Revue des pathologies dermatologiques de la population pédiatrique d un CHU (intérêt d une étroite collaboration entre pédiatres et dermatologues)

Objectif : Décrire la population pédiatrique du CHU de Grenoble consultant pour raison dermatologique ou présentant une pathologie dermatologique intercurrente lors d une hospitalisation et étudier la fréquence et les motifs de recours à un dermatologue par les pédiatres. Patients et méthodes : Etude prospective sur 6 mois colligeant les pathologies dermatologiques chez les enfants ambulatoires et hospitalisés des services de pédiatrie et de dermatologie. Résultats : 1012 venues enregistrées. Le service des urgences pédiatriques (UP) regroupe 55% des inclusions, soit 8% de son activité globale. 28% des inclusions ont été réalisées dans le service de dermatologie et 15% à la maternité. Aux UP, les 3 diagnostics les plus fréquents sont l urticaire, les piqûres d insectes et les lésions virales aspécifiques. Une hospitalisation a été nécessaire pour 12,4% des consultants des UP. Une consultation spécialisée de dermatologie a été demandée pour 10% des enfants du département de pédiatrie pour aide diagnostique et thérapeutique. Pour les enfants vus dans le service de dermatologie, les diagnostics principaux sont les naevus, la dermatite atopique et les hémangiomes. Dans ce secteur, 26% des consultations étaient demandées par le département de pédiatrie. Conclusion : D étiologie et de gravité variables, les pathologies dermatologiques représentent un motif de consultation fréquent en pédiatrie. Les pédiatres ont recours à un dermatologue dans un nombre non négligeable de cas soulignant l importance d une bonne formation et d une collaboration étroite entre pédiatres et dermatologues pour une prise en charge optimale de l enfant.Objective : Description of a group of children, aged under 15 years and 3 months old, outpatients or inpatients presenting a dermatologic disease, at the Grenoble Teaching Hospital, and study of the motivations of pediatricians requests to dermatologists and the frequency of their collaboration. Patients and methods : Prospective study carried out over 6 months from May 17th to November 17th 2011 including all the dermatologic diseases of outpatients and inpatients seen in pediatric and dermatologic departments. Results : 1012 consultations were registered in different activity centers. The Pediatric Emergency Department (PED) represents 55% of all the inclusions and 8% of its global activity. Dermatologic department is about 28% and dermatologic disease in maternity 15% of inclusions. The 3 most frequent diagnostics in PED are hives, insect bites and nonspecific viral eruption. Hospitalisation was necessary in 12.4% cases. There was no death based on any dermatologic pathology. A dermatologic consultation was requested in PED for 10% of patients to help with diagnostic and treatment. In the dermatology department, the most frequent diagnostics have been nevus, atopic dermatitis and hemangioma. In this sector, 26% of the consultations were asked by PED. Conclusion : Dermatologic diseases, of very different etiology and variable severity, represent a major motivation for consultation, thus leading pediatricians to frequently turn to dermatologic advice. Hospitalisation is often needed. This study underlines the necessity to proceed to a good training and create a close collaboration between pediatricians and dermatologists, which is key to obtain the best care for children.GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF

Acrodermatite entéropathique et syndromes apparentés (à propos d'un cas de pseudo-acrodermatite entéropathique lié à un déficit en isoleucine)

GRENOBLE1-BU Médecine pharm. (385162101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Étude rétrospective de 105 cas de lymphomes cutanés primitifs suivis au CHU de Grenoble entre 1997 et 2008 (caractéristiques épidémiologiques, anatomocliniques, évolutives et évaluation de nos pratiques cliniques)

Les lymphomes cutanés primitifs (PCL) constituent un secteur de la dermatologie en pleine évolution avec l établissement récent de référentiels de prise en charge. Le but de cette étude était de faire un état des lieux des PCL suivis au CHU de Grenoble entre 1997 et 2008 et d évaluer nos pratiques cliniques. Nous avons recensé 105 PCL et noté une augmentation du nombre annuel de diagnostics depuis 2006. L âge médian au diagnostic était de 60 ans avec une prédominance masculine. Comme dans les articles de référence, les lymphomes T, notamment les mycosis fungoïdes (MF) (62%), étaient les plus représentés. Le délai diagnostique médian des MF (12 mois) était plus court que celui habituellement rapporté dans la littérature et la plupart (92%) était diagnostiquée à un stade précoce. La moitié des papuloses lymphomatoïdes était associée à une autre pathologie lymphoïde. La majorité des PCL bénéficiait d un traitement local en première intention, en accord avec les recommandations actuelles, permettant une rémission complète dans 50% des cas. Dix pour cents des patients décédaient de leur maladie. Nous avons montré un meilleur suivi des recommandations de prise en charge des PCL depuis 2007, en partie grâce à l intégration du CHU de Grenoble au Groupe Français d Etude des Lymphomes Cutanés et à la création d une réunion de concertation pluridisciplinaire locale. Toutefois, des insuffisances persistent dans l évaluation clinique et paraclinique initiale des patients et nous proposons l utilisation de fiches de bilan standardisées pour y remédier.GRENOBLE1-BU Médecine pharm. (385162101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Characterisation of organic matter from organo-mineral complexes in an Andosol from Reunion Island

International audienceOrgano-mineral complexes play a major role in the stabilisation of organic matter (OM) within soils, but only few data are presently available about the nature of the OM bound to mineral phases. In this study, we aimed at determining the nature of the OM present in various organo-mineral complexes in a tropical soil (Andosol). Organo-mineral complexes were isolated thanks to densimetric separation techniques. The mineral phases of organo-mineral complexes were identified using XRD, and OM was analysed by Py-GC-MS after carbon enrichment obtained through 5% hydrofluoric acid hydrolysis.We thus studied OM bound to poorly crystallised aluminosilicates (PC-AlSi), gibbsite and iron oxides, as well as free-OM (<1.9 g cm(-3) fraction), which represents OM that is not bound to mineral phases. In the organo-mineral complexes of the studied Andosol, lipids were mainly present with PC-AlSi while polysaccharides and proteins/amino acids were the main organic compounds associated with gibbsite. Lignin compounds were found in high quantities in free-OM but were not found in organo-mineral complexes. Only few organic compounds were bound to iron oxides. Furthermore, proteins/amino acids and lipids were also observed in all organo-mineral complexes, but polysaccharides were not. The present results show that mineral phase type influences not only the proportion but also the nature of the organic compounds present in organo-mineral complexes. This study provides new information about the nature of the OM bound to mineral phases, and will thus contribute to improving models of organo-mineral complexes in order to better understand OM stabilisation in soils

Exogenous human herpesvirus 6 reinfection after tumor-infiltrating T-lymphocyte therapy

International audienceExogenous human herpes virus 6 (HHV-6) reinfection has never been reported in patients receiving tumor-infiltrating T lymphocytes therapy. We report an unusual case of HHV-6 infection following infusion of HHV-6 infected autologous T lymphocytes. HHV-6 infection could interfere with the tumor antigen immune recognition and the efficacy of immunotherapy

An innovative plasmacytoid dendritic cell line-based cancer vaccine primes and expands antitumor T-cells in melanoma patients in a first-in-human trial.

The efficacy of immune checkpoint inhibitors has been shown to depend on preexisting antitumor immunity; thus, their combination with cancer vaccines is an attractive therapeutic approach. Plasmacytoid dendritic cells (PDC) are strong inducers of antitumor responses and represent promising vaccine candidates. We developed a cancer vaccine approach based on an allogeneic PDC line that functioned as a very potent antigen-presenting cell in pre-clinical studies. In this phase Ib clinical trial, nine patients with metastatic stage IV melanoma received up to 60 million irradiated PDC line cells loaded with 4 melanoma antigens, injected subcutaneously at weekly intervals. The primary endpoints were safety and tolerability. The vaccine was well tolerated and no serious vaccine-induced side effects were recorded. Strikingly, there was no allogeneic response toward the vaccine, but a significant increase in the frequency of circulating anti-tumor specific T lymphocytes was observed in two patients, accompanied by a switch from a naïve to memory phenotype, thus demonstrating priming of antigen-specific T-cells. Signs of clinical activity were observed, including four stable diseases according to IrRC and vitiligoïd lesions. Four patients were still alive at week 48. We also demonstrate the in vitro enhancement of specific T cell expansion induced by the synergistic combination of peptide-loaded PDC line with anti-PD-1, as compared to peptide-loaded PDC line alone. Taken together, these clinical observations demonstrate the ability of the PDC line based-vaccine to prime and expand antitumor CD8+ responses in cancer patients. Further trials should test the combination of this vaccine with immune checkpoint inhibitors

A Single-Arm Phase II Trial of Lenalidomide in Relapsing or Refractory Primary Cutaneous Large B-Cell Lymphoma, Leg Type

International audienc