Background. Many investigators have identified distinct medical, demographic and psychosocial prefracture conditions that influence the functional outcome of patients surgically treated for a fracture of the hip. However, to design efficient intervention care programs addressing the needs of these patients, at optimal economic and social costs, more information is required on the typical combinations of prognostic determinants actually encountered. Methods. Data on specific descriptors of the prefracture status and on mobility and functioning 1 year after surgical intervention were collected by interview from 253 consecutive patients hospitalized for a fracture of the proximal femur. Cluster analysis was used to form homogeneous groups of patients with similar profiles in terms of the 13 predictive variables and the 7 outcome variables significantly interrelated. The modeling procedure generated four clusters of patients with a typical profile sharply contrasted by their structure. Results. Subjects of two clusters could walk without difficulty and were functionally independent prior to their hip fracture. One year later, however, mobility and functioning were only fully recovered by the members of one cluster. The majority of predictors were of less favorable prognostic value for the members of the second cluster. The other two clusters regrouped patients with impaired prefracture mobility that were either unaltered or even aggravated 1 year later. Conclusions. Cluster analysis identified typical profiles of elderly hip fracture patients. Close scrutiny of their respective global structure, in terms of combined prognostic determinants and outcomes, may help to develop specific management strategies that are more efficiently adapted to these different groups of patients.

Chez les personnes âgees, la fracture du col du femur est une pathologie traumatique frequente et souvent a l'origine d'une remise en cause sur le plan medical, social et economique. Le suivi pendant un an d'une serie de patients hospitalises a Geneve et en Valais, suite a un tel accident, montrent que les determinants socio-economiques et culturels du retablissement de l'independance fonctionnelle et de la mobilite sont fortement associes a leur etat de sante aussi bien psychique que physique. La manifestation de troubles depressifs, souvent consecutive a la fracture femorale, peut affecter defavorablement l'impact des facteurs predictifs d'un bon pronostic. Ce qui justifie la prise en charge des patients âges, victimes d'un accident majeur, dans le cadre d'une geriatrie multidimensionnelle et pluridisciplinaire.

Background: Abnormal QS complexes in the right precordial leads are one of the most useful electrocardiographic signals in the diagnosis of anteroseptal myocardial infarction. Their presence is also attributable to other causes, however. Our aim was to assess the relative prevalence of different causes of abnormal QS complexes in elderly patients. Methods: Clinical, electrocardiographic and anatomopathological data were collected from 36 autopsied in-patients who had presented with a QS complex in leads V1-V3 on admission to hospital. Results: Twenty-one patients (58%) had no evidence of old myocardial infarcts on postmortem histological examination. In eight of these patients, the abnormal QS complex could be attributed to infiltrative or congestive cardiomyopathies, and in eight others to hypertrophic cardiomyopathy associated with aortic valve stenosis or hypertension. Three individuals had only altered ventricular activation; in two of these patients, the abnormal QS complexes were positional in origin. Conclusion: The presence of a QS complex in the right precordial leads of the electrocardiogram is important in the diagnosis of anteroseptal infarction. However, abnormal QS complexes may also result from a wide spectrum of other disease states. Faced with abnormal QS complexes on the electrocardiogram, the clinician should make sure that echocardiographic features of left ventricular function are outside normal limits before suspecting anteroseptal necrosis.

Au cours d'une étude prospective menée sur une période de 4 mois, nous avons évalué sur échelle analogique l'opinion de consultants et médecins en formation (internes des hôpitaux validant un stage de médecine interne) ayant pris part à 771 consultations dispensées à des patients admis à l'Hôpital Universitaire de Gériatrie de Genève. Tant les consultants que les internes ont reconnu que la plupart des consultations étaient utiles pour les patients et pour l'apprentissage professionnel en gériatrie. Mais les médecins en formation pensaient que les consultations étaient plus utiles pour le bien-être des patients que pour l'éducation des médecins. Le médecin en formation a montré une tendance à sous-estimer les aspects fondamentaux de médecine gériatrique (en particulier l'autonomie des sujets les plus âgés), au profit de préoccupations médicales plus classiques (diagnostic et traitement). Les consultants connaissaient la spécificité de la pathologie gériatrique, mais limitaient leur enseignement, au cours des interventions, aux problèmes soulevés par le médecin en formation.

The absence of specific clinical signs makes the diagnosis of cardiac amyloidosis difficult. Moreover, it is established that this condition, the prevalence of which increases with age, aggravates the prognosis of cardiac failure. Tne present study was undertaken to identify the clinical or paraclinical signs enabling more accurate diagnosis of this disease.Analysis of 2589 autopsy reports from the University Institutes of Geriatrics of Geneva between January 1972 and January 1990 recensed 58 cases of microscopic cardiac amyloidosis, but this diagnosis was not made in any of these patients before death. Of the potential indicators, the good specificty but poor sensitivity of atrial fibrillation and low voltage electrocardiogramme was confirmed.On the other hand, the author's research found the association of radiological cardiomegaly and a raised erythrocyte sedimentation rate in nearly 70 % of cases of cardiac amyloidosis with a false positive rate of only 10 % in a control group.

The absence of specific clinical signs makes the diagnosis of cardiac amyloidosis difficult. Moreover, it is established that this condition, the prevalence of which increases with age, aggravates the prognosis of cardiac failure. The present study was undertaken to identify the clinical or paraclinical signs enabling more accurate diagnosis of this disease. Analysis of 2589 autopsy reports from the University Institutes of Geriatrics of Geneva between January 1972 and January 1990 recensed 58 cases of microscopic cardiac amyloidosis, but this diagnosis was not made in any of these patients before death. Of the potential indicators, the good specificity but poor sensitivity of atrial fibrillation and low voltage electrocardiogram was confirmed. On the other hand, the author's research found the association of radiological cardiomegaly and a raised erythrocyte sedimentation rate in nearly 70% of cases of cardiac amyloidosis with a false positive rate of only 10% in a control group.

In a prospective study carried out over a 3 month period we analysed the views of consultants and residents taking part in 771 consultations to patients admitted to the Geriatric University Hospital of Geneva with the help of visual analogue scales. 27 medical subspecialities were involved. Both consultants and residents agreed that most of the consultations were useful for the elderly patient and for postgraduate teaching and learning. But the residents thought that consultations were more important for the patients' welfare than for the residents' education. Residents showed a tendency to underestimate crucial aspects of geriatric medicine (in particular the autonomy of the elderly patient) in preference to more << classical >> medical preoccupations (diagnosis and treatment). Consultants were aware of the specificity of geriatric pathology but restricted their teaching during the intervention to what was requested by the resident.

In a prospective study carried out over a 3 month period we analysed the views of consultants and residents taking part in 771 consultations to patients admitted to the Geriatric University Hospital of Geneva with the help of visual analogue scales. 27 medical subspecialties were involved. Both consultants and residents agreed that most of the consultations were useful for the elderly patient and for postgraduate teaching and learning. But the residents thought that consultations were more important for the patients' welfare than for the residents' education. Residents showed a tendency to underestimate crucial aspects of geriatric medicine (in particular the autonomy of the elderly patient) in preference to more "classical" medical preoccupations (diagnosis and treatment). Consultants were aware of the specificity of geriatric pathology but restricted their teaching during the intervention to what was requested by the resident.

In the past decades, the recognition of polymorbidity as an important characteristic of geriatric medicine lead to important improvements in the multidisciplinary approach of the elderly. Coexistence of somatic and psychiatric diseases with various forms of etiopathogenic relations has been described early in this century. Dementia may be caused, aggravated, revealed or randomly accompanied by somatic diseases and inversely. However, very few attempts have been made in order to analyze the significance of these associations. This study is meant to give a better epidemiological knowledge of the relation between cardiovascular diseases and cerebral aging. This could lead to a better diagnostic approach and to a more complete physiopathological conception of dementia. 904 autopsy reports (patients who died between 1972 and 1986 in the Hôpital de Gériatrie of Genova) have been reviewed and classified in three groups according to neuropathological findings: 335 subjects with vascular encephalopathy of various types, 382 patients with degenerative diseases of Alzheimer type and 187 patients with normal brain. The subjects of these three groups had not all been considered demented. For each patient, age, sex, cause of death and 14 cardiovascular items have been appointed. The patients of the Alzheimer group died older and were more often women than those of the two other groups. The subjects of the vascular group died older than those of the normal group and were more often men than those of the two other groups. Stoke was considered to be the cause of death in 3% of the vascular patients whereas, by definition, it was absent from the two other groups.(ABSTRACT TRUNCATED AT 250 WORDS)

In 9 of the 14 national samples of diabetic patients assembled for the WHO Multinational Study of Vascular Disease in Diabetes additional laboratory data made it possible to relate manifestations of macrovascular disease to blood glucose concentrations as well as to diabetes duration and to other potential determinants. In five of the samples, serum triglyceride concentrations were also measured and were included in simple and multivariate analyses. Ischemic heart disease defined from Minnesota-coded EKGs and standardized WHO questionnaires was more strongly associated with serum triglyceride concentrations than with serum cholesterol concentrations, an association less notable in non-insulin-dependent diabetic patients. Ischemic heart disease was not related to the single fasting plasma glucose estimated for this study. Stroke and amputation were much more strongly related to the known duration of diabetes than was ischemic heart disease, and they were both related to blood glucose concentration measured at the time of study. Despite major variation in arterial disease prevalence rates between collaborating centers, risk for diabetic women appeared to equal that for diabetic men. The major variation in arterial disease prevalence between national groups could be accounted for only in part by the risk factors studied. Other factors, genetic or more likely environmental, are likely to contribute to the variation in arterial disease susceptibility and, if definable, may be potentially preventable.

In a multinational study, fasting plasma glucose values in 3583 diabetic patients, aged 34-56 years, were related to the characteristics of these subjects and to the presence and severity of microangiopathy as ascertained by standardised methods. The patients were from nine different populations and ranged in number from 193 to 686 per population (London, Warsaw, Berlin (FRG), New Delhi, Tokyo, Havana, Oklahoma Indians, Arizona Pima Indians, and a national sample in Switzerland). In the total group, mean fasting plasma glucose was 8.1 mmol/l for those on diet alone, 9.7 mmol/l for those on oral agents, and 12.7 mmol/l for insulin-treated patients, of whom 25% had values exceeding 16.5 mmol/l. Since many variables were measured in each patient, it was possible to take into account many confounding factors in evaluating the relationship of plasma glucose levels to retinopathy and nephropathy.