Cause of death in older patients with anatomo-pathological evidence of chronic bronchitis or emphysema: a case-control study based on autopsy findings.

OBJECTIVES: To determine the most frequent causes of death of hospitalized older patients based on anatomo-pathological evidence and to compare the relative frequency of fatal events between patients with and without evidence of either chronic bronchitis (CB) or emphysema (E). DESIGN: Retrospective, case-control study based on a computerized database including anatomo-pathological data of patients deceased and autopsied over a 25-year period. SETTING: Two geriatric hospitals in Geneva. PARTICIPANTS: Not applicable. MEASUREMENTS: Autopsy records for cause(s) of death in patients with CB or E. RESULTS: 3,685 patients deceased in our institution (1,540 men; 2,145 women) were autopsied between 1972 and 1996; mean age at death was 81.5 +/- 8.0 years. Anatomo-pathological evidence of CB or E was found in 983 patients (26.6% of total); 262 (7.2%) had predominantly CB, and 456 (12.3%) predominantly E. Pneumonia was the most frequent cause of death in all patients (21.8%). Myocardial infarction (MI) (17.6% vs 14%), and respiratory failure (5.1% vs 1.5%) occurred more frequently in subjects with CB and/or E than in controls. Fatal pulmonary embolism (PE) was more frequent in patients with E (18.4%) than in patients with CB (10.7%; odds ratio ( OR) = 1.89, P =.008), or in controls (12.7%; OR = 1.56, P =.0008). CONCLUSION: Anatomo-pathological evidence of CB or E is highly prevalent in older patients, suggesting that CB and E are clinically underdiagnosed in this age group. Fatal MI occurred significantly more frequently in older patients with E or CB than in controls. Furthermore, patients with E were at significantly higher risk of fatal PE than patients with CB or controls.

Pulmonary microsporidiosis in a patient with the acquired immunodeficiency syndrome. A case report.

BACKGROUND: Microsporidian protozoa are increasingly recognized as pathogenic organisms related to host immunosuppression. CASE: We report a case of pulmonary microsporidiosis detected in aspirated bronchial material and in bronchoalveolar lavage fluid collected from a 26-year-old, male acquired immunodeficiency syndrome patient presenting pulmonary symptoms and known to have intestinal microsporidiosis. The diagnosis was made on cytologic examination of the material processed according to the Papanicolaou technique, evaluated by Giemsa, Gram's, Grocott and chromotrope-2R modified trichrome preparations and by fungi-fluor fluorescent mycology stain. CONCLUSION: Our findings reveal an important fluorescent property of intracellular microsporidian spores, heretofore undescribed in the literature.

Metastatic and invasive tumours involving the heart in a geriatric population: a necropsy study.

In a series of 744 necropsied subjects with a diffuse malignant process, 57 cases of cardiac involvement were observed (50 metastatic carcinomas and 7 lymphomas or myeloproliferative disorders). The most frequent site of involvement was the pericardium and epicardium in lung or breast carcinoma, suggesting regional lymphatic invasion. Myocardial involvement was rarer and usually associated with cutaneous melanoma and lymphoma, suggesting haematogenic invasion. Endocardial involvement was exceptional. The multiple causes of heart disturbance in the elderly cloud the clinical diagnosis of such cardiac involvement; however, isolated pericardial and/or epicardial abnormalities should heighten suspicion of a neoplastic process.

Collagenous colitis with protracted course and fatal evolution. Report of a case.

We report the case of a female patient who suffered from collagenous colitis for 13 years, the complications of which may have contributed to her death. The disease was associated with seropositive rheumatoid arthritis and Sjögren's syndrome. Cases of collagenous colitis with a course leading to death have not been reported in the literature, to the best of our knowledge.

The frequency of unsuspected tuberculosis found post-mortem in a geriatric population.

Over a period of 14.5 years, 1911 complete autopsies were performed consecutively in two divisions of the same University Department of Geriatric Care, i.e., the Geriatric Hospital and the Center for Continuous Care. Sixty cases of active tuberculosis were observed, of which 37 cases (mean age of 84.51 years) had been clinically undiagnosed. Comparison with other published series indicate that the risk of unsuspected active (in fact, reactivated) tuberculosis mainly concerns "high age". The conditions which favor the disease are mainly in the context of immunodeficiency. Those which hinder the diagnosis are various, e.g., non-indicative tuberculin test, frequent impossibility to perform eye fundus examination or more aggressive investigations, frequency of cancer, and frequency of dementia in elderly people.

A case of intracortical tuberculosis of the femur.

This is the report of an anatomical-radiological study of a case of femoral intracortical tuberculosis observed at the autopsy of an 83-year-old woman presenting with diffuse miliary tuberculosis. Among the differential diagnoses, carcinoma metastasis is the main alternative to be discussed.

Is a certain degree of osteomalacia involved in femoral neck fractures of the elderly? Histological approach to the problem and practical applications.

A study was made in Geneva of 14 patients with femoral neck fractures (7 subcapital and 7 trochanteric) to determine whether a certain degree of osteomalacia might be involved (group I). No patients with risks factors for osteomalacia were used. For ethical reasons, double tetracycline labelling was not possible and osteomalacia criteria were based on osteoid tissue values determined in a histomorphometric study directly on cancellous bone samples of the femoral head. A comparison was made with femoral head bone tissue taken from 12 patients with hip osteoarthritis at a distance from the remodelled territory (group II) and with iliac crest bone tissue taken from 6 patients with clinically and biochemically determined osteomalacia (group III). The patients were part of a larger group of subjects used for a biochemical blood study in which levels of albumin, calcium and 25 OHD3 as an index of vitamin D content were determined. Based on the data of the literature and the results obtained for group II, slight signs of osteomalacia were diagnosed for only one case (group I), although 25 OHD3 deficiency was found in more than a third of the subjects in that group as well as in some subjects of group II and in some of the aged controls. Skeletal aging must be considered not only in terms of unavoidable physiological factors but also within the context of living conditions. Hence the necessity of controlling calcium and vitamin D intake in the elderly, and of a histological examination for signs of osteomalacia in surgical specimens from patients with femoral neck fractures.

[is there an osteomalacia component in femur neck fractures?]. / Y a-t-il une composante ostéomalacique dans les fractures du col du fémur?

In 29 patients with fractures of the femoral neck (group A) and 22 patients operated on for osteoarthritis of the hip (group) B), plasma levels of 25-hydroxycholecalciferol (25-OH-D3) were compared with the results of histological bone tests. A third group of 19 patients at the Geriatric hospital served as a control in this age group for 25-OH-D3 values (group C). The average level of 25-OH-D3 was 9.64 +/- 5.8 micrograms/l in group A and 13.25 +/- 7.6 micrograms/l in group B. This difference is not significant. On the other hand, the difference between groups B and C (9.31 +/- 4.04) is significant (2 p less than 0.05). Evaluation of the histological sections did not reveal evidence of osteomalacia. Generally speaking, the levels of plasma 25-OH-D3 in these patients were low, but without signs of osteomalacia on histological evaluation.

Synovial deposit of osmic acid after intra-articular injection. Anatomical and radiologic study of a case.

An anatomical and radiologic study of a synovial autopsy specimen 32 months after an intra-articular injection of osmic acid for the local treatment of a rheumatoid synovitis. Osmium deposits are seen within peripheral cells of a fat lobule and also in a few histiocytes of the scar tissue which replaced the rheumatoid synovitis. These osmium deposits in the fat cells are present in a sufficient quantity to give a radiologic opacity.