Terms used by physicians when deciding to withhold treatment for older patients not having received palliative care in an acute geriatric care unit.

PURPOSE: There are no guidelines or consensus statements on the terms to be used when discussing withholding of treatment for patients in acute geriatric care units and who have not received palliative care. The objective of the present study was to analyze the terms used in medical records to refer to the withholding of treatment for patients who died in an acute geriatric care unit and did not receive palliative care. METHODS: We conducted an ambispective multicentre cohort study based on the DAMAGE study. Data on 53 patients who died in the acute geriatric care unit and who had not received palliative care were extracted from medical records. The verbatims referring to the withholding of treatment were analyzed in terms of keywords and then key concepts, as defined by several reviewers in a consensus-based approach. RESULTS: The mean age of the patients was 86.4 years, 34.1% were male. Terms referring to the withholding of treatment were found for 25 of the 53 patients (47.2%). Most of the decisions on the withholding of treatment were recorded in the week following admission to the acute geriatric care unit. Our analysis of the terms identified 11 key concepts: treatment limitation, no resuscitation, withholding diagnostic procedures, justification of care, ethical considerations, disease progression, uncertainty, the patient's wishes, the family's wishes, patient's comfort, and collegiality. The terms used to describe key concepts varied markedly from one physician to another. CONCLUSION: Decisions about the withholding of treatment are frequently noted in the medical records of patients who die in the acute geriatric care unit without having received palliative care. The broad variety of key concepts and differences in the choice of words highlight the need for standardized terms.

[Pomalidomide for multiple myeloma]. / Le pomalidomide dans le myélome multiple.

Once characterized by a very poor outcome, multiple myeloma (MM) now has a significantly prolonged survival, with major improvements allowed by the use of "novel agents": proteasome inhibitors (first-in-class bortezomib) and immunomodulatory compounds (IMiDs; first-in-class thalidomide and lenalidomide). However, the vast majority - if not all - of patients with MM ultimately end up being refractory to all existing drugs, including these efficient novel agents. There is a clear unmet medical need in this situation, which warrants the development of the next generation of proteasome inhibitors and IMiDs, as well as new drug classes. This review focuses on pomalidomide, the next generation IMiD, recently approved by the US FDA and the EMA for patients with relapsed or refractory MM who have received at least two prior therapies, including lenalidomide and bortezomib, and have demonstrated disease progression on their last therapy.

Pathophysiological variations in the rat liver plasma membrane serine proteinase activity.

The effects of fasting, diabetes, cholestasis, two-third hepatectomy and adrenalectomy on the rat liver plasma membrane serine proteinase activity were studied. Our results show a significant decrease of the enzyme activity during fasting (-50%), during experimental diabetes (-50%), in regenerating liver after partial hepatectomy (-70%) and after extrahepatic cholestasis (-70%). No modifications are noted when the rats are bilaterally adrenalectomized. These findings suggest that the enzyme activity may be linked to the level of circulating insulin, and may be regulated in physiological cellular proliferation so as to prevent undesirable protein degradation.

Alpha-L-fucosidase in rat testis during sexual maturity.

alpha-L-fucosidase (EC 3.2.1.51) activity, concentration of testosterone (T), and its metabolite dihydrotestosterone (DHT) were tested in rat testis during the onset of puberty. This study was also carried out in testes of rats treated with 17-beta-N,N-diethylcarbamoyl-4-methyl-4-aza-5-alpha-androstane-3-one (DMAA), an inhibitor of the 5-alpha-reductase-mediated conversion of T into DHT. alpha-L-fucosidase activity in seminiferous tubules of control and DMAA-treated rats was found to be relatively high on the 25th day after birth (approximately 24 units) but decreased and remained relatively constant the following days (approximately 10 units). In contrast, alpha-L-fucosidase activity was nearly undetectable in the immature interstitium of the control rats but sharply increased the following days. A maximum was reached at the 55th day, followed by a rapid decrease. alpha-L-fucosidase activity evolved in parallel with an increase and decrease of DHT concentration. In DMAA-treated rats with DHT levels and an alpha-L-fucosidase activity significantly lower than in the control rats between the 55th and the 65th days, this parallelism existed as well.