Quantitative analysis of urinary daidzein and equol by gas chromatography after solid-phase extraction and high-performance liquid chromatography.

Daidzein and its main metabolite equol are isoflavone phytoestrogens. Several studies have suggested that intake of an isoflavone-rich diet may prevent hormone-related cancer and estrogen-related disorders (cardiovascular disease, osteoporosis and menopausal symptoms). To better understand the role of isoflavones in preventing such severe disease, several methods have been developed to measure these compounds in biological fluids. However, the analytical procedures to measure isoflavones are often time-consuming and require highly skilled technicians. In this paper we describe a method for urinary daidzein and equol measurement that combines solid phase extraction and HPLC purification before gas chromatographic determination. The specificity of the method was confirmed by the gas chromatography-mass spectrometry technique. The mean recovery of daidzein and equol was 94.6% and 97.0%, respectively. The repeatability of the method was in the range of 2.0-7.4% for daidzein and 1.3-4.9% for equol. A linear relationship between observed and expected values was found in the dilution (r2=0.9983 for daidzein; r2=0.9982 for equol) and addition (r2=0.9984 for daidzein; r2=0.9989 for equol) assays. The method is suitable to measure changes in the urinary excretion of isoflavones and to investigate urinary isoflavonoids as biomarkers of isoflavone exposure.

[Cryosurgery of basal cell carcinoma: a study of 358 patients]. / Cryochirurgie des carcinomes basocellulaires: étude de 358 malades.

INTRODUCTION: Cryosurgery is a well-established therapeutic modality for basal cell carcinoma. We report herein an important series of basal cell carcinoma treated by cryosurgery, with a five year cure rate evaluation. PATIENTS AND METHOD: Retrospective study with 395 basal cell carcinomas (over 358 patients - sex ratio H/F: 0.85) treated by cryosurgery between 1981 and 1992. For each patient the data were: age, sex, size of the lesion, location, clinical sub-type, tissue-temperature monitoring, recurrence date and esthetic outcome. RESULT: The lesions were located on the face (93 p. 100) and back (7 p. 100). Mean size was 17 mm. Clinical sub-types were known for 178 lesions; 11 p. 100 of BCC were morpheaform. Tissue-temperature monitoring was performed for 55 p. 100 of cases. 111 tumors were observed for more than 5 years. The 5-year actuarial failure rate was 9 p. 100. The 5-year cure rate was not significantly altered by sex, size of lesions, location and clinical sub-type. No frequent recurrences were observed when tissue-temperature monitoring had not been performed. Complications were rare and esthetic outcome was good. DISCUSSION: The 5-year actuarial recurrence rate with cryosurgery is similar to conventional surgery. It is not essential to control tissue-temperature for preventing recurrences. Cryosurgery is a reliable treatment and outcome depends on surgeon experience. Quickness and low cost of this procedure argue for choosing cryosurgery when treating elderly patients.

Urinary 5 alpha-androstanediol and 5 beta-androstanediol measurement by gas chromatography after solid-phase extraction and high-performance liquid chromatography.

Urinary androstanediol measurement, often in association with other androgens, is commonly used to support the clinical diagnosis of idiopathic hirsutism. In addition, androgen excess has been shown to be the endocrine abnormality which characterizes patients with breast cancer. We recently developed a method for the measurement of urinary testosterone employing solid-phase extraction and HPLC purification before quantitative measurement by gas chromatography. In the present report we verify the feasibility of the method for the simultaneous measurement of 5 alpha-androstane-3 alpha,17 beta-diol and 5 beta-androstane-3 alpha,17 beta-diol in addition to testosterone in the same urine sample. The mean recovery for the whole procedure was 89.8% for 5 alpha-androstane-3 alpha,17 beta-diol and 87.8% for 5 beta-androstane-3 alpha, 17 beta-diol. The estimates of the coefficients of variation were 4.9% (95% confidence limits: 3.9-6.5%) and 3.9% (95% confidence limits: 3.1-5.2%), respectively. Accuracy was evaluated by standard addition and dilution assays and a linear relationship was found between expected and observed values (r2 = 0.997 for 5 alpha-androstane-3 alpha,17 beta-diol and r2 = 0.999 for 5 beta-androstane-3 alpha,17 beta-diol). The method is rapid, effective and suitable for the measurement of testosterone, 5 alpha-androstanediol and 5 beta-androstanediol in the same urine sample.

[Lichenoid contact dermatitis from the ink of a red pen]. / Dermite de contact lichénoïde à l'encre rouge d'un stylo.

INTRODUCTION: Numerous cutaneous inflammatory reactions have been reported in literature, after using red dyes; most of them are lichenoid reactions and occur after tattooing. Few reports have mentioned inflammatory complications after using red ink. CASE REPORT: A 21-year-old woman was examined for papular erythematous, pruritic lesions on the back of her left hand. They developed within the area of a red inked pen writing, a few days before. There was an isomorphic reaction on the cheek which was in contact with the hand during sleep. Diagnosis of lichen reaction to red ink was made, and histologically confirmed on the hand. DISCUSSION: We report the first case to our knowledge of lichen reaction to red inked pen, which can be compared to hypersensitivity reactions to red pigment reported in literature. A Koebner phenomenon by friction, usual with lichen, is possible, but doesn't explain the reaction on the cheek. A contact dermatitis to red pigment of ink can also be suggested, although mostly eczema-like reactions have so far been reported; it seems moreover that lichenoid reactions reported only occur after intradermal injection of pigment during tattooing. This contact mechanism would nevertheless explain both localizations of lichen reaction in our patient.

[Palmoplantar filiform parakeratotic hyperkeratosis and digestive adenocarcinoma]. / Hyperkératose palmo-plantaire filiforme parakératosique et adénocarcinome digestif.

INTRODUCTION: There are very few observations of filiform palmo-plantar hyperkeratosis reported. Nevertheless it's worth knowing this entity for his potential association with a visceral neoplasia. CASE REPORT: We report the first case of filiform palmo-plantar hyperkeratosis associated with a digestive adenocarcinoma and a polycystic kidney disease. DISCUSSION: After a review of palmar and plantar filiform hyperkeratosis in the literature, we will discuss the possible association with neoplasia or other pathologies. This pathology requires a strict clinical and paraclinical follow-up.

Erythema multiforme due to pyrazinamide.

Drug-induced erythema multiforme is reported with many antimicrobial and antipyretic medications. We present one patient who experienced erythema multiforme and urticaria after administration of pyrazinamide for treatment of cutaneous tuberculosis. The side-effects of pyrazinamide include hepatic or dermatologic disorders, but erythema multiforme has not yet, to our knowledge, been described. Clinical features and discontinuation and reintroduction of the drug led us to consider pyrazinamide the cause of the erythema multiforme, but allergologic studies remained negative, except for the presence of circulating immune complexes. The mechanism of this eruption remains obscure, and definite withdrawal of pyrazinamide seems to be the best therapeutic choice.

[Unilateral gustatory flushing syndrome in a child]. / Syndrome des flushs gustatifs unilatéraux de l'enfant.

BACKGROUND: Auriculo-temporal syndrome is rarely seen in children: it is sometimes considered as secondary to an obstetrical injury. CASE REPORT: A 2.5 year-old boy was examined because he suffered from post-prandial flushing of the right cheek for 2 years. He was born normally and neurologic examination was normal. The rash was not associated with sweating or tearing. CONCLUSION: There is no evidence to support food allergy in this case: rather, this syndrome probably occurs in response to salivation.

[Vulvar lymphangiectasis 14 years after treatment for epidermoid carcinoma of the cervix. Treatment with cryosurgery]. / Lymphangiectasies vulvaires 14 ans après le traitement d'un carcinome épidermoïde du col utérin. Traitement par cryochirurgie.

INTRODUCTION: Lymphangiectasia are different from lymphangioma because they arise following damage to the deeper lymphatic vessels. No clinical or histological features are known to distinguish lymphangioma from lymphangiectasia. CASE REPORT: We report a case of vulvar lymphangiectasia occurring 14 years after therapy of squamous carcinoma of the cervix (surgery and post-operative radiotherapy). Our treatment was cryosurgery. DISCUSSION: We analysed the 12 case reports of vulvar lymphangiectasia in the literature, emphasizing misleading clinical aspect of the warty lesions and the risk of repeated infection justifying an appropriate treatment. We propose cryosurgery which provides real benefits with a minimal trauma.

[Cutaneous metastases of melanoma localized on the cicatrix at the site of flap taking]. / Métastases cutanées de mélanome situées sur une cicatrice de prise de greffe.

INTRODUCTION: We report one case of melanoma cutaneous metastases strictly localized on a skin graft donor site distant from the tumor site. CASE REPORT: A patient with a shoulder melanoma was treated by surgery. A split-thickness skin graft was taken from a thigh to cover the raw area. Six months later, nodular cutaneous metastases strictly localized on the skin graft donor site appeared. COMMENTS: Physiopathology of those lesions is unknown. Hyaluronic acid is increased in granulation tissue and could be chimiotactic for melanoma cells.

[Bazex paraneoplastic acrokeratosis. Treatment with acitretin]. / Acrokératose paranéoplasique de Bazex. Traitement par acitrétine.

INTRODUCTION: Bazex paraneoplastic acrokeratosis remains a therapeutic challenge when the cancer cannot be treated. We report the third patient in which a complete clearance of the lesions was obtained with oral acitretine. CASE REPORT: A 67 year-old patient had Bazex paraneoplastic acrokeratosis. Despite a complete cancer screening, no cancer was found. A cervical lymph node metastasis was treated with surgery and radiotherapy. Because the cutaneous lesions got worse after this treatment, the patient received oral acitretine. A complete clearing of the lesions was observed within 2 months. DISCUSSION: Only 2 similar cases have been reported to our knowledge. The comparison with these 2 cases supports the efficacy of oral retinoids in this disease. The search and the treatment of the cancer remain compulsory. CONCLUSION: In some definite cases, oral retinoids can be proposed as a treatment of cutaneous lesions in Bazex paraneoplastic acrokeratosis.

[Acute febrile pustular and bullous neutrophilic dermatosis (Sweet syndrome) disclosing acute myeloblastic leukemia]. / Dermatose neutrophilique aiguë fébrile pustuleuse et bulleuse (syndrome de Sweet) révélant une leucémie aiguë myéloblastique.

We report a patient with Sweet's syndrome (acute febrile neutrophilic dermatosis) revealing an acute myelogenous leukemia. About 10% of Sweet's syndromes are associated with a malignant disease that they can reveal. Among those, hemopathies are the most frequent, and 42% are myelogenous leukemia. These observations emphasize the particular clinical aspects of the Sweet's syndrome associated with an hemopathy.

[Gianotti-Crosti acrodermatitis. Description of a case of rare etiology]. / Acrodermatite di Gianotti-Crosti. Descrizione di un caso ad eziologia rara.

Originally described in 1955, papular acrodermatitis is considered a rare disease whose manifestations are mainly cutaneous. The disease is characteristically associated to a non icteric hepatitis with B serologic tests positive. We recently observed a case whose etiology is unusual and, therefore, in our opinion worth of a brief description.

Non-opposable triphalangeal thumb in an Italian family.

This report describes a family with bilateral non-opposable triphalangeal thumb, bringing to two the number of families with this autosomal dominant disorder.

[Facio-auriculo-vertebral syndrome: description of a case]. / Sindrome facio-auricolo-vertebrale: descrizione di un caso.

The authors report the case of a fourteen months old girl who presented with emisomal, uropoietic and vertebral anomalies associated with neurologic handicap. These features can be considered characteristic of facio-auriculo-vertebral spectrum. This syndrome was not frequently described in Italian pediatric literature.