Previous in-home physiotherapy prevents institutionalization after short-term hospitalization in community-dwelling older dependent people.

AIMS: Short-term hospitalization of community-dwelling older dependent people in a geriatric acute care unit is sometimes needed to treat an acute health problem. Serious loss of independence can lead to difficulties in maintaining home care and is followed, at hospital discharge, to institutionalization in a long-term care home. We investigated the variables, particularly those related to the paramedical staff at home, predicting a return home or an institutionalization at hospital discharge. METHODS: Retrospective observational study of 398 sixty and more year-old patients, living at home, having a natural caregiver, and hospitalized in an acute care unit of the State Geriatric Center. RESULTS: 289 (72.6%) patients returned home, 101 (25.3%) were admitted in a long-term care home, and 8 (2%) died. Independent predictors of institutionalization were length of stay in the acute care unit [adjusted OR (AOR) = 1.102, P < 0.001], disruptive behavioral and psychological symptoms of dementia (BPSD, AOR = 1.827, P = 0.039), caregiver burden (AOR = 1.976, P = 0.038), moderately severe-to-severe cognitive impairment (AOR = 2.121, P = 0.011), and living alone with a close or a remote caregiver (AOR = 2.620 and 4.446, P = 0.003 and 0.001, respectively). In-home physiotherapy was independently associated (AOR = 0.393, P = 0.002) with a lower risk of institutionalization. CONCLUSION: In-home physiotherapy should be recommended to community-dwelling older dependent people, especially if they are living alone and/or if they present disruptive BPSD and/or moderately severe-to-severe cognitive impairment.

[Idiopathic periaortic fibrosis: a difficult diagnosis in internal medicine]. / Les fibroses péri-aortiques idiopathiques: un diagnostic difficile en médecine interne.

Peri-aortitis retroperitoneal fibrosis is characterized by a reaction of a variable inflammatory nature while constricting the organs crossing the retroperitoneal space, notably the ureters and the blood vessels. It is difficult to diagnose such a rare disease. We bring about here six cases of periaortic retroperitoneal fibrosis diagnosed from systemic, digestive, urinary or vascular signs. Early diagnosis is often difficult and is shown to be established after an average of three months investigation. The average age of these patients, all of the male sex, is 58 years old (54 to 90). In the six cases this disease appears to be idiopathic even though in two cases it is associated to giant temporal arteritis and polymyalgia rheumatica. TDM remains the best diagnostic tool to point out the existence of this fibrosis, to observe its evolution and to investigate for any extension of the disease. The etiology of this fibrosis remains a mysterious one; however an immunologic origin has been suggested. Medical treatment by corticosteroids is often successful but the long term evolution of the disease is still uncertain.

[Thrombosis of the superior mesenteric artery and Behçet's syndrome]. / Thrombose de l'artère mésentérique supérieure et syndrome de Behçet.

The authors describe the third case in the literature of superior mesenteric artery's thrombosis occurring in the course of the Behçet's syndrome according to Mason and Barnes classification. Clinical manifestations in the patient were represented by intestinal angor. The literature data concerning vascular involvement in Behçet's disease, particularly thrombosis are reviewed. The value of noninvasive paraclinic arterial digestive explorations is discussed.

Treatment of pterygia in Queensland.

All practising ophthalmologists in Queensland completed a written survey on their current methods of treatment of pterygia. The indications for surgical removal, in decreasing order of importance, were mainly size, symptomatic complaints, cosmetic appearance and activity. Most surgeons graded pterygia into a variety of classifications. The most common form of treatment for primary pterygia was simple excision plus mobilisation of conjunctiva and suturing conjunctival free edges together followed by bare sclera technique, and simple excision plus thiotepa drops. For recurrent pterygia simple excision plus beta-irradiation was the most common form of treatment, followed by simple excision plus thiotepa drops and simple excision plus mobilisation of conjunctiva and suturing conjunctival free edges together. A third of the ophthalmologists electively avoid cautery use during pterygium surgery, while almost a quarter of the ophthalmologists attempt to polish the corneal and limbal region. When beta-radiation or Thiotepa is used there is a general consensus on the dosage for each of these. Seventeen per cent of ophthalmologists said they had not encountered any complications after pterygium surgery with the remainder quoting corneoscleral necrosis from beta-radiation and Tenon's granuloma as the most common complications. It would appear that there is no consensus on the best way to treat pterygia in Queensland, which probably reflects the lack of scientific proof for one method being superior to another.

Pterygium recurrence rate at the Princess Alexandra Hospital.

Over two separate time periods, 136 consecutive pterygium operations in 103 patients were performed at the Princess Alexandra Hospital. These patients were evaluated for recurrence of their pterygia in a retrospective study by chart review and re-examination. In 136 eyes there was an overall recurrence rate of 46% using a number of therapies. This study highlights the relatively unsatisfactory result of pterygium removal in a day surgery and eye outpatient department surgical setting by a number of trainee ophthalmologists, and stresses the need for a reassessment of pterygium and its treatment.

Branch retinal artery occlusion in a child.

BACKGROUND: Retinal artery occlusive events are unusual in the paediatric population. The average age of their occurrence is 60 years and the aetiology most often related to cardiovascular disease. CASE REPORT: A healthy 11-year-old white girl developed permanent unilateral visual field loss as a result of a branch retinal artery occlusion. An extensive work-up included transthoracic and transoesophageal echocardiograms, routine haematological and biochemical testing including serum lipids, screening for thrombophilia and thrombolysis, as well as autoantibodies, all of which proved to be within normal limits. CONCLUSIONS: Recognition of the underlying aetiology is not always possible, but should be sought as prognosis for vision or survival may rest upon these findings.

Pterygium recurrence time.

PURPOSE: To define the amount of time necessary to follow patients after pterygium removal to identify a recurrence. METHODS: The authors reviewed patients who supposedly had a recurrence of their pterygium and analyzed the records to determine the duration of these recurrences. RESULTS: One hundred sixty-one known pterygium recurrences were identified from records. Those patients with frequent follow-up in whom recurrence could be determined to within 1 month were in group A, and those in whom the time of recurrence was indefinite were in group B. For patients in group A, there was an average time to the first recurrence of 123 +/- 113 days, with second and third recurrences at 97 +/- 58 and 67 +/- 47 days, respectively. Survival curve analysis showed that there was a 50% chance that there would be a recurrence within the first 120 days, and there was a 97% chance there would be a recurrence within 12 months of its removal. CONCLUSION: This suggests that a 1-year follow-up time is likely to identify a recurrence.

Non-traumatic mycotic keratitis.

Two patients presented with culture proven Paecilomyces corneal infection, and a further patient with histologic evidence of fungal infection, on deep corneal biopsy. In all three cases the corneal infection was macroscopically present only in the depth of the cornea and on the endothelial surface with an intact epithelium and no overlying stromal involvement. Repeated surgery with large corneo-scleral grafts in two cases, and with medical therapy and a small patch-graft alone in the third case, resulted in long-term eradication of the infection and preservation of the globes. Antecedent modulation with steroid and/or cyclophosphamide may well have delayed the diagnosis, however, as there was no history of trauma in any of these cases, we postulate that these infections were not exogenously derived.

Autoantibodies to malondialdehyde-modified epitope in connective tissue diseases and vasculitides.

Malondialdehyde (MDA), a peroxidative end-product released during polyunsaturated fatty acid degradation, reacts strongly with lysine residues of cellular proteins. MDA-modified proteins become immunogenic and may elicit specific autoantibody formation. We hypothesized that systemic diseases in which inflammatory events occur, could be an interesting model for studying oxidative stress. A few studies have suggested that MDA-modified proteins may exist in systemic diseases, and that autoantibodies to MDA-modified structures might reflect this oxidative process. Autoantibodies to MDA-modified epitope(s) were therefore assayed in sera of patients with systemic lupus erythematosus (SLE, n = 29), scleroderma (SCL, n = 11), giant cell arteritis (GCA, n = 11), periarteritis nodosa (PAN, n = 10), rheumatoid arthritis (RA, n = 9), and healthy subjects (HS, n = 32). Significantly increased anti-MDA-modified epitope(s) autoantibodies were found in patients with SLE and also in other systemic diseases such as PAN and SCL. Autoantibodies to MDA-modified epitope(s) were predominantly of IgM isotype, with low levels of IgG and no IgA activity. In SLE, anti-MDA-modified epitope(s) autoantibody titres correlated strongly with systemic lupus activity measure (SLAM, r = 0.702, P = 0.0001), anti-nuclear antigen autoantibodies (ANA, r = 0.4, P = 0.029), IgG anti-cardiolipin (r = 0.558, P = 0.03) and the steroid drug regimen (r = 0.52, P = 0.004). Autoantibodies to MDA-modified epitope(s) may reflect oxidative modifications occurring in systemic diseases, and might be useful as clinical markers of SLE activity if further investigated.