[Physical activities and sport; implications for health and society]. / Les activités physiques et sportives--la santé--la société.

The practice of physical and sporting activities (PSA) throughout life is now known to increase healthy life expectancy, to delay the onset of dependency, and to be an effective complementary treatment for many disorders, particularly obesity and disability. The notion of a "sedentary death syndrome " [SeDS] has been evoked on the other side of the Atlantic. Although the beneficial effects of PSA have long been known, statistical analyses have only recently confirmed at the group level what was often disputed at the individual level. Knowledge of the impacts of PSA on cellular, tissular and metabolic functions has improved considerably. PSA is no longer seen simply as a leisure activity but is now considered necessary for a healthy body and mind. PSA also has considerable social, educational and integrative implications. Can any society ignore these evident health benefits with impunity? The aims of this article are 1) to provide a quick overview of the advantages of regular, measured and reasonable PSA, as well as the potential risks of excess; 2) to discuss the quantity of PSA providing the optimal balance between benefits and risks, and the means of achieving this balance; 3) to highlight the lack of enthusiasm for PSA among the French population, and to analyze its causes, and 4) to propose a new organization designed to help more of our fellow citizens to adopt PSA, in the interests of their health and well-being.

[Health risks of long-distance air travel. Role of the general practitioner]. / Santé des voyageurs sur des vols aériens de longue durée. Rô1e du méecin traitant.

Air transport is seeing an increase in long-distance flights (12-16 hours average flight time), greater seating capacity, and a higher proportion of elderly, and hence more fragile, passengers. The French Academy of Medicine recommends that medical care be reinforced, particularly on long-distance flights, through the following measures: (i) passengers should be informed in advance of potential risks, through a Passenger's Guide, (ii) all future passengers should be encouraged to seek health advice and information from their general practitioner, (iii) flight crew members should receive training as "in-flight medical correspondents", and (iv) airlines and plane designers should reserve a "medical space" on the plane, equipped with appropriate medical materials.

Photodistribution of blue-gray hyperpigmentation after amiodarone treatment: molecular characterization of amiodarone in the skin.

BACKGROUND: For decades, the photodistributed blue-gray skin hyperpigmentation observed after amiodarone therapy was presumably attributed to dermal lipofuscinosis. Using electron microscopy and high-performance liquid chromatography, we identified amiodarone deposits in the hyperpigmented skin sample from a patient treated with this antiarrhythmic agent. Our findings therefore indicate that the hypothesis relating the blue-gray hyperpigmentation to lipofuscin should be challenged. OBSERVATIONS: A 64-year-old man, skin phototype III, presented with asymptomatic skin hyperpigmentation that had been slowly developing on sun-exposed areas since April 2004. He had been taking amiodarone for 4 years (cumulative dose, 277 g). Electron microscopy did not show lipofuscin pigments in his skin. Conversely, abundant electron-dense membrane-bound granule deposits were observed in most of the dermal cells (fibroblasts, macrophages, pericytes, Schwann cells, and endothelial cells), especially in photoexposed skin. High-performance liquid chromatography confirmed that the skin deposits were composed of amiodarone. These results demonstrate that amiodarone hyperpigmentation is related to drug deposition on photoexposed skin. CONCLUSION: Amiodarone-related hyperpigmentation should be considered a skin storage disease that is secondary to drug deposition.

[Piercing and tattooing: regulation is needed to reduce complications]. / "Piercings" et tatouages : la fréquence des complications justifie une réglementation.

The increasing popularity of piercing and tattooing, and the resulting increase in complications, calls for legislation in order to reduce the number of incidents and accidents. The most frequent complications are local and systemic bacterial and viral infectious. Some are serious, such as gangrene and endocarditis. Cases of tuberculosis and viral hepatitis have also been reported. Allergic complications are far from rare, including a risk of acquired sensitization with later harmful consequences. Late systemic complications include pseudolymphomas and sarcoidosis. Attempts have been made to regulate this activity in several countries, and at the European level. In France, members of parliament have prepared draft legislation. The French National Academy of Medicine considers that such procedures, and especially piercing, with breaching of the skin or mucosae and foreign body insertion, constitute real physical insults that require precautions identical to those of minor surgical procedures. This particularly applies to certain parts of the body (cartilage, mouth and tongue, nose, nipples, genitalia). Simple earlobe piercing could be exempt from these regulations, but nonetheless necessitates proper disinfection. The Academy has drawn up a list of eleven measures concerning information for future customers on possible risks, parental authorization for minors, norms for premises and materials, training, legal responsibility, health authority controls, and exclusion from blood donation for the year following such procedures.

[The syndrome of bazex or acrokeratosis paraneoplastica]. / Le syndrome de bazex ou acrokératose paranéoplasique. Revue de la littérature.

Bazex syndrome or acrokeratosis paraneoplastica is a rare dermatosis usually associated with a squamous cell carcinoma of upper aerodigestive tract or with metastases in the cervical lymph nodes. It presents as psoriasiform violaceous scaly patches over extremities, tip of the nose, earlobes and helices. This syndrome evolves in three stages parallel to the growth of the tumor, thus the utility of recognition of the syndrome which may unmask the associated neoplasia at an early stage. Treatment consists of treating the underlying neoplasia whether by surgery, chemotherapy and/or radiotherapy. Recurrence of cutaneous lesions may reveal the recurrence of the tumor.

[Teledermatology in Midi-Pyrenees]. / La télédermatologie en Midi-Pyrénées.

Telemedicine has become commonplace since the creation of the European Center of Telemedicine, and dermatology was a pioneering discipline in this new technology. The Division of Dermatology is now involved at three different levels--The Midi-Pyrénées regional network, which allows doctors in the private and public sectors to seek expert advice, in real time, from university hospital specialists.--He Division of Dermatology pioneered telemedicine sessions devoted to file review, histological/clinical diagnosis, and information exchanges among subspecialists in dermatology. Both French and foreign specialists attend these sessions.--Teaching, particularly for students and private practitioners. Telemedicine has clear benefits for patients, doctors and society as a whole. The private and hospital community of the Midi-Pyrénées region is constantly seeking to improve its health services, and ensures that all new approaches are subject to strict quality controls.

Treatment of mammary and extramammary Paget's skin disease with topical imiquimod.

BACKGROUND: Paget's disease is an uncommon epidermal cancer, affecting all skin regions wherever apocrine glands are present. It is divided into extramammary (EMPD) and mammary Paget's disease (MPD). It can be confined to the epithelium or may be associated with an underlying adenocarcinoma. The diagnosis is confirmed by skin biopsy and the treatment depends on characteristics of the underlying cancer. Surgery is the first-line treatment. Imiquimod, a topical immunomodulator, approved its efficiency in several skin neoplasms and has been shown as a safe treatment for EMPD. However, it has never been reported for the treatment of MPD. OBSERVATIONS: We report on two cases of EMPD and MPD successfully treated with imiquimod 5% cream. CONCLUSION: This non-surgical method may be considered as a primary treatment when Paget's disease is not associated with an underlying malignancy. The good prognosis with a long-term survival, the anatomic localization and the poor general condition of elderly people may favor imiquimod as an alternative treatment. On the other hand, it will reduce the extent of excision when it anticipates surgery.

[Neutrophilic dermatosis and neutrophil disorders. A study of 31 clinical cases]. / Place des dermatoses neutrophiliques dans la pathologie neutrophilique. A propos de 31 cas.

Neutrophilic diseases are a group of disorders--mainly dermatoses--in which polymorphonuclear neutrophils accumulate in the absence of an identified pathogen. Such neutrophil infiltration can lead to a variety of clinical manifestations, including inflammatory disorders of the digestive tract, and hematological and rheumatological disorders; monoclonal or polyclonal circulating IgA levels are elevated, and the disorders are sensitive to drugs acting on neutrophils. Other disorders associated with neutrophil accumulation do not share these criteria. Non neutrophilic manifestations may also be present, and determine the prognosis. Neutrophilic dermatoses are often chronic and relapsing-remitting. Spontaneous regression occurs in some cases. It is unclear whether these pleomorphic disorders should be grouped together under a single heading In addition, the causes of the neutrophil accumulation are unknown. During the past five years, we have managed 31 patients with neutrophilic dermatoses. Here we describe our findings and review previous reports.

Surgical margins in cutaneous melanoma (2 cm versus 5 cm for lesions measuring less than 2.1-mm thick).

BACKGROUND: This study addressed the question of whether limited surgery for primary malignant melanoma with a 2-cm margin is as good as a 5-cm margin. An update of a 16-year follow-up is provided. METHODS: Nine European Centers, over a period of 5 years, prospectively randomized 337 patients with melanoma measuring less than 2.1 mm in thickness to undergo a local excision with either a 2-cm or a 5-cm margin. Three hundred twenty-six patients were eligible for statistical analysis. Excluded from the trial were patients older than 70 years; those with melanomas from the toe, nail, or finger; and those with acral-lentiginous melanoma. A separate randomization was performed to independently test an adjuvant treatment with a nonspecific immunostimulant, isoprinosine, compared with observation. The median follow-up time was 192 months (16 years) for the estimation of survival and disease recurrences. RESULTS: There were 22 tumor recurrences in the 2-cm arm and 33 in the 5-cm arm. The median time to disease recurrence was 43 months and 37.6 months, respectively. The 10-year disease-free survival rates were 85% for the group with a 2-cm margin and 83% for the group with a 5-cm margin. There was no difference in the 10-year overall survival rates (87% vs. 86%). Isoprinosine did not demonstrate any activity in this setting. CONCLUSIONS: The authors concluded that for melanoma less than 2.1-mm thick, a margin of excision of 2 cm is sufficient. A larger margin of 5 cm does not appear to have any impact on either the rate or the time to disease recurrence or on survival.

[Necrolytic migratory erythema revealing glucagonoma without diabetes]. / Erythème nécrolytique migrateur révélateur d'un glucagonome sans diabète.

We report a case of glucagonoma syndrome, revealed by a necrolytic migratory erythema that had developed for four Years, associated with anorexia, severe weight loss, anemia, hypoprotidemia, and hypoaminoacidemia. The fasting blood glucose level tended paradoxically to be low (0.6 g/l). Elevated plasma glucagon levels confirmed our diagnosis. The absence of diabetes was explained by an independent insulin secretion derived from this composite pancreatic tumor, authenticated by the histological analysis and the proinsulin level. This level was similar to those typically observed in insulinomas. Six Months after a complete surgical exeresis, symptoms disappeared and biological results returned to normal values.

[Alpha-1-antitrypsin deficiency. Role in skin disorders]. / Le déficit en alpha-1-antitrypsine. Place au sein des états pathologiques cutanés.

Alpha1 antitrypsin (AAT) deficiency is an autosomic codominant inherited disorder characterized by inefficient or non-functional serum AAT. The principal clinical manifestations are panlobular emphysema and cirrhoses. Among cutaneous aspects, about 30 cases of panniculitis have been reported in the literature, likewise rare clinical cases: pemphigus herpetiformis, Muir Torre syndrome, urticaria and angioedema, cutis laxa and Marshall syndrome, lupus erythematosus, psoriasis, vasculitis. Probably because of it's high frequency, numerous others diseases have been reported described in association. Acting on several factors of inflammation, AAT deficiency seems product or modify the expression of some, notably cutaneous diseases.