48 / 210
S40
Poster presentations / European Geriatric Medicine 6S1 (2015) S32
–
S156
Conclusion:
This study shows that aec is suitable for patients aged
90 years and above regardless of their functional status. Aec services
must therefore be inclusive of the very old in their design.
P-031
Urinary tract infection
–
what are the barriers to accurate
diagnosis?
K. O’Kelly
1
, D. Kondova
1
, S. Conroy
2
1
University Hospitals of Leicester, Leicester, United Kingdom;
2
United
Kingdom
Urinary tract infection, ‘UTI’, is commonly applied to older people,
but is it correct, was urine testing indicated and why are we so
quick to label patients with the diagnosis?
We surveyed the notes of 28 adult patients seen in the Emergency
Department. Of the 15 (54%) given a diagnosis of UTI, 9 (32%) had
typical symptoms. Seventeen of the 28 patients (61%) underwent
urine dipstick testing with 8 (29%) having a positive result for
nitrites/leucocytes. Eighteen of the 28 patients (64%) had urine
sent for culture with 4 (14%) growing a urinary pathogen.
This demonstrates that clinicians are over-diagnosing UTI, perform-
ing urinary dipstick testing inappropriately and misinterpreting the
results. Possible reasons for this include poor understanding of
existing guidelines, resistance to changing previous practice and
fear of adverse outcomes.
Subsequently, a mapping review was undertaken aimed at
identifying the barriers to correctly diagnosing UTI in adults. A
search of MEDLINE, CINAHL and EMBASE databases was conducted
using the following terms: UTI OR urinary tract infection OR urin*
infection OR urine dip OR urine AND dipstick OR urinalysis. Titles
and abstracts were reviewed, inclusion/exclusion criteria applied
and papers analysed using a thematic approach.
Several themes emerged including the role of human factors and
behaviours but there is a paucity of evidence in this area. We aim
to better define the problem using qualitative interviewing on a
one-to-one basis exploring the behavioural factors impacting upon
UTI diagnosis. By identifying these factors, a more robust solution
to this problem may be devised.
P-032
Tumour in a tumour
S. Ponnambath
1
, S. Das
2
, P. Foster
2
1
Royal United Hospital, NHS, Bath, United Kingdom;
2
Yeovil District
Hospital, Yeovil, United Kingdom
Case report:
76-year-old man presented with left sided weakness.
Past medical history included castrate resistant metastatic prostate
cancer for which he had escalating modalities of treatment from
2003 to 2014, TURP in 1998 and subsequently in 2001 he had
rise in prostate specific antigen for which he was on watchful
waiting till he was started on harmone manipulation in 2003.
On examination he had left arm and leg weakness. CT head scan
showed a 2 cm lesion in the right fronto-parietal region possibly
meningioma or metastasis. Subsequent MRI brain was still unclear.
As the diagnosis was unclear the scans were discussed at the
regional neuroradiology meeting and the outcome was to obtain
histological confirmation which showed evidence of meningioma
and prostate adenocarcinoma secondary. The patient has since been
started on third line chemotherapy. He is currently in a hospice.
Conclusion:
This case brought forward the rare event of brain
metastases in prostate cancer, to an even rarer event of
metastases to an existing meningioma, which was not previously
diagnosed. While this turn of events was of great academic
interest, it presented a diagnostic uncertainty, and required careful
multidisciplinary deliberation before commencing treatment.
P-033
An interesting case of facial pain
S. Ponnambath
1
, J. Klapper
2
, K. Peacock
2
1
Royal United Hospital, NHS, Bath, United Kingdom;
2
Royal United
Hospital, Bath, United Kingdom
Case report:
81-year-old lady presented with facial pain and fever.
She had multiple visits to dentist and GP with no clear diagnosis.
Past history included hypertension and osteoporosis. Threre was
nil significant on examination. Investigations showed raised CRP,
eGRF 72ml/min/1.73m
2
(baseline for her). Urine dipstick was
negative. On further enquiry she gave recent history of bilateral
hearing loss. CT head showed diffuse sinus opacification. Oral
and maxillofacial team found no cause for the symptoms. ENT
team advised to treat for sinusitis and continue intravenous
antibiotics. She continued to spike temperature, CRP continued to
rise and renal function gradually deteriorared (eGFR worsened to
18ml/min/1.73m
2
). Repeat urine dipstick was positive for blood
and protein. Vasculitis screen showed positive C ANCA(1:320)
and Anti-PR3 (184.0 U/ml). She was commenced on prednisolone
by rheumatologist and care taken over by Renal team for renal
biopsy and they commenced cyclophosphamide. Renal biopsy was
in keeping with acute vasculitis due to Wegener’s. CT Chest
demonstrated multilple nodules likely granulomas. With treatment
there was some evidence of disease supression. The condition had
left her with mixed sensorineural and conductive hearing loss.
Audiology team was arranging hearing aids. Patient was not keen
on renal replacement therapy if her condition deteriorated.
Conclusion:
This is an interesting case of Wegener’s granulomatosis
presenting with facial pain. Facial pain can be a manifestation of
various infectious and inflammatory conditions. One should also
think of rare causes like systemic vasculitis when patient presents
with facial pain.
P-034
Primary percutaneous coronary intervention in a centenarian
woman. A case report
A. Pratesi
1
, F. Orso
2
, A. Foschini
2
, F. Meucci
2
, G.J. Baldereschi
2
,
P. Valoti
2
, S. Fumagalli
2
, S. Baldasseroni
2
, N. Marchionni
2
,
A. Ungar
3
1
Geriatric Cardiology and Medicine, Careggi University Hospital,
Florence, Florence, Italy;
2
Geriatric Cardiology and Medicine, Careggi
Univesrity Hospital, Florence, Florence, Italy;
3
Azienda Ospedaliero
Universitaria Careggi, Florence, Italy
A 101-year-old female, partially dependent in BADL (lost 2
areas) and in IADL, with no cognitive impairment (MMSE 25/30)
and history of hypertension and one minor stroke, at 10 p.m.
complained of a sudden onset of resting chest pain. Alerted
the Emergency Local Service, on arrival of the doctor the
electrocardiogram showed a ST-segment elevation in leads V1-
V4 (10:40 p.m). In the local hospital pPCI (primary Percutaneous
Coronary Intervention) was not performed. So, after an alert to
the Emergency Department and Geriatric Cardiology Department
of Careggi University Hospital, the patient was transferred to
this hospital for pPCI. On arrival (10:59 p.m.), the patient was
still symptomatic for angina. Coronary angiography (femoral
access) demonstrated total thrombotic occlusion in the proximal
Left Anterior Descending artery (single vessel disease). Load of
clopidogrel 600mg was administered. Primary PCI was performed
by thromboaspiration, pre-dilatation of the residual lesion and
BMS implantation with good angiographic final result. “Door-to-
balloon”: 30 minutes. The patient was transferred in Geriatric
Coronary Care Unit: the patient’s condition stabilized, Troponin I
levels increased to 226.27 ug/L. Blood tests showed moderate renal
failure. The echocardiography revealed left ventricular dysfunction
(EF 40%), moderate mitral and tricuspid regurgitations. After 6 days
the patient was discharged. Two years later the patient was still