Health Sciences

Too-tight trunks and other seldom mentioned quandaries

In September, 2004, a 76-year-old man had surgery for traumatic left hip fracture; his preoperative platelet count was 160×109/L. 6 h after surgery, subcutaneous enoxaparin was started (60 mg/d). 4 days later acenocoumarol (3 mg/d) was restarted and added to enoxaparin because of previous recurrent deep vein thromboses (target International Normalised Ratio [INR]: 2·0–3·0). 8 days postoperatively, he had swelling and pain of the left leg, which rapidly progressed to limb gangrene (); INR was 2·9 and platelets 150×109/L.

SummaryAdvances in telecommunication technologies have created new opportunities to provide telemedical care as an adjunct to medical management of patients with heart failure. Meta-analyses suggest that telemedicine can reduce morbidity and mortality in such patients; however, two prospective clinical trials not included in the analyses do not support these findings. Therefore, the effectiveness of telemedicine in heart failure is not established. Telemedicine approaches range from computer-based support systems to programmes led by nurses and physicians.