[Equitest and high performance patients]

The purpose of this study was to verify whether a clinical tool used to assess balance deficits could be used to document the enhanced equilibrium skills of highly trained individuals. A sensory organization test (SOT) based on computerized dynamic posturography (Equitest Neurocom) was administered at two levels of difficulty (sway-reference gains 1.0 and 1.99) to six populations of subjects (n = 81): controls, active duty fighters pilots, former fighter pilots, windsurfers, T-kwando athletes and firemen. The more difficult SOT (gain 1.99) provided the best estimation of performances differences among the six populations. Specifically, performance scores were significantly higher (p > 0.001) for wind surfer and active duty pilots compared to the other groups. Differences between active duty are retired pilots suggest that the enhenced balance of milots is an acquired skill required continued practice. Results furthers suggest that dynamic posturography can be reliable tool for identifying subjects with enhenced equilibrium skills.

CD4 lymphocytopenia as a risk factor for skin cancers in renal transplant recipients

BACKGROUND

Renal transplant recipients are at increased risk of developing skin cancer. It remains difficult to establish the actual influence of overimmunosuppression in the development of skin cancers. We investigated whether lymphocyte subset count may predict the risk of developing skin cancer in long-term renal transplant recipients.

METHODS

One hundred fifty long-term renal transplant recipients were followed for a mean period of 26 months. Each patient was examined at least annually by a dermatologist. Lymphocyte subsets were measured annually.

RESULTS

Fifteen patients exhibited skin cancers. Patients with and without skin cancer did not differ in age, gender, transplant duration, hemodialysis duration before transplantation, immunosuppressive regimen, and serum creatinine concentration. CD4 cell counts were significantly lower in patients with skin cancers (330+/-179/mm3 vs. 503+/-338/mm3; P<0.01), whereas total lymphocyte and CD8 and CD19 cell counts were similar between the two groups.

CONCLUSIONS

CD4 cell depletion is associated with skin cancer in long-term renal transplant recipients.

Sweet's syndrome associated with cutaneous T cell lymphoma

Although the association of Sweet's syndrome with haemoproliferative disorders or solid malignant tumors is well known, only two previous observations associated with T lymphoma have been reported. We report the first observation of Sweet's syndrome associated with cutaneous T cell lymphoma. The role of a cytokine cascade released by an abnormal T cell clone is discussed as an initiating event responsible for secondary infiltration with neutrophils.

[Vertigo in normal vestibulo-cochlear balance. Vestibular omissions]

Some vertigo can be found in normal vestibulo-cochlear balance. The authors showed diagnostic and treatment problems. Treatment of the vertigo lean for rehabilitation.

[Lipoid proteinosis: importance of dermabrasion. Apropos of a case]

The authors report case of lipoid proteinosis. This is an autosomal recessive genetic disease involving the skin and mucous membranes. Skin lesions have a granular appearance, with infiltration and wrinkling of the skin, especially on the face. The authors show the success of dermabrasion on skin lesions on the face of a 21-year-old girl displaying typical symptoms of lipoid proteinosis.

[Serum and salivary immunoglobins A in atopic dermatitis. Prospective and comparative case control study]

IgA system has been poorly studied in patients with atopic dermatitis (AD). Previous studies have showed that a transient serum IgA deficiency in infancy could lead to atopic disease. In addition, decrease in salivary IgA has been demonstrated in patients with AD. The purpose of our work was to study the IgA system both in serum saliva in patient with AD.

PATIENTS AND METHOD

We conducted a controlled prospective study from January 1994 to May 1996. 46 patients with AD and 52 healthy volunteers matched for sex and age were included. Atopic patients fulfilled at least three major and three minor features defined by Hanifin and Rajka. None above atopic criteria were present in the control group. Saliva was collected using a small cylinder of a cotton-wool-like substance (Salivette) kept in the buccal fold. Serum and saliva samples were assayed for IgA using standard nephelometric method and time-resolved immunofluorometric assay. Secretory IgA were assayed by a sandwich-type enzyme linked immunosorbent assay. Blood eosinophils and serum IgE were also evaluated.

RESULTS

IgA and secretory IgA were detected in all serum and saliva collected. No statistically significant difference were observed in serum or in saliva for both IgA and secretory IgA between patients with AD and controls. As expected, blood eosinophils and serum IgE were significantly increased in patients with AD.

DISCUSSION

None patients (atopic or control) exhibited IgA deficiency. Although no statistically significant, a trend to higher concentrations of serum and salivary IgA was observed in patients with AD suggesting a stimulation of mucosa-associated lymphoid tissue in these patients.

Equivalence of nasal spray and subcutaneous formulations of salmon calcitonin

The aim of this study was to assess the efficacy and safety of nasal spray and subcutaneous formulations of salmon calcitonin. Two-hundred-four patients, 27 males and 177 females, aged 72 years on average, with a recent, painful, vertebral crush fracture were given either 50 IU/day of subcutaneous salmon calcitonin (SCSCT, 102 patients) or 200 IU/day of intranasal salmon calcitonin (INSCT, 102 patients) for 30 consecutive days, according to a double-blind, double-placebo design. The two-sided 95% confidence interval of the difference between the two formulations for the pain on D30 assessed by Huskisson's Visual Analogue Scale (VAS) [-5.3 mm, 7.9 mm] was included in the [-10 mm, 10 mm] reference interval. Equivalence of the two formulations, was demonstrated. At the end of the study, the 95% confidence intervals of VAS of both treatment groups were included in the [0 mm, 30 mm] interval, which is considered to be clinically pertinent. Relief was obtained in less than 10 days for more than 50% of patients. The urinary hydroxyproline/creatinine and calcium/creatinine ratios remained constant between D1 and D30 with both formulations. General safety was comparable between the two formulations. Local safety of INSCT was similar to that of its placebo.

The Riluzole Early Access Programme: descriptive analysis of 844 patients in France. ALS/Riluzole Study Group III

Recent controlled trials in outpatients with amyotrophic lateral sclerosis (ALS) indicate that riluzole prolongs tracheostomy-free survival. After 12 months' treatment, riluzole 50 mg, 100 mg and 200 mg daily reduced the risk of death or tracheostomy (relative to placebo) by 24%, 34% and 31%, respectively (by 28%, 43% and 43%, respectively, after adjustment for known prognostic factors). This survival advantage (6-9 patients require treatment with riluzole to avoid 1 death/tracheostomy annually) compares favourably with that achieved therapeutically in breast cancer and coronary artery disease. Some 6000 ALS patients are currently receiving riluzole 50 mg twice daily within the Riluzole Early Access Program. In France, this programme is being implemented as an open-label multicentre trial to assess patients' functional status and quality of life. To date, 844 patients have been enrolled, and they will be followed up for 12 months on riluzole. Baseline demographic and clinical characteristics of this study population are presented here.

[Double-blind randomized comparative study of nicergoline naftidrofuryl on the quality of life in chronic obliterative arteriopathy of lower limbs with intermittent claudication]

The functional limitation of patients with obliterative arterial disease, and with intermittent claudication, damages their quality of life. The purpose of this trial was to compare the effects of nicergoline and naftidrofuryl on the quality of life and the functional discomfort of the 131 patients with claudication. It was a multicentre, randomised, double-blind trial with parallel groups. The patients were asked to complete a quality of life questionnaire and a Visual Analogue Scale, and to evaluate the number of steps on flat ground before the pain began. After 6 months of treatment, we observed, for all treatments combined, a significant improvement (p = 0.0001) in the quality of life and in the functional discomfort. Three variables favoured nicergoline: the estimated time before the onset of the pain (p = 0.003), the functional discomfort quantified by the Visual Analogue Scale (p < 0.05), the distance covered on flat ground (p = 0.013). The other variables, and especially the total score on the self-questionnaire, confirmed this impression, without reaching significance (p = 0.136). The data suggest that in terms of quality of life nicergoline is superior. The clinical tolerance is good and comparable between the two treatments.

Eosinophilic pustular folliculitis in infancy: report of two affected brothers

We describe two brothers with eosinophilic pustular folliculitis. Both had recurrent crops of papules and pustules, primarily affecting the scalp. The eruption began in the neonatal period. Both children had a leucocytosis with eosinophilia. Histology revealed folliculitis, with an infiltrate in which eosinophils were predominant. Bacteriological and fungal cultures of pustules were negative. There was a good clinical response to treatment with a topical corticosteroid and dapsone. We review the 28 previously reported cases of eosinophilic pustular folliculitis in infancy. The occurrence of this disorder in brothers suggests that an inherited or contagious factor may be involved in its aetiology.

Phototherapy in the treatment of cutaneous graft-versus-host disease. Our preliminary experience in resistant patients

Graft-versus-host disease (GVHD)* is a frequent complication of allogeneic bone marrow transplantation. The potentially beneficial effect of phototherapy for treatment of cutaneous manifestations of GVHD led us to investigate retrospectively the effect of this therapy in a larger series of patients. Eleven patients with cutaneous GVHD (acute GVHD in 4 patients, chronic lichenoid GVHD in 6 patients, and chronic sclerodermatous GVHD in 1 patient) resistant to standard immunosuppressive drugs were treated with phototherapy. Skin lesions showed a complete clearing in 75% of patients with acute GVHD, and a response rate of 70% was observed in patients with chronic GVHD. No effect of phototherapy was achieved in 3 patients. Our results suggest that phototherapy is a nonaggressive treatment that may benefit patients with cutaneous GVHD, who already take high doses of immunosuppressive drugs.

Improvement of some schizophrenic deficit symptoms with low doses of amisulpride

OBJECTIVE

The authors assessed the effects on primary negative symptoms of low doses of amisulpride, a substituted benzamide neuroleptic with high affinity for D2 and D3 dopamine receptors.

METHOD

Young, drug-free schizophrenic patients with pure negative symptoms participated in a 6-week double-blind trial of placebo (N = 10) or low-dose amisulpride (N = 10). They were assessed with the Scale for the Assessment of Negative Symptoms.

RESULTS

Amisulpride significantly improved negative symptoms. Improvement in avolition, attentional impairment, and retardation was significantly greater with amisulpride than with placebo.

CONCLUSIONS

These findings suggest that some primary negative symptoms may be directly affected by low doses of benzamide neuroleptics.

Treatment of negative symptoms in schizophrenia with amisulpride

BACKGROUND

The efficacy of low doses of certain neuroleptics in improving negative symptoms is still controversial. This study assessed the efficacy of amisulpride, a benzamide which increases dopaminergic transmission at low doses via presynaptic dopamine receptor blockade, on negative symptoms of schizophrenia.

METHOD

The study was designed as a parallel-group, double-blind, placebo-controlled trial. Patients had to fulfil DSM-III criteria for schizophrenia, Andreasen's criteria for negative schizophrenia, and to have a total score of at least 75 on the SANS; those treated with neuroleptics or antidepressants underwent a six-week placebo wash-out. One hundred and four in-patients were randomly assigned to amisulpride 100 mg/d, amisulpride 300 mg/d, or placebo for six weeks; 85 patients completed the study.

RESULTS

Both amisulpride doses were significantly more effective than placebo on the primary evaluation criterion (SANS total score, MANOVA P < 0.02). No significant changes were found in positive symptoms or in extrapyramidal symptoms.

CONCLUSIONS

Negative symptoms can be improved by low doses of amisulpride, favouring the hypothesis of dopaminergic hypofunction as one of the causes of negative symptoms.

Effects of a new psoralen, 5-geranoxypsoralen, plus UVA radiation on murine ATPase positive Langerhans cells

5-geranoxypsoralen (5-GOP), commonly called bergamottin, is a highly photoreactive psoralen, which in contrast to most furocoumarins, does not strongly interact with DNA. 5-GOP gives the opportunity to study, in a more selective way, the mechanisms of phototoxic and immunological activities induced by psoralen and UVA radiation. We investigated the effects of repetitive treatments with 5-GOP plus UVA radiation (320-400 nm) on the number of ATPase+ epidermal Langerhans cells and on the induction of photoreactivity. These effects were compared with those of 8-methoxypsoralen (8-MOP) or 5-methoxypsoralen (5-MOP) plus UVA radiation and UVA radiation alone. C3H/HeN mice were treated topically with the psoralen three times/week for 4 consecutive weeks followed each time by 1 J/cm2 of UVA radiation. At the end of the treatment, mice treated with 8-MOP or 5-MOP plus UVA radiation exhibited severe gross phototoxicity and nearly total depletion of ATPase-stained Langerhans cells. Both treatments produced severe morphological alterations of Langerhans cells. No gross but a microscopic phototoxic effect was observed after 5-GOP plus UVA radiation treatment, while the number of ATPase+ Langerhans cells was also greatly reduced. Interestingly the latter treatment induced no morphological alterations of the remaining Langerhans cells in contrast to treatment with 8-MOP or 5-MOP plus UVA radiation. We conclude that phototoxicity and decrease in the number of ATPase-stained epidermal immune cells observed after treatment with 5-GOP plus UVA radiation are not related to the DNA binding activity of the psoralen.(ABSTRACT TRUNCATED AT 250 WORDS)