[Sexually transmitted diseases and the place of the antivenereal clinic].
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Biomedical subjects
Publications and source records attributed to J Bazex.
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Fibrinolytic activity in response to venous occlusion (fibrin plate assay and tissue plasmogen activator antigen) was measured in 19 hypogonadic men (group 1), 23 non-hypogonadic men with deep venous thrombosis (DVT) antecedents and 20 healthy men (control group). Four hypogonadic men had DVT antecedents. Two of 20 controls were low responders against 6/19 and 6/23 in groups 1 and 2, respectively, (non-significant difference). The four hypogonadic men with DVT antecedent had abnormal response to venous occlusion. Whether defective fibrinolysis is causally related to hypogonadism cannot be established from these results but this study indicates that the combination of defective fibrinolysis, hypogonadism and DVT in man is relatively common.
Cimetidine, a histamine H2 antagonist, seems to have anti-androgenic activity. 22 young women were studied during follicular phase prior to and after a 3 month period of treatment with cimetidine (1,200 mg daily). Three month treatment with cimetidine resulted in a significant decrease of seborrheic index (p less than 10(-4)) and casual level (p less than 10(-4)). Testosterone level, TeBG binding capacity and free testosterone were unaffected by the treatment. Cimetidine decrease sebum secretion without change in androgen parameters.
Three patients with karyotype XYY who had presented with deep vein thrombosis and leg ulcers (plus pulmonary embolism in two of them) were investigated for: (1) androgens (plasma testosterone measurement, testosterone oestradiol binding globulin (TeBG) assay, GnRH 50 micrograms test), and (2) haemostasis by fibrinolysis tests (euglobulin lysis time and area, antigenic plasminogen activator assay before and after 10 min venostasis). Full evaluation of haemostasis failed to demonstrate the presence of circulating anticoagulant or of antithrombin III, protein C and protein S deficiencies. One patient had neither hormonal nor fibrinolytic abnormality. The other two patients shared some clinical features with male hypogonadism (gynoid morphotype in both, hypotrophy of the testes in one, gynaecomastia in the other). They also had hormonal disorders ("over-response" to the GnRH test in one case, elevated TeGB in the other case) and abnormalities of fibrinolysis (poor response to venostasis, high baseline level of plasminogen activator). Response to venostasis became normal after 3 months of treatment with percutaneous dihydrosterone 125 mg per day in the two patients with initially poor response. The mechanism of venous pathology in XYY subjects is discussed. A genetic defect not involving the fibrinolysis system is possible since fibrinolysis was normal in one patient; however, abnormal fibrinolysis may have been responsible for the venous pathology in the other 2 patients. The role played by abnormalities of fibrinolysis in the pathogenesis of deep vein thrombosis and leg ulcers is recalled, and the possible implication of these abnormalities in patients with XYY karyotype is emphasized.(ABSTRACT TRUNCATED AT 250 WORDS)
We present here an exceptional case of cutaneous and vascular sarcoidosis associated with lesions of the liver, spleen and lymph nodes. The disease began when this male patient was 27 years' old and gradually extended over 35 years, despite long-term systemic corticosteroid therapy. Clinically, the initial cutaneous lesions were atrophic, erythematous and squamous, resembling those of erythroderma; they were located on the skin of the right popliteal fossa, the left arm, the neck, the upper part of the chest and around the waist. Subsequently, they spread slowly to involve almost the entire skin, except for the face, right upper limb, left lower limb, hands and feet. The most ancient of these lesions were distinctly black. The skin was paper thin due to complete disappearance of the subcutaneous tissue. Left temporo-parietal alopecia of the cicatricial type developed towards the end of the patient's life. The nails remained normal throughout, and there were no other cutaneous signs of sarcoidosis. Initially, the venous network was clearly visible beneath the atrophic skin, but later on, the veins became grossly dilated and sacculated in those areas which had first been invaded by skin atrophy. Phlebography of the left upper limb confirmed the venous dilatation, while arteriography of the upper limbs showed multiple sacciform aneurysms of the subclavian, axillary and brachial arteries, with distal thrombosis of the latter vessel. Histology showed typical lesions of sarcoidosis in a vein; no arterial biopsy was performed. The muscles had a nodular and sclerous appearance; amyotrophy developed in the last stages of the disease; tendons and joints were normal.(ABSTRACT TRUNCATED AT 250 WORDS)
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A physicochemical study of subcutaneous calcium deposits was performed in a patient with typical Thibierge-Weissenbach syndrome which had begun, ten years previously, with Raynaud's phenomenon and sclerodactylia. Calcium deposits had progressively developed, forming large plates on the arms, flanks and thighs. In the course of the disease they had become ulcerated, exuding a white, chalky material. X-ray films and xerograms demonstrated the extent of these deposits. The calcium-phosphorus balance was normal, and the other clinical and laboratory examinations were concordant with a diagnosis of Thibierge-Weissenbach syndrome (calcinosis). Only systemic corticosteroid therapy slowed down the pathological process; calcium chelating agents (diphosphonate) proved ineffective. The physicochemical study showed that the deposits consisted of carbonated apatite type B with the following formula: Ca8.0(PO4)4.1(CO3)1.2(HPO4)0.8 The mineral substance seemed to be less reactive and more stable than normal bone. This would account for the total lack of effectiveness of all treatments, notably calcium chelating agents, on the course of the deposits. Treatments usually produce bone demineralization before they influence the calcium deposits. This study provides much more detailed information than was hitherto available on calcium deposits and on carbonate ion contents in the apatite phase. The presence of carbonates increases the solubility and reactivity of calcium apatite.
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Extensive lesions on 36 patients with psoriasis were treated by Tigason, I mg/kg/day plus PUVA until skin clearance. A clinical score was calculated for each body area, and erythema, scaling, thickness and pruritus of the lesions were scored from 0 to 3. Skin clearing was defined as a clinical score less than 10% of the initial score. Double-blind maintenance treatment was then started. This was Tigason at half of the maximal dose tolerated during the clearing phase of the treatment v. placebo. Relapse of the disease was defined as the occurrence of a clinical score greater than 50% of the initial score. Among the 36 patients randomized, 20 received placebo and 16 received Tigason. Relapses increased quickly in the patients on placebo, but occurred in few patients treated by Tigason with 60% remaining clear after 1 year (P less than 0.05). Surprisingly, the kinetics of disappearance of the most frequent side effect, cheilitis, was the same in the Tigason group and in the placebo group. This double-blind randomized clinical trial shows that Tigason at low doses is an efficient and well-tolerated maintenance treatment of psoriasis.
Castrated rats submitted to androgenic stimulation present hyperseborrhea with an increase in foamy cells associated with an increase in cutaneous lipids and a change in the number of epidermal cell layers. 13-cis-retinoic acid and aromatic retinoid (Ro 10-9359) were given orally during 17 days (10 mg/kg) to castrated rats which had received a testosterone implant. Cyproterone acetate was chosen as the antiandrogenic drug; it was given at doses of 10 mg/kg i.m. once every other day. As opposed to cyproterone acetate, the two substances studied had no effect on the seminal vesicle and ventral prostate. 13-cis-retinoic acid and retinoic aromatic acid increased the total number of epidermal layers: In the case of 13-cis-retinoic acid, the increase involves especially the nonnucleated cell layers, whereas with retinoid aromatic acid it involves the nucleated cell layer. The number of sebaceous glands is not changed by either products, on the other hand, the number of foamy cells is considerably decreased and the weight of cutaneous lipids is decreased as well.
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In 1955, Cronkhite and Canada described two patients presenting abnormal skin pigmentation, alopecia, onychodystrophy and gastrointestinal polyposis. In the first French case reported here, the skin pigmentation has been the object of a special electron microscope study. M. E..., 48-year old, developed, in 1968, pigmented maculae with a metallic gloss around his pelvic girdle. The melanoderma rapidly expanded, associated with fall of hair, body hairs and eyebrows. Onyxis and perionyxis of the right thumb, milium-like epidermal cysts, tumoral lesions of the keratoacanthoma type on the nose and scrotum and, chiefly, generalized cockade-like bullous erythema associated with buccal erosions soon completed the clinical picture. The bullae were subepidermal, and direct and indirect immunofluorescence tests revealed the presence of antibodies directed against the basal membrane area. A few years later, a gastrointestinal syndrome developed progressively, consisting of liquid diarrhoea (8-10 stools per day) with deterioration of the patient's general condition and loss of weight leading to cachexia and, ultimately, death. During periods when the gastrointestinal symptoms regressed the general condition improved, hair and hairs started growing again and pigmentation was less pronounced. Examinations of the digestive tract discarded a malabsorption syndrome. Endoscopy revealed the presence of false polyps with paved appearance of the colonic and rectal mucosae. The mucosa was congested, inflamed and strewn with ulcerations. Histology showed signs of acute proctitis. The abnormal skin pigmentation was the object of histological and ultrastructural analysis. Under the light microscope the epidermis was thicker than normally with increased melanin content. There was marked pigment leakage with numerous melanophages. At electron microscopy the melanocytes, more numerous, showed increased melanogenic activity.(ABSTRACT TRUNCATED AT 250 WORDS)
The authors discuss the main features of paraneoplastic acro keratosis, a new cutaneous marker of malignancy. Clinically, the condition begins at the extremities of the limbs and spreads upwards secondarily. The eruption is psoriasis-like squamous erythema of the face, hands and feet. Nail changes are present from the onset. These lesions are always associated with a malignant epithelioma, usually of the spino-cellular type localised in the upper respiratory and digestive tracts. Surgical cure of the primary malignant tumour leads to regression of the skin lesions which reappear in case of relapse.
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