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Schweizer A.,Novartis | Halimi S.,University Hospital of Grenoble | Halimi S.,Joseph Fourier University | Dejager S.,Novartis
Vascular Health and Risk Management | Year: 2014

A large proportion of Muslim patients with type 2 diabetes mellitus (T2DM) elect to fast during the holy month of Ramadan. For these patients hypo- and hyperglycemia constitute two major complications associated with the profound changes in food pattern during the Ramadan fast, and efficacious treatment options with a low risk of hypoglycemia are therefore needed to manage their T2DM as effectively and safely as possible. Dipeptidyl peptidase-4 (DPP-4) inhibitors modulate insulin and glucagon secretion in a glucose-dependent manner, and consequently a low propensity of hypoglycemia has consistently been reported across different patient populations with these agents. Promising data with DPP-4 inhibitors have now also started to emerge in patients with T2DM fasting during Ramadan. The objective of this review is to provide a comprehensive overview of the currently available evidence and potential role of DPP-4 inhibitors in the management of patients with T2DM fasting during Ramadan whose diabetes is treated with oral antidiabetic drugs, and to discuss the mechanistic basis for their beneficial effects in this setting. © 2014 Schweizer et al.

Pichot O.,University Hospital of Grenoble | De Maeseneer M.,University of Antwerp | De Maeseneer M.,Erasmus Medical Center
Perspectives in Vascular Surgery and Endovascular Therapy | Year: 2011

Nowadays, various surgical and endovenous methods are available to treat varicose veins. Theoretically, every technique is applicable to treat any kind of patient. However, it seems appropriate to consider the specific indications and limitations of each of the techniques. To choose the most appropriate treatment method, several issues have to be taken into account. The patient's reason for consulting and clinical condition will define the aim of the treatment. Anatomical and hemodynamic characterization of the varicose veins by means of duplex ultrasound will define the technical feasibility. Although a definitive algorithm still remains to be developed, some of the most important questions that should be included in a decision tree can already be proposed: Is high ligation necessary or at least justified? Is stripping or ablation necessary or at least justified, and in that case, what is the most appropriate technique to be used? All this should help us define a reasonable "à la carte" treatment for each patient. © The Author(s) 2011.

Galasso O.,University of Catanzaro | Jenny J.-Y.,University of Strasbourg | Saragaglia D.,University Hospital of Grenoble | Miehlke R.K.,Rhine Main Center for Joint Diseases
Orthopedics | Year: 2013

The use of a keel in the tibial component during modern primary total knee arthroplasty (TKA) has become common, and its cementation may affect the future performance of the prosthesis. Although proponents of cementing the entire tibial component argue that this technique provides better initial fixation and may prevent aseptic loosening, reasons exist to apply cement only to the tibial baseplate. In this study, 232 patients who underwent TKA using full or surface cementation of the tibial baseplate were evaluated at an average 5.6-year follow-up to assess survivorship and clinical results. The cumulative survival rate at 8 years was 97.1%. With revision of either component for any reason considered the endpoint, no significant difference was noted between full and surface cemented groups. Knee Society Score, range of motion, and femorotibial mechanical angle significantly increased postoperatively. Multivariate analysis revealed that good preoperative range of motion and Knee Society Scores were related to good postoperative range of motion and Knee Society Scores. Follow-up length was a negative predictor of postoperative Knee Society Score. The use of full or surface cementation of the baseplate was unrelated to the postoperative clinical outcomes. Clinical outcomes did not differ according to the tibial component cementation technique. The results of this study suggest that cementing the keel of the tibial component during primary TKA has no advantage for patients. Longer-term follow-up and proper patient randomization are required to confirm these findings.

Context: Androgen-deprivation therapy (ADT) as an adjuvant to radiation therapy (RT) is an established treatment for locally advanced prostate cancer (PCa). Objective: To examine the established clinical evidence on the use of short-term and/or long-term adjuvant ADT plus external irradiation and discuss recent data devoted to the duration of ADT with RT. Evidence acquisition: During the 2010 Annual Congress of the European Association of Urology (EAU) in Barcelona, Spain, a satellite symposium was held on the individualised management of patients with PCa. This paper is based on one of the presentations given at the symposium. Data were retrieved from recent review articles, original articles, and abstracts on the use of ADT in the neoadjuvant and/or concomitant and adjuvant settings with RT in patients with locally advanced PCa. Evidence synthesis: A number of studies have evaluated the survival benefits of short-term and long-term adjuvant ADT with RT in locally advanced PCa. European Organisation for Research and Treatment of Cancer (EORTC) study 22863 demonstrated that immediate androgen suppression given during and for 3 yr after external irradiation improved disease-free survival (DFS) and overall survival (OS) of patients with locally advanced PCa out to 10 yr. The OS benefits of long-term adjuvant ADT with RT were subsequently shown in Radiation Therapy Oncology Group (RTOG) protocols 85-31 and 92-02. More recently, EORTC study 22961 provided a definitive observation that 6-mo androgen suppression in association with three-dimensional conformal RT (3D-CRT) resulted in inferior survival compared with RT and 3 yr of ADT in the treatment of locally advanced PCa. Not only was OS improved but there was a significant improvement in all parameters of progression-free survival (PFS). Conclusions: Locally advanced PCa should be managed with 3D-CRT plus concomitant and adjuvant 3-yr androgen suppression. Several studies have evaluated the survival benefits of short-term and long-term adjuvant androgen-deprivation therapy (ADT) with radiation therapy in locally advanced prostate cancer. Definitive evidence for the superior benefits of long-term (3 yr) ADT plus three-dimensional conformal radiotherapy was provided by European Organisation for Research and Treatment of Cancer study 22961. © 2010 European Association of Urology.

Aptel F.,University Hospital of Grenoble | Aptel F.,Joseph Fourier University | Lafon C.,French Institute of Health and Medical Research
International Journal of Hyperthermia | Year: 2015

Glaucoma is a common disease mainly due to an increase in pressure inside the eye, leading to a progressive destruction of the optic nerve, potentially to blindness. Intraocular pressure (IOP) is the result of a balance between production of liquid that fills the eye-aqueous humour-and its resorption. All treatments for glaucoma aim to reduce IOP and can therefore have two mechanisms of action: reducing aqueous humour production by the partial destruction or medical inhibition of the ciliary body-the anatomical structure responsible for production of aqueous humour-or facilitating the evacuation of aqueous humour from the eye. Several physical methods can be used to destroy the ciliary body, e.g. laser, cryotherapy, microwave. All these methods have two major drawbacks: they are non-selective for the organ to be treated and they have an unpredictable dose-effect relationship. High intensity focused ultrasound (HIFU) can be used to coagulate the ciliary body and avoid these drawbacks. A commercially available device was marketed in the 1980s, but later abandoned, essentially for technical reasons. A smaller circular device using miniaturised transducers was recently developed and proposed for clinical practice. Experimental studies have shown selective coagulation necrosis of the treated ciliary body. The first three clinical trials in humans have shown that this device was well tolerated and allowed a significant, predictable and sustained reduction of IOP. The aim of this contribution is to present a summary of the work concerning the use of HIFU to treat glaucoma. © 2014 Informa UK Ltd. All rights reserved.

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