Severe spontaneous intracranial haematoma in a HIV-negative 66-year-old mild haemophiliac. Complete recovery with the use of 1-month factor VIII replacement.

Intracranial haemorrhage is the most feared manifestation of haemophilia and is usually seen in severe forms. We report herein the case of a 66-year-old HIV-negative patient with mild haemophilia (factor VIII: 7%) who presented with a spontaneous and massive intracranial haematoma causing hemiplegia and aphasia. We discuss the management of this peculiar situation emphasizing the need for rapid and adapted FVIII replacement. A complete recovery was obtained using this strategy combined with initial resuscitation measures and subsequent physical therapy.

[Short-stay hospitalization of elderly persons: first step toward institutionalization?]. / L'hospitalisation en court-séjour des personnes âgées: premier pas vers l'entrée en institution?

One month outcome after hospitalization was studied in 1695 persons aged 75 and over, living in the community and admitted to acute care medical units: only 9.6% of them were then institutionalized. Returning home requires a high level of independence for feeding, mental status and continence. The level of dependence of institutionalized patients was particularly high for dressing or bathing, technical care, mental status and security. A multivariate analysis showed that the only independent predictors of institutionalization were: sex, living alone, mental status and hospital type. The role played by physical disability must be counterbalanced by the effective physical assistance, brought to the elderly by institutional or informal home care after hospitalization. These results allow early identification of persons at high risk of institutionalization.

[Malaise and loss of consciousness in the elderly patient: prospective evaluation of methods of investigation]. / Malaises et pertes de connaissance du sujet âgé: évaluation prospective des méthodes d'investigation.

60 consecutive patients (mean age: 80,7 yrs; s.d.: 6,1 yrs; range 70-94 yrs) referred to a geriatric medicine department with syncope or dizziness were proposectively compared with 40 age and sex matched controls. A battery of non-invasive investigations including tilt-test, glycemia, 12 lead ecg., eeg, 24 hour ambulatory ecg recording,. M--mode echocardiogram and cervical Doppler velocimetry was applied blindly to patients and controls. The proportion of abnormalities was similar in both groups having sick sinus syndrom or complete atrio-ventricular block versus no control (p less than 0.05). By contrast history-case was of great predictive value: 6 of 13 patients reporting abrupt syncope had a 24 ecg recording showing sick sinus syndrom or complete atrio ventricular block, versus 2 of 47 other patients (p less than 0,01); 11 of 14 patients reporting orhostatic dizziness or syncope had a tilt-test consistent with orthostactic hypotension versus 6 of 46 other patients (p less than 0,01).

[Measurement of the intestinal clearance of alpha 1-antitrypsin and the exchangeable potassium pool in elderly patients treated with anthraquinone glycosides]. / Mesure de la clairance intestinale de l'alpha 1-antitrypsine et du pool potassique échangeable chez des patients âgés, traités par des glucosides anthraquinoniques.

In order to check the long-term tolerance of a laxative treatment, the authors supervised during six months a group of 14 elderly people (12 women and 2 men) with a mean age of 81.3 years suffering from long-standing constipation without any organic cause. The laxative was given in a daily dosage corresponding to 20 mg of sennosides. Alpha 1-antitrypsin (alpha 1-AT) clearance and exchangeable potassium pool (PPE) were measured, at the beginning (T0), and at the end of the third (T3) and the sixth (T6) months of the study. No abnormal variation of intestinal protein loss (alpha 1-AT: T0, 6.74 +/- 3.16; T3, 2.96 +/- 1.35; T6, 4.15 +/- 1.45 ml/24 h; T0-T3; p less than 0.05, T0-T6, T3-T6: NS) and exchangeable potassium pool (PPE: T0, 19.54 +/- 2.55; T3, 20.29 +/- 3.46, T6, 23.56 +/- 4.92 mEq/kg; T0-T3, T0-T6, T3-T6: NS) was observed. In opposition to current views, all long-term laxative treatments do not necessarily induce significant intestinal protein and potassium losses.

[Medium-stay for geriatric patients: a long-stay waiting room or an active rehabilitation unit?]. / Le moyen séjour gériatrique: antichambre du long séjour ou unité active de réadaptation.

From May 1979 to April 1980, 223 patients were discharged from a "medium stay" unit (mean length of stay: 45 days) for geriatric patients in Bordeaux (France). The outcome at discharge was established from retrospective data, and the long-term outcome (18 months) through a letter sent to general practitioners (rate of response: 88,5% with, in some instances, a prompting phone-call). The mortality rates were 22,5% in hospitalized patients and 38% in survivors after discharge. When those hospitalized for social reasons only are excluded, 62,9% of the remaining patients returned to their former place of residence at discharge. Moreover, 83% were still living at the same place after 18 months (range: 12-24 months). Considering the patients' ages and the seriousness of their conditions, "medium stay", geriatric units seem efficient in helping to maintain the aged at home.

Filterability and cerebro-vascular disease.

800 mg of pentoxifylline 400 was administered daily to two groups of elderly patients (average age 80 years) with the aim of increasing cerebral efficiency. Fifty patients (Group I) were treated for 30 days and of these, 25 patients (Group II) were treated for a further, 60 days. The programme included a battery of psychometric tests (Rey's R.P.M. Recit of Barbizet, coupled image tests, immediate memory test) two geriatric scales (Geriatric Rating Scale and Nosie 30) and study of the deformability of red cells. Results at the 30th and 90th day were compared with pre-experimental results: corrected filterability was increased (Group I and II, P less than 0.05), memory tests showed significant improvement (Group I and II, P less than 0.005), geriatric rating scale showed no modification. There was no correlation between changes in corrected filterability and improvement in psychometric tests.

[Wolff-Parkinson-White syndrome after 50 yars of age. Clinical and electrophysiological data]. / Le syndrome de Wolff-Parkinson-White après cinquante ans. Données cliniques et électrophysiologiques.

The Wolff-Parkinson-White syndrome is usually observed in young people and is much rarer in patients over 50 years old. This fact may be explained by the demise of a certain number of patients before the age of 50 and/or a change in the clinical features of the syndrome with age and/or of the electrophysiological properties of the normal and accessory conduction pathways. To test the latter hypothesis, the clinical and electrophysiological data of 15 patients over 50 years old with the Wolff-Parkinson-White syndrome (Group I) were compared with that of 10 patients under 30 years old with the same syndrome (Group II). The same protocol of electrophysiological investigation was used in both groups of patients. The results showed a significant difference (p < 0.001) between the two groups in the incidence of associated cardiac disease. This was more common in Group I (1 4 out of 15 patients) than in Group II (2 out of 10 patients). The cardiothoracic ratio was significantly higher in Group I (p < 0.01). The two groups also differed in the age at which tachycardia first occured. 9 out of 11 patients in Group I only had symptoms after thirty years. On the other hand, there was no significant difference in the types of tachycardia and the frequency of attacks. There was no significant difference in QRS, PR, AH, HV intervals, in the ventriculo-atrial conduction time and the effective refractory periods of the atrium, right ventricle or atrio-ventricular node. There was no significant difference in the anterograde and retrograde refractory periods of the accessory pathways between the two groups. Reciprocating tachycardia, initiated by electrical stimulation in 7 patients in Group I and 6 patients in Group II, was conducted anterogradely to the ventricles through the normal pathway and retrogradely to the atria through the the accessory pathway. This study suggest that age-related changes in the electrophysiological properties of the accessory are not an important prognostic factor in the Wolff-Parkinson-White syndrome.

[Ventricular tachycardia. A possible complication of intravenous atropine in the coronary patient]. / Tachycardie ventriculaire. Complication possible de l'atropine intraveineuse chez le coronarien.

Ventricular tachycardia occurred with chest pain in a 64 year old man with coronary artery disease after an intravenous injection of atropine. The particular feature of this case as compared to the other 8 reported cases is the restoration of sinus rhythm after a passage of accelerated idioventricular rhythm by the administration of oxygen and nitroglycerin. The increased oxygen consumption and myocardial ischaemia due to the tachycardia seem to be the factors responsible for these ventricular arrhythmias. Such cases, though rare, incite caution in the administration of atropine to patients with coronary artery disease.