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R Buckley

Publications and source records attributed to R Buckley.

At least 19 recordsLinked to original sources
PubMed2003

Complications following management of displaced intra-articular calcaneal fractures: a prospective randomized trial comparing open reduction internal fixation with nonoperative management.

OBJECTIVE: To report on all complications experienced by patients with displaced intra-articular calcaneal fractures (DIACFs) following nonoperative management or open reduction internal fixation (ORIF). DESIGN: Prospective, randomized, multicenter study. SETTING: Four level I trauma centers. PATIENTS: The patient population consisted of consecutive patients, age 17 to 65 at the time of injury, presenting to 1 of the centers with DIACFs between April 1991 and December 1998. INTERVENTIONS: Patients were randomized to the nonoperative treatment group or to operative reduction using a lateral approach to the calcaneus. MAIN OUTCOME MEASUREMENTS: Follow-up for patients was at 2 weeks, 6 weeks, 3 months, 12 months, 24 months, and once greater than 24 months following injury. At each follow-up interval, patients were assessed for the development of major and minor complications. After a minimum of 2-year follow-up, patients were asked to fill out a validated visual analogue scale questionnaire (VAS) and a general health review (SF-36). RESULTS: There were 226 DIACFs (206 patients) in the ORIF group with 57 of 226 (25%) fractures (57 of 206 patients [28%]) having at least 1 major complication. Of 233 fractures (218 patients) nonoperatively managed, 42 (18%) (42 of 218 patients [19%]) developed at least 1 major complication (indirectly resulting in surgery). CONCLUSION: Complications occur regardless of the management strategy chosen for DIACFs and despite management by experienced surgeons. Complications are a cause of significant morbidity for patients. Outcome scores in this study tend to support ORIF for calcaneal fractures. However, ORIF patients are more likely to develop complications. Certain patient populations (WCB and Sanders type IV) developed a high incidence of complications regardless of the management strategy chosen.

Adolescent↗
PubMed2001

Alterations of the X-linked lymphoproliferative disease gene SH2D1A in common variable immunodeficiency syndrome.

X-linked lymphoproliferative (XLP) disease is a primary immunodeficiency caused by a defect in the SH2D1A gene. At least 3 major manifestations characterize its clinical presentation: fatal infectious mononucleosis (FIM), lymphomas, and immunoglobulin deficiencies. Common variable immunodeficiency (CVID) is a syndrome characterized by immunoglobulin deficiency leading to susceptibility to infection. In some patients with CVID, a defective btk or CD40-L gene has been found, but most often there is no clearly identified etiology. Here, 2 unrelated families in whom male members were affected by CVID were examined for a defect in the XLP gene. In one family previously reported in the literature as having progressive immunoglobulin deficiencies, 3 brothers were examined for recurrent respiratory infections, whereas female family members showed only elevated serum immunoglobulin A levels. A grandson of one of the brothers died of a severe Aspergillus infection secondary to progressive immunoglobulin deficiency, FIM, aplastic anemia, and B-cell lymphoma. In the second family, 2 brothers had B lymphocytopenia and immunoglobulin deficiencies. X-linked agammaglobulinemia syndrome was excluded genetically, and they were classified as having CVID. The occurrence of FIM in a male cousin of the brothers led to the XLP diagnosis. Because the SH2D1A gene was found altered in both families, these findings indicate that XLP must be considered when more than one male patient with CVID is encountered in the same family, and SH2D1A must be analyzed in all male patients with CVID. Moreover, these data link defects in the SH2D1A gene to abnormal B-lymphocyte development and to dysgammaglobulinemia in female members of families with XLP disease.

Amino Acid Sequence↗
PubMed2001

Age, gender, work capability, and worker's compensation in patients with displaced intraarticular calcaneal fractures.

OBJECTIVES: To determine which demographic variables are linked with outcome in displaced intraarticular calcaneal fractures. The variables studied were age, gender, work capability, Workers' Compensation Board (WCB) support, and injury type. DESIGN: A prospective cohort study with a minimum of two years of follow-up. SETTING: A university-affiliated Level I trauma hospital. PATIENTS: One hundred sixty-nine patients who required treatment for displaced intraarticular calcaneal fractures treated by a single surgeon. To be included in the study, patients had to be aged between fifteen and sixty-five years at the time of the injury, have closed injuries, and have posterior facet displacement greater than two millimeters. INTERVENTION: Patients were treated nonoperatively or operatively, using a lateral approach to the calcaneus. MAIN OUTCOME MEASUREMENTS: Outcome was measured by return of patients to full-time work, change in work capability after treatment, the SF-36 health survey, and visual analog scales. RESULTS: Male gender, medium and heavy labor, presence of WCB support, and presence of bilateral intraarticular fractures all proved to be associated with a poorer prognosis. Female patients did well when treated nonoperatively and operatively, whereas male patients always were less able to return to work at the same level as before the injury. Operatively treated patients returned to work quicker (average, eighty-seven days). CONCLUSIONS: Males, multiply injured patients, and heavy laborers may have better outcomes with operative treatment, whereas females and non-WCB patients may do better with nonoperative treatment.

Adolescent↗
PubMed2001

Assessment of osteoporosis using standard radiographs of the wrist.

BACKGROUND: This study evaluated the ability of the orthopaedic surgeon to radiographically assess bone density in the wrist with sufficient accuracy to determine which patients require treatment for osteoporosis. METHODS: Thirty-eight patients with unilateral distal radius fractures, 30 of whom were female, were included in this study. The mean age was 55 years (range 45 to 82). Standard radiographs of the fractured and normal wrists were taken. Dual energy x-ray absorptiometry was performed on the normal distal radius of all patients within 1 week of their injury. The radiographs were viewed in blinded randomized fashion on two separate occasions by three orthopaedic surgeons and once by a fourth. The participants were required to determine the presence of osteoporosis. Visual analog scales (VAS) were used to evaluate (1) porosity, (2) cortical thickness, (3) trabecular thickness, and (4) the number of trabeculae in the ultradistal radius. RESULTS: Intraobserver agreement assessing osteoporosis averaged 81% (kappa of 0.5393). VAS assessment was unreliable for all four parameters. Radiographic determination of osteoporosis had a specificity of 61% and a sensitivity of 61% using x-rays of the uninjured wrist. CONCLUSION: We conclude that orthopaedic surgeons cannot predict with sufficient accuracy using plain x-rays whether a patient is significantly osteoporotic.

Absorptiometry, Photon↗
PubMed2000

Monitoring Diffuse Impacts: Australian Tourism Developments.

/ The scientific quality of monitoring for diffuse environmental impacts has rarely been quantified. This paper presents an analysis of all formal environmental monitoring programs for Australian tourism developments over a 15-year period from 1980 to 1995. The tourism sector provides a good test bed for this study because tourism developments are (1) often adjacent to or even within conservation reserves and other relatively undisturbed natural environments, and (2) often clustered, with resulting cumulative impacts that require detection at an early stage. Here we analyze the precision and reliability with which monitoring programs as actually implemented can detect diffuse environmental impacts against natural variation. Of 175 Australian tourism developments subject to EIA from 1980 to 1993 inclusive, only 13 were subject to formal monitoring. Only 44 individual parameters, in total, were monitored for all these developments together. No baseline monitoring was conducted for nine of the 44 parameters. For the remaining 35, only one was monitored for a full year. Before, after, control, impact, paired sampling (BACIP) monitoring designs were used for 24 of the 44 parameters, and power analysis in 10. The scientific quality of monitoring was significantly better for developments subject to control by the Great Barrier Reef Marine Park Authority (GBRMPA). The key factor appears to be the way in which GBRMPA uses external referees and manages external consultants. The GBRMPA model merits wider adoption.

Journal Article↗
PubMed2000

CJD and the eye.

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Creutzfeldt-Jakob Syndrome↗
PubMed2000

Imiquimod therapy for molluscum contagiosum.

BACKGROUND: Molluscum contagiosum virus (MCV) is a large double-stranded DNA virus that is a member of the family Poxviridae, and which has a worldwide distribution. As with other poxviruses, MCV does not appear to develop latency but evades the immune system through the production of viral specific proteins. OBJECTIVE: To evaluate the therapeutic efficacy of imiquimod 5% cream for MCV. METHODS: Thirteen children >5 and <10 years old, 19 immune-competent adults and four adults with advanced, but stable HIV-1 disease with >10 MCV lesions were treated with topical 5% imiquimod cream three times weekly for up to 16 weeks. RESULTS: Fourteen of 19 immune-competent adults, four of four adults with HIV-1 disease, and six of 13 children had resolution of their MCV lesions in <16 weeks of imiquimod therapy. Children tended to have more pruritus and inflammatory reactions with imiquimod, although most treated lesions appeared to respond. The development of new MCV lesions resulted in a lower overall resolution of the lesions in children. Imiquimod appeared to be the most efficacious in patients with HIV-1 disease and in the genital area in immune-competent adults. CONCLUSION: Although topical imiquimod appears to have some efficacy in the therapy of MCV, in children the pruritus correlated relatively well with the development of new lesions. In adults, areas that would be expected to have better penetration appeared to respond more consistently. Although the HIV-1-positive patients had the largest clinical lesions at the onset of therapy, as a group they had the best overall response to therapy.

AIDS-Related Opportunistic Infections↗
PubMed2000

Generalized essential telangiectasia in a patient with Graves' disease: should the spectrum of autoimmune diseases associated with generalized telangiectasia be expanded?

Generalized essential telangiectasia (GET), as originally described, is not associated with any underlying disease. Although patients with GET lack the typical periungual telangiectases associated with autoimmune collagen vascular diseases, these patients may have an underlying autoimmune process. We present a patient with a history of Graves' disease and low-titer anti-nuclear antibodies, who developed rapidly progressive generalized telangiectases. The gender and age of the majority of patients with GET fit well within the demographics of most autoimmune diseases. The documented occurrence of an autoimmune disease in several of the limited number of patients previously diagnosed with GET provides additional evidence that GET may be associated with an underlying autoimmune disease.

Adult↗
PubMed2000

Lamivudine (3TC)-induced contact dermatitis.

The nucleoside analogue lamivudine (3TC) is commonly used in multidrug therapy of human immunodeficiency virus-1 disease because it not only potentiates the antiviral effects of other reverse transcriptase inhibitors, but it is also relatively nontoxic. We present a patient who developed a contact dermatitis to lamivudine after prolonged exposure.

Adult↗
PubMed2000

Stop the trade.

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Animals↗
PubMed1999

Phenomenology and treatment of psychotic disorders in the psychiatric emergency service.

The emergency evaluation of a psychotic patient calls on all of the skills of the psychiatrist. The immediate control of dangerous behavior takes place at the same time that clinicians evaluate patients for delirium. A screening physical examination, a brief mental status examination, and a high index of suspicion for medical diseases are essential tools in the first few minutes of a patient's stay in the psychiatric emergency service. Drugs of abuse are often part of a patient's presentation. Here, too, the first task is to rule out delirium, particularly from sedative or alcohol withdrawal. As soon as a patient's condition is stabilized, the psychiatrist should review all of the available information, develop a working diagnosis, and initiate definitive treatment of the presumed disorder. With fewer emergency patients being hospitalized and with shorter lengths of hospital stay, these initial decisions acquire increasing significance for patient outcome.

Delirium↗
PubMed1999

Comparison of two regimens of beta-adrenergics in acute asthma.

BACKGROUND AND METHODS: Inhaled adrenergics and steroids are the main agents used in acute asthma. Dosing recommendations for adrenergics, while generally becoming more aggressive, lack prospective validation. A double blind, randomized trial of two regimens of nebulized metaproterenol was conducted in patients presenting to an Emergency Department with an acute asthma exacerbation. Asthmatics age 16-55, with no other cardio-pulmonary disease, presenting with peak expiratory flow rate (PEFR) < 30% of predicted and greater than 80 L/m were enrolled. All patients received 125 mg of methylprednisolone and theophylline, if needed, to reach therapeutic levels. The experimental group received 0.3 cc metaproterenol in 2.5 cc of saline at times 0, 20", 40", 1', 2', 3', 4', 5', 6', and 7'. The control group received metaproterenol at times 0, 1 hr, and hours 3, 5, and 7. Placebo was given to control group patients at 20", 40", 2', 4', and 6'. PEFR and vital signs were measured 10 min after each treatment. Study end points included discharge upon reaching set criteria or admission if patients were not discharged following the hour 7 treatment. RESULTS: Seventy one patients were enrolled, 40 in experimental group and 31 in the control group. The group characteristics did not differ at entry in any significant way, and the groups began with mean expected PEFR of 23.4% and 24.5%, respectively. There were no significant differences at any point in PEFR outcomes, time to discharge, or admission rate. The experimental group showed a greater increase in pulse rate and a reduced diastolic blood pressure at 20, 40 and 60 min. The experimental group had a 12- and 8-fold increase in the risk of a pulse rate > 140 at 40 and 60 min, respectively. This group also had two moderate complications, both near the 60-minute mark. These were an induction of atrial fibrillation in one patient and ischemic electrocardiographic changes in another. CONCLUSION: Three treatments in the first hour, and hourly thereafter showed no benefit over treatments initially, at one hour, and every other hour in acute, moderate, or severe exacerbation of asthma. Side effects were markedly increased in the control group. Such dosing should not be recommended as routine therapy.

Acute Disease↗
PubMed1999

Bohler's angle: correlation with outcome in displaced intra-articular calcaneal fractures.

OBJECTIVES: Bohler's tuber joint angle is commonly assessed when evaluating calcaneal fractures. A severe heel fracture will result in a significant decrease or loss of this angle. The purpose of this study was to evaluate the correlation between Bohler's angle and functional outcome in displaced intra-articular calcaneal fractures. DESIGN: Prospective cohort study. SETTING: Level I trauma center. METHODS: Ninety-five fractures in eighty-eight patients were analyzed for clinical outcome as measured by previously validated visual analogue scale (VAS) and SF-36 Health Survey scores. Radiographic results were measurements of Bohler's angle on plain x-rays. Angles were measured twice by two observers working independently. RESULTS: This prospective randomized cohort study indicates that patients initially presenting with a severely depressed Bohler's angle have a poor two-year outcome regardless of treatment. As well, fractures of lesser initial displacement, as measured by Bohler's angle, had higher functional scores on both VAS and SF-36 scoring scales. CONCLUSION: In this study, Bohler's angle had significant prognostic value in terms of predicting morbidity. Fractures with a markedly diminished Bohler's angle demonstrated a much poorer two-year outcome regardless of treatment. It would seem that the initial Bohler's angle was highly prognostic, regardless of treatment modality.

Ankle Joint↗
PubMed1998

Two novel mutations in exon 11 of the PAH gene (V1163del TG and P362T) associated with classic phenylketonuira and mild phenylketonuria. Mutations in brief no. 143. Online.

PKU is one of the commonest genetic disease in man, affecting 1/10,000 individuals. It presents a wide phenotypical spectrum, from classic PKU to moderate Hyperpheylalaninemia depending on the residual enzymatic activity. Two novel mutations 1163/1164delTG and P362T in exon 11 have been detected during the mutational screening of the PAH gene in 84 families. 1163/1164delTC can be confused with V388M if the mutational screening is performed with BsaAI restriction enzyme, this mutation in heterozigosis presents a moderate phenotype. P362T mutation in heterozigosis with V388M shows a classical PKU phenotype. We report here two new mutations in exon 11 of the PAH gene (GenBank U49897), V1163delTG and P362T (using cDNA sequence), detected during the analysis of 57 PKU and 36 HPA patients belonging to 84 unrelated families detected under a neonatal screening program performed in Catalonia.

DNA Mutational Analysis↗
PubMed1998

Diagnosis and treatment of prostatitis in Canada.

OBJECTIVES: There is a general consensus among physicians that the present management of chronic prostatitis is dismal. We undertook a survey of Canadian primary care physicians (PCPs) and urologists to determine the degree and source of frustration and to analyze present practice patterns in this disease. METHODS: Five thousand PCPs and all 545 Canadian urologists were asked to complete a comprehensive computer-assisted telephone survey that explored practice characteristics, attitudes, and diagnostic and treatment strategies in the management of prostatitis. Randomization of attribute banks, adherence to questionnaire routing, validation by on-site monitoring, and possible bias were addressed. RESULTS: Completed interviews were obtained from 10% of PCPs and 28% of urologists. PCPs see on average 3.5 (median 2) patients with prostatitis per month and urologists see on average 21.8 (median 11) patients with prostatitis per month. All physicians experience significantly more frustration in treating prostatitis than they do in treating patients with benign prostatic hyperplasia (BPH) and prostate cancer, and they perceive that prostatitis affects patients' quality of life significantly more than BPH and almost as much as prostate cancer. The degree of frustration and unhappiness in dealing with prostatitis is driven by a lack of confidence and comfort in their ability to accurately diagnose and subsequently rationalize treatment. Most PCPs and urologists continue to employ steps in addition to history and physical examination to establish a diagnosis but only a few PCPs and a third of urologists use specific lower urinary tract cultures. Physicians tend to use trimethoprim or trimethoprim-sulfamethoxazole (TMP-SMX) or a fluoroquinolone as their usual first line therapy for chronic prostatitis. The most commonly used therapeutic strategy (40%) for chronic prostatitis was TMP-SMX as first line therapy and a fluoroquinolone as second line therapy. CONCLUSIONS: There is widespread frustration, discomfort, and lack of confidence in both PCPs' and urologists' perceived ability to manage prostatitis. Physicians have expressed a desire for a better understanding of this disease, simpler and clearer diagnostic guidelines, and more rational treatment strategies.

Canada↗