Biomedical subjects
R E Donnelly
Publications and source records attributed to R E Donnelly.
Reducing the dangers of pediatric pneumococcal disease with a new vaccine.
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Management of new-onset atrial fibrillation.
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Childhood immunization: schedule for 2000.
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The growing presence of complementary and alternative medicine.
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Intelligence patterns among children with high-functioning autism, phenylketonuria, and childhood head injury.
High-functioning children with autistic-spectrum disorder show the typical pattern of lower Comprehension relative to their own scores on Block Design. This profile is shared, almost exactly, by age- and IQ-matched children with poorer control PKU. Quite distinct profiles are shown by children with better control PKU, who show no difference between Block Design and Comprehension, and by children with head injury involving frontal lobe contusion, who show slightly better Comprehension that Block Design. The data bear on several questions: the relation between Comprehension deficits and language functions measured by Vocabulary; the limits of the advantages conveyed by higher IQ to autistic individuals; whether impaired Comprehension in autism indexes persisting symptoms and/or impairments on theory of mind tasks; the possibility that dopamine deficiency is common to autism and poorer control PKU; and the need for future research aimed at understanding the relations among neurodevelopmental disorders.
Managing minor closed head injury in children.
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Modified chevron osteotomy for hallux valgus.
The chevron osteotomy for hallux valgus was modified by addition of screw fixation and change of the osteotomy angle. Thirty-six patients underwent this modified osteotomy. All had mild to moderate symptomatic hallux valgus deformities. No other forefoot procedures were performed. Standing radiographs were taken before surgery, at 1 month after surgery, and, for the 15 patients who returned for long-term follow-up, at 1 year or more after surgery. Overall, 35/42 procedures were rated as satisfactory without reservations and 7 were rated as satisfactory with mild reservations. All patients stated that they had some improvement in their preoperative symptoms, which included pain, cosmetic concerns, and shoe wear difficulties. Radiographically, none of the capital fragments displaced and there were no malunions, nonunions, nor evidence of avascular necrosis. The average metatarsophalangeal-1 angle improved 8 degrees and the average intermetatarsal 1-2 angle improved 4 degrees. This modification is relatively simple, increases stability, and allows early weightbearing. In our experience, the modified chevron osteotomy has been a very reliable procedure for mild to moderate symptomatic hallux valgus deformity.
Tibiotalocalcaneal arthrodesis with an intramedullary device.
An intramedullary fixation device was devised by the senior author (K.A.J.) to use in conjunction with a previously described method for tibiotalocalcaneal arthrodesis. Satisfactory results were obtained in approximately 87% of the initial 30 patients; union was radiographically or clinically evident in all but two patients. Many of these patients had been offered or were considering below the knee amputation; only two ultimately chose this reconstructive option at a follow-up that ranged from 4 to 27 months.
Occurrence and distribution of the parasitic copepod Leposphilus labrei on corkwing wrasse (Crenilabrus melops) from Mulroy Bay, Ireland.
Corkwing wrasse (Crenilabrus melops: Labridae), used to control ectoparasites on sea-farmed salmon, were found to contain the copepod parasite Leposphilus labrei (Philichthyidae) within the lateral line. Prevalence was 30.7% in 6,270 wrasse examined from Mulroy Bay, Ireland. Significantly more males than females or juveniles were infected; this appears related to size at age, as prevalence increases above 100 mm total length. Intensity was normally unity and the parasite showed a significant preference to infect the left rather than the right side of male wrasse. It is suggested that this preference is due to asymmetric fish locomotion, equivalent to "handedness."
The patellar tendon-bearing brace as treatment for neurotrophic arthropathy: a dynamic force monitoring study.
UNLABELLED: The effects of shoe wear, custom-made inserts, patellar tendon-bearing (PTB) braces, and extra-padded PTB braces on load transmission to neuroarthropathic (Charcot) feet of six diabetic patients were assessed. A PTB brace with a free ankle and an extradepth shoe without external modifications was used. Four distinct anatomical regions were evaluated by an in-shoe technique measuring vertical force. The mean peak force transmitted to the entire foot was higher in the affected than in the unaffected extremity barefoot and shod. The mean peak forces under the midfoot were higher for the affected than for the unaffected extremity for all tested circumstances. In the affected foot, use of the standard PTB brace reduced mean peak force to the entire foot by 15%. Adding extra padding to the brace decreased the mean peak force 32%. The effect of padding on vertical load transmission was greatest for patients who had worn the brace the longest. For the patients who had worn it longer than average, the addition of padding decreased the mean peak force to the entire foot by 19%, to the hindfoot by 37%, and to the midfoot by 20%. CLINICAL RELEVANCE: In this preliminary study, we found that a properly fitted PTB brace can reduce load transmission to the Charcot foot. Specifically, load transmission was reduced to the hindfoot, but not to the midfoot or forefoot. Based on these results, we cannot recommend its use to reduce vertical force transmission to the Charcot midfoot or forefoot. Long-term PTB brace use, especially in the limited weight-bearing patient, should be regularly adjusted to ensure adequate brace fit.
The impact of Alzheimer's disease on driving ability: a review.
As our elderly population continues to increase, diseases that are more prevalent with aging, such as Alzheimer's disease, are assuming ever greater relevance for society and the practicing clinician. An important practical situation faced by physicians caring for individuals with Alzheimer's disease is advising the affected individuals, their families, and often the licensing authorities about whether the patient can safely drive an automobile. Surprisingly, there is little guidance on how to arrive at a clinical impression of the fitness of an individual with Alzheimer's disease to drive. This article outlines potential inadequacies in driving skills that may occur with elderly people in general, and more specifically those with Alzheimer's disease. Studies that focused on Alzheimer's disease and driving are then reviewed. We conclude with recommendations for dealing with the problem of driving abilities in Alzheimer's disease.
Surgical treatment for mild deformities of the rheumatoid forefoot by partial phalangectomy and syndactylization.
Thirteen patients (14 feet) were treated for mild rheumatoid forefoot deformities with lesser toe partial proximal phalangectomies and partial syndactylizations. Eleven patients (85%) were reviewed at an average of 8 years postoperatively. The results were completely satisfactory in four patients, satisfactory with minor reservations in three patients, satisfactory with major reservations in one patient, and unsatisfactory in three patients. The major cause of reservations and lack of satisfaction was metatarsalgia. Seven patients (64%) reported that their activities were limited by intermittent metatarsalgia. Four patients (36%) considered the cosmetic appearance of the forefoot to be unsatisfactory. All but one patient required some form of shoewear modification. Based on this study, we believe the indications for this procedure are limited. These include rheumatoid patients with mild forefoot deformities without significant metatarsalgia or ongoing disease who have failed nonoperative treatment. Relative contraindications to this operation appear to include the recent onset of rheumatoid arthritis, active disease, significant metatarsalgia, and strong cosmetic concerns regarding outcome. In borderline clinical decisions that involve whether or not to leave or excise the lesser metatarsal heads, they probably should be excised to decrease late metatarsalgia.
The Fluoroscan imaging system in foot and ankle surgery.
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