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Biomedical subjects

P Chassagne

Publications and source records attributed to P Chassagne.

At least 19 recordsLinked to original sources
PubMed2001

[How to manage very elderly patients in the emergency room? Evaluation of 150 very elderly patients at the Rouen university hospital center].

OBJECTIVES: There are few data in the literature concerning care provided to very elderly subjects referred to emergency care units. The emergency room setting would not be particularly adapted to management of this rising population. The purpose of our work was to assess the frequency of referral to emergency care units, the characteristics of the elderly population, and patient management. PATIENTS AND METHODS: One hundred fifty consecutive patients aged over 90 years addressed to the emergency unit of the Charles Nicolle hospital in Rouen France were studied. These patients were cared for by the medical and surgical teams. We recorded, type of referral, hour and reason for admission, degree of handicap and residence, gravity at admission using the clinical classification for emergency care patients (CCMU), complementary tests performed in the emergency unit, duration of stay in the unit and subsequent referral. The characteristics of these "very" elderly patients aged over 90 years were compared with those of "elderly" patients aged 75-90 years. RESULTS: Over a period of 33 days, the unit cared for 4888 patients, including 150 very elderly patients aged over 90 years (mean age 92.6 years). Daily, 4.4 patients were referred by a primary care physician (76.), mainly between 8 a.m. and 8 p.m. (81.3%). Forty-two percent of the patients had a surgical problem. Two-thirds were unable to walk, one-third had cognitive disorders, and one-third had urinary incontinence. However, half of these very elderly patients lived in a private home. According to the CCMU classification, 14.6% of the patients had a life-threatening disorder. Complementary tests were ordered for most patients (85%). Mean duration of stay in the emergency unit was 3.6 +/- 2.6 days. One quarter of the patients returned to their former residence, with a higher percentage among the surgery patients (37%) than among the medical patients (14.6%). There was no significant difference between the "very elderly" and "elderly" patients in terms of type of referral, duration of stay in the unit and subsequent referral. CONCLUSION: "Very elderly" patients are frequently addressed to emergency care units by their primary care physician. They have severe conditions with major handicaps that largely explain their hospitalization. Our results point out possible improvements for care in the emergency unit.

Activities of Daily Living↗
PubMed2001

Does age play a role in mylohyoideus muscle function?

Because swallowing disorders are frequent in the elderly, we assessed the relationship between age and mylohyoideus muscle contraction, which is an important component of the initial step in swallowing. In a prospective study, 120 subjects without any personal history of diseases associated with swallowing disorders underwent electromyographic recording (EMG) of mylohyoideus muscle activity. Four groups of equal size (n = 30) were defined according to age (< or = 50, 51-70, 71-85, >85 years). The frequency and duration of mylohyoideus muscle asynchronisms were compared among the four groups. The comparison of mylohyoideus muscle EMG among groups did not show a significant difference in the mean number of asynchronisms, in duration per subject or in the frequency of long-lasting asynchronisms. Asynchronisms were a very frequent event, observed in 98% of subjects, and were mostly short, lasting less than 0.1 s in 90% of subjects. In healthy elderly patients, there was no linear relationship between the mean duration of asynchronisms and ageing. The occurrence of one or more long-lasting asynchronisms or of at least six asynchronisms during a sequence of 10 successive swallows should be considered to be abnormal.

Aged↗
PubMed2000

[Is cognitive change related to hypothyroidism reversible with replacement therapy?].

PURPOSE: Although cognitive impairment related to hypothyroidism has been investigated, issues regarding treatment have been less extensively studied. The aim of this study was to assess cognitive function in patients with hypothyroidism just before treatment and after hypothyroidism had resolved. METHODS: Standardized psychometric assessment (including ten tests) was done in 30 outpatients with biochemical evidence of hypothyroidism (TSH = 92.1 mU/L, range: 11.4-400) and in 30 control subjects matched for age and gender with normal thyroid function. These tests were repeated twice before treatment and after hypothyroidism had been cured. Statistical analysis was done using the Mann-Whitney U test. RESULTS: The baseline characteristic of patients with hypothyroidism showed that attention, motor speed, memory and visual-spatial organization were significantly impaired. Cognitive decline was significantly greater with increasing age. Cognitive impairment significantly decreased after hypothyroidism had been cured, reaching values obtained in age-matched control subjects. CONCLUSION: Attention, motor speed, memory and visual-spatial organization are significantly impaired in hypothyroidism, particularly in the elderly, suggesting that ageing could have potential effects on cognitive functions. Hormone-replacement therapy leads to normalization of the cognitive functions.

Age Factors↗
PubMed2000

Does treatment of constipation improve faecal incontinence in institutionalized elderly patients?

OBJECTIVE: to evaluate whether faecal incontinence can be improved by treatment of constipation in elderly patients with faecal incontinence associated with impairment of rectal emptying. DESIGN: a prospective randomized study with a 2-month follow-up. SETTING: five long-term care units. SUBJECTS: 206 patients with daily faecal incontinence associated with chronic rectal emptying impairments such as faecal impaction received either a single osmotic laxative (group I) or an osmotic agent along with a rectal stimulant and weekly enemas (group II). MEASUREMENTS: episodes of faecal incontinence and associated details of soiled laundry (used as indicators of the workload for caregivers). We performed periodic digital rectal examinations on group II patients to evaluate whether treatment resulted in complete and long-lasting rectal emptying. We compared data between groups and in group II between persistently constipated patients and patients with complete rectal emptying. RESULTS: the frequency of faecal incontinence did not significantly differ between the two groups. The 23 patients in group II who had complete rectal emptying had 35% fewer episodes of faecal incontinence and 42% fewer incidents of soiled laundry than the rest of the group. CONCLUSIONS: when long-lasting and complete rectal emptying is achieved by laxatives, the number of episodes of faecal incontinence as well as the workload for caregivers is reduced.

Aged↗
PubMed1999

[Drug use in the elderly. Undesirable drug effects in the elderly: epidemiology and prevention].

A COMMON PROBLEM: Adverse drug effects are common and severe in patients over 70. Most concern widely prescribed drugs or drugs with small safety margins. CLINIC: It is important to recognize the most frequently encountered modes of expression including cardiovascular, metabolic and neuropsychiatric manifestations. The effects of bleeding and low blood sugar are particularly severe. PREVENTION: Certain pharmacological favoring factors are closely related to the aging process. A large number of iatrogenic side effects could however be avoided if the patientís clinical situation is carefully considered in light of the risk of drug interactions, the patientís behavior (observance errors), or prescriber behavior (inappropriate prescriptions in light of the therapeutic goals).

Aged↗
PubMed1999

Fecal incontinence in the institutionalized elderly: incidence, risk factors, and prognosis.

PURPOSE: This study was conducted to evaluate the incidence, identify the risk factors, and assess the prognosis of elderly institutionalized patients who develop fecal incontinence. PATIENTS AND METHODS: We enrolled 1,186 patients 60 years of age and older living in long-term care facilities who did not have fecal incontinence. We assessed their medical history, treatment, mobility, and cognitive function. Patients were followed up for 10 months to determine the incidence of fecal incontinence, defined as at least one involuntary loss of feces. Independent risk factors associated with fecal incontinence were identified using Cox proportional hazards models. The prognosis of incontinent patients was assessed by comparing their survival rate with that in the continent patients. RESULTS: Fecal incontinence occurred in 234 patients (20%), and was usually associated with acute diarrhea or fecal impaction. We identified five risk factors for the development of fecal incontinence: a history of urinary incontinence (rate ratio [RR]: 2.0, 95% confidence interval [CI] 1.5 to 2.6); neurological disease (RR: 1.9, 95% CI 1.0 to 3.4); poor mobility (RR: 1.7, 95% CI 1.2 to 2.4); severe cognitive decline (RR: 1.4, 95% CI 1.1 to 1.9); and age older than 70 years (RR: 1.7, 95% CI 1.0 to 2.8). Ten-month mortality in the 89 patients with long-term (> or = 8 days) incontinence was 26%, significantly greater than that observed in the continent group (6.7%) or in the 145 patients with transient incontinence (10%). CONCLUSIONS: Long-lasting or permanent fecal incontinence was associated with increased mortality, suggesting that this symptom is a marker of poor health in older patients. Actions that improve mobility might help prevent fecal incontinence in elderly patients.

Aged↗
PubMed1999

[Innovative teaching, a successful invention: the European Academy for Medicine of Ageing (EAMA). The viewpoint of teachers and students].

INTRODUCTION: The origins of the EAMA (European Academy for Medicine of Aging) course are described in this paper by the Scientific Committee of this new post-graduate teaching activity. CURRENT KNOWLEDGE AND KEY POINTS: Innovations are constantly introduced to improve training methodology so as to enable the students to update their knowledge, help them improve their skills in data gathering and in the critical interpretation of information, and exchange geriatric experience and know-how. To reach such goals, an interactive teaching method is implemented by the professors, with world experts being called in to ensure scientific soundness and quality. Evaluations by students and teachers are regularly carried out with the aim of perfectly adjusting their training methodologies and increasing the scientific level of exchanges. FUTURE PROSPECTS AND PROJECTS: If the students progress, so do the teachers....

Academies and Institutes↗
PubMed1998

Nosocomial febrile illness in the elderly: frequency, causes, and risk factors.

BACKGROUND: Although nosocomial febrile illness (NFI) is common in hospitalized patients, it has been less extensively studied in the elderly. OBJECTIVE: To determine the frequency, causes, and risk factors of NFI in elderly inpatients. METHODS: This prospective study involved 608 patients (> or = 65 years of age) admitted in an acute geriatric unit. Investigators followed this cohort until 1 of the following events occurred: development of NFI, discharge from the geriatric unit, or death. The cause of NFI was classified into 3 groups: infectious, noninfectious, and no apparent diagnosis. We systematically studied 17 comorbid conditions, 6 drugs, and 7 invasive procedures. For comparison, the patients were stratified into 2 groups: patients with NFI and patients without NFI. RESULTS: Sixty-six patients (10.9%) with NFI were identified. They were compared with the remaining 542 patients without NFI. In 49 patients (74%) with NFI, the cause was infectious; in 9 (13.5%), it was noninfectious; and in 8 (12.5%), there was no apparent cause. After multivariate analysis, only fecal incontinence (odds ratio [OR], 5.54; 95% confidence interval [CI], 2.13-14.5), congestive heart failure (OR, 2.97; 95% CI, 1.53-5.76), and pressure ulcers (OR, 2.93; 95% CI, 1.19-7.17) were independent risk factors for NFI. The number of invasive procedures preceding the febrile episode was a significant predictor of infection (OR, 3.68; 95% CI, 1.14-9.21). CONCLUSIONS: Nosocomial febrile illness is a common event in elderly hospitalized patients. In 74% of the patients with NFI, an infection is found. Measures to decrease infectious NFI in the elderly require a reduction in the number of invasive procedures.

Aged↗
PubMed1996

Is presentation of bacteremia in the elderly the same as in younger patients?

OBJECTIVE: To compare the presentation of bacteremia in young and elderly patients. PATIENTS AND METHODS: Seventy-one elderly (mean age 80.4 years) and 34 younger inpatients (mean age 45.7 years) with bacteremia were prospectively studied. These were compared with a control group of 187 geriatric patients (mean age 81.3 years) with clinical signs of bacteremia but in whom blood cultures were negative. Bacteremia was defined as one or more positive blood cultures showing a pathogenic bacteria in patients with clinical signs of bacteremia. In all 105 patients with bacteremia, 16 common clinical or biological signs of the disease were immediately investigated after blood culture. Patients were classified into three groups: elder patients and young patients with bacteremia and elderly patients without bacteremia. RESULTS: Only three clinical findings of the 16 studied were found in at least 70% of the bacteremic elderly patients: fever, increased erythrocyte sedimentation rate, and a clinical indication of the source of infection. These three signs were found statistically more often in bacteremic elderly compared with nonbacteremic elderly patients (P < 0.01). Seven other signs (hypothermia, altered mental state, leukopenia, and lymphopenia) had a specificity above 80%. On a logistic regression analysis, four variables were significantly and independently associated with bacteremia in the elderly: rapid onset of infection (defined as a period < or = 48 hours between the earliest manifestation of bacteremia and the time of blood blood sample), fever, altered general state, and clinical indication of the source of infection. Younger infected patients had more chills, sweating, alter general state, altered mental state or lymphopenia than did the bacteremic elderly patients. Bacteremic elderly patients had statistically few symptoms than the young infected patients (P < 0.001). CONCLUSIONS: In elderly patients with early stage bacteremia, most of the signs or symptoms that are considered typical in the literature appear irregularly. None appeared pathognomonic. Elderly patients with bacteremia had fewer signs or symptoms than younger infected patients.

Aged↗
PubMed1996

Drug-drug interactions related to hospital admissions in older adults: a prospective study of 1000 patients.

OBJECTIVE: To investigate the frequency, nature, and side effects of drug-drug interactions (DDI) in a group of geriatric inpatients. DESIGN: Study of drugs administered at home in the 2 weeks preceding hospitalization. SETTING: Evaluation of patients admitted to a geriatric unit from the emergency unit. PATIENTS: One thousand inpatients more than 70 years of age (83.0 +/- 7.1 years), admitted consecutively to a hospital for acute illness. MEASUREMENTS: All possible two by two combinations of drugs administered at home were considered to determine whether these associations could lead to a DDI and whether side effects resulted from these interactions. RESULTS: Five hundred thirty-eight patients were exposed to 1087 DDI. The most frequently involved drugs were cardiovascular and psychotropic medications. There were 189 side effects observed in 130 patients. The most frequent side effects were neuropsychological impairment, arterial hypotension, and acute renal failure. The number of side effects did not differ between the 66 contraindicated drug associations and the 1021 associations that only required precautionary use. CONCLUSIONS: DDI frequently lead to side effects in older adults. Classifications of DDI must be adapted to increased DDI sensitivity in this population. Nevertheless the frequency of side effects might be reduced by limiting the prescription of the most frequent and dangerous DDI.

Aged↗
PubMed1996

Differences in the signs and symptoms of hyperthyroidism in older and younger patients.

OBJECTIVES: To determine if aging modifies the clinical presentation of hyperthyroidism and the signs of thyrotoxicosis in older people. DESIGN: Prospective cohort study. SETTING: A French university hospital. SUBJECTS: Eighty-four new patients with overt hyperthyroidism confirmed chemically between January 1992 and January 1993. Controls were 68 older euthyroid patients matched to the older hyperthyroid patients. MEASUREMENTS: Comparison of 19 classical signs of hyperthyroidism between 34 older patients (> or = 70 years; mean age 80.2) and 50 younger patients (< or = 50 years; mean age 37.4). Older patients were also compared with controls (mean age 81.3). RESULTS: Three signs were found in more than 50% of older patients: tachycardia, fatigue, and weight loss. Seven signs were found significantly less frequently in older patients (P < .001): hyperactive reflexes, increased sweating, heat intolerance, tremor, nervousness, polydipsia, and increased appetite. Only anorexia (32% vs 4%) and atrial fibrillation (35% vs 2%) were more found frequently in older people (P < .001). A goiter was present in 94% of the younger and in 50% of the older patients (P < .001). The mean number of clinical signs found in the older subjects was significantly smaller than the number found in younger patients (6 vs 10.8; P < .001). Comparison with older controls showed three signs that were highly associated with thyrotoxicosis in older people: apathy (Odd ratio (OR): 14.8), tachycardia (OR: 11.2), and weight loss (OR: 8.7). CONCLUSION: This study confirms the paucity of clinical signs of hyperthyroidism in older adults. These results suggest the necessity of routine screening for thyroid disease in this age group.

Adult↗
PubMed1995

Distribution of albumin, alpha 1-inhibitor 3 and their respective mRNAs in periportal and perivenous rat hepatocytes isolated by the digitonin-collagenase technique.

The expression of albumin and alpha 1-inhibitor 3 genes was investigated in rat cell suspensions enriched in periportal (n = 10) and perivenous (n = 10) hepatocytes obtained by the digitonin-collagenase technique. The degree of enrichment of the cell suspensions was assessed: (1) by enzymic assays for the periportal marker alanine aminotransferase and for the perivenous marker glutamine synthetase; and (2) by their content of mRNAs for the periportal marker hepatic glutaminase and for glutamine synthetase. The existence of an antegrade intra-lobular gradient for albumin and alpha 1-inhibitor 3 mRNAs was demonstrated, with periportal:perivenous ratios of 2.33 and 3.80, respectively. However, no gradient was demonstrated for the respective protein contents with corresponding ratios of 0.98 and 1.21. A certain degree of overlap existed between periportal and perivenous suspensions for their content in albumin and alpha 1-inhibitor 3 mRNAs. A morphometrical analysis of the surface of digitonin-permeabilized hepatic tissue revealed that this overlap could be explained by a variable extent of permeabilization of the mediolobular zone from one rat to another and from one lobule to another in a given animal. These results suggest that while the digitonin-collagenase technique is well suited for studies in vitro of proteins expressed in sharp intra-lobular gradients or restricted to an intra-lobular compartment, it is not completely reliable for proteins distributed in continuous moderate intra-lobular gradients, such as albumin and alpha 1-inhibitor 3.

Acute-Phase Proteins↗