[Balloon mitral commissurotomy in patients aged 60 years and more]

Of 745 patients treated by balloon mitral commissurotomy [BMC] between February 1988 and December 2002, 45 were over 60 years old. Immediate and late outcomes in this group [group 1] were compared with those in the patients aged under 60 years [group 2]. Baseline hemodynamic parameters were comparable in the two groups. Mitral surface area and hemodynamic parameters improved significantly after BMC in group 1: mean left atrial pressure fell from 18.76 +/- 6.18 to 10.65 +/- 4.38 mm Hg [p<0.001], mean transmitral gradient from 11.03 +/- 4.70 to 4.63 +/- 2.05 mm Hg [p< 0.001] and mitral valve area from 0.99 +/- 0.22 to 1.88 +/- 0.41 cm 2 [p< 0.001]. Similar significant improvements were seen in group 2. The hemodynamic result was good in 69% of group 1 patients. Tamponade occurred in one patient. Mitral regurgitation grade I or II developed in 8 patients and remained stable in 13 patients. These complication rates were comparable to those seen in group 2. In the group 1, a good result was maintained in 60% of patients after 43 +/- 23 months of follow-up. Although restenosis was observed in 40% of patients, functional amelioration was obtained in most of cases. In the group 2, restenosis was observed in 25% of patients. The data from this study suggest that BMC is effective first therapy in patients aged >/= 60 years with symptomatic mitral stenosis

[Analysis of the appropriateness of hospitalizations in Monastir, Tunisia]

We aimed to measure the extent of inappropriate hospital admissions and to identify factors associated with inappropriate hospital use. A descriptive study was carried out on a r and omized sample of 411 hospitalizations in 3 regional hospitals. The appropriateness of admissions was assessed using the Appropriateness Evaluation Protocol [AEP]. We found 21% [95% CI: 17%-25%] of the admissions were avoidable according to the AEP. Inappropriate admissions were associated with the hospital [P = 0.005], patient age [P = 0.003], length of stay and diagnosis [P < 0.001]. The most frequent reasons for appropriate admissions were parenteral therapy, an acute or progressive sensory motor circulatory or respiratory condition sufficient to incapacitate the patient and severe electrolyte or blood gas abnormality. Our study highlights the need to improve hospital management and to develop alternatives to hospitalization