Characterization of patients admitted to specialized geriatric acute care hospital units with the German version of the Standardized Evaluation and Intervention for Seniors at Risk (SEISAR) screening-instrument: a cross-sectional study

BACKGROUND

The Standardized Evaluation and Intervention for Seniors at Risk (SEISAR) screening tool records major geriatric problems, originally applied in the emergency department. Particularly, the distinction of compensated and uncompensated problems is an interesting and new approach. Therefore, we translated the SEISAR in German language and used it to characterize patients in specialized geriatric hospital wards in Germany and to gather initial experience regarding its usability and practicability.

METHODS

The tool was translated by three independent specialists in geriatric medicine and backtranslated for quality-assurance by a non-medical English native speaker. In a second step, 8 acute care geriatric hospital departments used the translated version to characterize all consecutive patients admitted over a period of one month between December 2019 and May 2020 at time of admission.

RESULTS

Most of the 756 patients (78%) lived in an own apartment or house prior to hospital admission. Participants had on average 4 compensated and 6 uncompensated problems, a Barthel-Index of 40 pts. on admission with a median increase of 15 points during hospital stay, and a median length of stay of 16 days in the geriatric hospital department.

CONCLUSION

SEISAR is an interesting standardized brief comprehensive geriatric assessment tool for the identification of compensated and uncompensated health problems in older persons. The data of this study highlights the number, variability, and complexity of geriatric problems in patients treated in specialized acute care geriatric hospital wards in Germany.

TRIAL REGISTRATION

German Clinical trial register (DRKS-ID: DRKS00031354 on 27.02.2023).

In Situ Measurement of Electron Energy Evolution in a Laser-Plasma Accelerator

We report on a novel, noninvasive method applying Thomson scattering to measure the evolution of the electron beam energy inside a laser-plasma accelerator with high spatial resolution. The determination of the local electron energy enabled the in-situ detection of the acting acceleration fields without altering the final beam state. In this Letter we demonstrate that the accelerating fields evolve from (265±119)  GV/m to (9±4)  GV/m in a plasma density ramp. The presented data show excellent agreement with particle-in-cell simulations. This method provides new possibilities for detecting the dynamics of plasma-based accelerators and their optimization.

[COVID-19 in old age-The geriatric perspective]

Predominantly the older population is affected by a severe course of COVID-19. The mortality of hospitalized patients with COVID-19 above the age of 80 years is up to 54% in international studies. These observations indicate the necessity to highlight the geriatric perspective on this disease. The diagnostics and treatment of COVID-19 do not differ between younger and older patients but atypical symptoms should be expected more frequently in old age. Older subjects show an increased need for rehabilitation after COVID-19. Paradoxically, increasing rehabilitation demands go along with a reduced availability of geriatric rehabilitation options, the latter being a consequence of closure or downsizing of rehabilitation departments during the pandemic. In general, measures of isolation and quarantine should be diligently balanced as the health and emotional consequences of such measures may be severe in older persons. In light of the poor prognosis of older COVID-19 patients, advanced care planning becomes even more relevant. Caregivers and physicians should be encouraged to compose advanced care directives that also reflect the specific circumstances of COVID-19. Fortunately, current data suggest that the effectiveness of the vaccination with the mRNA-vaccines approved in Germany may be equally high in older compared to younger persons.

FLASHForward: plasma wakefield accelerator science for high-average-power applications

The FLASHForward experimental facility is a high-performance test-bed for precision plasma wakefield research, aiming to accelerate high-quality electron beams to GeV-levels in a few centimetres of ionized gas. The plasma is created by ionizing gas in a gas cell either by a high-voltage discharge or a high-intensity laser pulse. The electrons to be accelerated will either be injected internally from the plasma background or externally from the FLASH superconducting RF front end. In both cases, the wakefield will be driven by electron beams provided by the FLASH gun and linac modules operating with a 10 Hz macro-pulse structure, generating 1.25 GeV, 1 nC electron bunches at up to 3 MHz micro-pulse repetition rates. At full capacity, this FLASH bunch-train structure corresponds to 30 kW of average power, orders of magnitude higher than drivers available to other state-of-the-art LWFA and PWFA experiments. This high-power functionality means FLASHForward is the only plasma wakefield facility in the world with the immediate capability to develop, explore and benchmark high-average-power plasma wakefield research essential for next-generation facilities. The operational parameters and technical highlights of the experiment are discussed, as well as the scientific goals and high-average-power outlook. This article is part of the Theo Murphy meeting issue 'Directions in particle beam-driven plasma wakefield acceleration'.

Erratum: Emittance Preservation in an Aberration-Free Active Plasma Lens [Phys. Rev. Lett. 121, 194801 (2018)]

This corrects the article DOI: 10.1103/PhysRevLett.121.194801.

Tunable Plasma-Based Energy Dechirper

A tunable plasma-based energy dechirper has been developed at FLASHForward to remove the correlated energy spread of a 681 MeV electron bunch. Through the interaction of the bunch with wakefields excited in plasma the projected energy spread was reduced from a FWHM of 1.31% to 0.33% without reducing the stability of the incoming beam. The experimental results for variable plasma density are in good agreement with analytic predictions and three-dimensional simulations. The proof-of-principle dechirping strength of 1.8  GeV/mm/m significantly exceeds those demonstrated for competing state-of-the-art techniques and may be key to future plasma wakefield-based free-electron lasers and high energy physics facilities, where large intrinsic chirps need to be removed.

Emittance Preservation in an Aberration-Free Active Plasma Lens

Active plasma lensing is a compact technology for strong focusing of charged particle beams, which has gained considerable interest for use in novel accelerator schemes. While providing kT/m focusing gradients, active plasma lenses can have aberrations caused by a radially nonuniform plasma temperature profile, leading to degradation of the beam quality. We present the first direct measurement of this aberration, consistent with theory, and show that it can be fully suppressed by changing from a light gas species (helium) to a heavier gas species (argon). Based on this result, we demonstrate emittance preservation for an electron beam focused by an argon-filled active plasma lens.

Synthese und Kristallstruktur der Benzyltriphenylphosphonium-bromide: [C6H5-CH2P(C6H5)3]+Br-CH2Cl2 und [C6H5-CH2P(C6H5)3]+Br3 - / Synthesis and Crystal Structures of (Benzyl)triphenylphosphonium Bromides, [C6H5-CH2P(C6H5)3]+Br-CH2Cl2 and [C6H5-CH2P(C6H5)3]+Br3 -

(Benzyl)triphenylphosphonium bromide, [C6H5-CH2P(C6H5)3]+Br- (CH2Cl2) (1) has been prepared by the reaction of triphenylphosphine with benzylbromide and its structure determined. The colorless crystals are triclinic, space group P1̄, Z = 2, a = 976.0(3), b = 1069.0(3), c = 1226.1(4) pm, α = 94.13(3), β = 104.70(3), γ = 100.14(3)°. The lattice contains Br- anions and [C6H5-CH2P(C6H5)3]+ cations. [C6H5-CH2P(C6H5)3]Br3 (2) has been obtained by treating compound 1 with equimolar quantities of elemental bromine in methylene chloride solution. The red crystals of 2 are monoclinic, space group P21/c, Z = 4, a = 917.9(2), b = 1022.6(2), c = 2573.6(5) pm, β = 99.11(2)°, and comprise[C6H5-CH2P(C6H5)3]+ cations and linear, slightly asymmetrical Br3 - anions with bromine-bromine distances of 246.19(11) and 263.69(11) pm.

Synthese und Kristallstruktur des Bromdifluormethyl-triphenyl- phosphoniumbromids, [(C6H5)3PCF2Br]+ Br- / Synthesis and Crystal Structure of Bromodifluoromethyl-triphenylphosphonium Bromide, [(C6H5)3PCF2Br]+ Br-

Difluorobromomethyl-triphenylphosphonium bromide [(C6H5)3PCF2Br]+ Br- (1) has been prepared by the reaction of triphenylphosphine with dibromodifluoro-methane in acetonitrile or methylene chloride. The colorless crystals are monoclinic, space group P 21/n, Z=4, a = 1067.1(2), b = 1488,5(2), c = 1178,2(2) pm, β = 95,67(3)°. The lattice contains Br- anions and [(C6H5)3PCF2Br]+ cations with a Br-Br distance of 322,33(11) pm.. For the title compound the results of AM 1, PM 3 ,and MNDO calculations are in good agreement with corresponding values determined by the X-ray analysis only in the case of PM 3.

The yellow-red [(C6H5)3PCF2Br]+ Br3 - (2) has been obtained by treating 1 with equimolar quantities of elemental bromine in methylene chloride solution.

Synthese und Kristallstruktur der (p-Brombenzyl)triphenylphosphonium-bromide: [(p-Br-C6H4-CH2)P(C6H5)3]+B-;[(p-Br-C6H4-CH2)P(C6H5)3]+Br2 - und [(p-Br-C6H4-CH2)P(C6H5)3]+Br3 -/ Synthesis and Crystal Structures of (p-Bromobenzyl)triphenylphosphonium Bromides, [(p-Br-C6H4-CH2)P(C6H5)3]+Br-;[(p-Br-C6H4-CH2)P(C6H5)3]+Br- and [(p-Br-C6H4-CH2)P(C6H5)3]+Br3-

(p-Bromobenzyl)triphenylphosphonium Bromide,

[(p-Br-C6H4-CH2)P(C6H5)3]+Br- · (CH2Cl2)2.5 (1) has been prepared by the reaction of triphenylphosphine with p-bromobenzylbromide and its structure determined (triclinic, space group P1̅, Z = 2, a = 1198.03(12), b = 1245.80(11), c = 1258.42(12)pm, a = 100.170(8), β = 103.543(9), γ = 1 18.158(7)°. The compound exists as Br- anions and [(p-Br-C6H4- CH2)P(C2H5)3]+ cations, with weak interactions between the chlorine atoms of the CH2Cl2 molecules and the bromine bonded in the cation.

[p-Br-C6H4-CH2)P(C6H5)3]Br2 (2) and [(p-Br-C6H4-CH2)P(C6H5)3]Br3·(CH2Cl2)1.5 (3) have been obtained by reactions of the corresponding amounts of bromine with 1 in methylenechloride solution. The yellow-red crystals of 2 are orthorhombic, space group Pccn, Z = 8, a = 2060.8(3), b = 1223.6(4), c = 1860.8(3) pm. Compound 2 exists as [p-Br-C6H4-CH2)P(C6HO5)3]+ cations and linear Br2- 4 units with a bromide-bromine distance of 297.3(4) pm. The red crystals of (3) are triclinic, space group P1̅, Z = 2, a = 1 171.16(7), b = 1260.97(8), c = 1270.35(7)pm, α = 65.510(5), β = 75.811(5), γ = 62.320(5)°, and contain [(p-Br-C6H4-CH2)P(C6H5)3]+ cations and linear, slightly asymmetrical Br- 3 anions. In all cases the cation has a slightly irregular tetrahedral geometry around the P atom.

Preparation and Crystal Structure of New 1,3-Diaza-λ5,λ5-diphosphetidines

Abstract Reaction of py · PS2Cl (py = pyridine) with benzyl amine in the presence of NEt3 yields triethyl-ammonium 1,3-dibenzyl-2,4-dithioxo-1,3-diaza-2λ5,4λ5-diphosphetidine-2,4-dithiolate which reacts with MeI to give the corresponding methyl ester. By fractional crystallization from cyclohexane three modifications of the methyl ester were obtained (two trans-(A and A') and one cis-modification (B)). The crystal structure of these modifications have been determined by single crystal X-ray diffraction. Crystal data: A: triclinic, space group P1̄ , Z = 2, a = 7.100(3), b = 10.088(6), c = 17.785(6) Å , α = 99.18(4)°, β = 93.75(5)°, γ = 106.96(4)°, A': monoclinic, P21/c, Z = 2, a = 7.933(3), b = 13.689(3), c = 9.917(4) Å, β = 111.98(3)°; B: orthorhombic, P cab, Z = 8, a = 12.962(6), b = 16.581(6), c = 19.475(7).

[Assessment of elderly intensive care patients]

The standard geriatric basic assessment validly presents the functional limitations of elderly patients. The prognosis estimation of elderly people is less precise using the instruments for cardiovascular and preoperative risk evaluation or by the intensive care medicine scores on organ failure. An adaptation and further development of score systems could clarify these vague areas.

[Evidence-based recommendations on primary diagnostics of peripheral arterial occlusive disease in geriatric patients]

The prevalence of peripheral arterial occlusive disease (PAOD) is high in elderly patients and its clinical manifestation is often atypical. Comorbidity and morbidity as a consequence of PAOD are significant. Therefore, standardized primary diagnostics are required among geriatric patients. Drawn from a search of the literature, evidence-based recommendations are provided. Pulse palpation and the evaluation of a patient's medical history are obligatory components of primary diagnostics, even in the absence of typical symptoms. In the case of pathological and ambiguous findings, measuring Doppler ankle pressures is suggested as the next diagnostic step. Further measures depend on the following factors: the presence of lesions on the leg with disturbed blood flow, predominantly in the foot and lower leg areas, degree of PAOD-related ailments, and, finally, intended surgery of the affected leg for other medical reasons.

[Elderly patients with cardiovascular diseases]

What is the difference in cardio-vascular diseases in the elderly? - In elderly patients with acute coronary syndrome the diagnosis is frequently hampered by non-specific symptoms and these patients often seek medical help later than younger individuals. Elderly and old patients with acute coronary syndrome are still less frequently being referred to percutaneous coronary intervention (PCI) than younger patients, although statistically even octogenarians profit from PCI more than from thrombolysis or purely drug therapy. In stable coronary artery disease the focus is on consistent treatment of risk factors. Therapy of systolic heart failure in the elderly is not fundamentally different from that administered to younger individuals, and therapy is just as effective. In old age diastolic heart failure is frequent. The risk of thrombo-embolic complications in atrial fibrillation increases with age. What makes the difference in cardio-vascular diseases in the elderly? - Physiological organ aging processes and immunosenescence provide possible explanations for the frequently atypical clinical presentation of severe ailments and altered pharmacokinetics in old age. Influenza and pneumococcus vaccinations are effective in preventing cardiovascular events.

[Life-threatening necrotizing fasciitis colli caused by Serratia marcescens]

Necrotizing fasciitis colli is a rare, but life-threatening disease. A 43-year-old female patient was admitted to our department because of increasing dysphagia and slight swelling of the left side of her neck due to severe necrotizing pharyngolaryngitis. Initial treatment with cephalosporin I was ineffective. The patient developed a rapidly spreading necrotizing fasciitis of the neck requiring open surgery for débridement and drainage as well as tracheostomy. Microbiological analysis revealed Serratia marcescens, thus allowing targeted and ultimately successful antibiotic therapy. The case shows that even saprophytes like Serratia marcescens may cause a necrotizing fasciitis. Therefore, the initially calculated antibiotic treatment should include a wide spectrum of aerobic and anaerobic germs.

Phosphorus-31 MAS NMR investigations of pyridine stabilized dithiomonometaphosphoryl halides

Phosphorus-31 magic-angle spinning NMR spectroscopy was chosen in order to study a series of N-donor stabilized dithiomonometaphosphoryl halides (F, Cl, and Br) and to extract structural and bonding information from their spectra. Additionally, an unusual line splitting was observed in the 31P MAS NMR spectra of pyridine dithiomonometaphosphoryl chloride (Py-->PS2Cl) and the analogous bromide (Py-->PS2Br). It is shown that this effect is due to a residual dipolar coupling between phosphorus and chlorine or bromine, respectively. This work is to our knowledge the first observation of this effect between P and Br in 31P MAS NMR spectra.

IGFBP-1 and glycodelin serum levels before and after hysterectomy with and without bilateral oophorectomy in premenopausal women

OBJECTIVES

The aim of our study was to investigate the role of the intact endometrium and ovaries for serum levels of insulin-like growth factor binding protein-1 (IGFBP-1) and glycodelin.

STUDY DESIGN

In 35 premenopausal patients with a planned hysterectomy, serum measurements of IGFBP-1 and glycodelin were done before surgery and 1, 3, 5, and 10 days after surgery. Patients were divided into three groups according to the kind and time of operation: (1) hysterectomy with bilateral adnexectomy in the luteal phase and (2) hysterectomy without adnexectomy in the follicular phase or (3) the luteal phase.

RESULTS

IGFBP-1-we could not show any differences in IGFBP-1 serum levels before and after hysterectomy with or without bilateral oophorectomy. Glycodelin-hysterectomized and oophorectomized patients showed decreasing serum levels up to day 3. After day 5, circulating concentrations of glycodelin increased continuously but remained below pre-operative levels. In both non-adnexectomized groups we saw a reduction up to day 5 but a rise at day 10. None of the results reached statistical significance.

CONCLUSION

The results indicate that endometrium and ovary are not the only sources of IGFBP-1 and glycodelin.

Tris(tert-butyl)phosphine sulfide, a phosphine sulfide with three bulky substituents

The title compound, C12H27PS, has crystallographic C3 symmetry. The bond angles at phosphorus are tetrahedral [C--P--S 109.31 (12) degrees and C--P--C 109.63 (12) degrees ] and the P--C bond length is 1.899 (4) A. The shortest intermolecular contacts exist between methyl H atoms and the S atom (3.09, 3.12 and 3.28 A). A survey of various phosphine sulfides containing three equal ligands (Me3PS, Et3PS, Cy3PS, tBu3PS, etc.) shows the influence of substituents with different steric demand on the geometry at phosphorus and on the P--C bond length.

Tris(tert-butyl)phosphine selenide, the missing link in tris(tert-butyl)phosphine chalcogenide structures (t)Bu(3)P==X (X = O, S, Se, Te)

In tris(tert-butyl)phosphine selenide, C(12)H(27)PSe, all the methyl ligands are disordered over two sites in the ratio 70/30. The molecule displays crystallographic C(3) symmetry. The bond angles at the P atom are distorted tetrahedral [C--P--C 110.02 (5) degrees and Se==P--C 108.91 (5) degrees ]. The P--C and P==Se bond lengths are 1.908 (1) and 2.1326 (6) A, respectively. A comparison of the structural data of the complete series of tris(tert-butyl)phosphine chalcogenides ((t)Bu(3)PO, (t)Bu(3)PS, (t)Bu(3)PSe and (t)Bu(3)PTe) with the corresponding data of other phosphine chalcogenides substituted by smaller organic groups shows the great influence of the bulky tert-butyl ligands.

Home-based multidisciplinary diagnosis and treatment of inner-city elders with dementia

The Memory and Aging Project Satellite (MAPS) of the Washington University Alzheimer's Disease Research Center was developed to meet the medical, social, and housing needs of minority and medically underserved elders with cognitive impairments. MAPS is located in the offices of the St. Louis Area Agency on Aging (AAA). This program provides multidisciplinary outreach, as well as home-based diagnosis, treatment, and case management. It differs from most other satellite programs in that it seeks to provide service to individuals who do not voluntarily seek help for dementia. Cognitively impaired clients had numerous, unmanaged medical conditions and social problems. Few clients were adequately served by health and social service systems. Despite recent contact, only 10% of clients received a formal diagnosis of dementia from a physician. Treatment was hampered by the absence or limitations of caregivers. Despite the complexities of these cases, the MAPS staff have been generally successful in addressing client problems.

Cancer associated serum antigen (CASA) levels in patients with breast carcinoma and in 3 control groups without breast cancer

We have examined the predictive value of measurements of CASA (Cancer Associated Serum Antigen) levels in patients with breast carcinoma. The measurement uses monoclonal antibodies that bind to an epitope on the polymorphic epithelial mucin. CASA levels were of less value compared with the levels of other tumor markers (CA 15-3, CA 549 and CEA) in the management of patients with early breast cancer.

Reducing the culture clash in family-provider relationships: a bilateral perspective

This chapter uses the concept of culture clash to take a fresh look at the slow progress toward family-provider collaboration. The authors discuss an intervention that targets both family culture and provider culture.

Increased contact with community mental health resources as a potential benefit of family education

OBJECTIVE

This study examined the hypothesis that families of adults with severe mental illness who participate in either a group family education workshop or individual family consultation will try to seek more assistance from community services than those in a control group assigned to a waiting list.

METHODS

A total of 225 family members who agreed to participate in the study were randomly assigned to one of three conditions: a ten-week group workshop, individual family consultation, or a waiting list (control group). Family members were interviewed about the extent of their contact with mental health professionals, providers, and community resources at baseline, termination of the interventions, and at six months after termination.

RESULTS

No differences were found between conditions in the extent of family members' contact with three types of services: conventional, psychosocial, and ancillary mental health services.

CONCLUSIONS

Neither of the educational interventions produced any change in behaviors of families seeking advice and assistance on behalf of their ill relative from the three types of services examined. Modifications in the interventions may be worthwhile. Increasing family members' contacts with community resources on behalf of their ill relative may increase the benefits of the intervention to the family as well as to the ill relative.

Applying research on family education about mental illness to development of a relatives' group consultation model

Results from a random field trial of family education interventions were applied to create a new model of family education programs. This paper reviews the family education literature, the random field trial results, and the pre-piloting of an adapted service model called group consultation. The new model emphasizes a more interactive approach to the conventional group workshop model as opposed to adherence to a pre-planned curriculum. Pre-pilot group participants were all past members of group workshops. In a process evaluation these group members were questioned about their reactions to the new group format and its usefulness.

Is the tumor marker CASA dependent on the menstrual cycle?

The time course and characteristics of the tumor marker CASA (Cancer Associated Serum Antigen) during the menstrual cycle were analysed. We investigated whether hormonal influences in women and the score of this tumor marker ought to be considered in diagnosis. It could be demonstrated that CASA is not influenced by physiological alterations of the hormonal status in regularly ovulating women.

First experiences with the use of CASA in mammary carcinoma

The expression of the tumor marker CASA (cancer associated serum antigen) was studied in patients with mammary carcinoma; increased values were almost exclusively seen in cases of manifest metastasis. No correlation existed between tumor stage, lymph node involvement and grading. Marker levels were tested by means of enzyme-immune-assay of the firm medac (Hamburg), with a cut-off value set at 4 U/ml.

Effectiveness of two models of brief family education: retention of gains by family members of adults with serious mental illness

The retention of benefits from two models of family education was compared with maturational effects in an untreated control group. The three-month interventions showed an initial effect for self-efficacy regarding a mentally ill relative that did not significantly diminish during the following six months. However, no significant differences on this measure were found between the treated groups and the untreated controls. Ways of refining the interventions and measures so as to improve gains and retain them over time are discussed.

Impact of brief family psychoeducation on self-efficacy

One hundred eighty-three relatives of people with serious mental illnesses were randomly assigned to receive individualized consultation or group psychoeducation or were placed on a 9-month wait list. Analysis of variance and multiple regression revealed that the individualized consultation increased the family members' sense of self-efficacy regarding mentally ill relatives. Group psychoeducation was helpful in increasing self-efficacy of family members who had never participated in a support or advocacy group for relatives of psychiatrically disabled individuals.

[Value of serum placental protein 14 determination in differential diagnosis of abnormal early pregnancy]

Single measurements of hCG and placental protein 14 were carried out in 32 patients with tubal pregnancies, in 38 patients with spontaneous abortion and 28 women with normal intrauterine pregnancies from the 5th to the 7th week of pregnancy. HCG-measurement could only show significant differences between normal and abnormal early pregnancies. PP 14-measurements showed significant differences between all groups. Low concentrations of serum PP 14 point to an ectopic pregnancy.

A study of serum CASA and CA 125 levels in patients with ovarian carcinoma

The assays of Cancer Associated Serum Antigen (CASA) and CA 125 were assessed in the management of patients with ovarian cancer. It was shown that CASA is sensitive to ovarian carcinoma, and both CASA and CA 125 are more useful when used in conjunction.

[Passive immunotherapy with Venimmun for the prevention of habitual abortion--early pregnancy factor, placenta protein 12, placenta protein 14, tumor necrosis factor alpha--parameters for monitoring immunotherapy]

In a study it was investigated to what extent the early pregnancy factor, the placental proteins 12 and 14 and tumor necrosis factor alpha are suited to control and select patients with habitual abortions for immunotherapy. Immunotherapy shows good clinical results. Placental protein 12 ist not suited for selecting patients. Placental protein 14 shows typical changes after the application of polyvalent immunoglobulin and could be an important prognostic factor. Tumor necrosis factor alpha seems to be useful for selecting patients for immunotherapy, because in cases of habitual abortions this factor can be a sign for immunological causes. In the late phase of pregnancy, early pregnancy factor is also an indicator for disturbances of pregnancy.

[Use of Diprivan for digestive system endoscopy]

After evaluation of the patient's clinical condition and appropriate premedication is seems reasonable to suggest for: 1. Endoscopic procedures involving the gastro-intestinal tract: slow, titrated induction, using 0.5 to 1 mg.kg-1 of propofol, until the required level of sedation has been achieved; this may or not be preceded by the injection of a low dose of midazolam (0.02 to 0.03 mg.kg-1) or of alfentanil (5 micrograms.kg-1); maintenance is achieved by bolus injections of 20 mg (up to 0.5 mg.kg-1); maintenance of spontaneous ventilation, with oxygen administration is the rule; SpO2 is monitored routinely; anaesthesia has to be performed according to the recommendations of the French Society of Anaesthesia and Intensive Care (SFAR) and the anaesthetist must be prepared to manage any incident during the endoscopy and the recovery period. 2. Procedures involving the biliary tract and the oesophagus, which require deeper anaesthesia: induction should again be titrated using a very slow infusion, with doses ranging from 0.9 to 2.2 mg.kg-1); the maintenance requires a continuous infusion, doses ranging from 4 to 6 mg.kg-1.h-1 when propofol is administered alone and from 4 to 12 mg.kg-1.h-1 when combined with an opioid; continuous oxygenation is necessary using a nasal airway; the need for intubation depends on the type of procedure and the status of the patient; the same monitoring devices and similar safety measures are required during and after procedure as for any anaesthetic or sedation, especially when it is performed in day-case patients or outside the operating theatre.

[Malignant fibrous histiocytoma of the thoracic wall in the area of a tuberculous pleural callosity]

The authors report on a patient of 85 years of age in whom a malignant fibrous histiocytoma of the thoracic wall had formed 51 years after a healed pulmonary tuberculosis that had resulted in the development of a pleural callosity. The malignant fibrous histiocytoma is interpreted as a neoplastic transformation of cells of the primary repair process. Age assumes the role of a predisposing factor.