Unexpected extradermatological findings in 31 patients with xeroderma pigmentosum type C

BACKGROUND

Xeroderma pigmentosum type C (XP-C) is a rare, autosomal, recessive condition characterized by the association of various clinical manifestations mostly involving the skin and eyes.

OBJECTIVES

To evaluate the clinical manifestations in a homogeneous, genetically characterized cohort of patients with XP-C.

METHODS

All patients with XP-C, which was confirmed genetically or by unscheduled DNA synthesis, from the registry of our department and from the French association of patients 'Les Enfants de la Lune' were contacted. During a planned consultation, clinical information was collected using a standardized case-record form.

RESULTS

In total, 31 patients were seen. The mean age at diagnosis was 2.95 years; skin symptoms started at a mean age of 1.49 years. Among the patients, 52% had relatively short stature, with a height-for-weight z-score below -1 SD; 62% showed pyramidal syndrome and 45% had photophobia and/or conjunctivitis. Four patients had several pyogenic granulomas. Twenty-four patients (77%) had skin cancer. The mean age of onset of the first skin cancer was 4.76 years (range 2-14.5 years). Basal-cell carcinoma was the most frequent cancer. Melanomas were rare and mostly desmoplastic. Multinodular thyroid was the most frequent internal tumour.

CONCLUSIONS

Our data highlight several new aspects of XP-C. Patients with XP-C are at risk of developing pyogenic granulomas, desmoplastic melanomas and multinodular thyroid. Involvement of the central nervous system is frequent, but its mechanism remains unclear. The relatively short stature of the patients needs further investigation in order to be explained. XP-C is not only a cancer-prone disorder but is also a polysystemic disorder.

[Telangiectasia during amlodipine therapy]

BACKGROUND

Calcium inhibitors are recommended as first-line treatment in hypertension. We report the development of telangiectasia on the trunk and upper limbs in a female patient on amlodipine (Amlor(®)) that subsided on treatment discontinuation.

PATIENTS AND METHODS

A 63-year-old woman consulted for numerous asymptomatic stellate telangiectasias on her upper trunk and shoulders, with sparing of the face. No Darier's sign was seen and clinical examination was otherwise normal. The patient had been treated with amlodipine (Amlor(®)) and a combination of bisoprolol and hydrochlorothiazide (Lodoz(®)) for 5years for essential hypertension. Laboratory tests, which included serum tryptase assay, were normal. Histological analysis showed a normal epidermis with dilated superficial dermal capillaries and no inflammatory infiltrate or dermal elastosis. Amlodipine was discontinued and replaced with ramipril (an ACE inhibitor). The other treatments were changed over and the telangiectasias regressed spontaneously within several months, with no relapse being seen at one year of follow-up.

COMMENTS

Reports of telangiectasia associated with calcium inhibitors most commonly involve the dihydropyridine family, of which amlodipine is a member. Inhibition of muscular contraction induced by this treatment results in vasodilatation, accounting for the associated antihypertensive properties, and this could play a role in telangiectasia formation. The literature contains reports of cases of photo-distributed telangiectasia, suggesting that as well as vasodilatation, calcium inhibitors may in certain cases cause abnormal sensitivity of blood vessels to ultraviolet radiation. The absence of facial lesions rules out the hypothesis of photo-induced lesions in our patient.

Capillary electrophoresis single-strand conformation polymorphism for the monitoring of gastrointestinal microbiota of chicken flocks

The objective of the present study was to evaluate the capillary electrophoresis single-strand conformation polymorphism (CE-SSCP) to characterize poultry gut microbiota and the ability of this molecular method to detect modifications related to rearing conditions to be used as an epidemiological tool. The V3 region of the 16S rRNA gene was selected as the PCR target. Our results showed that this method provides reproducible data. The microbiota analysis of individuals showed that variability between individual fingerprints was higher for ileum and cloaca than for ceca. However, pooling the samples decreased this variability. To estimate the variability within and between farms, we compared molecular gut patterns of animals from the same hatchery reared under similar conditions and fed the same diet in 2 separate farms. Total aerobic bacteria, coliforms, and lactic acid bacteria were enumerated using conventional bacteriological methods. A significant difference was observed for coliforms present in the ceca and the cloaca depending on the farm. Ileal contents fingerprints were more closely related to those of cloacal contents than to those of ceca contents. When comparing samples from the 2 farms, a specific microbiota was highlighted for each farm. For each gut compartment, the microbiota fingerprints were joined in clusters according to the farm. Thus, this rapid and potentially high-throughput method to obtain gut flora fingerprints is sensitive enough to detect a "farm effect" on the balance of poultry gut microbiota despite the birds being fed the same regimens and reared under similar conditions.

Digestive tract measurements and histological adaptation in broiler lines divergently selected for digestive efficiency

Two lines of broilers divergently selected for a high (D+) or a low (D-) AME(n) on a wheat-based diet were studied for morphological and histological characteristics of the digestive tract. A total of 630 birds of both lines were slaughtered after a 23-d feeding period. Digestive tract morphology and intestinal histology were investigated on a total of 24 birds to describe the consequences of divergent selection. Birds of the D+ line had 34% heavier gizzards (P < 0.001) and 22% heavier proventriculi than their D- counterparts. In contrast, intestines were 15 to 40% heavier in D- birds, mainly in the jejunum (P < 0.001) and ileum (P < 0.001). Intestinal segments were also longer (between 3 and 6%) in the D- birds. Intestinal villi were larger and longer in D- birds (P < 0.001), mainly in the jejunum (14 to 16%), and crypts were 10 to 15% deeper for the 3 intestinal segments in D- birds (P < 0.001). Muscle layers of the intestine were 17 to 24% thicker (P < 0.001) and goblet cells were 27 to 34% more numerous in the jejunum and ileum of D- birds (P = 0.027). This new characterization of the 2 lines shows that divergent selection based on AME(n) modified the morphology of the proventriculus and gizzard, suggesting greater activity of this compartment in D+ than in D- birds. Intestinal adaptation revealed by visceral organ weight and length and histological modifications in D- birds can be viewed as an attempt to compensate for the low functionality of the gastric area.