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Biomedical subjects

E F Shaw Wilgis

Publications and source records attributed to E F Shaw Wilgis.

11 recordsLinked to original sources
PubMed2006

Reasons why rheumatoid arthritis patients seek surgical treatment for hand deformities.

PURPOSE: Previous studies have found that function and pain are the main factors that persuade physicians to recommend surgical reconstruction to patients with rheumatoid arthritis (RA). The factors that influence patients to choose surgical reconstruction, however, are not known fully. The purpose of this study was to determine how function, pain, and aesthetics rank in order of importance to RA patients who are considering metacarpophalangeal (MCP) joint arthroplasty for rheumatoid hand deformities. METHODS: Study participants are part of a larger National Institutes of Health-sponsored study. Participants who are eligible to receive MCP joint arthroplasty are enrolled in our study using defined inclusion and exclusion criteria. All patients have RA and MCP joint extensor lag and/or ulnar deviation. Study participants choose whether they want to enroll in a surgical group to receive MCP joint arthroplasty or in a nonsurgical group. At enrollment all participants complete the Michigan Hand Outcomes Questionnaire. Function, pain, and aesthetic domains from the Michigan Hand Outcomes Questionnaire were used in a logistic regression model as predictors to determine the factors associated with patients choosing reconstruction for rheumatoid hand deformities. RESULTS: Younger age and female gender were associated significantly with an increased likelihood for choosing MCP joint arthroplasty surgery. The age- and gender-adjusted odds ratios of choosing MCP joint arthroplasty were 0.50 for function, 1.47 for pain, and 0.83 for aesthetics. Patients with less function and greater pain were more likely to choose MCP joint arthroplasty. Aesthetic consideration was not a statistically significant predictor. CONCLUSIONS: Impaired function had the strongest association with patients choosing reconstruction and pain relief was the next most important factor. Although aesthetic consideration was less important, it may prove to be an important factor in determining patient satisfaction after surgery. Understanding which factors are associated with choosing rheumatoid hand reconstruction is an essential component of patient preoperative counseling.

Activities of Daily Living↗
PubMed2006

Relationship between the duration and severity of symptoms and the outcome of carpal tunnel surgery.

PURPOSE: There is no consensus regarding the prognostic value of preoperative symptom severity and duration for determining the anticipated results of carpal tunnel release. Some studies show a detrimental influence of symptom duration and severity on outcomes; others have found no effect. To study these contradictions, a database was created at 2 separate hand centers to explore the extent to which the duration and severity of symptoms before surgery are predictive of surgical outcome. METHODS: At 2 hand centers 523 hands from the United States and United Kingdom completed surgery and follow-up evaluation. Symptoms, time of onset, duration, prior treatment, and medical history were recorded. Each patient had a physical examination and completed the Levine-Katz questionnaire. RESULTS: Symptom duration, corrected for gender, was not associated with Levine-Katz symptom severity, Levine-Katz functional status, or changes in these scores from the pretreatment to 6-month follow-up evaluations. CONCLUSIONS: Preoperative symptom duration does not affect the surgery outcome as determined by the Levine-Katz symptom severity or functional status scores. The more severe the symptoms as determined by patient self-assessment, the greater the amount of change in the Levine-Katz symptom severity and functional status scores, although at 6 months after surgery the scores were still higher than those of patients with milder cases.

Age Factors↗
PubMed2006

Staged versus simultaneous bilateral endoscopic carpal tunnel release: an outcome study.

BACKGROUND: This study compared outcomes of bilateral simultaneous endoscopic carpal tunnel release to staged release using the Levine-Katz outcome instrument and physical measurements. METHODS: Seventy-one patients were evaluated preoperatively and at 6 months postoperatively. One group underwent simultaneous releases, a second group underwent staged releases 1 to 3 weeks apart, and a third underwent staged releases more than 3 weeks apart. Preoperative data included age, gender, race, medical history, initial symptom severity score, and body mass index. Preoperative and postoperative data included Semmes-Weinstein testing, grip and pinch strength, Tinel's sign, Phalen's test, Levine-Katz questionnaire, occupational history, postoperative complications, and patient satisfaction. RESULTS: Groups were similar demographically except that the simultaneous group had more men and patients were younger. Level of preoperative symptom severity was similar in all groups. Physical measurements were similar for all groups preoperatively and improved similarly at follow-up. All groups improved Levine-Katz mean symptom severity score and functional status score at follow-up. The groups had no significant difference in number of complications, and patient satisfaction was similar. CONCLUSIONS: In selected patients, bilateral simultaneous endoscopic carpal tunnel release has an outcome similar to that for surgery staged weeks apart. However, patients who choose simultaneous surgery may benefit from a shorter postoperative disability period and earlier return to work.

Activities of Daily Living↗
PubMed2005

Common risk factors seen in secondary carpal tunnel surgery.

BACKGROUND: We hypothesized that there are several common risk factors associated with secondary carpal tunnel releases. Therefore, we chose to investigate these common factors by analyzing the charts of those patients requiring a second carpal tunnel release (CTR) procedure. METHODS: A retrospective chart review was performed, and patients were identified by searching hospital medical record databases using the Common Procedural Terminology. RESULTS: Between January 1, 2000, and March 31, 2004, 2357 patients had a primary CTR, and 48 of them were found to have had a secondary CTR (of these 48, 9 had diabetes mellitus, 11 had hypertension, and 6 had gastrointestinal-related illnesses). Seven percent of those who had an open release primarily required a second CTR, while only 0.2% of those who had an endoscopic release primarily required a second CTR. CONCLUSION: A greater number of secondary CTR procedures were required for those patients with symptoms of carpal tunnel syndrome in the group that had an open release primarily versus those that had an endoscopic release primarily. Diabetes mellitus and hypertension may also contribute to the need for secondary surgery.

Adult↗
PubMed2005

Clinical utility of portable versus traditional electrodiagnostic testing for diagnosing, evaluating, and treating carpal tunnel syndrome.

Data indicate that a portable electrodiagnostic device (NC-Stat; Neurometrix, Inc, Cambridge, Mass) provides objective preoperative evidence of the severity of median nerve dysfunction as well as useful objective postoperative data. With traditional electrodiagnostic studies for comparison, we studied the utility of this device as a diagnostic tool, evaluated patient satisfaction with the instrument, and found statistically significant improvement in recorded distal motor latency at 6-month follow-up. Such data can be of great value in treating a patient who does not exhibit subjective symptom improvement. This portable electrodiagnostic device provides a reliable, convenient, and relatively inexpensive way to obtain objective data that can be used in diagnosing, evaluating, and treating carpal tunnel syndrome.

Action Potentials↗
PubMed2004

Timing of improvement after carpal tunnel release.

This prospective study of 52 patients from the authors' institutional carpal tunnel database investigated which patient subpopulations were most likely to benefit from carpal tunnel release and documented the time course of recovery. Preoperatively and postoperatively at 6 and 12 months, patients completed a Levine-Katz questionnaire, and NC-Stat studies and clinical parameters were recorded by a certified occupational therapist. For individual parameters from preoperative to 6 months postoperative, statistical improvements were found in Tinel's and Phalen's signs, pinch strength, delayed motor latency, and symptom severity and functional scores. None of these parameters changed significantly from 6 to 12 months. Grip strength did not change significantly postoperatively. Analysis based on age or carpal tunnel release technique showed no differences postoperatively. Preoperative symptom and functional scores correlated statistically with postoperative scores, peaking at 6 months postoperatively. The study concluded that most clinical signs and symptoms of carpal tunnel release fail to improve after 6 months postoperatively.

Adult↗
PubMed2002

Growth hormone receptors in the porcine testis during prepuberty.

Supplementation of exogenous growth hormone (GH) during prepuberty advances onset of spermatogenesis in boars, but the mechanism of action is unknown. The present study is an investigation of the presence and characteristics of testicular growth hormone receptors (GHR). A total of 36 boars were castrated, three boars every 10 days, between the ages of 10 and 120 days. Testicular membrane preparations of 10, 20, 30, 50, 70, 100 and 120-day-old boars were used to determine (125)I-bGH binding and Scatchard analysis. Liver from a 60-kg barrow was used for comparison. Specific (125)I-bGH binding to testicular membrane preparations occurred in all age groups with the exception of 20-day-old boars at levels of 30-40% of liver binding. At 30 days of age the unlabelled bGH at 1.1 ng/tube achieved half maximal inhibition (ID(50)). Results of Scatchard analysis indicated a single class of binding sites. Binding affinity was 2.89 x 10(9) m with a binding capacity of 12 fmole/mg membrane protein. The results from this study suggest that GH may act directly on the cells of the prepubertal boar testis.

Animals↗
PubMed2001

Alternative model for teaching microsurgery.

Animals have been widely used as a training model for teaching microsurgery. However, unlimited access to the animal laboratory is not always possible, and increased scrutiny of the ethical use of laboratory animals is a major factor to consider when teaching microsurgery. In such situations, an alternative method is required for microsurgical training techniques, such as medical grading tubes, and surgical gloves. These alternative teaching tools provide an ideal training model and present an alternative for teaching microsurgical techniques. They are readily available and abundant in the laboratory. In addition, these alternative tools can be used to provide initial training before entering the clinical setting. A practice card designed from surgical gloves and medical grading tube was used to practice simple sutures. The training progressed to a more difficult level, using medical-grade tubing for end-to-end anastomosis, end-to-side anastomosis, side-to-side anastomosis, and free graft placement. This alternative proved challenging for the trainees, but improved hand coordination was observed. The alternative models familiarized trainees with the instruments and with developing a surgical approach before moving on to more clinical settings. The use of surgical gloves and medical grading tubes resulted in a significant reduction in the numbers of laboratory animals used for teaching microsurgery, as well as reduced cost.

Clinical Competence↗
PubMed2000

Innervation of the metacarpophalangeal and interphalangeal joints: a microanatomic and histologic study of the nerve endings.

Six pairs of fresh human cadaver hands were dissected under the surgical microscope at x28 to x32 and selectively silver stained. In addition, 18 proximal interphalangeal and metacarpophalangeal joints of fresh cadaver hands were processed with protein gene product 9.5 for measurement and analysis of nerve endings in those joints. The results demonstrated that the proximal interphalangeal joints are innervated by 2 palmar articular nerves (mean diameter, 0.21-0.53 mm). Each metacarpophalangeal joint of the second through fifth fingers is predominantly supplied by 1 palmar articular nerve (mean diameter, 0.41-0.59 mm), which comes from the deep branches of the ulnar nerve, as well as by 2 dorsal articular nerves (mean diameter, 0.11-0.24 mm). The metacarpophalangeal joint of the thumb also had 2 dorsal articular nerves (mean diameter, 0.18-0.24 mm) and 2 palmar joint nerves (mean diameter, 0.29-0.31 mm). The mean densities of the type IV free nerve endings and the mean numbers of the encapsulated endings in the palmar capsules were consistently much greater than in the dorsal or lateral capsules. The majority of encapsulated endings were pacinian corpuscles. The anatomic and histologic information may help the surgeon avoid damaging these small joint nerves during operative procedures and to reconstruct or de-innervate them if necessary. (J Hand Surg 2000; 25A:128-133.

Finger Joint↗