167 / 290
(6-SMT)
–
the main metabolite of melatonin - during daytime (12
hours) and during nighttime (12 hours). The same determination we
did after 3 month of 3 mg Melatonin drug administration every
evening, added to antihypertensive treatement. We observed in the
dippers the nocturnal levels of 6-SMT was rising, while in nondippers
the levels were flatten. After 3 month of Melatonin administration, the
dipping pattern was changed and B.P values falled down like in the
dippers.
Conclusion:
It is a relationship between circadian rhytm of mela-
tonin secretion and nocturnal variation of B.P in the hypertensive
old patients. The complementary addition of 3 mg Melatonin in the
evening decrease B.P in nondippers hypertensive elderly.
P-499
Nitric oxide as a signaling molecule in regulation of subclinical
inflammation and apoptosis in hypertensive elderly patients
N.K. Gorshunova
1
, N.V. Medvedev
1
, N.I. Soboleva
1
, O.V. Rakhmanova
1
.
1
Kursk State Medical University, Kursk, Russia
Objectives:
Nitric oxide (NO)
–
a signaling molecule is determined
by a high capacity to synthesize and penetrate into target cells by
controlling their metabolism
а
nd realizing intercellular interactions.
For estimation the effect of NO and its products on the subclinical
inflammation and apoptosis of endothelial cells in the development of
endothelial dysfunction 66 elderly patients with arterial hypertension
(AH) of II stage and 24 persons of similar age without cardiovascular
diseases were examined.
Methods:
The degree of endothelial dysfunction was examined by
dopplerography of brachial artery, the endotheliocytemia level - by the
Hladovec and Rossmann method, the NO concentration - in the Griess
reaction, the levels of C-reactive protein, tumor necrosis factor (TNF)-
α
,
caspase-3 and nitrotyrosine
–
were determined by the immune
enzyme method.
Results:
In the progression of endothelial dysfunction (ED) from state
of light relaxation to vasotonic disorders a number of phases were
identified: a compensation phase with increased secretory activity of
endothelium, an intermediate phase when the balance is disrupted
due to changes in the secretion process of production and inactivation
of endothelial factors, a decompensation phase as a result of structural
and metabolic disorders of endothelium resulting in its functional
failure, death and desquamation. Regulatory effect of NO on subclinical
inflammation and apoptosis intensity was confirmed by its strong
inverse correlation with the level of TNF-
α
and caspase-3.
Conclusion:
Various concentrations of NO does not only determine
vasotonic disorders, but also change the structure of the vascular wall
as a target organ in hypertension.
P-500
Diagnosis of crystalline arthritis by joint aspiration is improved by
use of portable ultrasound
W.J. Ward, L.E. Ward, L.J.S. Greenlund.
Mayo Clinic, Rochester, MN, USA
Introduction:
Crystalline arthritis commonly affects older patients
and is increasing in prevalence. Joint aspiration is oftentimes
performed for definitive diagnosis. The first metatarsophalangeal
(MTP) joint is commonly involved in acute crystalline arthritis and is
difficult to aspirate because of the relatively small size of the joint,
surrounding soft tissue swelling, and pain in the joint associated
with an acute exacerbation. We have recently implemented the use of
portable ultrasound to improve the procedure with the goal of
increasing the likelihood of obtaining a sample adequate for diagnosis
by microscopic crystal analysis.
Methods:
We compared the likelihood of obtaining an adequate first
MTP joint aspirate sample without and with the use of ultrasound. For
our baseline data, without the use of ultrasound, we carried out a
review of our Mayo Clinic electronic medical record of 25 consecutive
patients seen by our most experienced physician for first MTP joint
aspiration. In this group anatomic landmarks alone were used to
determine the joint location for the procedure. An aspiration sample
was considered adequate if a sufficient quantity of synovial fluid
was obtained to prepare a slide for diagnosis by microscopic crystal
analysis by polarized light microscopy (approximately 10 μL). We
compared this to a group of 25 consecutive patients seen by the same
physician as the baseline group or a second experienced physician
for first MTP joint aspiration with the use of ultrasound to visualize
the joint either before or during the procedure. Patients were included
only if they were undergoing joint aspiration for diagnosis of possible
crystalline arthritis.
Results:
In the baseline group, where anatomic landmarks alone were
used to determine joint location, 52% of MTP joint aspirates were
adequate for diagnosis (total n = 25; 13 of 25 adequate). In the group
where portable ultrasound was used to assist the procedure, 92% of
aspirates were adequate for diagnosis (total n = 25, 23 of 25 adequate).
Key conclusions:
In patients with suspected crystalline arthritis, the
use of portable ultrasound to visualize the first MTP joint before or
during aspiration markedly increased the likelihood of obtaining an
aspiration sample adequate to make a diagnosis.
P-501
Use of noninvasive ventilation in the elderly, in an Internal
Medicine Ward
I. Figueiredo, S.G. Castro, F.G. Magalhães, G.V. Pinto, A. Mateus,
I. Fonseca, L. Guerra, P. Pacheco, M. Antunes, H. Gruner, A. Panarra.
Serviço Medicina 7.2 - Hospital Curry Cabral, CHLC
Introduction:
Noninvasive ventilation (NIV) is frequently used for the
management of acute respiratory failure (ARF) in elderly patients,
often in the context of a do-not-intubate order (DNI).
Methods:
A retrospective descriptive study of the elderly patients (>65
years) admitted to the medical ward of a tertiary hospital during
a 3-month period in two consecutive years, managed with NIV.
Characterization made according to age, gender, functional status,
underlying pathology, medication and one-year survival/readmission.
Results:
Of the 456 patients admitted, 18 (3.95%) received NIV. Among
these, 44.4% were >80 years old, 33.3% female, 83.3% lived at home,
22.2% were independent for activities of daily living and 50% were
previously on long term NIV. The average number of prescribed drugs
at admissionwas 9.4 and at discharge 10.3. The average Charlson index
was 10.6. One-year mortality was 25% in patients with >80 years
and 50% in patients <80 years. Among the discharged patients 88.9%
were discharged on NIV. There were 66.7% readmissions at one-year
due to worsening of the respiratory symptoms.
Discussion:
The sample was small sized. However the mortality rate
was higher in the patients with
≤
80 years, with a lower average
Charlson index 9,4 vs.11,4 and lower number of prescribed drugs 6,5
vs.11 but with higher dependency level.
P-502
Safety of single chamber pacemakers (AAI) in sick sinus syndrome
(SSS)- does the advancement of old age matter?
M. Gulaj
1
, E. Gulaj
1
, Z.B. Wojszel
2,3
.
1
Department of Cardiology, Hospital
of the Ministry of the Interior in Bialystok,
2
Department of Geriatrics,
Hospital of the Ministry of the Interior in Bialystok,
3
Department of
Geriatrics, Medical University of Bialystok, Poland
Introduction:
Sick sinus syndrome (SSS) is a disease of old age, and
cardiac pacemaker implantation is the only form of the therapy. The
aim of the study was to evaluate revalence of adverse events (defined
as the necessity of upgrade to dual chamber (DDD) pacemaker, onsets
of atrial fibrillation, and death) in people with SSS treated with AI
pacemakers, with regard to patients age.
Methods:
8-year long retrospective analysis of 103 consecutive
patients with AAI pacemaker implemented in 2004
–
2008 was
performed, based on medical records of the department of cardiology
and outpatient peacemaker control clinic. Comparisons between
two age strata among these patients were made to clarify differences
between the young-old (60 to 74 years), and the old- old (75 years
and older).
Poster presentations / European Geriatric Medicine 7S1 (2016) S29
–
S259
S161