[Disseminated pulmonary tuberculosis. Current features and frequency of haematogenous forms (author's transl)]

Seventy-five cases of disseminated tuberculosis of the lung were observed between 1960 and 1978. On radiology, they presented as fine or coarse miliary nodules or diffuse infiltrates. The disease occurred at all ages and were afebrile in 25% of the cases. It was frequently haemategenous, as shown by the presence of extrathoracic foci (Pott's disease, tuberculosis of the urinary or genital tracts), or, more often, by associated lesions indicating bacteraemia, such as meningitis, granulations on the fundus oculi, miliary tuberculosis of the liver and positive urine culture with normal urographic findings. Positive urine cultures, which were encountered in 32% of the patients, appeared to be reliable criterion of dissemination through the blood stream. Disseminated pulmonary tuberculosis usually responded to modern combined antibiotic therapy, but 8 patients over 60 years of age died during the first six weeks of treatment. Relapses were rare with prolonged therapy including isoniazid and streptomycin and did not occur after rifampicin was introduced into the therapeutic regimen.

[Skin lesions in systemic candidiasis (author's transl)]

Skin lesions in systemic candidiasis are erythematous maculopapules and maculonodules which appear at the onset of the septicaemic phase. Their presence, especially when associated with diffuse myalgia, suggest the diagnosis which must be confirmed by haemocultures, histological examination of the skin with PAS stain and culture of skin fragments in Sabouraud's medium. Systemic candidiasis with skin lesions seems to be mainly due to Candida tropicalis and to occur with great frequency in patients with underlying blood disease. Of the three cases reported here, one concerned a 24-year-old man with premyelocytic acute leukaemia, the second a 45-year-old woman with drug-induced agranulocytosis and the third one a man aged 25 admitted to hospital for peritonitis secondary to Crohn's disease.

[Squamous cell carcinoma of the lung in a patient treated for small cell carcinoma. Does chemotherapy encourage the development of histologically different tumour? (author's transl)]

A 60-year-old male patient with small carcinoma of the lung was treated with chemotherapy and radiotherapy. The tumour regressed, but two squamous cell carcinomas appeared in the contralateral lung. The first one was discovered after 3 months' treatment and developed slowly; the second one, diagnosed after 9 months' treatment, was rapidly progressive. The patient died 13 months after the beginning of treatment, and only the squamous cell carcinomas could be confirmed on autopsy. Such cases may reflect either selection of tumours that were present from the beginning of treatment, or development of other malignancies, or treatment-induced histological changes in the original tumour.

Secondary ion emission microanalysis: applications to the study of human skin

Secondary ion emission microanalysis is a new method of physical analysis recently applied in biology. The apparatus required (CAMECA SMI 300) enables pictures to be taken of the distribution of certain elements, with a space resolution of the order of 1 microgram. Concentrations below 1 p.p.m. are perceptible for most elements. The present results are the first obtained for human skin sections. Investigation of the natural elements of normal skin reveals no particular accumulation. Elements foreign to the skin are easy to detect. We show here the distribution in the epidermis of clinical antiseptics applied locally. This method has two advantages compared to X-ray microanalysis. It is more sensitive and allows analysis of even the lightest elements. However, its use in skin penetration studies is limited because it does not permit quantitative analysis and serious interference problems may occur.

Cellular events leading to blister formation in bullous pemphigoid

Cellular events occurring in eight patients with bullous pemphigoid were studied by light and electron microscopy. Sections (0.5 micrometer) of large surface area, overlapping blisters and surrounding skin, were examined and correlated ultrastructural studies were performed on selected areas. The peroxidase contained in granules of neutrophils, eosinophils and young macrophages was visualized by incubation with diaminobenzidine and hydrogen peroxide. This cytochemical reaction was used as a marker to study the release of granule enzymes from these inflammatory cells. The release of such enzymes from eosinophils and occasionally from macrophages on the epidermal basement membrane (more precisely in the lamina lucida) was demonstrated in the skin surrounding the blisters in four patients. The release of these enzymes was also observed in the floor of the blisters in all eight patients. It is well known that these granules contain several proteolytic enzymes. These observations are therefore consistent with the proposal that proteolytic enzymes of eosinophils play a pathogenic role during the initial stages of blister formation in bullous pemphigoid.

Endogenous peroxidases: a morphological and functional marker to study inflammatory skin diseases

The visualization of peroxidase positive lysosomes by diaminobenzidine plus H2O2 allowed easy identification of neutrophils, eosinophils, monocytes and young tissue macrophages in 0.2 micrometer to 0.5 micrometer skin plastic sections of large surface area. Evaluation of the lysosomal functions of these phagocytic cells was greatly improved by the possibility of correlating observations on the same cell at light and electron microscopic levels.

[Pleural effusion in rheumatoid arthritis (R.A.). Biochemical study of the pleural fluid (author's transl)]

The diagnosis of pleural effusion in R.A. is largely done by exclusion. Histopathological data, obtained by pleural punch-biopsy, are unreliable. It is generally a serofibrinous pleural effusion. Biochemical study of the pleural fluid shows a high protein level (> 40 g/l), high latex factor (larger than or equal to 1/2560) and, predominantly, low sugar rate in pleural fluid (< 0,35 g/l) and low complement level (whole hemolytic complement C3 and C4).

[Rheumatoid pleurisy with cholesterol pleural effusion. A single case. Literature review (author's transl)]

The authors report a new case of rheumatoid pleurisy proved by the clinical contest and the biological samplings of pleural fluid: a pleurisy with cholesterol pleural effusion. Six observations of rheumatoid pleurisy with cholesterol pleural effusion were found in the literature. This new case confirms this biological peculiarity of rheumatoid pleurisies and the authors insist on the existence of acute pleurisies with cholesterol pleural effusion.

A simple method for correlating observations on skin at the light and electron microscopic levels

A method is described which allows the embedding of 6 mm cutaneous punch biopsies for subsequent light and electron microscopic examination. Sections of 20 mm2 cut at 0.5-I micrometer are stained for light microscopy. The subtle tinctorial affinities, which approach those achieved on haematological smears, and the preservation of cellular detail frequently make subsequent ultrastructural examination unnecessary. However, when required, a special technique for trimming and resectioning the tissue blocks allows a good correlation between light and electron microscopic observations.

[Eosinophilic fasciitis (Shulman syndrome) associated with insulin-dependent diabete. 1 case (author's transl)]

A patient with eosinophilic fasciitis and insulin-dependent diabete mellitus is recorded. Diabete and blood hypereosinophilia occurred four months before acute onset of severe proximal sclerodermic features. The deep seated level of fibrosis, mainly localized in subcutaneous fat and fascia was documented by histologic examination. Prednisone therapy (0,75 mg/kg/day) resulted in cutaneous improvement and disparition of eosinophilia. Survey of pertinent literature lead us to consider Shulman's syndrome as a distinct entity amid the broad scleroderma spectrum. Features of esosinophilic fasciitis are very close to, and sometimes undistinguable from generalized morphea. Simultaneous occurence of diabete mellitus in this case is not fortuitous. The same association has already been recoreded with various sclerodermic syndromes.

[Cutaneous psoriasis. Symptoms and therapy]

Skin psoriasis, a multi- causal disease with unknown mechanism, has several clinical aspects. Besides ordinary psoriasis with mica-like plaques and its special locations, two less known notions are underlined: the localized forms are often less typical (for example: scalp, ears, folds of the hand, foot and nails). They may be relevant to the rhumatologist for the diagnosis the inflammatory forms are often disseminated with pustules and keratosis and constitute another groups where the rhumatologic manifestations are more frequent and more severe. Various forms of treatment are active on the cutaneous symptoms, chronic or relapsing topical therapy with tar, corticoids, nitrogen mustard, photochemytherapy, oral derivatives of retinoic acid, and exceptionally immunosuppressors. Each technic has its advantages, its disadvantages on a short or long term. Therefore each patient should receive the therapy which is adapted to his form of psoriasis, the need and possibilities of the patient. Collaboration is a must and each patient should receive the adequate care making possible an improvement of his condition.

Photochemotherapy (PUVA) of psoriasis using 3-carbethoxypsoralen, a non-carcinogenic compound in mice

The carcinogenic risk of photochemotherapy (PUVA) with bi-functional furocoumarins such as 8-methoxypsoralen (8-MOP) which form cross-links in cellular DNA has initiated a search for active but less hazardous psoralens. A new compound, 3-carbethoxypsoralen (3-CPs), studied in the yeast Saccharomyces cerevisiae (eukaryote), has been shown to be very photoactive on DNA and to form only mono-additions to DNA. These lesions appear to be more easily repaired than the cross-links induced by 8-MOP. 3-CPs produces less nuclear genetic events such as nuclear mutations and mitotic crossovers, but more cytoplasmic 'petite' mutations (damage to mitochondrial DNA) than 8-MOP. In mice it was demonstrated that after local or intra-peritoneal administration, in contrast to 8-MOP, 3-CPs is non-toxic, non-erythematogenic, and non-carcinogenic. A study of ten psoriatic patients had shown that local applications of 3-CPs plus UV-A exhibit about the same therapeutic activity for the clearing of psoriatic lesions as local treatment with 8-MOP plus UV-A, but without any localized hyperpigmentation.

[Iridium 192 interstitial radiotherapy of carcinoma of the penis. Carcinologic results, dermatologic evaluation (about 87 cases) (author's transl)]

87 cases of epidermoid carcinoma of the penis treated by Ir 192 interstitial radiotherapy are studied. The 5 years survival rate, estimated on a 51 patients group, is 61 p. 100. Among these 51 patients, 12 had a local recurrence. The post-radiotherapy early reaction is estimated on a 79 patients group, with a mean duration of 3, 4 months. The early reaction is correlated to tumor size and not correlated to number of radio-active lines. The later dermatologic evolution is studied in 59 patients. In 22 cases, the scar remained supple, without any further local change. Local changes occurring in the 37 other cases are studied in their clinical aspect, signification and frequency. Of 34 patients followed longer than 40 months, 14 had local complications with 4 cases of local recurrence. The carcinologic reliability of this method is similar to that by surgery. It seems however it must be restricted to tumors limited to glans penis.

[Treatment of alopecia areata with D.N.C.B. (author's transl)]

The results of treatment of 16 cases of alopecia areata with dinitrochlorobenzene (D.N.C.B.) are reported. The chemical is applied to the scalp once a week, beginning three weeks after sensitivation (patch-test 1/50). We have available to us a battery of D.N.C.B. solutions of various concentrations (11 solutions ranging from 1/20,000 to 1/25). The concentration used varies at each application with the desired result being a contact dermatitis. In the 16 cases studied, 4 were classified as good results, 8 as poor and 4 as failures. Hairgrowth begins with three weeks following the first D.N.C.B. application to the scalp. Good prognostic signs include the facility in sensitizing the patient as well as the intensity of this reaction. The reasons for this treatment's efficacy being as yet unknown, the standardization, as well as the actual technique are, at the present time difficult and hazardous.

[Eosinophilic pustular folliculitis (Ofuji) (author's transl)]

A case, the first French observation of eosinophilic pustular folliculitis (Ofuji) is reported. The long lasting condition of unknown etiology is characterized by slightly indurated erythematous plaques and formation of follicular small papules and pustules. The lesions have a tendency to central healing and peripheral extension and proceed with remissions and exacerbations. Histological features are pustular folliculitis composed chiefly of eosinophiles. Blood eosinophila is often founded. Local corticotherapy and dapsone are sometimes a effective treatment.

[Pathology of the polymorphonuclears in dermatology. Methods of investigation. Clinical pictures (author's transl)]

A remarkable increase in the number of recognized clinical abnormalities of neutrophil function has occurred within the 8 years past. Of major importance in the delineation of these disorders is the establishment of appropriate methodology of their characterization. This review discusses phagocytosis and its disorders by dividing it into stages that encompass the way in which phagocytes ferret out injection, how they recognize pathogens and the intracellular events leading to engulfment and killing of micro-organisms. The pathology of chemotaxis and random mobility is described: the lazy leukocyte syndrome, the Chediak-Higashi syndrome, the familial chemotaxis pecular dermatosis, and a variety of serum abnormalities of the serum complement system associated with deficient generation of chemotactic activity. The second part of these disorders is dailing with the inherited abnormalities of the oxygen dependent killing mechanisms of phagocytes, the chronic granulomatous disease, the glucose-6-phosphate deshydrogenase deficiency, the myeloperoxydase deficiency and the glutathione peroxydase deficiency.

[Dermatitis herpetiformis (author's transl)]

Detailed investigations of 9 patients with dermatitis herpetiformis are presented. In all cases cutaneous lesions were controlled by dapsone alone or by dapsone and gluten free diet. Granular IgA deposits were found in 7 patients, linear IgA deposits in one, and C3 component of complement in one. 3 patients out of 8 tested, carried the specific HLA-B8 antigen. Despite an extensive investigation, no malabsorption was detected. Jejunal biopsies were performed in 8 cases. Jejunal villous flattening was observed in one patient. It improved after a 2 months gluten free diet on subsequent jejunal biopsies. D. H. seems peculiar in France as compared with case reports from other countries: low prevalence of gluten sensitive enteropathy; rare occurrence of the specific HLA-B8 antigen; incidence of D. H. seems to be low in France. It is noticeable that french incidence of coeliac disease is low as well. This suggests a genetic difference in the investigated population (low prevalence of HLA-B8 antigen) and/or different alimentary habits, particularly a low dietary gluten amount.

[Extensive apical pulmonary fibrosis complicating ankylosing spondylitis. 2 cases (author's transl)]

The authors describe two cases of pulmonary fibrosis in patients suffering from ankylosing spondylitis. The diagnosis of tuberculosis was rejected on the basis of negative studies for tubercle bacilli and the total ineffectiveness of specific therapy. No evidence of microbial or parasitic infection was found. This fibrosis was associated with a considerable worsening in general condition. Nevertheless, the first patient remains alive 15 years after the onset of this pathological manifestation. The second patient died but autopsy was not possible. A wide review of the literature is undertaken in the light of these two cases.