European Geriatric Medicine - Supplement 1 - Volume 7 - October 2016

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fractions that lasted <7 minutes the motion in all axes is statistically
significantly (p < 0.003) lower than in the radiotherapy fractions
lasting ≥7 minutes.
Conclusions: During radiotherapy fractions prostate motion is great-
est in the vertical and sagital axes. During radiotherapy fractions that
lasts ≥7 minutes prostate motion is greater than in procedures that
lasts <7 minutes.
P-522
The older patient with dysautonomia. A syncope unit experience
M. Rafanelli, I. Marozzi, A. Ceccofiglio, F. Tesi, A. Riccardi, G. Rivasi,
S. Venzo, F.C.G. Sacco, E. Schipani, N. Marchionni, A. Ungar. Syncope
Unit, Division of Geriatrics, University of Florence, Azienda Ospedaliero-
Universitaria Careggi, Florence, Italy
Objectives: dysautonomia can be primary or related to typical diseases
of the older adult and is often misdiagnosed. Our Unit has decided to
extend its activity, applying the screening for cardiovascular auto-
nomic failure and assessing its reliability and diagnostic yield in the
clinical practice.
Methods: Between March 2014 and July 2015, 26 consecutive patients
referred from Neurology and Cardiology department, underwent
60°-tilt testing, deep breathing, hand grip, mental stress, Valsalva
manoeuvre, cold pressor test, hyperventilation and active standing
test, under continuous monitoring (Nexfin®).
Results: The mean age was 63.5 ± 18.8. Cardiovascular autonomic
failure was diagnosed in 5 patients (19.2%), 1 with AL amyloidosis, 3
with Parkinson’s disease and 1 with Multiple System Atrophy: the
Valsalva manoeuvre was blocked in 13,6% of the patients, orthostatic
hypotension was detected in 65,4%. Orthostatic hypotension was
confirmed in 12 patients, with normal Valsalva, complaining syncope
(50%), pre-syncope and dizziness (66.7%).
Conclusions: The present evaluation allowed the detection and better
understanding of complex clinical conditions, highlighting the need
for cooperation between different medical specialties in the assess-
ment of dysautonomia, both for the diagnosis and the treatment, in
order to reduce symptoms and improve patient’ s quality of life.
P-523
Cardiovascular risk factors associated with aortic stenosis in
octogenarians and nonagenarian patients
M. Ramos 1, R. Toro2, R. Ayala1, J.G. Pavón 3, Z. Rivas3, M. Quezada1.
1Department of Cardiology: Hospital Universitario Central Cruz Roja,
Madrid, 2Department of Internal Medicine, University Hospital Puerta del
Mar, Cádiz, 3Department of Geriatrics: Hospital Universitario Central Cruz
Roja, Madrid, Spain
Introduction: Degenerative aortic stenosis (DAS) has become the
most frequent type of valvular heart disease. Cardiovascular risk
factors (CRF) involved in the development of DAS share similarities
with atherosclerosis.
Methods: Prospective longitudinal study from June 2014 to April 2016
that included 97 over 75 years old patients with moderate or severe
AS stenosis seen in outpatient cardiology clinic. Epidemiological,
anthropometric and CRF data was collected. They underwent
transthoracic echocardiography. Surgical risk logistics Euroscore
scale mortality prediction was quantified. The variables analyzed
were CRF and the ones included in Charlson index.
Results: 52.6% had severe and 47.4% moderate AS. The average age was
86 y (IQR 79–90) and 69.1% were women. 71% were symptomatic.
Dyspnea was the most frequent symptom followed by chest pain 3.1%.
32% were obese and 38% overweight. The most common CRF was
hypertension (HTA) 90.7% followed by dyslipidemia 56.7% type 2 DM
37% and smoking 2.1%. 42% of patients presented atrial fibrillation
and 13,4% had history of coronary events. 46.6% were under statins
treatment. In the multivariate analysis, only dyslipidemia was the CRF
associated with aortic stenosis.
Conclusion: There is a high prevalence of cardiovascular risk factors
associated with EA. Modification of atherosclerotic risk factors must be
strongly recommended, especially dyslipidemia, to slow progression
or prevent the disease.
P-524
Late onset lupus – a case report
F. Ribeiro1, R. Cruz1, F. Sousa1, M. Cruz1, I. Zão1, G. Jesus2. 1Resident of
Internal Medicine, Centro Hospitalar Baixo Vouga, 2Graduated consultant
of Internal Medicine, Centro Hospitalar Baixo Vouga
Introduction: Systemic lupus erythemtous (SLE) is a multissystemic
autoimmune disease, traditionally considered a disease of young
women. However several reports have described SLE in elderly
populations, with a 9% development after the age of 50 in the Euro-
Lupus cohort.
Case presentation: 71- year old woman with chronic heart failure
class II (NYHA), atrial fibrillation, hypertension and dyslipidemia
treated with furosemide, valsartan+ hydrochlorothiazide, lercanidi-
pine, diltiazem, synvastatin and rivaroxaban, admitted with an
acute decompensated heart failure. X-ray: increased cardiothoracic
index. Echocardiogram: large pericardial effusion without evidence
of hemodynamic compromise, tricuspid regurgitation and right
ventricular dysfunction. During the hospitalization she manifested
biphasic Raynaud, that she had been presenting for 7 years, and non-
erosive arthritis. She reported a history of arthritis at 12 and 4 years
before, treated with corticosteroids and occasional painless oral
ulceration. Additional study: sedimentation rate 56 mm, positive
antinuclear antibodies (1/320), anti-dsDNA (62 UI/mL), anti-SSA/Ro
(17 U/mL) and C3 consumption. Serologic tests for syphilis and virus
and neoplastic markers were negative. Thoraco-abdomino-pelvic
CT: small pericardial effusion and small pleural effusion. The diagnosis
of systemic lupus erythematosus was made and she began treatment
with hydroxychloroquine with good response.
Conclusions: The low prevalence of SLE in the elderly and its non-
specific symptoms make the diagnosis difficult and may reflect
senescence of the immune system. Due to all the potential differential
diagnosis and the consequences of polymedication, it also gets mis-
or undiagnosed. As early diagnosis and treatment is necessary for
these patients, careful attention needs to be paid to symptoms and
laboratory findings.
P-525
Is age a discriminative factor? – patients with breast cancer older
than 80
M. Malheiro1, D. Cardoso1, C. Rodriguez1, A. Pissarra1, M. Miguens1,
L. Fernandes1, H. Miranda1, A. Plácido1, A. Martins1. 1Centro Hospitalar
de Lisboa Ocidental - Hospital São Francisco Xavier, Medical Oncology
Introduction: Longer life expectancy results in more cancer in
elderly. According to the National Cancer Institute’ s Surveillance
Epidemiology and End Results (SEER) half of breast cancer patients are
over 65 years old, 25% between 75 and 84 years and 10% over 85.
Methods: Retrospective, observational, descriptive study, between
01.2010 and 06.2015, of breast cancer patients 80 years or older.
Results: 93 women. Minimum age: 80 and maximum: 96 years. 22
in stage IA; 3 IB; 19 IIA; 10 IIB; 9 IIIA; 12 IIIB; 4 IIIC; 14 metastasized:
bone (n = 6), lung and skin (n = 2), lymph node (n = 3) and brain (n = 1).
Histological Subtypes: 31 Luminal A, 48 Luminal B, 12 Triple
negative, 2 HER2. Neoadjuvant Hormonotherapy (HT): 7. Surgery:
71 (21: modified radical mastectomy; 9: Simple mastectomy; 21:
lumpectomy + GS 14: lumpectomy, 6: lumpectomy + GS). 5 refused
surgery. Adjuvant therapy: 2 chemotherapy and 60 HT (Tamoxifen:
20; Aromatase Inhibitor (AI): 40). Patients who didn′t underwent
surgery: 1 vinorelbine+trastuzumab, 20 HT, 2 RT (anti-Algic), 1 never
met conditions for treatment. 55 would have indication to QT, but
only 3 did. HT was suspended in 3 patients: 1 stroke, 1 toxidermia,
1 headache. Three deaths (2 stage IV and 1 IIA). Progression-free
survival: 15 months. Overall survival: 31 months. Median value of
Charlson comorbidities index: 7.9%, translates relative mortality risk:
19.37%.
Poster presentations / European Geriatric Medicine 7S1 (2016) S29–S259 S167