[Emergency room management of patients with lung cancer and organ failure]. / Prise en charge aux urgences de patients avec cancer thoracique et défaillance d'organe.

BACKGROUND: When patients with lung cancer present to the emergency department with organ failure the question of admission to intensive care has to be considered. Our aim is to describe the process leading to the proposed management. METHODS: Retrospectively, all patients admitted to the emergency room between December 2010 and January 2015 with a diagnosis of ICD-10 C34.9 (lung cancer) were reviewed. Those with at least one organ failure were included. RESULTS: The records of 561 patients were reviewed, 79 (14%) had at least one organ failure. The majority of these patients received maximal medical care (59%), 25% exclusive palliative care, and 15% intensive care. Performance status, metastatic status and efficacy of anti-tumor treatment were recorded in the emergency medical record in 20%, 66% and 74% of cases, respectively. An opinion was obtained from the oncologist in 44% of cases and from the intensivist in 41% of cases. No external advice was provided in 27% of cases. CONCLUSION: In the majority of cases, the decision on the intensity of care to be provided to patients with lung cancer and organ failure was made in a collective manner.

The contribution of aging to the understanding of the dimensionality of executive functions.

It has been reported in the literature that executive functions may be fractioned into updating, shifting, and inhibition. The present study aimed to explore whether these executive sub-components can be identified in a more age-heterogeneous sample and see if they are prone to an age-related decline. We tested the performances of 81 individuals aged from 18 to 88 years old in each executive sub-component, working memory, fluid intelligence and processing speed. Correlation analysis revealed only a slight positive relationship between the two updating measures. A linear decrement with age was observed only for two complex executive tests. Tasks indexing working memory, processing speed and fluid intelligence showed a stronger linear decline with age than executive tasks. In conclusion, our results did not replicate the executive structure known from the literature, and revealed that decrement in executive function is not an unavoidable concomitant of aging but rather concerns specific executive tasks.

Cognitive impairment in late-onset depression. Limited to a decrement in information processing resources?

BACKGROUND: While cognitive dysfunction in late-onset depression (LOD) is common, the nature and determinants of this impairment are heterogeneous. It has been suggested that neuropsychological decrements in LOD patients might result from a deficit in processing resources. In order to address this issue, we analyzed processing resources in LOD to see if their decrease explains higher-level cognition (episodic memory and naming capacity) deficits. METHODS: Measures of processing speed, working memory, inhibition, episodic memory and naming capacity were administered to 14 LOD inpatients and 14 controls. RESULTS: The LOD patients performed significantly worse than the controls in all domains except for inhibition. Hierarchical regression analyses showed that naming capacity impairment was totally mediated by processing speed and working memory, whereas episodic memory dysfunction was only partially mediated by working memory. CONCLUSION: The reduction in certain processing resources (working memory, processing speed) in late-onset depressed patients appears to mediate impairments in episodic memory and naming capacity. However, episodic memory impairment cannot only be explained by processing resource decrement in LOD patients, suggesting that a primary episodic memory dysfunction is present in this condition.

[Emergency unilateral mydriasis]. / Mydriase unilatérale aux urgences.

UNLABELLED: UNEQUAL PUPILS: Or anisocoria is frequent and can be physiological, benign or life threatening. VARIATIONS IN THE PUPIL: Constriction depends on the parasympathetic system and dilatation on the sympathetic system. IN PARASYMPATHETIC DISORDERS: Peripheral or central neurological causes can be distinguished, among which acute cerebral lesions with compression of the trunk are the most dramatic. Differential diagnosis can be made by studying the local causes, which may represent ophthalmologic emergencies (acute glaucoma or lesions of the retina). AMONG THE SYMPATHETIC DISORDERS: Claude-Bernard-Horner's syndrome is the most classical example. Other particular cases exist, such as Adie's pupil, affecting young women (1/20,000), associating mydriasis and occasionally tendinous areflexia. Diagnosis is generally confirmed by the ophthalmologist, following a normal or evocative of the disease neurological examination. IN PRACTICE: Rapid but careful clinical examination permits orientation of the diagnosis and appropriate treatment.