107 / 210
Poster presentations / European Geriatric Medicine 6S1 (2015) S32
–
S156
S99
in random double-blinded order. Subjects were fed a standardized
meal and then continuously monitored for 90 minutes.
Results:
14 out of 15 Type 2 diabetes subjects in our
study demonstrated PPH during the placebo session. Subjects
demonstrated 0.7 fewer PHEs (p = 0.042, 0.1 to 1.2, 95 percent
confidence interval) during the acarbose session (0.8
±
0.2 PHEs)
as compared to the placebo session (1.5
±
0.3 PHEs). Systolic
blood pressure (SBP; main effect of session, p = 0.030) and mean
arterial pressure (MAP; p = 0.035) were higher during the acarbose
session by 2-way mixed design analysis of variance with repeated
measures.
Conclusions:
This is the first study to demonstrate acarbose
reduced PHEs and raises postprandial blood pressure in older adults
with Type 2 diabetes complicated by PPH.
P-252
Transcatheter aortic valve implantation registry with
comprehensive geriatric assessment (CGA-TAVI)
G. Mannarino
1
, G. Santoro
2
, M. Stolcova
2
, L. Piccioli
3
,
N. Marchionni
4
, A. Schoenenberger
5
, P. Bramlage
6
, J. Kurucova
7
,
J.-P. Michel
8
, M. Thoenes
7
, A. Ungar
9
1
AOU Careggi Universit`a Degli Studi Firenze, Florence, Italy;
2
AOU Careggi, Florence, Italy;
3
Universit`a di Firenze, Florence, Italy;
4
Geriatric Cardiology and Medicine, Florence, Italy;
5
Switzerland;
6
IPPMed, Mahlow, Germany;
7
Edwards, Geneve, Switzerland;
8
EUGMS,
Geneve, Switzerland;
9
Azienda Ospedaliero Universitaria Careggi,
Florence, Italy
Objectives:
Many elderly patients are never considered for surgery
as treatment of severe degenerative aortic stenosis, resulting in
a curtailed survival rate at 32%, 60% after one, 5 years. The
transcatheter aortic valve implantation (TAVI) has shown an
absolute reduction in all-cause mortality of 20% compared to
medical therapy. The aim of the registry is to identify patient
characteristics and indicators related to complications and clinical
benefit in the elderly.
Methods:
CGA-TAVI commenced in February 2014. The co-
primary objectives are to establish predictive value of CGA
(with Multidimensional-Prognostic-Index (MPI), short-physical-
performance-battery (SPPB), and SilverCode) for mortality and
hospitalization and to demonstrate CGA changes after TAVI.
Results:
As of April 2015 44 patients had been enrolled. Patients
had a mean age of 85.4
±
2.7 years. The majority of patients had
NYHA class III/IV (82.4%). At baseline mean MPI was 0.34
±
0.11, SPPB
6.4
±
3.3 and SilverCode 21.2
±
8.4, compared to 0.33
±
0.14, 7.6
±
2.8,
and 23.4
±
6.9 three months after TAVI. One patient had NYHA III,
none NYHA IV. A total of 6 patients reached the combined endpoint
of death or stroke within 3 months after TAVI which had a higher
MPI (0.42
±
0.14) and SilverCode (23.3
±
4.4) at baseline compared to
those without (0.34
±
0.10; 20.9
±
8.3).
Conclusions:
These preliminary results show improvement of
NYHA functional class at 3 months follow-up. Although of the
limited number of patients the registry hint to identify patients
who would benefit by TAVI.
P-253
Acute respiratory distress in geriatrics: the saving call to the
medical intensivist
A. Martin-Kleisch
1
, A.-A. Zulfiqar
1
, J.-L. Novella
2
1
CHU Reims, Reims, France;
2
France
Objectives:
The vital distress in geriatric populations is common,
however, the appeal of a medical intensivist is not systematic as it
could allow a saving care.
Methods:
We illustrate this problem by a clinical case.
Results:
A patient of 80 years is hospitalized in our department
for blood transfusion for anemia. She is followed for mixed chronic
respiratory failure treated by oxygen therapy 1 Litre per minute.
On the seventh day, she presented an episode of desaturation and
significant bronchial congestion. The blood pressure of the patient
was of 135/85mmHg, the heart rate was 75 beats per minute, the
saturation in 1 liter of ambient O2 was 75% and a temperature at
38.6°C. Clinical examination showed only confusion, a draw sternal
and intercostal and the emergence of left basal crackling. The gasses
blood showed a pH 7.21, a 35mmHg pO2, pCO2 at 108mmHg,
the HCO3–37mmol / L. Biology showed the appearance of a CRP
increased to 280mg / L. The chest radiograph showed atelectasis
in the left lung base. Given this acute carbonarcosis associated
with a probable bronchopulmonary infection, we contacted the
intensivists who have accepted the patient in intensive care.
However, the evolution has proved fatal after 48 hours non-invasive
ventilation.
Conclusions:
It is essential to have a constructive dialogue with
intensivists. Geriatricians must be convinced of the usefulness of
a transfer in the ICU, which also determines the approval of the
medical intensivist.
P-254
Aseptic osteonecrosis of the femoral neck: a diagnosis not
to ignore in the elderly
A. Martin-Kleisch
1
, A.-A. Zulfiqar
1
, J.-L. Novella
2
1
CHU Reims, Reims, France;
2
France
Objectives:
Aseptic osteonecrosis of the femoral neck is a diagnosis
not to ignore in the elderly.
Methods:
We illustrate this problem by this case.
Results:
A patient of 92 years was referred to our department
for minor drop repeatedly for several months. She was diagnosed
with type 2 non-insulin dependent diabetes treated with biguanide.
She would have fallen with his walker and wouldn’t have been
able to stand up. The patient had spontaneous pain at the
right hip flexion without flessum, but had a limited mobility of
the lower limb in external rotation to 20°, internal rotation to
about 10°, adduction and abduction to about 20° flexion to 70° bent
knee and extension at 5°. Otherwise, the physical examination
was normal. The pelvis radiograph showed osteoarthritis of the
hip, but also possible signs of osteonecrosis with a focus of
sclerosis of the femoral neck may correspond to a stage IV
of Ficat’s classification. This was complemented by a CT report
confirming this osteonecrosis stage 4. The etiological balance of this
osteonecrosis did not find any inflammatory, neoplastic particular
abnormality
Given the absence of chronic alcoholism and cancer, often the
traumatological cause associated with an ancient type 2 diabetes
could be retained in the diagnosis of osteonecrosis of the femoral
head. Surgical management was decided.
Conclusions:
In front of all repeated fall, radiological examination
must be performed and the only fracture is not the only orthopedic
diagnosis to look in the elderly.
P-255
Age and gender differences in the haemodynamic response
of patients with neurally mediated syncope
N. Obiechina
1
, A. Michael
2
, D. Bezzina
1
, M. Oldfield
1
, L. Jones
1
,
L. Barber
1
, N. Naseer
1
, C. Jackson
1
, C. Jayakumar
1
1
Queen’s Hospital, Burton on Trent, United Kingdom;
2
Russells Hall
Hospital, Dudley, United Kingdom
Introduction:
Neurally mediated (reflex) syncope is the most
common cause of syncope. The incidence of syncope shows a sharp
rise after the age of 70 years.
We studied the age and gender differences in the haemodynamic
response in patients with positive Tilt Table Tests (TTT).
Methods:
Audit of all patients, referred as part of syncope and falls
work up, who had a TTT in a 62 months period in a UK district
general hospital. The modified Westminster protocol was used.