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internal medicine wards, including infectious focus, most frequent

microbiological agents implied, treatment and outcomes.


We have performed a retrospective cohort study including

281 patients aged >65 years old with sepsis admitted to internal

medicine wards of our hospital during a 12-month period.


Their mean agewas 82.42 years, 52.3% were female and 94.3%

had significant comorbidities. On admission, 192 patients (68.3%) had

community acquired infection. 106 patients (37.7%) presented septic

shock. 91.5% of this infected population had microbiological docu-

mentation. More than half received inappropriate initial antibiotic

therapy, but still one quarter kept the initial treatment. 52.3% and

35.2% had urinary and respiratory infectious focus, respectively.

Multiresistant agents were found in 10.8% blood cultures, 28.4% in

urine cultures and 30.3% in spuctum cultures. 31.3% of the patients

died and roughly half of these patients had septic shock. Mean admis-

sion length was of 12 days. On multivariate analysis, the presence of

septic shock was an independent prognostic factor of mortality.


Sepsis in the elderly remains a challenge due to age-

related vicissitudes and to their comorbidities. Higher functional

disability as well as the use of inapropriate antibiotics are independent

prognostic factors wich adversely affect the outcome of patients with

sepsis admitted to Internal Medicine wards.


Cameron ulcers

forgotten cause of severe anemia

F. Pontes, J. Leite, D. Aguiar, M. Valério, C. Athayde, A. Rodrigues.

Hospital Geral dos Covões, Coimbra, Portugal


Cameron lesions are an uncommon and frequently

overlooked cause of insidious gastrointestinal bleeding and iron

deficiency anemia. They are described as chronic linear erosions

or ulcers positioned on the crests of folds at the diaphragmatic

impression in patients with a large hiatal hernia. The cause of Cameron

lesions remains unclear and its diagnosis requires a high index of

suspicion. The response to medical treatment is variable. Treatment is

based on oral iron replacement therapy and antisecretory therapy with

proton pump inhibitors. A case with typical clinical and endoscopic

presentation and good response to medical therapy is reported.


To report a case of severe anemia due to Cameron Ulcer.

Design: Case report. Setting: Community teaching hospital. Patient:

84-year-old woman coming to the hospital with dyspnea and cough.

The X Ray reveled a Community Adquired Pneumonia. On presenta-

tion, her blood hemoglobin level was 4.6 g/dL, so she had to receive

blood transfusion. She underwent EGD which confirmed a large hiatal

hernia and showed milimetric ulcer, consistent with a Cameron lesion.

The ulcer was treated with a proton pump inhibitor. She started iron

and folic acid replacement therapy and recovered uneventfully.


Cameron ulcers are a mechanical phenomenon, related to

extrinsic compression of the diaphragm on the stomach in patients

with large hiatal hernias. These lesions should be suspected during

upper endoscopy in patients with large hiatal hernias as Cameron

ulcers may be overlooked due to their location along the diaphrag-

matic impression.


A difficult case of refractory heart failure

A. Pratesi


, F. Orso


, A. Baroncini


, A. Foschini


, E. Carrassi


, C. Ghiara



S. Parlapiano


, A. Herbst


, N. Marchionni


, M. Di Bari


, S. Baldasseroni




Department of Experimental and Clinical Medicine, Careggi University

Hospital, University of Florence, Florence,


University of Florence, Florence

A 77 years old woman remained in good health until December 2013

when began to lose weight and to complain fatigue and dyspnea.

In March 2014 a cardiological evaluation was performed: echocardi-

ography showed moderate mitral regurgitation, elevated LV filling

pressures and increased PAPS. She was started on diuretic therapy and

nitrates. From May to June she was admitted three times for acute

heart failure; echocardiographic findings were stable. Cardiac MRI

demonstrated increased thickness of intraventricular septum and

widespread iperenhancement, especially in basal and middle seg-

ments of subepicardial layer. Protein electrophoresis detected two

monoclonal components (IgA lambda and small level of free lambda

chains). Periumbilical fat biopsy resulted negative. Abdominal CT


t show significant evidences. The patient returned home, but

from discharge dyspnea rapidly worsened together with increased

peripheral edema refractory to diuretic therapy. In July, again

hospitalized, the patient appeared somnolent, with low blood

pressure and in an anasarcatic state. At the Electrocardiography,

reduced voltage in the peripheral leads appeared; Nt-proBNP was

50,000 pg/mL. Serum immunofixation confirmed monoclonal com-

ponent IgA LAMBDA with abundant free light chains in serum

(428.00 mg/L; ratio kappa/lambda 0.0080). Sampling of periumbilical

fat was repeated with positive result. We concluded for diagnosis of

isolated cardiac AL amyloidosis. Chemotherapy was contraindicated

and the patient died after 12 days of hospitalization. Isolated cardiac

amyloidosis is a rare disease (3.9%): It should be suspected in all

patients with heart failure who have a wall thickening at echocardi-

ography, with normal size of the heart chambers and low ECG voltages.


Start low

Go slow? Twomonths experience in the first Portuguese

geriatric unit

F.R. Rocha, R.T. Martins, E.D. Haghighi, J.A. Barata.

Geriatric Unit, Internal

Medicine Department, Hospital Vila Franca de Xira, Portugal


In Portugal Geriatric medicine it is in its early days and a

comprehensive health care approach of this age group is still sparse.

The pilot project of the Geriatric Unit of Hospital Vila Franca de Xira is

pioneer in Portugal and started on March 1st of 2016.


We retrospectively analysed the patients admitted to the

Geriatric Unit between March 1st and April 30th 2016. All patients

were submitted to a comprehensive geriatric assessment (CGA). We

divided the sample between patients with and without criteria for

admission, and in the former we evaluated the distribution by sex, age,

number of diagnosis and drugs taken, length of stay, CGA, admission

cause and final diagnosis.


From the 43 patients sample, 34 (79%) had admission criteria.

The main exclusion criteria were age, no reversibility potential, acute

disease only and terminal illness. Within the patients with criteria the

average age was 83.4 years, 67.6% were female and 32.4% male, 17.7% of

patients have had an admission in the previous month. The average of

drugs on admission was 7.8, the average of co-morbidities was 4. The

average length of stay was 8.9 days. The most common first discharge

diagnosis was acute tracheobronchitis, congestive heart failure

exacerbation and urinary tract infection.

Key conclusions:

As in many new projects, the Geriatric Unit Team

foresees several obstacles on the way to achieve the optimal elderly

care. The biggest barrier expected is the non-recognition by all

healthcare providers of a truly geriatric patient.


Emergency room utilization in tertiary Portuguese hospital by

older adults

G. Sarmento


, F. Leal-Seabra


, M. Brinquinho


, R. Veríssimo



A. Oliveira




Internal Medicine Department of Centro Hospitalar Vila

Nova de Gaia/Espinho


Emergency departments [ED] are challenged to provide

rapid access to high-quality care and are needed to create a pathway to

assist the elders. We describe the older profile.


Data were obtained from a sequence of 4 weeks. The

variables analyzed were: gender, age, ICD9, color of the Manchester

Triage System, discharge and length of stay. Statistical analysis was

used for comparing means to a pvalue <0.05 and relative risk (RR).


The admission to ED were 7827, and the data represent 87.7%.

Older adults comprised 33.7% of all ED visits during this time. Of note,

ED visits were more likely to be associated with women with middle

age, triage with yellow color [63.9%], moderate severity, ICD 9 injury

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