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[Lasers in dermatology].

Lasers are mainly used in therapeutics for their thermic effects. In dermatology, the most appropriate is the argon laser and its only uncontroverted indication is part-wine stain. The blue-green radiations of the argon laser are selectively absorbed by the haemoglobin pigment, so that coagulation necrosis is maximum in the dysplastic vessels. Since the non-pigmented surrounding tissues and, more precisely, skin appendages are relatively respected, healing is rapid and of good quality. Following the often protracted treatment, a satisfactory downgrading of colour is obtained, without scar in 60-80% of cases. The best results are observed in dark portwine stains located on the face or trunk in adults. All other indications are open to discussion since the superiority of laser over other treatments remains to be demonstrated or confirmed. Interesting indications are spider angioma and telangiectasis of the face (argon laser), extensive ano-genital verrucosis (CO2 laser or argon laser), mucosal leukoplasia and some cases of Bowen's disease affecting the genitalia.

Argon↗

[Acrosclerosis, Gougerot-Sjögren syndrome, myxedema and anti-centromere antibodies. 3 cases of this association].

The authors report three identical cases of the association of acrosclerosis with telangiectasis without calcinosis, Sjögren-Gougerot syndrome, myxoedema with antithyroid antibodies and anti-centromere antibodies. The association of these conditions one with another has already been published, but, to the authors' best knowledge, this is the first report of all of them grouped together in the same patients. With reference to the literature, the authors discuss the problems of individualization of the CRST syndrome and its varieties and the clinical significance of the presence of anti-centromere antibodies.

Aged↗

[Left predominance of varices: myth or reality?].

The study of 843 legs operated for major varices shows that they are equally distributed between the two lower limbs (48.6% on the right, 51.4% on the left). There is little sex-determined variation in this distribution (410 women - 184 men), the main difference being that found in men: +4.6% on the left. Other studies carried out in Europe come to much the same conclusion. Two of these studies do, however, note a much clearer predominance of left-leg varices in men (+10%). For some studies, the lack of information about the type of varices being considered has proved troublesome (for example the many isolated telangiectasis and varices) and means that it is impossible to come to any exact conclusion. Clinical quantification is therefore desirable: at least it takes into account the diameter of the varices studied.

Adolescent↗

CT patterns in histopathologically complex cavernous hemangiomas.

Computed tomographic (CT) studies were correlated with microscopic findings in 10 histologically verified cavernous hemangiomas in nine patients. In four of the 10 lesions, two or more distinct types of cerebrovascular malformations were identified histopathologically. These included arteriovenous malformations, venous malformations, and telangiectasis. Such coexistence of various types of cerebrovascular malformations has been reported rarely. In each of the four combined lesions, there was evidence of recent or old hemorrhage. The CT findings were nonspecific and were similar to those seen in a variety of intracranial pathologic conditions.

Adult↗

Sclerodactyly in a patient with mycosis fungoides.

A 44-year-old man had mycosis fungoides and generalized plaque disease involving 80% of his skin surface with diffuse lymphadenopathy and alopecia of the scalp and groin. In addition, distal to the wrist, there were sclerodermatous changes involving the skin of the hands with associated sclerodactyly of all digits with loss of normal palmar creases. There were no subungual telangiectasis or digital ulcers. The changes in the hand that occurred in this case, no doubt arose as a result of the patient's neoplasm. Abnormalities of collagen biosynthesis and degradation probably occur with mycosis fungoides as a result of the extensive infiltration of the epidermis and dermis with malignant cells. To our knowledge, the association of sclerodactyly with mycosis fungoides has not been previously reported.

Adult↗

[Vascular anastomoses at the posterior pole of the eye (author's transl)].

Anastomoses between vessels of the fundus may occur as congenital malformations or secondary to vascular diseases affecting the eye. Congenital anastomoses can be of the racemose hemangioma type, with severe malformation of the retinal vessels, ocular complications, and neurologic manifestations, or as simple A-V shunts with visual impairment but limited tendency to show other ocular or neurologic involvement. These anastomoses must be distinguished from other vascular malformations like telangiectasis (Leber, Coats) or the angiomatous lesions of von Hippel's disease. Secondary anastomoses may be confined to the retinal vessels or involve chorioretinal connections. Retinal anastomoses occur in vascular disorders like retinal vein occlusions, diabetes, periphlebitis and hemoglobinopathies. They are often amenable to treatment by light coagulation. Chorioretinal anastomoses occur whenever Bruch's membrane is destroyed by traumatic, inflammatory, degenerative or physical (light coagulation) influences. Light coagulation may be the appropriate treatment, although complications are not rare.

Adolescent↗

Abnormal regulation of DNA replication and increased lethality in ataxia telangiectasia cells exposed to carcinogenic agents.

The effect of different carcinogenic agents on the rate of semiconservative DNA replication in normal and ataxia telangiectasis (AT) cells was investigated. The rate of DNA synthesis in all AT cell strains tested was depressed to a significantly lesser extent than in normal cells after exposure to X-rays under oxia or hypoxia or to bleomycin, agents to which AT cells are hypersensitive. In contrast, inhibition of DNA replication in normal human and AT cells was similar after treatment with some DNA-methylating agents or mitomycin C. Colony-forming ability of AT cells treated with these agents was not different from normal cells. Treatment with 4-nitroquinoline 1-oxide elicited a variable response in both AT and normal cell strains. In some strains, including those shown to be hypersensitive to the drug by other workers, the inhibition of DNA synthesis was more pronounced than in other cell strains, but no significant difference between AT and normal cells could be detected. The rejoining of DNA strand breaks induced by X-rays, measured by DNA elution techniques, occurred within l2 hr after treatment and could not be correlated with the difference in DNA synthesis inhibition in AT and normal cells. After low doses of X-rays, AT cells rejoined single-strand breaks slightly more slowly than did normal cells. The rate of DNA replication in X-irradiation AT and normal cells was not affected by nicotinamide, an inhibitor of poly(adenosine diphosphate ribose) synthesis. These data indicate that the diminished inhibition of DNA replication in carcinogen-treated AT cells (a) is a general characteristic of all AT cell strains, (b) correlates with AT cellular hypersensitivity, (c) is not directly caused by the bulk of the DNA strand breaks produced by carcinogenic agents, and (d) is not based on differences in the induction of poly(adenosine diphosphate ribose) synthesis between X-irradiated AT and normal cells.

4-Nitroquinoline-1-oxide↗

[Cerebral abscesses disclosing pulmonary angioma. Rendu-Osler disease].

A 50-year old male patient presented with two successive cerebral abscesses over a 9-month period. Rendu-Osler-Weber disease was diagnosed on the basis of recurrent epistaxis and telangiectasis of the mucosae and skin. In addition, many members of the patient's family had a history of epistaxis and one had a cerebral angioma of unusual location. Our patient's chest was normal on physical and radiological examination, but pulmonary angiography disclosed a small angioma. Removal of the angioma prevented further cerebral infections. The prevalence of pulmonary arterio-venous fistulae in Rendu-Osler-Weber disease and their clinical manifestations (especially in the central nervous system) are reviewed, together with the value of family studies and the therapeutic approach.

Brain Abscess↗

[Basal cell epitheliomas of the extremities. Presentation of 16 cases].

The authors study 16 cases of basal cell epithelioma of the limbs, 5 from the upper ones and 11 of the lower ones. They expose their particular clinical characteristics which have not been shown at bibliography there are studied. Are atypical forms all the distal or acral sectors: erythemato-squamous, exofitic and nodular without melanic pigmentation, pearl papulae or telangiectasis, which makes difficult a precise diagnosis. Proximal limb lesions shown the typical semiology of basal cell epitheliomas of head and neck. The exofitic forms have fasted evolution, while the others grow slowly. Histologically it has been demonstrated a clear predominance of solid undifferentiated forms: 12/16. The statistical studies suggest an increase of basal cell epithelioma of the limbs during the lats quinquenium, probably related to a more intensive exposition to sunlight.

Aged↗

Benign skin changes associated with chronic sunlight exposure.

Chronic and heavy sun exposure will insidiously induce changes in human skin during the course of many years. These changes include wrinkles, atrophy, cutis rhomboidalis nuchae, yellow papules and plaques of the face, colloid milium, telangiectasis, diffuse erythema, diffuse brown pigmentation, ecchymoses, freckles, actinic lentigo, nevi, Favre-Racouchot syndrome, poikiloderma of Civatte, actinic keratosis, basal cell carcinoma, squamous cell carcinoma, melanoma, actinic lichen planus, actinic reticuloid, porphyria cutanea tarda, and erythropoietic protoporphyria. In particular, we describe the clinical appearance of the benign changes caused by chronic sunlight exposure.

Adult↗

Implications of radiotherapeutical techniques.

Radiotherapy is implicated when reconstruction of the breast is to be made because sclerosis and skin atrophy with telangiectasies must be avoided. This can be achieved by the use of high energy radiation of 60Co and electrons of the linear accelerator, keeping in mind that the postoperative treatment of the disease needs the application of doses ranging from 4,000 to 5,000 rads delivered in 4 to 5 weeks.

Breast Neoplasms↗

Susceptibility of Fanconi's anemia lymphoblasts to DNA-cross-linking and alkylating agents.

In order to develop the usefulness of Fanconi's anemia (FA) lymphoblast lines for biochemical and genetic studies, we have determined their sensitivity to a variety of DNA-damaging chemicals. We have adapted a growth inhibiton protocol in which the sensitivity of a cell line is characterized by the drug concentration yielding a 50% inhibiton of growth (EC50). The DNA-cross-linking agents, mitomycin C, nitrogen mustard, melphalan, 1,3-butadiene diepoxide, cis-diaminedichloroplatinum(II), and cyclophosphamide, were all more toxic to four FA cell lines than to five normal lines. Three lines, HSC 72 (FA), 99 (FA) and 230 (FA), had EC50s that were 10 to 20 times lower than that of controls while the fourth line, HSC 62 (FA), had an intermediate EC50. Three nitrosourea compounds were also more toxic to FA cells than to controls. However, 2 normal cell lines (HSC 92 and 93) had nitrosourea EC50s 4 to 7 times lower than the other nine controls and overlapped the sensitivity of the intermediate [HSC 62 (FA)] cell line. The same 2 normal cell lines were also more sensitive than 12 other controls, including FA heterozygotes, xeroderma pigmentosum, and ataxia telangiectasis, to the monofunctional alkylating agents, ethyl methane sulfonate, methyl methane sulfonate, and N-methyl-N'-nitro-N-nitrosoguanidine. Heterogeneity was also found with FA lines. Two FA cell lines (HSC 72 and 230) had EC50s lower than all control lines while one FA line (HSC 99) had an EC50 similar to that of the resistant normal lines. FA and normal cells had nearly the same sensitivity to 4-nitroquinoline-1-oxide and bleomycin. These results demonstrate that FA lymphoblast lines are more sensitive than normal cell lines to all DNA-cross-linking agents examined. These cell lines should therefore be useful for the analysis of DNA cross-link repair and the biochemical defect in FA. We have also found an unexpected sensitivity of some FA and normal lines to monofunctional alkylating agents.

4-Nitroquinoline-1-oxide↗

From Fegan forwards.

We use injection therapy under the following circumstances: 1. After groin ligation in all cases with LSV varices and associated veins in thigh and around the knee. 2. When veins remain after groin ligation +/- stripping. 3. All patients with below knee veins whether new or previously operated affecting LSV or SSV. 4. Dilated dermal telangiectasis. 5. In the management of some ulcers. Why do methods of treatment go wrong? 1. Incomplete documentation and out of date examination of the patient. 2. Failure to follow the correct technique of treatment. 3. Failure to recognize deep venous insufficiency or underestimating stasis complications. Our indications for investigating the deep veins before treatment are: 1. Persistent oedema of the leg. 2. Recent or recurrent phlebothrombosis.

Humans↗

[Pseudo-tumoral neurological affections in adults localized to the middle and posterior sections of base of skull (author's transl)].

Many neurological affections of the middle and posterior sections of base of skull may simulate tumors. Vascular disorders include diabetic lesions, diffuse cerebral vascularitis, vascular malformations, posterior fossa angioma, telangiectasis or cavernous hemangioma, and basilar artery aneurysms. Degenerative or deficiency nervous system affections may also simulate tumors, as well as bone or nerve malformations, such as erosions due to basilar artery compression. Arnold-Chiaris malformation, aqueduct stenosis, or an empty sella turcica.

Adult↗

[Hair disorders and neurological impairments (neurotricosis): three new cases].

Three children with hair-shaft abnormalities and neurological disorders are reported. The first case is a young girl with monilethrix and Friedreich's ataxia that presented IgG and IgA deficiency, without telangiectasis. The second patient is a young girl with monilethrix and HMSN I. The third patient is a boy with a peculiar face, hypotrichosis and pili torti; he was mentally retarded and had epileptic seizures. His diagnosis was compatible with Noonan's syndrome or with a cardio-facio-cutaneous syndrome, because of the existence of hyperkeratosis and the neurological features. It is our aim to emphasize the heterogeneity of neurotrichosis, whose limits are not well established and whose manifestations are shared by some of them.

Brain↗

Vascular malformations.

MR angiography supplements conventional MR imaging in the diagnosis and evaluation of patients with arteriovenous malformations. MR angiography may also have a significant role in the planning and follow up of patients undergoing radiosurgical treatment. The technique has a much more limited role in the evaluation of vascular formations with low flow or no flow, such as developmental venous anomalies, cavernous malformations, and capillary telangiectasis.

Humans↗

Eosinophilic fasciitis with occlusive vasculitis and gangrene of the finger.

Eosinophilic fasciitis (EF) is characterized by the presence of scleroderma-like changes in the skin, inflammation and thickening of the fascia, associated with peripheral eosinophilia. Visceral involvement, telangiectasis, Raynaud's phenomenon, or gangrene of the digit is very unusual in EF. We describe a patient with EF that was accompanied by Raynaud's phenomenon and gangrene of the finger due to occlusive vasculitis of small and medium arteries in extremities.

Adult↗

Intracranial vascular malformations.

Magnetic resonance imaging is a useful process in the evaluation and follow-up examination of intracranial vascular malformations. Magnetic resonance imaging as related to the four subtypes of these malformations, arteriovenous malformations, venous angiomas, cavernous malformations, and capillary telangiectasis, is discussed.

Adolescent↗