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Introduction:
Elderly patients requiring cardiac surgery for degen-
erative aortic stenosis has increased, but often are not refered only
because of advanced age.
Methods:
97 patients with moderate or severe aortic stenosis seen
in outpatient cardiology clinic were recruited. Echocardiographic,
geriatric assessment and surgical risk evaluation by Euroscore scale
were done. The number of admissions for all causes and for heart
failure (HF) was assessed. Follow-up was at 6 months and a year.
Results:
Mean age was 86 y. 61% were women. The average body
surface was 1.6, no sex diference. 70% overweight or obese. Most
common symptomwas dyspnea 71%. Average modified Charlson Index
(MCHI) was 2. Patients > 85 years had higher MCHI (p < 0.02). The
mortality risk estimated by logistic Euroscore was 18.5 (SD ± 14.96).
44.3% were in NYHA functional class IV. 44% had entered at least once
because of heart faillure (HF) (average 1 IC (DE ± 0.7
–
1.2)). The mean
ventricular eyection fraction was 65%. The indexed aortic valve area
0.40 cm
2
/m
2
. Mortality was 20.6%, for valve disease 21% and overall
cardiovascular causes 57.9%. The actual treatment is conservative in
76%, 14.4% refused surgery and in 6.2% TAVI was implanted, and
surgery was performed in 3.1%.
Conclusion:
We observed most frecuently patients were small, obese
and women. Modified MCHI increases with increasing age of patients.
HF and cardiovascular mortality is high in patients who did not
undergo surgical treatment, but by the time in octagenarian and
nonagerian population conservative treatment is still the most
common.
P-515
Recurring polyserositis as manifestation of occult tumor in an
edlerly patient
R. Moreira da Cruz, M. Cruz, F. Sousa, I. Zão, F. Ribeiro, M. Aveiro,
G. Jesus.
Baixo Vouga Hospital Center, Aveiro, Portugal
Polyserositis is a serous membrane chronic inflammation that results
in fibrosis and fluid in the pleural, pericardial and peritoneal cavities.
It can be induced by autoimmune diseases, medications, infections
and neoplasm
’
s. Pleural metastasis generally appear after the primary
neoplasm is diagnosed and are a late complication with poor
prognosis. It is more frequent in breast and lung cancer, leukaemia
and lymphoma, ovary cancer and only then gastrointestinal cancer.
Citology is positive in over 50% of patients.
79 year old male, admitted with chest pain, dyspnoea with 2 months
evolution, orthopnea and oedema of the lower extremities. Lab panel
showed Ureia 144 mg/dL, Creatinine 3,46 mg/dL and respiratory
insufficiency. Chest X-ray had bilateral pleural effusion. Was admitted
with cardio-renal syndrome. Submitted to several thoracocentesis
with relapsing pleural effusion and paracentesis, with presence of
cancer cells in all citology exams. Pleural biopsy showed malignant
cells, suggestive of adenocarcinoma of the Gastro Intestinal Tract.
Endoscopy, colonoscopy and thorax, abdomen and pelvis CT showed
pleural and peritoneal fluid and had no evidence of the primary
neoplasm. Prostatic ultrasound was negative. The patient had an
unfavourable evolution and was put on palliative care after oncology
evaluation.
This case reflects the difficulty in the diagnosis of the primary tumor.
In the elderly it can be even more challenging to diagnose due to all
comorbilities associated. The presence of cancer cells in all cytology
and in pleural biopsy led to a more extensive study, but even with
immunohistochemistry indicating Gastro Intestinal origin the primary
cancer wasn
’
t found.
P-516
Therapy-related leukemia after lung cancer chemotherapy
K. Natori, N. Daisuke, S. Ishihara, A. Sakai, Y. Toyoda, M. Kato,
Y. Kuraishi, K. Arai, H. Izumi.
Division of Hematology & Oncology,
Internal Medicine, Toho University Medical Center Oomori Hospital
Background:
Therapy-related leukemia defined by the World health
Organization 2008 classificationscheme of hematolymphoid tumors
including therapy-related acute myeloid neoplasms (t-AML),
myelodysplastic syndrome (t-MDS). They occur as late complication
of cytotoxic chemotherapy, radiation therapy and molecular target
agents therapy against primary neoplasms. Recently, for lung cancer
chemotherapy, new anti-cancer agent and molecurar target agents are
increased and more intensification chemotherapy performed. We
report that we reviewed t-AML cases who survived from lung cancer
and sufferd t-AML.
Methods:
We intended for multiple neoplasms 342 cases including
hematological malignancy. We reviewed 39 multiple neoplasms
including the lung cancer. In 39 cases, second neoplasms that were
acute myeloid leukemia cases were 2 cases. We selected more than 65
years patients. All patients were followed up until death or untile
December 2014. Survival was measured from the diagnosis of multiple
cancer to time of death or last contact. We investigated cytogenetic
abnormality, therapy, clinical outcome, prognosis, and cause of death.
Results:
There were 3 cases multiple neoplasms including lung
cancer and acute myeloid leukemia. In 3 cases, metachronous type
and primary neoplasms that were lung cancer were 3 cases. This 2
cases were diagnosed therapy-related leukemia by WHO2008 classi-
fication. 2 of cases were male and femal 1 respectively, primaly
diagnosis were small cell carcinoma, squamous carcinoma. Previous
cases, he treated operation and radiationtherapy, another cases treated
operation and chemotherapy that included cisplatin and camptotecin.
One case was acute promyelocytic leukemia(t-APL) that had t(15;17)
and PMLRAR
α
, another case was M2 type(French-American-British
Classification) that indicated t(8;21) abnormality. About t-APL, he
treated by all-trans retinoic acid and he reached complete response. T-
M2 type, he treated by chemotherapy included daunorbicin and Ara-C
(DC3-7), she did not achieve complete response. About prognosis, t-
APL case, he lived 1 month after complete response, he died by lung
cancer, t-AML cases, she lived 25 months after partial response, she
died by t-AML relapse and refractory for salvagy chemotherapy.
Conclusion:
As the number of lung cancer survivors increased due to
improvement in chemotherapy, clinician must more take attention of
therapy-related leukemia and myelodysplastic syndrome by previous
treatments.
P-517
Paraneoplastic RS3PE
–
a case report
A.R. Nogueira
1,2
, D. Ferreira
1,2
, A. Aragão
2
, M.T. Veríssimo
1,2
,
A. Carvalho
1,2
.
1
Faculty of Medicine of the University of Coimbra,
2
Coimbra Hospital and Universitary Center, Portugal
Remitting seronegative symmetrical synovitis with pitting edema
(RS3PE) is an uncommon type of acute polysynovitis affecting older
patients. It has a good outcome if no underlying disorder is identified.
In some cases is associated with other pathologies, namely auto-
immune or neoplastic. We present a case of a 78 years old female
patient who had acutely developed edema of the extremities, associa-
ted with arthralgia affecting bilateral proximal interphalangeal
and metacarpophalangeal joints, wrists and ankles. She also reported
significant weight loss and asthenia. There was a positive past medical
history of arterial hypertension, type 2 diabetes, atrial fibrillation
and chronic renal disease (stage 3). Examination revealed bilateral
pitting edema of dorsum of hands and feet and synovitis at proximal
interphalangeal joints and wrists, with functional limitation. Blood
tests revealed normochromic and normocytic anemia (haemoglobin
of 9,9 g/dL) and raised erythrocyte sedimentation rate (110 mm/h).
Autoimmunity screening detected a low titer of anti-nuclear anti-
bodies (1:160), with a dense fine speckled pattern and negative
rheumatoid factor and anti-CCP antibody. Radiological findings of
hands and feet did not show any erosions. The patient performed a
colonoscopy that revealed a lesion within 20 cm from the anal verge,
which histopathological analysis was compatible with adenocarcin-
oma. No metastasis were identified at a thoraco-abdomino-pelvic
CT scan. The treatment was started with methylprednisolone 16 mg
with a satisfactory response. She was referred to a surgeon and a left
Poster presentations / European Geriatric Medicine 7S1 (2016) S29
–
S259
S165