Eczema is common in the elderly people who often use topical medicaments. Previous studies in the elderly people have noted allergic positive patch tests in between 43% and 64% of those tested. We set out to assess whether medicament contact allergies are more common in elderly patients. We undertook a retrospective age-stratified study of all patients patch tested at the Royal Hallamshire Hospital, Sheffield, between January 1994 and July 2005. We confirmed that contact allergy to topical medicaments is more common in those aged more than 70 years compared with the younger age groups. There was no sex difference. The commonest problematic allergen types found in medicaments were fragrances and preservatives. The most frequent individual allergens were fragrance mix, Myroxylon pereirae, lanolins, local anaesthetic agents, neomycin and gentamicin, and tixocortol pivolate. The pattern of medicament contact allergens was similar to that of the younger age groups except that multiple allergic positives were more frequent and sensitivities to local anaesthetics and Myroxylon pereirae were proportionally more common. Elderly patients were more likely to have multiple contact allergies than the younger ones. Care needs to be taken when prescribing topical medicaments to elderly patients with eczema, especially for preparations that contain perfumes, lanolins, and local anaesthetics.

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Accurate fall risk assessments and adequate patient supervision are essential to minimize risks of falls, as the inpatient FNOF is linked to a higher mortality rate than patients injured in the community. A standardized method of analyzing such incidents and dissemination of the results of investigation are also required to reduce the risk of similar incidents from occurring within the hospital environment.

BackgroundOptimising post-operative joint function is challenging when treating periarticular soft tissue sarcoma (STS). Radiotherapy reduces local recurrence rates but periarticular fibrosis may adversely affect joint function. Neo-adjuvant radiotherapy requires lower doses and smaller treatment volumes and therefore has potential benefits for the management of periarticular STS, but has previously been shown to be associated with an increased risk of post-operative wound complications. This study assesses initial outcome and complications after treatment with neo-adjuvant radiotherapy and surgery for patients with periarticular STS.MethodsSeventeen patients (mean age 52.5 years) were treated using a standard protocol between January 2009 and June 2012 with three-dimensional conformal neo-adjuvant radiotherapy to a dose of 50 Gy in 25 fractions at a single centre, followed by limb salvage surgery. Patients were assessed weekly for adverse effects during radiotherapy. Surgery was planned for 6 weeks following completion of radiotherapy. Patients remain under follow-up with regular Toronto Extremity Salvage Scores (TESS) performed.ResultsNo patients had a significant adverse effect during radiotherapy. Three patients (17.6%) suffered a wound complication following surgery, all treated conservatively. Magnetic resonance imaging (MRI) demonstrated a reduction in mean maximal tumour diameter from 7.56 to 5.24 cm (p = 0.017, 11 of 17 patients). Tumour necrosis was measured between 50% and 100% in 10 of 11 resections where accurate assessment was possible. One patient had further surgery due to incomplete margins. No patients required post-operative radiotherapy. No local recurrences have occurred after a mean follow-up of 32 months (range 19 to 59 months). Two patients have developed metastatic disease. Mean TESS scores for upper and lower limb patients were 98.5 and 85.5, respectively, at latest follow-up.ConclusionsWe have demonstrated improved wound complication rates compared to the existing literature on the use of neo-adjuvant radiotherapy. This may relate to modification of the technique and patient selection compared to previous series. Excellent functional outcomes can be obtained with this treatment strategy.