[Anatomoclinical and dermatoscopic study of trichoadenoma]

INTRODUCTION

Trichoadenoma is a very rare follicular tumour with a remarkable histopathological appearance. In this article we present a series of 12 cases of trichoadenoma, as well as the anatomoclinical and dermatoscopic findings in a typical case. We discuss these findings in the light of an extensive literature research.

PATIENTS AND METHODS

We collated 12 cases of trichoadenoma of indisputable diagnosis made at the dermatopathology laboratory of the Dermatological Clinic of the University Hospitals of Strasbourg over a 30-year period (1989-2018).

RESULTS

The 12 cases comprised 7 women and 5 men, of average age 58.9 years, the majority having lesions on the cephalic extremity followed by the buttocks and thighs. Histopathological examination, which was similar in all 12 cases, showed multiple epidermal cysts containing an eosinophil lamellar keratin with a stratified wall without any visible hair, located in the superficial and mid dermis and appearing to be stacked on top of one another. In immunohistochemistry, broad spectrum keratin markers were still positive, the follicular marker Ber-EP4 weakly expressed and PHLDA1 was negative. For the case examined using polarized-light dermatoscopy, small rounded white-yellow areas were observed corresponding to cystic structures surrounded by irregular linear vessels.

DISCUSSION

Trichoadenoma is a rare tumour seen in middle-aged adults of mean age 45 years, and has no sexual predominance. It is asymptomatic, slow-growing, variable in colour, measures less than one centimeter and is most often located on the face or buttocks. In terms of histology, the juxtaposition of multiple small cystic structures suggests a follicular origin. Differential diagnosis is made with trichoblastomas, which always intensely express PHLDA1 and/or Ber-EP4, desmoplastic trichoepithelioma, which consists of multiple much thinner spans in a highly fibrous stroma with clearly visible arborescent vessels over a white-yellow ivory background at dermatoscopy, microcystic carcinoma, which has a deeper extension, and plaque milium, in which the cysts are larger.

[A rare cause of oral pain: The pterygoid hamulus syndrome]

INTRODUCTION

Pterygoid hamulus syndrome (PHS) is a rare cause of orofacial and oropharyngeal pain. PHS can be associated with a hamulus hypertrophy or with a bursitis of the palatosalpingeus but it has not always an anatomic cause.

OBSERVATION

A 36-year-old woman was seen for a constant posterior palatal pain spreading towards oropharynx, increasing during swallowing and lasting for more than 6 months. Physical examination showed an erythema of the soft palate, medially to the hamulus. Hamulus palpation was painful and revealed hamulus hypertrophia on both sides. A bilateral PHS was evocated.

DISCUSSION

This observation is typical of a PHS. We propose a review of the literature of this little-known syndrome. Treatment is initially conservative (corticosteroids) but surgery can be proposed in case of morphological anomalies of the hamulus.

Human dental pulp stem cells cultured in serum-free supplemented medium

Growing evidence show that human dental pulp stem cells (DPSCs) could provide a source of adult stem cells for the treatment of neurodegenerative pathologies. In this study, DPSCs were expanded and cultured with a protocol generally used for the culture of neural stem/progenitor cells.

Methodology: DPSC cultures were established from third molars. The pulp tissue was enzymatically digested and cultured in serum-supplemented basal medium for 12 h. Adherent (ADH) and non-adherent (non-ADH) cell populations were separated according to their differential adhesion to plastic and then cultured in serum-free defined N2 medium with epidermal growth factor (EGF) and basic fibroblast growth factor (bFGF). Both ADH and non-ADH populations were analyzed by FACS and/or PCR.

Results: FACS analysis of ADH-DPSCs revealed the expression of the mesenchymal cell marker CD90, the neuronal marker CD56, the transferrin receptor CD71, and the chemokine receptor CXCR3, whereas hematopoietic stem cells markers CD45, CD133, and CD34 were not expressed. ADH-DPSCs expressed transcripts coding for the Nestin gene, whereas expression levels of genes coding for the neuronal markers β-III tubulin and NF-M, and the oligodendrocyte marker PLP-1 were donor dependent. ADH-DPSCs did not express the transcripts for GFAP, an astrocyte marker. Cells of the non-ADH population that grew as spheroids expressed Nestin, β-III tubulin, NF-M and PLP-1 transcripts. DPSCs that migrated out of the spheroids exhibited an odontoblast-like morphology and expressed a higher level of DSPP and osteocalcin transcripts than ADH-DPSCs.

Conclusion: Collectively, these data indicate that human DPSCs can be expanded and cultured in serum-free supplemented medium with EGF and bFGF. ADH-DPSCs and non-ADH populations contained neuronal and/or oligodendrocyte progenitors at different stages of commitment and, interestingly, cells from spheroid structures seem to be more engaged into the odontoblastic lineage than the ADH-DPSCs.

Partial volume effect estimation and correction in the aortic vascular wall in PET imaging

We evaluated the impact of partial volume effect (PVE) in the assessment of arterial diseases with (18)FDG PET. An anthropomorphic digital phantom enabling the modeling of aorta related diseases like atherosclerosis and arteritis was used. Based on this phantom, we performed GATE Monte Carlo simulations to produce realistic PET images with a known organ segmentation and ground truth activity values. Images corresponding to 15 different activity-concentration ratios between the aortic wall and the blood and to 7 different wall thicknesses were generated. Using the PET images, we compared the theoretical wall-to-blood activity-concentration ratios (WBRs) with the measured WBRs obtained with five measurement methods: (1) measurement made by a physician (Expert), (2) automated measurement supposed to mimic the physician measurements (Max), (3) simple correction based on a recovery coefficient (Max-RC), (4) measurement based on an ideal VOI segmentation (Mean-VOI) and (5) measurement corrected for PVE using an ideal geometric transfer matrix (GTM) method. We found that Mean-VOI WBRs values were strongly affected by PVE. WBRs obtained by the physician measurement, by the Max method and by the Max-RC method were more accurate than WBRs obtained with the Mean-VOI approach. However Expert, Max and Max-RC WBRs strongly depended on the wall thickness. Only the GTM corrected WBRs did not depend on the wall thickness. Using the GTM method, we obtained more reproducible ratio values that could be compared across wall thickness. Yet, the feasibility of the implementation of a GTM-like method on real data remains to be studied.

Discovery of Pyridones As Oral AMPK Direct Activators

AMP-activated protein kinase (AMPK) is an evolutionarily conserved fuel-sensing enzyme that is activated in shortage of energy and suppressed in its surfeit. AMPK activation stimulates fatty acid oxidation, enhances insulin sensitivity, alleviates hyperglycemia and hyperlipidemia, and inhibits proinflammatory changes. Thus, AMPK is a well-received therapeutic target for type 2 diabetes and other metabolic disorders. Here, we will report the discovery of pyrrolopyridone derivatives as AMPK direct activators. We will illustrate the synthesis and structure-activity relationships of the series as well as some pharmacokinetic results. Some compounds exhibited encouraging oral exposure and were evaluated in a mouse diabetic model. Compound 17 showed oral activity at 30 mg/kg on blood glucose.

Giant canine with dentine anomalies in oculo-facio-cardio-dental syndrome

Radiculomegaly affecting incisors, canines or premolars is a rare radiological finding (Maden et al., 2010) but is pathognomomic of a rare x-linked dominant syndrome called oculo-facio-cardio-dental syndrome (OFCDS). As this syndrome includes cardiac malformations and can lead to blindness due to congenital glaucoma, oral and maxillofacial surgeons should be aware of the somatic anomalies potentially associated with radiculomegaly. We report a typical case of OFCDS and provide the first description of the microscopic dental anomalies associated with this syndrome.

From ApoA1 upregulation to BET family bromodomain inhibition: discovery of I-BET151

The discovery, synthesis and biological evaluation of a novel series of 7-isoxazoloquinolines is described. Several analogs are shown to increase ApoA1 expression within the nanomolar range in the human hepatic cell line HepG2.

[Maxillary sinus osteoma associated with a mucocele]

INTRODUCTION

Maxillary sinus osteomas are rare benign tumours with a poorly documented clinical evolution. Their craniofacial localization may be part of a syndrome. We report a case of maxillary sinus osteoma associated to a mucocele and a cyst probably of dental origin, with no sign of associated Gardner syndrome.

CASE REPORT

A 52-year-old woman consulted for chronic maxillary sinusitis and an oral vestibular fistula. The CT-scan suggested a mucocele with reactive bone formation. Macroscopically, a pediculated bone tumour was found next to a mucocele, and to a cyst probably of dental origin. The anatomopathological examination led to a diagnosis of cancellous osteoma.

DISCUSSION

Several hypotheses have been made on the etiology of sinus osteomas. When identified, screening for Gardner's syndrome should be implemented because of the associated risk for colic malignancy.

[Modified functional genioplasty]

Functional genioplasty is indicated to correct excessive lower anterior facial height. Michelet's surgical technique is commonly used for these indications because of improvement of the stability of the fixation of the bone. The authors present a modified genioplasty of Michelet's technique with preservation of suprahyoid muscles' insertions.

[Dental extraction in patients with bleeding disorders. Proposal of a protocol based on the type of anesthesia used]

INTRODUCTION

The authors propose a protocol to avoid bleeding complications in patients with bleeding disorders.

MATERIAL AND METHOD

When a general anesthesia or trunk nerve infiltration is indicated, clotting factor concentrates are to be used in patients with severe bleeding disorders. Desmopressin is to be used in patients with mild bleeding disorders but who are good responders and in patients with thrombopathy. An antifibrinolytic treatment and a fibrin glue are also used. Ninety-six patients underwent 107 extractions with this protocol.

RESULTS

Only two patients had bleeding complications requiring an additional treatment.

DISCUSSION

In case of bleeding disorders, the treatment depends on disease severity and type of anesthesia. A general treatment (clotting factor concentrates or desmopressin) is indicated with general anesthesia and with local anesthesia in severe bleeding disorders, but not absolutely necessary with local anesthesia in mild bleeding disorders. However, desmopressin can used in all good responders.

Management of dental extractions in patients with bleeding disorders

OBJECTIVE

This study evaluated the effectiveness of a protocol to prevent bleeding after dental extraction in patients with hemophilia, von Willebrand's disease (VWD), or platelet disorders.

STUDY DESIGN

Replacement therapy was used in cases involving general anesthesia, and nerve trunk infiltration was used in patients with severe bleeding disorders (severe-to-moderate hemophilia or type 2-3 VWD). Desmopressin was used in good responders with mild hemophilia A, type 1 VWD, and platelet disorders. Local hemostatic measures and antifibrinolytic treatment were used systematically.

RESULTS

Ninety-three patients underwent 103 dental extractions; 2 of these patients had secondary bleeding requiring surgical hemostasis.

CONCLUSION

The indication for replacement therapy depended on the type of anesthesia that was used. Coagulation factor concentrates or desmopressin were necessary to avoid upper airway hematoma with general anesthesia or nerve trunk infiltration. With local anesthesia, substitutive treatment was indicated in patients with severe-to-moderate hemophilia and type 2-3 VWD. Inexpensive desmopressin was effective in those who responded well. Local hemostatic measures and antifibrinolytic treatment were performed systematically.

[Secondary radiodermatitis caused by endovascular explorations: 5 cases]

BACKGROUND

Fluoroscopically guided interventional procedures expose patients to high doses of ionizing radiation.

OBSERVATIONS

We describe 5 patients in whom radiodermatitis developed following vascular catheterization: cardiac catheterization and coronary angioplasty in 4 cases and renal artery catheterization and angioplasty in 1 case. All patients were men. The endovascular procedures have been repeated or prolonged in all cases excepted one. The clinical aspects were those of a chronic radiodermatitis (4 cases) and acute radiodermatitis (1 case). An extensive and painful ulceration was observed in 3 patients for which surgical excision was proposed. In one case lesions were bilateral. Delay of onset after the last exploration varied from a few weeks to 3 years. Biopsy specimen was suggestive of chronic radiodermatitis but, in 2 cases, was not contributive in the absence of clinical proposal.

DISCUSSION

About 20 cases of radiodermatitis following coronary angioplasty have been reported in the literature since 1996. The cumulative radiation doses to which the patients were exposed are compatible with the occurrence of radiodermatitis. Coronary angiography using fluoroscopy and cineradiography delivers notably higher radiation doses than any other routine procedure. Even higher levels of radiation may result from percutaneous transluminal angioplasty, which is a more complicated and lengthier procedure frequently repeated. Radiodermatitis have been described during many other vascular procedures like radiofrequency catheter ablation, renal angioplasty, interventional neuroradiologic and hepato-biliary procedures. Medical facilities and physicians performing interventional procedures should be aware of these sides effects and implement measures to reduce the potential for radiation skin injuries.

[Risk factors of contamination by hepatitis C virus. Case-control study in the general population]

In 30% of patients with hepatitis C virus, the source of infection is unknown.

OBJECTIVE

To identify the risk factors of infection by hepatitis C virus in a case-control study.

METHODS

Cases had positive hepatitis C virus serology, and were living in Fecamp (Normandy, France). Controls (2 for each case) were age and sex-matched subjects with negative hepatitis C virus serology, living in Fecamp. Demographic, medical, professional, and environmental data were collected. Statistical analysis included chi 2 or Fisher's exact test and multiple logistic regression.

RESULTS

The risk factors of hepatitis C virus by univariate analysis were: history of transfusion, high number of sexual partners, hepatitis C virus infection in a relative, history of digestive or genitourinary surgery, an invasive medical procedure, digestive endoscopy, biopsy, lumbar or pleural puncture, medical care after an accident, injections, multiple deliveries or abortion. Risk factors of hepatitis C virus infection by multivariate analysis: hepatitis C virus infection in a relative (Odds ratio: 4.58), history of transfusion (Odds ratio: 2.32), of a surgical procedure (Odds ratio: 2.50), of medical care after an accident (Odds ratio: 1.51), of injections (Odds ratio: 2.24).

CONCLUSION

Our results suggest the possible nosocomial transmission of hepatitis C virus. Intrafamilial transmission is also possible.

[Acne induced by amineptin: adnexal toxiderma]

INTRODUCTION

Amineptine-induced acne is a classical side effect often encountered after prolonged and excessive use of the antidepressor.

CASE REPORT

We report the case of a young female drug addict (benzodiazepines and alcohol) who denied overuse of amineptine. The initial inflammatory aspect of the lesion was unusual as was the histology report. The sebaceous glands were the site of cystic dilatation as would be expected, but in addition the sudoriparous glands showed keratinizing syringometaplasia with areas of neutrophilic eccrine hidradenitis.

DISCUSSION

This is the second report of such a case similar to other due to chemotherapy, benaxoprofene or toxic agents for example, and corresponds to direct toxicity to the sudoriparous glands which accumulate amineptine. We therefore propose the term of adnexal toxic drug eruption.

[Multiple congenital smooth-muscle hamartomas]

BACKGROUND

Smooth muscle hamartoma is an uncommon lesion. Diagnosis is usually made at birth in infants presenting a plaque with minimal or no infiltration and covered with long dark hairs. Congenital forms with multiple plaques are rarely reported.

CASE REPORT

A 5-day-old infant (normal pregnancy and delivery) had plaques localized on the buttocks, the left thigh, leg and shoulder and the right ankle. The plaques were minimally infiltrative and covered with long black hairs. Histology examination showed hyperplastic smooth muscle bundles with varying orientation. The diagnosis was smooth muscle hamartoma. The rest of the clinical examination was normal.

CONCLUSION

This case of congenital smooth muscle hamartoma showed a particular form with partially regressive multiple plaques.

[Role of coral blocks in cheek augmentation surgery. Prospective study of 23 patients]

A two-year multicentre prospective study was performed from 1992 to 1995 in order to evaluate the real value of various kinds of coral blocks as bone substitute in maxillofacial surgery. This study was supported by the French National Agency for Research Valorization (GBM/TEP procedure). Ten Maxillofacial Surgery Units were included. During this time, 28 coral blocks (23 patients) of two different shapes were used as malar implants for correction of congenital or acquired zygomatic hypoplasia. The mean follow-up was 1.8 year (min: 1.5; max: 2). The tolerance was perfect for 89% of cases. The radiologic opacity never decreased more than 30% and the volume augmentation was always stable at the end of the follow-up period. Three implants were removed because of septic complications. Rigid fixation between the implant and the zygomatic bone appears to be the most important factor of success. On the other hand, the surgical approach (endo- or exo-buccal) does not seem to influence the success rate. The aesthetic improvement was always evaluated as satisfactory and stable by the patients and the surgeons. The authors discuss the real value of the various kinds of biomaterials and especially coral, comparing their personal data with those of the literature. Coral blocks clearly constitute a safe and reliable bone substitute, but further investigations are required to determine its long-term behavior.

[5 conventional radiographic projections are necessary and sufficient for the study of the zygoma. Technics and results]

Though clinic examination gives us much information, radiology still is essential in head trauma. Many standard radiographic projections have been described in the past and yet since the eighties it appears that C.T. scanner (C.T.) has become absolutely necessary to a great number of us. In fact, C.T. is indispensable when there is a matter of vital urgency or when a functional problem appears (diplopia). But most of the time high quality standard radiographic projections are sufficient. We have selected five radiographic projections: the occipito-mental's such as Mahoney's or Blondeau or Louisette, the submento-vertical's, the rotated occipito-mental's. For each of these radiographic projections we have specified the angular definition, the realization techniques, the criterions of quality and the results. The use of conventional radiology gives us images of which the quality is high enough to allow a precise topographical diagnosis and is far cheaper than C.T. So we can assert that standard radiographic projections are necessary and sufficient and that the use of C.T. becomes indispensable only in the few cases of diplopia or enophthalmia or complicated maxillary fracture. In the case of a lateral head trauma, our strategy of radiographic exploration will be represented as indicated on picture n degrees 20.

Metastasizing eccrine porocarcinoma: report of a case and review of the literature

Eccrine porocarcinoma is a rare malignant tumor arising from the intraepidermal ductal portion of the eccrine sweat gland (acrosyringium). It usually affects older persons and is located most commonly on the lower extremities. We describe a 55-year-old man with an aggressive metastasizing eccrine porocarcinoma diagnosed 10 years after the primary lesion. The metastatic lesions were located in the public area and scrotum and were associated with progressive lymphedema. Several biopsy specimens revealed numerous tumor cells in the dermis and especially in the lumina of lymph and blood vessels. Immunohistochemical studies showed staining with cytokeratin KL1, epithelial membrane antigen, Ca 15-3, and Ca 19-9. Vimentin, S-100 protein, neuron specific enolase, and carcino-embryonic antigen were negative. Treatment with carbon dioxide laser failed. The use of interferon alfa-2a for 9 months stopped progression of the tumor.

Usefulness of the galea flap in treatment of extensive frontal bone defects: a study of 14 patients

We present a technique for treating extensive frontal bone loss after chronic osteitis and subsequent treatment. Unlike the technique usually performed in such cases (exclusion and filling), the frontal sinuses were conserved by isolating them from the reconstructed frontal vault. Isolation was achieved by means of a temporal galea and periosteum flap with a pedicle arising from the superficial temporal vessels. The study concerned 14 patients operated on from two to seven times for osteitis, which persisted in many patients for more than 10 years.

[The Bichat ball. The surgical value of oro-sinus communications]

Bichat's ball is a mass of adipose tissue used to fill communications between the buccal cavity and the sinus. The anatomy of the structure is presented. it has a body and 6 extensions. A surgical technique is proposed in comparison with previously described methods. At 6 weeks, there has been no recurrence of buccal-sinus communication in a series of approximately 300 cases operated over a period of 15 years.

Spectrophotometric assay of superoxide dismutase activity based on the activated autoxidation of a tetracyclic catechol

A new spectrophotometric assay of superoxide dismutase (SOD) activity is described. The assay is based on the SOD-mediated increase in the rate of autoxidation of 5,6,6a,11b-tetrahydro-3,9,10-trihydroxybenzo[c]fluorene (BXT-01050) in aqueous alkaline solution. This autoxidation yields a chromophore with a maximal absorbance wavelength of 525 nm. The optimized assay of SOD activity is performed at pH 8.8, 37 degrees C, in 50 mM air-saturated 2-amino-2-methyl-1,3- propanediol buffer containing 3 mM boric acid and 0.1 mM diethylenetriaminepentaacetic acid. The kinetic measurement of 525-nm absorbance is performed for 1 min upon addition of BXT-01050. BXT-01050 is stabilized in stock solution acidified at pH 1.5. The SOD activity is determined from the Vs/Vc ratio of the autoxidation rates measured in the presence (Vs) and in the absence (Vc) of sample. One SOD activity unit (U-525) has been defined as the activity that doubles the autoxidation background (Vs/Vc = 2). The equation that fits the standard curve is the same with all studied SODs. Another reagent, 1,4,6-trimethyl-2-vinylpyridinium trifluoromethanesulfonate, directly eliminates interference due to sample mercaptans such as glutathione by means of a very fast alkylation reaction. A fast and reproducible measurement of SOD activity requires only a single determination per sample. At pH 8.8, an optimal assay sensitivity is achieved without strongly affecting the activity of known SODs such as Cu/Zn-, Mn-, or Fe-SOD.

[Evaluation of velopharyngeal function using an aerophonoscope before and after surgery for snoring]

Following surgery for snoring, regardless of the technique used, velopharyngeal insufficiency remains an infrequent but disabling complication. In an attempt to assess the risk of velopharyngeal insufficiency, we used a new, simple, rapid, and noninvasive method of evaluating palatal function, the aerophonoscope. Pre and postoperative aerophonoscopic studies were carried out in 25 chronic snores undergoing a single step uvulopalatoplasty with a laser under local anesthesia. The aerophonoscope revealed signs of palatal dysfunction in 2 patients (8%) preceding surgery and confirmed the absence of palatal dysfunction in all patients following our technique of uvulopalatoplasty. We also present the aerophonoscopic findings in 3 patients with nasopharyngeal stenosis and 2 patients with velopharyngeal insufficiency following surgery for snoring.