Recommandations sur la prise en charge de l'arthrose de la hanche et du genou. Pour qui ? Pourquoi ? Pour quoi faire ?

in Presse Médicale (Paris, France : 1983) (2010)

This paper summarizes the guidelines published by the Osteoarthritis research society International(OARSI) and compares these guidelines with others. The OARSI guidelines are based on a systematic review ... [more ▼]

This paper summarizes the guidelines published by the Osteoarthritis research society International(OARSI) and compares these guidelines with others. The OARSI guidelines are based on a systematic review of the literature, a meta-analysis and an expert consensus. The OARSI has developed 25 guidelines including 8 for pharmacology modalities, 12 for non-pharmacology modalities and 5 for surgery modalities. The usefulness of the guidelines in the daily practice is very low. The barriers for the guidelines implementation are the lack of interest of the practitioners, the lack of scientific advances in the OA diagnosis and treatments and the low applicability of these guidelines in the daily practice. [less ▲]

Déficit en vitamine D chez l'homme âgé vivant à domicile ou en institution en milieu urbain

in Presse Médicale (Paris, France : 1983) (2008), 37(2, Pt 1), 191-200

OBJECTIVES: Many studies report severe vitamin D deficiency in the elderly and its involvement in various health problems (not limited to bone metabolism disorders). Most papers concern elderly women ... [more ▼]

OBJECTIVES: Many studies report severe vitamin D deficiency in the elderly and its involvement in various health problems (not limited to bone metabolism disorders). Most papers concern elderly women, however, and little is known about this problem among elderly men. This study focused on vitamin D deficiency in elderly men living in urban areas, whether at home or in an institution. METHODS: Between December 2005 and June 2006, we randomly recruited from general practices 336 men aged 65 years or more, living either at home or in institutions for the elderly. The variables studied were: age, residence (home or institution), fall and fracture history, independence (Katz), mobility (TUG), balance, outdoor walking, blood 25-OH-D level, glomerular filtration rate (MDRD) and PINI index. RESULTS: Of the 336 men, 45 (13%) were excluded because they were already receiving vitamin D treatment. The study thus included 291 patients, 174 community-dwelling and 117 institutionalized. The latter were significantly older and had less independence. Their 25-OH-D levels were also significantly lower than for community-dwelling subjects. The prevalence of severe vitamin D deficiency (25-OH-D < 12 ng/mL) was 79% among men in institutions and 57% among those living in the community (p<0.0001), and for mild and moderate vitamin D deficiency (12-32 ng/mL), 21% and 42%, respectively. Overall, only 2 men, both living at home, had normal vitamin D levels (25-OH-D > or = 32 ng/mL). In institutions, factors predictive of severe deficiency were TUG > or = 30s, walking distance < or = 100 m and lack of outdoor walking. Among the men living at home, none of the variables studied was associated with severe vitamin D deficiency. DISCUSSION: Potential biases of the study are discussed. Seasonal variations of vitamin D levels were small and comparable in both groups. The study confirms the high prevalence of vitamin D deficiency in elderly men. These results could probably be extended to other European cities with similar characteristics. The problem of interpreting 25-OH-D results with respect to current laboratory norms for defining severe or moderate vitamin D deficiency (12 and 32 ng/mL, respectively) is also discussed. CONCLUSION: Vitamin D deficiency is widespread and severe in elderly men, especially those living in institutions. Moderate to severe deficiency is also frequent among men living at home. Vitamin D supplementation should be routinely prescribed in institutions for the elderly and probably also to any individual over 65 years. Laboratory norms should be harmonized and consistent with recent medical evidence. [less ▲]

Quatre ans d'application de la loi de depenalisation de l'euthanasie en Belgique

in Presse Médicale (Paris, France : 1983) (2008), 37(9), 1281-8

Legislation decriminalizing euthanasia came into effect in Belgium in 2002. Its application is monitored by a federal Commission, which submitted 2 reports to the Parliament, one covering the first 15 ... [more ▼]

Legislation decriminalizing euthanasia came into effect in Belgium in 2002. Its application is monitored by a federal Commission, which submitted 2 reports to the Parliament, one covering the first 15 months of application and the other the years 2004 and 2005. This article analyzes and comments on the contents of these 2 documents, which provide interesting information on the medical practice of euthanasia in Belgium. [less ▲]

Orthophonie, le tremplin du passe, le dynamisme du present, l'essor du futur.

in Presse Médicale (Paris, France : 1983) (2004), 33 Spec No

Maladie de Kaposi chez une patiente souffrant d'une immunodéficience acquise VIH négative

in Presse Médicale (Paris, France : 1983) (1994), 23(38), 1760-1761

A 79-year-old woman of Mediterranean ascent suffered from corticosteroid-dependent chronic obstructive lung disease, hypogammaglobulinemia (IgG 1 and 2), decreased CD16 natural killer cell function and ... [more ▼]

A 79-year-old woman of Mediterranean ascent suffered from corticosteroid-dependent chronic obstructive lung disease, hypogammaglobulinemia (IgG 1 and 2), decreased CD16 natural killer cell function and non-HIV related CD4 and CD8 lymphopenia. Such immunodeficiency could be either a variant of common variable immunodeficiency or an early stage of the idiopathic CD4 + T lymphocytopenia syndrome. She developed bilateral lesions of Kaposi's sarcoma on the lower extremities resembling the classic European type of the disease. The tumors contained both CD34 + and Factor XIIIa + cells. The HLA-DR5 haplotype was not found. Weekly low intravenous dosages of vinblastine improved the lesions but the patient died from pontic infarction. [less ▲]