RESUMEN
The proportion of adults over 60 years of age is rapidly increasing and is estimated to reach approximately one-sixth of the global population by 2030. An ageing population is a real challenge for healthcare resources, including dermatologists and geriatricians, as age-related changes in skin integrity and barrier function make older adults more susceptible to developing skin pathologies such as pruritus, dermatitis and infections. Fragile skin arises from several interlinked causes, including age-related changes in skin barrier integrity, previous and current lifestyle choices, skin pathologies and medical interventions. Dermo-cosmetics can play a key role in enhancing skin care regimens and preventing pathologies in this age group. In vitro studies, clinical, and in-daily clinical practice studies of dermo-cosmetics have shown them to be effective in many skin conditions in older adults, like xerosis and pruritus. Incontinence-associated dermatitis (IAD), a common condition arising from contact with irritants such as urine and faeces which can significantly impact the quality of life of sufferers, can also be improved with a barrier cream in incontinent patients aged 70 years and older. This supplement focuses on the increased fragility of older skin, the development of common skin pathologies and the efficacy and tolerance of dermo-cosmetic products in older adults.
Asunto(s)
Epidermis/patología , Epidermis/fisiopatología , Enfermedades de la Piel/epidemiología , Factores de Edad , Anciano , Humanos , Persona de Mediana Edad , Cuidados de la Piel , Fenómenos Fisiológicos de la PielRESUMEN
Within their first days of life, newborns' skin undergoes various adaptation processes needed to accommodate the transition from the wet uterine environment to the dry atmosphere. The skin of newborns and infants is considered as a physiological fragile skin, a skin with lower resistance to aggressions. Fragile skin is divided into four categories up to its origin: physiological fragile skin (age, location), pathological fragile skin (acute and chronic), circumstantial fragile skin (due to environmental extrinsic factors or intrinsic factors such as stress) and iatrogenic fragile skin. Extensive research of the past 10 years have proven evidence that at birth albeit showing a nearly perfect appearance, newborn skin is structurally and functionally immature compared to adult skin undergoing a physiological maturation process after birth at least throughout the first year of life. This article is an overview of all known data about fragility of epidermis in 'fragile populations': newborns, children and adolescents. It includes the recent pathological, pathophysiological and clinical data about fragility of epidermis in various dermatological diseases, such as atopic dermatitis, acne, rosacea, contact dermatitis, irritative dermatitis and focus on UV protection.
Asunto(s)
Epidermis/fisiología , Adaptación Fisiológica , Adolescente , Células Cultivadas , Niño , Células Epidérmicas , Humanos , Recién Nacido , Queratinocitos/citologíaRESUMEN
BACKGROUND: The reliability of the biophysical properties of skin equivalents (SEs) remains a challenge for medical applications and for product efficacy tests following the European Directive 2003/15/EC2 on the prohibition of animal experiments for cosmetic products. METHODS: We propose to adapt the biophysical in vivo testing techniques to compare full thickness model growth vs. time. The interest in using such techniques lies in possible comparisons between in vivo and in vitro skin as well as monitoring samples over the culture time. RESULTS: High frequency ultrasound technique, optical coherence tomography (OCT), and laser scanning microscopy were used to analyze SEs morphology at days D42 and D60 whereas their microstructure was assessed through transmission electron microscopy and classical histology. A correlation between these observations and mechanical measurements has been proposed so as to underline the consequence of both the development of the dermis elastic fibers and the epidermis differentiation. CONCLUSION: Ultrasounds measurements show a highly homogeneous dermis whereas the OCT technique clearly distinguishes the stratum corneum and the living epidermis. The increase in the thicknesses of these layers as well as the growth in elastin and collagen fibers results in strong modifications of the samples mechanical properties.
Asunto(s)
Órganos Bioartificiales/efectos adversos , Bioprótesis/clasificación , Ensayo de Materiales/métodos , Fenómenos Fisiológicos de la Piel , Piel Artificial/clasificación , Piel/anatomía & histología , Humanos , Microscopía Confocal/métodos , Microscopía Electrónica de Transmisión/métodos , Piel/diagnóstico por imagen , Ingeniería de Tejidos/métodos , Tomografía de Coherencia Óptica/métodos , Ultrasonografía/métodosRESUMEN
Induction of skin cancer is the most deleterious effect of excessive exposure to sunlight. Accurate evaluation of sunscreens to protect the genome is thus of major importance. In particular, the ability of suncare products to prevent the formation of DNA damage should be evaluated more directly since the Sun Protection Factor is only related to erythema induction. For this purpose, we developed an in vitro approach using a recently characterized reconstituted human epidermis (RHE) model engineered from hair follicle. The relevance of this skin substitute in terms of UV-induced genotoxicity was compared to ex vivo explants exposed to solar-simulated radiation (SSR). The yield of bipyrimidine photoproducts, their rate of repair, and the induction of apoptosis were very similar in both types of skin samples. In order to evaluate the protection afforded by sunscreen against DNA damage, bipyrimidine photoproducts were quantified in tissue models following SSR exposure in the presence or absence of a SPF50+ formula. A rather high DNA protection factor of approximately 20 was found in RHE, very similar to that determined for explants. Thus, RHE is a good surrogate to human skin, and also a convenient and useful tool for investigation of the genoprotection of sunscreens.
Asunto(s)
Evaluación Preclínica de Medicamentos/métodos , Folículo Piloso/citología , Protectores Solares/farmacología , Adulto , Apoptosis/efectos de los fármacos , Caspasa 3/metabolismo , Reparación del ADN/efectos de los fármacos , Epidermis , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas de Mutagenicidad , Dímeros de Pirimidina/metabolismo , Reproducibilidad de los Resultados , Piel/efectos de los fármacos , Luz Solar/efectos adversos , Protectores Solares/toxicidadRESUMEN
OBJECTIVE: Outer root sheath (ORS) cells of human hair follicles are a readily available, non-invasive source of keratinocytes for epidermis reconstruction. The aim of this study was to characterize a model of epidermis reconstructed from ORS cells (ORS-derived model) and to evaluate its reproducibility, in comparison with native human skin and two marketed reconstructed skin models (model A, Episkin(®) and model B, Skinethic(®) ). METHODS: Cell morphology and tissue architecture of the three models were analysed histologically and proliferation and differentiation marker expression by immunohistochemistry and mRNA quantification. RESULTS: All models displayed the same general epidermal architecture as native epidermis, but with a thicker stratum corneum in models A and B. Compared with native epidermis, Ki67 was correctly localized in epidermal basal cells in all models, as K10 in suprabasal layers. In all skin models, transglutaminase 1 (TGM1) was prematurely expressed in suprabasal layers. However, this expression was only observed from the upper stratum spinosum in the ORS-derived model. In this model, filaggrin and loricrin were correctly located in the stratum granulosum. Filaggrin, involucrin, loricrin and TGM1 mRNAs (markers of keratinocyte terminal differentiation) were transcriptionally expressed in all models. In the ORS-derived model, transcriptional expression level was similar to that of native skin. CONCLUSION: ORS cell-based reconstructed epidermis is a valid and reproducible model for human epidermis and it may be used to evaluate the effects of active substances and cosmetic formulations.
Asunto(s)
Epidermis/anatomía & histología , Cabello/citología , Queratinocitos/citología , Modelos Biológicos , Biomarcadores/metabolismo , Ciclo Celular , Diferenciación Celular , Proteínas Filagrina , Expresión Génica , HumanosRESUMEN
The revised French version of the Hierarchic Dementia Scale (HDS) was assessed in 88 DAT patients (30 men, 58 women, mean age: 70, MMS from 0 to 26). The HDS consisted of 20 subtests which covered the entire range of cognitive functions; each subtest was hierarchically organized. This scale has been validated by the authors in 149 control subjects (Démonet et al., 1990). The goals of the present study were to validate this scale in DAT patients in comparison with the MMS scores and to specify the cognitive impairments of our pathologic population. Results showed that the scores on the HDS were highly correlated with the MMS scores (p < .0001). Some subtests of the HDS (memory subtests and mental control) allow good discrimination between mild demented patients and controls (sensibility = 80.8 p. 100, specificity = 96 p. 100). Conversely some subtests allowed a cognitive follow-up of patients for whom the MMS was no longer useful (MMS scores from 0 to 10). In conclusion, it appears that this scale is useful for drawing cognitive profile of DAT patients and to approach the heterogeneity of dementia.
Asunto(s)
Enfermedad de Alzheimer/diagnóstico , Cognición , Demencia/clasificación , Anciano , Enfermedad de Alzheimer/psicología , Demencia/psicología , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Escala del Estado Mental/estadística & datos numéricos , Persona de Mediana Edad , Psicometría/métodosRESUMEN
Seventeen cases of late ulnar paralysis treated by neurolysis-transposition are reported. The clinical characteristics of these paralyses are emphasized: very prolonged symptom free interval, rapid onset and severe involvement. Ulnar transposition was most often done subcutaneously. Cubitus valgus and definite nerve compression proximal to the arcade of the flexor carpi ulnaris muscle are almost always present. The results as regards the neuropathy are undependable: no patient is completely cured and only half are improved. An anatomical study of the nerve path shows the essential role, in the compression of the nerve, of the muscular arcade of the flexor carpi ulnaris muscle which acts in a way similar to the bridge of a violin. Hence, opening it longitudinally is the principal step of neurolysis. This should be routine before the first signs of neuropathy occur in an elbow whose axis is out of alignment as a sequela of a childhood injury.
Asunto(s)
Lesiones de Codo , Síndromes de Compresión Nerviosa/etiología , Parálisis/etiología , Nervio Cubital , Adulto , Femenino , Fracturas Óseas/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Parálisis/diagnóstico , Parálisis/cirugía , Seudoartrosis/complicaciones , Factores de Tiempo , Nervio Cubital/patología , Nervio Cubital/cirugíaRESUMEN
Recent advances in computer and radiological technology have permitted reassessment of intravenous angiography in the evaluation of cerebrovascular disorders. Although digital subtraction angiography is a relatively new technique, it has rapidly gained a widespread acceptance. It has extended the use of angiography to outpatients and to people in whom conventional angiography is contraindicated. This reliable, safe, and relatively noninvasive technique offers the user two benefits: real-time subtraction and enhanced image quality. The system allows angiographic evaluation of the extracranial and intracranial vessels by means of intravenous injection of contrast material. Extracranial studies clearly demonstrate stenoses and occlusions of the major cervicocephalic arteries. Intracranial studies usually detect major cerebrovascular occlusions and provide insight into the collateral flow patterns. Intravenous digital subtraction angiography permits accurate assessment of cervicocephalic vessels after surgical repair. Although intravenous digital subtraction angiography obviates the need for conventional angiography in many cases, movements from the patients, or superimposition of vascular structures can substantially degrade the quality of the images. Digital subtraction angiography with intra-arterial injection of contrast medium will be contemplated in patients with poor intravenous digital subtraction angiography studies prior to surgery.
Asunto(s)
Trastornos Cerebrovasculares/diagnóstico por imagen , Angiografía Cerebral/métodos , Humanos , Inyecciones Intraarteriales , Inyecciones Intravenosas , Técnica de SustracciónRESUMEN
Seventeen cases of late ulnar paralysis treated by neurolysis-transposition are reported. The clinical characteristics of these paralysis are emphasized. A very prolonged symptom free interval, a rapid onset and a severe involvement. The ulnar transposition was most often done subcutaneously. Cubitus valgus and definite nerve compression proximal to the arcade of the flexor carpi ulnaris muscle are almost always present. The results as regards the neuropathy are notable: no patient is completely cured and only half are improved. An anatomical study of the nerve path shows the essential role, in the compression of the nerve, of the muscular arcade of the flexor carpi ulnaris muscle which acts in a way similar to the bridge of a violin. Hence, opening it longitudinally is the principal procedure of the neurolysis. This should be routine before the first signs of neuropathy occur in an elbow whose axis is out of alignment as a sequela of a childhood injury.
Asunto(s)
Parálisis/cirugía , Nervio Cubital/cirugía , Adolescente , Adulto , Axones/patología , Niño , Articulación del Codo/inervación , Electromiografía , Femenino , Dedos/inervación , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Músculo Esquelético/inervación , Músculo Esquelético/patología , Vaina de Mielina/patología , Regeneración Nerviosa , Parálisis/patología , Parestesia/cirugía , Enfermedades del Sistema Nervioso Periférico/patología , Enfermedades del Sistema Nervioso Periférico/cirugía , Resultado del Tratamiento , Cúbito/patología , Nervio Cubital/patología , Síndromes de Compresión del Nervio Cubital/patología , Síndromes de Compresión del Nervio Cubital/cirugía , Lesiones de CodoRESUMEN
The analgesic effect of clomipramine and the possible relationships between the antalgic action, the doses and the plasma levels of this tricyclic drug have been studied in 15 patients with chronic pain induced by nervous lesions determining a deafferentiation. Eight of 15 patients treated with clomipramine (100 mg/IV during 10 days and then 150 me per os) reported a significant improvement (up to 50 per cent during 3 to 18 months). The study of the partial coefficients of correlation did not show a relationship between plasma levels and analgesia in the total population or in the subgroup of the 8 improved patients. These results confirm the analgesic properties of clomipramine and suggest that regular monitoring of plasma levels of clomipramine does not appear of practical interest in the treatment of chronic pain.
Asunto(s)
Analgésicos , Clomipramina/uso terapéutico , Dolor/tratamiento farmacológico , Adulto , Anciano , Enfermedad Crónica , Clomipramina/administración & dosificación , Clomipramina/sangre , Femenino , Estudios de Seguimiento , Humanos , Cinética , Masculino , Persona de Mediana EdadRESUMEN
Intravenous angiography is a a safe, rapid, simple examination, which, with sonography, is complementary in selecting patients for conventional angiography. This examination is not designed to replace conventional angiography, but, rather, to study high-risk stroke patients, patients with asymptomatic cervical bruit, or postoperative patients. Improvements in contrast media, film subtraction, the use of oral anesthesia with viscous lidocaine, and the technique of cooling the contrast medium have made the procedure more successful. A review of 1,000 examinations was undertaken to determine the accuracy of the technique and to emphasize technical points. Excellent results, comparable to conventional angiography, were obtained in 50.3% patients and good results in 32%. Poor or uninterpretable results were obtained in 17.7%. These were secondary to either patient movement or the presence of venous reflux or statis of contrast medium.
Asunto(s)
Angiografía Cerebral , Enfermedades Arteriales Cerebrales/diagnóstico por imagen , Adulto , Anciano , Femenino , Humanos , Inyecciones Intravenosas , Masculino , Persona de Mediana EdadRESUMEN
Pure motor hemiplegia (PMH) is a well defined syndrome usually caused by ischemic lesions of lacunar type located either in the internal capsule or in the pons. Angiography and isotope scanning are usually normal. CT scan reveals small deep infarcts and appears to be the most reliable investigative method. The CT scan findings are described of thirty patients with PMH of rapid onset (less than 36 hours). In 29 of the 30 cases a lesion was found which could explain the PMH. Small hemorrhages (2 cm in diameter) in the posterior limb of the internal capsule were noted in two cases. Ischemic lesions were found in 27 patients, 22 patients had a single lesion (20 capsular and 2 pontine), while 5 patients had 2 lesions (2 bi-capsular, 3 capsular and pontine). Three varieties of ischemic capsular lesions were observed. We found in 15 cases a capsulo-putamine-caudate infarct (type I); in 8 cases a capsulo-pallidal infarct (type II); and in 2 cases an anterior capsulo-caudate infarct (type III). Type I corresponded to the area of the lateral lenticulostriate branches of the middle cerebral artery. Type II involved the territory of the perforating branches of the anterior choroidal artery. We suggest that type III involves the territory of the internal lenticulostriate branches of the anterior cerebral artery. Lacunes are generally linked to arterial systemic hypertension. However, only 16 of 30 patients in this series were chronically hypertensive.
Asunto(s)
Encéfalo/diagnóstico por imagen , Hemiplejía/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Anciano , Núcleo Caudado/diagnóstico por imagen , Infarto Cerebral/complicaciones , Infarto Cerebral/diagnóstico por imagen , Niño , Preescolar , Femenino , Globo Pálido/diagnóstico por imagen , Hemiplejía/etiología , Humanos , Lactante , Masculino , Persona de Mediana Edad , Putamen/diagnóstico por imagenRESUMEN
The purpose of this study was two-fold: (1) to attempt to localize the different parts of the internal capsule on computed tomography (CT) axial sections and (2) to correlate clinical data and CT appearance of 25 cases of ischemic capsular lesions. Twenty-three of the ischemic lesions produced a pure motor hemiplegia. The internal capsule was studied on routine CT axial sections parallel to the canthomeatal line with 8 mm collimation before and after intravenous contrast medium injection. Absorption values of the white matter at the level of the anterior limb of the internal capsule were found to be a little higher (mean, 32 Hounsfield units [H]) when compared with the posterior limb (mean, 28 H). Lesions were classified according to the topography of the internal capsule: anterior limb (three), genu (one), posterior limb (seven), and putaminocapsulocaudate (14). CT appears to be the most sensitive and reliable method to investigate small deep cerebral infarcts since isotope scans were positive in only two of 13 cases, while angiography was positive in eight of 17 cases.
Asunto(s)
Isquemia Encefálica/diagnóstico por imagen , Cuerpo Estriado/anatomía & histología , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Anciano , Niño , Cuerpo Estriado/irrigación sanguínea , Cuerpo Estriado/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Since 1975, various entrapment neuropathies have been reported in patients undergoing periodic haemodialysis, the most frequent being the carpal tunnel syndrome. Ten patients on chronic haemodialysis developing 15 carpal tunnel syndromes (5 unilateral and 5 bilateral) are reported. Various causes for the renal failure were present and clinical signs of the carpal tunnel syndrome developed at a late stage. The arteriovenous fistula required for extrarenal epuration was antebrachial and of the laterolateral type, except in one case when it was lateroterminal. The carpal tunnel syndrome was always on the same side as the fistula, developing at a later stage on th contralateral side in the 5 cases of bilateral disorders. Lesions were severe, in 11 of the 15 cases. Some patients noted fluctuations in pain symptoms during haemodialysis, either improving or becoming worse. Gross pathological findings during operation (13 cases) were tenosynovitis with epineural hypervascularisation on the opposite side. In 9 cases, however, atypical hypertrophic tenosynovitis was observed. Histological examination in 12 cases demonstrated typical tenosynovitis in 3 patients, but granulomatous tenosynovitis with amyloid deposits was reported in 9 patients. Lesions were bilateral in 2 cases thus present, on the side opposite to the fistula. Ultrastructural study confirmed the amyloid nature of the deposits in 3 cases, the microfibrillary appearance (80 to 100 A) being characteristic of amyloid substance. This rare complication does not represent a common carpal tunnel syndrome, and three mechanisms may be involved in its induction : peripheral uraemic neuropathy, haemodynamic modifications resulting from the antebrachial arteriovenous shunt, and amyloid formation in the flexor synovial sheaths. In the latter case, the type of amyloid disease may be a primary systemic amyloidosis not previously detected, or an elective amyloid process localised to the tenosynovial and periarticular tissues.
Asunto(s)
Amiloidosis/patología , Síndrome del Túnel Carpiano/etiología , Diálisis Renal/efectos adversos , Tenosinovitis/etiología , Adulto , Anciano , Amiloide/análisis , Derivación Arteriovenosa Quirúrgica , Síndrome del Túnel Carpiano/patología , Femenino , Humanos , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Tenosinovitis/metabolismo , Tenosinovitis/patologíaRESUMEN
Nineteen cases of cervical syringomyelia, five surgically confirmed, were examined with metrizamide computed tomographic myelography. While a collapsed cord appeared to be a very reliable finding in this series, those cases with distended cords can be studied with sequential scans (at 3 and 24 hr), allowing the distinction between syrinx and cystic intramedullary tumor by the presence or absence of delayed cyst opacification.
Asunto(s)
Metrizamida , Mielografía/métodos , Siringomielia/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Estudios de Evaluación como Asunto , Humanos , Inyecciones Espinales , Intensificación de Imagen RadiográficaRESUMEN
Intravenous angiography with systematic subtraction is a simple, physiological method of simultaneously studying the common carotids, carotid bifurcations, internal carotids (up to the carotid siphons), and vertebral arteries. It can be employed in fasting patients without anesthesia or premedication and without the risks of an arterial approach. Used in 500 patients (of whom 30% were outpatients and some were older than 80), it was tolerated well, easily repeated, and gave 80.6% good or excellent results and only 19.4% poor or uninterpretable results. This is a practical method of screening atheromatous lesions and monitoring their development, particularly after surgery.
Asunto(s)
Angiografía Cerebral/métodos , Trastornos Cerebrovasculares/diagnóstico por imagen , Adulto , Anciano , Arterias Carótidas/diagnóstico por imagen , Arteria Carótida Interna/diagnóstico por imagen , Medios de Contraste/administración & dosificación , Femenino , Humanos , Inyecciones Intravenosas , Masculino , Persona de Mediana Edad , Arteria Subclavia/diagnóstico por imagen , Técnica de Sustracción , Arteria Vertebral/diagnóstico por imagenRESUMEN
The authors use the term "complicated migraine" to describe the onset of neurological disorder occurring during an acute attack in a patient with chronic migraine. The disturbance may last for long periods or may be permanent, and these irreversible cerebral lesions have to be differentiated from the transient neurological effects characteristic of ophthalmic on secondary migraine. Patients with migraine and retinal lesions, as well as those with ophthalmoplegic or familial hemiplegic migraine, were excluded from the study. The seven cases reported included 5 women and 2 men with an average age of 30 years (from 14 to 51 years). A more or less severe lesion in a hemisphere was present, which led to sensory-motor signs of a hemiplegia (4 cases), an aphasia (4 cases), and a homonymous lateral hemianopia (3 cases). Exploration revealed the presence of an ischemic cerebral lesion in all cases. One or more arterial occlusions were also noted in 5 out of the 6 patients who were investigated by angiography. All cases showed the presence of the criteria thought to be essential for associating the cerebral ischemic lesion with migraine. 1) the patient had true migraine, 2) there was a close chronological relationship between the migraine attack and the lasting neurological disorder, 3) no other associated vascular disease was present (atheroma, cardiopathy). The very severe and prolonged spasm, which could be the cause of neurological disturbances in secondary and ophthalmic migraine, does not appear to be sufficient for producing an irreversible ischemic lesion and, more especially, a persistent vascular obstruction. The roles played by edema of the arterial wall and parietal changes in the vessels are discussed. It could be that thrombosis formation is encouraged by the changes in blood coagulability which may be associated with a migraine attack. The fact that anomalies in platelet aggregation have been demonstrated merits closer study.
Asunto(s)
Isquemia Encefálica/diagnóstico , Trastornos Migrañosos/diagnóstico , Adolescente , Adulto , Arteriopatías Oclusivas/diagnóstico , Edema Encefálico/complicaciones , Isquemia Encefálica/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos Migrañosos/complicaciones , Trombosis/diagnósticoRESUMEN
BRomocriptine (15-75 mg per day) alone or with L-dopa was studied during five to 29 months on 44 patients with Parkinson's disease. Used as sole therapeutic agent, it was found excellent in 12 patients who had never received regular L-dopa treatment either because it was never attempted or because of intolerance from the outset. Its anti-Parkinsonism activity was comparable with L-dopa. The gain was stable in the long term until this report. The side effects of L-dopa were not seen after bromocriptine. In cases where L-dopa had ceased to be active, bromocriptine produced a further improvement if mental deterioration was not associated. In very advanced forms of Parkinson's disease with associated dementia, bromocriptine did not produce durable results. Bromocriptine did not improve the "on-off" effects but reduced a number of the side effects of L-dopa, in particular cardiac, painful contractions, and dyskinesia without "on-off" effects.