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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


7 minutes.


During radiotherapy fractions prostate motion is great-

est in the vertical and sagital axes. During radiotherapy fractions that


7 minutes prostate motion is greater than in procedures that

lasts <7 minutes.


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.


Unit, Division of Geriatrics, University of Florence, Azienda Ospedaliero-

Universitaria Careggi, Florence, Italy


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.


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




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%).


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.


Cardiovascular risk factors associated with aortic stenosis in

octogenarians and nonagenarian patients

M. Ramos


, R. Toro


, R. Ayala


, J.G. Pavón


, Z. Rivas


, M. Quezada




Department of Cardiology: Hospital Universitario Central Cruz Roja,



Department of Internal Medicine, University Hospital Puerta del

Mar, Cádiz,


Department of Geriatrics: Hospital Universitario Central Cruz

Roja, Madrid, Spain


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.


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.


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.


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.


Late onset lupus

a case report

F. Ribeiro


, R. Cruz


, F. Sousa


, M. Cruz


, I. Zão


, G. Jesus




Resident of

Internal Medicine, Centro Hospitalar Baixo Vouga,


Graduated consultant

of Internal Medicine, Centro Hospitalar Baixo Vouga


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.


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.


Is age a discriminative factor?

patients with breast cancer older

than 80

M. Malheiro


, D. Cardoso


, C. Rodriguez


, A. Pissarra


, M. Miguens



L. Fernandes


, H. Miranda


, A. Plácido


, A. Martins




Centro Hospitalar

de Lisboa Ocidental - Hospital São Francisco Xavier, Medical Oncology


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.


Retrospective, observational, descriptive study, between

01.2010 and 06.2015, of breast cancer patients 80 years or older.


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:


Poster presentations / European Geriatric Medicine 7S1 (2016) S29