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Poster presentations / European Geriatric Medicine 6S1 (2015) S32
–
S156
S97
P-244
A rare case of delirium and deranged liver function tests due
to levetiracetam in an elderly patient
T. Chavan
1
, D. D’Costa
1
1
Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, United
Kingdom
Background:
Levetiracetam is increasingly used in elderly for
treatment of seizures due to its good bioavailability, linear kinetics,
minimal side effects and few drug-drug interactions. There have
been few case reports of Levetiracetam as a cause of liver failure
and delirium predominantly in younger patients. We report a rare
case of an elderly patient with Levetiracetam drug reaction using
the Naranjo Drug Reaction Probability Scale (Score = 5 suggestive
of probable reaction).
Case:
An 88-year-old male presented with unresponsiveness and
incontinence. His GCS on admission was 9/15 with no focal
neurology. Blood tests showed normal liver and kidney functions
and normal inflammatory markers. A CT head showed occipital
atrophy but no infarct/bleed. A clinical diagnosis of seizure was
made and he was commenced on Levetiracetam. On day 4 his ALT
rose to 2676, Bilirubin- 32, Alkaline phosphatase- 82. He became
confused, agitated, unsteady and suicidal. An Ultrasound liver,
autoantibody screen, hepatitis serology, ammonia levels were all
normal. Levetiracetam was stopped immediately and LFT’s returned
to normal by day 21. His mental state, mobility and balance
improved back to baseline.
Conclusion:
This case highlights the challenges in managing
delirium. Validated probability scales for drug reactions are
available in clinical practice. In the exhaustive list of differentials
for delirium, we as geriatricians should keep an open mind for rare
drug reactions.
P-245
A rare cause of hemoptysis in the elderly: bronchiectasis
secondary to measles
B. Marques
1
, M. Antunes
2
, S. Gurreiro Castro
1
, F.G. Magalh˜aes
1
,
H.K. Gruner
3
, N. Riso
3
1
Servi ¸co de Medicina 2
–
Hospital Curry Cabral, Centro Hospitalar
de Lisboa Central, EPE, Lisbon, Portugal;
2
Servi ¸co de Medicina 2,
Hospital Curry Cabral, Centro Hospitalar de Lisboa Central, EPE,
Lisbon, Portugal;
3
Hospital de Curry Cabral, Servi ¸co de Medicina 2,
Lisboa, Portugal
Introduction:
Hemoptysis may originate from any part of the
respiratory tract. The most common causes are acute or chronic
tracheobronchitis, bronchiectasis, pulmonary tuberculosis (TB) or
lung cancer. It is associated with high morbidity and its etiological
investigation often requires invasive complementary exams.
Methods:
An 84-year-old male patient was admitted with hemop-
tysis. He had hypertension, dyslipidemia, carotid atherosclerotic
disease and measles during childhood. A comprehensive study
excluded cancer and TB. Thoracic CT showed bilateral calcic
pachypleuritis, ground glass opacities in the upper left lobe and
fibrotic scarring with bronchial wall tickening in the middle lobe.
The bronchofibroscopy was consistent with infection.
Radiologically, bronchiectasis could be secondary to TB or measles.
As the patient had no history of TB, it was assumed as case of
hemoptysis secondary to bronchiectasis due to measles.
The patient had numerous recurrences within the first year,
which, along with the need for chronic antiplatelet therapy, led
to therapeutic bronchial artery embolization. Complete remission
was verified after 6 months of follow-up, with improved quality of
life.
Discussion and Conclusion:
This clinical case raises awareness
for the existence of bronchiectasis in elderly patients without
history of repeated respiratory infections or TB. An increase in
measles’ prevalence should be expected due to the some countries’
unsatisfactory vaccination status.
It also stresses the need for an individualized approach in the
elderly, as factors other than age and current co-morbidities should
be taken into account and diagnostic and therapeutic resources
should not be withheld.
P-246
Radiofrequency ablation of thyroid nodules in frail elderly
patients: preliminary results
M. Gkeli
1
, I. Katsoulis
2
, I.G. Karaitianos
3
1
Department of Radiology, St. Savvas Cancer Hospital, Athens, Greece;
2
Department of Surgical Oncology, St. Savvas Cancer Hospital, Athens,
Greece;
3
Hellenic Association of Gerontology and Geriatrics, Greece
Objectives:
We aim to present our initial experience with
radiofrequency ablation (RFA) of symptomatic thyroid nodules in
elderly patients who are unsuitable for surgery due to serious co-
morbidities.
Methods:
The symptoms and signs of each patient and
the sonographic characteristics of the thyroid nodules (size,
echogenicity, internal vascularity and consistency) are recorded.
Cytological diagnosis is established by at least two separate
fine needle aspirations. RFA is applied into the nodules with
the “transisthmic approach method” and the “moving shot
technique” under ultrasound guidance. Follow-up is carried out
with ultrasound and serum concentration of the thyroid stimulating
hormone (TSH) in 1, 3 and 6 months.
Results:
RFA was applied in 4 female patients (age
>
65 years) with
benign thyroid nodules (Bethesda classification II). The size of the
nodules varied with maximum diameter
>
2 cm and volume ranging
from 1.7 cc to 59.6 cc. On follow-up examination the nodules
appeared hypoechoic and avascular with a volume reduction after
one month that ranged from 40 to 80%. Symptoms and neck
cosmesis improved significantly in all patients. Furthermore, RFA
was applied to a 75 years old male patient with a recurrence of
papillary thyroid cancer in a cervical lymph node. He had been
managed in the past with total thyroidectomy and radioactive
I-131 but could not tolerate further surgery. Both the lymph node’s
volume and serum thyroglobulin concentration decreased.
Conclusions:
RF ablation can be used to treat both benign thyroid
nodules and inoperable, recurrent thyroid cancers located in the
surgical bed as well as lymph nodes.
P-247
Breast cancer immunohistochemical characteristics and
prognostic factors in the elderly
I. Katsoulis
1
, S. Gantzoulas
1
, D. Nasikas
1
, D. Mitsaka
1
, G. Sakorafas
1
,
I.G. Karaitianos
2
1
Department of Surgical Oncology, St. Savvas Cancer Hospital, Athens,
Greece;
2
Hellenic Association of Gerontology and Geriatrics, Greece
Objectives:
The aim of the present study was to explore differences
in the tumour characteristics between older and younger patients
with breast cancer.
Methods:
Retrospective study of all breast cancer patients who
were managed over a two year period in a department of
general surgical oncology. The patients were divided in two
groups according to their age (
<
65 and ≥65 years). Group A was
comprised of 84 patients and group B was comprised of 71 patients.
Immunohistochemical characteristics and prognostic factors of the
tumours were recorded and comparison between the two groups
was performed with the software PASW Statistics 18. Differences
with p values
<
0.05 were considered significant.
Results:
Estrogen receptors were positive in 79.8% of tumours in
group A versus 88.7% in group B, while progesterone receptors were
positive in 67.8% and 74.6%, respectively. The average expression
of Ki-67 marker was 20.4% versus 16.7% and the percentage of