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Biomedical subjects

François Piette

Publications and source records attributed to François Piette.

16 recordsLinked to original sources
PubMed2006

Motor score of the Unified Parkinson Disease Rating Scale as a good predictor of Lewy body-associated neuronal loss in the substantia nigra.

BACKGROUND: How well the motor symptoms assessed by the motor section of the Unified Parkinson Disease Rating Scale (UPDRS3) reflect the neuronal loss observed in the substantia nigra is not known. OBJECTIVE: To study the relationships among the motor symptoms assessed by the UPDRS3, Lewy body-associated neuronal loss in the substantia nigra, and duration of disease. DESIGN: Longitudinal, prospective, clinicopathological study. SETTING: Long-term care facility of a university hospital. PATIENTS: Eighteen elderly patients with a parkinsonian syndrome, studied prospectively but selected post mortem on the basis of the presence of Lewy bodies, and 5 age-matched control subjects. METHODS: One map of a section of the substantia nigra, indicating the location of all the nucleolated neuronal profiles, was drawn for each case. Neuronal density was estimated using a tessellation method. The relationship between time and neuronal loss and between neuronal loss and motor symptoms (assessed by the UPDRS3) was studied by means of regression analysis, using linear and exponential models. RESULTS: The neuronal density was linearly linked with the UPDRS3 score (r = -0.83 [P<.001]). Each point added to the UPDRS3 score corresponded to an estimated loss of 25 neurons/mm(3). The density of neuronal profiles in the substantia nigra decreased exponentially with time (r = -0.73 [P<.001]). Extrapolation of the curve suggested a presymptomatic phase of 5 years. CONCLUSION: The UPDRS3 score is linearly linked to neuronal density, which, in Lewy body diseases, decreases exponentially with time at a similar pace in this series of elderly patients and in the younger patients described in the literature.

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PubMed2006

[Medication and memory: interactions among the elderly].

Several different systems govern human memory, and different drugs may act specifically on one or more of them. The central nervous system in the elderly is particularly sensitive to drugs, and an iatrogenic cause must be sought for all recent and/or sudden alterations in memory functions. In the case of recent alterations in memory, all nonessential drugs, especially psychotropic agents; should be withdrawn or reduced. Elderly persons, especially those with dementia, are at risk because of the frequent and substantial effects of drugs on their memory: the benefit-risk ratio must be evaluated regularly and essential treatments maintained.

Adrenal Cortex Hormones↗
PubMed2006

Sarcopenia is predictive of nosocomial infection in care of the elderly.

Protein-energy malnutrition and nosocomial infection (NI) are frequent in elderly patients, and a causal link between the two has often been suggested. The aim of the present study was to identify the nutritional parameters predictive of NI in elderly patients. We assessed on admission 101 patients (sixty-six women, thirty-five men, aged over 65 years) admitted to an acute care of the elderly department. Sarcopenia was detected by dual-energy X-ray absorptiometry, with appendicular skeletal muscle mass expressed with respect to body area. Weight, BMI, albuminaemia, serum transthyretin and C-reactive protein values were also determined on admission, and known risk factors, such as functional dependence and invasive biomedical material, were also evaluated. After up to 3 weeks of hospitalisation, patients were classified according to whether they had developed an NI. After 3 weeks of hospitalisation, we found that twenty-nine patients had suffered an NI, occurring after a mean of 16.1 d. Patients who were sarcopenic on admission had a significantly higher risk of contracting an NI (relative risk 2.1, 95 % CI 1.1, 3.8). None of the other morphometric or biological parameters differed significantly between the two groups of patients on admission. Patients who experienced an NI were also more likely, on admission, to have a medical device (P=0.02 to P=0.001 depending on the device), to have swallowing problems (P=0.002) or to have restricted autonomy (P<0.01). Sarcopenia on admission to an acute care of the elderly unit, as measured by X-ray absorptiometry, was therefore associated with a doubled risk of NI during the first 3 weeks of hospitalisation.

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PubMed2005

Randomized controlled drug trials on very elderly subjects: descriptive and methodological analysis of trials published between 1990 and 2002 and comparison with trials on adults.

BACKGROUND: Very elderly subjects (VES; aged 80 years or older) constitute a special population as they frequently present multiple diseases (polypathology). Results from trials on general adult populations therefore cannot be extrapolated to VES. We performed a census of randomized controlled trials (RCT) on VES published between 1990 and 2002, and carried out a descriptive and methodological analysis of these RCT/VES, comparing them with matched RCT on general adult populations (control RCT, RCT/C). METHODS: We searched for RCT/VES in two international databases (EMBASE and MEDLINE) and then manually. RCT/C were matched to RCT/VES for disease area and year of publication. The methodological quality of each RCT was assessed with Chalmers' scale. RESULTS: We identified 84 RCT/VES, 63 of which were conclusive and 21, inconclusive. Subjects were institutionalized in 48 RCT, and community dwelling in 11 RCT (unspecified in 25 RCT). Efficacy was the main criterion in 75 RCT; tolerance in 9 RCT. Twenty-six RCT were published by geriatrics journals, and 58 by general medical journals. The RCT/VES covered most of the disease areas of geriatrics. The 84 RCT/VES had a mean methodological quality score of 0.578 +/- 0.157. The matched 84 RCT/C had a mean methodological quality score of 0.592 +/- 0.116 (p = .466). The methodological quality score of RCT/VES increased with the number of included subjects (p = .004) and the year of publication (p = .001). CONCLUSIONS: The methodological quality of RCT/VES is equivalent to that of RCT in general adult populations. Nevertheless, RCT/VES remain very scarce, and neglect certain diseases. RCT/VES and the inclusion of very elderly subjects in RCT on adults should be strongly encouraged.

Adult↗
PubMed2004

Risk factors for deep vein thrombosis in inpatients aged 65 and older: a case-control multicenter study.

OBJECTIVES: To identify independent risk factors of symptomatic deep vein thrombosis (DVT) in geriatric inpatients and to define high-risk patients likely to benefit from preventive treatment. DESIGN: Hospital-based case-control multicenter study with prospective data collection. SETTINGS: Geriatric university hospitals with long-, intermediate-, and short-term care facilities. PARTICIPANTS: All patients aged 65 and older in 19 geriatric departments were submitted to clinical surveillance over a 16-month period. MEASUREMENTS: Twenty-three potential risk factors of phlebitis were screened for. Comparison using logistic regression of 310 consecutive patients with symptomatic DVT versus 310 randomly selected controls was performed. The risk for symptomatic DVT in geriatrics was then scored from the clinical risk factors identified using multivariate analysis. This score is defined by the sum of the odds ratio (OR) of each risk factor present. RESULTS: Six factors were identified as independently related to the development of DVT: restriction of mobility (from OR=1.73, limited mobility without immobilization, to OR=5.64, bedridden during <15 days), aged 75 and older (OR=1.5/10 years), history of DVT or pulmonary embolism (OR=3.38), acute heart failure (OR=2.52), chronic edema of the lower limbs (OR=2.51), and paresis or paralysis of a lower limb (OR=2.06). The defined score of 8 or higher corresponded to an 88.7% probability of having symptomatic DVT. CONCLUSION: Treatments to prevent symptomatic DVT in hospitalized elderly should be evaluated on patients with these factors.

Age Factors↗
PubMed2003

[Anatomo-physiological aspects of the lower urinary tract in men and modifications related to ageing].

MICTURITION AND INCONTINENCE: The lower urinary tract, composed of several organs necessary for micturition, is controlled by the encephalic and peripheral centres, which have a synergic effect and coordinate the lower urinary tract. Continence is ensured by the effect of the adrenergic sympathetic nerve that increases urethral sphincter tonus and maintains low pressure in the bladder during filling. Micturition appeals to the cholinergic system mediated by the muscarinic receptors situated in the bladder. AGEING OF THE PROSTATE: Under the influence of dihydrotestosterone and growth factors, ageing of the prostate is characterized by histological modifications leading to hypertrophy, obstructing the flow of urine. AGEING OF THE BLADDER: Electronic microscopy studies have shown the presence of degenerative lesions and, on urodynamic level, are characterised by over or under-activity. Ageing of the peripheral and central nervous centres is morphological and metabolic with the production of vascular and free radicals, involving the systems that control micturition and continence. The ageing kidney has a tendency to produce more urine at night because of the functional changes that intervene in the salt and water balance regulation systems.

Adult↗
PubMed2003

[Clinical manifestations of urinary disorders and their treatment in ageing men].

PROBLEMS OF THE PROSTATE: Benign hypertrophy of the prostate (BHP), when it occurs, is manifested by an obstruction or irritation related to overactivity of the bladder. The obstructive syndrome is defined by urodynamic tests. Urge incontinence and study of the pressure-flow ratio are the tests of choice. The functional handicap and impact on quality of life are assessed using the International Prostatism Symptoms Score (I-PSS). Efficient and fairly well tolerated medical treatment has reduced the indications for surgery. It relies on alpha-blockers, 5a-reductase inhibitors and phytotherapy. When indicated, the surgical treatment of choice is endoscopic resection of the prostate. Among the non-prostatic micturition disorders, urge micturition with, in extreme cases, incontinence are due to detrusor instability. This is of multifactor origin; enhanced by the local irritation or environmental factors, it usually occurs within a context of acute or chronic pathologies. Treatment is recommended with anticholinergic agents. New molecules have recently been launched, better tolerated than oxybutinine. Electrostimulation can be a good alternative in mentally normal patients. Micturition due to excess urine may be due to overactivity of the bladder, the major risk of which is acute urine retention. It can also be observed during neurological affections such as Parkinson's disease or during administration of certain drugs. Nocturnal polyuria is a frequent problem. However, simple hygiene and dietary measures and the control of certain concomitant diseases can usually relieve the symptoms. Medical treatment relies on desmopressine.

Adult↗
PubMed2002

Evaluation of a new hands-up ergonomics for chest radiography in geriatric patients.

RATIONALE AND OBJECTIVES: Pneumonia is the leading cause of death after the age of 85 years. Chest radiography (CXR) requires forced inspiration for accurate assessment, but kyphosis, denutrition, muscular weakness, and neurologic disorders limit active inspiration. The aim of this study was to evaluate a new passive expansion technique, by raising the patient's arms above the head, in the radiographic diagnosis of pneumonia. METHODS: During a 10-month period, CXR were performed in 1452 geriatric patients for pulmonary acute disorders in our geriatric university hospital. When fewer than five anterior rib segments were visible on the conventional front view, a second CXR was performed with the patient's arms being raised above the head by a radiologist. The diagnostic questions were: Are more than five anterior rib segments present? Is pneumonia visible? The chest radiographs were independently analyzed (3-step confidence scale) by two radiologists and compared by interobserver kappa-coefficients calculation. RESULTS: One hundred three patients (97 female, 6 male), representing 7% of the examined population, with an average age of 86.5 years (range, 70-104 years) were included. An additional anterior rib segment was visible on the front CXR when the arms were raised above the head (P < 0.001). Pneumonia was diagnosed in 59 patients with high agreement (kappa = 0.84) by the passive expansion technique, whereas the pneumonia infiltrate was visible in only 44 patients with considerably lower agreement (kappa = 0.36) when the arms were positioned along the trunk (P < 0.03). CONCLUSIONS: Raising the arms above the head optimizes the quality of CXR and increases the detection of pneumonia in the geriatric patient. New ergonomics and adequate contention are required.

Aged↗
PubMed2002

[Percutaneous endoscopic gastrostomy in elderly patients. A prospective study in a geriatric hospital].

OBJECTIVES: The purpose of this work was to search for prognostic factors after percutaneous endoscopic gastrostomy (PEG) for enteral nutrition in geriatric patients by studying complications, nutritional benefits, and impact on quality of life. METHODS: In this prospective study, 59 elderly patients referred for PEG were followed for 1 year or until tube removal or death. Complications, tolerance to enteral nutrition, nutritional status, infection, bedsores and quality of life were assessed by a questionnaire at tube insertion, at 1 month and every 3 months. Multivariate analysis was performed to look for factors predictive of early mortality before one month. RESULTS: Insertion of the PEG tube was always successful. Pneumonia in the week before tube insertion was predictive of early mortality (odds-ratio: 8.77 [1.63-47.2], P=0.01). Thirty-day mortality was 25%, but was never related to PEG tube insertion. During follow up, no local complication was observed and enteral feeding was well tolerated. After 3 months, serum albumin and prealbumin levels increased (P<0.001). There were fewer infections (P<0.001) and bedsores remained unchanged. Quality-of-life scores were not modified. At one year, the PEG tube was removed in 16 patients who resumed normal oral nutrition, and 6 other patients were able to return to their home. CONCLUSION: In a cohort of aged institutionalized patients, PEG for enteral nutrition was well tolerated and not definitive in more than one-quarter of them. Active lung infection is a risk factor of early mortality.

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PubMed2002

[Monoclonal gammopathy of undetermined significance].

Monoclonal gammopathy of undetermined significance (MGUS) is an asymptomatic disorder with serum monoclonal immunoglobulin less than 30 g/l. It preferentially affects elderly patients; MGUS prevalence is about 1% in the general population and about 10% in patients aged over 80 years. MGUS diagnosis is based on elimination of other causes of serum monoclonal immunoglobulin, particularly multiple myeloma. Within the 20 years following diagnosis of MGUS, about 25% of patients will evolve towards myeloma or other malignant lymphoproliferative disorder. No factor has been identified to date which can efficiently predict this evolution. Recent data concerning immunophenotype, cytogenetics and molecular biology of plasma cells demonstrate the link between MGUS and multiple myeloma. MGUS clearly appears now as a plasma cell monoclonal pathology with reduced malignity. Soon, new biological data would help to discriminate patients with MGUS who will remain asymptomatic life-long from those who will evolve towards malignant lymphoproliferative disorder.

Aged↗
PubMedDate not supplied

Placement of the VenaTech LP caval filter in the elderly: feasibility and clinical benefits of insertion via the arm.

PURPOSE: To evaluate routine use of access sites in the arm for percutaneous caval filter placement (PCFP) in elderly patients. Neck arthritis, patient anxiety, access site thrombosis or fecal/urinary incontinence complicating jugular or femoral access may require alternative access sites in this population. METHODS: Access via the right arm was chosen for PCFP (VenaTech LP). The indication for PCFP was deep vein thrombosis, a history of pulmonary embolism, and a contraindication to anticoagulant therapy. Ultrasound-guided puncture was performed after diameter measurement of the arm veins (ØAV). The filter was inserted with standard imaging procedures. Procedural difficulty was graded and compared with ØAV and the angle from the arm vein to the superior vena cava (alphaAV/SVC). RESULTS: Over 2 years, 16 patients (14 women, 2 men) with an average age of 90 years (range 79-97 years) were included in the study. The average ØAV value of the basilic or brachial veins was 4.2 mm (range 3.0-5.1 mm). The minimal ØAV for successful access was determined after the first 15 patients. No hematoma occurred at the puncture sites. The average alphaAV/SVC value was 62 degrees (range 29 degrees -90 degrees ). Arm access was possible in 12 of 16 patients (75%) with ØAV >or= 3.5 mm and alphaAV/SVC >or= 29 degrees . Every procedure via the arm was graded "easy" by the operator, regardless of angulation values. Femoral access was used in one case due to the impossibility of traversing the heart (patient no. 2), and jugular access was used in 3 of 16 (19%) patients due to puncture failure (patient no. 4), small ØAV (3 mm) (patient no. 6), and stenosis of the distal right subclavian vein (patient no.16), respectively. CONCLUSION: PCFP via the arm can be routinely accomplished in patients older than 75 years, provided ØAV >or= 3.5 mm, and alphaAV/SVC >or= 29 degrees .

Aged↗
PubMedDate not supplied

Effects of malnutrition on cytochrome P450 1A2 activity in elderly patients.

Little is known of the influence of nutritional status on cytochrome P450 (CYP) 1A2 activity in elderly patients. Thirty elderly institutionalised patients with malnutrition (group A, aged 88 +/- 5 years) and 24 without (group B, aged 81 +/- 9 years) were included. Malnutrition was defined as weight loss of >10% over the previous 6 months and/or a body mass index (BMI) <21 kg/m2 and albuminaemia < or = 32 g/L. CYP1A2 activity was evaluated by the plasma paraxanthine/caffeine (PAX/CAF) metabolic ratio. The plasma PAX/CAF metabolic ratio was similar in both groups regardless of nutritional status (0.34 +/- 0.13 [A] versus 0.30 +/- 0.11 [B]; p = 0.11). The CYP1A2 metabolic ratio was not correlated to either BMI, serum albumin or renal clearance. CYPI A2 activity, as measured by the plasma PAX/CAF ratio, was not influenced by nutritional status in elderly patients.

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PubMedDate not supplied

[Clinical trials in very elderly people: the point of view of geriatricians].

BACKGROUND: Very elderly subjects (aged > or =80 years) and polypathological elderly subjects experience frequent and serious adverse drug effects. They are nevertheless still excluded from clinical research. METHODS: We questioned geriatricians through a questionnaire about the usefulness and feasibility of randomised controlled trials (RCTs) in this population. RESULTS: Forty-eight percent of geriatricians questioned did participate in RCTs, but 96.8% considered that RCTs including very elderly subjects were scientifically necessary. Among geriatricians who never participated in RCTs, 36% were never contacted regarding participation in such clinical research. The most important difficulties in developing RCTs in very elderly subjects were methodological difficulties (narrow eligibility criteria incompatible with patient heterogeneity) and those associated with patient consent. For 38.2% of the geriatricians, the fact that pharmaceutical companies are under no obligation to promote RCTs in very elderly subjects represents a major obstacle in the development of such RCTs. CONCLUSIONS: The development of RCTs involving very elderly subjects depends first on a political choice, together with an adapted regulatory framework.

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