A clinico-demographic analysis of maxillofacial trauma in the elderly Introduction: The elderly represent an increasing proportion of society. Management of maxillofacial trauma in this population may be complicated by coexisting medical conditions, requiring multidisciplinary care. Methods: This retrospective audit assesses the incidence and pattern of maxillofacial trauma in elderly patients ( ‡60 years) presented to the Merseyside Regional Maxillofacial Unit. Over the time period of 2003, 2004 and 2005, 7905 trauma patients presented to the accident and emergency department, of whom 757 were elderly (10%). Results: Results indicated that the male to female ratio was 1:1.4. The commonest cause of injury was a fall (83%) followed by an assault (6%); the majority of falls occurring in the home. Conclusion: Management of maxillofacial injuries in this population should focus on targeted prevention programmes, which address known risk factors for falling. We believe that this is a public health issue. Members of the maxillofacial team should be aware of common risk factors of falls in elderly. Better collaboration with the Medicine for Elderly team should be considered at an early stage on managing these patients.
Hyponatraemia and CSF drainage in posthaemorrhagic hydrocephalus Sir, MacMahon and Cooke' have shown that repeated cerebrospinal fluid drainage in low birthweight babies can create a negativesodium balance due to extra loss ofsodium. They do not, however, exclude excessive renal sodium leak or syndrome of inappropriate antidiuretic hormone secretion (SIADHS). SIADHS has been well documented in neonates2 3 and intracranial haemorrhage is a known predisposing factor. Sodium content of tapped cerebrospinal fluid can be measured easily and accurate replacement done. As the tapping continues occasional serum sodium estimation could be done to exclude hyponatraemia, which, if present, would be due to causes other than sodium loss. Before giving the massive sodium supplements of the magnitude of 23 mmol/kg/day that were needed in MacMahon and Cooke's second case, one must exclude SIADHS. Differentiation of these two conditions is crucial, as treatment of each is diametrically opposite. Simultaneous measurements of serum and urinary osmolality would resolve the question in most patients.
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