[Dermatomyositis with cutaneous necrosis revealing a fallopian tube carcinoma]. / Dermatomyosite avec nécroses cutanées révélatrice d'un cancer de la trompe utérine.

INTRODUCTION: Adult dermatomyositis is a rare inflammatory myopathy associated with typical cutaneous lesions and an increased incidence of internal malignancies, notably cancers of the female genital tract. Nevertheless, fallopian tube carcinoma is exceptionally associated with dermatomyositis. EXEGESIS: We report an unusual case of dermatomyositis because of cutaneous necrosis revealing a cancer of the fallopian tube. CONCLUSION: Predictive factors of cancer can improve prognosis of dermatomyositis due to earlier diagnosis of associated cancer. In our observation as in literature review, cutaneous necrosis lesions are highly predictive of an associated neoplasia even as rare as a fallopian tube carcinoma.

Parent-directed, intensive early intervention for children with pervasive developmental disorder.

We examined parent-directed, intensive early intervention for children with Pervasive Developmental Disorder. Children's parents recruited paraprofessional therapists and requested consultations on how to implement the UCLA treatment model in their homes (Smith & Lovaas, 1998). Parents and therapists then received six one-day workshops over a five-month period, with additional consultations for the next 2-3 years. Six boys participated (intake age 35-45 months, intake IQ 45-60). The study addressed 1) the children's skill acquisition during the first five months of treatment; 2) outcome 2-3 years later; 3) treatment quality; and 4) parents' impressions. Five of 6 children rapidly acquired skills when treatment began, but only 2 clearly improved on standardized tests at the 2-3 year follow-up. Therapists usually employed correct treatment procedures but were less consistent than therapists employed at a clinic. Parents reported high satisfaction with treatment. These mixed results highlight the need for multimodal assessment of parent-directed treatment.

Ethical dilemmas in care for HIV infection among French general practitioners.

A survey was carried out in May-June 1992, in the city of Marseille (South-Eastern France), to analyze attitudes towards ethical issues associated with the care of HIV-infected patients in a random sample of general practitioners (GPs) (telephone interviews; answer rate = 78.6%; n = 313). A total of 70.6% were consulted by HIV carriers and 48.9% regularly took care of these patients over the past year. Multi-dimensional analysis showed that support for HIV mandatory screening was related to lack of knowledge and experience with HIV infection, high perception of risks associated with HIV care, and the individual characteristics of GPs, such as religious beliefs and intolerance to uncertain situations. GPs with experience of regular care of HIV carriers had the same opinions than the rest of the sample about 'creation of specialized hospitals for AIDS patients' and similar attitudes toward HIV testing 'without patients' consent' or breaching of confidentiality of HIV diagnosis. Debates on ethical issues among GPs cannot be reduced to a simplistic division of a 'liberal group' highly involved in prevention and HIV care and a 'conservative' majority more or less inclined to stigmatize HIV-infected patients. Ambiguous messages on these issues from health authorities and professional ethical bodies may have very negative impacts on the attitudes of primary care physicians regarding the acceptability of HIV-infected patients.

[Cutaneo-mucosal hyperpigmentation in AIDS. 4 cases]. / Hyperpigmentation cutanéo-muqueuse au cours du SIDA. 4 observations.

Four cases of pigmentation of the skin and mucous membranes in homosexuals of the IVC1 group (CDC classification) are reported. The aetiological investigation, although incomplete, pointed to a medicinal origin which could not be formally confirmed. The drugs suspected were azidothymidine, pyrimethamine and ketoconazole. There was no clinical or laboratory evidence of adrenal insufficiency. The few published cases of cutaneo-mucosal pigmentation in HIV infection, often mimicking adrenal insufficiency, emphasize the need for thorough toxicological investigation; this may avoid prescribing an unnecessary and dangerous corticosteroid therapy which might be harmful in these deeply immunocompromized patients who often have multiple infections.

[Neuropathies and HIV retrovirus infections]. / Neuropathies et infections par le rétrovirus HIV.

Neurologic complications are frequently observed during HIV-related infections and particularly in AIDS. According to the literature, these complications more often pertain to the central nervous system (CNS) than the peripheral nervous system (PNS). A prospective study was carried out in order to determine the frequency and type of PNS disorders during HIV infections, the neurotropism of which is now well established. Forty-one HIV-infected patients - 5 asymptomatic subjects, 14 ARC (AIDS-related complex) and 22 AIDS patients - were studied from a clinical and biological angle; 40 equally underwent an EMG and nervous conduction velocity tests, 26 a lumbar puncture and 25 a nervous biopsy (associated in three cases with a muscular biopsy). The study showed that a PNS-alteration is extremely frequent (36/41, or 88% of all cases), generally mild or even subclinical (17/36); most often, the aspect is that of a sensitive axonal polyneuropathy. More severe types (polyradiculoneuritis, sensorimotor polyneuropathy, etc.) are equally observed, but much rarer. Whatever their form may be, the PNS-lesions can be observed in so-called asymptomatic subjects (2/5) as well as ARC (12/14) and AIDS (22/22) patients. They are the manifestation either of a direct lesion of the nerve through HIV, or of immune mechanisms (of humoral or cellular mediation) or of both mechanisms combined.

[Stewart-Treves syndrome. 2 cases with an ultrastructural study]. / Syndrome de Stewart-Treves. Deux cas avec étude ultrastructurale.

The authors present an ultrastructural study of two cases of Stewart-Treves syndrome in elderly women. Under light microscopy, the dermal and hypodermal proliferations showed vascular features which were more clearly preceptible in the second case than in the first. Ultrastructural studies showed, in the first case, clefts containing erythrocytes and surrounded by neoplastic cells which were linked by zonulae adherentes. A rudimentary form of basal membrane was also noted, with an exterior lining of pericyte-like cells. In the second case, typical capillary vessels were bordered by endothelial cells containing a few pinocytotic vesicles and microfilaments, in contact by zonulae adherentes. The walls of these vessels consisted of a clearly defined membrane lined with pericytes, and constituting, in some areas, an anastomotic network due to the swelling of the endothelial cells. Ultrastructural study suggests an angiosarcomatous origin of these lesions. Finally, the article includes a review of the literature.

[Hormonotherapy in acute, idiopathic hirsutism, and seborrheic alopecia (author's transl)]. / Place de l'hormonothérapie dans le traitement de l'acné, de l'hirsutisme idiopathique et des alopécies séborrheiques.

It has been established that, through skin responds to circulating androgens, it can also produce androgens from precursors. Therapy can address either of the two following physiopathological steps: the secretory step can be countered by replacement or suppressive therapy which is now fairly well mastered; the target-organ step opens new possibilities concerning receptor abnormalities and receptor control. The medical literature was reviewed for data on hormonal therapy for women with acne, idiopathic hirsutism and seborrheic alopecia, three conditions which are usually only partially improved by cosmetic treatment.

[Montgomery xanthomatosis (author's transl)]. / La xanthomatose normolipidémique de Montgomery.

A typical case of Montgomery xanthomatosis is reported by the authors. Out of this case and of a hundred other ones gathered from the literature, they outline the main features of the disease. It is revealed as being stereotyped and particularly the prognosis is usually good. Whether the ultra structural study may show Langerhans corpuscules or not, it brings us a material to the discussing of border-line cases (xanthomatosis with diabetes insipidus, Hand-Schüller-Christian disease with cutaneous lesions similar to Montgomery's.

Acne rheumatism. Report of a case.

A case of acne conglobata with myo-osteoarticular involvement is described. The occurrence of a subacute, symmetrical polyarthritis with radiological changes was the unique feature of this patient. The immunologic work-up demonstrated impairment of delayed hypersensitivity. Control of the systemic symptoms was obtained initially with corticosteroids and during a relapse with indomethacin. Clofazimin was effective in longterm treatment of the acne. Following cessation of all therapy, there has been no evidence of recurrence of either acne or rheumatic symptoms.

[Cutaneous manifestations of mediterranean periodic disease. Concerning an observation. Review of the literature (author's transl)]. / Manifestations cutanées de la maladie périodique. A propos d'une observation: revue de la littérature.

Méditerranean Periodic Disease is frequently encountered in non-aschenazic Jews and in Armenians. Aside from the classic triad of pseudo-palustral febrile crises, paroxysms of abdominal and articular pain, and a biological syndrome of inflammation; cutaneous manifestations were noted in 25 to 35% of the cases according to various authors. The most commonly encountered lesions consisted of erysipel-like plaques and subcutaneous nodules. We observed the case of a 47 years old Armenian male, afflicted with Mediterranean Periodic Disease for 30 years in which the dermatologic symptoms are quite classic aside from a vitiligo having progressively appeared since 15 years. Possibly a coincidental association, but to the best of our knowledge, which has not as yet been reported.