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Biomedical subjects

S P Kay

Publications and source records attributed to S P Kay.

At least 37 records · Page 2Linked to original sources
PubMed1994

Decision-making by parents and children in paediatric hand surgery.

The task of decision-making about microvascular toe-transfer surgery is a complex one for parents and their children. The process involves balancing risks and benefits within the context of the emotional responses of the parents and the future needs of their children. This paper describes a model of clinical practice which incorporates that process through a multi-disciplinary approach. The factors which influenced parents in their decision are examined, and the issue of the competence of the child to participate is discussed. 34 families were assessed, of whom 7 did not proceed with surgery. It was found that parents were more influenced by factors within the process, such as communication, than by concerns about technical outcome. Specialised psychological counselling played an integral role in the making of stable decisions.

Adult↗
PubMed1994

The psychological impact of microvascular free toe transfer for children and their parents.

This paper is based on a prospective study of microvascular toe transfers which examined psychosocial, functional and aesthetic outcome for children with congenital hand anomalies and their parents. 14 families were assessed both pre-operatively and 2 years post-operatively. There were five boys and nine girls. Their ages ranged from 6 months to 13 years (mean age = 5.08 years). The parents were assessed on the basis of a parental adjustment measure, a detailed semi-structured interview and a measure of anxiety and depression. The children were assessed on the basis of behaviour and social competence, social experience, self-consciousness about the hand and the perceptions of their own functional competence. Both parents and children were asked to rate their satisfaction with the hand. In addition, function and appearance was assessed using an independent professional panel. It was found that parental adjustment to the hand was an important independent variable in determining psychosocial outcome. The children of poorly-adjusted parents had more social and psychological problems prior to surgery, and showed an increase in behavioural problems after surgery. Their parents were less anxious and happier after surgery and it was of particular benefit to them. The children of well-adjusted parents had fewer pre-operative problems and showed a general slight improvement after surgery. For all the children, there was a significant improvement in both function and appearance of the hands after surgery.

Adolescent↗
PubMed1994

Arthroscopic distal clavicle excision. Technique and early results.

Since 1941, distal clavicle excision has been a reliable technique for alleviating pain caused by acromioclavicular joint arthritis. Disadvantages of the procedure include permanent shoulder weakness, a lengthy recovery time ranging from weeks to months before useful function of the extremity returns, and lack of cosmesis. By modifying the standard portals used to perform arthroscopic subacromial decompression, the authors have successfully excised the distal clavicle of ten consecutive patients. Using this arthroscopic technique, the surgical time averaged approximately one hour 40 minutes, blood loss was negligible, and there were no complications. Operations were performed in an outpatient setting. Five of ten patients missed work only on the day of surgery, and seven of ten patients required no formal physical therapy. All ten patients achieved a good or excellent result on the UCLA. Shoulder Scale for short-term follow-up evaluation. Postoperative radiographs documented adequate bone resection in all cases. In experienced hands, arthroscopic distal clavicle excision is an excellent substitute for the "open" procedure.

Acromioclavicular Joint↗
PubMed1993

Harvest of palmaris longus tendon: technique.

We present a modification of Bunnell's technique for harvest of the palmaris longus tendon. Using a 0.5 cm distal incision and a proximal stab incision the tendon is harvested with minimal scarring and, in our experience of over 30 cases, no morbidity.

Humans↗
PubMed1993

Free tissue transfers to the upper limb.

90 consecutive free tissue transfers to the upper limb have been performed in 75 patients (33 children and 42 adults) by one surgeon over a 3-year period. The average age for children was 5 years, and 25 years in adults. 17 transfers were performed as emergency or urgent procedures. The main indications were congenital and traumatic defects. Included in this series were 44 toe transfers, 28 lateral arm flaps and six functional muscle transfers. The overall success rate was 99%. The re-exploration rate was 5.6% with only one failure. There were no failures in children.

Adolescent↗
PubMed1993

Arthroscopic treatment of full-thickness rotator cuff tears: 2- to 7-year follow-up study.

This study analyzes the midterm follow-up results of 40 full-thickness rotator cuff tears treated by arthroscopic subacromial decompression and debridement. Patients were selected for this prospective study based on a variety of factors, including physiologic age, handedness, activity level in occupation or avocation, and preoperative estimate of repairability. Patients were divided into three groups based on the size of the tear as measured during surgery; results were evaluated on the UCLA shoulder rating scale. This study emphasizes the importance of patient selection when applying arthroscopic treatment for full-thickness rotator cuff tears. Small (0-2 cm) tears (n = 10) in older individuals not involved in strenuous activities did well (90% satisfactory). Patients with larger (2-4 cm) repairable tears (n = 8) did poorly (50% satisfactory) in comparison with our previous study of the results of open repair (84% satisfactory). Arthroscopic treatment in patients with massive, irreparable tears (n = 22) did not restore lost strength or range of motion, but there was significant pain relief, and 86% were satisfied with the results on a limited-goals basis. The study concludes that with proper patient selection, arthroscopic treatment has a valuable, but limited, role in the treatment of full-thickness rotator cuff tears.

Aged↗
PubMed1992

Early degenerative joint disease simulating impingement syndrome: arthroscopic findings.

Eighteen patients who underwent shoulder arthroscopy for impingement syndrome were shown at operation to have coexisting glenohumeral degenerative joint disease (DJD) which was not apparent during preoperative clinical and radiographic evaluation. Because traditional ("open") techniques of anterior acromioplasty do not allow inspection of the glenohumeral joint, it is almost certain that this pathology would have been missed at operation if open acromioplasty had been performed. We conclude that arthroscopic subacromial decompression (ASD), by allowing easy inspection of the glenohumeral joint, offers a distinct advantage over traditional acromioplasty. Furthermore, arthroscopic evaluation of some of these patients' glenohumeral joints provided us with evidence supporting the existence of subluxation arthropathy. We have also developed a new clinical test, the "compression-rotation" test, which has been helpful in distinguishing patients with both impingement syndrome and early DJD syndrome from those with isolated impingement syndrome. Although patients in this study appeared to be doing well at short-term follow-up status post-ASD and glenohumeral debridement, no long-term results are yet available.

Adult↗
PubMed1992

Effect of addition of hyaluronidase to bupivacaine during axillary brachial plexus block.

We have studied in 22 patients the effect of adding hyaluronidase to bupivacaine during axillary brachial plexus block (BPB) in a double-blind design. Patients received BPB using bupivacaine 2 mg kg-1 with adrenaline 1 in 200,000, either with or without hyaluronidase 3000 iu, in a volume of 0.5 ml per 2.54 cm of the patient's height. The use of hyaluronidase did not increase the speed of onset of anaesthesia or reduce the incidence of inadequate nerve block. Hyaluronidase produced a significant reduction in the duration of anaesthesia. Changes in grip strength and skin temperature were useful in assessing the onset and progress of BPB.

Adult↗
PubMed1991

Arthroscopic subacromial decompression for chronic impingement. Two- to five-year results.

Subacromial decompression was performed arthroscopically on 65 patients who were evaluated two to five years after the procedure. None had full thickness rotator cuff tears. Patients with partial thickness cuff tears were included in this study in order to allow comparison of arthroscopic acromioplasty with open acromioplasty for stage II impingement. On the UCLA shoulder rating scale, 89% of the cases in this study achieved a satisfactory result. These results compare favourably with those reported following open acromioplasty. The arthroscopic procedure is technically demanding. When properly performed in patients with appropriate indications, hospitalisation is brief, return to activities is rapid, there is little risk of deltoid muscle complications, and the results are lasting.

Acromioclavicular Joint↗
PubMed1991

Non-union of fractures of the mid-shaft of the clavicle. Treatment with a modified Hagie intramedullary pin and autogenous bone-grafting.

We reviewed a series of fifty patients who had a non-union of a fracture of the clavicle. Twenty-one patients (42 per cent) who had a symptomatic non-union of the middle of the shaft of the clavicle were treated with open reduction, internal fixation with a modified Hagie intramedullary pin, and autogenous bone-grafting, and those patients form the basis for the report. The average duration of follow-up was thirty-five months (range, five months to eleven years). Healing occurred in twenty (95 per cent) of the twenty-one patients. Intramedullary fixation has several advantages compared with other treatments, such as fixation with a plate and screws. It can be performed through a cosmetically acceptable incision in the Langer line; less dissection of the soft tissues is needed; and, after healing, the pin can be removed through a small incision under local anesthesia.

Adult↗
PubMed1990

Vascularised reconstruction of the clavicle.

A rare malignant tumour presented as a pathological fracture in the clavicle of an 11-year-old girl. This was resected and the defect reconstructed using a pedicled bilobed flap based on the thoracodorsal system with latissimus dorsi and serratus anterior with a rib to replace the clavicle. The innervation of both donor muscles was preserved. The reconstruction was cosmetically acceptable and maintained the function of the thoracohumeral articulation. Although the use of vascularised rib grafts in composite flaps is well documented, this is the first report of clavicular reconstruction using the technique.

Bone Neoplasms↗
PubMed1988

Shoulder hemiarthroplasty at UCLA.

Of fifteen patients who had shoulder hemiarthroplasty between 1979 and 1984, eleven had acute four-part proximal humeral fractures, three had avascular necrosis, and one had osteoarthritis. Ten Designed After Natural Anatomy (DANA) and five Neer prostheses were implanted. Four complications occurred. The mean follow-up period was just under three years (range, 13-69 months). Pain relief was excellent but return of function was less consistent. Postoperative active flexion averaged 99 degrees (range, 20 degrees-150 degrees), abduction averaged 99 degrees (range, 50 degrees-150 degrees), and rotation arc averaged 95 degrees (range, 60 degrees-160 degrees). The results were better for patients with avascular necrosis (AVN) than for patients with shoulder trauma. Pain relief was uniformly excellent for patients in both categories, but only AVN patients consistently regained excellent active motion in their shoulders following hemiarthroplasty.

Female↗
PubMed1987

MR imaging of the normal shoulder: anatomic correlation.

The complex anatomy and the requirement to image in the peripheral magnetic field have made the shoulder difficult to examine with MR. However, the use of high-resolution scanning techniques and specialized surface coils has improved the quality of MR images obtained. Seventy-five scans of the shoulders of normal volunteers were correlated with multiplanar cryomicrosections of six cadaver shoulders to study the MR appearance of normal structures. MR was shown to provide excellent depiction of shoulder anatomy.

Cadaver↗