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P OSTER
A BSTRACTS
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The Use of 308nm Excimer Laser as an Effective and Safe
Treatment for Psoriasis in the Geriatric Population.
J. W. Wong, 1,2 J. Koo. 2 1. University of Utah School of Medicine, San
Francisco, CA; 2. Dermatology, University of California San
Francisco, San Francisco, CA.
Supported By: Photomedex supports this research.
Introduction: In dermatology, one of the most common and miserable
skin conditions is psoriasis. Geriatric patients suffer from psoriasis
with a greater proportion than any younger age group because
psoriasis is a chronic disease. Psoriasis is one condition which tends to
become more generalized and severe with age. The worst and most
miserable type of psoriasis is generalized plaque psoriasis, which is almost
uniformly treated with immunosuppressants such as methotrexate,
cyclosporine, and biologic agents. However, geriatric patients are
most at risk for lifelong systemic immunosuppression. Due to the risk
of cancer, infection, heart disease, and other comorbidities, there is a
great need to find a way to treat geriatric patients with generalized
psoriasis that is not immunosuppressive and with less systemic risks.
Excimer laser is an ideal treatment. It is more powerful than traditional
UVB or PUVA phototherapy because it is a targeted treatment
that only exposes thick psoriasis plaques to therapy and is not
limited to side effects such as causing noninvolved skin to burn. Thus,
more aggressive amount of energy can be delivered to the plaques.
Our study has shown that the use of the 308nm excimer laser in combination
with topical therapy achieves better therapeutic efficacy
than any available biologic agents in half of the time with no possibility
of systemic side effects. Methods: Moderate-to-severe psoriasis patients
have been recruited for the study. 308 nm excimer laser is used
twice weekly until reaching 75% or better improvement according to
the psoriasis area and severity index (PASI 75) for a maximum of 12
weeks. Patients are instructed to apply clobetasol spray twice daily
for the first 4 weeks (Weeks 1-4), then calcitriol ointment for the next
4 weeks (Weeks 5-8), and finally, both clobetasol spray and calcitriol
ointment for the last 4 weeks (Weeks 9-12). Results: Of the 14 patients
enrolled, 85% have achieved great improvement (PASI 75) in
only 6 weeks as compared to etanercept, adalimumab, and ustekinumab
where no more than 68% achieve PASI 75 in double the time
(12 weeks). Conclusion: Our study shows promising results that geriatric
patients with generalized psoriasis can be treated most conveniently
with an external therapeutic modality with essentially no systemic
side effects and no immunosuppression.
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Cardiac structure and function and renal insufficiency in the oldest old.
J. Stessman, 1 Y. Maaravi, 1 J. M. Jacobs, 1 D. Leibowitz. 2 1. Institute for
Aging Research, Department of Geriatrics and Rehabilitation,
Hadassah-Hebrew University Medical Center, Jerusalem, Israel; 2.
Heart Institute, Hadassah-Hebrew University Medical Center,
Jerusalem, Israel.
Background:
People over the age of 85 are the world’s most rapidly growing
age group and have a high incidence of both cardiovascular disease
and chronic kidney disease (CKD). The relationship of abnormalities
in cardiac structure and function and renal insufficiency in this age
group is unclear. The objective of this study was to examine the association
between renal function and cardiac structure and function in
an age-homogenous, community-dwelling population of subjects
born in 1920-1921.
Methods:
Subjects were recruited from the Jerusalem Longitudinal Cohort
Study. Echocardiography was performed with a portable
echocardiograph at the subjects place of residence. Standard
echocardiographic assessment of cardiac structure and function was
performed. Glomerular filtration rate (GFR) was assessed by the
Cockroft-Gault formula with abnormal GFR defined as ≤ 60
ml/min/1.73 m2.
Results:
310 subjects (146 males, 164 females) were enrolled in the study.
There were no significant differences between subjects with normal
and abnormal GFR in indices of cardiac structure. Ejection fraction
(57.0 ± 10.4% vs. 54.4 ± 10.3%; p < 0.08) and indices of diastolic function
(E:e’ 12.4 ± 5.0 vs. 12.3 ± 4.6; p = 0.89) were not significantly different
between the two groups.
Conclusions:
Our study did not demonstrate an association between reduced
GFR and echocardiographic indices of systolic and diastolic function
in a community-dwelling population of the oldest old.
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Mass Houdini:The Case of the Disappearing Duodenal Mass.
L. M. Thomas, A. Prakash, K. Ramasamy, J. Smith, H. Choudhry.
Bayonne Medical Center, Bayonne, NJ.
Case Presentation:This is a case of 72 year old female presenting
to the ER with right upper quadrant abdominal pain radiating to the
back and vomiting for the past 3 weeks.She had difficulty in tolerating
food due to the vomiting.No history of diarrhea,fever,chills or urinary
complaints.Her past history was significant for uterine cancer diagnosed
15 years ago,treated with hysterectomy and brachytherapy,CAD
s/p CABG and osteoarthritis for which she is on NSAIDS for the past
10 years.Her physical examination was unremarkable.CBC,amylase,lipase
and liver function tests were within normal limits.Her K(5.8)and
creatinine(2.4)levels were elevated.CT abdomen showed diffuse,infiltrative
mass encircling the duodenum,invading the pancreatic head and
gallbladder.With a working diagnosis of adenocarcinoma arising from
the duodenum,infiltrating the pancreas and gall bladder,a biopsy was
done.Biopsy samples showed extensive chronic duodenitis with gastric
heterotopias and gastric mucus cell metaplasia.With a benign result on
biopsy,a diagnosis of penetrating duodenal ulcer was made.The patient
was kept NPO and was started on TPN and IV PPIs.She responded
well and was symptomatically better. After one week,she was started
on a diet and was able to tolerate the intake.Repeat CT scan done two
months later, showed complete resolution of the previously seen duodenal
mass and she remains asymptomatic till now.Discussion:Peptic
ulcer disease in the elderly can present as an intra abdominal mass simulating
malignancy due to penetration of surrounding tissues leading to
inflammation and adhesions.Studies show that even though the prevalence
of active duodenitis is low in chronic NSAIDS users,local ulceration
can take place and is dose dependent. Conclusion:This case illustrates
that awareness of this uncommon complication of peptic gastro
duodenal ulcer disease is helpful in the diagnosis of this benign lesion.
An unnecessary invasive procedure and incorrect treatment strategy
can be avoided by making a firm diagnosis with the help of biopsy.
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The effect of cholinesterase inhibitors on cardiovascular health.
M. George, 1 G. Azhar, 1 A. Balamurugan, 2 J. Wei. 1 1. Geriatrics,
University of Arkansas for Medical Sciences, Little Rock, AR; 2.
Family and Preventive Medicine, University of Arkansas for Medical
Sciences, Little Rock, AR.
Background: Cholinesterase inhibitors (donepezil, rivastigmine,
galantamine) are often prescribed to slow the progression of demen-
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