Postural insufficiency, gait disorders and fear of falling have been observed after falling in frail older patients. The aim of this study was to assess the benefit of a specific rehabilitation program in patients demonstrating 'post fall syndrome'. The studied population consisted in 13 females aged 70 years and over who were admitted to hospital after falling. They suffered from post-fall syndrome. 'Get-Up and Go' and 'Timed Get-Up and Go' tests, and assessment of functional activities and postural abilities (AFAPA) were performed at hospital admission (T1), then at hospital discharge (T2) again. A specific rehabilitation program was performed during the hospital stay. The main goal of this rehabilitation program was to correct postural insufficiency and to improve motor patterns, which underlie independence in ADL. The results showed a significant improvement in score and time of 'Get up and Go' test between T1 and T2. In the same way, a great number of subjects showed better performances in several items of AFAPA between T1 and T2, and rising from the floor with support was performed by 6 out of the 13 subjects at T2 compared to 0 subject at T1. This study highlights the efficiency of specific rehabilitation programs in frail elderly people demonstrating 'post fall syndrome'.

Journal Article↗

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Psychomotor desadaptation syndrome.

This article constitutes a description of a clinical entity that has been observed and that we have described in French literature for over 10 years. This syndrome has been named 'la Régression Psychomotrice' in the french language and is termed here 'psychomotor desadaptation syndrome' (PDS). Postural impairments, neurological signs and psychological features have been found to be associated with PDS. Postural and neurological disorders were characterized by retropulsion, muscle tone modification, and the loss of reactive and protective postural reactions. Psychological features consisted of slowness of cognitive processing, often associated with anxiety and a fear of falling. PDS may be considered as a functional disorder, and clinicians must identify not only predisposing factors, but also etiological ones. The medical treatment of these factors and specific readaptation approaches must be associated with the management of PDS. PDS appears to be a reversible syndrome if a multidisciplinary approach and early management are undertaken.

Journal Article↗

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[Current aspects of paraneoplastic acute polyarthritis].

Paraneoplastic acute polyarthritis (PAP) is a recognized rheumatological entity with semeiological features that are based only on a few published cases. We thought that it would be of interest to review the literature and present the current characteristics of PAP, taking into account only those cases where the acute polyarthritis and a neoplastic disease followed parallel courses. The clinical manifestations of PAP are extremely varied, making it difficult to distinguish this disease from some forms of rheumatoid arthritis, the RS3 PE syndrome or polymyalgia rheumatica. Clinicians must be vigilant when they are faced with a particularly progressive acute polyarthritis in a patient aged over 60, and particularly when this patient's general condition is altered and when fever and a clear-cut inflammatory syndrome are present. In such circumstances, it is mandatory to investigate for an underlying neoplasia.

Acute Disease↗

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[Pulmonary amyloidosis of the AA type associated with Hodgkin's disease].

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Amyloidosis↗

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[The nightly cramps of the elderly].

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Aged↗

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Primary hyperparathyroidism in very old patients.

OBJECTIVES: To evaluate the clinical presentation and biological features of primary hyperparathyroidism (pHPT) in very old subjects. METHODS: Thirty patients aged 75 years or more, with pHPT were analyzed retrospectively. The diagnosis of pHPT was based on usual biological signs and was always confirmed by the finding of morphological abnormalities with parathyroid imaging or neck surgical exploration. RESULTS: At initial examination, recent general symptoms and neuromuscular symptoms were observed in 87% and 83% of the cases, respectively. Neuropsychiatric manifestations were noted in 73% of the cases. Confusion and depression were the most frequent findings, observed in 30% and 27% of the cases, respectively. In one of two patients with dementia like state, the mental status improved dramatically after surgery of the parathyroid adenoma. Serum calcium levels were in the normal range in 13% of the cases and equal or below 110 mg/L in 47% of the cases. There was no correlation between serum calcium level and the severity of mental changes. Serum parathyroid hormone determinations were abnormal in 93% of the patients. Thirteen patients underwent surgery with biological improvement in all cases. An ultrasonically guided percutaneous ethanol injection of parathyroid adenoma was performed in 10 patients with a biological cure rate of 50%. CONCLUSION: This study shows the major prevalence and potential severity of neuropsychiatric disorders in pHPT in very old patients. Because neuropsychiatric disturbances can respond favourably to surgical treatment, the clinician must systematically look for pHPT in elderly patients with cognitive impairment.

Acute Disease↗

PubMedDate not supplied

Prevalence of ANCA in a hospitalized elderly French population.

OBJECTIVE: The prevalence of some autoantibodies in the elderly population has been reported to be greater than in younger controls. The prevalence of ANCA has been shown to be low in a generally healthy population, but has not been established in the elderly. Thus, the presence of ANCA in elderly patients might not have the same clinical significance as in younger people. The aim of this study was to evaluate the prevalence of ANCA in elderly subjects. PATIENTS AND METHODS: Serum samples from 137 subjects (96 females, 41 males; mean age = 82.2 years +/- 6.97 SD) were evaluated. Criteria for exclusion included suspected or established systemic vasculitis, connective tissue or neoplastic diseases, acute infection, HIV infection, current therapy with corticosteroids or cytotoxic drugs, and recent blood transfusion. ANCA were detected by indirect immunofluorescence on ethanol-fixed normal human neutrophils. Fluorescence patterns were classified as c-ANCA, p-ANCA or nuclear. Sera exhibiting p-ANCA or nuclear fluorescence were further tested by IIF on formalin-acetone fixed normal human neutrophils. Sera whose reaction pattern was cytoplasmic were considered as positive for "true" pANCA. Additionally, sera were tested for the presence of antinuclear antibodies (IIF), anti-double-stranded DNA (enzyme immunoassay) and IgM rheumatoid factors (enzyme immunoassay). RESULTS: The prevalence of c-ANCA was 0% (95% CI = 0-2.66), the prevalence of p-ANCA was 2.2% (95% CI = 0.45-6.3), and the prevalence of "true" p-ANCA was 0.73% (95% CI = 0.02-4). The prevalence of ANA, anti ds-DNA and RF were respectively 38%, 3.6%, and 11.7%. CONCLUSION: The prevalence of ANCA is not increased in elderly people. Thus, the presence of ANCA in elderly subjects may have the same clinical significance as in younger people.

Aged↗