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This multicentre study conducted on a nationwide scale shows that pain relief can be improved in the ED. Pain intensity is not sufficiently reassessed, analgesics are underutilised, morphine sulfate is rarely used and delay in treatment is common. Reasons for inadequate analgesia were identified in order to identify relevant corrective measures to improve quality of pain management in the ED.

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A high prevalence of venous thromboembolism (VTE) has been reported during Intensive Care Unit (ICU) hospitalisation in patients with severe coronavirus disease (COVID-19) [1, 2]. In most cases, the diagnosis of pulmonary embolism (PE) was incidental as patients underwent computed tomography pulmonary angiography (CTPA) for aggravation of their respiratory condition. Higher mortality is also described in patients with high D-Dimer levels suggesting that VTE complication may contribute to unfavourable prognosis [3, 4]. Even though, prevalence of thromboembolic complications during ICU hospitalisation seems to be high, the prevalence of PE at hospital admission for COVID-19 is unknown and may be underestimated.

Duplex ultrasonography is reliable in detecting arterial lesions in peripheral arteries and could be used routinely in the initial evaluation of patients with lower limb arterial disease.

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suMMARY The effectiveness of repeated plasma exchange with 2 to 4 litres of plasma protein fraction as long-term treatment for familial hypercholesterolaemia has been evaluated in six severely affected patients receiving conventional cholesterol lowering treatment. Cell-separator mediated exchange at monthly intervals for one to two years reduced mean serum cholesterol levels from 18 5 mmol/I (715 mg/dl) to 12-4 mmol/l (480 mg/dl) in two female homozygotes but failed to influence xanthomata or prevent a two-to threefold increase in their left ventricular aortic systolic pressure gradients. More effective reduction of mean serum cholesterol levels from 15 7 mmol/l (608 mg/dl) to 8-6 mmol/l (333 mg/dl) in two male homozygotes by plasma exchange at fortnightly intervals for two to three years was accompanied by resolution of xanthomata and by stabilisation of aortocoronary lesions. In two male heterozygotes with angina, coronary angiographic appearances were unaltered or improved after one to two years of thrice-monthly plasma exchange, which reduced mean serum cholesterol levels from 6-4 mmol/I (248 mg/dl) to 4 7 mmol/I (182 mg/dl). We conclude that plasma exchange every one to two weeks, combined with oral nicotinic acid and/or cholestyramine, retards the rate of progression of atheroma in homozygotes and possibly induces regression in heterozygotes.Familial hypercholesterolaemia is a dominantly inherited defect of beta-or low-density lipoprotein metabolism which affects approximately 1 in 500 persons in Britain' and North America.2 The great majority of affected subjects are heterozygotes in whom the disorder is characterised by hyperbetalipoproteinaemia (type II hyperlipoproteinaemia) from birth, appearance of tendon xanthomata in early adult life, and the premature onset of coronary heart disease. Men