Colonoscopy in the elderly: a study of 200 cases.

OBJECTIVES: To evaluate tolerance and diagnostic yield of colonoscopy in elderly patients. METHODS: We studied retrospectively 200 consecutive colonoscopies performed in patients older than 80 years (mean age: 83.5 +/- 3.1). We analyzed the following factors: indication, type and tolerance of the preparation, analgesia, tolerance of the procedure, information provided by the examination and therapeutic consequences. RESULTS: The indications were: anaemia in 81 cases, change in bowel habits in 58 cases, rectal bleeding in 26 cases and others in 35 cases. Preparation (4.2 +/- 1.3 L Polyethylene-glycol) was good 150 times (75%), moderate 27 times and poor 23 times. It was tolerated well 122 times (61%) and poorly 78 times (39%). Sixty-six colonoscopies were performed without any analgesia, diazanalgesia was used in 108 cases, general anesthesia in 8 and diazepam and/or antispasmodics in 18. Tolerance of colonoscopy was good in 140 cases (70%), moderate in 37 cases and poor in 23 cases. Tolerance was better with analgesia than without (p < 0.001). The caecum was reached in 167 cases (83.5%). Colonoscopy was normal in 68 cases (34%). The lesions discovered were: 40 polyps larger than 10 mm, 41 diverticulosis, 29 cancers, 7 ischaemic colitis, 5 angiodysplasias, 5 sigmoiditis, 3 villous adenomas, 1 Bothriocephalus and 1 thermometric ulceration. A lesion responsible for the symptoms was diagnosed in 80 cases (40%). Diagnostic yield was better when indication was anaemia (52%) than change in bowel habits (24%) (p < 0.001). The lesions were treated endoscopically in 41 cases (38 polypectomies, 3 electrocoagulations) and surgically in 22 cases. Colonoscopy as well as its preparation were well tolerated in 93 cases (46.5%). CONCLUSION: In a selected elderly population, colonoscopy was better tolerated with analgesia; large bowel preparation was often difficult. The diagnostic yield was relatively good. A multicentric prospective study is underway in order to determine the predictive criterias allowing an improvement of colonoscopic yield in the elderly.

[Type B Niemann-Pick disease and sea-blue histiocytes syndrome]. / La maladie de Niemann-Pick type B avec syndrome des histiocytes bleu de mer.

We report two new cases, in the same family, of type B Niemann-Pick disease associated with sea-blue histiocytes syndrome. In one patient the disease was revealed by spontaneous rupture of the spleen. The sea-blue histiocytes syndrome is due to the histiocytes being overloaded by ceroids, and it usually occurs in a context of blood disease or thesaurismosis. Twenty-five cases of sea-blue histiocytes syndrome associated with type B Niemann-Pick disease have been reported, with rupture of the spleen in two of them. The link between the two conditions is the transformation into ceroids of the sphyngomyelin accumulated in histiocytes.

[Hepatitis caused by clometacin (Dupéran). Retrospective study of 30 cases. A model of autoimmune drug-induced hepatitis?]. / Hépatites à la clométacine (Dupéran). Etude rétrospective de 30 cas. Un modèle d'hépatite auto-immune médicamenteuse?

Thirty cases of clometacin-induced hepatitis were retrospectively collected over a nine-year period in hepatogastroenterological units of non university, public hospitals. There was a strong female predominance (90 percent). Clometacin (Dupéran) was taken because of arthritis in 8 out of 10 cases. Administration was continuous in 85 percent of cases and median duration was 445 days. median dose was 450 mg per day. Jaundice, fatigue, and weight loss were the most frequent symptoms, but edema, ascites and palmar erythema were not uncommon. Thrombopenia (38 percent) was the most frequent hematologic abnormality. Renal failure, always with benign course, was present in 1/4 of cases. Biochemical disorders indicated hepatocellular and cholestatic hepatitis in 3/4 and 1/4 of cases respectively. Hypoprothrombinemia below 50 percent was noted in 1 out of 6 cases, and was associated with death in half cases. Gamma-globulins were increased in 80 percent of cases, with a predominant increase of IgG. Antinuclear or anti-smooth muscle antibodies were present in 60 percent of cases, whereas antimitochondrial and antimicrosomes were absent. Histopathological examination of the liver biopsy specimens obtained in 25 patients showed acute hepatitis in 8 and chronic active hepatitis with fibrosis in 17--including 6 patients with cirrhosis; there were no epidemiological, clinical (except ascites), or biochemical differences between these two groups. Four of the 7 patients tested had HLA B8 antigens; they all had chronic active hepatitis, with autoantibodies in 3 cases. Median duration of hospitalization was 21 days. Hepatitis was directly responsible for death in 3 patients; biochemical sequelae (hypergammaglobulinemia or anicteric cholestasis) were present in 8 patients, 2 of whom most likely had cirrhosis.(ABSTRACT TRUNCATED AT 250 WORDS)