Medicine by Alexandros G. Sfakianakis

Τετάρτη 6 Ιουνίου 2018

Vulvite granulomateuse de type Miescher

Publication date: Available online 6 June 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): K. Alhazmi, S. Berville, M. Moyal-Barracco, F. Plantier
IntroductionLa chéilite de Miescher, isolée ou dans le cadre d'un syndrome de Melkerssohn-Rosenthal, est une inflammation granulomateuse rare de cause inconnue dont il existe un équivalent génital encore plus rare. Nous en décrivons un cas, avec son évolution sur douze années.ObservationUne femme de 27 ans présentait des poussées d'œdème vulvaire unilatéral, régressives au début puis aboutissant au fil du temps à des tuméfactions permanentes, vulvaire et périnéale. Les prélèvements histologiques montraient des granulomes histiocytaires épithélioïdes, si discrets qu'ils étaient passés inaperçus au début de l'évolution. L'œdème demeurait un signe isolé pendant douze ans et deux bilans digestifs à la recherche d'une maladie de Crohn étaient négatifs, permettant d'écarter ce diagnostic.DiscussionLa vulvite granulomateuse de type Miescher est un diagnostic d'élimination, essentiellement de la maladie de Crohn. Notre observation illustre la difficulté du diagnostic de cette pathologie rare et les incertitudes concernant sa physiopathologie. Le diagnostic impose de savoir répéter les prélèvements et pratiquer des biopsies profondes avec des niveaux de coupes répétés pour identifier les granulomes paravasculaires caractéristiques, parfois très discrets.BackgroundMiescher's cheilitis, whether occurring alone or as part of Melkersson-Rosenthal syndrome, is a rare type of granulomatous inflammation of unknown cause with an even rarer genital equivalent. Herein, we describe a case of the latter condition developing over a 12-year period.Patients and methodsA 27-year-old woman presented episodes of unilateral vulvar oedema, which initially regressed but resulted over time in permanent vulvar and perineal tumefaction. Histology revealed epithelioid histocytic granulomas so mild that they were not noticed at the start of the disease. The oedema remained the sole sign for 12years and two gastrointestinal screening tests for Crohn's disease proved negative, diagnosis of the latter condition was ruled out.DiscussionMiescher's granulomatous vulvitis requires differential diagnosis, essentially with regard to Crohn's disease. Our case illustrates the difficulty in diagnosing this rare disease as well as the uncertainties surrounding its physiopathology. Diagnosis rests upon repeated sampling and biopsies with repeated levels of sections in order to identify the characteristic perivascular granulomas, which may be very mild.

Exposure to Wood Dust, Microbial Components, and Terpenes in the Norwegian Sawmill Industry

Abstract

Sawmill workers are exposed to wood dust (a well-known carcinogen), microorganisms, endotoxins, resin acids (diterpenes), and vapours containing terpenes, which may cause skin irritation, allergy, and respiratory symptoms including asthma. The health effects of most of these exposures are poorly understood as most studies measure only wood dust. The present study assessed these exposures in the Norwegian sawmill industry, which processes predominantly spruce and pine. Personal exposures of wood dust, resin acids, endotoxin, fungal spores and fragments, mono-, and sesquiterpenes were measured in 10 departments in 11 saw and planer mills. The geometric mean (GM) and geometric standard deviation (GSD) thoracic exposures were: 0.09 mg m⁻³ dust (GSD 2.6), 3.0 endotoxin units (EU) m⁻³ (GSD 4.9), 0.4 × 10⁵ fungal spores m⁻³ (GSD 4.2), 2 × 10⁵ fungal fragments m⁻³ (GSD 3.2), and 1560 ng m⁻³ of resin acids (GSD 5.5). The GM (GSD) inhalable exposures were: 0.72 mg m⁻³ dust (2.6), 17 EU m⁻³ (4.3), 0.4 × 10⁵ fungal spores m⁻³ (3.8), and 7508 ng m⁻³ (4.4) of resin acids. The overall correlation between the thoracic and inhalable exposure was strong for resin acid (r_p = 0.84), but moderate for all other components (r_p = 0.34–0.64). The GM (GSD) exposure to monoterpenes and sesquiterpenes were 1105 µg m⁻³ (7.8) and 40 µg m⁻³ (3.9), respectively. Although mean exposures were relatively low, the variance was large, with exposures regularly exceeding the recommended occupational exposure limits. The exposures to spores and endotoxins were relatively high in the dry timber departments, but exposures to microbial components and mono-and sesquiterpenes were generally highest in areas where green (undried) timber was handled. Dust and resin acid exposure were highest in the dry areas of the sawmills. Low to moderate correlation between components (r_p ranging from 0.02 to 0.65) suggests that investigations of exposure–response associations for these components (both individually and combined) are feasible in future epidemiological studies.

Performance Comparison of Field Portable Instruments to the Scanning Mobility Particle Sizer Using Monodispersed and Polydispersed Sodium Chloride Aerosols

Abstract

This study compared the performance of the following field portable aerosol instrument sets to performance of the reference Scanning Mobility Particle Sizer (SMPS): the handheld CPC-3007, the portable aerosol mobility spectrometer (PAMS), the NanoScan scanning mobility particle sizer (NanoScan SMPS) combined with an optical particle sizer (OPS). Tests were conducted with monodispersed and polydispersed aerosols. Monodispersed aerosols were controlled at the approximate concentration of 1 × 10⁵ particles cm⁻³ and four monodispersed particle sizes of 30, 60, 100, and 300 nm were selected and classified for the monodispersed aerosol test, while three different steady-state concentration levels (low, medium, and high: ~8 × 10³, 5 × 10⁴, and 1 × 10⁵ particles cm⁻³, respectively) were selected for the polydispersed aerosol test. For all four monodispersed aerosol sizes, particle concentrations measured with the NanoScan SMPS were within 13% of those measured with the reference SMPS. Particle concentrations measured with the PAMS were within 25% of those measured with the reference SMPS. Concentrations measured with the handheld condensation particle counter were within 30% of those measured with the reference SMPS. For the polydispersed aerosols, the particle sizes and concentrations measured with the NanoScan-OPS compared most favorably with those measured with the reference SMPS for three different concentration levels of low, medium, and high (concentration deviations ≤10% for all three concentration levels; deviations of particle size ≤4%). Although the particle-size comparability between the PAMS and the reference SMPS was quite reasonable with the deviations within 10%, the polydispersed particle concentrations measured with the PAMS were within 36% of those measured with the reference SMPS. The results of this evaluation will be useful for selecting a suitable portable device for our next workplace study phase of respiratory protection assessment. This study also provided the advantages and limitations of each individual portable instrument and therefore results from this study can be used by industrial hygienists and safety professionals, with appropriate caution, when selecting a suitable portable instrument for aerosol particle measurement in nanotechnology workplaces.

Differential diagnostic significance of epithelial and stromal CD10 expression in tumors of trichogenic origin

JDDG: Journal der Deutschen Dermatologischen Gesellschaft, Volume 16, Issue 6, Page 719-728, June 2018.

Journal‐Club

JDDG: Journal der Deutschen Dermatologischen Gesellschaft, Volume 16, Issue 6, Page 815-815, June 2018.

In Memoriam Professor Dr. Dr. h. c. mult. Otto Braun‐Falco

JDDG: Journal der Deutschen Dermatologischen Gesellschaft, Volume 16, Issue 6, Page 817-818, June 2018.

Differenzialdiagnostische Bedeutung epithelialer und stromaler CD10‐Expression in Tumoren trichogenen Ursprungs

JDDG: Journal der Deutschen Dermatologischen Gesellschaft, Volume 16, Issue 6, Page 719-729, June 2018.

ÖGDV Preisträger stellen sich vor: Der Österreichische Dermatologenpreis – Unilever Preis 2017 ging an Dr. Stefan Blunder aus Innsbruck

JDDG: Journal der Deutschen Dermatologischen Gesellschaft, Volume 16, Issue 6, Page 816-816, June 2018.

S3‐Leitlinie zur Therapie der Psoriasis vulgaris Update – Kurzfassung Teil 2 – Besondere Patientengruppen und spezielle Behandlungssituationen

JDDG: Journal der Deutschen Dermatologischen Gesellschaft, Volume 16, Issue 6, Page 806-814, June 2018.

Tumoren der Kopfhaut

JDDG: Journal der Deutschen Dermatologischen Gesellschaft, Volume 16, Issue 6, Page 730-754, June 2018.

Impact of red versus blue light on tolerability and efficacy of PDT: a randomized controlled trial

JDDG: Journal der Deutschen Dermatologischen Gesellschaft, Volume 16, Issue 6, Page 711-717, June 2018.

Einfluss von Rot‐ versus Blaulicht auf Verträglichkeit und Wirksamkeit der PDT: eine randomisierte kontrollierte Studie

JDDG: Journal der Deutschen Dermatologischen Gesellschaft, Volume 16, Issue 6, Page 711-718, June 2018.

Scalp tumors

JDDG: Journal der Deutschen Dermatologischen Gesellschaft, Volume 16, Issue 6, Page 730-753, June 2018.

What is psoriasis? – Perception and assessment of psoriasis among the German population

JDDG: Journal der Deutschen Dermatologischen Gesellschaft, Volume 16, Issue 6, Page 703-710, June 2018.

Pachyonychie eines Zehnagels bei einem Kind

JDDG: Journal der Deutschen Dermatologischen Gesellschaft, Volume 16, Issue 6, Page 794-797, June 2018.

Mehrere erworbene pigmentierte Läsionen bei einem Patienten mit Melanom

JDDG: Journal der Deutschen Dermatologischen Gesellschaft, Volume 16, Issue 6, Page 791-793, June 2018.

Erythematous atrophic, sharply demarcated plaques with comedo‐like follicular hyperkeratoses, tense blisters and crusts on the extensor aspects of the lower extremities

JDDG: Journal der Deutschen Dermatologischen Gesellschaft, Volume 16, Issue 6, Page 802-804, June 2018.