Severe accidental hypothermia treated with cardiopulmonary bypass.

This case report describes the successful treatment of severe accidental hypothermia with cardiopulmonary bypass (CPB). A known intravenous drug misuser aged 22 years was found to be unresponsive at his home (winter evening) with a Glasgow coma scale of 3/15. In the ambulance, the patient went into cardiac arrest, cardiopulmonary resuscitation being started. On arrival to the emergency department, he had a core body temperature of 27°C which was refractory to conservative management. He underwent femoro-femoral CPB, which was successful in rewarming the patient slowly. The patient was discharged home with no neurological deficit 10 days later.

Does left ventricular diastolic dysfunction progress through stages? Insights from a community heart failure study.

UNLABELLED: We performed a retrospective pilot study on a group of symptomatic patients attending our community heart failure clinic with left ventricular diastolic dysfunction (LVDD), rising or elevated LV end diastolic pressure, elevated brain natriuretic peptide (BNP), but with no clinical or radiographic evidence of heart failure; a group we hypothesised may be in the pre-HFPEF stage. METHODS: Those with LVEF >45% and LV diastolic dysfunction were included and divided into two groups: E/e' <15 and E/e' ≥15 corresponding with rising and raised LVEDP, respectively. Clinical events (deaths and hospital admissions) were compared at 1year and were grouped into all-cause events or cardiovascular events. The total numbers of all-cause and cardiovascular events of the individual groups and the entire cohort were assessed at 1year. RESULTS: Out of 584 screened, 80 patients were included. Thirty five patients had E/e' <15 and 45 had E/e' ≥15. At 1year follow-up the 1year all-cause events in the E/e' ≥15 group was higher compared to the E/e' <15 group (p=0.03). At 12months, in the entire cohort there were a total of 45 clinical events (39 hospital admissions and 6 deaths) out of which 20 events were cardiovascular. CONCLUSION: Patients in the pre-HFPEF stage had many events and those with elevated E/e' ≥15 had a poor 1year outcome. As this was strongly influenced by comorbidities we suggest close monitoring of these patients in dedicated HFPEF clinics along with vigorous management of comorbidities.

Flat trachea syndrome: a rare condition with symptoms similar to obstructive airway disease.

Flat trachea syndrome, commonly known as 'tracheobronchomalacia', is a central airway disease characterised by excessive expiratory collapse of the tracheobronchial posterior membrane due to weakness in the airway walls. Patients present with symptoms such as chronic cough, dyspnoea and recurrent respiratory tract infections, which are often attributed to more common conditions such as asthma and chronic obstructive pulmonary disease (COPD). The term 'Flat Trachea Syndrome' was first proposed by Niranjan and Marzouk in 2010 following a retrospective study of 28 patients with the condition who underwent surgery for it. The authors advocated the term due to the primary abnormality being collapse of the posterior membranous wall of the central airways as opposed to softening of the tracheal cartilage (tracheobronchomalacia), which they proposed is a misnomer. We present a rare case of a patient with flat trachea syndrome on a history of COPD who initially presented with recurrent respiratory tract infections.