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Resume Objectifs – Dans une revue de la litterature, en 1990, nous avions mis l’accent sur une comorbidite d’observation recente : les troubles des conduites alimentaires (TCA) dans le diabete insulino-dependant (DID), pour insister sur la severite potentielle de son evolution. Nous avions souligne les difficultes methodologiques soulevees par leur etude systematique. D’autres etudes ont ete publiees depuis, en particulier une meta-analyse sur les etudes les plus robustes. Nous avons voulu faire le point des connaissances actuelles sur cette comorbidite, examiner l’apport des etudes les plus recentes et verifier si elles confirment les resultats de la meta-analyse. Resultats – La prevalence des TCA dans le DID semble voisine ou peu augmentee par rapport a la population generale. Seuls de tres grands effectifs permettraient d’affirmer qu’il n’y a pas de difference par rapport a la population generale ou seulement une elevation moderee mais significative de ce risque. L’ensemble des donnees depuis 1986 est en faveur d’un risque accru de desequilibre metabolique mesure par l’hemoglobine glyquee (HbA1C) et de micro-angiopathie retinienne. La nature des liens entre DID et TCA reste peu claire. Aucune etude de traitement valide n’a ete conduite, bien que differentes propositions aient ete faites. Le surpoids, frequemment associe a cette comorbidite chez les adolescentes, semble un element de comprehension psychobiopathologique de cette comorbidite, ainsi que la glycosurie auto-induite qui rendrait compte du risque somatique. Nous proposons un profil type de l’association DID et TCA integrant ces donnees. Conclusion – S’il parait difficile de conclure actuellement que le DID est un facteur de risque important de survenue de TCA, en revanche cette comorbidite represente une source de detresse importante pour les patientes et un haut risque somatique imposant la vigilance du diabetologue pour la depister et la collaboration entre somaticiens et psychiatres pour la traiter avant des complications irreversibles.

A decrease of the basal glucose metabolism with senescence in the isolated rat adipose tissue has been demonstrated. In the presence of insulin, the oxidation of (U14C)-D-glucose and its incorporation into triglycerides are significantly increased at all ages studied. No significant difference between groups of animals was noted when the insulin-stimulating effect was related to basal metabolism. The synthesis of fatty acids from glucose is highly enhanced by insulin at 6 weeks, poorly at 6 months and no more at 24 months. It is concluded that the insulin sensitivity of the rat adipose tissue is not affected by ageing. Nevertheless, as far as fatty acid synthesis is concerned, a different metabolic pathway could be involved.

No modification in basal radioglucose metabolism by isolated rat diaphragm could be seen with senescence. Insulin increased the production of 14CO2 only in growing animals. On the opposite, incorporation of radioglucose into glycogen is enhanced in the different age groups; nevertheless, the response in 3-month-old animals was lower than in 6-week-old ones. No significant difference has been detected between the adult and the old rats. Therefore, it is concluded that a diminution of insulin sensitivity appeared during the period of transition between growing up and maturity without any further modification during old age.

Chronic pancreatitis (CP) is an inflammatory disorder characterized by inflammation and fibrosis, resulting in a progressive and irreversible destruction of exocrine and endocrine pancreatic tissue. Clinicians should attempt to classify patients into one of the six etiologic groups according to the TIGARO classification system. MRI/MRCP, if possible with secretin enhancement, is considered the imaging modality of choice for the diagnosis of early-stage disease. In CP, pain is the most disabling symptom, with a significant impact on quality of life. Pain should be assessed using the Izbicki score and preferably treated using the "pain ladder" approach. In painful CP, endoscopic therapy (ET) can be considered as early as possible. This procedure can be combined with extracorporeal shock-wave lithotripsy (ESWL) in the presence of large (> 4 mm), obstructive stone(s) in the pancreatic head, and with ductal stenting in the presence of a single main pancreatic duct (MPD) stricture in the pancreatic head with a markedly dilated MPD. Pancreatic stenting should be pursued for at least 12 months in patients with persistent pain relief. On-demand stent exchange should be the preferred strategy. The simultaneous placement of multiple, side-by-side, pancreatic stents can be recommended in patients with MPD strictures persisting after 12 months of single plastic stenting. We recommend surgery in the following cases : a) technical failure of ET; b) early (6 to 8 weeks) clinical failure; c) definitive biliary drainage at a later time point; d) pancreatic ductal drainage when repetitive ET is considered unsuitable for young patients; e) resection of an inflammatory pancreatic head when pancreatic cancer cannot be ruled out; f) duodenal obstruction. Duodenopan-createctomy or oncological distal pancreatectomy should be considered for patients with suspected malignancy. Pediatricians should be aware of and systematically search for CP in the differential diagnosis of chronic abdominal pain. As malnutrition is highly prevalent in CP patients, patients at nutritional risk should be identified in order to allow for dietary counseling and nutritional intervention using oral supplements. Patients should follow a healthy balanced diet taken in small meals and snacks, with normal fat content. Enzyme replacement therapy is beneficial to symptomatic patients, but also in cases of subclinical insufficiency. Regular follow-up should be considered in CP patients, primarily to detect subclinical maldigestion and the development of pancreatogenic diabetes. Screening for pancreatic cancer is not recommended in CP patients, except in those with the hereditary form.

This paper gives a survey of frequency domain identification methods for rational transfer functions in the Laplace (s) or z-domain. The interrelations between the different approaches are highlighted through a study of the (equivalent) cost functions. The properties of the various estimators are discussed and illustrated by several examples

We report a case of an intramedullary thoracic primary melanocytic tumor of the leptomeninges in a 38-year-old woman. According to the WHO classification, the lesion showed the histological features of a meningeal melanocytoma. Two local recurrences were successively operated on, two and three years after the first surgery respectively. The patient died of a subarachnoidian dissemination after a four year course. This case emphasized the therapeutic problems we have to deal with when facing an isolated black tumor of the central nervous system. The features and the differential diagnosis of the meningeal melanocytoma are detailed.