[Hyponatremia in the elderly: its role in frailty]. / L'hyponatrémie du sujet âgé: implication dans la fragilité.

Hyponatremia is the most common electrolyte disorder in elderly patients. The incidence is about 7% in elderly healthy people but can exceed 40% in hospitalized patients. Considering all its aetiologies hyponatremia is associated with increased mortality and appears as a factor of poor prognosis. Alteration in the regulation of water homeostasis in the elderly result from multiple consequence of aging: change in body composition, alteration in renal function and hormonal changes. The high frequency of nutritional problems, particularly protein malnutrition predisposes the elderly to the development of hyponatremia. Although diuretics especially thiazides are implicated as a frequent cause of hyponatremia on geriatric medicine, normovolemic hyponatremia and more particularly the syndrome of inappropriate antidiuresis is the most common cause. The aetiology of this syndrome can be determined in only approximately half of the cases. Cancers and medications, principally psychotropic agents commonly prescribed in geriatrics are the most frequent aetiologies. Hyponatremia could be a factor of frailty in geriatrics. Mild to moderate hyponatremia is generally considered asymptomatic but recent studies reported that asymptomatic hyponatremia contributes to neurological troubles like cognitive disorders, posture and gait impairments. Hyponatremia could be an independent risk factor of falls and could be associated with the development of osteoporosis. This review of the literature emphasizes the importance of screening and a systematic management of hyponatremia in the elderly people, even in the minor forms and those considered as asymptomatic.

[Urinary incontinence in the elderly: distinctive feature and management]. / Incontinence du sujet âgé: particularités et prise en charge.

Urinary incontinence is very common among the elderly and results in a series of personal and economic complications. This population is often very heterogeneous with the aetiologies or dependences which are not very obvious. It is thus important to carry out among these patients a total assessment which will make it possible to detect the affections or the dependence from which it suffers. The BGMST (Belgian Geriatric Minimum Screening Test) includes a series of non aggressive tests which will answer this need. The performance of urodynamic tests is not easily achieved in case of not very autonomous or intellectually little collaborating patients. The prescription of surgical treatments is not necessarily to reject (urge incontinence). With regard to drugs, a good knowledge of their metabolism, of their interferences with other treatments in progress, is important especially in the absence of literature taking into account this heterogeneous old population. The prescriptions must be regularly re-examined in order to avoid weakening of these patients. In addition, in the elderly, aetiologies of incontinence are often multiple and consequently its daily management becomes particularly difficult.

[Peripheral ulcerative keratitis and a form of limited wegener's granulomatosis]. / Kératite périphérique ulcérative et forme limitée de la granulomatose de Wegener.

A man aged 68 years presents superior limbal infiltrates at his left eye two weeks before a marginal ulcer which quickly perforates. He has no systemic complaint. Clinical, biological, radiologic and histological evaluations disclose superior airways and lungs implications, an inflammatory syndrome, high ANCA (antineutrophiles cytoplamic antibodies) titer and vasculitis. There is no sign of renal involvement. A limited form of Wegener's granulomatosis is diagnosed. The outcome is favorable with a partial penetrating keratoplasty and systemic corticosteroid therapy in association with immunosuppressive drugs. This so called limited form of Wegener's granulomatosis is sight threatening when eye is the initial presentation. The early diagnostic and treatment will be performed by the help of ANCA in cases with subclinical systemic manifestations.