[Management of myocardial infarction in patients over 75 years of age from 1983 to 1999]. / Prise en charge de l'infarctus du myocarde du suiet de plus de 75 ans de 1983 a 1999.

Elderly patients are often excluded from therapeutic methods which have been shown to improve the prognosis of myocardial infarction (MI). The aim of this study was to describe the changes in management of MI in the elderly and to analyse the factors associated with hospital mortality due to MI during this period. All cases of acute MI in patients over 75 years of age from 1983 to 1999 and admitted to the Centre Hospitalier du Val d'Ariège were reviewed. The clinical features, the modalities of initial management and their treatment on discharge were compared by periods: 1983-88, 1989-93 and 1994-99. The changes in hospital mortality and the factors associated with this mortality were studied. Five hundred and forty-four cases of patients with an average age of 81 years were reviewed. The proportion of patients who were treated medically alone decreased over the 3 periods whereas treatment by angioplasty and thrombolysis increased (1.2% in 1983-88 versus 18.2% in 1994-99). Betablockers, ACE inhibitors and aspirin were much more prescribed on discharge from hospital. In parallel, the hospital mortality from MI decreased by half (50.8% in 1983-88 versus 24.9% in 1994-99). The independent factors associated with hospital mortality were age, anterior infarction (OR = 2.08 [1.39-3.13]), revascularisation of the culprit artery by thrombolysis or angioplasty (OR = 0.24 [0.09-0.61]) and the period of hospital stay (OR = 0.22 [0.12-0.38] in 1994-99 compared with 1983-88). The authors' experience reflects an improved prognosis of MI in the elderly partially due to the benefits of treatment by angioplasty and thrombolysis. Improvement of pre-hospital treatment, better diagnostic methods and more aggressive management of the elderly with MI also contribute to these results.

[Bacterial endocarditis due to Staphylococcus epidermidis. Two cases (author's transl)]. / Endocardites bactériennes à Staphylococcus epidermidis. Deux observations.

Bacterial endocarditis due to Staphylococcus epermidis is rare and severe. In a first patient, a 58-year-old-man, it developed 40 days after the insertion of a double prosthesis (mitral and aortic). Cure was obtained by medical treatment using a combination of vancomycin and gentamicin, followed by pristinamycin and tobramycin. The second patient, a 50-year-old-woman, suffering from cirrhogenic hepatitis and treated with corticosteroids. Staphylococcus epidermidis endocarditis developed without any portal of entry being discovered. After the failure of various antibiotic combinations (even though bactericidal in vitro), a mitral Starr valve was inserted which resulted in cure. None of the patients showed any sign of valvular mutilations or disinsertion of prosthesis.