La Revue du praticien
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Evidence-based therapeutic decisions in type 2 diabetes are considered here in terms of both the individual and public health policy. They lead to the recommendation which has proved to be the most effective: early, intensive, global care, first for glycemic control, then, according to the case, for the other risk factors of atheromatosis.
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Vascular acrosyndromes group several disorders around Raynaud's phenomenon, characterized by a distal involvement and a vasomotor pathogenesis. Their exact mechanisms remain unknown, but epidemiological data favour disturbances of thermoregulation: cold climate, outdoor occupation and low body mass index are significant risk factors for most of them. ⋯ There is no link between Raynaud's phenomenon and tobacco use, alcohol consumption, oestrogen treatment, carpal tunnel syndrome or thoracic outlet syndrome. By contrast, the role of connective tissue diseases and occupational disorders (vibration exposure and hand-hammer syndrome) are established.
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Acrocyanosis is an acrosyndrome frequently found among adolescent or young women. Four clinical symptoms are necessary and sufficient to establish the diagnosis: permanent and painless cyanosis of extremities, local hypothermia, permanent sweatiness, and elastic infiltration of the integument. ⋯ Treatment is mainly preventive: protection against cold. Two conditions can be regarded as false acrocyanosis: acrorhigosis and acroiodesis.