[Ethical approach to severe dementia]. / Pour une approche éthique dans la démence sévère.

General principles of medical ethics are discussed in the context of care for patients with severe dementia.

[Hypoalbuminemia and invalidating edema in an elderly subject: treatment with parenteral albumin infusion]. / Hypoalbuminémie et syndrome oedémateux invalidant chez le sujet âgé: utilisation de l'albumine par voie parentérale.

Many factors can lead to edema. Hypoalbuminemia and the inability of the renal distal tubule to excrete salt are a common cause of edema, that can be due to a defect of albumin synthesis or malnutrition, kidney disease, protein-losing enteropathy, or increased protein catabolism. Hypoalbuminemia is frequent amongst elderly people. Its prevalence ranges from 4% to 50% depending on whether they live at home or in hospice. In normal circumstances, albumin has a double function to maintain oncotic pressure and to transport endogenous or exogenous substances. Lack of albumin is thus responsible for numerous pathological states. In this article, we report two clinical observations in patients aged over 65, suffering from generalized, highly invalidating edema, with low albumin states due to malnutrition. A rapid long-term recovery was observed after administrating albumin, and produced a far better quality of life for the patients. The clinical results obtained following this specific indication warrant further research work to verify their scientific validity on a larger scale.