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Diabet. Med. 29, 56–61 (2012) Abstract Aims To assess the outcome of patients with diabetes with suspicion of osteomyelitis of the foot who had undergone a percutaneous bone biopsy that yielded negative microbiological results, with focus on the occurrence of osteomyelitis at the biopsied site. Methods Medical charts of adult patients with diabetes with a negative percutaneous bone biopsy were reviewed. Patients’ outcome was evaluated at least 2 years after the initial bone biopsy according to wound healing, the results of a new bone biopsy and bone imaging evaluation when applicable. Results From January 2001 to January 2008, 41 patients with diabetes (30 men/11 women; mean age 58.1 ± 9.6 years; mean diabetes duration 15.8 ± 6.7 years) met study criteria. Osteomyelitis was suspected based on combined clinical and imaging diagnostic criteria. On follow-up at a mean duration of 41.2 ± 22.5 months post-bone biopsy, 16 patients had complete wound healing (39.0%). Of the 25 other patients, 15 had a new bone biopsy performed, six of which yielded positive microbiological results, and among the 10 patients who neither healed nor underwent bone biopsy, comparative radiography of the foot showed a stable aspect of the biopsied site in six of them, for whom the data were available. Finally, osteomyelitis of the foot at the site where the initial bone biopsy had been performed was confirmed during follow-up in six patients (14.6%) and was suspected in four additional patients (9.7%). Conclusions The results of the present study suggest that, of patients with diabetes with the suspicion of osteomylelitis and a negative percutaneous bone biopsy, only one out of four will develop osteomyelitis within 2 years of the biopsy.

Introduction Le SBS est un syndrome lipodystrophique partiel considere comme acquis caracterise par une lipoatrophie cephalothoracique progressive, d’origine mal connue immunologique (complement) ou genetique (LMNB2…). Cette etude avait pour but de preciser le phenotype metabolique du SBS en comparaison a des temoins sains et des syndromes lipodytrophiques partiels familiaux de type 2 (FPLD2) lies a une laminopathie. Patients et methodes Cette etude retrospective monocentrique a compare les parametres metaboliques et anthropometriques (DEXA, IRM) de 6 SBS, 16 femmes FPLD2 et 9 femmes temoins sains appariees pour l’âge. Resultats Cinq femmes et un homme le seul avec C3Nef et nephropathie, tous d’origine caucasienne presentaient un SBS dont quatre, familial. Trois patients avaient un diabete, deux une intolerance, quatre une hypertriglyceridemie, trois une steatose hepatique (10–28 % ; IRM), deux une degenerescence graisseuse musculaire. Les cinq femmes SBS, dont une mutee LMNA , avaient un(e) IMC (29(26–33) vs. 22(20–22)kg/m 2 ; p = 0,0035), glycemie a jeun (0,93(0,91–1,80) vs. 0,83(0,79–0,84)g/L ; p = 0,006), HbA1c (8,7(5,4–12,0) vs. 5(4,9–5,1) % ; p = 0,0098), leptinemie (31(30–32) vs. 10(4–13)ng/mL ; p = 0,002), graisse intra-abdominale (GIA : 122(110–139) vs. 21(19–35)cm 3 ; p = 0,0098), rapport graisse intra-abdominale/abdominale totale (GIA/GAT : 0,39(0,29–0,53) vs. 0,11(0,10–0,18) ; p = 0,0112) et CRP (3(3–4) vs. 0(0)mg/L ; p = 0,0005) augmente(e) compares aux temoins. Lipides, insulinemie et pourcentage de masse grasse (%DEXA) ne differaient pas entre SBS et temoins. Leptinemie (FPLD2 : 6,9(4,4–11,2) ; p = 0,0004) et %DEXA (FPLD2 : 20,7(16,9–27,5) ; p p = 0,0643). Conclusion Le SBS semble plus rare que le FPLD2 et plus souvent familial qu’anterieurement admis. Leptinemie et CRP accrues etaient les meilleurs biomarqueurs des SBS compares aux temoins et FPLD2.

Summary Objectives The diagnosis of osteomyelitis in patients with diabetic foot is difficult both clinically and radiologically. An early diagnosis is crucial to optimize therapeutic strategy. Among the diagnostic methods currently used, scintigraphy with ex-vivo labelled white blood cells is the gold standard, but cannot be performed in all centers; therefore 67 Gallium citrate ( 67 Ga) imaging in combination with a bone scintigraphy is still widely used. Method The results of imaging 24 diabetic patients with 31 suspected osteomyelitic lesions using the antigranulocyte Fab' fragment (Sulesomab or LeukoScan® or immunoscintigraphy) were prospectively compared with results from the bone scan coupled with 67 Ga. The diagnosis of osteomyelitis was confirmed by either biopsy or follow-up, radiological imaging and clinical outcome. Results and conclusion Sulesomab correctly identified 12 of 18 osteomyelitic lesions while 67 Ga was able to detect only 8 of 18. Therefore the sensitivity is 67% for Sulesomab and 44% for 67 Ga. Among the 13 non-osteomyelitic lesions imaging with Sulesomab was able to rule out infection in 11 cases and 67 Ga in 10 cases. The specificity is therefore 85% for Sulesomab and 77% for 67 Ga. Image interpretation for Sulesomab in this group of patients is occasionally suboptimal when imaging is performed at 3 hours post injection. High vascular background in the early images may obscure infection especially in small bones. Practically, scintigraphy with Sulesomab is fast and simple due to ease of labeling, no ex-vivo handling of blood, low radiation and provides rapid diagnosis. The diagnosis of osteomyelitis obtained by the antibody fragment scintigraphy influences the management (guided biopsy) and therapy. In several patients, imaging with Sulesomab was able to rule out osteomyelitis, helping to avoid useless antibiotic therapy and its associated side effects.

Resume La frequence et la gravite des reactions allergiques a l’insuline ont considerablement diminue depuis l’utilisation des insulines humaines. La prevalence des reactions immediates au cours de l’insulinotherapie est aujourd’hui estimee a 10 %. Dans la majorite des cas, il s’agit d’allergies aux adjuvants des preparations insuliniques. Les manifestations sont alors le plus souvent localisees au point d’injection et sans gravite. Les allergies a l’insuline proprement dite sont exceptionnelles. Nous rapportons 3 observations de patientes qui presentaient des manifestations allergiques immediates generalisees apres les injections d’insuline. Alors que les tests cutanes etaient negatifs pour plusieurs insulines humaines recombinantes chez des temoins diabetiques non allergiques et des temoins non diabetiques, la positivite de ces tests chez ces 3 patientes suggere l’existence d’une allergie IgE dependante vis-a-vis de l’insuline humaine.

AIM To undertake a proof-of-concept study to determine whether a removable offloading device (the Ransart boot) for the management of diabetic foot ulcers (DFU) was as effective as reports of non-removable devices. RESEARCH DESIGN AND METHODS This observational study used the Ransart boot for patients with DFU, in seven specialist centres. If a patient had two or more ulcers, one was selected as the index ulcer. Ulcers were classified by the University of Texas (UT) system. RESULTS There were 135 patients (mean age 60.3 +/- 11.4 years); 96 (71.1%) male. Median ulcer duration at presentation was 90 [interquartile range (IQR) 30-1825] days. Seven were lost to follow-up, seven developed other major illnesses and four died; outcomes were documented in the remaining 117. Eighty-two (70.1% of 117) healed, after a median (IQR) 60 (43-99) days, while 22 (18.8%) ulcers were resolved by amputation (one major). The remaining 13 (11.1%) patients were judged non-compliant. There was a close correlation between ulcer classification at baseline and both time to healing (P < 0.001 chi(2)-test) and amputation (P < 0.001; Spearman's rank correlation coefficient). There was a positive correlation between ulcer duration at presentation and time to healing (P < 0.02), UT class (P < 0.01), glycated haemoglobin (P < 0.02) and amputation (P < 0.04). CONCLUSIONS Time to healing and incidence of amputation were comparable with those previously reported for non-removable devices. Given that a removable device is much more acceptable to the patient, the effectiveness, cost and acceptability of the removable devices, such as the Ransart boot, need to be compared with a non-removable device in a randomized trial. Diabet. Med. 26, 778-782 (2009).

Serum concentration of 1–25 OHD3 was determined by radioimmunologic assay in 140 patients with various endocrine or metabolic diseases. It appears that this determination has a poor value for diagnosis and prognosis but a real interest for comprehension of bone repercussion in these situations.

Thyroid hormones, TSH and antithyroid antibodies were prospectively controlled in 116 patients treated with amiodarone. Hypothyroidism occurred in 4 patients (3.7%) mainly early (average = 6 months). Hyperthyroidism was seen among 13 patients (11.9%) and its prevalence was proportional to therapy duration.