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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



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.


Nitric oxide as a signaling molecule in regulation of subclinical

inflammation and apoptosis in hypertensive elderly patients

N.K. Gorshunova


, N.V. Medvedev


, N.I. Soboleva


, O.V. Rakhmanova




Kursk State Medical University, Kursk, Russia


Nitric oxide (NO)

a signaling molecule is determined

by a high capacity to synthesize and penetrate into target cells by

controlling their metabolism


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.


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)-



caspase-3 and nitrotyrosine

were determined by the immune

enzyme method.


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-


and caspase-3.


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.


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


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.


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.


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.


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


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).


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.


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.


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.


Safety of single chamber pacemakers (AAI) in sick sinus syndrome

(SSS)- does the advancement of old age matter?

M. Gulaj


, E. Gulaj


, Z.B. Wojszel




Department of Cardiology, Hospital

of the Ministry of the Interior in Bialystok,


Department of Geriatrics,

Hospital of the Ministry of the Interior in Bialystok,


Department of

Geriatrics, Medical University of Bialystok, Poland


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.


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