ABSTRACT
AIM: Pseudogout is an important causative disease of febrile illness in elderly patients. We experienced cases of pseudogout during or after the progression of inflammatory disease. METHODS: We investigated 14 patients with pseudogout admitted to the Department of Geriatric Medicine at Kyorin University Hospital. Seven patients who developed inflammatory disease prior to the onset of pseudogout are described in greater detail. RESULTS: The affected joint was the knee joint in 12 of 14 cases. Other joints were affected in four cases, and four patients had more than two affected joints in this series. Clear joint cartilage calcification was noted on X-rays in nine of 14 cases, and CPPD crystals were detected in two patients treated with joint puncture. NSAIDs were administered in all cases for treatment. Seven patients had a preceding inflammatory disease, with infectious disease in all cases. Repeat elevation of temperature and inflammatory reactions were seen in seven cases, with progression to bimodal disease in two cases. The average duration of antimicrobial use was 11 days. In three cases, the average duration of antimicrobial use was 33 days, and two or more antimicrobials were used for long-term treatment. CONCLUSIONS: Pseudogout appears as delayed infective disease and fever of unknown origin in the elderly. This condition may easily be overlooked until joint symptoms become apparent. It is extremely important to keep pseudogout in mind as a differential diagnosis of thermogenesis in elderly patients.
Subject(s)
Gout/physiopathology , Inflammation/physiopathology , Aged , Aged, 80 and over , Diagnosis, Differential , Female , Gout/drug therapy , Humans , MaleABSTRACT
BACKGROUND: Little has been known about clinical features and prognosis of very old patients with heart failure with preserved ejection fraction (HFPEF). The aim of this study was to compare clinical features and clinical outcomes between HFPEF and heart failure with reduced ejection fraction (HFREF) in patients older than 80 years. METHODS: We enrolled a total of 113 patients over 80 years old, who were admitted for heart failure between 2006 and 2009. We retrospectively analyzed the clinical features including laboratory data and echocardiography parameters. RESULTS: In 53 patients (49%) left ventricular ejection fraction was preserved. The clinical characteristics and treatment between HFPEF and HFREF showed that anemia was one of the risk factors for HFPEF, and the long-term outcomes of HFPEF in this population were not different from that of HFREF. CONCLUSION: These results suggest that anemia is one of the important risk factors for HFPEF in the very elderly.
Subject(s)
Heart Failure/physiopathology , Stroke Volume/physiology , Age Factors , Aged, 80 and over , Anemia/complications , Female , Humans , Male , Retrospective Studies , Risk FactorsABSTRACT
A 79-year-old woman attended the Center for Comprehensive Care of Memory Disorders at the Kyorin University Hospital in 2006 due to forgetfulness. Her initial diagnosis was vascular dementia. In 2007, her cognition declined gradually. Then, impaired verbal fluency and stuttering, the symptoms of non-fluent aphasia, were presented. Thereafter, 5 mg/day donepezil hydrochloride was prescribed. She later suffered type II respiratory failure. Needle electromyography revealed denervation of lower motor neurons. This led to the diagnosis of frontotemporal dementia with motor neuron disease. Interestingly, before developing type II respiratory failure, cognitive decline and non-fluent aphasia occurred in this case.
