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Misery L.,Hopital University | Sibaud V.,Laboratoires Dermatologiques Avene | Merial-Kieny C.,Laboratoires Dermatologiques Avene | Taieb C.,Pierre Fabre
International Journal of Dermatology | Year: 2011

Introduction Sensitive skin is a complex dermatological condition, defined by abnormal sensory symptoms. The aim of this epidemiological survey was to assess the prevalence of sensitive skin and collect data on sensitive skin in the US population. Methods A phone survey was conducted in the USA by a poll institute in 2007. A sample was drawn from a representative national cohort of the American population at least 18years of age through the quota method. Data on demographic characteristics, environmental and climatic factors, skin characteristics, dermatological disorders, cosmetics use, and visits to the dermatologist were collected. Results Of 994 subjects who answered (495 men and 499 women), 44.6% declared having "sensitive" or "very sensitive" skin. Women were more concerned than men (50.9% vs. 38.2%, P<0.0001). There was no significant difference related to geographic localization, age, or ethnic distribution. Subjects with sensitive skin had mainly dry (34.5%) or mixed skin (35.7%), fair phototypes, dermatological disorders, higher skin reactivity to cosmetics and various environmental factors in comparison with subjects who stated having only a "slightly" sensitive or not sensitive skin. The dermatologist had a strong influence on subjects with "sensitive" or "very sensitive" skin through the prescription of skin care products. Conclusion This study, based on a representative sample of the American population, reveals a high prevalence of sensitive skin in the USA. Sensitive skin is mainly associated with dry skin, fair phototype, reactivity to climatic and environmental factors, and cosmetics. American dermatologists seem largely involved in the care of this condition. © 2011 The International Society of Dermatology. Source

Godot C.,Service dOnco Hematologie pediatrique | Patte C.,Institute Gustave Roussy | Blanche S.,Service dImmuno hematologie Pediatrique | Rohrlich P.,Hopital University | And 3 more authors.
Journal of Pediatric Hematology/Oncology | Year: 2012

Chronic HIV infection leads to increased risk of non-Hodgkin B-cell lymphoma. However, only few recent data are available about their current management and prognosis in HIV-infected children since the advent highly active antiretroviral therapy (HAART). This multicenter retrospective study describes the 12 cases of B-cell non-Hodgkin lymphoma diagnosed in HIV-infected children in France between 1996 and 2009. All children had moderate to severe immunosuppression and high viral load at the time of diagnosis. Nine children had extracerebral primary sites and 3 had a primary central nervous system lymphoma. Eight patients had Burkitt lymphoma; 4 had diffuse large B-cell lymphoma. Concomitantly with HAART, all children with extracerebral lymphoma received intensive chemotherapy according to LMB protocol, those with primary central nervous system lymphoma received high-dose methotrexate. No toxicity-related deaths occurred. Ten patients entered complete remission (CR), 2 died of tumor progression despite a second line of therapy. No relapses occurred after CR (median follow-up, 72 mo). Thus, prognosis of patients unresponsive to first-line lymphoma treatment remains poor, but relapse seems to be rare when CR is achieved. Children without severe comorbidities can tolerate intensive chemotherapy with a mandatory HAART treatment, taking into account drug interactions. Copyright © 2012 by Lippincott Williams &Wilkins. Source

Ades L.,University of Paris 13 | Ades L.,French Institute of Health and Medical Research | Guerci A.,University of Lorraine | Raffoux E.,University Paris Diderot | And 23 more authors.
Blood | Year: 2010

Acute promyelocytic leukemia (APL) is highly curable with the combination of all-trans retinoic acid (ATRA) and anthracycline-based chemotherapy (CT), but very long-term results of this treatment, when CT should be added to ATRA and the role of maintenance treatment, remain uncertain. In our APL93 trial that included 576 newly diagnosed APL patients, with a median follow-up of 10 years, 10-year survival was 77%. Maintenance treatment significantly reduced 10-year cumulative incidence of relapses, from 43.2% to 33%, 23.4%, and 13.4% with no maintenance, maintenance using intermittent ATRA, continuous 6 mercaptopurine plus methotrexate, and both treatments, respectively (P < .001). Maintenance particularly benefited patients with white blood cell (WBC) count higher than 5 × 109/L (5000/μL). Early addition of CT to ATRA significantly improved 10-year event-free survival (EFS), but without significant effect on overall survival (OS). The 10-year cumulative incidence of deaths in complete response (CR), resulting mainly from myelosuppression, was 5.7%, 15.4%, and 21.7% in patients younger than 55, 55 to 65, and older than 65 years, respectively, supporting the need for less myelosuppressive treatments, particularly for consolidation therapy. This study is registered at http://clinicaltrials.gov as NCT00599937. © 2010 by The American Society of Hematology. Source

In current psychoanalytical perspectives, one of the central axes of development at adolescence is envisaged as a subjective process of appropriation which can only be conceived as a second period of preliminary deconstruction. Deconstruction is often experienced by adults, and secondarily by the adolescents themselves as violent, although this violence, which is deeply structuring, constitutes a condition of psychic growth and authentic personal development above all else. In fact, it responds to the violence which is inherent in the primary narcissistic contract. The distinction between deconstruction and destructiveness constitutes a condition of appreciation of the dynamics at play during adolescence which preserve their potential for vitality and creativity as well as they can. From this point of view, on the level of psychoanalytical theory, it is important to dispel the confusion introduced by Freud beginning in 1920 between the processes of bonding-debonding, an inherent part of development and of thought, from the range of destructiveness. The movements of deconstruction at adolescence concern the body, the connections to parents and the modalities of relationships to social structures. They can be hindered by the limitations linked to capacities specific to adolescence as well as to different forms of taboos. They can also deteriorate in the direction of destructiveness. In this respect, the differentiation between movements of deconstruction which attempt to transform objectal links and those which aim to abolish them is important on the clinical and therapeutic levels. This difference is illustrated by the comparison between two films dealing with adolescent revolt, Rebel without a Cause and Into the Wild. Source

Cottin V.,Hospices Civils de Lyon | Nunes H.,Hopital Avicenne and Assistance Publique Hopitaux de Paris | Mouthon L.,University of Paris Descartes | Gamondes D.,Hopital Louis Pradel | And 6 more authors.
Arthritis and Rheumatism | Year: 2011

Objective Connective tissue diseases (CTDs) are associated with several interstitial lung diseases. The aim of this study was to describe the recently individualized syndrome of combined pulmonary fibrosis and emphysema (CPFE) in a population of patients with CTD. Methods In this multicenter study, we retrospectively investigated data from patients with CTD who also have CPFE. The demographic characteristics of the patients, the results of pulmonary function testing, high-resolution computed tomography, lung biopsy, and treatment, and the outcomes of the patients were analyzed. Results Data from 34 patients with CTD who were followed up for a mean ± SD duration of 8.3 ± 7.0 years were analyzed. Eighteen of the patients had rheumatoid arthritis (RA), 10 had systemic sclerosis (SSc), 4 had mixed or overlap CTD, and 2 had other CTDs. The mean ± SD age of the patients was 57 ± 11 years, 23 were men, and 30 were current or former smokers. High-resolution computed tomography revealed emphysema of the upper lung zones and pulmonary fibrosis of the lower zones in all patients, and all patients exhibited dyspnea during exercise. Moderately impaired pulmonary function test results and markedly reduced carbon monoxide transfer capacity were observed. Five patients with SSc exhibited pulmonary hypertension. Four patients died during follow up. Patients with CTD and CPFE were significantly younger than an historical control group of patients with idiopathic CPFE and more frequently were female. In addition, patients with CTD and CPFE had higher lung volumes, lower diffusion capacity, higher pulmonary pressures, and more frequently were male than those with CTD and lung fibrosis without emphysema. Conclusion CPFE warrants inclusion as a novel, distinct pulmonary manifestation within the spectrum of CTD-associated lung diseases in smokers or former smokers, especially in patients with RA or SSc. © 2011 by the American College of Rheumatology. Source

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