Efficacy and tolerance of calcium alginate versus vaseline gauze dressings in the treatment of diabetic foot lesions.

BACKGROUND: The study aimed at comparing the efficacy and tolerance of an alginate wound dressing with a vaseline gauze dressing in the treatment of diabetic foot lesions. METHODS: This open-label randomized multicenter controlled study was designed to assess the effect of an up to 6-week treatment with either calcium alginate or vaseline gauze dressings. Lesions were either acute or chronic, under cleansing, and with a surface area of 1-50 cm(2); osteomyelitis and severe hypovascularization were non-inclusion criteria. Dressings were changed every day then, once granulation had occurred, every 2 to 3 days. Primary outcome was the proportion of patients with granulation tissue over 75% of the wound area and having a 40% decrease in wound surface area; secondary outcomes were pain on dressing changes, the number of dressing changes, and adverse events. RESULTS: Seventy-seven patients were enrolled. Due to the premature cessation of treatment in 13 patients, it was decided to reduce the period of the efficacy analysis to 4 weeks (without revising the criteria of efficacy). The success rate was of 42.8% in the calcium alginate group and of 28.5% in the vaseline gauze group (not significant difference). A subsequent analysis of granulation tissue surfaces covering the wounds at week 4 (all surfaces taken together) showed a superiority of calcium alginate (p=0.04). Pain on dressing change was lower in the calcium alginate group (p=0.047) and the total number of dressing changes tended also to be lower (p=0.07). Adverse events, which occurred 4 times in the calcium alginate group and 6 times in the other, were judged independent of the treatments. CONCLUSIONS: As compared with vaseline gauze, calcium alginate appears to be more appropriate for topical treatment of diabetic foot lesions in terms of both healing and tolerance.

[Health costs associated with the diabetic foot in developed countries.A plea for the creation of health care networks]. / Coûts de santé liés aux lésions du pied chez les diabétiques dans les pays développés. Plaidoyer pour la création de structures de soins adaptées.

COST OF DIABETIC FOOT: A limited number of epidemiological and economical studies on diabetic foot in France is available. Studies conducted in other countries, namely USA, Netherlands, UK and especially Sweden, have evidenced major direct and indirect costs that generally are underestimated in overall economical cost of diabetes forecast. The rapid increase of diabetes prevalence throughout the world, combined with diabetic population aging, allows to speculate that this situation may dramatically worsen in the future. In order to reduce the economical and human burden of this complication, it is an urgent public health necessity in France to set multidisciplinary organisations, dealing with both in-patient care, which importance should be decreasing, and out-patient care, as well as prevention and foot care networks. The swedish experience figures an interesting model for our healthcare system.

[Contribution of molecular biology to the diagnosis of familial hypercholesterolemias in children]. / Apport de la biologie moléculaire au diagnostic des hypercholestérolémies familiales chez l'enfant.

The detection of children at high risk in families with a genetic form of hypercholesterolemia is important for acceptance of prevention under medical control. However, usual lipidic parameters are difficult to interpret during infancy. So we studied by a molecular biology approach 11 families presenting with syndrome of pure hypercholesterolemia where a defect of the LDL receptor (LDL-R) gene was suspected (Familial Hypercholesterolemia: FH IIa). Markers of the LDL-R gene (Restriction Fragment Length Polymorphism RFLP) were studied with intragenic probes. The segregation of the abnormal gene was studied in each family. Our results illustrate the limits of such an approach (its heaviness and the fact that, in 2 families, the analysis was not informative), but also its advantages: indeed, in 8 families, the diagnosis was established (particularly in one case at birth). Moreover in 2 families the LDL-R abnormality was excluded. In such case, as an alternative, the hypothesis of an apo B abnormality was envisaged. This differential diagnosis is interesting since it permits the choice of an adequate treatment.

[A fatal respiratory form of type C Niemann-Pick disease]. / Forme respiratoire mortelle de maladie de Niemann-Pick type C.

An unusual case of Niemann-Pick disease type C is reported. The disease was first manifested in utero with hepatomegaly and ascitis. At the age of 3 months, respiratory signs were noted due to diffuse alveolar and interstitial pneumonia. Both bronchoalveolar lavage and blood serologic studies revealed respiratory infection by respiratory syncitial virus and Chlamydia trachomatis. These concomitant infections delayed the diagnosis of Niemann-Pick disease which was finally made by the electronic microscopic studies of liver biopsy and bone marrow specimens. Type C was identified by biochemical characterization of lipid accumulation in hepatocytes and by lipid enzyme profiles obtained from cutaneous fibroblast cultures. The child died at the age of 6 months from respiratory failure. Post mortem examination of the lung showed the presence of numerous overloaded alveolar macrophages in the alveolar spaces and walls. The severity of the lung issue disease is unusual in type C Niemann-Pick disease, in which neurologic involvement is usually the main prognosis factor.

[Familial form of hypoglycemia due to leucine hypersensitivity]. / Forme familiale d'hypoglycémie par hypersensibilité à la leucine.

The authors report on a boy and his mother showing signs of hypoglycemia due to hypersensitivity to leucine that is related to a that dominant autosomal. The cyclic inheritance glycemia test shows hyperinsulism; oral as well as intravenous loading dose of leucine tests showed that this hyperinsulism is due to hypersensitivity to leucine. The clinical picture, outcome of the disease dietary and medical treatment with diazoxide, and the role of GIP in insulin secretion is discussed.

[Diet in familial hypercholesterolemia type IIa. Grenoble survey 1983-1988]. / La diététique dans les hypercholestérolémies familiales type IIa. Enquête Grenobloise 1983-1988.

In 19 children with familial hypercholesterolemia type IIa measures to reduce the amount of saturated fat and cholesterol in the diet lead to a mean decrease of cholesterolemia of 15%, thus confirming the favorable effect of the diet previously reported in the literature. However, there were large variations in the efficacy of the diet from no effect up to a 30% decrease. "Non-responders", in whom the diet was not effective, require treatment with drugs. The diet must be individualised and should involve the whole family. Children must be followed in order to encourage compliance to the dietetic measures and to detect eventual side effects. Furthermore, the dietetic measures must be associated with steps to control the other risk factors of arteriosclerosis.

[Epstein-Barr virus encephalitis. Apropos of a case in a child]. / Encéphalite à virus d'Epstein-Barr. A propos d'un cas chez l'enfant.

Encephalitic illnesses with Epstein-Barr virus (EBV) only represent a small percentage of the causes of viral encephalitis. Clinical symptoms are not specific. Biological standards tests carry few elements of direction, only serologic test of infectious mononucleosis confirms the diagnostic of recent EBV infection. Previous observation shows that the initial study can present similarities with herpes simplex encephalitis, which forces the immediate start of treatment by Acyclovir.