Consensus sur la démence de type Alzheimer au stade sévère

Under the auspices of the French Society of Gerontology and Geriatrics, a multidisciplinary team including geriatritians, neurologists, epidemiologists, psychiatrists, pharmacologists and public health specialists developed a consensus on care for patients with severe dementia. They defined 21 recommendations for general practitioners, long-term care physicians and specialists based on knowledge available in 2005. At all stages of the disease, the objective of care is to improve as much as possible quality-of-life for the patient and his/her family, including a life project until the end of life. It is always possible to do something for these patients and their family: nutritional status, behavior disorders, and incapacities to deal with basic activities of daily life have to be taken in consideration. Resource allocation and proximity care have to be targeted. Research areas necessary to improve the care of patients with severe dementia has been selected.

Fluoxetine modulates motor performance and cerebral activation of patients recovering from stroke

In order to determine the influence of a single dose of fluoxetine on the cerebral motor activation of lacunar stroke patients in the early phase of recovery, we conducted a prospective, double-blind, crossover, placebo-controlled study on 8 patients with pure motor hemiparesia. Each patient underwent two functional magnetic resonance imaging (fMRI) examinations: one under fluoxetine and one under placebo. The first was performed 2 weeks after stroke onset and the second a week later. During the two fMRI examinations, patients performed an active controlled motor task with the affected hand and a passive one conducted by the examiner with the same hand. Motor performance was evaluated by motor tests under placebo and under fluoxetine immediately before the examinations to investigate the effect of fluoxetine on motor function. Under fluoxetine, during the active motor task, hyperactivation in the ipsilesional primary motor cortex was found. Moreover, fluoxetine significantly improved motor skills of the affected side. We found that a single dose of fluoxetine was enough to modulate cerebral sensory-motor activation in patients. This redistribution of activation toward the motor cortex output activation was associated with an enhancement of motor performance.

Effects of cefmetazol, cefoxitin and imipenem on polymorphonuclear leukocytes

1. We have investigated the effects produced in vitro by Cefmetazol, Cefoxitin and Imipenem on the chemotaxis, spontaneous mobility, adherence, phagocytosis and candidicide power of human polymorphonuclear neutrophils (PMNs). 2. The three antibiotics tested significantly stimulated the adherence of neutrophils to nylon fibre at doses either equal (50 mg/l) or superior (500 mg/l) to the therapeutic one. 3. Cefmetazol, Cefoxitin and Imipenem bring about a maximum increase of chemotaxis at the therapeutic dose, whereas the spontaneous mobility diminishes with any one of the doses used. 4. The capacity of the PMNs to phagocytize and produce lysis of Candida albicans is increased in Cefmetazol with therapeutic doses. Cefoxitin produced an increased lysis of candidas.

[The patella and the femoro-patellar joint during rheumatoid polyarthritis]

The authors report 2 series of cases of rheumatoid arthritis, one prospective of 115 cases, the other retrospective of 72 cases, and note the frequency of clinical and radiological patellar and femoro-patellar involvement during this disease. Signs of active rheumatoid disease in the patella were present in 31 cases. The most common lesions of the femoro-patellar joint space are narrowing and lateral dislocation of the patella. The femoro-patellar lesions evolve in parallel to the femoro-tibial lesions, but dissociation is possible. The early detection of a femoro-patellar syndrome permits effective treatment by isometric rehabilitation of the quadriceps. On the most advanced lesions, and when pain is limited to the femur and patella, an operation of reaxation of the patella may provide remarkable functional improvement.