[Falls, frailty and osteoporosis in the elderly: a public health problem]. / Chutes, fragilité et ostéoporose chez la personne âgée: un problème de santé publique.

INTRODUCTION: Elderly people can be subdivided into three groups: healthy elderly persons (65-70% of the population), elderly subjects with diseases (about 5%) and frail old people. Frailty represents "age-related physiologic vulnerability resulting from impaired homeotasic stock and a reduced capacity of the organism to withstand stress". It could lead elderly subjects to pathological, barely reversible, ageing. CURRENT KNOWLEDGE AND KEY POINTS: One of the main objective of geriatricians is to develop useful screening tools to identify people at high risk, thus allowing them to benefit from preventive interventions as early as possible. It has been suggested that the decline in homeostatic stock involves numerous physiological systems. Those at the core of frailty would be neuromuscular changes resulting in sarcopenia, neuroendocrine dysregulation, and immune disorders. A recent study has shown that increased levels of interleukin 6 is a risk factor for frailty. FUTURE PROSPECTS AND PROJECTS: Work in progress aimed at identification of at-risk patients should: lead to early detection; draw attention on underestimated fields such as the nutritional status, sarcopenia, or gait disorders; promote the development of the standardized gerontological evaluation in order to identify the different components of frailty; and promote the development of non-pharmacological programmes including physical training, nutritional managing, and optimal social life.

Sarcoma after radiation therapy: retrospective multiinstitutional study of 80 histologically confirmed cases. Radiation Therapist and Pathologist Groups of the Fédération Nationale des Centres de Lutte Contre le Cancer.

PURPOSE: To evaluate the best strategy for treatment of sarcoma that occurs after radiation therapy. MATERIALS AND METHODS: Records were retrospectively reviewed for 80 patients with a confirmed histologic diagnosis of sarcoma that occurred after radiation therapy performed during 1975-1995. The patients were treated for breast cancer (n = 33, 42%), non-Hodgkin lymphoma (n = 9, 11%), cervical cancer (n = 9, 11%), benign lesions (n = 4, 5%), or other tumors (n = 25, 31%). Sarcoma occurred after a mean latency of 12 years (range, 3-64 years), with most (70%) developing in the soft tissue. Treatment included surgery (28 patients), surgery and chemotherapy (18 patients), chemotherapy only (15 patients), and radiation therapy (14 patients). RESULTS: By the end of the study, 51 patients were dead, including 46 due to sarcoma. Median survival was 23 months. Overall survival rates at 2 and 5 years, respectively, were 69% and 39% for patients treated with surgery, 10% and 0% for those treated with chemotherapy, and 52% and 35% for those treated with surgery and chemotherapy (P =.001). The 2- and 5-year rates for survival without recurrence were 54% and 32%, respectively. CONCLUSION: The results confirm the beneficial effect of surgery. Further study is needed to explore the roles of combined treatments.

[Dietary intake recommended for elderly persons]. / Apports alimentaires à recommander aux personnes âgées.

Recommendations for dietary intake in elderly persons must account for wide interindividual variation. We propose different recommendations for: generally self sufficient elderly persons in good health. The recommended dietary intakes are very similar to those for adults, with a few exceptions (reduced calorie intake, the importance of protein and certain vitamins or minerals: vitamins B6, D, C, calcium, zinc ...); patients with an intercurrent disease or an event causing a loss of appetite and a reduction in dietary intake. Recommendations for these subjects should aim at correcting or preventing deficiencies by the use of supplementary and complementary nutritional products; subjects in a state of protein-calorie malnutrition. Recommended dietary intake should take into account the effect of malnutrition on the digestive functions of the pancreas and the intestine in the elderly. Such recommendations must be based on the findings of numerous studies now being carried out and of which we report here the first results.

Influence of aging on the activity of the hemostatic system: prothrombin fragment 1+2, thrombin-antithrombin III complexes and D-dimers in 80 healthy subjects with age ranging from 20 to 94 years.

To determine the influence of aging on the activity of the hemostatic system, we measured the plasma concentration of prothrombin fragments 1+2 (F 1+2), thrombin-antithrombin III complexes (TAT) and fibrin degradation fragments D-dimers (D-D) in 80 healthy subjects with age ranging between 20 and 94 years. All subjects were free of acute or chronic diseases. The three markers (semi-log scale) were positively correlated with age (r greater than 0.7, p less than 0.01). Mean plasma levels of F 1+2, TAT and D-D were two- to five-fold higher in subjects with age greater than or equal to 60 as compared to those less than 60 years (n = 40 in both groups). In these two groups, normal values for F 1+2, TAT and D-D ranged from 0.3-1.2 vs 0.7-2.4 nmol/l, 1.4-2.6 vs 1.9-6.4 micrograms/l and 33-433 vs 312-1180 micrograms/l, respectively. Sex did not influence the results. We conclude that the activity of the hemostatic system is markedly age-dependent, and that elderly subjects display a biological picture of "prethrombotic" state. In addition, for a right clinical use of these three markers, age should be taken into account when normal range is to be established.

[Use of very low doses of intravenous immunoglobulins for the treatment of bullous pemphigoid]. / Utilisation de très faibles doses d'immunoglobulines intraveineuses pour le traitement des pemphigoïdes bulleuses.

High dose intravenous immunoglobulins have proved effective immunosuppressants in various autoimmune diseases, including bullous pemphigoid. However, their specific point of impact remains undetermined and no study supports the need for high doses. We treated elderly patients with proven and corticosteroid-resistant bullous pemphigoid, using a therapeutic regimen consisting of continuous oral corticosteroid therapy and continuous infusion of immunoglobulins in very low doses by means of an electric syringe. Clinical improvement was observed in every case without any characteristic change in immunological parameters (anti-basal membrane antibody, cutaneous immune deposits), which suggests that immunoglobulins administered in that way act on immune response regulatory mechanisms. The therapeutic effect observed potentiates that of corticosteroids which can thus be given in lower doses in bullous pemphigoid.

[Myocardial infarct of effort with normal coronaries. Study of in vivo platelet activation]. / Infarctus du myocarde d'effort à coronaires saines. Etude de l'activation plaquettaire in vivo.

Platelet activation may play a part in causing myocardium infarction with angiographically normal coronary arteries. We investigated this possibility by performing ergometric stress testing in a series of 9 patients (Group A) who had suffered myocardial infarction after a violent effort with angiographically documented coronary insufficiency responsible for a stable effort angina (Group B) and 11 healthy subjects (Group C). Blood samples were taken separately before exercise, at the peak of exercise, and during the recovery period. Platelet morphology, a sensitive indication of the degree of platelet activation, was studied by phase contrast microscopy after immediate fixation of the blood. The percentage of non-discoidal platelets presenting with one or several spicules was measured. At the same time, the plasma concentrations of platelet factor 4 (PF4) and beta-thromboglobulin (beta-TG) were measured. At rest, there was no difference in platelet morphology or specific platelet proteins between the 3 groups. At the peak effort, there was a significant increase of the number of morphologically modified platelets in Groups A and B but not in healthy subjects. This platelet activation could not be linked to the presence of myocardial ischaemia because it was found both in patients with a negative maximal exercise stress test (Group A). Finally, no increase of the plasma concentrations of the platelet protein was observed in any of the groups.

[Tolerability of an aromatic retinoid (RO 10 9359, etretinate, Tigason, Roche). Research on its toxicity on hematopoietic, renal and thyroid functions. Interactions with the metabolism of natural retinoids]. / Tolérance du rétinoïde aromatique (RO 10 9359, étrétinate, Tigason, Roche). Recherche d'une toxicité sur les fonctions hématopoïétique, rénale et thyroïdienne. Interactions avec le métabolisme des rétinoïdes naturels.

59 patients with keratinisation diseases have been received RO 10 9359. There is a clinical medicum tolerance. Biologic controls have been carried out before and after a 3 month treatment. There is a good biological tolerance for the hematopoietic, glucidic, renal and thyroid functions. Thus the hepatic tolerance is poor for the patients with a predisposition for hepatic diseases (plethorics, alcoholics).

[Macroglobulinemia (Waldenström) with specific cutaneous nodules (author's transl)]. / Nodules cutanés spécifiques d'une macroglobulinémie de Waldenström.

The authors present a case of Waldenström's disease in a 68-year-old woman. The only symptoms were several nodes on the leg. The pathological, and immunological finding showed the presence of lymphoplasmocytic cells in the middle dermis; there was a positive reaction with the anti-IgM serum. Ultrastructural studies showed large cells with dilated reticulum and abnormal IgM globulin was found in the serum in large amounts. The rate of the others immunoglobulins was normal. There was a lymphoplasmocytic proliferation in the bone medullar. The specific cutaneous manifestation of the Waldenström's disease are 1) large "plaques" or/and 2) nodes. The pathological studie shows numerous lymphoplasmocytic or immunoblastic cells and sometimes the presence of an amorphous material which is the abnormal globulin.