Bilateral fractured neck of the femur in an adult patient with cystic fibrosis.

A 34-year-old man with cystic fibrosis (CF) sustained a bilateral fractured neck of the femur during the course of six grand mal seizures. The fractures were successfully treated with bipolar hemi-arthroplasties. Several risk factors for osteoporosis were present. Bone pathology showed reduced femoral head bone density. Osteoporosis of the lumbar spine was confirmed by dual-energy X-ray absorptiometry. As the life expectancy of patients with CF continues to improve, osteoporosis and its sequelae will become more common. We should be aware of the increased risk of bilateral fractured neck of the femur following epileptic seizure in CF.

Early discharge and home supervision of patients with pulmonary embolism treated with low-molecular weight heparin.

BACKGROUND: The objective of the study is to determine the efficacy, safety and feasibility of home treatment with low-molecular weight heparin (LMWH) in patients with symptomatic pulmonary embolism (PE). METHODS: All patients with PE on the home treatment programme between January 1998 and December 1999 were identified. Age, sex, length of hospital stay, risk factors for PE, ventilation perfusion (V/Q) lung scanning results, baseline investigations and treatment regimen were recorded. PE was defined as a clinical diagnosis supported by a high, intermediate or low probability V/Q lung scan. The efficacy of the treatment is defined as the event rate of recurrent PE. The safety outcome is defined as the rate of haemorrhage and the mortality that was related to the treatment during the 6-month follow-up period. RESULTS: Seventy patients were identified. Of these, 68 were hospitalised initially with a mean+/-S.D. length of hospital stay of 4.0+/-3.3 (range 0-17) days; their mean+/-S.D. age was 54.6+/-20.5 (range 19-87) years. Cardiopulmonary disease was the commonest pre-existing condition and 86% patients had at least one risk factor. All except one was haemodynamically stable. During the 6 months after discharge, 20 patients (28.6%) were readmitted at least once. One patient (1.4%) had symptomatic recurrent PE, one (1.4%) had haemoptysis and the remainder had unrelated pathology. There were no episodes of serious haemorrhage, and the two deaths that occurred in this period were not due to further PE. CONCLUSION: Early discharge home for stable patients with PE treated with LMWH (tinzaparin) is feasible, effective and safe, provided that patients are clinically stable, accessible by phone, receive daily administration of LMWH and have their international normalised ratio (INR) monitored.