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Elderly patients requiring cardiac surgery for degen-

erative aortic stenosis has increased, but often are not refered only

because of advanced age.


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.


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




. 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%.


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



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


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.


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


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.


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.


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)



, 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.


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



Paraneoplastic RS3PE

a case report

A.R. Nogueira


, D. Ferreira


, A. Aragão


, M.T. Veríssimo



A. Carvalho




Faculty of Medicine of the University of Coimbra,


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