[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.

[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.