Biomedical subjects
D Couilliet
Publications and source records attributed to D Couilliet.
[Allergic contact dermatitis to the Comfeel hydrocolloid dressing].
INTRODUCTION: Allergic contact dermatitis is frequent in patients with chronic leg ulcers. However, it rarely occurs with modern wound dressings and is exceptional with hydrocolloids. CASE REPORT: A 66-year-old woman was treated for a leg ulcer with the Comfeel plus(R) transparent hydrocolloid dressing for two months. She developed a pruriginous, erythematous and vesiculous dermatitis under the hydrocolloid plaques. Patch tests for the Comfeel plus(R) transparent hydrocolloid, the Comfeel plus(R) hydrocolloid, balsam of Peru and epoxy resin were positive. Only the positive test for the Comfeel plus(R) transparent hydrocolloid was clinically pertinent. The histological examination of the positive test was suggestive of eczema. DISCUSSION: To our knowledge, allergic contact dermatitis to Comfeel plus(R) hydrocolloid dressings has not been reported. Most previous studies which included systematic patch-testings in patients with leg ulcers showed high sensitization rates for various allergens, but no allergy to hydrocolloids. Only isolated cases of allergic contact dermatitis to another hydrocolloid (Duoderm E(R)) have been reported. Our case report shows that allergic contact dermatitis is a possible side-effect of Comfeel plus(R) hydrocolloid dressings. However, it seems exceptional. Since the patch-tests failed to identify the constituent responsible for this allergy in our observation, comprehensive allergologic investigations should be repeated in further cases.
[Hydrocolloid dressings].
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[Managing chronic wounds. A new rubrics for continuing medical training in the Annales de Dermatologie].
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[Managing chronic wounds. Knowledge and practice of nurses].
BACKGROUND: Recommendations on chronic wound management have greatly evolved during the last years. Practice in the medical units of the Civil Hospital of Colmar (France) appears to controversy these recommendations. Since nurses have a central place in such cares, we conducted a management audit among those working in different departments, before organising an educational program. METHODS: One hundred and ten nurses (20 p. 100), randomly selected among the 546 concerned by chronic wounds working in the hospital were invited to participate in this audit composed of 23 questions. RESULTS: Participation rate was 72 p. 100. Response rates were higher than 80 p. 100 for 18 of 23 questions. The percentages below are those of the expressed answers. For 58 p. 100 of nurses executing the care after medical prescription, 31 p. 100 did so without medical advice and 11 p. 100 in collaboration with a doctor. Five and 14 p. 100 respectively knew all the classical clinical characteristics of venous and arterial leg ulcers. Some important risk factors for pressure sores were not well known, and only 15 p. 100 of nurses regularly used an evaluation scale of this risk. The massage-kneading of a stage I pressure ulcer was practiced by 49 p. 100 of nurses. Depending on the questions, 64 to 82 p. 100 of them routinely used antiseptics, and 82 p. 100 thought it was more important than compression for the healing of a venous leg ulcer. In more than one third of the answers, the dressing of a chronic wound was described as sterile. Finally, if an average knowledge of hydrocolloids was observed, there was little on alginates, foams and hydrogels, with a majority of nurses avoiding to answer these questions. COMMENTS: Although important is the management of chronic wounds, basic knowledge was insufficient to hope for the nurses' collaboration. Prevention policy of pressure sores was not optimal. There were discrepancies between local practices and actual knowledge. Knowledge of new dressings was inadequate, and there was a risk for limited clinical benefit. We believe the results would have been similar if the audit had conducted among the doctors. Hense, a vast educational program has been initiated.
[Nursing protocol of chronic wounds for nurses. General principles and techniques].
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[Cutaneous manifestations of Lyme borreliosis].
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The severity of histopathological changes of leukocytoclastic vasculitis is not predictive of extracutaneous involvement.
Leukocytoclastic vasculitis is defined by histologic features and can be observed in a wide range of entities. Independent of the causative disease, extracutaneous complications are frequent, mainly in the kidneys and gastrointestinal tract. It has been suggested that the severity of histological changes could correlate with the clinical course of the disease. We have therefore compared the severity of histological changes of leukocytoclastic vasculitis to clinical and laboratory findings indicative of extracutaneous involvement in a large group of patients. Among 289 patients followed for cutaneous vasculitis, we included 184 patients with purpuric papules and proven leukocytoclastic vasculitis who all had standardized investigations. A cutaneous biopsy was performed early and standardized laboratory investigations were carried out. The slides were retrospectively randomized and the depth of vasculitis and severity of vascular necrosis were determined according to a semiquantitative scale. These data were compared to the renal, gastrointestinal and articular symptoms using Fischer's exact test, Chi-square test and variance analysis. The intensity of vascular necrosis and the depth of vasculitis were no more severe in patients having renal changes, gastrointestinal involvement or articular symptoms. Both variance analysis and Chi-square tests failed to show a significant increase in the severity score in patients having extracutaneous complications. In this study, the severity of histopathological changes was not predictive of extracutaneous involvement. Thus it appears that the degree of involvement of the cutaneous vessels probably does not correlate with that of vessels in visceral organs.
[History and nosology of rheumatoid purpura].
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[Plantar hidradenitis].
INTRODUCTION: Plantar hidradenitis, one of several possible causes of painful papulo-nodular lesions of the foot in children and young adults, was recently described as the presence of characteristic lesions of the eccrine sweat glands. CASE REPORT: A 15-year-old boy consulted for a sudden-onset painful eruption on the sole of the right foot. Physical examination revealed papulo-nodular erythromato-violet infiltrated lesions located on the anterior part of the right planta. Histology examination showed dense neutrophil inflammatory infiltration predominating at the dermo-hypodermic junction around the eccrine sweat glands. The excretory ducts of the sweat glands were infiltrated but the secretory glomerulae were intact. A dense infiltration of venular thrombi without vasculitis was also seen. The lesion regressed with aspirin (8 days) and rest. No recurrence has been recorded after 18 months. DISCUSSION: This clinical and histological presentation led to the diagnosis of plantar hidradenitis, confirming the disease entity. Former cases may have been described as trauma-induced plantar urticaria or plantar erythema nodosum. This diagnosis should be entertained in children or young adults with painful papulo-nodular eruptions of the soles. The histology examination should include the eccrine sweat glands.
[Comparative measurements of oral and rectal temperatures in 224 hospitalized patients].
We made a simultaneous measurement of oral temperature with an electronic thermometer and rectal temperature with a glass mercury thermometer in 224 in-patients. The results show that the difference between oral and rectal temperature is unpredictable and often important especially when the patient is febrile. It is impossible to determine a correction factor of the oral temperature which would allow a more sensitive and specific detection of patients with fever.
[Multiple keratosis induced by hydroxyurea].
INTRODUCTION: Specific skin manifestations including skin atrophy and stripes of erythema on the extremities have been reported in patients with long-term treatment with hydroxyurea (HU). CASE REPORT: A 60-year-old patient who had been treated with HU since 1986 for chronic myeloid leukaemia presented in March 1992 with lesions characteristic of HU-induced skin changes. Hydroxyurea was continued for two more years and the lesions worsened. Unusually encountered multiple skin keratoses developed rapidly creating a clinical picture compatible with carcinomatous transformation until the withdrawal of hydroxyurea. DISCUSSION: The chronology and the clinical signs were in favour of implicating hydroxyurea in the development of these keratoses. The literature on the subject revealed one comparable case with actinic keratoses and multiple skin carcinomas. The interactions between hydroxyurea and the keratinocytes of the basal layer could explain different aspects of hydroxyurea-related toxidermia. The most severe manifestation could be the development of epithelial skin cancer.
[Modalities of follow-up after excision of stage I melanoma: practice survey in hospitals].
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[A case for diagnosis: Kawasaki disease in the adult].
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[Flavivirus meningitis after tick bite: a new case in an urban area].
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[Case for diagnosis. Benign hemorrhagic bullous stomatitis].
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