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Biomedical subjects

R Savage

Publications and source records attributed to R Savage.

At least 19 recordsLinked to original sources
PubMed1994

Experience of the early use of technetium 99 bone scintigraphy in wrist injury.

In a retrospective study, patients with suspected scaphoid fracture had an average of three sets of scaphoid radiographs prior to scintigraphy. Scans were performed an average of 3 months after injury and many were inconclusive because of disuse changes. A prospective analysis of early scintigraphy in 35 cases over 18 months was carried out. Scans were performed at an average of 15.5 days after injury in selected cases. Patients had an average of 1.28 sets of negative radiographs prior to scanning. There were no false negative scans and in 13 with focal uptake a wrist fracture was demonstrated. Diffuse uptake was thought to be indicative of ligamentous damage or reflex sympathetic dystrophy. Early scintigraphy was found to be a sensitive, reliable and cost-effective examination in cases of suspected significant wrist injury.

Adolescent↗
PubMed1993

Do patients with less than 'echo-perfect' results from mitral valve repair by intraoperative echocardiography have a different outcome?

BACKGROUND: Not all valve repairs for mitral regurgitation (MR) have a perfect result, with no MR on postpump intraoperative echocardiography. Although more than 2+ MR by postpump echocardiography has led to second pump runs for further surgery in 6% to 8% of our patients, those left with 1+ or 2+ MR, traditionally an acceptable result, have not previously been evaluated for clinical outcome. METHODS AND RESULTS: Among 530 patients undergoing mitral repair during 1987 to 1989, 76 patients with 1+ or 2+ MR by postpump intraoperative echocardiography were compared with 76 patients who had equivalent age, sex, left ventricular function, and concomitant surgery but who had no MR by postpump echo. In-hospital morbidity measured by the frequency of respiratory complications, strokes, time in intensive care unit, and duration of hospital stay was actually higher in the patients with no MR after repair. Hospital mortality was not significantly different. There were no significant differences in posthospital mortality (4-year survival estimate of 86% in both groups), thromboembolic events, hospitalizations for heart failure, or functional class, although more patients in the group with no MR after repair were using diuretics. There was a trend toward more reoperations in patients with 1+ or 2+ MR compared with those with no MR by intraoperative echocardiography after repair (4-year estimates of freedom from reoperation, 83% versus 94%; adjusted risk ratio, 3.30). CONCLUSIONS: The presence of 1+ or 2+ MR by postpump intraoperative echocardiography does not confer increased morbidity or mortality. However, the trend toward more reoperations suggests the need for close follow-up for possible recurrence of MR. These data support our low threshold for performing further surgery during second pump runs.

Female↗
PubMed1992

Carbon-fibre reinforced plates for problem fractures.

We report our experience with carbon-fibre reinforced plastic (CFRP) plates in the management of 19 problem fractures complicated by either infection, nonunion, comminution or contamination. The combination offers secure fixation without inhibition of callus formation.

Biopsy↗
PubMed1990

Effect of a general practitioner's consulting style on patients' satisfaction: a controlled study.

OBJECTIVE: To compare the effect of directing and sharing styles of consultation by a general practitioner on patients' satisfaction with the consultation. DESIGN: Patients were randomised to receive a directing or sharing style in the part of the consultation concerned with giving treatment, advice, and prognosis. SETTING: An inner London general practice. PATIENTS: 359 Randomly selected patients consulting with one general practitioner. Four patients refused to participate and five were excluded. Thirty failed to complete the initial assessment and 110 failed to complete the assessment a week later, giving response rates of 89% and 58% respectively. MAIN OUTCOME MEASURES: Patients' satisfaction with the general practitioner's perceived understanding of their problem and the explanation they received and whether they felt that they had been helped immediately after the consultation and one week later. RESULTS: Patients who had the directing style of consultation reported significantly higher levels of satisfaction on almost all the outcome measures. This was particularly striking for patients with physical problems (excellent explanation 23/68 (34%) v 10/65 (15%), p less than 0.02; excellent understanding 25/68 (37%) v 9/66 (14%), p = 0.004), and for patients who received a prescription (excellent explanation 20/60 (33%) v 9/59 (15%), p less than 0.04; excellent understanding 27/60 (45%) v 10/59 (17%), p = 0.04). There was no significant difference in the responses to the directing and sharing styles in longer consultations (8/31 (26%) v 8/31 (26%)), in which the main treatment was advice (10/30 (33%) v 7/36 (19%)), and among patients with psychological (6/17 (35%) v 6/27 (22%)) or chronic problems (14/28 (50%) v 8/32 (25%)). CONCLUSIONS: Style of consultation does influence the satisfaction of the patient, but its effect is most noticeable in consultations with patients with physical problems and patients who receive a prescription.

Adolescent↗
PubMed1990

The mechanical effect of partial resection of the digital fibrous flexor sheath.

In the context of primary flexor tendon repair, a study has been made to determine how much of the flexor sheath may be opened without causing mechanical disadvantage to the finger. In five cadaver hands, measurement of profundus tendon excursion, distance from nail to distal palmar crease, profundus flexion force, and tendon bow-stringing, showed that there was no material change of these parameters when up to four contiguous pulleys were divided. Along with other individual pulleys, A2 and A4 cannot be regarded as inviolate.

Biomechanical Phenomena↗
PubMed1990

Carpal tunnel syndrome in association with vibration white finger.

In a prospective study, eight patients with 15 hands affected by both vibration white finger and carpal tunnel syndrome were treated by surgical decompression of the carpal tunnel. On review six months later, the symptoms of carpal tunnel syndrome were improved in all cases and the symptoms of white finger were improved in half of the cases. Nerve conduction studies and palmar skin histology are discussed.

Adult↗
PubMed1989

Signals from the dorsal blastopore lip region during gastrulation bias the ectoderm toward a nonepidermal pathway of differentiation in Xenopus laevis.

Epi 1, a monoclonal antibody, was generated against an epidermal specific epithelial antigen; it does not stain neural epithelium. We have used Epi 1 as a marker to determine when the spatial patterns delineating neural from nonneural epithelium become established. We used ventral ectoderm in a sandwich assay to show that signals from the central blastopore lip region, passing through the plane of the ectoderm sheet, define the pattern and boundary characteristics of Epi 1 expression. The dorsal blastopore lip at stages 10 and 12 are the strongest in inhibiting Epi 1 expression. The involuted chordamesoderm has only a limited inhibitory effect on Epi 1 expression in ventral ectoderm recombinates and does not appear to establish pattern boundaries. We suggest that the blastopore lip region establishes a preneural bias in the adjacent ectoderm prior to the interaction of the latter with chordamesoderm.

Animals↗
PubMed1989

Flexor tendon repair using a "six strand" method of repair and early active mobilisation.

A "six strand" method of tendon repair has been used to treat 36 fingers with flexor tendon lacerations. Following surgery, active mobilisation in a protective splint was begun immediately. 63% of lacerations were in zone 2 and 27% in zone 1. 69% and 100% respectively achieved an excellent or good result using Buck-Gramcko's assessment method. 81% of all the fingers were rated excellent or good.

Adolescent↗
PubMed1988

The influence of wrist position on the minimum force required for active movement of the interphalangeal joints.

Active and passive muscle tension is discussed in relation to finger flexor and extensor tendons. Minimising active tension required to produce finger movement is seen as an important part of post-operative finger mobilisation following flexor tendon repair in which active movement is used. It is argued that "minimal active tension" in the flexors is equal to, or just exceeds, the passive tension in the extensors. A method of measuring passive tension in finger tendons has been described. In 24 volunteers, it has been used to determine that if the metacarpo-phalangeal joints are held flexed, there is least "minimal active tension" in the flexor tendons when the wrist is splinted in extension.

Adult↗