Frontal impairment and hypoperfusion in neuroacanthocytosis

Cerebral blood flow tomography, by xenon 133 inhalation or HMPAO (99mTc-d, l-hexamethyl-propylene amine oxime) technetium Tc 99m injection, revealed a severe hypoperfusion in both frontal lobes of a 40-year-old woman with confirmed neuroacanthocytosis. This finding occurred in conjunction with neuropsychological deficits consistent with selective frontal lobe dysfunction. This observation is the first documentation of this type of dementia in neuroacanthocytosis.     

Smoothing the mosaic subclinical melanoderma by calcipotriol

BACKGROUND: The observation of photo-exposed skin under ultraviolet light reveals a mosaic pattern of varying intensity in epidermal melanization. Several patterns of mosaic subclinical melanoderma (MSM) have been described using a specially designed CCD camera and the ultraviolet light-enhanced visualization (ULEV) method. Vitamin D(3) and its analogues influence the biology of keratinocytes and melanocytes. OBJECTIVE: To assess the effect of calcipotriol on MSM. METHODS: This randomized split-face study was conducted in 27 men to compare the effect of once daily applications of 5% calcipotriol cream or a moisturizing cream on the heterogeneity of facial MSM. Computerized image analysis of video images was used at 1-month intervals before and during a 2-month treatment, as well as during a 3-month follow-up. RESULTS: At both sites, the average melanin content of the epidermis showed no significant change over time. However, the mottled appearance was smoothened at the calcipotriol site, whereas it was increased at the site receiving the moisturizer. CONCLUSION: The decreased heterogeneity in MSM after calcipotriol applications suggests a control of the epidermal melanocyte unit by the vitamin D(3) derivative.     

Cryoscopy: a novel enhancing method of in vivo skin imaging

BACKGROUND: It is a common observation that superficial freezing of normal skin and skin tumors may create a transient superficial whitening effect. In this respect, cryoscopy refers to the direct observation by dermoscopy, with or without digital recording, of the visual alterations of the frozen tissues. AIMS: To define the optimal method of cryoscopy and to describe the cryoscopy patterns of normal skin and selected skin lesions. MATERIALS AND METHODS: The influence of (a) different cryogenic sources [solid carbon dioxide (-78.5 degrees C), liquid nitrogen (N(2), -196 degrees C), and a mixture of dimethyl ether and propane (-57 degrees C)], (b) various application methods (spraying, cotton chill tips, copper plate), and (c) freezing time was assessed with regard to clinical feasability, visualization quality, and persistance time of the whitening effect. Cryoscopy patterns of normal skin, callosities and of histologically proven seborrheic keratoses, verrucous hamartomas, molluscum contagiosum, keratoacanthomas, viral warts, condylomas, actinic keratoses, dermatofibromas, skin tags, basal cell carcinomas, angiomas, and melanocytic naevi were assessed. RESULTS: The cryoscopy images of skin highlighted the skin lines. They appeared similar regardless of the freezing source and the application method. The aspects differed according to the nature of the lesions. The cotton chill tip method provided a longer whitening period compared with the other cold sources, both in normal and lesional skin. Hence, it represented the most convenient way for performing digital recording cryoscopy. On normal skin, cryoapplication was limited to about 1.5 s due to pain, resulting in whitening times ranging from 6 to 9 s, which was too short for easy digital recording. On all studied skin tumors, a 10-s N(2) freezing time was not experienced as painful, and blanching time persisted for 20-34 s, allowing easy digital recording. The whitening time was longer with increasing freezing time on both normal and lesional skin. Every single examined normal skin site and all the skin lesions showed a strong whitening effect, except heavily cornified structures, including some keratoses, callosities, and viral warts. Increased contrast of the skin surface texture was observed in almost every studied lesion. CONCLUSION: The N(2) cotton chill tip technique appeared to be the most convenient technique for cryoscopy and provided longer whitening periods compared with the other freezing sources. Pain prevented its use on normal skin, but a series of exophytic skin lesions was conveniently accessible to cryoscopy. The differences in whitening periods of various epidermal components resulted in increased visual contrast, creating typical cryoscopy images for the different exophytic skin tumors. Cryoscopy represents a novel in vivo skin imaging technique that is rapid, non-invasive, cost-effective, and easily performed. It shows both investigative and diagnostic potentials. It is remarkable that cryoscopy pictures closely resemble those yielded by skin capacitance imaging.     

Curietherapy using a ruthenium and iridium disk in the treatment of choroid melanoma

Following the experience of the German authors, the treatment of choroidal melanoma with ruthenium 106 disk was introduced in Lyon. Between 1983 and 1988, 127 patients were treated. Results are analysed on a group of 84 patients followed 18 months and more. In 72 cases a reduction of thickness was noted. It was complete in 33 cases. Enucleation was performed in 10 patients due to no response or regrowth. In 3 cases the tumor was sterilized. Five patients died of metastases, and 73 are alive, 3 of them with liver metastases. An afterloading iridium template disk was used in 8 patients. 4 of them with a tumor thickness between 6.5 and 8 mm had a good response. Edema of the fovea was observed in 21% of cases, while cataracts were very unusual with Ru 106. An enucleation was performed in 6 patients because of a complication. A useful vision may be preserved in 60% of cases. The scleral tolerance dose is close to 1,500 Gy. These results are in agreement with those of the literature and are considered to be satisfactory for tumors not exceeding 5 to 6 mm in thickness. If the tumor is located close to the fovea or the papilla, and/or if the thickness is 8 mm or more, proton beam could be a good alternative.     

Développement du tissu adipeux : importance des lipides alimentaires

A well-balanced development of white adipose tissue (WAT) is physiologically important. Longitudinal studies indicate that excess of adipose tissue at early age is predictive of subsequent overweight and obesity, emphasizing infancy as a critical period for WAT development. In this respect, in response to a positive energy balance, its expansion takes place from adipocyte precursor cells which remain present throughout life. Moreover, lipoatrophy and lipodystrophy on one hand, overweight and obesity on the other hand, lead to the metabolic syndrome. In obese patients, the earlier is the obesity onset, the higher is adipocyte size and even more so adipocyte number. As adipocytes do not divide, this observation indicates that excessive proliferation of adipocyte precursor cells is a critical issue, hampered by the lack of specific markers of these cells which represent the true potential of WAT development.In animals and humans, both cross-sectional and longitudinal studies have shown that a caloric excess, i.e. fat-enriched foods in most cases, is associated to enhanced fat mass. The role of dietary fat as a major player in adult human obesity remains controversial because the prevalence of overweight and obesity has increased dramatically over the last decades despite no recent major change in the amount of ingested fats. However the importance of qualitative changes in the fatty acid composition of fats has been largely disregarded despite a dramatic alteration over decades of the balance of essential polyunsaturated fatty acids (PUFAs). There is evidence from animal and human studies that changes in the balance of ω6 and ω3 PUFAs may alter the early stages of adipose tissue development. Under isonenergetic conditions, pups from wild-type mother mice fed a linoleic acid (LA)-enriched diet were 40% heavier 1 week after weaning than those from mothers fed a LA/α-linolinenic acid (LA/LNA) diet, and the weight difference is maintained at the adult age. The LA-induced enhancement of fat mass is abolished in mice invalidated for the cell surface prostacyclin receptor (ip ^-/- mice), demonstrating the critical role of arachidonic acid and prostacyclin in excessive adipose tissue development. Changes observed in the past decades in the fatty acid composition of dietary fats observed in breast milk and formula milk, i.e. an increase in LA with slight or no change in LNA content, acting in concert with a positive energy balance, may be responsible at least in part for the dramatic rise in the prevalence of childhood overweight and obesity. The significant change in the composition of PUFAs in most consumed foods can be traced to changes in human food habits but, quite importantly, also in the feeding pattern of breeding stock. Since prevention of obesity appears critical to avoid difficult if not insurmountable health problems in the future, and in addition to a better control of energy balance, the composition of dietary lipids should be reconsidered from the very beginning of the food chain.     

Local fibrinolysis for superior mesenteric artery thromboembolism

A 66-year-old man with atrial fibrillation was referred soon after developing left lower limb and abdominal pain with rectal bleeding. An immediate flush aortogram showed embolic occlusion of the left distal superficial femoral artery and superior mesenteric artery (SMA), 3 cm from its ostium. Recombinant tissue plasminogen activitor (rtPA) 40 mg was selectively in stilled in the SMA in two boluses. Abdominal symptoms resolved within 48 h, and complete recanalization of the SMA was shown on angiography. Exploratory laparotomy after 72 h showed a normal small bowel and right colon, and was completed by femoropopliteal embolectomy. Six months later, the patient remained asymptomatic.     

Comparative study of oral conditions in schoolchildren of Strasbourg, France, 1974–85

A representative sample of 1650 children randomly selected in the 6-15-yr-old schoolchild population of Strasbourg was examined by well-calibrated examiners. The prevalence of caries was determined with the DMFT, DMFS and dft indices using bitewing radiographs. Plaque, calculus and gingival indices were also determined. The results obtained were compared with the initial study of 1974 performed in Strasbourg using the same epidemiologic methods. Whereas no important variations were observed in caries prevalence of primary teeth, a significant reduction of caries activity was observed in DMFT and DMFS indices in all age groups. There was a reduction of these two indices of respectively 32% and 33% in the 12-yr-old children. The reduction was the most significant on approximal surface lesions. A statistically significant decrease of the calculus and gingival indices was also observed between 1974 and 1984. A less significant decrease was observed for the plaque index.