[Diagnostic value of the clinical probability score of deep venous thrombosis in the elderly]. / Intérêt du score de probabilité clinique dans le diagnostic de thrombose veineuse profonde en gériatrie.

SUBJECT: There is a lack of scientific data concerning the incidence, clinical signs, risk factors and diagnostic management of deep vein thrombosis (DVT) in the elderly. METHODS: We carried out a prospective case-control study in a geriatric setting. We included one in-patient without clinical signs of deep vein thrombosis for each hospitalised patient with clinically suspected DVT. Clinical signs, risk factors of DVT and a compression ultrasonography of the proximal and distal leg veins were performed in all patients at admission. Also, the clinical probability was assessed by means of the clinical score model described by Wells. RESULTS: There were 102 patients aged over 85 included during the 5 months period of the study. Fifty-one patients have had a clinical suspicion of DVT and 51 patients were clinically asymptomatic. There were 43% symptomatic DVT and 12% asymptomatic DVT. Clinical signs and symptoms of DVT were neither sensitive nor specific. Risk factors associated most frequently with DVT were: immobilisation (prevalence 64%), paralysis of the legs (22%), varicose veins (25%), deshydratation (28,5%), infections (18%). A significant relationship between a risk factor and DVT was found only for immobilisation (P<0,05) and deshydratation (P<0,02). The prevalence of DVT increased with the clinical probability score: 11.4% for the low score, 27.6% for the moderate score and 55% for the high score. CONCLUSION: Incidence of DVT is high among hospitalised elderly patients, especially for the asymptomatic ones. Clinical signs alone do not reliably predict DVT. Clinical probability score could be useful to improve diagnostic management of DVT in this population.

[Appropriate medication prescribing in older people]. / Bon usage des médicaments chez le sujet âgé.

Drug-induced adverse effects are one of the main avoidable causes of hospitalization in older people. Numerous lists of potentially inappropriate medications for older people have been published, as national and international guidelines for appropriate prescribing in numerous diseases and for different age categories. The present review describes the general rules for an appropriate prescribing in older people and summarizes, for the main conditions encountered in older people, medications that are too often under-prescribed, the precautions of use of the main drugs that induce adverse effects, and drugs for which the benefit to risk ratio is unfavourable in older people. All these data are assembled in educational tables designed to be printed in a practical pocket format and used in daily practice by prescribers, whether physicians, surgeons or pharmacists.

[Ambulatory blood pressure and heart rate at 60 +/- 5 years. Differences between men and women]. / Pressions artérielles et fréquence cardiaque ambulatoires à 60 +/- 5 ans. Différences entre homme et femme.

Ambulatory measurements of systolic and diastolic arterial pressures and heart rate were performed during daytime in 68 subjects (37 men and 31 women) of mean age 55 +/- 5 years. These subjects had no history of cardiovascular or cerebral disease and no clinical or biochemical abnormalities. Bar charts for ages showed unimodal distribution with a 59-year mode in both sexes. Hourly profiles of arterial pressures and heart rate from 09:00 to 22:00 h were established in both groups. Throughout that time ambulatory arterial pressures were constantly higher in men than in women, especially in the morning (about 09:00 - 10:00 h; p less than 0.01), late in the afternoon and in the evening (17:00 to 22:00 h; p less than 0.01). In contrast, women always had a higher heart rate than men, the difference being greatest in the morning till early afternoon (10:00 to 15:00 h; p less than 0.01) and in the late evening (22:00 h; p less than 0.01). A difference in arterial pressures between men and women has already been recognized in younger subjects. It would be interesting to find out whether it increases or decreases in subjects older than those of the present study.

[Drug interactions: study of 409 prescriptions at the time of discharge from geriatric hospitalization]. / Interactions médicamenteuses: étude de 409 ordonnances établies à l'issue d'une hospitalisation gériatrique.

In order to specify the frequency and the potential consequences of drug interactions in the elderly, we retrospectively analysed 409 discharge prescriptions. The possibility of drug interactions was screened out for each prescription in the software version of the Vidal drug compendium. It appears that prescriptions are mainly adapted to the elderly with respect to posology and pharmacokinetics. Potentially dangerous drug interactions ('contraindicated' or 'unsuitable' associations) were found in 6 per cent of prescriptions; after careful assessment, this frequency decreased to less than 1 per cent. The most common orthoergic side effects were sedation (15 per cent) and hypotension (14.5 per cent). This study points out the multiplicity of criteria to be considered in order to prevent drug interactions, and the gaps in available software.

[Calcification of the pectineal ligament. An usual radiological imaging in pediatrics]. / Calcification du ligament pectiné. Une image radiologique d'observation courante en gériatrie.

OBJECTIVES: Since its first description several years ago in the elderly subject, calcification of the Cooper ligament is often considered as a rare anecdotal phenomenon. We present the radiographic presentation which is often not well known. METHODS: Two experienced radiologists examined independently a series of 100 consecutive X-rays of the pelvis performed in a population of elderly subjects (mean age 84.4 +/- 9.2), looking for calcification of the Cooper ligament. RESULTS: Calcification of the Cooper ligament was observed on 7 of the 100 images of the pelvis. There was no significant difference in age, sex, or reason for ordering the examination between subjects with calcification and those without calcifications. Arterial calcifications were observed at an equal frequency. The usual aspect of the Cooper ligament was a fine opaque line following along the upper border of the iliopectinate crest. Oblique views visualized the calcification better. The line of calcification was either continuous of fragmented and was bilateral in all 7 cases. CONCLUSION: These images are apparently of no pathological significance. Clinicians should however be aware of the radiographic presentation in order to avoid confusion with visceral calcification or periosteal deposits.