Takotsubo cardiomyopathy in elderly female trauma patients: a case series.

BACKGROUND: Takotsubo cardiomyopathy is a syndrome characterized by acute left ventricular wall motion abnormalities leading to left ventricular systolic dysfunction. It remains an important differential diagnosis for acute coronary syndrome. CASE PRESENTATIONS: Here we describe three cases of Takotsubo cardiomyopathy occurring in three Caucasian female trauma patients (aged 79, 81, and 82 years old) and the impact on their clinical course. CONCLUSIONS: For patients requiring surgical management, delays in the diagnosis of Takotsubo cardiomyopathy may lead to postponement of urgent operative management. This delay in surgery likely impacts on length of hospital stay, leading to an increasing morbidity and mortality.

The Influence of Cervical Spine Angulation on Symptoms Associated With Wearing a Rigid Neck Collar.

INTRODUCTION: Rigid cervical spine collars can be used to maintain the position of the cervical spine following injury or surgery. However, they have been associated with difficulty swallowing, pressure sores and pain, particularly in older patients. We aimed to investigate the relationship between cervical spine angulation, a rigid neck collar and neck pain in healthy young and older adults. METHODS: Twenty healthy young adults aged 25 ± 3 years and 17 healthy older adults aged 80 ± 8 years were tested. Magnetic resonance imaging scans of their cervical spines were taken before and after the rigid neck collar was worn for 1 hour. Measurement of vertebral angulation involved digitization of the scans and joint angle calculations using image processing software. Pain was quantified before and after the collar was worn, using a visual analogue scale. RESULTS: Pain scores increased in the young group after the collar was worn (p = 0.001). The older group showed no difference in pain score after the collar was worn. Statistical tests showed no significant correlations between the change in cervical angles and the change in pain scores after the collar was worn. DISCUSSION: The aging process may contribute to the changing distribution of subcutaneous tissue and increase risk of symptoms associated with wearing a collar. Oesophageal compression is not a result of collar use. CONCLUSION: There is no correlation between cervical spine vertebrae angulation and symptoms associated with wearing a neck collar. Generally, older individuals have greater cervical lordosis angles, and more straight and lordotic neck shapes. Older individuals may be more prone to skin-interface pressures from the neck collar than younger individuals.

Does the Weather Contribute to Admissions of Neck of Femur Fractures?

BACKGROUND: The effects of weather on overall mortality are well documented. Anecdotally, icy conditions are perceived to result in more falls and admissions for neck of femur (NOF) fractures. The aim of this pilot study was to determine whether relationships could be extracted or at least not ruled out by analysing a small dataset, and so give impetus to a larger project. METHODS: Seven trauma units across North West London were identified and NOF fracture data extracted for 5 years. Visual inspection of the time series, consideration of the weather on specific days and correlation analysis were used to assess associations between fracture numbers and a variety of weather parameters (temperature, rainfall, wind and ice risk). RESULTS: Overall, 10929 individuals with hip fractures were admitted over the 5-year period. The highest number of admissions in a day was 14. No clear association was found between a weather parameter and daily admissions. However, when accumulated to a weekly timescale, a negative relationship with maximum temperature was found. No seasonal cycle was detected. CONCLUSION: The lack of a daily relationship and presence of a weekly relationship points to a possible delayed response to weather or insufficient daily data to extract a signal. The inconclusive results also indicate a larger data sample is required in future studies. In addition, even in cold weather an urban environment may not create icy conditions, being ameliorated by the heat island effect and gritting.

Delirium after emergency hip surgery - common and serious, but rarely consented for.

A quarter of patients admitted with a proximal femoral fracture suffer from an acute episode of delirium during their hospital stay. Yet it is often unrecognised, poorly managed, and rarely discussed by doctors. Delirium is important not only to the affected individuals and their families, but also socioeconomically to the broader community. Delirium increases mortality and morbidity, leads to lasting cognitive and functional decline, and increases both length of stay and dependence on discharge. Delirium should be routinely and openly discussed by all members of the clinical team, including surgeons when gaining consent. Failing to do so may expose surgeons to claims of negligence. Here we present a concise review of the literature and discuss the epidemiology, causative factors, potential consequences and preventative strategies in the perioperative period.