Consultants in Ireland: time for decision.
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Biomedical subjects
Publications and source records attributed to E T O'Brien.
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Forced plantar flexion can result in tibiotalar dislocation, subtalar dislocation and total dislocation of the talus. Forced dorsal flexion can cause fracture of the neck of the talus, with or without subtalar dislocation, or dislocation of the body of the bone. Accurate diagnosis is important and sometimes difficult. Reduction must be prompt. Complications include osteomyelitis, malunion and avascular necrosis of the talar body. The last may be partial and revascularization can occur.
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Glucagon was administered to six patients with acute myocardial infarction. Three of them had cardiogenic shock syndrome. Glucagon produced a positive inotropic response in all cases, which resulted in a significant rise in blood pressure, with only slight chronotropic effect. No arrhythmias were induced, and all patients with cardiogenic shock improved temporarily. Further evaluation of glucagon in shock syndrome to determine the dose and method of administration is required.
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In clinical medicine, blood pressure is usually measured by conventional sphygmomanometry. Although it seems simple at first sight, this procedure is fraught with potential sources of error, which may arise from the subject, the observer, the sphygmomanometer or the overall application of the technique. Automated techniques of blood pressure measurement, such as ambulatory monitoring and self-measurement, reduce the limitations of conventional sphygmomanometry. However, the diagnostic thresholds applicable for conventional sphygmomanometry cannot be extrapolated to automated measurements. During the past 10 years criteria for normality have gradually been developed for ambulatory blood pressure (ABP) monitoring of adults. First, the distribution of the ABP in normotensive subjects and untreated hypertensive patients who had initially been recruited and classified on the basis of their conventional blood pressure was studied. Second, authors of various epidemiological studies investigated the distributions of the conventional blood pressure and the ABP in the population at large. Third, authors of several reports attempted to validate the preliminary thresholds for ambulatory monitoring by correlating the ABP to left ventricular hypertrophy, other intermediary signs of target-organ damage or the incidence of cardiovascular morbidity or mortality. Finally, clinical trials should be mounted to prove that it is beneficial to patients as well as cost-effective to diagnose and treat hypertension on the basis of ambulatory monitoring rather than solely under the guidance of conventional sphygmomanometry. For measurements of systolic/diastolic ABP in adults, the proposed upper limits of normotension are 130/80 mmHg for the 24h blood pressure and 135/85 and 120/70 mmHg for the daytime and night-time blood pressures, respectively; for the self-measured blood pressure 135/85 mmHg might be the upper limit of normality. With regard to ABP monitoring, a large database already supports the proposed diagnostic thresholds in terms of their associations with left ventricular hypertrophy and with the incidence of cardiovascular complications; the evidence to validate the thresholds for the self-recorded blood pressure, to a large extent, must still be collected. In conclusion, the newer techniques of blood pressure measurement are now well established in the diagnosis and management of adult subjects with hypertension.