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extruded two hard fragments that appear to be bone, which are used

for morphological study.


The submitted sample is described as necrotic bone tissue

with abundant bacterial colonies of Actinomyces. Amoxicillin treat-

ment is initiated for a period of six weeks, being the patient

asymptomatic at the time of writing this report.

Key conclusions:

The correct diagnosis of this entity is critical to set a

successful therapeutic treatment to prevent disabling symptoms such

as delirium.


Doctor, I have a terrible headache

T. Martínez Maroto, E. García Tercero, A. Blanco Orenes, F. Moreno

Alonso, B. Cámara Marín.

Hospital Virgen del Valle


Painful ophthalmoplegia is characterized by painful

ocular paralysis and resistant to analgesic treatment ipsilateral

headache. It is produced by an affectation of the cavernous sinus that

may be due to multiple causes.


The case below is a 84-year-old patient referring headache,

progressive, with twenty days of evolution. After having been valued

on several occasions in the Emergency Department, with normal

results on complementary tests, with analgesic treatment without

clinical improvement, the patient was hospitalized in our hospital.

She refers severe left hemicraneal headache with left cranial nerve VI

(CN VI) paralysis. Triptans were prescribed, persisting the symptons, so

we gave corticosteroids at high dose and request nuclear magnetic

resonance (NMR). Afer 24 hours with costicosteroids, she refers CN VI

paralysis without headache.


The NMR shows diffuse meningeal thickening in both

cavernous sinus with left dominance, thickening of both ophthalmic

veins and perineural enhancement of both optic nerves, with left

dominance. Findings from imaging tests along with the clinical

improvement and discarded other pathologies, are compatible with

Tolosa-Hunt syndrome.

Key conclusion:

Tolosa-Hunt syndrome is a rare disease, defined as a

idiopathic granulomatous inflammation of the cavernous sinus and

superior orbital fissure, characterized clinically by unilateral painful

ophthalmoplegia, associated with abnormalities in brain

s NMR. In

his diagnosis, exclusion of other causes of painful ophtalmoplegia

is important. The main pillar of the treatment are corticosteroids at

high doses and maintained over time, with fast response, showing

improvement in pain before 72 hours, although the ophthalmoplegia

may take weeks or months to resolve.


Walking in hospital is associated with a shorter length of stay in

older medical inpatients

R. McCullagh


, C. Dillon


, D. Dahly


, N.F. Horgan


, S. Timmons





for Gerontology and Rehabilitation, University College Cork,



of Epidemiology and Public Health, University College Cork,



Research Facility Cork, Mercy University Hospital, Cork,


Royal College of

Surgeons in Ireland, Dublin, Ireland


We aimed to estimate the associations of step-count

(walking) in hospital with physical performance and length of stay in

older medical inpatients.


Medical in-patients aged

65 years, premorbidly mobile,

with an anticipated length of stay

3 days, were recruited.

Measurements included average daily step-count, continuously

recorded until discharge, or for a maximum of five weekdays

(Stepwatch Activity Monitor); co-morbidity (CIRS-G); frailty (SHARE

F-I); and baseline and end-of-study physical performance (Short

Physical Performance Battery). Linear regression models were used

to estimate associations between step-count and end-of-study

physical performance or length of stay. Length of stay was log

transformed in the first model, and step-count was log transformed

in both models. Similar models were used to adjust for potential



Data from 154 patients (mean 77 years, SD 7.4) were analysed.

The unadjusted linear regression models estimated for each unit

increase in the natural log of step-count, the natural log of length of

stay decreased by 0.18 (95% CI

0.27 to

0.09). After adjustment of

potential confounders, while the strength of the inverse association

was attenuated, it remained significant (


log(steps) =

0.15, 95%CI

0.26 to

0.04). This showed a 50% increase in step-count was

associated with a 6% shorter length of stay. There was no apparent

association between step-count and end-of-study physical perform-

ance once baseline physical performance was adjusted for.


The results indicate that step-count is independently

associated with hospital length of stay, and merits further



Acute kidney injury: case report

C.M. Mendes


, J.M. Dias


, H. Silva


, E. Nogueira


, S. Jorge


, J.M. Lopes



J.A. Lopes




Centro Hospitalar de Lisboa Norte - Hospital de Santa Maria,

Medicina Interna 2,


Centro Hospitalar de Lisboa Norte

Hospital de

Santa Maria, Nefrologia e Transplantação Renal, Lisboa, Portugal


Acute interstitial nephritis (AIN) is an important cause

of acute kidney injury (AKI) and its prevalence in the elderly may be



We report a case of an 83-year-old man, with a prior

history of uncomplicated hypertension, who started ciprofloxacin for

acute infectious colitis. Three days later, he presented new onset of

nausea, vomiting and nonoliguric stage 3 (KDIGO) AKI with need of

renal replacement therapy. Urinary sediment revealed leukocytes,

erythrocytes and granular casts. The autoimmune study and renal

ultrasound were normal. Although kidney biopsy was inconclusive,

chronology of the events and evolution of the disease suggest AIN

due to ciprofloxacin. The patient started prednisolone 1 mg/Kg/day,

achieving normal renal function within 3 weeks.


The majority of AIN among elderly are due to drugs,

while autoimmune or systemic causes are uncommon. The classical

presentation is featured by hypersensitivity manifestations (skin

rash, eosinophilia, fever) but has been largely replaced by oligosymp-

tomatic presentations that require a higher suspicion index. The

definitive diagnosis is dependent on kidney biopsy, however, a

relatively normal biopsy and urinalysis findings should not exclude

it. Therefore, drug-induced AIN (DI-AIN) should be suspected in a

patient who presents with AKI after administration of a known culprit

drug and a suggestive urinalysis. The presumptive diagnosis may be

established when drug discontinuation results in clinical improve-

ment. So, the mainstream of therapy is rapid discontinuation of the

culprit agent. Although corticosteroids are widely used in DI-AIN to

speed kidney function recovery and avoid chronic kidney disease, their

efficacy remain unproven.


Multidisciplinary frailty assessment in the emergency department:

driving the future today!

L. Mieiro


, O. Kayode


, F. Hayat


, F. McCarthy


, S. Green





of Medicine for Elderly People, Whipps Cross University Hospital, Barts

Health NHS Trust,


Forest Assessment Unit, Whipps Cross University

Hospital, Barts Health NHS Trust,


Admissions Avoidance Team, Whipps

Cross University Hospital, Barts Health NHS Trust, London, United



Demographic change is an increasing challenge for

Emergency Departments (EDs). Frail elderly patients attending EDs are

exposed to more adverse outcomes, such as hospital admission and

multiple attendances. The authors analyse the impact of comprehen-

sive geriatric assessment (CGA) delivery in ED and explore possible

predictors of hospital admission in frail elderly patients.


Prospective observational cohort study in the ED of a British

University Hospital over an 8-week period. All cases assessed in the ED

Frailty Unit included. Statistical analysis performed on SPSSv23.

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