Acquired deforming hypertonia and contractures in elderly subjects: definition and prevalence in geriatric institutions (ADH survey).

OBJECTIVE: By proposing a new terminology (acquired deforming hypertonia or ADH) and a new definition for contractures, the main objective of this study was to establish their prevalence among institutionalized elderly patients. Secondary objectives were to analyze the negative impact of ADH and collect the opinions of clinicians on the possible treatments available. METHODOLOGY: A multicenter cross-sectional study was conducted among residents of 39 geriatric institutions (29 EHPAD and 10 USLD). All subjects presenting at least one ADH were surveyed over a one-week period. RESULTS: Among 3145 observed patients (mean age 88.9±9.7 years) 22% (n=692) presented at least one ADH. In average, each patient presented 4.4±3.2 ADHs. Negative consequences on self-care, nursing and difficulties in getting dressed were most frequently observed. Only 25.4% of clinicians considered the ADH to be potentially reversible. Physical therapy was the therapeutic option most frequently chosen over medication and surgery. CONCLUSION: This study confirms the important prevalence of ADH among elderly institutionalized patients. Consequences on the level of dependence were significant. It seems relevant to elaborate hierarchical therapeutic strategies in order to counter these disorders and the fatalism that ensues.

[Changes in urethral pressure after intravenous injection of moxisylyte hydrochloride in urethral instability in women. Preliminary results]. / Evolution des pressions urétrales après injection intraveineuse de chlorhydrate de Moxisylyte dans l'instabilité urétrale de la femme. Résultats préliminaires.

OBJECTIVE: To study the action of an alpha blocker, Moxisylyte hydrochloride, during an intravenous test on the course of urethral pressure in women with urethral instability associated with urethral hypertonia. METHODS: The population consisted of 20 women with a mean age of 38 years, presenting with a clinical disorder of micturition (urinary incontinence: 15 cases, urgency: 17 cases, frequency, 17 cases) present for an average of 4 years and associated with resting urethral pressure variations ranging from 22 to 88 cm H2O (mean: 44.8 cm H2O) and static urethral pressures ranging 72 to 150 cm H2O (mean: 102.5 cm H2O). An urodynamic assessment was performed before and after intravenous injection of Moxisylyte hydrochloride at the dose of 0.5 mg/kg. RESULTS: Moxisylyte hydrochloride induced a significant reduction of urethral pressure variations, ranging from 8 to 42 cm H2O (mean: 21.9 cm H2O) and static urethral pressures, ranging from 47 to 102 cm H2O (mean: 68.8 cm H2O). Treatment was well tolerated in every case. CONCLUSION: These preliminary results need to be completed by a randomized placebo-controlled study to confirm a statistically significant effect of Moxisylyte hydrochloride on urethral pressure stability in women presenting with urethral instability.

[Urethral calibration in menopausal women examined for vesico-sphincter disorders]. / Calibrage urétral chez la femme ménopausée consultant pour troubles vésico-sphinctériens.

In order to appreciate the consequences of aging on the urethra, two prospective studies assessed its caliber in postmenopausal women. The population included aged women who came to consultation for disorders of the bladder and sphinecters. The clinical checkup, assessing the patient's age, morphology, time elapsed since menopause, local consequences of hormonal deficiency and urinary functional signs, was completed by an urodynamic examination. In the first study (76 patients), the urethra was calibrated using two Peters dilating bougies ranging from Charrière 10 to Charrière 26. In the second study (50 patients), measurements were made with OTIS-type ball dilators ranging from Charrière 9 to Charrière 30. This exploration was made in 126 patients. Urethral caliber was greater than or equal to Charrière 24 in 78% of patients. Only 2.3% of women had urethral "stenosis" with a Charrière score under 18. Contrary to what we were expecting, the urethral caliber does not seem to decrease with age. This unexpected statement and the difficulties of statistical analysis we have encountered lead us to complement our study.

[The value of a clinical test for the evaluation of bladder-sphincter function in the management of urinary disorders of the elderly]. / Intérêt d'un test clinique d'évaluation de la fonction vésico-spinctérienne dans la prise en charge des troubles urinaires du sujet âgé.

The authors report the value of a clinical test for the evaluation of vesico-sphincteric function in the demonstration of urinary disorders in the elderly. This simple, inexpensive test which can be performed at the patient's bedside, was performed in 175 elderly patients with a mean age of 81.2 years, mostly suffering from urinary incontinence (66.2%) and mostly (80%) derived from intermediate and long-term geriatric units. The mechanisms most often detected was detrusor instability (41% of patients). Cystomanometric data, obtained in 80 patients, were analysed and compared retrospectively with the data of the test: they demonstrated a good correlation in terms of evaluation of detrusor stability. As part of the overall management, this test constitutes a real diagnostic tool available to nursing staff, particularly in geriatric institutions not equipped with more specialised investigations.

[Value of a clinical test for the assessment of bladder and sphincter function in the management of urinary disorders in the aged]. / Intérêt d'un test clinique d'évaluation de la fonction vésico-sphinctérienne dans la prise en charge des troubles urinaires du sujet âgé.

The authors report about the merits of a clinical test for the evaluation of bladder and sphincter function in the analysis of urinary disorders in the aged. This simple and inexpensive bedside test has been carried out in 175 subjects whose mean age was 81.2 years, and the majority of whom (66.2%) presented with urinary incontinence; 80% of the patients came from longterm-care geriatric departments. The most frequent mechanism is bladder instability (41% of all patients). The cystomanometric data obtained in 80 subjects were analysed and retrospectively compared to the test data: they showed good correlation for the study of vesical stability. From the viewpoint of general health care, this test is a real diagnostic tool for the practitioners, in particular in geriatric departments without further specialised exploration commodities.

Total serum IgE concentrations in adolescents and adults using the phadebas IgE PRIST technique.

Total serum IgE measured with the Phadebas PRIST technique was titrated in 117 normal non-allergic subjects, 237 allergic adolescents or adults and 89 non-allergic patients who suffered from asthma, rhinitis, or conjunctivitis. All subjects were of Caucasian origin. In normal subjects, mean total serum IgE was 38 +/- 43 kU/l. This value is exactly the same as that found in a study of Caucasian New Zealanders and very similar to the values found in most U.S. studies. This suggests that the mean total serum IgE concentration is remarkably constant in normal non-allergic Caucasians. The upper limit of the normal range is considered to be 150 kU/l. 38% of allergic patients have total IgE concentrations within the normal range. Some pollen or hymenoptera venom-sensitive patients have a total serum IgE concentration below 20 kU/l. The non-allergic patients had a mean IgE concentration of 94 +/- 93 kU/l, and 25% of them had a total serum IgE above the normal range. Asthmatic patients had higher mean IgE levels than those who were suffering from either rhinitis or conjunctivitis.

Clinical and immunological surveys in bee keepers.

Two hundred and fifty bee keepers in the South of France, working seasonally, were clinically investigated by means of a questionnaire. Forty-three per cent had presented anaphylactic symptoms and 7.0% toxic reactions when stung by bees. The personal atopic history was found to be significantly (P less than 0.01) elevated in bee keepers who experienced anaphylaxis. Total serum IgE and been venom-specific IgE were titrated in 100 subjects. Total serum IgE was significantly elevated in allergic bee keepers (P = 0.02). Although bee venom-specific IgE were significantly (P less than 0.01) higher in allergic bee keepers this parameter cannot discriminate between allergic and non-allergic bee keepers owing to a considerable overlap. Bee venom-specific IgG was assayed in seventy subjects. Their level was significantly (P less than 0.001) higher in allergic and non-allergic bee keepers as compared with non-allergic blood donors and non-bee-keeping allergic patients. In both bee keeper groups there was no difference in bee venom-specific IgG titres.

Comparison of cord blood immunoglobulin E concentrations and maternal allergy for the prediction of atopic diseases in infancy.

Total serum IgE levels were determined in 136 newborns and their mothers and in 54 of their fathers, using the paper radioimmunosorbent test (PRIST) technique. IgE specific antibodies for house dust (Dermatophagoides pteronyssinus), orchard grass, timothy grass, and cow's milk were measured with the radioallergosorbent test (RAST). One hundred thirty-three RAST assays were negative in newborns, and in three cases RAST for cow's milk was positive. Cord blood IgE ranged from 0 to 5.5 IU/ml (mean 0.32 +/- 0.54 IU/ml); levels were significantly (p less than 0.05) higher when maternal IgE was over 100 IU/ml and when mothers had received progesterone therapy during the pregnancy. Salbutamol administration or tobacco smoking during pregnancy did not influence newborn IgE. A clinical follow-up study was conducted in 83 infants for 9 mo. Nine infants developed definite atopic disease, and possible allergic diseases were noted in eight other infants. The IgE level at birth appeared to be more predictive for the development of allergy in infancy than the family history.

Enzyme determination and RAST inhibition assays for orchard grass (Dactylis glomerata): a comparison of commericial pollen extracts.

Pollens release enzymes when they are dropped into water. Orchard Grass extracts were tested by two methods. The Api-Zym System determined 19 enzymes and colorimetric amounts of Leucine Aminopeptidases, Acid phosphatase and trypsin. These were compared with RAST inhibition assays. A good correlation was shown between the techniques. Thus the enzyme dosage may be useful for the standardization of pollen extracts.