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Biomedical subjects

E Heid

Publications and source records attributed to E Heid.

At least 55 records · Page 3Linked to original sources
PubMed1998

[Melanoma in the Strasbourg University Hospital. A 30-year study].

INTRODUCTION: The incidence of melanoma has increased more than the incidence of any other cancer in the past twenty years. There is no cure for advanced-staged melanoma and it's early diagnosis has become a main issue of health policy. Therefore, precise epidemiological data are needed. These data depend on the geographical setting and very few data are available for France. We studied these data in Strasbourg. PATIENTS AND METHODS: All patients hospitalized for melanoma between 1960 and 1989 at the academic dermatology department, Strasbourg, were included in this retrospective, monocentric, study. The diagnosis of melanoma was confirmed in all cases by a dermatopathologist. Clinical, histopathologic and epidemiological data of the patients were recorded. RESULTS: Six hundred seventeen patients with a mean age of 52 years were included. The number of new patients hospitalized for melanoma grew steadily. The mean tumor thickness was 2.31 mm (+/- 1.59) and it remained unchanged between 1970 and 1989. The mean duration between the first clinical signs of melanoma and excision of the tumor was 22 months. Only 4 p. 100 of the melanomas were diagnosed by means of routine examination, and this concerned almost exclusively patients hospitalized after 1980. Eighty five p. 100 of the patients had localized melanoma (stage I) at time of diagnosis. Forty two p. 100 of the patients developed metastasis. The mean five year survival rate was 68 p. 100. CONCLUSION: The number of new patients hospitalized each year for melanoma grew steadily, but the mean tumor thickness remained unchanged. This indicates that the ratio "thick"/"thin" melanomas has remained unchanged between 1960 and 1989 and that the number of melanomas of any thickness has increased. Clinical data show an unawareness of the local population of the dangers of pigmented lesions during the reference period. This unawareness can be partially explained by the fact that no specific information campaign has ever taken place in this area. These data suggest that such a campaign should be recommended.

Adult↗
PubMed1998

[Photosensitivity as presenting sign of HIV infection. Control with triple antiretroviral therapy].

BACKGROUND: We report a case of photosensitivity which occurred as the presenting sign of HIV infection. Photosensitivity regressed completely after introducing antiretroviral tritherapy. CASE REPORT: A 44-year-old woman developed a photo-distributed eczematous eruption which did not respond to topical steroids or hydroxychloroquine. Histologic examination showed eczematous dermatitis. T-cell marker analysis showed a majority of CD8 cells in the infiltrate. The patient was found to be HIV-positive and CD4 counts were markedly reduced to 190/mm3 while CD8 counts were increased to 1260/mm3. Antiretroviral tritherapy cured the photosensitivity. Cure was apparently related to increased CD4 lymphocyte and normalized CD8 lymphocyte counts. DISCUSSION: Photosensitivity was the presenting disorder of HIV infection in this case. Cure of the photosensitivity with antiretroviral tritherapy has not been reported previously. CD8 T-cell infiltration and very low CD4/CD8 ratio would appear to play a key role in the pathogenesis of photosensitivity in these patients.

Adult↗
PubMed1998

[Interstitial granulomatous dermatitis and paraneoplastic rheumatoid polyarthritis disclosing cancer of the lung].

INTRODUCTION: Interstitial granulomatous dermatitis is a histological entity usually associated with systemic auto-immune conditions or malignant lymphoproliferation. Its spontaneous regression after surgical treatment of a lung cancer suggests an eventual paraneoplasic variant. OBSERVATION: A 62 year old male patient, a smoker, was hospitalized for weakness, pruritus and symmetrical arthritis of small and large joints. Numerous rheumatoid nodules were located on the extensor aspects of the involved joints. During hospitalization, he developed an inflammatory plaque located on a thigh, which showed histologic features consistent with the diagnosis of interstitial granulomatous dermatitis. He had elevated E.S.R., blood eosiniphilia, and the search for antinuclear antibodies and antineutrophilic leukocyte cytoplasm antibodies (ANCA), of the p-ANCA type, was positive. A lung C.T. scan showed a cavitary tumor. Surgical removal of this tumor evidenced a bronchial squamous cell carcinoma. Four week after surgery, clinical signs and eosinophilia disappeared. After 6 months, ANCA became undetectable. DISCUSSION: Parallelism between the evolution of the cutaneous and articular symptomatology and of the cancer are diagnosis of paraneoplastic rheumatoid arthritis and paraneoplastic interstitial granulomatous dermatitis. Paraneoplastic rheumatoid arthritis is very unusual and this is the first reported case of simultaneously occurring paraneoplastic interstitial granulomatous dermatitis.

Antibodies, Antineutrophil Cytoplasmic↗
PubMed1998

[Contact sensitization in leg ulcers].

BACKGROUND: The leading complication of leg ulcers is the development of peri-lesional eczema. The etiological diagnosis is often difficult due to the large number of topical agents used. PATIENTS AND METHODS: Fifty patients, 35 women and 15 men, mean age 67.8 years, range 37-91 years, with leg ulcers of variable duration (15 days to 32 years, median 2 years) underwent explorations using the standard EECDRG battery in search of contact allergies. Eighteen potential allergens and the topical agents employed were tested. Readings were made at 48, 72, 96 or 120 hours. RESULTS: Sensitization rate was 76 p. 100 (90 p. 100 of the patients with a history of contact dermatitis and 50 p. 100 in those without such history). The respective percentages of positive tests were: balm of Peru 40 p. 100, fragrance-mix 28 p. 100, Amerchol L101 18 p. 100, lanoline alcohols 14 p. 100, colophane 12 p. 100, glycol propylene and parabens-mix 8 p. 100, stearylic alcohol, thiomersal, clioquinol and sorbic acid 6 p. 100, cetyl-stearylic alcohol, cetylic alcohol, eosin, cetrimide, chlorocresol, budesonide, tixocortol pivalate, bufexamac, formaldehyde, nickel, thiuram-mix and P.P.D. 4 p. 100, hexamidine, chlorhexidine, neomycin, benzocaine, potassium bichromate and cobalt 2 p. 100, triethanolamine, ethanol and other allergens in the EECDRG battery 0 p. 100. Tests were positive in 29 cases with commercial formulations, Biafine (8 cases), Parfenac (7 cases), and Rifocine ampoules (3 cases). Among 13 of the 29 cases, tests were positive with one or more allergens common to the product and the complementary battery. DISCUSSION: Contact sensitization rate is high in leg ulcer patients. Most of the tests had a relationship with leg ulcers. The number one causal agent is balm of Peru. Thirty percent of all the patients are sensitized to at least one excipient, generally lanoline. Allergy tests are positive in 22 p. 100 for one or more antiseptics and in 18 p. 100 for preservatives. Allergy to latex and neomycin is unusual, but sensitization to steroid anti-inflammatory agents was not tested. The main active ingredient in a topical agent is not always the allergen and a detailed test must be performed, generally with a complementary battery adapted to common prescriptions for leg ulcers.

Adult↗
PubMed1997

[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↗
PubMed1997

[Macrophage activation syndrome disclosing leukemic transformation of mycosis fungoides].

BACKGROUND: Mycosis fungoides can mimic pigmented purpuric dermatitis. We report such a case which progressed to peripheral T-cell lymphoma; progression was revealed by reactive hemophagocytic syndrome (RHS). CASE REPORT: A 65-year old male patient was hospitalized for a pigmented and purpuric eruption. The skin lesions appeared 2 years earlier and at that time biopsy had shown pigmented and purpuric dermatitis. One month before hospitalization, general signs appeared. On admission, he had papular and purpuric rash, mainly on the trunk, hepatosplenomegaly, enlarged axillar and inguinal lymph nodes, and fever at 38.2 degrees. A skin biopsy showed histologic changes typical of mycosis fungoides. He also had bicytopenia, hepatitis, and increased triglyceride and ferritin levels suggesting RHS which was proved by means of bone marrow biopsy. These tests also evidenced peripheral T-cell lymphoma. The patient was treated with two courses of chemotherapy (CHOP) but the disease progressed and he deceased. DISCUSSION: Mycosis fungoides can occasionally begin with an eruption very closely resembling pigmented purpuric dermatitis. Therefore, repeated biopsies should be done in case of widespread permanent pigmented purpuric dermatitis of no apparent origin. RHS is a life-threatening disease. The diagnosis should be suspected in any cytopenic patient with fever, increased triglyceride levels and abnormal liver tests. A search for an etiology must then be undertaken a prompt treatment is needed.

Aged↗
PubMed1996

[Blaschkolinear eruption with biological signs of lupus].

INTRODUCTION: Acquired inflammatory dermatoses of the adult with a blaschkolinear arrangement are rare. Their cause is unknown. CASE REPORT: We report the case of a 35-year-old man who presented an unilateral skin eruption covering the forearm and with secondary blaschkolinear extension to the arm, the axillary region and the chest. In this particular case, the patient was positive for RNP type anti-nuclear antibodies and direct immunofluorescence was positive in both biopsies of the lesions and of healthy skin. The eruption lasted 6 months and regressed spontaneously. DISCUSSION: Such cases are exceptional and the nosology is difficult to establish. A particular form of lupus erythematosus? Fortuitous coexpression of lupus antibodies and blaschkitis in an adult?

Adult↗
PubMed1996

[Granulosis rubra nasi and pheochromocytoma].

INTRODUCTION: Granulosis rubra nasi, a papular red lesion of the nose associated with hypersudation is an uncommon dermatosis usually seen in children. CASE REPORT: A noradrenalin secreting pheochromocytoma was found in 19-year-old girl with hyperhidrosis, granulosis rubra nasi and tachycardia. Surgical exeresis of the pheochromocytoma was followed by involution of the hyperhidrosis, regression of the nasal dermatosis and normalization of urinary catecholamines. DISCUSSION: The diagnosis of pheochromocytoma should be entertained in patients with hypersudation and tachycardia. Granulosis rubra nasi could be a complication of hyperhidrosis.

Adrenal Gland Neoplasms↗
PubMed1996

[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↗
PubMed1996

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↗
PubMed1996

[Abnormal central nervous conduction in long-term treatments with retinoids].

INTRODUCTION: Neurological manifestations are uncommon among the undesirable effects of systemic retinoid therapy. We observed a case of axial rigidity imputable to acitretine. Somesthesic evoked potentials were also altered. We therefore searched for such abnormal findings in patients given long-term systemic retinoid therapy. PATIENTS AND METHODS: A neurological exploration was performed in two groups of patients, G1 and G2, with psoriasis and no neurological complaint. The exploration included a physical examination, a study of the somesthesic evoked potentials of all 4 limbs and an electromyogram in case of abnormal findings. There were 8 patients (3 women, 5 men, mean age 56 years, age range 39-71) in G1 treated with systemic retinoids for a mean 140 months (80-185). Cumulative dose was 50 to 280 g with a daily dose of 0.2 to 0.6 mg/kg/day, i.e 20 to 50 mg/d of etretinate or acitretine. In G2, there were 5 subjects (mean age 42 years, range 21-52) with psoriasis (mean duration 20 years range 14-25) who had never been treated with systemic retinoids. RESULTS: Alterations in somesthesic evoked potentials were observed in 7 of the 8 patients in G1. Bilateral disturbances were seen in 6 cases, demonstrating abnormal lemniscal central nervous conduction in the dorsal and/or cervical level in 3 cases and the cervical level alone in 3 cases. There was one asymmetrical case involving the lumbar level on the right and the dorsal and/or cervical level on the right. Only one of the 5 controls in G2 had a minimal unilateral reduction in somesthesic evoked potentials involving the lower limb. Direct effect of systemic retinoids was retained in absence of any other cause due to metabolic, toxic or deficient disorders or spinal compression. CONCLUSION: Long-term use of systemic retinoids induces frequent latent neurological anomalies expressed as lemniscal central nervous conduction. It is hypothesized that pathogenesis involves changes in the lipid composition of the nervous membranes.

Adult↗
PubMed1995

Porphyria cutanea tarda and hepatitis C viral infection. A clinical and virologic study.

BACKGROUND AND DESIGN: The role of hepatitis C virus (HCV) infection in porphyria cutanea tarda (PCT) is probable since the global HCV antibody prevalence among patients with PCT is about 70%. The purpose of this study was to evaluate the virologic characteristics in 12 patients with sporadic PCT and in one patient with familial PCT. Anti-HCV antibodies were detected by enzyme-linked immunosorbent assay and confirmed by recombinant immunoblot assay. Hepatitis B virus and antihuman immunodeficiency virus markers were also determined. The polymerase chain reaction was performed to detect the following: (1) both positive and negative HCV RNA 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 at onset of PCT was significantly lower in HCV-positive patients than in HCV-negative patients. The HCV RNA was detected in all patients who had HCV antibodies, and the replicative intermediate of HCV was detected in three of them. The positive RNA titer ranged from 1:10 to 1:10(6). Four patients were infected by HCV genotype I, two by genotype II, and one patient was coinfected by type I and type II. Three of the seven HCV-positive patients also had HBV antibodies, but HBV DNA was never detected. All patients were negative for the human immunodeficiency virus. CONCLUSIONS: The HCV infection rate was high (58%) in this series, and all HCV-infected patients had HCV RNA, reflecting an active replication of the virus. The young age at onset of PCT suggests that HCV is a major triggering factor of PCT. Nevertheless, the clinical changes of PCT were not related to the virologic findings, suggesting an indirect role of HCV.

Adult↗