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Biomedical subjects

P E Savage

Publications and source records attributed to P E Savage.

At least 19 recordsLinked to original sources
PubMed2000

Orthopaedic specialist registrar selection: the advantages of a candidate ranking procedure at interview.

For five years an orthopaedic specialist registrar appointments committee has been using a points system to rank candidates at interview. By so doing committee members have been able to devote the discussion period, after all candidates have been interviewed, to considering the merits of those candidates who have achieved the greatest degree of support. This system maximises the efficient use of committee discussion time without restricting the freedom of the committee to make the most appropriate appointments.

Education, Medical, Graduate↗
PubMed1997

Education and training opportunities in trauma and orthopaedics in SE Thames Region.

In preparation for the introduction of the specialist registrar grade the specialist advisory committee (SAC) in orthopaedics developed a six-year structured training programme leading to the award of the Certificate of Completion of Specialist Training (CCST). A team comprising the regional adviser in orthopaedics, the two regional programme directors and an associate dean of postgraduate medicine visited all the departments of orthopaedics in the South East Thames Region in order to evaluate the training opportunities they provided. This paper describes the methodology used during these visits, the lessons learned and the conclusions drawn.

Education, Medical, Graduate↗
PubMed1989

Cardiovascular response during cerebral angiography under general and local anaesthesia.

Nineteen patients with subarachnoid haemorrhage who had cerebral angiography with the new contrast medium iohexol, were randomly allocated to receive either local anaesthesia plus sedation, or general anaesthesia. Arterial blood pressure, PaO2, PaCO2 and patient acceptability were examined. Significant fluctuations in arterial blood pressure occurred in the patients who received general anaesthesia. Local anaesthesia was associated with a stable blood blood pressure, adequate spontaneous ventilation and good patient acceptability. The quality of films obtained was examined and found to be of good or very good diagnostic quality in all cases in both groups of patients. Greater use of local anaesthesia with sedation for angiography is recommended.

Adolescent↗
PubMed1986

Assessment of regional left ventricular function by magnetic resonance.

The ability of magnetic resonance to determine regional left ventricular function was investigated in 18 patients--13 with coronary artery disease (nine with previous infarction), one with congestive cardiomyopathy, one with mitral stenosis, one with an atrial septal defect, and two without detectable cardiac abnormality. Coronal magnetic resonance images were acquired through the aortic valve and sagittal images were acquired in the plane of widest diameter of the left ventricle seen in the coronal image, both at end diastole and end systole. Regional wall motion assessed by magnetic resonance was compared with the results of anteroposterior and left lateral x ray ventriculograms by two independent observers. The left ventricular wall was divided into three segments in each plane and the motion of the segments was classified as normal, hypokinetic, akinetic, or dyskinetic. Muscle thickness was measured in each segment of the magnetic resonance images and was considered to be abnormal if in the systolic images it was less than 75% of that in neighbouring segments or if it failed to increase by at least 25% between diastole and systole. Wall motion assessments by the two methods agreed in 68 of 105 segments analysed, but differed by one class in 32 segments and by two classes in five segments. The differences can be explained by the conditions under which the investigations were performed and by the disparity between a tomographic section and an x ray projection. Magnetic resonance showed 25 segments to have abnormal wall thickness. Only one patient with infarction did not have an area of wall thinning and no patient without infarction had an area of thinning. It is concluded that magnetic resonance allows an accurate non-invasive assessment of left ventricular wall motion and thickness.

Adult↗
PubMed1986

Ovarian carcinoma follow-up: US versus laparotomy.

Ultrasound (US) was compared with surgical findings in 98 patients with carcinoma of the ovary undergoing follow-up laparotomy after chemotherapy. US had an overall accuracy of 94% in the pelvis, with only small and sheetlike lesions escaping detection. It was more sensitive than clinical examination. Overall accuracy for the liver was 91% with very few false-positive results. For the peritoneal cavity in general, however, accuracy was low, with even large masses escaping detection. Ascites is reliably detected (accuracy of 97%) but is a poor indicator of peritoneal involvement. US is a useful noninvasive complement to laparoscopy in the follow-up of patients with carcinoma of the ovary.

Adult↗
PubMed1985

Oestrogen measurement to predict multiple pregnancy from gonadotrophin therapy in amenorrhoea.

Twenty-four hour urinary oestrogen results obtained in 20 amenorrhoeic patients undergoing human menopausal gonadotrophin (hMG) therapy have been analysed in detail in an attempt to improve their value in predicting multiple conception. Of 96 treatment cycles 88 were acceptably stimulated including 76 presumed ovulatory (midluteal serum progesterone concentration greater than or equal to 30 nmol/l). Conception occurred in 27 (26% of all, 33% of ovulatory cycles), of which 10 were multiple (37%). The chance of conception or multiple conception could not be related to luteal progesterone or preovulatory peak urinary oestrogen levels (at least within the clinically imposed limits of the oestrogen values). Discriminant analysis applied to all oestrogen results in individual cycles failed to predict conception, but in the conception cycles was 86% successful in predicting a single or multiple conception. Multiple conceptions were associated with an earlier but slower rise in oestrogen excretion during the last 5 days of hMG therapy, although the starting and final oestrogen levels were approximately the same. Unfortunately, the differences were small and as conception cycles were in the minority and could not be distinguished from non-conception cycles the oestrogen results could not be used reliably in practice to predict multiple pregnancy.

Amenorrhea↗
PubMed1984

Fibrous dysplasia of the femoral neck.

Fibrous dysplasia of the femur is usually observed in the intertrochanteric region. It is rarely confined to the femoral neck. We present four cases illustrating the radiographic appearance and spectrum of this condition which all showed the relatively lucent variety of fibrous dysplasia with varying degrees of expansion and surrounding sclerosis. The natural history of this condition is discussed.

Adolescent↗
PubMed1984

The appearance of the pyramidal lobe on thyroid scintigraphy.

The standard nuclear medicine textbooks describe the pyramidal lobe of the thyroid as arising from the upper part of the thyroid lobes. Anatomy and surgical texts however describe it as a thyroglossal tract remnant and state that it arises from the isthmus. Review of 150 thyroid scintigrams confirms that on scintigraphy the pyramidal lobe does appear to originate from the upper pole. We have used single photon emission tomography to demonstrate the true origin of the pyramidal lobe by removing overlying thyroid tissue. We suggest that the pyramidal lobe arises from the isthmus and the appearances on scintigraphy are due to the lower part of the lobe being obscured behind the main thyroid lobe.

Humans↗
PubMed1982

Anovulatory and ovulatory infertility: results with simplified management.

A simplified scheme for the management of anovulatory and of ovulatory (usually called unexplained) infertility was evaluated in 244 women. Eighteen patients were excluded because of primary ovarian failure, 164 were treated for ovulatory failure, and 62 with ovulatory infertility remained untreated. Twenty-five patients had a properly validated negative postcoital test. In the remaining 201 patients the two-year conception rates were 96% in patients with amenorrhoea, 83% in those with oligomenorrhoea, 74% in those with luteal deficiency, and 88% in those with ovulatory infertility. Comparison with normal rates implied that amenorrhoea represents a pure form of ovulatory failure that is completely correctable whereas in other conditions unexplained factors also contribute to infertility though to a much smaller extent than was previously thought.

Adult↗
PubMed1982

The value of a single serum progesterone measurement in the midluteal phase as a criterion of a potentially fertile cycle ("ovulation") derived form treated and untreated conception cycles.

A single midluteal serum progesterone concentration was obtained in 212 untreated cycles in 113 infertile patients, including 138 cycles in 72 patients in whom tubal, seminal, and cervical causes of infertility had been excluded. There were 16 conception cycles in the latter group. In an extended study a total of 21 untreated singleton conception cycles have been observed with a mean progesterone value of 40.7 nmol/l (12.8 ng/ml), 95% confidence limits of 28 to 53 nmol/l (8.8 to 16.7 ng/ml), and a range of 27 to 53 nmol/l (8.5 to 16.7 ng/ml), which extended significantly above as well as below the conception range, indicating that there is an optimal range for fertility with both an upper and a lower limit. The lower limit is of greater practical importance; and, partly to allow for assay variation, we suggest it should be taken as 30 nmol/l (9.4 ng/ml). It provided a clinically reliable criterion of potential fertility ("ovulation") in related studies. Our findings in treated conception cycles suggest that a higher value may be needed after treatment with clomiphene or gonadotropins because of the contribution from other stimulated follicles.

Adult↗
PubMed1982

Prognostic value of the postcoital test: prospective study based on time-specific conception rates.

Time-specific conception rates were studied prospectively after a carefully validated post-coital test (PCT) in a consecutive series of 80 ovulatory women without any pelvic or seminal cause for their previous infertility. The PCT was performed on endocervical mucus collected 6-18 h after intercourse. The definition of a negative result, indicated by the absence of forward-moving sperm, depended on the finding being repeated in a second cycle and on the presence each time of fully developed mucus, indicated simply by its abundance, ductility and clarity. The time to conception was inversely related to the number of motile sperm seen. Simpler analysis showed a fivefold greater chance of conception associated with a positive compared with a negative PCT; after 2 years the cumulative conception rates were 84 and 16% respectively.

Adult↗
PubMed1981

Normal fertility in women with post-pill amenorrhoea.

After exclusion of primary ovarian failure and causes of infertility not due to contraception 48 patients with post-pill amenorrhoea (PPA) and 47 patients whose amenorrhoea did not follow oral contraception received treatment aimed at inducing ovulation. In the patients with PPA the cumulative conception rate was 91% at 12 months from the start of treatment and 98% at 24 months. 80% gave birth to a child by 18 months and 95% by 30 months. These rates were similar to those of the non-PPA group and to previously published normal rates. Hence PPA poses no serious threat to fertility, unlike the tubal damage that may result from use of an intrauterine device. Whatever their previous menstrual history women, especially the nulliparous, who are concerned about their future fertility should be recommended oral contraception in preference to an intrauterine device.

Amenorrhea↗