[Methotrexate for the treatment of patients with chronic cutaneous sarcoidosis: 4 cases]

INTRODUCTION

Pathogenesis of sarcoidosis remains partially unknown. Cutaneous lesions are frequent (20 to 35% of cases). Their clinical features and follow-up data are highly variable. Numerous treatments have been proposed. The clinical features and follow up data of four patients with chronic cutaneous sarcoidosis treated with methotrexate are reported.

CASE REPORT

Mean age of patients (3 female, 1 male) was 40 years old (34-49 years). One patient presented with a lupus pernio, two patients with papules and nodules, and the last with an annular lesion of the face. All patients had been previously treated with topical corticosteroids and/or hydroxychloroquine without any success. Patients were treated with methotrexate at doses ranging from 12.5 mg to 30 mg per week for at least 6 months. Complete remission of cutaneous lesions was observed in 3 of 4 patients after a mean treatment duration of 29 months (16 to 36). Methotrexate side effects were observed in one patient (elevated liver enzymes) leading to methotrexate discontinuation.

DISCUSSION

Methotrexate seems to be an effective treatment of cutaneous sarcoidosis. It should be used namely in patients who failed to respond to previous treatments with topical corticosteroids or antimalarial drugs.

Factors contributing to variation in the proportion of casein in cows' milk true protein: a review of recent INRA experiments

The aim of this study was to identify and rank the various factors, in particular those involving feeding, that affect the proportion of caseins in milk true protein. Twenty-nine feeding trials involving 821 lactations were assessed, and lactoprotein genetic variants were known for 551 of these. The main factor affecting the casein: protein ratio was the genetic variant of beta-lactoglobulin: once corrected for other factors, the milk of BB type animals had a ratio nearly 30 g/kg total protein higher than AA animals. kappa-Casein variant B also had a positive effect (+12 g/kg in favour of BB relative to AA animals). Except in the last weeks of pregnancy and the first weeks of lactation, the casein: protein ratio varied little during lactation. It was significantly reduced when milk cell count exceeded 200,000 cells/ml, even in the absence of clinical mastitis. It also decreased slightly with parity. Among the various dietary factors studied (level and type of nitrogen and energy supplies, forage type and preservation method), none had any significant effect on the milk casein: protein ratio, except in drastic dietary situations. That ratio increased very slightly in parallel with the animals' milk yield and milk protein content. In practice, measuring the milk protein content in animals free from clinical mastitis remains a very precise predictor of casein content, accounting for 93% of its variation.

Contact dermatitis from a textile flame retardant

We report a case of contact sensitivity to Flammentin ASN, a flame retardant used on cotton and wool. The patient was a painter who was protecting his face with a white cotton cap. He presented with eczema of the forehead at the sites of cap contact. Patch tests with the treated cap and flame retardant were positive; a formaldehyde patch test was negative. Flame retardants are used in construction, materials and textiles. Contact sensitivity is rarely described and we compare our case to those published in the literature.

Umbilical Paget's disease and prostatic carcinoma

We report a case of umbilical Paget's disease occurring in a patient with a prostatic carcinoma. No other malignancy was found, and the patient was treated by surgical excision of the lesion. To our knowledge, the occurrence of extramammary Paget's disease of the umbilicus has not been reported previously. The clinical presentation, its association with prostatic carcinoma, and the possible pathogenesis are discussed.

Slow release somatotropin in dairy heifers and cows fed two levels of energy concentrate. 2. Plasma hormones and metabolites

Fifty Holstein dairy cows (26 primiparous) were used to evaluate effects of level of concentrate and of slow release recombinant bST on plasma hormones and metabolites. Blood was sampled at wk 14 and 20 of lactation, which was 5 and 11 wk after the first bST injection. In addition, at d 3 and 10 after the third bST injection, diurnal profiles of somatotropin and metabolites were studied in 7 bST cows and 5 control cows by blood sampling every 20 min over 6 h. Supplementation by bST enhanced plasma somatotropin and insulin-like growth factor-I but did not significantly affect plasma concentrations of triiodothyronin and insulin. The bST supplementation increased plasma NEFA at wk 14 and reduced uremia at wk 20. Primiparous cows showed higher plasma NEFA and triiodothyronin than multiparous cows at both sampling periods, higher insulin-like growth factor I, and lower beta-hydroxybutyrate at wk 14, and higher glucose and lower insulin at wk 20. In the diurnal kinetic study, bST supplementation did not alter bST spike frequency and duration but increased spike magnitude, the area under the curve above the baseline, and the baseline mean. Sixty-one to 56% of the increase over controls in plasma bST total area was due to increase in the area under the curve above baseline. Preprandial NEFA were increased by bST at d 10.

Slow release somatotropin in dairy heifers and cows fed two levels of energy concentrate. 1. Performance and body condition

Fifty-two Holstein dairy cows (27 primiparous) were used in a 2 x 2 factorial design during wk 9 to 39 of lactation to assess the effects of slow release recombinant bST (500 mg injected at 14-d intervals) and the effects of the level of energy concentrate in the diet on dairy performance. After a winter period, cows were turned out to pasture at wk 24 of lactation. During winter, cows given low concentrate (2.5 vs. 5.4 kg DM/d) ate significantly more corn silage (13.9 vs. 11.9 kg DM/d), so that treatment had no significant effect on any measured parameter. The milk yield of bST-supplemented cows increased by 2.1 kg/d (11.0%) throughout the total experimental period. The response did not differ according to parity. Milk fat content and SCC were not altered, but milk protein was lower (.8 g/kg) from cows receiving bST during winter, and lactose increased (.5 g/kg). Lactation curves of bST-supplemented cows showed a cyclic response in milk production. Gross efficiency of milk yield was improved (.18 units) by bST administration without change in diet digestibility. No difference due to bST was found in the health or reproduction of cows. Live weight change did not differ among the groups. Multiparous cows gained body condition (bST-supplemented animals gained less than controls: .1 vs. .7 point on a five-point scale; NS). Control primiparous cows gained body condition (.1 point) but bST-supplemented cows significantly lost body condition (1.4 point).