[Risk factors for the development of medical complications in patients with hip fracture]

OBJECTIVE

To evaluate the clinical features and outcome of inpatients with hip fracture and to investigate the clinical variables associated with the risk of medical complications.

METHODS

Prospective study of hip fracture patients aged 65 or more, admitted to the Department of Orthopaedic Surgery of the Xeral-Calde Hospital, in Lugo, Spain, in 2008. The different clinical and biochemical variables as regards the baseline health status and presentation features of the hip fracture and its complications were all recorded. The factors associated with the development of medical inpatient complications, including death, were determined, using univariate and multivariate analyses.

RESULTS

A total of 258 patients were studied. The mean age was 82.2 (9.5) years, and 76% were women. The fracture was osteoporotic in 96.8%, and 92.6% were treated surgically. The mean Barthel index was 72.9 (25.7) and the age adjusted Charlson comorbidity index was 5.2 (1.5). A total of 63.9% patients had a major medical complication during their hospital stay. Mortality was 5.8%. The following variables were associated with the development of medical inpatient complications: Barthel index (OR=2.21; 95% CI, 1.1-4.25; p=0,01), age (OR=1.09; 95% CI, 1.02-1.12; p=0.006), haemoglobin at admission (OR=0.76; 95% CI, 0.62-0.93; p=0.01).

CONCLUSIONS

Patients with hip fracture are fragile elderly with a high degree of functional dependence and comorbidity. Those with a high risk of developing medical inpatient complications can be identified at admission.

Aspergillus pacemaker endocarditis presenting as pulmonary embolism

Pacemaker endocarditis (PME) is a rare but severe complication of endocardial pacemaker implantation. Fungal PME is extremely uncommon. The case of a 66-year-old female patient who was diagnosed as having a pulmonary embolus based upon the patient's clinical presentation and computed tomography angiography findings is presented. Transthoracic echocardiography demonstrated a huge vegetation attached to the pacemaker wire. The pacemaker system was removed surgically during cardiovascular bypass. The vegetation was cultured, the results of which were positive for Aspergillus spp. No risk factors for Aspergillus infection were found in the patient. She was treated with liposomal amphotericin B for 3 weeks, followed by itraconazole for 40 weeks. At 1 year later, the patient remains asymptomatic.

[Neuro-Behçet: a follow-up of 4 cases treated with chlorambucil]

Four patients diagnosed with Behçet's disease developing neurologic manifestation are described. Central nervous system findings were observed in three of them and peripheral neuropathy in ther other patient. All the patients were treated with chlorambucil, 0.1-0.2 mg/kg/day as initial dose. Three of them ended the immunosuppressive therapy after a period of treatment between 12-18 months. None of the four patients suffered neurologic relapses once that the therapy with chlorambucil was started. In a similar way to other authors, we think that treatment with chlorambucil in neuro-Behçet's disease may be useful to reduce morbility related to neurologic relapses.