Update on vitamin D and evaluation of vitamin D status.

Knowledge about vitamin D has greatly improved during the last few years. Vitamin D cannot any more be considered as exclusively necessary to prevent ricket/osteomalacia. Its role in the prevention of some osteoporotic fractures in the elderly (in association with calcium nutrition) is now well demonstrated and many epidemiologic and laboratory data argue for a role in the prevention of several diseases or anomalies (cancer, auto-immune diseases, cardiovascular events, sarcopenia...). A few intervention studies confirming some of these effects also exist. Vitamin D status can easily be assessed by measuring serum 25 hydroxy vitamin D (25OHD) level. However, many experts have claimed that the population-based reference values for 25OHD are too low and that the cut-off value below which vitamin D insufficiency can be present is somewhere between 20 and 40ng/mL with a clear tendency to target values above 30ng/mL (75nmol/L). The main consequences are that vitamin D insufficiency is highly frequent whereas the currently recommended supplementation doses are not sufficient

Merkel Cell Polyomavirus Strains in Patients with Merkel Cell Carcinoma

We investigated whether Merkel cell carcinoma (MCC) patients in France carry Merkel cell polyomavirus (MCPyV) and then identified strain variations. All frozen MCC specimens and 45% of formalin-fixed and paraffin-embedded specimens, but none of the non-MCC neuroendocrine carcinomas specimens, had MCPyV. Strains from France and the United States were similar

Cutaneous consequences of environmental changes

National audienceThe skin is normally well protected against a majority of substances. Ultraviolet rays play an essential role in the occurrence of cancer and skin aging. There are numerous pollutants, which act on the skin or enter the body through the skin. The new lifestyle entails new risks. We must be vigilant but also avoid unjustified peremptory opinions scientifically unproven

The CONSORT statement (CONsolidated Standards Of Reporting Trials)

National audienceThe CONSORT group, made up in particular of methodologists and journal editors, has created a tool in the form of a list. This tool, known as the "CONSORT statement", sets out all items that must be reported when preparing for publication in medical journals with regard to methods, results and discussion of randomised controlled trials (RCT). The aim of this group and of the CONSORT statement is to help authors prepare a standard presentation of the methodology and results of their studies. The desired effect is to ensure greater transparency and optimal rigor in such presentations, and thus in study design. This will make it easier for readers to verify such studies and to assess any potential sources of study bias. (C) 2013 Elsevier Masson SAS. All rights reserved

Parameatal cyst in a 4-year-old boy

International audienceA 4-year-old boy presented a translucent cyst on the left lateral side of the urethral meatus. The lesion was excised. Histological examination showed features of a cystic lesion within the dermis surrounded by a thin epithelium of columnar cells with a round apical pole. Immunohistochemical staining was positive for pan-cytokeratins (AE-1/AE-3) and negative for actin. These findings led to a diagnosis of urethral parameatal cyst. In conclusion: this entity is a rare congenital malformation and consists of a parameatal benign cyst occurring in prepubertal males. Treatment consists of complete resection of the cyst

Giant congenital naevus

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Diffuse Linear and Whorled Nevoid Hypermelanosis in a Newborn

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Angiosarcoma as a potential consequence of autologous lymph node transplantation for lymphoedema

International audienceWith high interest have we read the article by Vignes et al., recording complications (lymphoedema, lymphocoele, hydrocoele and donor-site pain) in patients undergoing autologous lymph node transplantation (ALNT) for limb lymphoedema.1 In addition, we recently witnessed a fatal case of angiosarcoma in a 21-year-old woman. We were amazed by the unusual presentation of this aggressive tumour in such a young otherwise healthy woman, located in the right groin exactly at the site of ALNT performed 14 and 7 years before

Comparative effectiveness of topical drugs in dermatologic priority diseases: geometry of randomized trial networks

Among the 100 initial priority topics for comparative effectiveness research, three concern topical drugs in the following dermatologic diseases: psoriasis, chronic lower-extremity wounds (CLEWs), and acne vulgaris (AV). Our objective was to explore the geometry of the corresponding networks of randomized controlled trials (RCTs). We performed a review of RCTs on topical drugs in psoriasis, CLEWs, and AV. We searched MEDLINE, Embase, and CENTRAL for published trials from 2007 to 2012 and ClinicalTrials.gov for unpublished trials registered since 2011. RCTs comparing at least one topical treatment with any active or inactive comparator, regardless of RCT design and outcomes, were eligible. We produced network graphs (each node representing a treatment and links between nodes representing trials) and tested for co-occurrence (preference or avoidance of specific comparisons). We included 60 RCTs on psoriasis (14,255 patients) and 19 registered RCTs, 50 of CLEWs (5,916 patients) and 7 registered RCTs, and 90 of AV (22,984 patients) and 21 registered RCTs. Head-to-head comparisons were made in 78%, 32%, and 57% of published RCTs of these conditions, respectively. The co-occurrence test suggested that no specific head-to-head comparison was significantly preferred or avoided (P-value=0.53, 0.20, and 0.57, respectively). This study has limitations, the main being that the search period was restricted to 5 years. In conclusion, more comparative effectiveness trials are needed for CLEWs, for which head-to-head comparisons are fewer than those for psoriasis and AV

Angiomes superficiels : traitements

Article in pressNational audienceBeta-blockers are efficient for treating complicated infantile hemangiomas; propranolol is currently the first-line treatment. Superficial vascular malformations have to be managed by multidisciplinary teams. T2 FAT-SAT MRI is the most interesting sequence to explore superficial vascular malformations. Recent advances in molecular biology allow exploring new genetic mutations which could be involved in vascular malformations and be the target of new drugs. Mammalian target of rapamycin (mTOR) inhibitors are promising drugs for slow-flow malformations. Arteriovenous malformations are aggressive lesions with very few treatment options.Les bêta-bloquants sont très efficaces dans le traitement des hémangiomes infantiles compliqués ; le propanolol constitue aujourd'hui le traitement de première ligne. La prise en charge des patients porteurs de malformations vasculaires superficielles doit se faire en consultation pluridisciplinaire dans un centre de référence ou de compétence. La séquence IRM T2 avec saturation de graisse (T2 FAT-SAT) est la séquence de choix pour l'exploration des malformations vasculaires par imagerie en coupe. Les progrès réalisés en biologie moléculaire ont permis d'identifier de nouvelles mutations génétiques potentiellement impliquées dans la survenue de malformations vasculaires, qui pourront être la cible de nouvelles thérapeutiques. Les études récentes sont marquées par l'intérêt porté aux inhibiteurs de mammalian target of rapamycin (mTOR) dans la prise en charge des malformations vasculaires à flux lents. Les malformations artério-veineuses sont des lésions vasculaires à haut débit, très agressives pour lesquelles les traitements disponibles aujourd'hui sont encore limités