La Revue de médecine interne
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Delirium is the most common complication of hospitalization in frail elderly. The prognosis is poor with increased mortality and morbidity. Confusion results from one or several precipitating factors in patients at risk. In a randomized study, a preventive multicomponent intervention reduced the incidence of delirium by 40%. The aim of our study was to evaluate the efficacy of such a preventive strategy, in the setting of an acute geriatric care unit. ⋯ This study shows that it is possible to apply the results of clinical research in clinical practice to prevent delirium in frail elderly hospitalized in an acute geriatric care unit. Such an easy preventive strategy could be applied in medical units admitting old patients at risk, in the context of a quality procedure.
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Increased incidence of cancers and the development of totally implanted venous access devices that contain their own port to deliver chemotherapy will lead to a greater than before numbers of central venous catheter related thrombosis (CVCT). Medical consequences include catheter dysfunction and pulmonary embolism. Compared with lower extremity deep venous thrombosis (DVT) (3 d) and with non CVC associated thrombosis (5 d), CVCT is associated with an increased duration of hospitalisation (9 d). CVCT oftentimes leads to the need to replace such ports at an average cost of 4500 euros. ⋯ The efficacy and safety of pharmacologic prophylaxis for CVC related thrombosis is not established. Additional studies performed in high risk populations are needed to define if LMWH or oral anticoagulation is indicated in this clinical setting.
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The transfusion-related acute lung injury frequency was for a long time underestimated since it lacked both a widely accepted clinical definition and a comprehensive etiologic description. Recent clinical and biological data have underlined its frequency and have allowed a better understanding of its mechanisms. ⋯ A better knowledge of Trali offers the opportunity of improving the understanding of the role of blood transfusion in lung edema occurring in complex situations and open the way for a better definition of at risk patient and at risk blood components.
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Case Reports
[Hypercalcemia of double origin: association of multiple myeloma and ectopic parathyroidal adenoma].
Multiple myeloma and primary hyperparathyroidism are two causes of hypercalcemia. This association has already been described to be not casual, despite their link is still unknown. ⋯ Multiple myeloma and parathyroidal adenoma should be both explored in all hypercalcemia, because they can be associated.