Association entre la dégénérescence maculaire liée à l’âge et les parodontites

Purpose: To evaluate the association between age-related macular degeneration (AMD) and periodontal disease, two frequent conditions in the elderly, with some risk factors in common. Methods: Single center, pilot, case-control study performed in a center specialized in the diagnosis and management of AMD. Periodontal status was evaluated in 43 AMD patients and 19 controls. Fundus examination and a complete periodontal examination were performed in all subjects. Results: AMD patients have a greater percentage of 3–4 mm clinical attachment loss compared to controls (47% vs. 38%, [P = 0.039]). However, no significant difference was found between the groups with regard to the prevalence of severe periodontitis. Conclusions: These results suggest an association between AMD and attachment loss characteristic of periodontal disease and support the need for larger prospective studies to elucidate the relationships between these 2 highly prevalent and potentially severe diseases

Indications for islet or pancreatic transplantation

Indications for islet or pancreatic transplantation : Statement of the TREPID working group on behalf of the Société francophone du diabète (SFD), Société francaise d'endocrinologie (SFE), Société francophone de transplantation (SFT) and Société française de néphrologie - dialyse - transplantation (SFNDT). While either pancreas or pancreatic islet transplantation can restore endogenous insulin secretion in patients with diabetes, no beta-cell replacement strategies are recommended in the literature. For this reason, the aim of this national expert panel statement is to provide information on the different kinds of beta-cell replacement, their benefit-risk ratios and indications for each type of transplantation, according to type of diabetes, its control and association with end-stage renal disease. Allotransplantation requires immunosuppression, a risk that should be weighed against the risks of poor glycaemic control, diabetic lability and severe hypoglycaemia, especially in cases of unawareness. Pancreas transplantation is associated with improvement in diabetic micro- and macro-angiopathy, but has the associated morbidity of major surgery. Islet transplantation is a minimally invasive radiological or mini-surgical procedure involving infusion of purified islets via the hepatic portal vein, but needs to be repeated two or three times to achieve insulin independence and long-term functionality. Simultaneous pancreas-kidney and pancreas after kidney transplantations should be proposed for kidney recipients with type 1 diabetes with no surgical, especially cardiovascular, contraindications. In cases of high surgical risk, islet after or simultaneously with kidney transplantation may be proposed. Pancreas, or more often islet, transplantation alone is appropriate for non-uraemic patients with labile diabetes. Various factors influencing the therapeutic strategy are also detailed in this report

Examination of the Igls Criteria for Defining Functional Outcomes of beta-cell Replacement Therapy: IPITA Symposium Report

Context: The Igls criteria were developed to provide a consensus definition for outcomes of beta-cell replacement therapy in the treatment of diabetes during a January 2017 workshop sponsored by the International Pancreas & Islet Transplant Association (IPITA) and the European Pancreas & Islet Transplant Association. In July 2019, a symposium at the 17th IPITA World Congress was held to examine the Igls criteria after 2 years in clinical practice, including validation against continuous glucose monitoring (CGM)-derived glucose targets, and to propose future refinements that would allow for comparison of outcomes with artificial pancreas system approaches.Evidence acquisition: Utilization of the criteria in various clinical and research settings was illustrated by population as well as individual outcome data of 4 islet and/or pancreas transplant centers. Validation against CGM metrics was conducted in 55 islet transplant recipients followed-up to 10 years from a fifth center.Evidence synthesis: The Igls criteria provided meaningful clinical assessment on an individual patient and treatment group level, allowing for comparison both within and between different beta-cell replacement modalities. Important limitations include the need to account for changes in insulin requirements and C-peptide levels relative to baseline. In islet transplant recipients, CGM glucose time in range improved with each category of increasing beta-cell graft function.Conclusions: Future Igls 2.0 criteria should consider absolute rather than relative levels of insulin use and C-peptide as qualifiers with treatment success based on glucose assessment using CGM metrics on par with assessment of glycated hemoglobin and severe hypoglycemia events.Diabetes mellitus: pathophysiological changes and therap

Bristow-Latarjet procedure with specific instrumentation: study of 34 cases

A Bristow-Latarjet procedure with specific instrumentation was performed for recurrent dislocation or subluxation of the glenohumeral joint in 34 patients. The procedure was performed through a subscapularis splitting approach with three specific instruments and a special screw. The clinical outcome was assessed by the Duplay and the Constant scores. Radiographic study was conducted on 23 patients and CT scan in 11 patients. Of the 27 patients interviewed 92% were satisfied. Of the 23 patients examined, 15 had an excellent Duplay score, four a good score, three a medium score, and only one had a bad score. One patient had subluxation episodes, and one patient was revised after a redislocation following violent trauma. On the standard radiographs, all bone blocks were in the correct position. A pseudarthrosis was diagnosed in the patient with subluxation episodes. This device simplifies the surgical technique and provides reproducibility to the procedure