Biomedical subjects
Publications and source records attributed to J Meynadier.
Paradoxical as it may seem, phototherapy, and in particular PUVA therapy, is of considerable interest in the treatment of such photodermatoses as polymorphous light eruptions, solar urticaria and remanent photosensitivity syndrome. When used rationally, with the appropriate therapeutic regimen and under close monitoring of the parameters, these treatments give very satisfactory results in preventing the occurrence of photo-induced skin eruptions.
BACKGROUND: The biologically active form of vitamin D3, calcitriol, may offer a new therapeutic approach to psoriasis. Calcipotriol, a new vitamin D3 analogue, is at least 100 times less calcemic than calcitriol. OBJECTIVE: Our purpose was to study the efficacy and safety of calcipotriol in the treatment of psoriasis vulgaris. METHODS: In a right/left comparative, double-blind study, treatment with calcipotriol ointment (50 micrograms/gm) twice daily and placebo was given for 4 weeks. The preferred treatment was continued, without opening the code, for another 4 weeks. Efficacy, as measured by the Psoriasis Area and Severity Index and by the investigator's and patient's global assessment, and safety were assessed every 2 weeks. RESULTS: The mean Psoriasis Area and Severity Index fell in 4 weeks from 14.2 to 6.3 with calcipotriol and from 14.1 to 9.2 with placebo (p < 0.001; 95% confidence interval for difference: 1.78-->3.94). Local side effects were equally common with calcipotriol and placebo. The mean serum calcium remained unchanged. CONCLUSION: Topical application of up to 50 gm of calcipotriol ointment per week was found to be an effective and safe treatment of psoriasis vulgaris.
In a left-right comparative study, the Philips TL-01 sunlamp, a new UVB fluorescent lamp, was evaluated in 15 patients with symmetrical psoriasis. One half of the body was treated in a cabin containing TL-01 lamps, and the other half in a cabin containing TL-12 lamps. The patients were treated three times/week, and the study was conducted in a randomized, double-blind fashion. The percentage response of psoriatic lesions was determined on the tenth and twentieth exposures. The therapeutic effect of the TL-01 lamps was superior to that of the TL-12 lamps, and treatment was better tolerated, particularly with regard to episodes of burning. This new lamp appears to provide more effective and safer phototherapy for psoriasis.
The authors report the results of an open study conducted on 53 patients with psoriasis treated by narrow-band UVB phototherapy, using Philips' TL01 lamp. With a simple procedure which did not require MED determination this treatment gave satisfactory results in 92 p. 100 of the cases, with mild burns in only 9 p. 100. The morphological type of psoriasis (patchy, guttate or nummular) had no influence on the therapeutic result, but the degree of infiltration of the lesions and their location on the lower limbs proved to be a factor of relative resistance. In most patients the results were obtained in 20 sessions with a mean cumulative dose of 20.19 +/- 2.7 J/cm2. Some patients had an additional treatment of 6 sessions. The results obtained with Philips' TL01 lamp were as satisfactory as those obtained with the conventional UVB lamps, but the TL01 lamp seemed to be easier to handle and better tolerated, which gives them some advantages over the latter.
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Ageing of the skin results from the synergistic effects of intrinsic, genetically determined factors and extrinsic factors the most important of which is chronic exposure to sunlight. The cumulative effects of ultraviolet radiations are responsible for specific dermo-epidermal alterations (actinodermatitis) with its two main manifestations: actinic elastosis characterized by accumulation of dystrophic fibres in the dermis, and lesions of senile keratosis which may become carcinomas. The so-called "premature ageing of the skin" can be alleviated by cosmetic treatments, photoprotective measures and vitamin A derivatives; regular applications of retinoic acid (vitamin A acid, tretinoin) can result in partial regression of actinodermatitis.
Forty-five patients with cutaneous T-cell lymphomas (CTCL), 32 with mycosis fungoides (MF) and 13 with Sézary syndrome (SS), were treated with interferon-alpha 2a (IFN-alpha 2a) (6-9 x 10(6) IU daily) for 3 months. Those responding to treatment were then treated with interferon-alpha alone (6-9 x 10(6) IU three times weekly), and non-responders received a combination of etretinate (0.5 mg/kg/day) and IFN-alpha 2a in similar concentrations. After 12 months of treatment, 28/45 patients (62.2%) were in complete or partial (greater than 50%) remission. Of these, 17 (60.7%) were receiving IFN-alpha alone and 11 the combined interferon-retinoid therapy. Of the patients with MF stage I and II, 20/25 were responders (12 receiving IFN-alpha alone and eight on combined therapy), whereas only 8/20 with stage IV or SS responded to treatment (five receiving IFN-alpha 2a alone and three combined therapy). These results suggest that the association of etretinate with low-dose recombinant IFN-alpha 2a is an effective means of treating epidermotropic CTCL, particularly in the early stages.
Atopic dermatitis is transmitted as an autosomal dominant trait. Its expressivity is variable, and flare-ups are triggered by environmental factors such as air-borne allergens, cutaneous flora or foodstuffs. Elevation of serum IgE levels is inconstant and not specific; it is associated with a deficiency of suppressor T cell population. The epidermis contains IgE bound to the surface of Langerhans cells; this abnormality seems to be specific as it is not found in atopic or non atopic healthy subjects. The lack of beta-adrenergic response is partially explained by the hyperactivity of the cyclic AMP-degrading phosphodiesterase. Disturbances in essential fatty acid metabolism (inactivation of delta 6 desaturase) are thought to be responsible for abnormalities in the permeability of epithelial structures. The relationships between pharmacological, biochemical and immunological dysregulations are unknown.
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After Leksell and Steiner's pioneering experience with the use of the gamma units, another technically different system has been developed, using a linear accelerator. It's a very precise stereotactic radiosurgical approach which allows to deliver the necessary dose of radiation to the target volume while sparing the surrounding structures from potentially dangerous levels of radiation. This hyperselective irradiation is a new and complementary method of treatment of arteriovenous malformations located in central or functionally critical areas of the brain. The aim is to obtain a progressive and total obliteration of the lesion. The place of radiosurgery is obviously reserved for the patients who do not seem able to profit from the benefits of open surgery and/or embolization techniques.
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The authors report their experience in the treatment of 79 patients suffering from intractable cancer pain with intra-cerebro-ventricular morphine. They obtain a long-lasting analgesia (34.2 hours at the beginning of treatment and 27.9 hours at the end; mean follow-up of 65 days) with a very low daily morphine consumption. The results obtained, good and very good in 95% of the cases, could be explained by patients' selection criteria and quality of the follow-up (prospective sheet given to the patients, regular phone calls and consultations in the pain clinic). The authors discuss the indications of this technique in relation with other neurosurgical procedures, taking into account the neurophysiological mechanism of action of morphine.
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HLA typing was performed in 35 French Caucasoids with bullous pemphigoid and compared with 160 healthy controls. 47 HLA antigens were characterized by a lymphocytotoxicity micromethod. Analysis of the results only reveals one statistically significant difference: an increased incidence of HLA-DR5, which reaches 51.43% in patients versus 22.42% in controls, with P = 0.0007 and Pc = 0.0329. Several bullous dermatosis are associated with various HLA-DR antigens. These data suggest a direct role of HLA-DR molecules in the constitution of these autoimmune disease. An abnormal expression of DR products on some skin cells membrane would permit the presentation of a non self peptide, accumulated in skin cells, to helper T lymphocytes. An heteroimmunization against the non self peptide could lead to lesion of self cells. This peptide perhaps derives from food protein.