[I am old and sick, therefore I "exit"?].

One hundred seventy patients (average age 79.9 years) with preserved cognitive faculties agreed to complete a questionnaire on the costs caused by their health conditions, the guilt they feel due to these costs, and their eventual resort to the Exit association. 48% answered that health care cost too much to the community, 10% reported feeling guilty about the potential costs generated by a consultation with their physician.

[Cancer in older patients: which assessment before treatment decisions].

Most of the deaths due to cancer affect the elderly population. The numerous and often underestimated co-morbidities, which weaken elderly cancer patients, interfere with the validity of medical decisions, by raising questions related to the true benefits of the suggested radiotherapy or chemotherapy, in the medium or long term. This leads, sometimes wrongly, either to an absence of oncologic treatment, or to excessive or aggressive therapeutic proposals.

[Orthogeriatric unit: a marriage of convenience between orthopedic surgeon and geriatrician?].

Hip fracture in the elderly can be associated with dramatic issues like death in the year or severe handicap requiring admission in a nursing home. Implementation of a close cooperation between orthopaedic surgeon and geriatrician materialize in the creation of unit, known as orthogeriatric unit where the roles of each member are precisely defined from admission to discharge, with coordinated care protocols and standardized orders. Benefits of the orthogeriatric ward are clarified in this paper, referring to literature, with description of an improvement of functional score after 3 months, reduction of in-hospital mortality and post-operative complications.

[Falls in the elderly: think about cervical fracture!].

Cervical spine fractures are not uncommon in the geriatric population. Lower energy injuries could be responsible, like a simple fall. After an injury, a fracture should always be suspected in patients who complain of cervical tenderness, until proven otherwise.

[The acute bacterial parotitis of the elderly].

Acute bacterial parotitis (ABP) in elderly is clinically described with a sudden onset of painfull swelling over the cheek and angle of the mandible. The occur of ABP is a factor of very bad prognosis, often an indicator of approaching death. In this paper we discuss eight cases observed in our geriatric clinic.

[Calcific uremic arteriolopathy (calciphylaxis)].

We present the case of a end stage renal failure patient treated with haemodialysis who developed painful nodules of the subcutis which progressed to ulcerative and necrotic lesions, gradually spreading. The diagnosis of calcific uremic arteriolopathy was made, based on histologic findings showing adipose tissue with necrotic areas and calcifications of the arterioles's media. We describe the clinical presentation of this syndrome which is associated with a high mortality and resume the actual conceptions about the pathogenesis, the diagnosis, prevention and treatment.

[Amyotrophic lateral sclerosis also threatens the octogenarian].

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease, incurable, mostly declared near the age of sixty-seventy, but more rarely for the older individuals. Because presenting symptoms are non specific (muscle weakness, functional decline, loss of ambulation, dyspnea, dysphagia), diagnosis in early stages may be difficult and delayed, particularly on polymorbid older patients. Symptomatic management is the mainstay of treatment for ALS; care in multidisciplinary team, with maximal psychologic support, is associated with enhanced quality of life.

[Post-fall syndrome: how to recognize and treat it?].

The post-fall syndrome is commonly observed in geriatric medicine, affecting near one out of five fallers. Left untreated, this condition can lead to a regressive syndrome, with physical, psychological and social consequences. To avoid such an evolution, specific physical therapy must be proposed as soon as possible.

[What perceptions do older people have of medical costs?].

This prospective study shows key elements by grouping the opinion of 200 hospitalized patients with an average age of 78 that have conserved their cognitive faculties. 57.5% of them think that medical cost of their age group is too high for the collectivity, and brings 15% of them to hesitate before consulting their doctor.

[Monitoring hypoglycemia in elderly diabetic patients: a prospective study].

Hypoglycaemia is often underestimated in the elderly diabetic patient, as clinical manifestations of hypoglycaemia in these patients are frequently atypical. This prospective study, enrolling 100 elderly diabetic patients (age: 79.3 years) shows a great incidence of hypoglycaemic events (24%) during the first day of hospitalisation in a geriatric unit.

[Various features of diabetes in the elderly].

Diabetes mellitus, a common condition in older persons, is caused by a complex interaction of genetic and environmental factors. Treatment objectives in older diabetic patient will be based on an individualized approach, the target goals varying with life-limiting comorbid illness, cognitive or functional impairments. Appropriate therapeutic goals are to avoid symptomatic hyperglycemic episodes and acute metabolic decompensation, as well as severe hypoglycemia in frail patients, while nutritional restriction should be minimized to prevent these patients' quality of life.

[From functional decline to the slipping syndrome].

Normal aging is accompanied by functional decline with a loss of independence in activities of daily living. In many cases, after acute medical events, such a functional decline is observed, for which rehabilitation therapies are indicated. However, uncommon types of functional decline are also seen, without trigger event, having a particuliar clinical course: some of these are described in this paper, ranging from the "failure to thrive" to the dramatic "slipping syndrome".

[The elderly patient and primary hyperparathyroidism].

Constant progress in technic of biochemical measurements allow to find easier the diagnostic of primary hyperparathyroidism, which is more usual with advanced age. We're trying in this study to assess the best treatment for the old patient, often asymptomatic. We propose four clinical cases reports to illustrate the discussion.

[Current role of biopsy in the diagnosis of hepatic disease].

The criteria for the use of liver biopsy as a diagnostic tool were retrospectively analyzed over a ten-year period in 390 consecutive patients. The four principal conditions in which this procedure was employed were alcoholism (33%), hepatitis (18%), abnormal hepatic tests (16%) and tumors (10%). The development of new, "non-invasive", investigative methods such as echography and tomodensitometry has led to an decrease in the number of liver biopsies performed annually, but no change in the relative frequency of the various indications.