The Ulster medical journal
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Comparative Study
Mobile coronary care and mortality from ischaemic heart disease in a predominantly rural community.
The mobile coronary care unit based at Coleraine Hospital was called to 155 patients in the community during a six-monthly period, 74 of whom had sustained a myocardial infarction. Over the same period, 25 of 49 patients admitted via the ordinary ambulance with suspected ischaemic heart disease had sustained a myocardial infarction and received medical care significantly later than those seen by the mobile unit. A further 12 patients out of 39 with suspected ischaemic heart disease admitted by other means (the accident and emergency department or other hospital units) brought the total number of patients admitted to hospital with myocardial infarction during the study period to 111. ⋯ No patients admitted by other means required emergency defibrillation. Although no significant difference in mortality was demonstrated between those seen before or after three hours from the onset of symptoms or between patients admitted by the mobile unit or by the ordinary ambulance, a subgroup of patients below 70 years of age and seen by the mobile unit less than three hours after the onset of symptoms had the lowest mortality of 6.7%. Estimated overall mortality from ischaemic heart disease in this community over the study period was in excess of those deaths accounted for in this survey, implying a high mortality in those not admitted to hospital.
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Important advances have been made within the last two decades in the field of fracture management. The development of the AO internal fixation system and the advances in cast bracing techniques are but two of the improvements worthy of mention. It is, however, in the field of external fixation of fractures that the greatest advances have been made. This paper traces the history of external fixation up to the present day and discusses, with examples, the application of external fixation in the management of complex limb fractures.
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Biography Historical Article
Anaesthetics. With special reference to Ivan Magill.
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In intussusception in early childhood, reduction by barium enema is the treatment of choice. In late cases when there is air and fluid distension of the small bowel on plain x-ray, barium enema is less useful. Generally 20-25% of childhood intussusception presents in this way. We have reviewed the experience of 65 intussusceptions at the Royal Belfast Hospital for Sick Children over the past 5 years and found only one successful barium enema reduction in 22 obstructed intussusceptions.