Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 6 de 6
Filter
1.
Rev Med Interne ; 36(4): 243-7, 2015 Apr.
Article in French | MEDLINE | ID: mdl-24973294

ABSTRACT

PURPOSE: To study pneumococcal immunization coverage in older patients in hospital, and the impact of two actions aiming at improving this coverage. METHODS: We reported a prospective and descriptive study conducted from November 2009 to August 2010, including all new patients ≥75 years old received in a geriatric short-stay department and residing in Val-de-Marne, France. This study was performed in three successive three-month periods, to assess the vaccination coverage in the months following hospital release. Period I was the reference; Period II included an awareness campaign of general practitioners relying on the hospitalization discharge report, containing an indication for the vaccination; Period III consisted in a systematic proposal of vaccination by the geriatric hospital department. RESULTS: Indication for pneumococcal vaccination has been given to 139 patients (61.2%) in 227 processed questionnaires. The main indication was heart failure for 105 patients (75.5%). Twenty-four patients were already vaccinated (17.2%). No vaccination was reported in the three months following period I in 33 included patients. The awareness campaign targeting regular doctors resulted in only one vaccination out of 37 patients. Immunization coverage in the department had reached 84.5% of inoculation (38 of 45 patients). CONCLUSION: Pneumococcal vaccination is often prescribed in elderly patients but generally not executed. The awareness campaign did not result in a big enough immunization coverage improvement, compared to a codified proposal of vaccination during hospital stay.


Subject(s)
Immunization/standards , Pneumococcal Vaccines , Quality Improvement , Aged , Aged, 80 and over , Female , Hospitalization , Humans , Male , Prospective Studies
2.
J Mal Vasc ; 36(6): 355-63, 2011 Dec.
Article in French | MEDLINE | ID: mdl-22014579

ABSTRACT

We report on a case of Clostridium septicum aortic mycotic aneurysm in an 83-year-old patient. This is a rare infectious disease. To our knowledge, only 31 cases have been reported in the literature. The clinical presentation is dominated by abdominal pain with fever. Although only the bacteriological samples can definitely identify the germ, the presence of gas bubbles around an aneurysm on abdominal computed tomography scan suggests C. septicum aortic infection. This infectious disease is frequently associated with neoplasia, mainly colonic. Treatment is primarily surgical resection with bypass or graft, associated with prolonged antibiotic therapy. The prognosis is poor due to vascular complications and pathogenesis of C. septicum. Patients cumulate the death risk from mycotic aneurysm and C. septicum sepsis.


Subject(s)
Aneurysm, Infected/diagnosis , Aortic Aneurysm/diagnosis , Clostridium septicum , Aged, 80 and over , Aneurysm, Infected/drug therapy , Aneurysm, Infected/surgery , Anti-Bacterial Agents/therapeutic use , Aortic Aneurysm/microbiology , Aortic Aneurysm/therapy , Humans , Male , Tomography, X-Ray Computed
3.
Rev Med Interne ; 31(2): 140-5, 2010 Feb.
Article in French | MEDLINE | ID: mdl-19740577

ABSTRACT

INTRODUCTION: Tumors of the pituitary stalk are rare and their diagnosis is sometimes difficult. CASE REPORT: We report a case of a primary lymphoma of the pituitary stalk in a 78-year-old patient. To our knowledge, only seven similar cases have been previously published: prominent symptoms were headache, fatigue and diplopia; biologically, anterior pituitary low secretion or hyperprolactinemia were found in the majority of cases; regarding the imaging, only three patients presented an initial and isolated lesion of the stalk; histological evidence was obtained by a trans-sphenoidal biopsy in case of hypothalamic or pituitary associated lesion or by a trans-cranial biopsy in the event of an isolated lesion. As an alternative, a lumbar puncture could be performed; although less invasive, its diagnostic performance is lower. CONCLUSION: Current treatment relies on chemotherapy with intravenous methotrexate associated with intrathecal methotrexate infusion if cerebrospinal showed abnormal cells. Unfortunately, the results remain poor with a median survival of 9 months.


Subject(s)
Lymphoma/pathology , Methotrexate/therapeutic use , Pituitary Neoplasms/pathology , Aged , Antimetabolites, Antineoplastic/administration & dosage , Antimetabolites, Antineoplastic/therapeutic use , Biopsy , Central Nervous System Neoplasms/pathology , Female , Humans , Lymphoma/diagnostic imaging , Lymphoma/drug therapy , Magnetic Resonance Imaging , Methotrexate/administration & dosage , Pituitary Neoplasms/diagnostic imaging , Pituitary Neoplasms/drug therapy , Spinal Puncture , Survival Analysis , Tomography, X-Ray Computed
4.
Clin Pharmacol Ther ; 87(1): 57-64, 2010 Jan.
Article in English | MEDLINE | ID: mdl-19794411

ABSTRACT

Determining the optimal dose of warfarin for frail elderly patients is a challenging task because of the low dose requirements in such patients, the wide interindividual variability of response, and the associated risk of bleeding. The objective of this study was to address the influence of 13 common variations in eight genes on the maintenance dose of warfarin in a cohort of frail elderly inpatients. For our study, we enrolled 300 Caucasian subjects who were hospital inpatients, with a mean age of 86.7 +/- 6 years. In addition to age, genetic variants of VKORC1, CYP2C9, CYP4F2, and EPHX1 were found to be significant predictor variables for the maintenance dose of warfarin, explaining 26.6% of dose variability. Among 132 patients in whom warfarin therapy was initiated with the same low-dose regimen, we studied the relative influences of genetic and nongenetic factors. The time to first international normalized ratio (INR) > or =2 was influenced by VKORC1 and CYP2C9 genotypes (P = 0.0003 and P = 0.0016, respectively); individuals with multiple variant alleles were at highest risk for overanticoagulation (INR >4) (odds ratio, 12.8; 95% confidence interval, 2.73-60.0). In this special population of frail elderly patients with multiple comorbidities and polypharmacy, we demonstrated the main impact of genetic factors on warfarin response.


Subject(s)
Aryl Hydrocarbon Hydroxylases/genetics , Cytochrome P-450 Enzyme System/genetics , Epoxide Hydrolases/genetics , Frail Elderly , Mixed Function Oxygenases/genetics , Warfarin/pharmacology , Age Factors , Aged , Aged, 80 and over , Cohort Studies , Cytochrome P-450 CYP2C9 , Cytochrome P450 Family 4 , Dose-Response Relationship, Drug , Female , Genetic Testing , Genetic Variation/drug effects , Genetic Variation/genetics , Hospitalization/trends , Humans , International Normalized Ratio/trends , Male , Polymorphism, Genetic/genetics , Prospective Studies , Risk Factors , Vitamin K Epoxide Reductases
5.
Rev Neurol (Paris) ; 164(11): 935-42, 2008 Nov.
Article in French | MEDLINE | ID: mdl-18808782

ABSTRACT

INTRODUCTION: Status epilepticus is quite frequent in the elderly but rarely studied despite the poor functional prognosis and significant mortality. METHODS: We retrospectively evaluated the clinical manifestations and electroencephalogram findings observed over a two-year period in 63 consecutive inpatients aged over 70 years presenting status epilepticus. The variables studied included age, sex, the number of concomitant chronic active diseases, previous neurological disorders, brain lesions on CT or MRI, the use and withdrawal of medications and outcome. RESULTS: The incidence of status epilepticus was 1%; two-thirds in women and one-third in men. The mean age was 83 years. Complex partial status epilepticus was noted in 91% with predominant features of confusion (89%), impairment of consciousness (75%) or psychiatric symptoms (46%). Etiologies were often multifactorial and acute symptomatic. Etiology was metabolic in 60%, drug-induced in 51%, demential in 44%, cerebrovascular in 37%, infectious in 30% and other neurological disorders in 28% of the cases. Antiepileptic drugs used to treat status epilepticus were benzodiazepine (60%), often in association with lamotrigine (51%), valproate (46%) or phenytoin (25%). Maintenance of an antiepileptic drug was found in 70% of cases. Complications were loss of autonomy (86%), malnutrition (67%), infections (51%), dementia (30%), pressure sores (14%), and recurrent epilepsy (13%). Mortality was 32% of cases and it was higher in men. CONCLUSION: These findings have shown some special features of status epilepticus among the elderly but other prospective studies are needed to confirm these results and to identify optimal management to decrease mortality, and improve the poor functional prognosis.


Subject(s)
Status Epilepticus/physiopathology , Aged , Aged, 80 and over , Alzheimer Disease/epidemiology , Anticonvulsants/therapeutic use , Brain Neoplasms/epidemiology , Comorbidity/trends , Confusion/epidemiology , Consciousness Disorders/epidemiology , Electroencephalography , Female , Humans , Hypertension/epidemiology , Life Style , Male , Middle Aged , Myocardial Ischemia/epidemiology , Radiography , Retrospective Studies , Sex Characteristics , Status Epilepticus/diagnostic imaging , Status Epilepticus/drug therapy , Status Epilepticus/epidemiology
SELECTION OF CITATIONS
SEARCH DETAIL
...