Marcel Afschrift

Serum cystatin C concentration compared with other markers of glomerular filtration rate in the old old.

OBJECTIVES: To assess serum cystatin C, compared with other markers of renal function, as a marker of renal function in the old old (aged 85 and older).

IS THERE A RATIONALE FOR PRESCRIPTION OF BENZODIAZEPINES IN THE ELDERLY? REVIEW OF THE LITERATURE

Abstract Benzodiazepines (BZDs) constitute the most widely used symptomatic treatment of insomnia and anxiety. Many of these drugs are associated with adverse effects, such as daytime sedation and dependence with continued use. There is a concern about the rationale for and extent of benzodiazepine (BZD) use in the elderly. The sedation due to BZD use is a main risk factor for falls and other accidents. Impaired cognitive function with continuous use appears to be a major side effect. There is a general awareness that BZD use is inappropriate in many patients, and therefore discontinuation should be recommended whenever possible. Moreover, long-term use of these drugs should be actively discouraged. Although no unanimous recommendations concerning the optimal duration of the withdrawal process exist, BZDs may easily be withdrawn during a short period in most patients who are habituated to a low dose, if an initial phase with dose reduction and psychological support are provided. Alternative approaches involve sleep hygiene guidelines, behavioural treatment and psychotherapy tailored to the needs of the individual patient.

Pancreatic lipomatosis in the shwachman. Diamond syndrome. Identification by sonography and CT-scan

The typical pathological finding in the pancreas of patients with the Shwachman-Diamond syndrome is fatty infiltration. In this report it is emphasized that this lipomatosis can be demonstrated by non-invasive techniques, using abdominal ultrasound and CT-scan.

Gallstone recurrence after successful shock wave therapy: the magnitude of the problem and the predictive factors.

Gallstone recurrence after successful shock wave therapy: the magnitude of the problem and the predictive factors

Acquired haemophilia in the elderly.

The occurrence of an acquired inhibitor of F VIII coagulant activity is a rare cause of a sometimes important bleeding diathesis. Antibodies against F VIII:C can spontaneously occur, mostly in elderly patients. Four elderly patients with such a typical clinical and biological syndrome are reported. No identifiable underlying disease was found and they responded favourably to an immunosuppressive treatment. In one patient plasmapheresis was successful.

A programme for short-term withdrawal from benzodiazepines in geriatric hospital inpatients: success rate and effect on subjective sleep quality.

We tested the hypothesis that a short‐term programme for withdrawal of benzodiazepines (BZD) is feasible in hospitalized geriatric patients.

Ultrasound measurement of the subarachnoid space in infants

An original non-invasive method for easy and reproducible measurement of the subarachnoid space width in infants is described. Preliminary results of normal values during the neonatal period are presented as well as of the validity of the ultrasound method for abnormal values obtained by available computed tomography scanning.

Sonographic diagnosis of gas embolism in the portal vein

A case of gas embolism in the portal vein detected by ultrasound is presented. Gas bubbles were characterized by strong reflections in the lumen of the portal vein, moving into the liver. Because they were trapped in the liver parenchyma, the gas bubbles caused strongly echogenic areas, sometimes with acoustic shadows.

Renal function in the oldest-old on an acute geriatric ward.

Aim: Evaluation of renal function and relation to risk factors for renal failure in very old patients admitted to an acute geriatric ward. Methods: Retrospective chart review ofpatients aged 80 years and over, admitted to the acute geriatric ward from August 1998 till August 1999. Recorded data were: age,gender, previous medical history, primary diagnosis, medicationuse, weight, serum creatinine, BUN, sodium, potassium,cholesterol, urine and ultrasound of the kidney. The creatinine clearance was estimated by the Cockcroft-Gault formula, the glomerular filtration rate by the MDRD equation. Results: 220 (60males/160 females) patients were included. The mean serum creatinine on admisssion and discharge was 1.17 ± 0.45 mg/dL and1.11 ± 0.48 mg/dL respectively. The mean estimated creatinine clearance in the very old was 38.11 ± 12.04 mL/min on admissionand 39.00 ± 11.01 mL/min on discharge. Renal failure arbitrarily defined as an estimated creatinine clearance on admission of less than 30 mL/min was found in 26.4% of the patients. Only a significant correlation between failure to thrive and renal failure was found (p < 0.0001). The correlation coefficient between the Cockcroft-Gault and the MDRD formula was r = 0.66 (p < 0.0001);between the Cockcroft-Gault and the reciprocal serum creatinine wasr = 0.60 (p < 0.0001) and between the MDRD and the reciprocal serum creatinine was r = 0.87 (p < 0.0001). Conclusion: The weak correlation between the Cockcroft-Gault and other estimations ofGFR in the acutely ill elderly, confirms the need to have areliable estimation of glomerular filtration rate in the elderly.Renal failure defined as a Cockgroft-Gault <30 mL/min is foundin 26.4% of the oldest-old admitted to an acute geriatric department. The elderly with renal failure is more often admitted for failure to thrive. No great differences were observed between renal function on admission and discharge.

Results of extracorporeal shock wave lithotripsy of gall bladder stones in 693 patients: a plea for restriction to solitary radiolucent stones.

During a period of 24 months 693 consecutive patients with symptomatic gall bladder stones (526 males, 167 females; mean age 51 years, range 18-89) were treated by extracorporeal shock wave lithotripsy with a Piezolith 2300. The procedure was carried out on an out-patient basis without analgesics or sedatives. Concomitant chemolitholytic treatment (ursodeoxycholic and chenodeoxycholic acid 7.5 mg/kg/day each) was administered until three months after total fragment clearance for a maximum therapy period of 1.5 years. In 601 patients with radiolucent stones complete clearance of all fragments was obtained after three, six, 12, and 18 months in respectively 20, 41, 64, and 78%. Actuarial analysis of the subgroups according to the stone mass (size and number) selected an ideal patient population with solitary stones less than 20 mm diameter (84% stone free after one year). The results are significantly less good when the greater the number of stones or their maximal diameter increases. Treatment was interrupted in 3.6% of the patients. In 90 sludge or fragments remain present. Twenty five patients were lost to follow up for non-biliary reasons. Stone recurrence was 5.7% at one year and was observed both in patients with solitary and multiple stones. A cost effectiveness analysis suggests that laparoscopic cholecystectomy is the most effective and economic solution, although extracorporeal shock wave lithotripsy for solitary radiolucent stones less than 2 cm is cheaper than conventional cholecystectomy. Extracorporeal shock wave lithotripsy for multiple stones is the most expensive and least effective option.