RESUMEN
BACKGROUND: The increasing age in the industrialized countries places significant demands on intensive care unit (ICU) resources and this triggers debates about end-of-life care for the elderly. OBJECTIVES: We sought to determine the impact of age on the decision-making process to limit or withdraw life-sustaining treatment (DWLST) in an ICU in France. We hypothesized that there are differences in the decision-making process for young and old patients. DESIGN, SETTING, PARTICIPANTS: We prospectively studied end-of-life decision-making for all consecutive admissions (n=390) to a tertiary care university ICU in Toulouse, France over a period of 11 months between January and October 2011. RESULTS: Among the 390 patients included in the study (age ≥70yo, n=95; age <70yo, n=295) DWLST were more common for patients 70 years or older (43% for age ≥70yo vs. 16% for age <70yo, p <0.0001). Reasons for DWLST were different in the 2 groups, with the 'no alternative treatment options' and 'severity of illness' as the most frequent reasons cited for the younger group whereas it was 'severity of illness' for the older group. 'Advanced age' led to DWLSTs in 43% of the decisions in the group ≥70yo (vs. 0% in the group <70yo, p <0.0001). Multivariate logistic regression showed a high SAPS II score and age ≥70yo as independent risk factors for DWLSTs in the ICU. We did not find age ≥70yo as an independent risk factor for mortality in ICU. CONCLUSION: We found that age ≥70yo was an independent risk factor for DWLSTs for patients in the ICU, but not for their mortality. Reasons leading to DWLSTs are different according to the age of patients.
Asunto(s)
Toma de Decisiones , Fragilidad , Cuidados para Prolongación de la Vida , Cuidado Terminal , Privación de Tratamiento , Factores de Edad , Anciano , Femenino , Fragilidad/diagnóstico , Fragilidad/mortalidad , Fragilidad/psicología , Francia/epidemiología , Humanos , Unidades de Cuidados Intensivos/organización & administración , Unidades de Cuidados Intensivos/estadística & datos numéricos , Cuidados para Prolongación de la Vida/psicología , Cuidados para Prolongación de la Vida/estadística & datos numéricos , Masculino , Estudios Prospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Puntuación Fisiológica Simplificada Aguda , Cuidado Terminal/psicología , Cuidado Terminal/estadística & datos numéricos , Poblaciones Vulnerables/psicología , Poblaciones Vulnerables/estadística & datos numéricosRESUMEN
Chromosomic alterations can be observed after the effect of a antimitotic amsidine on metaphases of cultured human lymphocytes: gaps, breaks, exchange figures, deletions, rings. Moreover we notice, among these cells, particular lines of big sized lymphoplasmocytoid cells, whose rate is abnormally high when compared to reference cultures.
Asunto(s)
Amsacrina/farmacología , Cromosomas Humanos/ultraestructura , Linfocitos/citología , Células Cultivadas , Cromosomas Humanos/efectos de los fármacos , Humanos , Cariotipificación , Linfocitos/efectos de los fármacos , Metafase/efectos de los fármacosRESUMEN
The authors describe cytogenetic aberrations observed in a case of T prolymphocytic leukemia. C11 deletion (q14) B5 deletion (pter), D14q +, E20 trisomy, and two markers are the main anomalies of the complement.