[Adverse drug events in hospitalized elderly patients in a geriatric medicine unit: study of prevalence and risk factors]. / Accidents iatrogènes médicamenteux chez le sujet âgé hospitalisé en court séjour gériatrique : étude de prévalence et des facteurs de risques.

INTRODUCTION: In the elderly, both the presence of a multiple pathology and multiple medication have been shown to be frequent risk factors for adverse drug events. However, a few studies only have included parameters of standardized geriatric assessment for the purpose of identifying other risk factors. Our study compared the parameters of standard geriatric assessment, in the presence or absence of adverse drug events and evaluated the prevalence of adverse drug events in elderly inpatients, the symptoms, and the drugs involved. METHODS: A total of 823 patients were studied during a two-year period. Two groups of patients were identified, according to the presence or absence of an adverse drug event. Eight fields of geriatric assessment were compared: comorbidities, number of drugs, functional status, nutritional status, mobility, mood, neurosensory disorders, and cognition. For patients who experienced an adverse drug event, we also analyzed the drugs involved and the symptoms of the adverse drug events. RESULTS: One hundred and twelve patients (13.6%) aged 82 years+/-7.5 experienced 144 adverse drug events. Significant differences between the two groups were observed in the following: symptoms of depression, problems of mobility, risk of malnutrition (respectively p=0.001, p=0.002, p=0.007), the female sex, number of drugs, number of comorbidities, and the administration of diuretics. Cardiovascular (23.2%), psychotropic (17.9%) and anti-infectious (17%) medicines were the most frequently involved. The symptoms that occurred most frequently were orthostatic hypotension (14.6%), gastrointestinal disorders (12.5%), and neuropsychological (10.4%) disorders. CONCLUSION: Elderly patients with multiple pathology and multiple medication are at high risk for adverse drug events. Other lesser known factors, such as depression, problems of mobility, and malnutrition must be researched, as they are evidence of the underlying the frailty of the elderly population.

[Estimation of the glomerular filtration rate in elderly inpatients: comparison of four methods]. / Quelle méthode d'évaluation de la fonction rénale utiliser chez le sujet âgé hospitalisé en unité de court séjour gériatrique ? Comparaison de quatre méthodes.

PURPOSE: High variability has been observed in the estimation of the glomerular filtration rate (GFR) in older patients, according to the formula used and no single formula has been recommended to date. The aim of this study was to quantify the precision and accuracy of the GFR estimated by means of three formulas and the measurement of cystatin C. METHODS: This prospective study was conducted in an acute care geriatric unit. Participants were patients, aged 70 years and over, having a possible 24-hour urine collection. The GFR was estimated using the Cockroft-Gault (CG), the Modification of Diet in Renal Disease (MDRD), and the Creatinine Clearance (Cl-Cr) formulas. The serum level of cystatin C was also measured. RESULTS: Eighty-one patients were included in the study. CG formula underestimated the GFR by a mean difference of 8.65 ml/min, compared with MDRD formula. Cl-Cr underestimated the GFR by a mean difference of 7.56 ml/min, compared with CG formula, and by a mean difference of 16.79 ml/min, compared with the MDRD formula. The degree of discrepancy between CG and Cl-Cr estimates, and between Cl-Cr and MDRD estimates decreased as the estimated GFR approached normal values. MDRD best matched the measurement of cystatin C, followed by CG and Cl-Cr (Kappa coefficient=0.43, 0.22 and 0.16, respectively). CONCLUSION: Our study confirms the high variability of GFR in older patients and particularly in those with abnormal renal function, depending on the formula used. Serum cystatine C level and MDRD formula appear to be the most concordant estimates of GFR in this population.

IL-6 and IL-8 production from cultured human endothelial cells stimulated by infection with Rickettsia conorii via a cell-associated IL-1 alpha-dependent pathway.

Mediterranean spotted fever due to infection by Rickettsia conorii, is characterized by a general vasculitis. This vasculitis is thought to be due to a direct injury to endothelial cells induced by R. conorii. However, production and activity of cytokines on endothelial cells is an important pathway in inflammation, and part of the underlying mechanism of vasculitis. In the present studies, human umbilical vein endothelial cells (HUVEC) infected with R. conorii actively secrete high levels of IL-8 and IL-6 (P < 0.002, and P < 0.03, respectively, compared with uninfected cells). IL-1alpha, IL-1beta, or TNFalpha were not detected in the culture supernates. Nevertheless, IL-6 and IL-8 production was due, in a large part, to a cell-associated form of IL-1 alpha expressed on R. conorii-infected HUVEC, since production of these cytokines was suppressed by 80% (P = 0.0001) and 85% (P < 0.04) by the addition of IL-1 receptor antagonist, or anti-IL-1alpha antibodies (60% inhibition, P < 0.01 and 65% inhibition, P < 0.05, respectively) and IL-1alpha was measured after lysis of R. conorii-infected HUVEC but not in uninfected cells (P < 0.01). Rickettsial lipopolysaccharide does not seem to be involved, since polymyxin B did not reduce cytokine secretion. On the contrary, infection by intracellular R. conorii appears to be necessary to induce IL-1alpha and subsequently IL-8, since formalin-fixed R. conorii did not induce cytokine production. These observations demonstrate that R. conorii-infected HUVEC secrete IL-6 and IL-8 via the induction of cell-associated IL-1alpha, providing a possible mechanism for the vasculitis observed in Mediterranean spotted fever.

[Nephrogenic diabetes insipidus during lithium acute intoxication]. / Diabète insipide néphrogénique au cours d'une intoxication aiguë au lithium.

Acute lithium intoxication may occur in circumstances causing kidney failure, when using lithium chronically. This situation may lead to neurological symptoms with coma, gastrointestinal disorders with diarrhea, cardiovascular symptoms with hypotension and metabolic symptoms with hypercalcemia. Nephrogenic diabetes insipidus may also develop. We report the case of a 69-year-old woman suffering from unipolar manic-depressive psychosis and treated by lithium for 10 years. This case highlights the need to monitor serum lithium levels in patients on long-term lithium regimens, especially in circumstances involving dehydration.

Accelerated hypertension and nephroangiosclerosis associated with antiphospholipid syndrome. Report of two cases and review of the literature.

We describe two patients with the primary antiphospholipid syndrome who presented with severe hypertension. Renal biopsy specimen provided histologic evidence of intra-renal vascular disease with intravascular microthrombosis and nephrosclerosis, without feature of proliferative glomerulopathy. Accelerated hypertension and nephroangiosclerosis might indeed be one of the complications associated with anticardiolipin antibodies. The mechanism responsible might be the interaction of anticardiolipin antibodies, platelets and endothelial cell leading to microthrombi formation and increased local mitogenic activity that attract and stimulate neighbouring smooth muscle cell and fibroblast proliferation.

Long-term results of therapy with interferon alpha for cryoglobulinemia associated with hepatitis C virus infection.

We describe the long term results of treatment with interferon (IFN) in two patients with cryoglobulinemia and chronic hepatitis related to Hepatitis C virus (HCV). Our results suggest that interferon may induce long remission in cryoglobulinemia associated with HCV infection and that the effect of IFN is not dependent on the effect on liver function, but results of its antiviral activity.

Anti-neutrophil cytoplasmic antibodies (ANCA) and infection.

As ANCA are occasionally noted in patients with infectious disorders independently of any vasculitis process, we examined serum from patients with acute infection (n = 22) and septic shock (n = 57). Only two patients with acute infection were ANCA positive as determined by indirect immunofluorescence and western blot analysis. The clinical recovery of both patients was associated with negative immunofluorescence and western blot tests.

[Secondary osteoporosis and internal medicine]. / Ostéoporoses secondaires en médecine interne.

INTRODUCTION: The term 'primary' osteoporosis refers to osteoporosis that results from the involutional losses associated with aging and, in women, additional losses related to natural menopause. Osteoporosis that is caused or exacerbated by other disorders or medication exposures is referred to as 'secondary' osteoporosis. CURRENT KNOWLEDGE AND KEY POINTS: This article describes the major causes and provides a framework for the diagnostic investigation of patients with suspected of having secondary osteoporosis. There are numerous causes of secondary bone loss, including endocrine disorders, disorders of the gastrointestinal or biliary tract, rheumatic diseases, haematological diseases, immobilization, adverse effects of drug therapy, and a wide miscellaneous group. FUTURE PERSPECTIVES: Secondary osteoporosis is potentially reversible during the treatment of the underlying disease. It must be identified and induce a symptomatic treatment in all cases plus an etiologic treatment when possible.

[Idiopathic thrombotic thrombocytopenic purpura or Moschowitz syndrome: current physiopathologic and therapeutic perspectives]. / Le purpura thrombotique thrombocytopénique idiopathique ou syndrome de Moschowitz: actualités physiopathologiques et perspectives thérapeutiques.

INTRODUCTION: The objective of this work was to review current data about the physiopathology, clinical features, and treatment of thrombotic thrombocytopenic purpura (Moschowitz's syndrome). CURRENT KNOWLEDGE AND KEY POINTS: Thrombotic thrombocytopenic purpura is a rare disorder characterized by widespread thrombotic injuries of platelets in the microcirculation. Its physiopathology has been elucidated recently. Evidence of a deficiency of Von Willebrand's factor-cleaving protease would be due to either IgG antibodies in the acute form of the disease or constitutional deficiency in the chronic form of the disease. FUTURE PROSPECTS AND PROJECTS: Plasma exchange is the current reference treatment. However, in the light of recent publications, either infusions of concentrates of purified enzyme or more intensive immunosuppressive therapy would be more specific.

[Lymphocytic colitis and Gougerot-Sjögren syndrome. Report of two cases]. / Colite lymphocytaire et syndrome de Gougerot-Sjögren. A propos de deux cas.

INTRODUCTION: Microscopic colitis describes a subset of patients with chronic watery diarrhea of unknown origin, and normal endoscopic findings and microscopic evidence of an inflammatory infiltrate in the colonic mucosa. We report two cases associated with sicca syndrome. EXEGESIS: A 56-year-old woman and a 76-year-old man presented with a history of lymphocytic colitis associated with sicca syndrome. Drugs or infectious agents were not implicated in the cause of lymphocytic colitis, suggesting that sicca syndrome may be involved in the pathogenesis of microscopic colitis. CONCLUSION: These cases suggest that sicca syndrome should be detected in patients with lymphocytic colitis.

[Danger of anti-erythrocyte antibodies during pregnancy]. / Danger des anticorps antiérythrocytaires au cours de la grossesse.

INTRODUCTION: Red cell autoantibodies are very rarely observed in pregnant women. We report one case related to the presence of a lupus anticoagulant. EXEGESIS: A 32-year-old woman had a history of two intrauterine deaths that had occurred at weeks 32 and 33, respectively. Due to the presence of a lupus anticoagulant, prednisone (20 mg/day) and subcutaneous calcium heparin were administered during her third pregnancy. The direct antiglobulin test remained positive throughout the pregnancy; however, hemolysis could not be detected. Caesarean section was done in emergency at week 29, due to fetal bradycardia related to severe fetal hemolysis. CONCLUSION: When autoimmune hemolysis occurs during pregnancy, risks for the fetus increase with the severity of hemolysis in the mother. It is thought that child mortality reflects the existence of anemia, rather than the existence of hemolysis. Our observation suggests that severe fetal hemolysis may occur, despite the absence of hemolysis in the mother.

[Amebic abscess of the liver. Contribution of ultrasonics to developmental diagnosis apropos of 983 cases]. / L'abcès amibien du foie. Apport de l'échographie au diagnostic évolutif à propos de 983 cas.

Diagnosis and course of acute single amebic abscess of liver were studied in 983 cases followed up regularly until recovery. A simple but very precise classification is proposed based on course of disease as determined by ultrasound imaging. Early appearances prior to ultrasound are emphasized, these involving pronounced reversible biliary and pancreatic modifications that should be recognized in patients presenting before development of an abscess evident on liver ultrasonography. Ultrasound assists follow up during medical treatment. It very effectively demonstrates the dissociation between pathologic and clinical findings characteristic of this course, with clinical recovery usually within 8 to 10 days contrasting with persistence of liver abscess over several months.

[Secondary bone cancer in the Ivory Coast. Apropos of 40 cases]. / Le cancer secondaire des os en Côte d'Ivoire. A propos de 40 observations.

From the statistics dealing with cancer yielded in the Internal Medicine Department, Treichville Hospital, secundary bone cancer appears with a low percentage. The short expectation of life and the reluctance of African patients to report to the hospital must be considered to appreciate these data. Most often, at their admittance, cases show numerous and large metastasises. Bone tumors related to a primitive liver cancer are rare. More often, metastasises in prostate cancer may be observed. They are generally osteocondensing. Breast cancer is, for its frequency, ranking just after it. In one third of the cases, the origine has not been cleared out.

[Bone manifestations of multiple myeloma in the Ivory Coast. Apropos of 27 cases]. / Manifestations osseuses du myélome multiple en Côte d'Ivoire. A propos de 27 observations.

Report on 27 cases of multiple myeloma recorded in 10 years and 24000 in-patients of Treichville University Hospital in Abidjan (Republic of Ivory Coast). The sex-ratio is 70% of males versus 30% of females and the frequency ranges from 25 years to a maximum between 55 and 75 years. First warning symptoms are pains (70%) then fractures (14,1%), biologic disorders (11,1%) and tumors (7,4%). Vertebrae and flat bones are most often affected with a special frequency for skull and jaw. Radiological aspects and biological changes are reviewed; a high blood sedimentation rate, rather common in Africans, has not the same value as in Caucasians.

[Acute disseminated lupus erythematosus in Ivory Coast (apropos of 9 cases)]. / Le lupus érythémateux aigu disséminé en Côte-d'Ivoire (a propos de 9 observations).

Nine cases of systemic lupus erythematosus (S.L.E.) among ivoirian Africans seen over a period of eleven years were studied. The pattern of clinical presentations is similar of that seen elsewhere. Photo-sensitivity is not described as in american Negroes. Death is usually due to severe infection. The incidence of the disease among populations of different african countries are compared. The low prevalence 0,18 p. mille may be a function of failure to diagnose the more mild cases.

[Hepatitic amoebiasis (75 cases observed in Treichville University Hospital Abidjan--Ivory Coast) (author's transl)]. / L'amibiase hépatique. A propos de 75 cas diagnostiqués au C.H.U. de Treichville (Abidjan).

Reporting 75 original cases the authors review the clinical radiological and biological syndroma of hepatitic amoebiasis. They emphasize the recent advances in medical treatments which frequently give opportunity of avoiding surgery. But surgical intervention cannot be systematically discarded and has been necessary in 11 p. 100 of the reported cases. Drainage strengthens drugs efficiency. Antibiotherapy is generally useless.