[Improvement of pneumococcal immunization coverage in older patients]. / Amélioration de la couverture vaccinale anti-pneumococcique chez le sujet âgé.

PURPOSE: To study pneumococcal immunization coverage in older patients in hospital, and the impact of two actions aiming at improving this coverage. METHODS: We reported a prospective and descriptive study conducted from November 2009 to August 2010, including all new patients ≥75 years old received in a geriatric short-stay department and residing in Val-de-Marne, France. This study was performed in three successive three-month periods, to assess the vaccination coverage in the months following hospital release. Period I was the reference; Period II included an awareness campaign of general practitioners relying on the hospitalization discharge report, containing an indication for the vaccination; Period III consisted in a systematic proposal of vaccination by the geriatric hospital department. RESULTS: Indication for pneumococcal vaccination has been given to 139 patients (61.2%) in 227 processed questionnaires. The main indication was heart failure for 105 patients (75.5%). Twenty-four patients were already vaccinated (17.2%). No vaccination was reported in the three months following period I in 33 included patients. The awareness campaign targeting regular doctors resulted in only one vaccination out of 37 patients. Immunization coverage in the department had reached 84.5% of inoculation (38 of 45 patients). CONCLUSION: Pneumococcal vaccination is often prescribed in elderly patients but generally not executed. The awareness campaign did not result in a big enough immunization coverage improvement, compared to a codified proposal of vaccination during hospital stay.

[Mycotic aortic aneurysm infected by Clostridium septicum: a case report and review of the literature]. / Anévrisme mycotique de l'aorte à Clostridium septicum: à propos d'un cas et revue de la littérature.

We report on a case of Clostridium septicum aortic mycotic aneurysm in an 83-year-old patient. This is a rare infectious disease. To our knowledge, only 31 cases have been reported in the literature. The clinical presentation is dominated by abdominal pain with fever. Although only the bacteriological samples can definitely identify the germ, the presence of gas bubbles around an aneurysm on abdominal computed tomography scan suggests C. septicum aortic infection. This infectious disease is frequently associated with neoplasia, mainly colonic. Treatment is primarily surgical resection with bypass or graft, associated with prolonged antibiotic therapy. The prognosis is poor due to vascular complications and pathogenesis of C. septicum. Patients cumulate the death risk from mycotic aneurysm and C. septicum sepsis.

[Lymphoma of the pituitary stalk]. / Lymphome cérébral primitif de la tige pituitaire.

INTRODUCTION: Tumors of the pituitary stalk are rare and their diagnosis is sometimes difficult. CASE REPORT: We report a case of a primary lymphoma of the pituitary stalk in a 78-year-old patient. To our knowledge, only seven similar cases have been previously published: prominent symptoms were headache, fatigue and diplopia; biologically, anterior pituitary low secretion or hyperprolactinemia were found in the majority of cases; regarding the imaging, only three patients presented an initial and isolated lesion of the stalk; histological evidence was obtained by a trans-sphenoidal biopsy in case of hypothalamic or pituitary associated lesion or by a trans-cranial biopsy in the event of an isolated lesion. As an alternative, a lumbar puncture could be performed; although less invasive, its diagnostic performance is lower. CONCLUSION: Current treatment relies on chemotherapy with intravenous methotrexate associated with intrathecal methotrexate infusion if cerebrospinal showed abnormal cells. Unfortunately, the results remain poor with a median survival of 9 months.