[Molecular mechanism of action of ezetimibe and recent therapeutics]

High blood Low density lipoprotein cholesterol is a major cardiovascular risk factor and must be the primary target of primary and secondary heart protection. Statines, 3-hydroxy-3-methylglutaryl-coenzyme A [HMG-CoA] reductase inhibitors, are the cornerstone of lipid-lowering therapy for reducing LDLc levels. However, some patients at high risk fail to achieve LDLc target despite high-dose statin therapy. Statins may also induce adverse effects. Ezetimibe is the first potent cholesterol absorption inhibitor. Several ongoing clinical interventional trials will shed more light on the association statin plus ezetimibe in high risk patients. A better understanding of intestinal cholesterol absorption will lead to novel approaches for the prevention and treatment of hyperlipidemia

Insulin therapy in diabetes type 2: indications modalities and results

After several years of evolution, insulin therapy becomes necessary in type 2 diabetes mellitus. However there is still an ongoing controversy in the studies devoted to this subject. The objective of our retrospective study was to evaluate the indications, the modalities and the results of insulin treatment in 106 patients with type 2 diabetes. Insulin treatment was temporary in 20 patients [18.86%] and definitive in 86 patients [81.14%]. The therapeutic protocol used a combined treatment with oral hypoglycaemic agents in 11 cases [10.38%], a conventional treatment in 48 cases [45.28%] or an intensive therapy in 47 cases [44.34%]. The outcome could be evaluated in 86patients after 6 months and 1 year. At the first follow-up [6 months], 59 patients [68.6%] had a significant reduction in fasting glycemia [7.8 vs 15.5 mmol/l], post prandial glycemia [8.9 vs 25.8 mmol/l] and glycated haemoglobin [6.9% vs 10.2%]. 69 patients [80.24%] had a mean weight gain of 7 +/- 5 kg and 8 [7.5%] had hypoglycaemic episodes. In the total number of 59 patients who improved with the insulin treatment, 46 patients 77.96% were treated with the intensive insulin protocol. Insulin treatment in type 2 diabetic patients seems to have a limited risk of hypoglycaemia but causes an important weight gain

[Quel est votre diagnostic?: Devant une ulceration du lit de l'ongle de l'index?. [Cell carcinoma of the nail bed]

Squamous Cell Carcinoma of the nail bed is rare, about 150 cases are reported in the literature. We present one case revealed after one year of evolution. It presented as an ulceration associated to an onycholysis. Because of this delayed diagnosis, amputation of the whole finger was needed

[Cutaneous mastocytosis in children. A review of 15 cases]

Introduction: Cutaneous mastocytosis [CM] is a rare disease defined as the infiltration of the skin by mast cells. This disorder is more frequentin children. The evolution of the pediatric form to a systemic disease is rare

Patients and Methods: Our study concerned 15 children seen in the dermatology department of Charles Nicolle Hospital between 1984 and 2002. The aim of this work is to show clinic, therapeutic and evolutive particularities of this disease

Results: Sex-ratio was about 0.87 [7 males and 8 females]. The age at onset of the lesion ranged from one month to 11.5 years. Urticaria pigmentosa was observed in 11 cases, diffuse cutaneous mastocytosis in 2 cases and and xanthelasmoid form in two other children. The treatment of our patients was based essentially on preventive measures and symptomatic therapy with histamine receptor antagonists. Over a mean follow-up period of 11 months we noted regression or resolution of the lesions in 9 cases

Discussion: Urticaria pigmentosa is the most benign. However, systemic signs are more frequent in the diffuse cutaneous mastocytosis form. Preventive measures are the main therapeutic mean; especially avoidance of histamine-releasing agents

Le syringocystadenoma papilliere: une tumeur cutanee benigne rare a propos de 3 cas

Syringo-cystadenome papillifer is a cutaneous benign and congenital tumor developed from sudoral apocrin glands. It is rare and often seen on the scalp. In many cases a sebaceous noevus accompagnies this kind of lesion. Histopathologic characteristics often lead to diagnosis