Impacts des mesures de prévention secondaire et de dépistage sur le comportement des patients atteints de mélanome (étude rétrospective sur 189 mélanomes chez 185 patients diagnostiqués entre 1998 et 2001 dans le service de dermatologie du CHU [centre hospitalier universitaire] de Poitiers)

POITIERS-BU Médecine pharmacie (861942103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Lymphangiomes kystiques de l'enfant (Etude rétrospective de 46 cas)

TOURS-BU Médecine (372612103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Anomalies du bilan hépatique chez les malades psoriasiques (étude rétrospective de 27 cas)

POITIERS-BU Médecine pharmacie (861942103) / SudocSudocFranceF

Carcinome épidermoïde cutané d'évolution fatale (particularités cliniques, histopathologiques et immunohistochimiques)

POITIERS-BU Médecine pharmacie (861942103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Mastocytose et intolérance alimentaire (37 patients)

Contexte : L'étude menée par l'association française pour les initiatives de recherche sur le mastocyte et la mastocytose (AFIRMM) en 2008 rapporte une prévalence de 61% des intolérances / allergies alimentaires sur 363 patients porteurs de mastocytose. Dans la population générale, la prévalence est estimée à 17% Objectifs : Evaluer la prévalence des intolérances alimentaires dans une population de patients atteints de mastocytose, identifier des facteurs prédictifs d'intolérance alimentaire aux aliments riches en histamine et histamino-libérateurs, déterminer des conseils alimentaires adaptés lors du diagnostic initial. Matériels et méthodes : Une étude prospective monocentrique a été réalisée dans le service de dermatologie du CHU de Poitiers de 2008 à 2012. Si le patient déclarait au moins une intolérance alimentaire, il devait remplir un questionnaire portant sur les effets (cutanés, digestifs, généraux) de 20 aliments histamino-libérateurs ou riche en histamine connus pour leur capacité à déclencher des manifestations en lien avec la dégranulation mastocytaire. Résultats : 37 patients ont été inclus. 54% des patients se déclaraient intolérants à au moins un aliment. dans le groupe intolérant, le taux de tryptase moyen était de 57,86 g/l; 95% des patient avaient une mastocytose systématique et 80% une atteinte digestive (fonctionnelle ou endoscopique). Dans le groupe tolérant, le taux de tryptase moyen était de 30,49 g/l. 59% des patients avaient une mastocytose cutanée pure. 78% des patients étaient intolérants à l'alcool. On remarque que les intolérances rapportées par l'alcool sont dominées par les manifestations cutanées (urticaire, prurit) et générale (flush, sensation de malaise). Il existe une différence significative entre les 2 groupes. Un taux de tryptase inférieur à 27 g/l est prédictif de l'absence d'intolérance alimentaire au risque 5%. Un taux de tryptase supérieur à 50 est prédictif de la présence d'une intolérance alimentaire au risque 5%. La mastocytose systémique est associée à un risque très élevé d'intolérance alimentaire. La présence d'une atteinte digestive spécifique de la mastocytose est également un facteur de risque. Conclusion : Une mastocytose systémique, une atteinte digestive, un taux de tryptase supérieur à 50 g/l sont prédictifs d'une intolérance alimentaire. En revanche, en présence d'une mastocytose cutanée et d'un taux de tryptase inférieur à 27 g/l, les consignes d'éviction de certains aliments ne sont pas utiles. L'alcool semble être très pourvoyeur de manifestations paroxystiques.POITIERS-BU Médecine pharmacie (861942103) / SudocSudocFranceF

Les dermites granulomateuses interstitielles (rôle des médicaments)

POITIERS-BU Médecine pharmacie (861942103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

A high neutrophil-to-lymphocyte ratio as a potential marker of mortality in patients with Merkel cell carcinoma: A retrospective study

The prognostic relevance of a high blood neutrophil-to-lymphocyte ratio (NLR) has been reported in many cancers, although, to our knowledge, not investigated in patients with Merkel cell carcinoma (MCC) to date.We assessed whether the NLR at baseline was associated with specific survival and recurrence-free survival in MCC.We retrospectively included MCC cases between 1999 and 2015 and collected clinical data, blood cell count at baseline, and outcome. A Cox model was used to identify factors associated with recurrence and death from MCC.Among the 75 patients included in the study, a high NLR at baseline (NLR ≥4) was associated with death from MCC in univariate (hazard ratio 2.76, 95% confidence interval 1.15-6.62, P = .023) and multivariate (hazard ratio 3.30, 95% confidence interval 1.21-9.01, P = .020) analysis, but not with recurrence.Because of the retrospective design, we excluded patients with missing data and not all confounding factors that may influence the NLR were available.A high NLR at baseline was independently associated with specific mortality in patients with MCC. The NLR seems to constitute an easily available and inexpensive prognostic biomarker at baseline

Narrow resection margins are not associated with mortality or recurrence in patients with Merkel cell carcinoma: a retrospective study

International audienceBackground: Wide local excision constitutes the standard of care for Merkel cell carcinoma, but the optimal margin width remains controversial.Objectives: To assess whether narrow margins (0.5 - 1 cm) were associated with outcome.Methods: Patients were recruited from a retrospective French multicentric cohort and included if they had had excision of primary tumor with minimum lateral margins of 0.5 cm. Factors associated with mortality and recurrence were assessed by multivariate regression.Results: Among the 214 patients included, 58 (27.1%) had undergone excision with narrow margins (0.5-1cm) versus 156 (72.9%) with wide margins (>1cm). During a median follow-up of 50.7 months, cancer-specific survival did not differ between groups [5-year specific survival rate 76.8% (95% CI 61.7-91.9) and 76.2% (95% CI 68.8-83.6)]. Overall survival, any recurrence-free survival and local recurrence-free survival did not significantly differ between groups. Cancer-specific mortality was associated with age, male sex, AJCC stage III, positive margins.Limitations: Retrospective design, heterogenous baseline characteristics between groups.Conclusion: Excision with narrow margins was not associated with outcome in this cohort, in which most patients had clear margins and post-operative radiation therapy. Residual tumor, mostly found on deep surgical margins, was independently associated with prognosis

Impact of adjuvant radiation therapy on survival and recurrence in patients with stage I-III Merkel cell carcinoma: A retrospective study of 312 patients

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Skin inflammatory response and efficacy of anti-epidermal growth factor receptor therapy in metastatic colorectal cancer (CUTACETUX)

International audienceAnti-epidermal growth factor receptor (EGFR) monoclonal antibody is a standard treatment of metastatic colorectal cancer (mCRC) and its most common adverse effect is a papulopustular acneiform rash. The aim of the CUTACETUX study was to characterize the skin inflammatory response associated with this rash and its relation to treatment efficacy.This prospective study included patients with mCRC treated with first-line chemotherapy plus cetuximab. Patients underwent skin biopsies before the initiation of cetuximab (D0) and before the third infusion (D28), one in a rash zone and one in an unaffected zone. Expression of Th17-related cytokines (IL-17A, IL-21, IL-22), antimicrobial peptides (S100A7 and BD-2), innate response-related cytokines (IL-1 beta, IL-6, TNF-alpha and OSM), T-reg-related cytokines (IL-10 and TGF-beta), Th1-related cytokine (IFN-gamma), Th2-related cytokine (IL-4), Thymic stromal lymphopoietin and keratinocyte-derived cytokines (IL-8, IL-23 and CCL20) were determined by RT-PCR.Twenty-seven patients were included. Levels of most of the cytokines increased at D28 in the rash zone compared to D0. No significant association was observed between variations of cytokines levels and treatment response in the rash zone and only the increase of IL-4 (p = .04) and IL-23 (p = .02) levels between D0 and D28 in the unaffected zone was significantly associated with treatment response. Increased levels of IL-8 (p = .02), BD-2 (p = .02), IL-1 beta (p = .004) and OSM (p = .02) in the rash zone were associated with longer progression-free survival.Expression of Th2-related and keratinocyte-derived cytokines in the skin was associated with anti-EGFR efficacy. If this inflammatory signature can explain the rash, the exact mechanism by which these cytokines are involved in anti-EGFR tumor response remains to be studied