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Nitrous oxide (N2O) is increasingly used as a recreational drug, and is presumed relatively safe and innocent. The risks for neurological complications are often known, however the risks of serious thromboembolic events are not. We describe three cases of acute thromboembolic events resulting in serious cardiovascular complications after N2O abuse: one case of myocardial infarction that resulted in a reduced ejection fraction, one case of peripheral arterial occlusion that led to limb amputation and one case of pulmonary embolism that resulted in hemodynamic instability requiring extracorporeal membrane oxygenation (ECMO) and surgical removal. All patients were young adults with a low cardiovascular risk profile. N2O inactivates vitamin B12, leading to vitamin B12 deficiency and subsequent to hyperhomocysteinemia, which is associated with the formation of fibrinolysis-resistant blood thrombi. In conclusion, we contest the safety and innocence of recreational N2O (ab)use. Our three cases illustrate that, next to previously described neurological complications, the use of nitrous oxide is associated with thromboembolic cardiovascular complications, presumably mediated by hyperhomocysteinemia.

Kidney international / Reports 5(8), 1327-1332 (2020). doi:10.1016/j.ekir.2020.05.030, Published by Elsevier, Amsterdam

Background: Different factors contribute to infection after arterial reconstructive surgery. Prophylactic antibiotic use during surgery is widespread, however, there is insufficient evidence to support the use of prophylactic antibiotics with autologous vein grafting. The aim of our study was to assess the effect of single-dose prophylactic antibiotics in patients undergoing autologous vein grafting. Methods: Patients undergoing arterial bypass reconstruction in the lower extremity between 2004 and 2012 were retrospectively screened for use of vein grafts. Patients receiving single-dose antibiotic prophylaxis (group 1) were compared with those not receiving prophylaxis (group 2). Results: Primary outcome was surgical site infection (SSI), and 142 patients were included. The SSI occurred in 22% of patients in group 1 and in 29% of patients in group 2 ( P = .39; odds ratio: 1.46 confidence interval 95%: 0.61-3.47). Conclusions: Results showed no significant effect from single-dose antibiotic prophylaxis on lowering the incidence of SSI.

Objective: Falls in older people are a common presenting complaint. Knowledge of modifiable risk factors may lead to a more tailored approach to prevent recurrent falls and/or fractures. We investigated prevalence of 8 modifiable risk factors for recurrent falling and/or a serious consequence of the fall among older patients visiting the emergency department after a fall with the Combined Amsterdam and Rotterdam Evaluation of Falls Triage Instrument (CTI), a self-administrated questionnaire that consists of questions concerning demographics, possible cause(s) of the fall, and questions relating to (modifiable) risk factors for falling. Methods: After treatment for their injuries, 1077 consecutive patients 65 years or older visiting the accident and emergency department due to a fall were evaluated by the CTI. The following were assessed: impaired vision, mobility disorder, fear of falling, mood disorder, high risk of osteoporosis, orthostatic hypotension, incontinence, and polypharmacy. Results: The percentage of respondents who returned the questionnaire was 59.3%. The mean (SD) age was 78.5 (7.5) years, and 57.8% experienced a fall with serious consequences. There were 60.9% of patients with a recurrent fall versus 51% with a first fall who experienced with a serious consequence (P = .025). Age and risk factors mobility disorder (odds ratio [OR], 1.9; 95% confidence interval [Cl], 1.1-3.3), high risk of osteoporosis (OR, 2.0; 95% Cl, 1.2-3.2), incontinence (OR, 1.7; 95% Cl, 1.0-2.7), fear of falling (OR, 2.2; 95% Cl, 1.3-3.7), and orthostatic hypotension (OR, 2.4; 95% Cl, 1.4-4.2) were independently associated with a recurrent fall. Age and high risk of osteoporosis were the only risk factors predicting a serious consequence of a fall (OR, 4.6; 95% Cl, 2.9-7.2). Conclusions: Age and 5 modifiable risk factors assessed with the CTI were independently associated with a recurrent fall. Only high risk of osteoporosis was associated with a serious consequence. (C) 2010 Elsevier Inc. All rights reserved.