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Biomedical subjects

O Saint-Jean

Publications and source records attributed to O Saint-Jean.

At least 19 recordsLinked to original sources
PubMed2004

[Concerning: aging, the beginning of dialysis, the beginning of dependence: repercussions on the psychopathology of the very old dialysis patient].

The incidence of psychopathology, particularly depression, is high in dialysed elderly patients whereas their perceived level of health in the mental domain is similar to that of a non-dialysed and, even younger, population. Although the losses associated with advancing years, chronic disease and then entry into dialysis renders the psyche of elderly people frail, they do not strictly add in negative terms: their psychological reserve or resignation helps very elderly people to tolerate dialysis and its constraints. However, maintaining functional autonomy (ability to provide for one's fundamental needs and preserve leisure activities) while remaining independent to take decisions (particularly in controlling ways of receiving assistance) and preserving close relationships emerge as major determinant factors of the quality of life of very elderly dialysed patients. Added to the dependency due to dialysis, losses in these domains very often represent a turning point by changing the patient's identity, predisposing to the development of relationship problems, leading the patient to question his self-esteem or even resulting in psychological dependency, which itself adversely affects the quality of life. These mechanisms of psychopathology may not hide the possibility of an underlying dementia.

Aged↗
PubMed2004

[Symptoms and quality of life of hemodialysis patients aged 75 and over].

BACKGROUND: The population of dialysed patients includes an increasing percentage of very elderly patients. Although their life expectancy continues to increase, there are few currently available data about their quality of life. OBJECTIVES: descriptive analysis of the determinants of quality of life, perceptual level of health and quality of life, and estimation of symptomatic complaints in a population of very elderly haemodialysed patients. METHOD: Study of 35 haemodialysed patients aged 75 years old and older, who answered a questionnaire divided into 7 parts, defining: the determinants of their quality of life by open-ended questions, the prevalence of complaints amongst 35 pre-determined symptoms, Folstein MMSE performance, scores on Katz (ADL) and Lawton (IADL) independence scales, SF-36 perceptual health scale, and score subjectively allocated by the patients to their quality of life. RESULTS: Maintenance of functional autonomy, independence in the decision-making process and maintaining good relationships with friends and family were major determinants of quality of life. Asthenia, the major complaint, was well reflected the reduced physical capabilities of the patients (mean SF-36 physical score: -1.1 SD). Despite the high prevalence of incapacitating painful symptoms (42%) and psychological symptoms (23%), autonomy remained satisfactory (mean ADL score: 5.6 out of 6 and IADL: 58%). The levels of perceptual health and of quality of life remained satisfactory for the majority of patients (mean mental SF-36 score: -0.06 SD, and 84% of the patients scored their quality of life > 5 out of 10). CONCLUSION: These figures indicate the considerable resources that these patients could mobilise. It also emerges as an additional argument against the exclusion, based only on the criteria of age and multiple pathologies, of the oldest patients from the access to dialysis.

Aged↗
PubMed1998

Venous thrombosis in older people: prevalence of the factor V gene mutation Q506.

OBJECTIVES: Old age is usually considered to be a risk factor for venous thromboembolism, in conjunction with other factors such as heart failure, major surgery, cancer, long-term immobilization, and antiphospholipid antibodies. Genetic risk factors, especially inherited deficiencies in coagulation inhibitors, also play a role in the pathogenesis of thrombosis, but these are usually diagnosed in thrombophilic patients before the age of 50. The factor V Q506 mutation, responsible for activated protein C resistance, was recently linked to thromboembolic disease. We therefore investigated the prevalence of biological risk factors in older hospital patients with venous thromboembolism. DESIGN: A 2-year study period. SETTING: Ivry sur Seine (Paris), France. PARTICIPANTS: Seventy-nine geriatric patients (60 women and 19 men, mean age 83+/-6.8 years, range 70-102 years) who had had at least one proven episode of venous thromboembolism were enrolled over a 2-year period. MEASUREMENTS: Lupus anticoagulant and antithrombin (AT), protein C (PC), and protein S (PS) levels were determined in plasma. The factor V Q506 mutation was detected on genomic DNA. RESULTS: Lupus anticoagulant was detected in two women, one of whom also had a high level of anticardiolipin IgG, leading to the diagnosis of an antiphospholipid syndrome. No hereditary deficiency in AT, PC, or PS was found, but one patient had an acquired AT deficiency. Interestingly, nine of the 79 patients (11.4%, six women and three men) were heterozygous for the factor V Q506 mutation, although none were homozygous. The only major risk factor for thrombosis identified in these patients was prolonged immobilization in four cases. Four of the nine patients who were heterozygous for the factor V Q506 mutation had recurrent thromboembolism, and two of these patients had been immobilized for long periods. CONCLUSIONS: This study confirms that hereditary deficiencies in coagulation inhibitors, and the lupus anticoagulant, are rarely involved in the pathogenesis of venous thromboembolism in older subjects. In contrast, the factor V Q506 mutation was frequently associated with thrombosis (11.4% of our patients) and should, therefore, be considered an important risk factor in the older people.

Activated Protein C Resistance↗
PubMed1997

[Dementia syndromes and length of stay of elderly patients in internal medicine].

Dementia is frequently observed in elderly patients admitted in Internal Medicine Units. Study of prospective data allowed comparison between 199 demented patients and 601 non demented ones, for life conditions, hospitalization parameters, way of discharge and associated diseases. Age and sex ratio are equal. Demented patients live more frequently in geriatric institutions and require more often nurse care at home. For them, social care is more frequent during hospitalization. There is no significant difference for mean duration of stay, discharge in step down unit and mortality. In both groups the predictive factors for the duration of stay are the need for social care during hospitalization and the number of comorbidities. In patients with degenerative dementia, hypertension and cardiopathies are less frequent than among other patients. These data suggest that adequate care, including social care, may produce the same duration of stay and way of discharge for demented and non demented elderly patients in Internal Medicine Units.

Aged↗
PubMed1993

Decreased erythropoietin responsiveness to iron deficiency anemia in the elderly.

The prevalence of anemia in the elderly raises the question of an inappropriate secretion of erythropoietin in response to increased demands. Therefore, the serum erythropoietin concentration of elderly patients (74-95 years) with iron deficiency anemia was measured and compared to that of iron deficiency anemic adults (25-60 years). A lowered erythropoietin secretion in response to anemia was observed in elderly patients in comparison with adults. However, the serum erythropoietin of the anemic elderly was inversely correlated with hemoglobin levels as shown for the anemic adults. The progressive reduction of the renal function observed with aging could explain the decreased capacity of erythropoietin secretion in elderly patients.

Adult↗
PubMed1993

Clinical and electrophysiological study of the peripheral nervous system in the elderly.

The effect of age on the peripheral nervous system was investigated by clinical examination and neurophysiological studies in 59 subjects aged 60-103 years and 23 young subjects. A full laboratory screen for factors which, though clinically silent, may constitute risk factors (RFs) for peripheral neuropathy was also performed in the elderly subjects. Our findings show that the presence of RFs affects exceptionally the electrophysiological parameters in a statistically significant way. The age-dependent changes in nerve conduction parameters were well predicted by non-linear models. The simultaneous electromyographical study demonstrates the re-innervation capacity of the motor system.

Action Potentials↗
PubMed1993

[Dementia syndrome and intercurrent pathologies in the elderly. A study of 100 patients over 75 years of age in a geriatrics internal medicine unit].

Elderly people with dementia are admitted in ever increasing number to Internal Medicine units for exploration of dementia and treatment of intercurrent diseases. The purpose of this prospective study of 100 demential subjects aged 75 or more (mean: 85.3 +/- 5.4 years) was to discover the cause of dementia, to investigate the associated diseases and to evaluate the effects of treatment of these pathologies on the patients' cognitive performance. The mean duration of stay in hospital was 25.5 +/- 14.5 days (extreme: 6-100 days); 69 returned home, 17 were institutionalized and 14 died. Dementia was degenerative and of the Alzheimer type (73%) with vascular lesions (24%) associated with brain tumours (2%) or normal-pressure hydrocephalus (1%). On average, 2 pathologies were associated with Alzheimer's dementia and 3.5 with dementia cum vascular brain lesions. Repeated evaluation of cognitive performance was carried out using Folster's Mini Mental Status (MMS), a global evaluation test. It showed that 18% of the patients were significantly improved while the other diseases were being treated. The hypothesis of regressive confusional elements superimposed on dementia is accepted by the authors as it fits the model of geriatric multipathology morbidity. Since there is no specific treatment for most types of dementia, particular attention must be paid to associated diseases likely to aggravate the clinical expression of dementia.

Aged↗
PubMed1991

[Polypathology and co-morbidity: a dynamic way for describing morbidity in aged patients. Study of 100 patients, aged 80 and over, in a short-stay geriatric internal medicine unit].

Descriptive epidemiology has demonstrated the increase with age of the number of identifiable diseases per subject. However, the clinical relevance of this polypathology varies according to the type of affliction, and all pathologies are not necessarily implicated in all morbid events. This prospective study analyzed the length of hospitalization (mean stay: 17.26 +/- 10.52 days) of 100 subjects at least 80 years old (mean age: 85.2 +/- 4.35 yr). The mean total number of recognized diseases per patients was 4.12 +/- 1.83 (range: 1-10). The mean number of diseases concerned by the hospitalization studied was 3.13 +/- 1.60 (range: 1-9). Dynamic analysis of the morbidity of these patients led to their classification into two groups: a) co-morbid patients with several diseases among which interaction is not possible; and b) polymorbid patients with several diseases able to interact. In a polymorbid patient, a disease event can occur as the result of such an interaction (leading to multiple organ failure) or the evolution of a single entity. The number of diseases concerned by the hospitalization varied significantly according to the different models of morbidity, which reflect the different types of medical activity. The lengths of the hospital stay observed did not seem to be influenced by the morbidity model, thereby indicating the existence of other factors prolonging hospitalization. The data collected supported the validity of this approach to disease in the elderly whose objective is a new description of medical activity in this population.

Age Factors↗
PubMed1990

[Properties of drug complications in elderly patients].

Adverse reactions to drugs are characteristically more frequent and more severe in elderly people as a result of factors that are found exclusively in this category of patients, such as multiple diseases, multiple medications, multiple prescribers, self-medication, age-related changes in pharmacokinetics and patient's compliance. Clinically, these reactions are atypical, often mixed, and they may take their symptoms from some other disease decompensated by the adverse reaction. The frequency of this iatropathology in elderly patients is such that it must systematically be suspected in the presence of any pathological episode.

Accidental Falls↗
PubMed1986

Systemic infections with Trichosporon beigelii (cutaneum). Report of three new cases.

Three new cases of systemic mycosis due to Trichosporon cutaneum are reported and compared with the 23 previous reports. Two patients had acute leukemia and one patient had a lymphoblastic lymphoma. Blood cultures in two patients and cerebrospinal fluid in the third patient were positive for T. cutaneum. Only one patient recovered after antimycotic therapy and concomitant remission of his leukemia. At autopsy, the two other patients showed widespread infection with T. cutaneum. The authors conclude that diagnosis and management of such infection in the immunosuppressed host are difficult and the prognosis is poor.

Adult↗
PubMed1985

[Secondary polycythemia with hypererythropoietinemia. Supratentorial meningioma].

A meningioma was discovered in a 66 year old man with non-progressive alcoholic cirrhosis and abstinence for the 5 previous years. The development of polycythemia ten months later was related to an inappropriate secretion of erythropoietin. Conventional causes for this phenomenon could not be found. Erythropoietin assays in erythroblast cultures from both the patient's blood and post-mortem, from tumor fragments demonstrated a significant elevation of erythropoietic activity. The diagnosis of polycythemia secondary to meningioma is suggested. Only one similar case has apparently been reported.

Aged↗