) in venous leg ulcer healing, in addition to compression therapy and standardized local care. DESIGN: Double-blind, multicentre, randomized, parallel groups, controlled versus placebo trial; stratification according to ulcer size. SUBJECTS: 107 patients, with venous ulcer of the leg for at least 3 months, and accepting bandaging therapy. RESULTS: 105 patients (Dios = 53, placebo = 52) were available for an intention to treat (ITT) analysis. Age (mean +/- SD, 71+/-11 years), gender (M = 33, F = 74) and ulcer size were evenly distributed among both groups. 99 patients completed the protocol (Dios = 51, placebo = 48). Among the 91 patients with ulcer size < or = 100 cm (Dios = 44, placebo = 47), a significantly higher number of patients had complete ulcer healing at 2 months in the Dios group (n = 14) in comparison to the placebo group (n = 6) after ITT analysis (32 vs. 13%, p = 0.028) and after per protocol analysis (32 vs. 14%, p = 0.048), and a shorter time duration of healing (p = 0.037). Among the 14 patients with ulcer size > 10 cm (Dios = 9, placebo = 5), no ulcer healed. CONCLUSION: This study showed that a 2-month course of purified micronized flavonoid fraction (2 tablets/day), in addition to conventional treatment, is of benefit in patients by accelerating complete healing of venous leg ulcers which are < or = 10 cm in diameter.

Adolescent↗
PubMed1997

Efficacy of Daflon 500 mg in venous leg ulcer healing: a double-blind, randomized, controlled versus placebo trial in 107 patients.

The objective of this study was to evaluate the efficacy of Daflon 500 mg (Dios)* in venous ulcers. A multicenter, double-blind, randomized, controlled versus placebo (Plac) trial was conducted, with stratification according to the size of ulcer (< or = 10 cm and > 10 cm). The protocol called for a two-month treatment with Dios (one tablet = 450 mg micronized purified Diosmin) or a placebo, two tablets/day, in addition to compression therapy. Evaluations were performed every fifteen days, from D0 to D60. The primary endpoint, in accordance with Alexander House group requirements were: percentage of patients with complete ulcer healing, ie, comparison between Dios and Plac group at D60, and comparison of survival curves in each group between D0 and D60 (log rank test). Secondary endpoints included ulcer surface area assessed by computerized planimetric measurements, qualitative evaluation of ulcers, and symptoms. The patients were 105 men and women ranging in age from eighteen to eighty-five years, with standard compression stocking, who were undergoing standardized local care of ulcer and had no significant arterial disease (ankle/arm systolic pressure index > 0.8). Fifty-three patients received Dios, and 52 received Plac. The 2 groups were well matched for age (m +/- 1 SD = seventy-one +/- eleven years), gender, ulcer size, and associated disorders. Among patients with ulcer size < or = 10 cm (Dios = 44, Plac = 47) a significantly larger number of patients had a complete ulcer healing at two months in the Dios group (n = 14) in comparison with the Plac group (n = 6) (32% vs 13%, P = 0.028) with a significantly shorter time duration of healing (P = 0.037). No difference was shown for the secondary criteria, except for sensation of heavy legs (P = 0.039) and a less atonic aspect of ulcer (P = 0.030) in favor of Dios. Among the 14 patients with ulcer size > 10 cm (Dios = 9, Plac = 5), subjected to a descriptive analysis only, no ulcer healed. This study showed that a two-month course of Daflon 500 mg at a daily dose of two tablets, in addition to conventional treatment, is of benefit in patients with venous ulcer < or = 10 cm by accelerating complete healing.

Adolescent↗