We measured the bone mineral density in 22 patients with the cylindrical stemmed cobalt-chrome AML prosthesis (collared) and in 22 patients with the tapered stem titanium CLS prosthesis (collarless). DEXA scanning was undertaken at a mean of 40 months in the AML and 52 months in the CLS group from the time of implant insertion. In both groups the greatest mean loss of BMD was found in Gruen zone 7 and the least change in Gruen zone 5. In all zones the BMD loss was greater in the AML group but only statistically significant in zones 6 (P<0.05) and 7 (P<0.01). Although numerous factors affect BMD changes around cementless implants, this study suggests that less bone loss can be associated with the titanium CLS stem.Résumé Nous avons mesuré la densité minérale de l'os chez 22 patients porteur d'une prothèse AML en cobaltchrome à tige cylindrique (avec colerette) et chez 22 malades avec une prothèse CLS en titane avec une tige conique et sans colerette. Une scanographie DEXA a été entreprise en moyenne 40 mois après implantation des prothèses AML et 52 mois après prothèse CLS. Dans les deux groupes la plus grande perte moyenne de DMO a été trouvée dans la zone 7 de Gruen et le plus petit changement dans la zone 5 de Gruen. Dans tous les zone la perte de densité osseuse était plus grande dans le groupe AML mais statistiquement uniquement dans les zones 6 (P<0.05) et 7 (P<0.01). Bien que de nombreux facteurs affectent les changements de DMO autour des implants sans ciment, cette étude suggère qu'il y a moins de perte osseuse avec la tige CLS en titane.

(40mg), early mobilisation and hydration. The 40mg enoxaparin dose over the previous 20mg regimen was worrisome, and its effect on pericardial effusion rates and mortality in proximal aortic surgery was investigated. METHODS Proximal aortic reconstructions performed between December 2008 and April 2011 were identified from prospectively collected data in a tertiary centre database. Retrospective analysis of patient notes was performed. Proximal aortic surgery patients were categorised as low dose (20mg) enoxaparin and high dose (40mg) enoxaparin, and compared for confounding variables. In-hospital, early and one-year readmission rates for pericardial effusion were ascertained from echocardiography reports. The primary outcome was total pericardial effusion rate. Secondary outcomes consisted of 30-day and 1-year mortality. RESULTS A total of 198 patients underwent proximal thoracic aortic surgery. Nine patients were excluded due to early postoperative death (n=5) and missing patient records (n=4). This left 189 cases for analysis. There were 93 patients in the low dose group and 96 in the high dose group. Groups were comparable for age, cardiopulmonary bypass time, aortic cross-clamp time, postoperative warfarin and antiplatelet agents. Pericardial effusion rates up to one year were comparable (low dose 19% vs high dose 21%). Thirty-day mortality was lower in the low dose group (0 vs 3 deaths). There were four deaths up to one year but these were not attributable to increased enoxaparin. CONCLUSIONS Increased perioperative thromboprophylaxis dosage does not increase pericardial effusion rates or mortality in proximal aortic surgery.

National and Trust IPC standards. Following reported cases of MRSA bacteraemia and colonisation, and MRSA cases missed through previous routine screening regimes in our Trust, the Team has implemented mandatory routine MRSA screening for patients who fulfilled locally-defined high-risk criteria. This audit aims to determine the standard of MRSA screening for these high-risk patients on the Neonatal and Acute Paediatric inpatient wards. Methods Patients admitted to Bluebell (Acute Paediatric) ward, the Children's Assessment Unit (CAU) or the Neonatal unit (NNU) were retrospectively identified and compared against a locally-defined set of criteria for patients at high risk of MRSA colonisation or infection. The criteria included previous MRSA infection or colonisation, transfer from or previous admission in another hospital, recurrent skin lesions or infections, and exposure to family member with known MRSA. The study began in May 2019 with data collected up to mid-October 2019. Electronic pathology records were then searched. The assumed target of MRSA testing, where appropriate, was 100%, with the Trust's IPC standard of >90%. Results Preliminary results yielded 136 high-risk patients and 145 appropriate instances for screening. An overall screening rate of 78.6% (114/145) was noted covering all areas during the audit period. The Neonatal Unit had the highest rate of screening at 97.6% (41/42), followed by CAU at 80% (16/20) and Bluebell at 68.7% (57/83). Month-by-month analysis showed June to have the lowest rate for all areas (50.0% 8/ 16) and August with the highest rate (95.0% 19/20). Conclusion The audit highlighted that compliance with guidelines is variable across areas and different months. Despite our study not being able to consider the many factors that contribute towards this, the data has identified gaps in current practice and will guide the goals on education and training of clinical staff regarding IPC guidelines, with the focus on MRSA high risk screening criteria, to ensure robust and safe practice.

The case demonstrates a hitherto undescribed phenomenon of a case of survival following an acute aortic syndrome without surgical intervention.