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P0255 MEDICAL COMPLICATIONS IN PATIENTS WITH HIP FRACTURE
S90
Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283
P0254 RENAL AFFECTATION IN SYSTEMIC AMYLOIDOSIS. ANALYSIS OF 67 PATIENTS:
Alejandro Junco García, Elpidio Calvo Manuel. Medicina Interna Introduction: Amyloidosis is a rare disease of unknown etiology, characterized by the deposition of amyloid in the extracellular spaces of various organs and tissues, and with an incidence of about 8 per million person per year. Objectives: 1.To review Systemic Amyloidosis cases (Primary amyloidosis:AL and Secondary amyloidosis:AA) admitted to our hospital over a period of twelve years.2.To determine the most frequent renal manifestations.3.To gain knowledge which is the organ’s biopsy for the diagnosis.4.To analysis the medical services implied in this disease. Materials and methods: We performed a retrospective descriptive statistical study of 67 patients admitted to the San Carlos Clinic Hospital from January 1996 to December 2007 with a diagnosis of Systemic Amyloidosis. Data were collected on renal clinical manifestation and biological data in blood and urine. The diagnosis of amyloidosis was established on positive biopsy for amyloidosis or negative biopsy, but meeting certain clinical criteria. Results: – Anthropometric data: Men: 41 (61.2%), women: 26 (38.8%). In AL: 19 (70.4%) were males and 8 (29.6%) females and in AA: 22 (55.0%) were males and 18 (45.0%) females. The median age of diagnosis was 67 years old (25-75 percentile: 54-75). The median age at diagnosis in AL was 73 years old (25-75 percentile: 61-81) and in AA was 62.5 years old (25-75 percentile: 43,2-73,7). – Clinical and biological criteria: *In AL: renal affectation: 23(85.2%): Proteinuria >1g/dl: 78.3% (in nephrotic range >3.5 g/dl: 83.3% and in non-nephrotic range: 22.2%); Bences-Jones proteinuria: 37.0%; renal failure (Cr>1.2) :82.6%; hypoalbuminemia (albumin <3): 47.8%; nephrotic syndrome: 65.2%; renal vein thrombosis: 4.3%; nephromegalia: 0.0%; microhematuria: 21.7%; anasarca 8.7%. *In AA: renal affectation: 33(82.5%): Proteinuria >1g/dl: 69.7% (in nephrotic range >3.5g/dl: 60.9% and in non-nephrotic range: 39.1%); Bences-Jones proteinuria: 0.0%; renal failure (Cr>1.2): 84.8%; hypoalbuminemia (albumin <3): 51.5%; nephrotic syndrome: 33.3%; renal vein thrombosis: 6.1%; nephromegalia: 6.1%; microhematuria: 12.1%; anasarca: 9.1%. – Biopsy-Diagnosis: *In AL, positive biopsy: 16 (69.9%): renal biopsy: 50.0%, rectal: 25.0%; abdominal fat: 12.5%; bowel :6.3%; ganglio: 6.3%. *In AA, positive biopsy: 21 (63.6%): renal biopsy: 57.1%, rectal: 28.6%; bowel: 19.0%; abdominal fat: 4.8%; endomyocardial: 4.8%; liver: 4.8%. – Distribution of patients with renal affectations in hospital servicies: Nephrology: 28(50.0%); IM: 20 (35.7%); Cardiology: 2 (3.6%). Rest of them: less than 2% each one. Conclusions: 1. Systemic amyloidosis are more common in men than women aged between 60 and 70 years old. 2. More than 80% of patients with systemic amyloidosis have got renal manifestations. 3. The most frequent clinical manifestations are renal failure and nephrotic range proteinuria. 4. Renal biopsy is the gold standard for diagnosis systemic amyloidosis in patients with renal manifestations. 5. Admitance is carried out by nephrology and internal medicine.
P0255 MEDICAL COMPLICATIONS IN PATIENTS WITH HIP FRACTURE
Laura Gonzalez Vazquez, Javier Montero, Francisco Fernandez Fernandez, Ruben Puerta Louro, Javier De La Fuente Aguado, Fernando Barahona Aragües. Departement of Internal Medicine, Povisa Background: Hip fractures in the elderly are a major public health burden problem. This population, usually, has multiple chronic diseases that play an important role in morbid-mortality in the perioperative period. Surgery remains the mainstay of treatment, but the efficient management of medical complications (such as hemodynamic and metabolic alterations, infections, renal and heart failure, etc) is also relevant. The early assessment and treatment of medical comorbidities in patients with hip fractures reduce mortality and in-hospital medical complications. Aims: To describe the morbid-mortality and hospital readmission rate within 30 days of discharge in a patient’s cohort with hip fracture admit in Orthopedic and Traumatology Service. Methods: Prospective observational study that included consecutive admissions for hip fracture conducted between September 15, 2007 and October 31, 2008. All patients were asses with a pre-established protocol specifically designed by Internal Medicine physicians and follow up during the hospitalization.
Results: The study included 131 patients with hip fracture in this period; the mean age was 80.9±10.3 years and 107 (82%) were women. Intracapsular fractures were the most frecuent: 65 (49.6%). One hundred fifteen (88%) patients were treated with surgery. Seventy seven (58.8%) patients had complications. The most frequents were: delirium: 24 (18.3%), hypertensive crisis: 20 (15.3%), and respiratory infections: 11(8.4%). Another complications were: heart failure, renal failure, glycemic descompensation, urinary tract infections, decubitus ulcers, stroke, pulmonary embolism, and syncope. Thirty-five patients had previous admission last year for medical illness, and 24 (68.5%) of them had perioperative complications. In the perioperative period died 10 patients (7.6%); half of them without surgery. Causes of death were: pulmonary embolism, end-renal failure, respiratory infections, stroke, gastrointestinal bleeding, sepsis, ruptured aneurysm, and cardiopulmonary arrest. Hospital readmission rate within 30 days were 10% (13 patients). Causes of readmission were: stroke, digoxin toxicity, hyperosmolar coma, pneumonia, pulmonary embolism, gastrointestinal bleeding, anaemia, diarrhea, elbow fracture and urinary tract infection. Five patients (3.8%) died in this period. Conclusions: In elderly patients with multiple chronic diseases, medical complications in perioperative hip fracture repair are frequent and mortality remains high. Previous admission for medical illness increased the risk of these complications. Hospital readmission rate within 30 days were high and with significant mortality. Results: demonstrate the importance of effective preoperative risk assessment and perioperative medical management by internists.
P0256 CARDIAC AFFECTATION IN SYSTEMIC AMYLOIDOSIS. ANALYSIS OF 67 PATIENTS
Alejandro Junco García, Elpidio Calvo Manuel. Medicina Interna Introduction: Amyloidosis is a rare disease of unknown etiology, characterized by the deposition of amyloid in the extracellular spaces of various organs and tissues, and with an incidence of about 8 per million person per year. Objectives: 1.To review Systemic Amyloidosis cases (Primary amyloidosis: AL and Secondary amyloidosis: AA) admitted to our hospital over a period of twelve years. 2.To determine the most frequent cardiac manifestations, echocardiographic and electrocardiographic data. 3. To gain knowledge which is the organ biopsy for the diagnosis. 4. To analysis the medical services implied in this disease. Materials and methods: We performed a retrospective descriptive statistical study of 67 patients admitted to the San Carlos Hospital from January 1996 to December 2007 with a diagnosis of Systemic Amyloidosis. Data were collected on heart clinical symptoms and echocardiographic and electrocardiographic cardiac data. The diagnosis of amyloidosis was established on positive biopsy for amyloidosis or negative biopsy, but meeting certain clinical criteria. Results: – Anthropometric data: Men: 41(61.2%), women: 26 (38.8%). In AL: 19 (70.4%) were males and 8 (29.6%) females and in AA: 22 (55.0%) were males and 18 (45.0%) females. The median age of diagnosis was 67 years old (25-75 percentile: 54-75). The median age at diagnosis in AL was 73 years old (25-75 percentile: 61-81) and in AA was 62.5 years old (25-75 percentile: 43,2-73,7). – Clinical manifestation, echocardiographic and electrocardiographic data: • In AL: cardiac manifestations: 19 (70.4%): Clinic manifestations: 16 (84.2%); electrocardiographic data: 7 (36.8%); echocardiographic data: 15 (78.9%). • In AA: cardiac manifestations: 18 (45.0%): Clinic manifestations: 14 (77.8%); electrocardiographic data: 7 (38.9%); echocardiographic data: 14 (77.8%). – Biopsy-Diagnosis: • In AL, positive biopsy: 12(63.2%): renal biopsy: 41.7%; rectal: 33.3%; abdominal fat: 8.3%; MO: 8.3%; ganglio: 8.3%; tongue: 8.3%. • In AA, positive biopsy: 11 (61.1%): renal biopsy: 36.4%; rectal: 45.5%; endomyocardial: 18.2%; bowel: 9.1%; abdominal fat: 9.1%; liver: 9.1%. – Distribution of patients with cardiac affectations in hospital servicies: MIN: 18 (48.6%); Nefrology: 14 (37.8%); Cardiology: 2 (5.4%); Rest of them: less than 3% each one. Conclusions: 1. The systemic amyloidosis are more common in men than women aged between 60 and 70 years old. 2. Cardiac manifestations in systemic amyloidosis depends on the type of amyloidosis, being more frequent cardiac affectation in AL. 3. The most frequent clinical manifestations are oedema and heart failure. 4. The more frequent echocardiographic data are: restrictive myocardiopathy and diastolic dysfunction in AL and hypertensive
Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283
P0254 RENAL AFFECTATION IN SYSTEMIC AMYLOIDOSIS. ANALYSIS OF 67 PATIENTS:
Alejandro Junco García, Elpidio Calvo Manuel. Medicina Interna Introduction: Amyloidosis is a rare disease of unknown etiology, characterized by the deposition of amyloid in the extracellular spaces of various organs and tissues, and with an incidence of about 8 per million person per year. Objectives: 1.To review Systemic Amyloidosis cases (Primary amyloidosis:AL and Secondary amyloidosis:AA) admitted to our hospital over a period of twelve years.2.To determine the most frequent renal manifestations.3.To gain knowledge which is the organ’s biopsy for the diagnosis.4.To analysis the medical services implied in this disease. Materials and methods: We performed a retrospective descriptive statistical study of 67 patients admitted to the San Carlos Clinic Hospital from January 1996 to December 2007 with a diagnosis of Systemic Amyloidosis. Data were collected on renal clinical manifestation and biological data in blood and urine. The diagnosis of amyloidosis was established on positive biopsy for amyloidosis or negative biopsy, but meeting certain clinical criteria. Results: – Anthropometric data: Men: 41 (61.2%), women: 26 (38.8%). In AL: 19 (70.4%) were males and 8 (29.6%) females and in AA: 22 (55.0%) were males and 18 (45.0%) females. The median age of diagnosis was 67 years old (25-75 percentile: 54-75). The median age at diagnosis in AL was 73 years old (25-75 percentile: 61-81) and in AA was 62.5 years old (25-75 percentile: 43,2-73,7). – Clinical and biological criteria: *In AL: renal affectation: 23(85.2%): Proteinuria >1g/dl: 78.3% (in nephrotic range >3.5 g/dl: 83.3% and in non-nephrotic range: 22.2%); Bences-Jones proteinuria: 37.0%; renal failure (Cr>1.2) :82.6%; hypoalbuminemia (albumin <3): 47.8%; nephrotic syndrome: 65.2%; renal vein thrombosis: 4.3%; nephromegalia: 0.0%; microhematuria: 21.7%; anasarca 8.7%. *In AA: renal affectation: 33(82.5%): Proteinuria >1g/dl: 69.7% (in nephrotic range >3.5g/dl: 60.9% and in non-nephrotic range: 39.1%); Bences-Jones proteinuria: 0.0%; renal failure (Cr>1.2): 84.8%; hypoalbuminemia (albumin <3): 51.5%; nephrotic syndrome: 33.3%; renal vein thrombosis: 6.1%; nephromegalia: 6.1%; microhematuria: 12.1%; anasarca: 9.1%. – Biopsy-Diagnosis: *In AL, positive biopsy: 16 (69.9%): renal biopsy: 50.0%, rectal: 25.0%; abdominal fat: 12.5%; bowel :6.3%; ganglio: 6.3%. *In AA, positive biopsy: 21 (63.6%): renal biopsy: 57.1%, rectal: 28.6%; bowel: 19.0%; abdominal fat: 4.8%; endomyocardial: 4.8%; liver: 4.8%. – Distribution of patients with renal affectations in hospital servicies: Nephrology: 28(50.0%); IM: 20 (35.7%); Cardiology: 2 (3.6%). Rest of them: less than 2% each one. Conclusions: 1. Systemic amyloidosis are more common in men than women aged between 60 and 70 years old. 2. More than 80% of patients with systemic amyloidosis have got renal manifestations. 3. The most frequent clinical manifestations are renal failure and nephrotic range proteinuria. 4. Renal biopsy is the gold standard for diagnosis systemic amyloidosis in patients with renal manifestations. 5. Admitance is carried out by nephrology and internal medicine.
P0255 MEDICAL COMPLICATIONS IN PATIENTS WITH HIP FRACTURE
Laura Gonzalez Vazquez, Javier Montero, Francisco Fernandez Fernandez, Ruben Puerta Louro, Javier De La Fuente Aguado, Fernando Barahona Aragües. Departement of Internal Medicine, Povisa Background: Hip fractures in the elderly are a major public health burden problem. This population, usually, has multiple chronic diseases that play an important role in morbid-mortality in the perioperative period. Surgery remains the mainstay of treatment, but the efficient management of medical complications (such as hemodynamic and metabolic alterations, infections, renal and heart failure, etc) is also relevant. The early assessment and treatment of medical comorbidities in patients with hip fractures reduce mortality and in-hospital medical complications. Aims: To describe the morbid-mortality and hospital readmission rate within 30 days of discharge in a patient’s cohort with hip fracture admit in Orthopedic and Traumatology Service. Methods: Prospective observational study that included consecutive admissions for hip fracture conducted between September 15, 2007 and October 31, 2008. All patients were asses with a pre-established protocol specifically designed by Internal Medicine physicians and follow up during the hospitalization.
Results: The study included 131 patients with hip fracture in this period; the mean age was 80.9±10.3 years and 107 (82%) were women. Intracapsular fractures were the most frecuent: 65 (49.6%). One hundred fifteen (88%) patients were treated with surgery. Seventy seven (58.8%) patients had complications. The most frequents were: delirium: 24 (18.3%), hypertensive crisis: 20 (15.3%), and respiratory infections: 11(8.4%). Another complications were: heart failure, renal failure, glycemic descompensation, urinary tract infections, decubitus ulcers, stroke, pulmonary embolism, and syncope. Thirty-five patients had previous admission last year for medical illness, and 24 (68.5%) of them had perioperative complications. In the perioperative period died 10 patients (7.6%); half of them without surgery. Causes of death were: pulmonary embolism, end-renal failure, respiratory infections, stroke, gastrointestinal bleeding, sepsis, ruptured aneurysm, and cardiopulmonary arrest. Hospital readmission rate within 30 days were 10% (13 patients). Causes of readmission were: stroke, digoxin toxicity, hyperosmolar coma, pneumonia, pulmonary embolism, gastrointestinal bleeding, anaemia, diarrhea, elbow fracture and urinary tract infection. Five patients (3.8%) died in this period. Conclusions: In elderly patients with multiple chronic diseases, medical complications in perioperative hip fracture repair are frequent and mortality remains high. Previous admission for medical illness increased the risk of these complications. Hospital readmission rate within 30 days were high and with significant mortality. Results: demonstrate the importance of effective preoperative risk assessment and perioperative medical management by internists.
P0256 CARDIAC AFFECTATION IN SYSTEMIC AMYLOIDOSIS. ANALYSIS OF 67 PATIENTS
Alejandro Junco García, Elpidio Calvo Manuel. Medicina Interna Introduction: Amyloidosis is a rare disease of unknown etiology, characterized by the deposition of amyloid in the extracellular spaces of various organs and tissues, and with an incidence of about 8 per million person per year. Objectives: 1.To review Systemic Amyloidosis cases (Primary amyloidosis: AL and Secondary amyloidosis: AA) admitted to our hospital over a period of twelve years. 2.To determine the most frequent cardiac manifestations, echocardiographic and electrocardiographic data. 3. To gain knowledge which is the organ biopsy for the diagnosis. 4. To analysis the medical services implied in this disease. Materials and methods: We performed a retrospective descriptive statistical study of 67 patients admitted to the San Carlos Hospital from January 1996 to December 2007 with a diagnosis of Systemic Amyloidosis. Data were collected on heart clinical symptoms and echocardiographic and electrocardiographic cardiac data. The diagnosis of amyloidosis was established on positive biopsy for amyloidosis or negative biopsy, but meeting certain clinical criteria. Results: – Anthropometric data: Men: 41(61.2%), women: 26 (38.8%). In AL: 19 (70.4%) were males and 8 (29.6%) females and in AA: 22 (55.0%) were males and 18 (45.0%) females. The median age of diagnosis was 67 years old (25-75 percentile: 54-75). The median age at diagnosis in AL was 73 years old (25-75 percentile: 61-81) and in AA was 62.5 years old (25-75 percentile: 43,2-73,7). – Clinical manifestation, echocardiographic and electrocardiographic data: • In AL: cardiac manifestations: 19 (70.4%): Clinic manifestations: 16 (84.2%); electrocardiographic data: 7 (36.8%); echocardiographic data: 15 (78.9%). • In AA: cardiac manifestations: 18 (45.0%): Clinic manifestations: 14 (77.8%); electrocardiographic data: 7 (38.9%); echocardiographic data: 14 (77.8%). – Biopsy-Diagnosis: • In AL, positive biopsy: 12(63.2%): renal biopsy: 41.7%; rectal: 33.3%; abdominal fat: 8.3%; MO: 8.3%; ganglio: 8.3%; tongue: 8.3%. • In AA, positive biopsy: 11 (61.1%): renal biopsy: 36.4%; rectal: 45.5%; endomyocardial: 18.2%; bowel: 9.1%; abdominal fat: 9.1%; liver: 9.1%. – Distribution of patients with cardiac affectations in hospital servicies: MIN: 18 (48.6%); Nefrology: 14 (37.8%); Cardiology: 2 (5.4%); Rest of them: less than 3% each one. Conclusions: 1. The systemic amyloidosis are more common in men than women aged between 60 and 70 years old. 2. Cardiac manifestations in systemic amyloidosis depends on the type of amyloidosis, being more frequent cardiac affectation in AL. 3. The most frequent clinical manifestations are oedema and heart failure. 4. The more frequent echocardiographic data are: restrictive myocardiopathy and diastolic dysfunction in AL and hypertensive