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Biomedical subjects

P Pfitzenmeyer

Publications and source records attributed to P Pfitzenmeyer.

At least 37 records · Page 2Linked to original sources
PubMed2000

Spontaneous insufficiency fractures of long bones: a prospective epidemiological survey in nursing home subjects.

A 30-month prospective observational cohort study was led to assess the prevalence of and describe the clinical features of spontaneous long bone insufficiency fractures (LBIF) in the 'oldest old' patients of long-term nursing homes (LTNH). The study was conducted in 30 LTNH in northeast France, which represented 3052 beds. Subjects aged 65 and more showing LBIF were included in the present study. Clinical data and outcome were collected. Fifty-five LBIF were found. The prevalence of LBIF calculated on the basis of the number of patients consecutively admitted in LTNH was 1%. The mean age of the subjects was 85+/-7 years. The LBIF sites were as follows (1) hip fractures in 15 subjects (27%); (2) femoral shaft fractures in 13 subjects (24%); (3) tibia and/or fibula fractures in 14 subjects (25%); (4) humerus fractures in 11 subjects (20%); (5) cubitus in 2 subjects. The global mortality at 2 months was 24%. The poorest outcome was observed in the group with femoral shaft fracture who showed mortality of 54% at 2 months. The dramatic repercussions in outcome and quality of life in bedridden patients show that the detection of LBIF should not be neglected in nursing homes. There is no consensus for a preventive pharmacological treatment in these patients. Educational programs for 'proper handling' by the nursing staff are highly recommended.

Journal Article↗
PubMed1999

[Clostridium difficile diarrhea in the very old. Clinical features and course in 21 cases].

OBJECTIVES: Determine the clinical and etiological features of Clostridium difficile diarrhea in elderly subjects. PATIENTS AND METHODS: We retrospectively analyzed 21 cases of C. difficile diarrhea observed in patients at the Dijon geriatric center from January 1994 through December 1995. The diagnosis was established on C. difficile toxin evidenced in fecal matter. RESULTS: There were 13 women and 8 men (mean age 85.9 years). All patients had several underlying disease conditions and were highly dependent. Three outbreaks involving 11 patients were observed. In more than half of the patients, the primary clinical signs were colitis with fever, highly elevated erythrocyte sedimentation rate and high white cell count. Eleven patients also had candidiasis of the digestive tract. All patients had received one or several antibiotics during the 15 days prior to diarrhea. The main antibiotic families were aminopenicillins, cephalosporins and fluoroquinolones. Twenty patients were given specific treatment: imidazoles in 15 cases and vancomycin in 9. Diarrhea was successfully controlled in 14 cases. There were 2 cases of recurrence and 6 patients died after a cascade of complications. C. difficile infection persisted in 2 at death. DISCUSSION: Over recent years C. difficile diarrhea has become a serious problem in geriatric units. Antibiotic therapy is the main risk factor as well as protein-calorie malnutrition, immunodeficiency, and colonic stasis. Morbidity and mortality are high in fragile elderly subjects.

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PubMed1998

[Reversible bronchial spasm syndrome in the very old].

UNLABELLED: HIGH PREVALENCE: Several epidemiological studies have shown that the prevalence of bronchial asthma is high in the elderly. It is often difficult to establish the diagnosis of asthma in this population because of the scarcity of symptoms. Pulmonary function tests are widely used to confirm the diagnosis. These tests are possible in most elderly people excepting cases of severe dementia. MECHANISMS: Pathophysiology of asthma in the elderly may be characterized by superimposition of different factors: 1) the effect of age which is associated with airway adrenoreceptor dysfunction; 2) the impact of chronic pulmonary diseases which may increase airways inflammation; 3) the role of triggers such as infections or various medications. MANAGEMENT: Management of asthma consists in a specific treatment of trigger(s) associated with anti-inflammatory and bronchodilator medications. Elderly subjects may have difficulty using offinhalators and spacer devices are widely used.

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PubMed1997

Colon cancer in the elderly: evidence for major improvements in health care and survival.

Time trends in therapeutic approaches and in the prognosis of colon cancer for patients aged 75 years and above have been investigated in comparison with corresponding trends for younger patients using a population-based series of 2089 colon cancer patients diagnosed between 1976 and 1990 in the Côte-d'Or area (478,000 inhabitants), Burgundy, France. Significant progress has been achieved in the management of patients with colon cancer in both age groups, but trends have been more noticeable in patients aged 75 years and above. In the elderly, the proportion of cancers limited to the digestive tract wall showed a 3-year average increase of 2.8% (P = 0.02) and the frequency of curative surgery an average increase of 8.6% (P < 0.001), so that it was performed in 80% of cases in the last 3-year period. Operative mortality decreased by 2.5% between 3-year periods (P < 0.004). Crude 5-year survival rates in elderly patients increased from 15% in the 1976-78 period to 29% in the 1985-87 period (P < 0.001), the corresponding figures being 36% and 44% (P > 0.10) in younger patients.

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PubMed1997

Vitamin B6 and vitamin C status in elderly patients with infections during hospitalization.

We have evaluated whether vitamin B6 and C metabolism may be altered by infection in the elderly. Vitamin B6 and C biochemical status has been assessed for times over a period of 21 days (days 0, 7, 14, and 21) in 18 subjects > or = 75 years. The subjects were divided into 3 groups: group I (8 subjects with acute infection), group II (4 malnourished subjects), and group III (6 control subjects). Vitamin B6 status was determined by plasma pyridoxal-5'-phosphate (PLP) and erythrocyte aspartate aminotransferase activation coefficient (alpha-EAST), and vitamin C status by plasma ascorbic acid. During the 3 weeks, vitamins B6 and C values were significantly different between groups: at days 7 and 14, PLP values were significantly higher in group III than in both groups I and II, and alpha-EAST values were significantly higher in group I than in both groups II and III. Plasma ascorbate values were significantly lower in group I than in both groups II and III. These data suggest that an acute catabolic state like infection may influence vitamin B6 and C metabolism. Nevertheless, more work is needed to assert that vitamin B6 and C supplementation may be useful during infection.

Acute-Phase Proteins↗
PubMed1996

Pleuropulmonary changes induced by ergoline drugs.

Classic ergolines, such as bromocriptine, methysergide and ergotamine, can induce chronic pleuropneumonitis. We present the cases of eight patients who developed similar changes whilst on other ergolines. In this retrospective case study spanning 1985-1995, clinical data, radiological material, pulmonary function, bronchoalveolar lavage and histopathology were reviewed. Earlier literature on ergoline-induced pleuropulmonary changes was reviewed. Eight middle-aged to elderly individuals of both sexes developed pleuropulmonary changes during long-term therapy with regular dosages of nicergoline (n = 4), dihydroergocristine (n = 3), or dihydroergotamine (n = 1). Bibasilar pleural thickening with or without pleural effusion was present on chest radiographs and computed tomographic (CT) scans in six cases. Increased erythrocyte sedimentation rate was seen in most. Pure interstitial pneumonitis developed in two patients on dihydroergocristine and was reversible in each. Bronchoalveolar lavage was performed in four cases and was abnormal in all, but demonstrated no consistent pattern. Most patients exhibited lung restriction. The outcome was favourable showing slow improvement in all cases following discontinuation of the ergoline. Slight residual pleural thickening was seen in five out of the six cases with pleural involvement. Nicergoline and dihydroergotamine can induce a syndrome of chronic pleural thickening/effusion that slowly improves after drug withdrawal. Dihydroergocristine can induce reversible interstitial pneumonitis.

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PubMed1995

[Evaluation of the ventilatory function in elderly subjects].

OBJECTIVES: Many elderly subjects are at risk of respiratory failure due to effect of age on ventilatory system and the deleterious effects of toxins and respiratory diseases. As spirometry is the main technique currently used to detect altered ventilatory function we first used this method in very elderly subjects then compared the results with clinical measurements of chest and abdominal ampliation. METHODS: Among 65 subjects over 75 years of age, with no cardiorespiratory or neuropsychologic impairment and who had undergone spirometry and chest and abdominal ampliation measurements in 1991, 24 were re-examined in 1994 using exactly the same techniques. Forced vital capacity and maximum expiratory volume/second were measured at the patient's home with a previously calibrated spirometer. All tests were run according to the recommendations of the European Respiratory Society. Variations in upper chest, lower chest and abdominal circumferences were also recorded. RESULTS: Mean age of the subjects was 84.1 +/- 3.7 years and all spirometric tests were reproductible within a given measurement session. There was no significant difference for forced vital capacity or for maximum expiratory volume/second between the 1991 and the 1994 values with variations of 2.1 +/- 0.4 and 9.4 +/- 3.4% respectively. Four of the 24 initially asymptomatic subjects had signs of obstruction which resolved in 2 with the salbutamol and/or ipratropium bromide. The correlations between spirometric data and chest and abdominal ampliations were significative. CONCLUSIONS: Spirometry can be an effective tool in elderly patients. In addition to frequent discovery of reversible bronchial obstruction (7 to 41% according to the series), it can be used to screen for reduced ventilatory "reserve". Chest ampliations measures also appear to be simple means of determining which subjects could benefit from physical therapy aimed at improving chest and abdominal musculature.

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PubMed1995

[Secondary hyperparathyroidism in the elderly. Apropos of 200 assays of intact parathormone].

OBJECTIVES: To evaluate the frequency of high levels of intact parathormone in an elderly population of hospitalized patients and to determine whether there are any correlations with different factors involved in phosphocalcium metabolism, nutritional status and renal function. METHODS: Intact parathormone was assayed in all patients admitted to a geriatric ward (n = 200). Other laboratory tests included serum phosphorus, calcium, total albumin, prealbumin, ionized calcium, creatinine with calculation of the clearance and in 50 patients radioimmunoassay for 25 hydroxyvitamin D. RESULTS: Intact parathormone was abnormally high (> 65 pg/ml) in 40 patients. Mean levels increased significantly with age and reached 70.5 pg/ml in patients 90 years of age and over. No correlation was found between intact parathormone and total serum calcium, corrected serum calcium, albumin or prealbumin. Inversely there was a significant correlation with serum phosphorus and creatinine and creatinine clearance. Serum levels of 25 hydroxyvitamin D were abnormally low in 82% of the patients. There was a constant and significant decrease in intact parathormone level 15 days after calcium and calcifediol substitution therapy in 13 patients. CONCLUSION: The frequency of hyperparathyroidism increases with age to affect nearly 1 out of 2 subjects over 90. It would be useful to determine a threshold level for elderly subjects with a major risk of bone fracture.

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PubMed1995

[Monoclonal gammopathies of undetermined significance in the elderly: apropos of 80 cases].

The authors reviewed the medical records of 80 patients with monoclonal gammopathy of undetermined significance who were examined at the hospital of Dijon between July 1990 and December 1992. The study included 43 males and 37 females with a mean age of 81.0 +/- 5.5 years. Type of M-component was IgG in 65% of the cases, IgA in 19% and IgM in 13.5%. A biclonal gammopathy was found in 2.5% of the cases. The follow-up duration was 24.6 +/- 10.8 months (range: 1-42 months). The survival probability of patients with monoclonal gammopathy of undetermined significance was 66.6% at 36 months compared with 75.6% in a control population. Lymphoplasmacytic disease developed in four patients (5%). There is a dramatic increase in monoclonal gammopathy with increasing age and the risk of malignant transformation must be continued whatever the age of patients. Further studies are required to determine routine follow-up in the elderly patient with monoclonal gammopathy of undetermined significance until the long term utility and cost/benefit ratio of screening techniques are known.

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PubMed1995

Predicting bacteremia in older patients.

OBJECTIVE: To evaluate potential clinical predictors of bacteremia in hospitalized geriatric patients and to propose an individual risk score as an alternative to "subjective" clinical judgment for a more efficient approach in early recognition and treatment of bacteremia. DESIGN: A 16-month prospective study. SETTING: The University Geriatric Hospital of Geneva, Switzerland. PATIENTS: Four hundred thirty-eight patients aged 62 years or older in whom 558 episodes of bacteremia were suspected. MEASUREMENTS: The unit of evaluation was the blood culture episode, which was defined as a 48-hour period beginning with the drawing of the first blood for culture. An extensive precoded protocol, including clinical and biological data, was completed by the resident who requested the blood cultures. For each episode, the resident also provided a subjective assessment of the probability of bacteremia. Odds ratios and their variances were used to estimate the relative risks of potential predictors of bacteremia. The performance of a predictive clinical model based on risk score threshold was evaluated by means of a receiver-operating characteristic analysis. RESULTS: Of the 558 potentially bacteremic episodes investigated, 46 (8.2%) yielded positive blood cultures. The bacteremia rate was strongly associated with the type of episode: it reached 15.6% among the community-acquired (CA) episodes (those occurring within 48 hours of hospital admission) and 6.0% only among the hospital-acquired (HA) episodes (those occurring after the first two days of hospitalization). Predictors of bacteremia with highest relative risks included: bladder catheter removal, fever (> or = 38.5 degrees C), rigors, shock, total band count > or = 1500/mm3, and lymphocyte count < or = 1000/mm3. When assessed by episode type, it appeared that bladder catheter removal and rigors were good predictors of bacteremia in HA episodes only, whereas fever (> or = 38.5 degrees C) had a good predictive value in CA episodes only. The performance of the clinical model was two times better than the physician's subjective ability to predict bacteremia when the threshold of the risk score was fixed at two or more predictors per episode. CONCLUSIONS: These findings provide means to identify older hospitalized patients at high risk of bacteremia. Although the proposed predictive model will need further validation and more precise evaluation of the potential benefits, it may nevertheless be of some help in early recognition and treatment of bacteremia.

Age Factors↗
PubMed1994

Thiamine status of elderly patients with cardiac failure including the effects of supplementation.

This study compared the thiamine status of 35 elderly hospital inpatients with cardiac failure (CF) with that of 35 elderly inpatients with other diagnoses (Non-CF). The CF group was then randomly allocated to CF1 group (thiamine treatment, 200 mg per day for 7 days), and CF2 group (non supplemented). The effect of the thiamine treatment on the cardiac failure course was examined. Although there was no significant difference in thiamine status between CF and Non-CF groups, 11.5% of the first group against only 6.0% of the second was deficient with the thiamine pyrophosphate stimulation effect (TPPE) test. The same trend was observed, if NYHA functional assessment was taken into account, thiamine deficiency was more frequent in class 4 than in class 3. No significant difference for thiamin status was observed in patients receiving furosemide treatment and those without furosemide treatment. Although vitamin treatment permitted a significant improvement in thiamine status, the course of the cardiopathy was not significantly different in CF1 (supplemented) and CF2 (non supplemented) groups. Whether systematic thiamine supplementation is indicated in CF patients requires further investigation.

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PubMed1994

Piroxicam induced pulmonary infiltrates and eosinophilia.

We describe 2 patients who developed pulmonary infiltrates while being treated with piroxicam. There was no satisfactory explanation other than drug induced lung disease for their illness. They had no exposure to pneumotoxic drugs or aerocontaminants. Microorganisms were not cultured in sputum or bronchoaveolar lavage. There was no underlying illness with possible lung involvement. Pulmonary infiltrates developed during piroxicam therapy, disappeared after drug withdrawal and recurred following rechallenge.

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PubMed1993

[Secondary hyperparathyroidism in hospitalized aged patients: apropos of 200 assays of intact parathyroid hormone].

Plasma intact parathyroid hormone (PTH) determinations were performed in 200 elderly patients admitted in a geriatric care unit. Abnormally high levels of PTH were observed in 40 subjects. There was a significant correlation between plasma ionized calcium determinations or creatinine clearance and PTH levels. Subjects with high PTH levels exhibited constantly reduced levels of 25 OH-D3. A calcium and vitamin D supplement, performed in 13 patients, was constantly followed by a decrease of the PTH level.

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PubMed1993

Lung function in advanced age: study of ambulatory subjects aged over 75 years.

Spirometric parameters including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1) and various parietal parameters (superior and inferior rib cage and abdominal maximal expansion amplitudes) were measured in 65 ambulatory subjects aged over 75 years. The population was divided into three age groups: group 1: 75-79; group 2; 80-84, group 3: 85 and older. A marked decrease in clinical and spirometric results was observed between groups 1 and 2, and 1 and 3, but there was no difference between groups 2 and 3. Such findings might be attributed to a survival effect. There was a high correlation between the parietal parameters and FVC and FEV1. In clinical practice, this simple parietal assessment may be of value in the identification of elderly subjects at risk of acute respiratory distress.

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PubMed1992

Nilutamide pneumonitis: a report on eight patients.

BACKGROUND: Nilutamide is a new, specific synthetic antiandrogen, released in several countries for the treatment of metastatic carcinoma of the prostate. Eight patients at the University Medical Centre at Dijon and affiliated referring hospitals developed reversible pulmonary opacities and respiratory symptoms while taking the drug. METHODS: Records of eight patients who developed new, otherwise unexplained chest opacities while taking nilutamide were reviewed. In each patient a careful aetiological search was made for other environmental or endogenous causes. Six patients underwent bronchoalveolar lavage, and lavage fluid was cultured. Corticosteroids were not given, unless gas exchange was compromised (two patients). RESULTS: The eight patients (all male) had had carcinoma of the prostate diagnosed on average 10.2 months earlier. All had improved with nilutamide, with a dramatic decrease of prostate specific antigen levels. Seven had received nilutamide at the recommended dosage of 150 mg/day, and one had received twice that amount. Treatment had lasted on average 113 (range 10-225) days, and the mean cumulated exposure was 21.8 (3-38) grams. The chest radiographs showed bilateral infiltrates, with no consistent topographic predilection. A restrictive lung defect was present in six patients and hypoxia in all (mean arterial oxygen tension (PaO2) 6.6 kPa). Bronchoalveolar lavage showed lymphocytosis in four patients and neutrophilia in two. The outcome was favourable in all patients after they had stopped nilutamide only (five patients), with corticosteroids (two patients) or a simple reduction of nilutamide from 300 to 150 mg/day (one patient). Recovery was associated with improvement of pulmonary function and PaO2. CONCLUSION: Nilutamide is associated with interstitial pneumonitis in about 1% of patients and appears reversible.

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