Sarcoidosis of the spinal cord is a rare disease. The aims of this study are to describe the features of spinal cord sarcoidosis (SCS) and identify prognostic markers. We analyzed 20 patients over a ...20-year period in 8 French hospitals. There were 12 men (60 %), mostly Caucasian (75 %). The median ages at diagnosis of sarcoidosis and myelitis were 34.5 and 37 years, respectively. SCS revealed sarcoidosis in 12 patients (60 %). Eleven patients presented with motor deficit (55 %) and 9 had sphincter dysfunction (45 %). The median initial Edmus Grading Scale (EGS) score was 2.5. The cerebrospinal fluid (CSF) showed elevated protein level (median: 1.00 g/L, interquartile range (IQR) 0.72–1.97), low glucose level (median 2.84 mmol/L, IQR 1.42–3.45), and elevated white cell count (median 22/mm
3
, IQR 6–45). The cervical and thoracic cords were most often affected (90 %). All patients received steroids and an immunosuppressive drug was added in 10 cases (50 %). After a mean follow-up of 52.1 months (range 8–43), 18 patients had partial response (90 %), 7 displayed functional impairment (35 %), and the median final EGS score was 1. Six patients experienced relapse (30 %). There was an association between the initial and the final EGS scores (
p
= 0.006). High CSF protein level showed a trend toward an association with relapse (
p
= 0.076). The spinal cord lesion was often the presenting feature of sarcoidosis. Most patients experienced clinical improvement with corticosteroids and/or immunosuppressive treatment. The long-term functional prognosis was correlated with the initial severity.
To determine the rate of inappropriate admissions to emergency departments (EDs) and to identify determinants of these admissions.
Prospective multicenter study.
Burgundy (France), EDs and medical ...nursing homes (MNHs).
1000 Burgundy MNH residents admitted to EDs, from April 17 to June 20, 2013.
For each subject, a questionnaire was completed. Data included age, gender, type of health professional who referred the resident to the ED (THP), whether or not a medical dispatcher organized the transfer to the ED, transport mode, reason for admission to the ED, level of independence according to the Groupes Iso-Ressource score (GIRS), and diagnosis made in the ED. The French version of the Appropriateness Evaluation Protocol grid was applied to each admission to the ED, and in some situations, the expert committee ruled on the appropriateness of the admission to the ED. MNH characteristics were also recorded. Two groups were constituted according to the appropriateness or not of admission to the ED.
Mean age of the 1000 residents was 87. There were 706 women. Two-thirds were referred to the EDs by a physician, mainly a general practitioner. In 91.7%, the transfer to the ED was organized by a medical dispatcher, and 8.8% were transported by medicalized transport. More than 95% had a GIRS ≤4. Among the admissions to EDs, 18.1% were inappropriate. Female gender (P = .017), nonmedicalized transport (P = .002), public MNH (P = .044), and nonaccess to a geriatric opinion in an emergency (P = .043) were determinants of inappropriate admission to EDs.
In this first study on admissions to EDs of MNH residents using French data, we found a lower rate of admissions to the ED than that reported in the literature. Female gender, nonmedicalized transport, public MNH, and nonaccess to a geriatric opinion in an emergency were associated with inappropriate admission to EDs.
Falls and depression in older people Turcu, Alin; Toubin, Sandrine; Mourey, France ...
Gerontology (Basel),
01/2004, Volume:
50, Issue:
5
Journal Article
Peer reviewed
Depression is one of the most common risk factors for falls, but links between falls and depression are still unclear. Few studies have examined the relationship between depression and gait ...alteration, which may increase the risk of fall.
This study aims to assess a possible relationship between depression, postural and gait abnormalities, and falls.
We conducted a 1-year prospective study on patients >/=70 years who were admitted to a geriatric unit for 'spontaneous' unexplained falls. Patients were tested for depression using the 30-item Geriatric Depression Scale (GDS). Their motor performances were assessed using the Mini Motor Test (MMT), which is an easy direct-observation test, validated in France, for assessment of frail old people who present with severe postural and gait impairment. This scale is composed of 4 categories of items: (1) abilities in bed; (2) quality of the sitting position; (3) abilities in the standing position, and (4) quality of gait.
Sixty-nine patients were included. Depression was found in 46 patients (66.7%). The MMT score was higher in the non-depressed fallers (NDF) group (GDS </=10) compared to the depressed fallers (DF) group (GDS>10; p < 0.05). The 2 groups were compared for each of the 4 items of the MMT: the difference between the DF and NDF groups was mainly explained by the impairment of postural abilities in the standing position.
Our results support the idea that depression is associated with postural abnormalities in the standing position, which may predispose to falls. In clinical practice, more attention should be given to old fallers concerning diagnosis and treatment of associated depression.
Vasculitis in the very elderly Turcu, Alin; Bielefeld, Philip; Besancenot, Jean-François ...
Gerontology (Basel),
05/2002, Volume:
48, Issue:
3
Journal Article
Peer reviewed
Whatever may be their clinical presentation, vasculitis syndromes (VS) have a bad prognosis in the very elderly.
The aim of this work was to study VS particularities in very old people. Most ...published studies on VS in elderly people concern patients older than 60 years; studies concerning very old patients are unusual.
We studied retrospectively subjects older than 75 years with a diagnosis of VS from the Departments of Geriatrics and Internal Medicine at Dijon University Hospital. These subjects were hospitalized between January 1995 and December 1999. Data were obtained from the medical files of these patients. Several aspects were considered: type of VS, associated diseases, treatment, complications, and outcome.
Twelve patients, 5 men and 7 women aged 79-91 (mean age 82.3) years, were included. Primary VS was observed in half of the patients and secondary VS in the others. The initial clinical presentation was often polymorphous and unspecific; 8 of the patients died, 2 developed progressive severe functional impairment, 1 was stabilized under therapy, and 1 patient with VS secondary to infection recovered. Most patients either died quickly or progressively deteriorated from infections, malnutrition, or functional impairment.
The health of the majority of patients (83%) deteriorated dramatically, leading to death or severe functional impairment.
Shape memory alloys, especially ferromagnetic shape memory alloys, are interesting new materials for the manufacturing of stents. Iron-palladium alloys in particular can be used to manufacture ...self-expanding temporary stents due to their optimum rate of degradation, which is between that of magnesium and pure iron, two metals commonly used in temporary stent research. In order to avoid blood clotting upon the introduction of the stent, they are often coated with anticoagulants. In this study, sulfated pectin, a heparin mimetic, was synthesized in different ways and used as coating on multiple iron-palladium alloys. The static and dynamic prothrombin time (PT) and activated partial thromboplastin time (APTT) of the prepared materials were compared to samples uncoated or coated with polyethylene glycol. While no large differences were observed in the prothrombin time measurements, the activated partial thromboplastin time increased significantly with all alloys coated with sulfated pectin. Aside from that, sulfated pectin synthesized by different methods also caused slight changes in the activated partial thromboplastin time. These findings show that iron-palladium alloys can be coated with anticoagulants to improve their utility as material for temporary stents. Sulfated pectin was characterized by nuclear magnetic resonance (NMR) and Fourier-transform infrared (FTIR) spectroscopy, and the coated alloys by scanning electron microscopy (SEM) and energy dispersive X-ray analysis (EDX).
The solvothermal polyol reaction is one of the most common methods known in the literature to synthesize magnetite nanoparticles and especially clusters. Despite this, its reaction mechanism is still ...not definitely determined. In the course of this work, a polyol reaction with sodium acrylate as stabilizer was used as a representative example. By using analytic tools such as TEM/SEM, XRPD, FTIR and Raman spectroscopy, XPS and magnetization measurements, the influence of several reaction parameters was examined, some of them for the first time for this type of reaction. The results detailed here have consequences for reproducibility as well as scale-up for this reaction. Using NMR techniques, the surface coating of the clusters was also analyzed. It was found that the coating consists of a variety of molecules, not just the stabilizer added in the reaction. By varying the temperature, it was possible to produce maghemite clusters instead of magnetite ones. Finally, on the basis of detailed analysis of intermediates, a possible reaction mechanism was formulated and used to explain several of the earlier findings.
