Normal skull suture variant mimicking intentional injury.
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Child Abuse↗
Biomedical subjects
D McAuley
Publications and source records attributed to D McAuley.
Is hot water immersion an effective treatment for marine envenomation?
Envenomation by marine creatures is common. As more people dive and snorkel for leisure, the incidence of envenomation injuries presenting to emergency departments has increased. Although most serious envenomations occur in the temperate or tropical waters of the Indo-Pacific region, North American and European waters also provide a habitat for many stinging creatures. Marine envenomations can be classified as either surface stings or puncture wounds. Antivenom is available for a limited number of specific marine creatures. Various other treatments such as vinegar, fig juice, boiled cactus, heated stones, hot urine, hot water, and ice have been proposed, although many have little scientific basis. The use of heat therapies, previously reserved for penetrating fish spine injuries, has been suggested as treatment for an increasing variety of marine envenomation. This paper reviews the evidence for the effectiveness of hot water immersion (HWI) and other heat therapies in the management of patients presenting with pain due to marine envenomation.
Animals↗
VEGF levels in the alveolar compartment do not distinguish between ARDS and hydrostatic pulmonary oedema.
Although overexpression of vascular endothelial growth factor (VEGF) 165 in the lung causes pulmonary oedema, its role in human acute lung injury (ALI) is unclear. VEGF levels are reported to be lower in bronchoalveolar lavage from ALI patients compared with normals, but these studies did not include a comparably ill control group with noninflammatory pulmonary oedema. The current authors hypothesised that VEGF levels in pulmonary oedema fluid would be lower in ALI patients compared with control patients with severe hydrostatic pulmonary oedema. VEGF was measured in pulmonary oedema fluid and plasma from 56 patients with ALI and 46 controls with severe hydrostatic pulmonary oedema. Pulmonary oedema fluid levels of VEGF did not differ between patients with hydrostatic oedema (median 799 pg x mL(-1), interquartile range (IQR) 226-2,281) and ALI (median 507, IQR 0.8-1,031). Plasma levels were also the same (median 20.5 pg x mL(-1), IQR 0-152 versus 4.8, IQR 0-99.8). There was no association between plasma or oedema fluid VEGF levels and outcomes including mortality. Vascular endothelial growth factor levels in pulmonary oedema fluid were depressed both in acute lung injury and hydrostatic pulmonary oedema. The decrease in air space concentrations of vascular endothelial growth factor in acute lung injury may not be a function of the degree of lung injury, but rather may result from alveolar flooding.
Adult↗
Adcon -L gel and intraoperative hypotension during lumbar discectomy.
This case report describes an intraoperative hypotensive event associated temporally with application of topical Adcon -L gel during lumbar surgery. Documented serum cardiac and immunological markers suggest a non-anaphylactoid aetiology. The aetiology of this phenomenon is discussed with reference to available literature.
Aged↗
Epidural fixation.
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Analgesia, Epidural↗
Bradykinin infusion in chronic cardiac failure and the effects of captopril.
BACKGROUND: Patients with chronic cardiac failure (CCF) have abnormal vascular responses. Bradykinin (BK) is thought to contribute to the vasodilator effects of ACE inhibitors, but the effect of BK itself in patients with CCF has not been examined. METHODS: We studied the responses to infused BK at 10, 30 and 100 pmol min(-1) in patients with CCF (n=10) and controls (n=10). The slope of the dose-response curve was used for comparisons between the groups. Forearm blood flow (FBF) was measured by venous occlusion plethysmography. RESULTS: Following BK, vasodilatation was observed in both groups as the slopes were positive in all, but the difference between the groups was not significant (P=0.77). The study was repeated with the co-administration of 4 micromol min(-1) of N(G)-monomethyl L-arginine (L-NMMA). The vasodilator response to BK was reduced in both groups, and the effect was somewhat greater in the patient group (P=0.23). The vasodilator response to the endothelium-independent vasodilator sodium nitroprusside was slightly less in the patient group (P=0.08). The patients only then underwent repeat infusion of BK before and after a single oral dose of captopril 12.5 mg or placebo. Following captopril, the vasodilator response to BK was unchanged when compared to placebo (difference between slopes, P=0.53). CONCLUSIONS: BK produces dose-dependent vasodilatation in both patients with CCF and controls; there was no difference in the responses, which were antagonised by L-NMMA and therefore in part NO (endothelium)-dependent. The responses were also unchanged after administration of an ACE inhibitor (captopril).
Aged↗
Spontaneous splenic rupture in infectious mononucleosis.
Spontaneous splenic rupture is a rare but life-threatening complication of infectious mononucleosis. Abdominal pain and tachycardia are unusual in uncomplicated infectious mononucleosis and should alert a doctor to the possibility of spontaneous splenic rupture.
Adult↗
Peritoneography in the assessment of peritoneal cerebrospinal fluid absorption potential for distal ventriculoperitoneal shunt catheter placement: technical case report.
OBJECTIVE AND IMPORTANCE: Distal ventriculoperitoneal shunt failure has been associated with absorption failure secondary to previous peritonitis. This assumption has caused surgeons to seek alternate sites for distal catheter placement. We propose that the absorptive potential of the peritoneal cavity should be assessed before that site is discounted for catheter placement. CLINICAL PRESENTATION: The case of a 14-month-old male patient is presented, demonstrating multiple ventriculoperitoneal shunt placement procedures and a diagnostic dilemma with respect to distal shunt placement. Peritoneography was performed to demonstrate peritoneal fluid absorption, allowing subsequent placement of a new distal shunt catheter with good clinical results. TECHNIQUE: Using aseptic technique, a 24-gauge spinal needle was inserted in the midline of the abdomen and water-soluble contrast material was instilled. Delayed radiographs delineated peritoneal adhesions and demonstrated renal excretion of the contrast material, confirming peritoneal absorption. CONCLUSION: The peritoneal cavity remains the site of choice for distal shunt catheter placement. If failure of peritoneal cerebrospinal fluid absorption is suspected as a cause of shunt failure, then peritoneography with water-soluble contrast material may be safely used to demonstrate the adequacy of fluid absorption before a secondary site is chosen.
Absorption↗
Forearm reactive hyperaemia is not mediated by nitric oxide in healthy volunteers.
AIMS: To determine the role of nitric oxide (NO) in forearm reactive hyperaemia in healthy human subjects. METHODS: Ten healthy subjects aged 19-34 years underwent brachial artery cannulation. Forearm circulatory arrest was achieved by means of an upper arm cuff inflated to 200 mmHg for 5 min. The blood flow responses during reactive hyperaemia were measured using venous occlusion plethysmography following a 10 min intra-arterial infusion of 8 micromol min-1 N-monomethyl L-arginine (L-NMMA) and following matching placebo administered in random order. Results were analysed by repeated measures anova and t-tests. RESULTS: L-NMMA resulted in a significant reduction of basal forearm blood flow indicating inhibition of basal NO release (P=0.005). There was no significant difference between the blood flow responses during reactive hyperaemia following L-NMMA and placebo (P=0.97). CONCLUSIONS: Nitric oxide production does not make a significant contribution to the vasodilatation associated with reactive hyperaemia in the human forearm.
Adult↗
Epidemiology and treatment of left ventricular hypertrophy in the elderly.
Left ventricular hypertrophy (LVH) is an important independent risk factor for cardiovascular disease and is associated with an increased risk of ventricular dysrhythmia, coronary artery disease, myocardial infarction, stroke, heart failure and peripheral artery disease. The prevalence of LVH increases strongly with advancing age and, consequently, the prevention or reduction of LVH should be an important consideration in the older age-group. This review summarises current knowledge on LVH and discusses management issues with particular reference to the elderly. Evidence suggests that antihypertensive treatment can reverse or prevent LVH. There have been few studies of LVH in the elderly, but since age does not appear to be a factor in the regression of LVH, results of studies among younger hypertensive patients can be extrapolated to the elderly population. Meta-analyses of clinical studies have not established conclusively that angiotensin-converting enzyme inhibitors and calcium antagonists are necessarily more effective than diuretics and beta-adrenoceptor antagonists in reducing LVH.
Aged↗
Accuracy and precision of blood pressure determination with the Finapres: an overview using re-sampling statistics.
The Finapres non-invasive blood pressure (BP) monitor uses the method of Penaz to indirectly record the arterial waveform; studies on its accuracy have suggested little systematic bias vs intra-arterial pressure (IAP) but substantial variability. Inconsistency between studies, in respect of the magnitude, direction and variance of bias, was described in the validation studies against the direct IAP. We have employed a novel re-sampling statistical method to combine the data from 20 published studies; a robust overall estimate of the accuracy and precision of the Finapres was thereby obtained. Based on 449 patients and 4490 re-samples, the average Finapres systolic bias (IAP- Finapres) was 2.2 mm Hg (s.d.+/-12.4) with limits of agreement (bias+/-2 s.d.) of -22.6 and 26.9 mm Hg. The average precision was 12.1 mm Hg (s.d.+/-8.4). The Finapres diastolic bias was -0.3 mm Hg (s.d.+/-7.9) with the limits of agreement of -16.1 and 15.5 mm Hg. The average precision was 7.6 mm Hg (s.d.+/-5.3). The average Finapres mean arterial pressure bias was 2.1 mm Hg (s.d.+/-8.6) with precision of 7.6 mm Hg (s.d.+/-5.3). The calculated percentage of Finapres systolic values expected to fall within +/-5 or +/-10 of the direct intra-arterial pressure was 35.9% and 73.1%, respectively. The calculated precision of the Finapres systolic pressure between 0-5 mm Hg was 1.6% and between 0-10 mm Hg 36.4%. The comparable values for Finapres diastolic BP for accuracy were 63.5% and 92.8% and for precision 23.1% and 79.2%. The Finapres device can provide an accurate estimate of diastolic and mean arterial pressure compared with the intra-arterial record; the apparent inaccuracy of the Finapres systolic pressure may have a physiological explanation. When the Finapres device is used in experimental or in clinical situations, then calibration against a reliable reference arterial pressure is desirable to obviate the possibility of an 'offset' error.
Blood Pressure Determination↗
Unsuspected penetrating maxillo-orbitocranial injury: a case report.
A healthy 37-year-old man presented to the emergency room, complaining of blunt trauma to his mandible from a tree branch. Plain radiographs and computed tomography demonstrated a penetrating orbitocranial foreign body with the maxillary sinus as the entry site. The foreign body was a chain-saw file. It was extracted successfully through the oral cavity. The patient's recovery was uncomplicated and he suffered no neurologic or opthalmic sequelae.
Adult↗
Reliability of blood pressure determination with the Finapres with altered physiological states or pharmacodynamic conditions.
The blood pressure waveform is modified on distal propagation by phenomena such as dispersion, reflection and the state of the arterial compliance. The consequent effects are amplification and narrowing of the wave, with an increased systolic, reduced diastolic and essentially unaltered mean blood pressure. The Finapres measures the peripheral pressure using the volume clamp principle; it has not been validated under altered physiological conditions and during pharmacodynamic interventions. We studied simultaneous Finapres and brachial blood pressures (using a conventional oscillometric sphygmomanometer-Vitalmap) in ten normal volunteers at rest, and during dynamic exercise and a cold pressor test. The effects of pharmacodynamic intervention were examined following beta-adrenoceptor blockade with propranolol (160 mg) or beta-adrenoceptor modulation with the beta-adrenoceptor partial agonist celiprolol (400 mg). The Finapres systolic pressure was significantly higher than the brachial value during all three test states. The difference between the systolic pressures measured by the two devices was shown to increase significantly during the cold pressor test, but not during dynamic (supine bicycle) exercise. The Finapres diastolic pressure was significantly higher than the Vitalmap value during exercise and the cold pressor test. The differences between the two methods increased significantly over time. Beta-adrenergic blockade with propranolol or modulation with celiprolol had no significant interaction with the pressure differences between the Finapres and Vitalmap techniques. The results would support the view that the Finapres can provide blood pressure information which is robust under most circumstances. Although this pharmacodynamic intervention did not alter the relationship between the peripheral and central blood pressure, it is important to note that this dynamic relationship is sensitive to circulatory loading conditions and wave transmission characteristics; it is possible that the Finapres could be less reliable in clinical settings where potent vasoactive agents were being administered.
Adrenergic beta-Antagonists↗
Forearm endothelium-dependent vascular responses and the potassium-ATP channel.
AIMS: Vasodilation to acetylcholine is mediated at least in part by endothelium-derived hyperpolarising factor (EDHF) which causes membrane hyperpolarisation by activating potassium channels. It is however uncertain which potassium channel mediates this effect. The aim of this study was to determine the role of the potassium-ATP (K(+)-ATP) channel in mediating endothelium-dependent vascular responses to acetylcholine. METHODS: In 10 healthy volunteers acetylcholine, an endothelium-dependent vasodilator, and sodium nitroprusside as a control assessing endothelium-independent vasodilatation were infused into the non-dominant brachial artery. Forearm blood flow (FBF) in response to each dose was measured by strain-gauge venous occlusion plethysmography. The K(+)-ATP channel blocker glipizide (2.5 mg) was then administered orally. After 45 min the infusions with FBF measurements were repeated. RESULTS: Acetylcholine (P < 0.01) and sodium nitroprusside (P < 0.01) both caused an increase in FBF. There was no significant difference in vascular responses to acetylcholine (P > 0.05) or sodium nitroprusside (P > 0.05) following K(+)-ATP channel blockade. CONCLUSIONS: The K(+)-ATP channel does not modulate forearm arteriolar endothelium-dependent responses in healthy volunteers and therefore does not play a role in membrane hyperpolarisation.
Acetylcholine↗
Sources of inaccuracy in the use of the Hawksley random-zero sphygmomanometer.
OBJECTIVE: To identify possible causes of inaccuracy in the use of the Hawksley random-zero sphygmomanometer and methods that could reduce this. METHODS: Four Hawksley random-zero sphygmomanometers were compared with a standard sphygmomanometer under static conditions. Two methods (standard and rapid) were used to release pressure from the inflated cuff with pressures recorded by independent blinded observers. The rate at which the hand valve released pressure was analysed. The effects of varying filling times and pressures on the size of the final zero correction were investigated. RESULTS: The Hawksley devices all under-recorded pressure compared with that measured by using a standard machine. A rapid means of pressure release approximately halved this error in each case. Pressure release through the hand valve was shown to have a characteristic and prolonged exponential decay. Using low filling times and pressures reduced the observed range of zeros seen, with the production of a correlation between the size of the zero and the inflation pressure used. CONCLUSION: These findings suggest that overestimation of the final zero correction is a common and major source of error in the use of the Hawksley sphygmomanometer. A simple change in the design of the final pressure release would improve the machine's reliability in clinical usage. The machine's zero mechanism is susceptible to unintentional misuse. Such misuse could occur when the machine is used in accordance with current sphygmomanometry guidelines.
Equipment Design↗
Peripheral nerve blocks for paediatric day-stay surgery: one year's experience in a district general hospital.
Two hundred children underwent day-care surgery using peripheral nerve blockade as an adjunct to general anaesthesia during a twelve month period. Total post-operative analgesia was achieved in 86%, simple oral analgesia was needed in 9% and the remaining 5% of patients required systemic opiate administration for pain.
Adolescent↗
An analysis of a board game as a treatment activity.
Occupational therapists often use tabletop board games in treatment to help adult clients with physical disabilities improve the perceptual, cognitive, sensory, and fine motor skill components of occupational behavior. Detailed activity analyses of these types of activities, including performance norms, are not available in the occupational therapy literature. Such analyses would help therapists consider the multiple skill demands of tabletop games and allow more systematic grading of these treatment activities. This paper presents a model for analyzing therapeutic activities in relation to relevant motor learning and cognitive-perceptual literature. Included in this analysis are a description of the activity, examination of its component skills and of the qualitative features of activity performance, suggestions for grading and for treatment goals, and some preliminary performance standards derived from a pilot study of 18 adults without physical disabilities. The issue of transfer of skills between games and functional activities is also discussed.
Adult↗