"Moreover, for the management of HPV-induced cutaneous and genital warts, standard methods such as cauterization and laser therapy seem relatively inefficient
. Aggressive surgical removal, Interferon or Cidofovir administration, as well as topical Imiquimod treatments all proved equally unsatisfying, as lesions tended to reappear. "
[Show abstract][Hide abstract] ABSTRACT: WHIM syndrome (WS), a rare congenital neutropenia due to mutations of the CXCR4 chemokine receptor, is associated with Human Papillomavirus (HPV)-induced Warts, Hypogammaglobulinemia, bacterial Infections and Myelokathexis. The long term follow up of eight patients highlights the clinical heterogeneity of this disease as well as the main therapeutic approaches and remaining challenges in the light of the recent development of new CXCR4 inhibitors.
This study aims to describe the natural history of WS based on a French cohort of 8 patients.
We have reviewed the clinical, biological and immunological features of patients with WS enrolled into the French Severe Chronic Neutropenia Registry.
We identified four pedigrees with WS comprised of eight patients and one foetus. Estimated incidence for WS was of 0.23 per million births. Median age at the last visit was 29 years. Three pedigrees encompassing seven patients and the fetus displayed autosomal dominant heterozygous mutations of the CXCR4 gene, while one patient presented a wild-type CXCR4 gene. Two subjects exhibited congenital conotruncal heart malformations. In addition to neutropenia and myelokathexis, all patients presented deep monocytopenia and lymphopenia. Seven patients presented repeated bacterial Ears Nose Throat as well as severe bacterial infections that were curable with antibiotics. Four patients with late onset prophylaxis developed chronic obstructive pulmonary disease (COPD). Two patients reported atypical mycobacteria infections which in one case may have been responsible for one patient’s death due to liver failure at the age of 40.6 years. HPV-related disease manifested in five subjects and progressed as invasive vulvar carcinoma with a fatal course in one patient at the age of 39.5 years. In addition, two patients developed T cell lymphoma skin cancer and basal cell carcinoma at the age of 38 and 65 years.
Continuous prophylactic anti-infective measures, when started in early childhood, seem to effectively prevent further bacterial infections and the consequent development of COPD. Long-term follow up is needed to evaluate the effect of early anti-HPV targeted prophylaxis on the development of skin and genital warts.
[Show abstract][Hide abstract] ABSTRACT: Generalized verrucosis has been described in the past as synonymous with epidermodysplasia verruciformis. It has been shown, however, that epidermodysplasia verruciformis and other genetic or immunodeficiency diseases are just a subset of diffuse infections with human papillomavirus termed "generalized verrucosis." This article defines generalized verrucosis and distinct diseases associated with generalized warts. The indications for histopathologic testing, human papillomavirus typing, and other laboratory analyses and potential treatment options are discussed.
Journal of the American Academy of Dermatology 05/2011; 66(2):292-311. DOI:10.1016/j.jaad.2010.12.011 · 4.45 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A long-standing issue in non-rigid image registration is the choice of the level of regularisation. Regularisation is necessary to preserve the smoothness of the registration and penalise against unnecessary complexity. The vast majority of existing registration methods use a fixed level of regularisation, which is typically hand-tuned by a user to provide "nice" results. However, the optimal level of regularisation will depend on the data which is being processed; lower signal-to-noise ratios require higher regularisation to avoid registering image noise as well as features, and different pairs of images require registrations of varying complexity depending on their anatomical similarity. In this paper we present a probabilistic registration framework that infers the level of regularisation from the data. An additional benefit of this proposed probabilistic framework is that estimates of the registration uncertainty are obtained. This framework has been implemented using a free-form deformation transformation model, although it would be generically applicable to a range of transformation models. We demonstrate our registration framework on the application of inter-subject brain registration of healthy control subjects from the NIREP database. In our results we show that our framework appropriately adapts the level of regularisation in the presence of noise, and that inferring regularisation on an individual basis leads to a reduction in model over-fitting as measured by image folding while providing a similar level of overlap.
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