Presse Med
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A growing number of old or very old patients benefits from a surgical procedure. Age is an independent risk factor of postoperative mortality and postoperative complications including cognitive dysfunction. ⋯ A multidisciplinary management involving all care providers around the patient is essential to reduce the risk of dependence after surgery which is higher in this population. Early postoperative rehabilitation is recommended in the elderly to improve the prognosis.
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Iatrogenic agitation is frequently drug-induced in the elderly. The management of the iatrogenic agitation is based on: a detailed analysis of the patient's medications, stopping non-essential drugs, prescribing drugs to the lowest and effective dose possible. This management of the iatrogenic agitation is also based on: adjustment of drugs according to renal function and limitation of polypharmacy. Special attention is necessary when prescribing treatments for patients with cognitive impairment.
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A sub-clinical inflammatory aortitis is very frequent in patients with giant cell arteritis, and can be the only localization of the disease. In most patients, this aortitis is asymptomatic and is of no consequence on the patient's survival. The relative risk of developing an aortic dissection or aneurysm is 17.3. ⋯ Isolated aortitis treatment is not consensual, but often similar to the treatment of giant cell arteritis and adapted to clinical and biological markers of disease activity. Screening for sub-clinical aortitis with FDG-PET should not be prescribed in patients with typical presentation of giant cell arteritis. A systematic screening of aortic complications in giant cell arteritis patients could be done with a chest X-ray and an abdominal ultrasound possibly completed with an aortic CT-scan at time of diagnosis, in order to look for aneurysms with possible surgical indication.
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In France, families of the deceased raised concerns as regards to the conditions of restoration of body. If scientists hospital autopsies are organized by the Bioethics Law of August 6, 2004, the forensic autopsies were so far not provided with such a legal framework. The legislator has proposed the creation of a new chapter in the Code of Criminal Procedure institutionalizing forensic activities. This legislative evolution allows the harmonization of practices; forensic pathologists must be involved in these changes by bringing their scientific expertise, notably through improving their autopsy techniques.