[Etiological diagnosis of syncope and brief loss of consciousness in patients over 65. Results of a multicenter prospective study of 188 cases]. / Diagnostic étiologique des lipothymies et pertes de connaissance brèves après 65 ans. Résultats d'une étude prospective multicentrique de 188 cas.

In a prospective multicentre study a series of 188 patients over 65 years of age admitted for syncope (90) or transient loss of consciousness (98) was collected. There were 120 women and 68 men; mean age was 78.7 +/- 6.6 years; 140 patients had a significant history mainly of arterial hypertension and coronary disease; 81 patients were taking drugs (4.1 on average) and notably diuretics, antihypertensive agents, antiarrhythmic agents, nitrites and psychotropic drugs. The most frequent diagnoses were arrhythmia (20.2 p. 100), postural hypotension (15.4 p. 100), reflex and vasodepressive syncope (12.2 p. 100) and coronary disease (5.3 p. 100). Taken together, these diagnoses could be divided into cardiac diseases (26.5 p. 100), extracardiac diseases (54.2 p. 100), diagnosis unknown (19 p. 100). The condition was iatrogenic in 45 patients (24 p. 100). The means by which the diagnosis was reached were studied: in two-thirds of the cases, careful physical examination and electrocardiography alone provided a diagnosis. Seven patients died during their stay in hospital. Among the 181 survivors 148 (81.7 p. 100) were discharged and returned home.

[1-year prognosis of syncope and brief loss of consciousness in patients over 65. A multicenter study of 188 cases]. / Pronostic à un an des lipothymies et pertes de connaissance brèves après 65 ans. Etude multicentrique de 188 cas.

The one-year outcome of syncope and transient loss of consciousness was studied prospectively in 188 patients aged over 65 admitted to internal medicine departments. Thirty-seven patients (19.6 p. 100) died. This mortality rate at one year was 2.34 times higher than that of a non-hospitalized french population of the same age group (standardized mortality ratio, SMR = 2.34, P less than 0.001). The frequency of sudden death (7 cases) was much higher than that observed in the reference population (0.05 expected deaths, P less than 0.0001). Overmortality was clearly apparent in groups with an initial diagnosis of heart disease (SMR = 2.36, P less than 0.01) or neurological disease (SMR = 4.25, P less than 0.001). The relapse rate was 28 p. 100 globally and up to 43 p. 100 in cardiac patients. In the group with iatrogenic symptoms treatment was appropriately corrected in 86 p. 100 of the patients, and none of these relapsed. One year after the initial episode 11 p. 100 of the surviving patients had been institutionalized.

[Changes in arterial pressure in the postprandial period in the elderly]. / Etude des variations de la pression artérielle en période post-prandiale chez les sujets âgés.

The repercussions of food intake on blood pressure may account for certain malaises which occur after meals in elderly people. In this study, blood pressure and heart rate were measured during and after a meal in 39 elderly hospital patients divided into two groups depending on whether or not they were taking drugs likely to act on arterial blood pressure. The patients were compared with two groups of controls: 29 young adults examined after a meal and 16 elderly subjects examined at a distance from meals. A significant fall in blood pressure starting 18 minutes after the meal and without concomitant increase in heart rate, was observed in the 2 groups of elderly patients. No significant changes in blood pressure and heart rate were observed in the 2 control groups. In elderly people, food intake might act on blood pressure through entrapment of blood in splanchnic territories and/or through alteration of baroreceptors.

[Glomerulonephritis secondary to ventriculo-atrial shunts]. / Glomérulonéphrites secondaires aux dérivations ventriculo-atriales.

The authors report the case of a 45 year old man who had undergone a ventriculo-atrial CSF shunt procedure 5 years previously for normal pressure hydrocephalus and who had several unexplained episodes of infection over a 12 months period and has now developed a mixed nephrotic syndrome associated with a septicaemia. Corynebacterium commensale and Staphylococcus epidermis were isolated from the valve culture. Ablation of the valve resulted in clinical cure with minimal functional renal sequellae. The initial renal biopsy showed type I proliferative glomerulonephritis with subendothelial deposits of complement and immunoglobulins, which did not completely regress after 3 months' evolution. The serum complement fractions suggested activation of the alternate pathway and the possible pathogenic role of circulating immune complexes.

[Anti-Gram-negative bacterial antibodies in alcoholic cirrhosis. Study of 58 patients]. / Les anticorps anti-bacille à Gram négatif au cours de la cirrhose alcoolique. Etude de 58 malades.

Gram-negative bacterial infections are frequent and severe in cirrhotic patients. Existence of endotoxemia in cirrhosis is controversial. The demonstration of Gram-negative bacterial antibodies could be an alternative approach to the pathogenic role of these bacteria. In 58 patients with alcoholic cirrhosis, the immunoglobulin G specifically directed against the Gram-negative bacteria lipopolysaccharide expressed by the J5 mutant of Escherichia coli 0111:B4 was measured. Antibody titres were compared to those of a control group of blood donors. The distributions of antibody titres were similar in cirrhotic patients and in control subjects. No correlation was found between antibody titres and biological parameters of liver function. These results seem to confirm previous reports on the absence of latent endotoxemia in cirrhotic patients, and they suggest that antibody production against Gram-negative bacteria lipopolysaccharides is not enhanced in these patients.