[Systemic necrobiotic xanthogranuloma with initial pericardial and pulmonary involvement]. / Xanthogranulome nécrobiotique révélé par une atteinte péricardique et pulmonaire.

INTRODUCTION: Necrobiotic xanthogranuloma is a rare disease, usually associated with a monoclonal gammapathy. We report a case with pericardial and pulmonary involvement that preceded the appearance of the cutaneous lesions. OBSERVATION: A 58 year-old woman was hospitalized for cardiac tamponade. She has a past history of a ductal carcinoma of the right breast that had been completely cured. Pericardial and pulmonary samples showed a predominantly histiocyte monomorphous infiltrate. Twelve months later, indurated papular-like cutaneous lesions appeared around the eye orbits and on the thorax. The histological examination of the skin revealed a necrobiotic xanthogranuloma and the diagnosis of cutaneous and visceral necrobiotic xanthogranuloma was retained. The patient exhibited an IgG Kappa monoclonal gammapathy of undetermined significance. Sequential treatment with melphalan and general corticosteroids moderately improved the cutaneous lesions but did not modify the monoclonal peak. DISCUSSION: To our knowledge, this is the first case of pericardial involvement of a necrobiotic xanthogranuloma. The discovery of the disease, revealed by a visceral manifestation at the onset is uncommon. The subsequent appearance of typical cutaneous lesions permits the retrospective diagnosis of systemic necrobiotic xanthogranuloma. Because its diagnosis is difficult in the absence of concomitant cutaneous involvement, visceral localizations of the disease must be recognized.

[Stefansky's serodiagnosis and ulcerative and mutilating acropathy (author's transl)]. / Séro-diagnostic de stefansky et acropathies ulcéro-mutilantes.

Systematic Stefansky's serodiagnostic test in the course of ulcero-mutilating acropathia reveals a frequent positivity (25/30 patients). Superinfection by atypical Mycobacterium of telluric extraction is considered. A delayed hypersensibility to several Mycobacterium antigens is proved to Mycobacterium kansasii, johnei, balnei. Perhaps, the same type of infection might exist in the course of chronic leg ulcers.

In vitro susceptibility of Listeria monocytogenes to some antibiotics and their combinations.

The Listeria monocytogenes strains isolated during recent years in our hospital have been tested for in vitro susceptibility against eleven antibiotics. The following tests were used: antibiotics discs method on Mueller-Hinton agar, determination of MICs by agar dilution method, study of the bactericidal potency of antibiotics combinations. Antibiotic discs method gives some too optimistic results, not confirmed by the MICs determined with agar dilution method. Ther are a few antibiotics used alone which are bactericidal upon Listeria monocytogenes at the concentration reached with usual therapeutic doses, and none regularly bactericidal. Bêtalactam-aminoglycoside combinations are the most effective ones but the ones involving gentamicin are more bactericidal than the ones involving streptomycin. Pristinamycin-aminoglycoside combinations have interesting activities and might be used as an alternative to betalactam-aminoglycoside ones in some peculiar and restricted indications. The other tested combinations are antagonistic or without interest.

[Epithelioma occurring on chronic leg ulcers (author's transl)]. / La dégénérescence épithéliomateuse des ulcères chroniques de jambes.

The authors report nine cases of epithelioma occuring on chronic leg ulcers of venous origin (6), or on fistula from chronic osteitis (3). Compared with the other trophic leg ulcers observed during the same period, the risk of malignant change approximatly is of 0,3 p. 100. It always concerns aged caucasian subjects (about 70 years old) and the evolution last long (5/20 years), except in one of the case. The first symptoms are hard, bleeding and exuberant granulation either on the edge of the ulcer, or on the ulcer itself. It is often necessary to repeat the biopsies to obtain histological corroboration of the diagnosis. Prognosis is severe (2 lung metastasis) and amputation seems to be the best treatment.

[Epitheliomatous degeneration of chronic leg ulcers. Apropos of 9 cases]. / La dégénérescence épithéliomateuse des ulcères chroniques de jambes. A propos de 9 observations.

The authors report nine cases of epithelioma occurring on chronic leg ulcers of venous origin (6), or on fistula from chronic osteitis (3). Compared with the other trophic leg ulcers observed during the same period, the risk of malignant change approximately is of 0,3 p. 100. It always concerns aged caucasian subjects (about 70 years old) and the evolution lats long (5/20 years), except in one of the cases. The first symptoms are hard, bleeding and exuberant granulations either on the edge of the ulcer, or on the ulcer itself. It is often necessary to repeat the biopsies to obtain histological corroboration of the diagnosis. Prognosis is severe (2 lung metastasis) and amputation seems to be the best treatment.