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Biomedical subjects

J M Buckingham

Publications and source records attributed to J M Buckingham.

At least 19 recordsLinked to original sources
PubMed2000

Implementing clinical practice guidelines: a community-based audit of breast cancer treatment. Australian Capital Territory and South Eastern New South Wales Breast Cancer Treatment Group.

OBJECTIVE: To improve breast cancer management by facilitating implementation of treatment guidelines. DESIGN: A prospective, longitudinal study (developed by clinicians and consumers) of all patients with newly diagnosed breast cancer. Four locally agreed breast cancer management guidelines were established (based on 1995 National Health and Medical Research Council guidelines) as practice indicators. SETTING: Breast cancer treatment facilities and medical practices in the Australian Capital Territory and South Eastern New South Wales, May 1997 to July 1998. MAIN OUTCOME MEASURES: Actual treatment received by patients for primary breast cancer during the study period. RESULTS: During the 14 months of the study, 19 clinicians registered 221 new patients with a proven diagnosis of breast cancer. Of 191 women with localised invasive breast cancer, 112 (59%) had tumours 2 cm or less in diameter. Axillary surgery in 173 (91%) of these women showed 107 (56%) had no axillary lymph node involvement. Of 87 women treated with breast-conserving surgery for locally invasive cancer, 85 (98%) also received postoperative radiotherapy. Some form of systemic adjuvant therapy was indicated in 99 women (axillary nodes positive or tumours > 2 cm diameter) and this treatment was received by 95 (96%). All 27 women aged under 50 years with node-positive disease received adjuvant chemotherapy. CONCLUSIONS: Enhancing uptake of breast cancer management guidelines is feasible at a regional level with an audit program and broad support among clinicians and consumers.

Adult↗
PubMed1999

Computed tomography in the diagnosis of equivocal appendicitis.

BACKGROUND: The clinically obscure right iliac fossa (RIF) pain remains a diagnostic problem. The present study examines the use of computed tomography (CT) in improving the accuracy of clinical assessment in these difficult surgical cases. METHODS: The trial design was a retrospective review of all patients admitted under one surgeon with suspected acute appendicitis, between 1 January 1995 and 30 June 1997. The study setting was a district hospital (Calvary Hospital) that received patients from both an urban and rural environment. The patient cohort was identified from the Unit Registry and an International Classification of Diseases-based review of medical records. Twenty-one prospective data points were obtained from patient records. Those patients admitted with RIF pain and equivocal symptoms and signs subsequently underwent a CT and/or ultrasound (US) examination, conducted by the attending radiologist. For those patients who proceeded to appendicectomy, the histopathological findings were correlated with the imaging report. Those patients who were discharged after imaging without proceeding to operation were not readmitted to any regional hospital during the course of the study. RESULTS: A total of 84 patients were identified. Thirty-three patients (39%) underwent appendicectomy without imaging and were excluded from further analysis. A total of 51 patients (61%) underwent 61 imaging procedures. The CT scan was correct in 35/36 patients (97%), while US was correct in 17/25 patients (68%). CONCLUSIONS: The present study suggests that CT can be used to improve the accuracy of diagnosis of obscure RIF pain. As a pilot study, it supports the development of a randomized controlled trial in a multicentre regional study.

Abdominal Pain↗
PubMed1991

Systematic generation of sequence-tagged sites for physical mapping of human chromosomes: application to the mapping of human chromosome 7 using yeast artificial chromosomes.

Basic to the development of long-range physical maps of DNA are the detection and localization of landmarks within recombinant clones. Sequence-tagged sites (STSs), which are short stretches of DNA that can be specifically detected by the polymerase chain reaction (PCR), can be used as such landmarks. Our interest is to construct physical maps of whole human chromosomes by localizing STSs within yeast artificial chromosome (YAC) clones. Here we describe a generalized strategy for the systematic generation of large numbers of STSs specific for human chromosome 7. These STSs can be detected by PCR assays developed following the sequencing of anonymous pieces of chromosome 7 DNA, which was derived from flow-sorted chromosomes or from lambda clones made from DNA of a human-hamster hybrid cell line. Our approach for STS generation is tailored for the development of PCR assays capable of screening a large YAC library. In this study, we report the generation of 100 new STSs specific to human chromosome 7.

Animals↗
PubMed1989

The distribution of interspersed repetitive DNA sequences in the human genome.

The distribution of interspersed repetitive DNA sequences in the human genome has been investigated, using a combination of biochemical, cytological, computational, and recombinant DNA approaches. "Low-resolution" biochemical experiments indicate that the general distribution of repetitive sequences in human DNA can be adequately described by models that assume a random spacing, with an average distance of 3 kb. A detailed "high-resolution" map of the repetitive sequence organization along 400 kb of cloned human DNA, including 150 kb of DNA fragments isolated for this study, is consistent with this general distribution pattern. However, a higher frequency of spacing distances greater than 9.5 kb was observed in this genomic DNA sample. While the overall repetitive sequence distribution is best described by models that assume a random distribution, an analysis of the distribution of Alu repetitive sequences appearing in the GenBank sequence database indicates that there are local domains with varying Alu placement densities. In situ hybridization to human metaphase chromosomes indicates that local density domains for Alu placement can be observed cytologically. Centric heterochromatin regions, in particular, are at least 50-fold underrepresented in Alu sequences. The observed distribution for repetitive sequences in human DNA is the expected result for sequences that transpose throughout the genome, with local regions of "preference" or "exclusion" for integration.

Chromosome Mapping↗
PubMed1988

Isolation and molecular characterization of a highly polymorphic centromeric tandem repeat in the family Falconidae.

An abundant tandem repeat has been cloned from genomic DNA of the merlin (Falco columbarius). The cloned sequence is 174 bp in length, and maps by in situ hybridization to the centromeric regions of several of the large chromosomes within the merlin karyotype. Complementary sequences have been identified within a variety of falcon species; these sequences are either absent or in very low copy number in the family Accipitridae. The cloned merlin repeat reveals highly polymorphic restriction patterns in the peregrine falcon (Falco peregrinus). These polymorphisms, which have been shown to be stably inherited within a family of captive peregrines, can be used to differentiate the Greenland and Argentina populations of this endangered raptor species.

Animals↗
PubMed1988

A highly conserved repetitive DNA sequence, (TTAGGG)n, present at the telomeres of human chromosomes.

A highly conserved repetitive DNA sequence, (TTAGGG)n, has been isolated from a human recombinant repetitive DNA library. Quantitative hybridization to chromosomes sorted by flow cytometry indicates that comparable amounts of this sequence are present on each human chromosome. Both fluorescent in situ hybridization and BAL-31 nuclease digestion experiments reveal major clusters of this sequence at the telomeres of all human chromosomes. The evolutionary conservation of this DNA sequence, its terminal chromosomal location in a variety of higher eukaryotes (regardless of chromosome number or chromosome length), and its similarity to functional telomeres isolated from lower eukaryotes suggest that this sequence is a functional human telomere.

Base Sequence↗
PubMed1979

Vascular access: long-term results, new techniques.

Effective approaches to unique problems of vascular access in renal failure have evolved from a five-year experience with 840 angioaccess procedures. Standard techniques plus innovations have required only 0.62 operations per year per patient with an average access life of 1.6 years. Classical forearm external arteriovenous (AV) cannulas and internal AV fistulas provided vascular access in 392 patients, while 61 required more complex procedures due to failure of primary cannulas and fistulas, inherently small forearm vessels, and iatrogenic vessel loss. Secondary techniques include reverse fistula, vascular graft AV fistulas using expanded polytetrafluoroethylene (E-PTFE), and arterioarterial (AA) jump graft. Presently, the new renal failure patient receives a forearm radiocephalic AV fistula; the cannula is restricted to emergency or short-term hemodialysis and may later be converted to a subcutaneous fistula. The reverse fistula is attempted before using E-PTFE grafts. Upper extremity AV and AA loops can then be constructed de novo or from the reverse fistula.

Arm↗
PubMed1977

An assessment of cell-mediated immunity in acute allograft rejection in man. A prospective study.

A detailed multifactorial computer analysis of several in vitro tests of cell-mediated immunity has been carried out before and after surgery in 15 renal transplant recipients. Factors studied include lymphocyte blastogenesis, T- and B-cell levels, and lymphocyte protein synthesis. Large doses of immunosuppressive agents chnage lymphocyte subpopulations. This is seen especially in transplant patients who have rejection and who have decreased numbers of circulating lymphocytes. The T cells are selectively depressed more than the B cells. This is also reflected in the greater responsiveness of pokeweed mitogen-stimulated lymphocytes compared with lymphocyte responsiveness to phytohemagglutinin and concanavalin A. In this environment, rejection takes place. These observations suggest that rejection may be initiated by cortisone-resistant lymphocytes of the thymic medullary type. Measurements of changes in lymphocyte responsiveness to mitogens or changes in lymphocyte subpopulations do not reliably predict rejection. However, measurement of lymphocyte protein synthesis fills the criterion of providing a reliable test that can be carried out quickly, and in the future may be valuable in predicting rejection.

B-Lymphocytes↗
PubMed1976

Surgical technic in en bloc bilateral cadaveric nephrectomy for transplantation.

En bloc bilateral cadaveric nephrectomy for transplantation has some advantages over excision of each kidney separately. There is also an advantage of single cannula perfusion through the aorta for two kidneys, especially when multiple renal arteries are present. The anatomic vascular variants are important, as are the incision and the approach to the suprarenal aorta and the lumbar venous drainage of the kidney.

Cadaver↗
PubMed1976

Internal marsupialization of lymphoceles after renal transplantation.

A technique of internal marsupialization of lymphoceles after renal transplantation in selected cases is described. This technique allows complete marsupialization of retrorenal lymphoceles not amenable to external marsupialization. It also can be carried out during concomitant intraperitoneal surgical procedures.

Cysts↗
PubMed1976

Plasma insulin and glucose levels after renal transplantation.

Plasma insulin and glucose levels were measured before and for twenty-four hours after operation in 13 patients who had undergone renal transplantation, 4 who had undergone bilateral nephrectomy, and 5 who had undergone donor nephrectomy. Postoperative hyperglycemia was noted in all patients, but the hyperglycemia was much greater after renal transplantation. Peripheral insulin antagonism rather than decreased insulin secretion appeared to account for the hyperglycemia. The peripheral insulin antagonism was largely due to surgical stress, but intravenous immunosuppressive medications contributed to the exaggerated hyperglycemia, hyperinsulinemia, and insulin antagonism observed in the transplant patient.

Adult↗
PubMed1976

Intestinal perforation due to fecal impaction after renal transplantation.

Three renal allograft recipients suffered major intestinal complications shortly after the operation. Identification of diverticular disease, adequate preoperative bowel preparation, avoidance of excessive amounts of non-absorbable antacids, early ambulation, and periodic laxatives and stool softeners can prevent these complications. Surgical management includes careful inspection for additional perforations, resection and colostomy, and continuous peritoneal lavage.

Adult↗
PubMed1976

The value of thymectomy in myasthenia gravis: a computer-assisted matched study.

In the absence of a prospective randomized study of patients treated conservatively or with thymectomy, a computer-assisted retrospective matches study was devised. Of 563 patients treated for myasthenia gravis without thymoma up to 1965, 104 had thymectomy. With computer assistance, each surgical patient was matched with a medical patient on the basis of age, sex, and severity and duration of disease. On this basis 80 of the 104 surgical patients could be matched satisfactorily. There were 16 males and 64 females in each of the matched surgically treated and medical control groups. A complete remission was experienced by 27 of the 78 patients in the surgical group as compared to 6 of the medical group. Improvement was noted by 26 of 78 surgically treated patients and 13 of 78 receiving medical treatment. Survival for patients having thymectomy. Thirty-four patients in the medical group had died as compared to 11 in the surgical group. Comparison of survival in relation to sex, duration of symptoms, or age (less than 30 or less than 30 years) did not show a significant difference. Until more effective treatment is available for myasthenia gravis, thymectomy deserves consideration for both sexes, and with increased age or long duration of symptoms.

Adolescent↗
PubMed1976

Evaluation of the Bacti-Lab streptococci culture systems for selective recovery and identification of group A streptococci.

Twenty-nine lots of Bacti-Lab streptococci culture plates containing nalidixic acid, neomycin, and amphotericin B were inoculated with 25 strains of group A, B, C, F, and G strepotocci, 13 strains of nonstrepotcoccal organisms representative of the throat flora, and 198 fresh clinical thorat specimens to determine the accuracy of the plates in identifying group A streptococci. With the Bacti-Lab test plates 98.87% of the beta-hemolytic streptococcal strains tested produced growth 95.51% yielding more than 50 colonies. Of the nonstreptococcal beta-hemolytic and non-beta-hemolytic organism tested, 79.54% were inhibited by the selective media. When bacitracin disks were used for presumptive identification group A streptococci from clinical thorat specimens, 12.00% false positive and 0.00% false negative results were obtained as measured by the direct flourescent-antibody and Lancefield grouping methods.

Agar↗
PubMed1975

Results of emergency surgical management of hemorrhagic duodenal ulcer.

The results of emergency surgical operations carried out on 61 patients with massively beleding duodenal ulcers between the years 1960 and 1969 were reviewed. The most useful diagnostic tool was gastric roentgenography. However, celiac axis arteriography was not in use during this period. The basic procedure carried out was either gastric resection or vagotomy and pyloroplasty. The mortality between the two groups was similar. However, patients more than 60 years of age had a much greater morbidity after gastric resection. Complications were more likely to occur in patients who had a history of chronic ingestion of aspirin prior to the bleeding episode or in whom bleeding from their duodenal ulcer developed while they were recovering from some other surgical procedure.

Adolescent↗