The use of thromboprophylaxis in total hip replacement surgery: are the attitudes of orthopaedic surgeons changing?

We conducted a survey of all 926 active members of the British Orthopaedic Association using a postal questionnaire to find out their current attitude to thromboprophylaxis in total hip replacement surgery. Previous surveys have been performed, and with all the recent literature on the subject we wanted to see if the attitude of British orthopaedic surgeons has changed. There were 676 replies, a response rate of 73%. Fifty-five replies were excluded, those from surgeons who had retired from practice or whose practice did not include total hip replacement surgery. Of the remaining 621 surgeons, 466 (75%) use some method of thromboprophylaxis, with 367 (59%) routinely using prophylactic pharmacological agents and 99 (16%) using mechanical methods of thromboprophylaxis. Twenty-five per cent (155) of surgeons used no routine method of thromboprophylaxis. Eight-six per cent (534) of surgeons used a pharmacological method of prophylaxis in those patients thought to have a high risk of developing a deep vein thrombosis (DVT) (eg previous DVT, cardiovascular disease, obesity). Thirty-two different methods of thromboprophylaxis were used. Low molecular weight heparin is now being used by 19% of surgeons routinely and by 25% of surgeons in high risk cases, whereas 3 years ago it was not used at all. Our survey shows that although there is still a great reluctance for British orthopaedic surgeons to use pharmacological agents routinely in thromboprophylaxis. Amongst those that do, low molecular weight heparin is being increasingly used. More surgeons may want to use low molecular weight heparin routinely, but in some hospitals it is not currently available.     

Granulocytic sarcoma of the brain: a case report and review of the literature

Granulocytic sarcoma (chloroma), a rare tumor usually associated with myelogenous leukemia, is capable of invading the meninges or brain parenchyma. Radiologic findings in a case of granulocytic sarcoma of the brain, as well as those in 11 previously reported cases of intracranial leukemic masses, are interpreted. On computed tomographic scans, the lesions can appear isodense or hyperdense, edema and necrosis are variable, and there is uniform enhancement following intravenous administration of contrast material. There may be some affinity for the posterior fossa.     

An investigation of the neuropsychological profile in adults with velo-cardio-facial syndrome (VCFS).

Velo-cardio-facial syndrome (VCFS) is associated with deletions on the long arm of chromosome 22, mild intellectual disability, poor social interaction and a high prevalence of psychosis. However, to date there have been no studies investigating the neuropsychological functioning of adults with VCFS. We compared 19 adults with VCFS with 19 age, gender and IQ matched controls using a comprehensive neuropsychological battery. Compared to controls, adults with VCFS had significant impairments in visuoperceptual ability (Visual Object and Space Perception Battery), problem solving and planning (Tower of London) and abstract and social thinking (Comprehension WAIS-R). It is likely that haploinsufficiency (reduced gene dosage) of a neurodevelopmental gene or genes mapping to chromosome 22q11 underlies the cognitive deficits observed in individuals with VCFS.