Respective roles of immune and nutritional factors in the priming of the immune response in the elderly.

Ninety-six institutionalized elderly (greater than 70 years old) (mean age: 82 +/- 7 years) subjects, negative for tetanus toxoid antibodies were primed with tetanus toxoid vaccination and dinitrochlorobenzene (DNCB). Correlations were studied between some immunological parameters, nutritional parameters prior to immunization and the immune response intensity after it. Levels of tetanus toxoid specific IgG (ELISA assay) were positively correlated with monocyte phagocytosis, DNCB response and prealbumin levels, and negatively correlated with total IgG, monocyte immune degradation and tetanus toxoid lymphocyte stimulation. No correlation was observed with IgA, IgM, PHA stimulation. Tetanus toxoid lymphocyte stimulation correlated positively with response to DNCB, and negatively with tetanus toxoid IgG as well as total IgG. DNCB response correlated with prealbumin, tetanus toxoid IgG and tetanus toxoid lymphocyte stimulation. Therefore, it appears that malnutrition, as measured by prealbumin level, is one of the main factors contributing to the inconstant senile immunodeficiency. Monocyte antigenic degradation function unaltered with age can impair immune response while conserved or increased phagocytosis enhances immune response in the elderly. High total IgG levels were linked with low specific responses to priming antigens. High specific antibody levels also correlated negatively with cellular specific response. It is assumed that regulatory IgG antibody accumulation, likely anti-idiotypic antibodies, play an important role in senile immunological depletion.

In vitro and in vivo effects produced by the immunomodulating agent RU 41740 on human polymorphonuclear leukocytes in the elderly.

The activity of RU 41740, a glycoprotein extract from Klebsiella pneumoniae has been investigated on some polymorphonuclear (PMN) functions. Chemotaxis, random migration and oxidative metabolism (assessed by chemiluminescence, O2 consumption and O2- generation) were studied in parallel. PMN were collected from adult and aged human volunteers. Experiments were performed either in vitro or in vivo in a double blind placebo assay. In both PMN populations RU 41740 enhanced oxidative metabolism either in in vivo or in vitro experiments. However, a higher and dose-related activity was observed on PMN collected from the younger subjects whereas maximal effective concentration was reached earlier with PMN collected from aged subjects. RU 41740 did not modify random migration but inhibited chemotaxis of PMN collected from the younger population in a dose-related manner. These data corroborated previous results observed on PMN collected from various animal species and suggested an interaction of RU 41740 on PMN membrane. Moreover drug-induced macrophage and lymphocyte stimulation might also explain, at least in part, the in vivo effects described in this study. Thus RU 41740 could partly account for the protective effects exerted against bacterial and fungal infections through its activity on PMN functions.

Influenzal acute myositis in the elderly.

We report an 84-year-old man with completely regressive acute myositis. The presumed etiology was an Influenza A virus infection, based on the serologic results.

[Nailfold capillaroscopy. Comparison of 100 subjects over 65 years of age and of 100 young adults]. / Capillaroscopie periungueale. Comparaison de 100 sujets âgés de plus de 65 ans et de 100 adultes jeunes.

Nailfold capillary microscopy patterns in 100 patients aged more than 65 years and free from inflammatory diseases were compared to those of 100 young healthy adults. A higher prevalence of arteriovenous sludge (36% vs 7%, p less than 10(-6)), increase in capillary loop length (12% vs. 0%, p less than 10(-3)) and especially prominent subpapillary plexus (63% vs 12%, p less than 10(-9)) was found in the geriatric group. Such capillary patterns cannot be considered as abnormal in patients aged more than 65 years. Enlargement of capillary loops and loss of capillaries were never encountered. Bushy capillary formations and hemorrhages were very uncommon in both groups.

[Myopericarditis during Horton disease]. / Atteinte myopéricardique au cours de la maladie de Horton.

INTRODUCTION: Myopericarditis is an rare form of Horton disease. We report two new cases. METHOD: Two patients, more than 60-years-old, had developed global cardiac insufficiency with predominant left insufficiency, with physical alteration and biological inflammation. Echocardiography revealed a myopericarditis. Bacteriological explorations were all negative. In the two cases, temporal artery biopsy revealed giant cell arteritis. Treatment with oral corticosteroids improved biological and clinical symptoms. CONCLUSION: Myopericarditis is a rare form of Horton disease. Classical clinical presentation is rarely associated. Temporal artery biopsy is essential in confirming and proposing a specific therapy, in order to prevent cardiovascular ischemic complications.

[Pancreatic endocrine tumor with metastases and increase of alpha-fetoprotein. A case report]. / Tumeur endocrine pancréatique avec métastases et élévation de l'alpha-foetoprotéine. A propos d'un cas.

The authors report the case of a 48 years old man presenting a pancreatic islet cell carcinoma (gastrinoma) with liver, nodes and peritoneal metastases, associated with an elevated alpha-fetoprotein (AFP) concentration. Incomplete remission was first obtained with a chemotherapy using Streptozotocin combined with 5-Fluorouracil, in association with a Somatostatin analogue (SMS 201-995). But when relapses occur, another chemotherapy was not so effective. Serum gastrin and AFP levels had the same evolution and appear to have the same interest to follow the course of the disease.

[The elderly and dementia: clinical approach]. / Sujets âgés et syndrome démentiel: approche du clinicien.

When you take care of elderly, you need to evaluate cognitive functions due to the frequency of dementia. However, before this evaluation, you must be aware of difficulties that you will encounter. You have to determine general characteristics of elderly patients and use geriatric reasoning in order to list pathologies that can interfere with cognitive functions. Thereafter, you need to precise frontiers between normal cognitive functions and dementia. When dementia is confirmed, CT scan or MRI appears very useful to exclude a cause of reversible dementia or to precise the nature of dementia. CT scan or MRI are useful during dementia to define the etiology of dementia or acute deterioration during evolution. A close collaboration between radiologist and clinician is mandatory to avoid diagnostic errors.

[Free radicals derived from oxygen and lipid peroxidation. Role in cellular biology and physiopathology]. / Les radicaux libres dérivés de l'oxygène et la peroxydation lipidique. Rôle en biologie cellulaire et en physiopathologie.

Lipid peroxidation results from the attack of membrane phospholipids by free radicals derived from oxygen. It plays a major role in normal cell life processes. Under physiological conditions, this attack is modulated by an enzymatic system (superoxide dismutase, catalase, glutathione peroxidase) and by a non-enzymatic system (vitamin E and others). Many pathological processes might be explained by a deficient protection system or by an imbalance between attack and protection. Lipid peroxidation is difficult to detect and measure, and the methods available still have low sensitivity.

[Study of oxidative stress in the elderly]. / Etude du stress oxydant chez le sujet agé.

OBJECTIVES: Determine the oxidative stress status and its significance in elderly subjects. METHODS: Six parameters marking oxidative stress evaluated in 52 elderly patients (mean age 85 +/- 6 years; range 74 to 98) admitted to a medium-term and long-term nursing home (n = 30) or a hospital ward (n = 22) were compared with those in 30 disease-free young subjects (age range 20-40 years). Plasma levels of thiobarbituric acid reactive substances vitamin E and selenium and activity of free-radical protective enzymes (erythrocyte superoxide dismutase, plasma and erythrocyte glutathione peroxidase) were assessed. RESULTS: Thiobarbituric acid reactive substances were higher and superoxide dismutase, erythrocyte and plasma glutathione peroxidase, and plasma selenium were lower in elderly patients than in young controls. There was no difference in vitamin E levels. In the nursing home population, erythrocyte superoxide dismutase was correlated with erythrocyte glutathione peroxidase and vitamin E, plasma glutathione peroxidase with erythrocyte glutathione peroxidase, vitamin E and selenium and erythrocyte g peroxidase, vitamin E and selenium and erythrocyte glutathione peroxidase with vitamin E. Only the correlation between erythrocyte and plasma glutathione peroxidase was found in the hospitalized population. These levels remained unchanged for a 30 day period in individual patients. CONCLUSION: "Oxidative stress" assessed by six parameters was thus observed in the elderly population and could be considered as a "biological marker of ageing". Supplementation with selenium or other anti-oxidants could be proposed.

[Recent data on the epidemiology and etiology of Crohn's disease]. / Données récentes sur l'épidémiologie et l'étiologie de la maladie de Crohn.

The disease described by Crohn and co-workers fifty years ago escapes precise definition as it involves not only the ileum but the whole digestive tract. When restricted to the colon, it cannot easily be differentiated from that other inflammatory disease of the large bowel: ulcerative colitis. Meanwhile, Crohn's disease seems to be increasingly frequent, spreading from north to south, with a higher incidence among Jews and relatives of patients presenting with the condition. This would suggest interaction between a specific genetic factor and an as yet undetermined environmental agent which becomes pathogenic in the digestive tract. The lesions of Crohn's disease point to an immune conflict but so far, no definite disorder of the immunoregulation system has been demonstrated.

[The immunology of Crohn Disease (author's transl)]. / Immunologie et maladie de Crohn.

Although the incidence of Crohn disease seems to be increasing, it's etiology remains unknown. The search for immunological mechanisms has been extensively carried out with conflicting results. At the present, most studies provide evidence suggesting a possible immunological dysfunction. Another interesting point is the possible role of an oxygen dependant cytotoxic activity of phagocytes in inflammatory processes, and particularly in Crohn disease.

[Free radicals and lipid peroxidation in cell biology: physiopathologic prospects]. / Radicaux libres et peroxydation lipidique en biologie cellulaire: perspectives physio-pathologiques.

Oxygen derived free radicals (OFR) arise in the course of normal cellular life, especially during cellular respiration. They are formed when molecular oxygen is reduced to water. These highly reactive species are controlled by a protective system both enzymatic and non enzymatic which helps to prevent the accumulation of peroxidative damage to the cell. Lipid peroxides result from the reaction of oxygen derived free radicals with polyinsatured fatty acids of membranes phospholipids and can be formed both non enzymatically and enzymatically (eicosanoids). Oxygen derived free radicals attack over-running beyond the protective system leads to oxidative stress. The cells involved in inflammation (polymorphonuclear, leucocytes, monocytes, platelets, endothelial cells) release oxygen derived free radicals and lipid peroxides and inflammatory diseases of infectious or non infectious origin can be considered as oxidative stress. Intracellular oxidative stress can lead to cellular death or trigger a strong inflammatory reaction. This occurs during ischemia reperfusion injury and hyperoxia. Exposure to ionizing radiation results in overproduction of oxygen derived free radicals both extra and intracellular. Oxidative stress may be involved in atheroma (where oxidised LDL are described), ageing and cancer.

[Hypoglycemia caused by anterior pituitary insufficiency associated with pulmonary fibrosis. Apropos of a case]. / Hypoglycémie par insuffisance antéhypophysaire associée à une fibrose pulmonaire. A propos d'un cas

The authors report the case of a young man with dissociated anterior pituitary insufficiency affecting somatotropic and corticotropic functions, presenting as hypoglycaemia as a result of the deficiencies mentioned, primary hypothyroidism and, in addition, pulmonary fibrosis of uncertain aetiology, pulmonary biopsy not having been carried out. The aetiology of this double pulmonary and endocrine involvement is presumably the same. Sarcoidosis seems unlikely, whilst histiocytosis X with pulmonary, anterior pituitary and/or hypothalamic and thyroid involvement is much more probable.

Brain tuberculomas.

Although brain tuberculomas have become rare in developed countries, diagnosis should be kept in mind when confronted with brain space-occupying lesion(s), particularly in immigrants from endemic countries. Surprisingly, Human Immunodeficiency Virus (HIV) infection does not seem to have affected the incidence of this tuberculous lesion. Clinical, biological and radiological signs are only suggestive. Thus, when no other active extracranial tuberculous process is found, the diagnosis should be confirmed by a biopsy before beginning antituberculous treatment which is rapidly effective. Adjunction of steroids may be warranted owing to the common paradoxical enlargement of lesions during the first weeks of therapy, as is now well described in lymph node tuberculosis. Cure can be obtained in more than 85% of the cases, but neurological sequelae are not rare.