Search PubMed⌕ Search

Biomedical subjects

R Gonthier

Publications and source records attributed to R Gonthier.

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

Factor analysis supports the evidence of existing hyperactive and hypoactive subtypes of delirium.

OBJECTIVE: The aim of this study was to examine whether delirium has specific clinical subtypes. METHOD: One hundred and eighty-three elderly subjects meeting DSM-IIIR criteria for delirium were evaluated using a 19-item symptom check-list assessing different dimensions of delirium symptomatology. Exploratory factor analysis was conducted in order to examine which symptoms clustered. RESULTS: Factor analysis confirmed the existence of two different clusters of symptoms: first, symptoms of hyperalert/hyperactive features (agitation, hyper-reactivity, aggressiveness, hallucinations, delusions); and second, symptoms of hypoalert/hypoactive features (decreased reactivity, motor and speech retardation, facial inexpressiveness). CONCLUSION: This preliminary study seems to support the evidence of hypoactive and hyperactive subtypes of delirium, even though their aetiology and prognostic values need to be further examined.

Aged↗
PubMed2000

[Self health evaluation using a visual analog scale for elderly patients presenting with pain or early dementia].

PURPOSE AND METHODS: Sixteen elderly patients with early dementia and 20 elderly patients with pain, all hospitalized in a geriatric hospital, evaluated their memory, health and mood, using a visual analog scale. Observations of their families and of the medical staff were also recorded for subsequent comparison. The patients' complaints were also compared to those of a control group including 16 healthy elderly subjects. RESULTS: Patients with early dementia complained more often than control subjects of memory loss and health and mood disorders, while patients with pain complained more often of only health and mood disorders. However, only patients with dementia complained of memory loss. Complaints noticed by their families and medical staff were in good agreement with theirs. Regarding patients with early dementia, the medical staff underestimated their complaint of memory loss. CONCLUSION: Visual analog scales appear to be valuable tools regarding not only evaluation of pain but also the patients' general condition. Complaints of memory loss could be of value as they would suggest the existence of early dementia in elderly patients. However, our study emphasizes the need for training medical staff to listen to such a complaint.

Aged↗
PubMed2000

Etiologic and outcome profiles in hypoactive and hyperactive subtypes of delirium.

The existence of hyperactive, hypoactive, or mixed clinical subtypes of delirium is widely accepted. But relationships between these motor profiles and etiology or outcome remain unclear. The aim of this study was to compare etiologic and outcome profiles in a case series of 183 elderly patients (mean age = 84.1 years, SD = 5.9) consecutively admitted into the geriatric wards of two French university hospitals or referred to a geriatric psychiatry consultation-liaison unit within a Swiss university hospital. All patients met DSM-III-R criteria for delirium and were classified into clinical subtypes according to the results of a previous factor analysis of scores on a 19-item checklist rating a wide range of delirium symptoms. The hyperactive subtype was more frequent (n = 85, 46.5%) than the unspecified (n = 50, 27.3%) and hypoactive subtypes (n = 48, 26.2%). There was no significant difference in terms of etiologic or outcome profile between clinical subtype groups. The presence of acute metabolic disorders, cardiovascular disease, and hyperthermia as etiologic factors was significantly associated with full recovery of the episode at 3 weeks follow-up, whereas probable preexisting dementia was significantly associated with partial recovery or failure to recover.

Aged↗
PubMed1999

[Drug use in the elderly. Multiple diseases in the aged and therapeutic management: avoidable pitfalls].

CAUSE OF UNDESIRABLE EFFECTS: The normal aging process leads to homeostatic changes and modified absorption, distribution and elimination of drugs. Elderly subjects are thus more exposed to undesirable drug effects. In addition, the presence of multiple diseases, multiple drugs, dependency, and certain social and behavioral factors act together to potentialize the generation of side effects. PREDICTABLE RISKS: Accidents can result from drug-drug or drug-disease interactions. Subjects at risk can be identified using the concept of fragility. POSSIBLE PREVENTION: Practical guide-lines have been established by expert groups and should be used to avoid inadequate use of drug therapies.

Aged↗
PubMed1999

Urine glycyl-L-proline increase and skin trophicity.

Glycyl-L-proline (gly-pro) is an end product of collagen metabolism that is further cleaved by prolidase (EC 3.4.13.9); the resulting proline molecules are recycled into collagen or other proteins. We postulated a relationship between defective gly-pro hydrolysis, increased collagen degradation and skin destruction. This relationship was tested using HPLC to measure the gly-pro in urine. 24 hour urine samples were collected from 27 old people (86 +/- 6 years old), of whom 15 were suffering from skin pressure sores of the sacrum or calcaneus. The urine from patients with pressure sores contained significantly more gly-pro than the urine from the control. A cut-off at 7 mumol/mmol creatinine gave the test a positive predictive value of 70%. Collagen breakdown was also increased as indicated by the increase of hydroxyproline (hyp) in the urine. But this breakdown seemed to stop at the gly-pro step.

Aged↗
PubMed1998

Relation between locomotion impairment, functional independence in retirement, and occupational strain resulting from work carried out during working life. Study of a sample population of 350 miners in the Loire valley in France.

STUDY OBJECTIVES: To analyse long term effects of working conditions experienced at an advanced age, and after retirement by quantifying occupational strain, impairment, and disability to establish their interrelation. DESIGN: Retrospective study. PARTICIPANTS: Retired miners from The French Coal Board who had worked in the coal fields of the Loire valley. From a potential population of 507 retired miners, 350 were completely evaluated. MEASUREMENT: The study examines the occupational strain experienced by each subject, measured using both auto-evaluation and evaluation by experts and the locomotion impairment and the functional independence. MAIN RESULTS: A significant relation between the evaluation of occupational strain and functional independence and locomotion impairment of the low back was found and also a significant relation between locomotion impairment of the low back and the length of time spent working at the coal face. CONCLUSIONS: This study confirms other studies as regards the effects of occupation on health status and on the aging process, but it goes further to show the consequences of this relation on functional independence.

Activities of Daily Living↗
PubMed1997

[Survival after 60 years of age among elderly retired miners].

This study analyses long term effects of working conditions at an advanced age and post retirement. A longitudinal study was done among 63,000 retired miners between 60 to 65 years old. The standardised mortality ratio (SMR) in the cohort was above that expected on the basis of concurrent mortality in the reference population (SMR = 111; 95% confidence interval (CI): 108-114). The excess mortality was observed in occupational groups with exposure to underground tasks (10 years of underground tasks: RR = 2; 95% CI: .1.7-2.5), but there was sign of a healthy worker effect after 25 underground years. The effects of modern technologies and of medical progress have changed working conditions and care has reduced mortality for retired manual workers: exposure to underground tasks before 1950: RR = 1.7; CI 95%: 1.4-2.0; after 1950: RR = 1.2; CI 95%: 1.1-1.2.

Aged↗
PubMed1996

[Confusion syndromes in hospitalized aged patients: polymorphism of symptoms and course. Prospective study of 183 patients].

Using explicit criteria contained in the DSM III R, we collected in a prospective cohort study clinical features, outcome and risk factors from two cohorts of delirium in hospitalized elderly patients: 138 hospitalized in geriatric department and 45 patients admitted to an acute and comprehensive care hospital. The clinical features were assessed using a quantitative scale (developed by Derouesné). Delirium was unrecognized or misdiagnosed by physicians in 34% of the cases. The onset was known only two thirds of cases. The incidence of hyperactive type, prolonged hospital stay, poor outcomes (persistent delirium leading up to dementia) were highest in subjects admitted in comprehensive hospital. The etiology of delirium is complex and multifactorial. An underlying cause was identified in 80% of patients. The length or the worsening of delirium was significantly higher in patients with psychiatric or dementia comorbidity (OR: 0.2; IC 95%: 0.1-0.5). The prognosis was better in patients without psychoactive medications (OR: 0.2; IC 95%: 0.1-0.4) or with metabolic abnormalities or acute diseases and disorders (OR: 3.3; IC 95%: 1.5-7.6). The predisposing factors to the development of dementia were prior use of psychoactive medications and signs of prior cognitive impairment. This article suggests delirium in elderly patients is associated with several outcomes. The prognosis should be improved at admission by specific scale and an evaluation of predisposing and precipitating factors.

Aged↗
PubMed1993

Myocardial infarction and nicotine patch: a contributing or causative factor?

A case of angina pectoris revealed by nicotine patch treatment is described in a patient who continued to smoke and subsequently suffered a myocardial infarction. The various side effects of nicotine and its derivatives are recalled. The action of nicotine on coronary vasomotricity and its mediators is discussed.

Administration, Cutaneous↗
PubMed1993

[A rare cause of loss of consciousness: mastocytosis. Apropos of 3 cases].

The authors report three cases of syncope due to systemic mastocytosis. This is a rare cause of syncope but should be recalled in certain circumstances. In the light of these cases, the authors review the literature with respect to this unusual presentation. Syncope may occur at any age. Loss of consciousness may be more or less complete, brief or prolonged, isolated or recurrent and usually accompanied by prodromal symptoms. The least controversial physiopathogenic mechanism of these syncopes is intense vasoplegia induced by the release of vasoactive mediators, especially histamine. When there is a clinical suspicion of mastocytosis, even in the absence of skin changes, the diagnosis is confirmed by biopsy which shows abnormally high numbers of mastocytes irrespective of the organ biopsied. The treatment of acute forms with collapse is based on intravenous infusion of macromolecular fluids and injections of epinephrine. Prevention is by drugs which inhibit the synthesis of histamine, the degranulation of mastocytes and the production of prostaglandin D2.

Aged↗
PubMed1993

[Painless infarction in antiphospholipid syndrome].

The authors report a rare case of myocardial infarction secondary to coronary thromboses caused by the antiphospholipid syndrome. The relations between the cardiac pathology, especially the coronary disease, and antiphospholipid antibodies are recalled. The importance and methods of monitoring the anticoagulant therapy are emphasised.

Anticoagulants↗