RESUMEN
OBJECTIVE: The national guideline recommends selective case finding as the main strategy by identification of high risk people. This study assessed whether high risk patients were identified before their presentation with fragility fracture. METHODS: A prospective study for 3.5 consecutive months on patients with low energy hip fractures to Brighton and Sussex University Hospital NHS Trusts, which serves a population of 460,000. Data were collected by interview using standardised form, medical record review, and communication with family physicians. Definition of high risk: (1) untreated hypogonadism (2) corticosteroid users (3) disorders with increased bone loss (4) previous fragility fractures. RESULTS: 98 patients were admitted with hip fracture. Thirty nine (40%) had at least one high risk factor. High risk patients (7 of 39, 18%) were no more likely to receive prophylaxis compared with patients without high risk factor (5 of 59, 8%) (p = 0.21). Previous fragility fracture (23) was the commonest risk factor followed by disorders with increased bone loss (10), premature menopause (10), and corticosteroid users (5). Fifteen patients (15%) had susceptibility to frequent falls and two had maternal history of osteoporosis. The proportion of treated patients were 20% (2 of 10) in premature menopause, 10% (1 of 10) in diseases with secondary osteoporosis, 13% (3 of 23) in previous fragility fracture, and 80% (4 of 5) in corticosteroid users (p = 0.01) CONCLUSION: Prevention of hip fracture is still inadequate in high risk patients. Discrepancy seemed to exist in treatment frequency among different high risk groups suggesting that emphasis on prevention of osteoporosis has not been reinforced in all people at risk.
Asunto(s)
Fracturas de Cadera/prevención & control , Osteoporosis/prevención & control , Anciano , Anciano de 80 o más Años , Femenino , Fracturas Espontáneas/prevención & control , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Medición de Riesgo , Factores de RiesgoRESUMEN
We report the successful use of MitroFast® annuloplasty ring in the setting of active endocarditis to preserve the native valve mechanism despite complete posterior leaflet destruction. This patient remained well at 20 month follow-up after her surgery.
Asunto(s)
Anuloplastia de la Válvula Cardíaca/métodos , Endocarditis Bacteriana/complicaciones , Prótesis Valvulares Cardíacas , Insuficiencia de la Válvula Mitral/cirugía , Válvula Mitral/cirugía , Infecciones Estafilocócicas/complicaciones , Staphylococcus aureus/aislamiento & purificación , Adolescente , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/cirugía , Femenino , Estudios de Seguimiento , Humanos , Insuficiencia de la Válvula Mitral/etiología , Diseño de Prótesis , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/cirugíaRESUMEN
Tectal plate cysts are very rare. We report two adult patients with benign tectal plate cyst and secondary hydrocephalus. The first patient had an unusual eye movement disorder with bilateral upper eyelid retraction (Collier's sign), limited upgaze, severe upgaze evoked nystagmus and retraction nystagmus. The second patient presented with ataxia and failure of upward gaze. Endoscopic fenestration of the tectal plate cyst and endoscopic third ventriculostomy in both cases result in neurological improvement. To the best of our knowledge, similar lesions at this site have not been reported in adults. The differential diagnosis with arachnoid cysts of the quadrigeminal CSF cistern is discussed.
Asunto(s)
Quistes del Sistema Nervioso Central/diagnóstico , Trastornos de la Motilidad Ocular/etiología , Techo del Mesencéfalo/patología , Techo del Mesencéfalo/fisiopatología , Adulto , Factores de Edad , Ataxia/etiología , Ataxia/fisiopatología , Quistes del Sistema Nervioso Central/complicaciones , Quistes del Sistema Nervioso Central/fisiopatología , Endoscopía , Movimientos Oculares/fisiología , Femenino , Humanos , Hidrocefalia/diagnóstico , Hidrocefalia/etiología , Hidrocefalia/fisiopatología , Imagen por Resonancia Magnética , Masculino , Vías Nerviosas/fisiopatología , Procedimientos Neuroquirúrgicos , Trastornos de la Motilidad Ocular/diagnóstico , Trastornos de la Motilidad Ocular/fisiopatología , Colículos Superiores/patología , Colículos Superiores/fisiopatología , Resultado del Tratamiento , VentriculostomíaRESUMEN
Intradural spinal cord teratoma is a very rare tumour that can be associated with dysraphism. The relationship of this lesion to pregnancy is unknown and its occurrence during pregnancy in the thoracic spine has not been previously reported. We report a 19-year-old pregnant woman with spinal dysraphism, who presented with a new onset thoracic myelopathy. The MRI scan showed an intradural, extramedullary lesion with solid and cystic component in the thoracic spine at the level of T5-T6. A thoracic laminectomy and excision of this lesion was followed by significant improvement of her lower limb function. Histopathology confirmed a benign mature teratoma. The rapid progression of this lesion during pregnancy suggests a hormonal mediated pathway for the tumour growth. Further analysis from the resected specimen confirmed that the tumour was oestrogen and progesterone receptors positive.