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Biomedical subjects

A S Jain

Publications and source records attributed to A S Jain.

13 recordsLinked to original sources

Lower limb amputee survival.

A total of 1710 primary amputees have been studied over a 25 year period and their survival time has been calculated. These were all consecutive primary lower limb amputees admitted to the Dundee Limb Fitting Centre during the period 1965-1989. Overall, the median survival was 4 yr 9 mth for the below-knee amputee (1019 patients) and 4 yr 3 mth for the above-knee amputee (586 patients). The vascular related amputees had an overall median survival of 4 yr. In the two decades 1970-1979 and 1980-1989 there were significant differences between the survival time of the below-knee and above-knee amputee. The survival of the amputee has increased during the two decades from 3 yr 6 mth to 6 yr 6 mth (p greater than 0.001). For the first decade male above-knee and male below-knee amputee median survival was 3 yr 1 mth and 3 yr 11 mth respectively and for the second the survival was 5 yr 9 mth and 6 yr 11 mth for these levels of amputation. For 1970-1979 no significant differences were found between male and female peripheral vascular disease (PVD) and diabetes mellitus related amputee survival. For 1980-1989 significant differences were found between PVD related male above-knee amputees (3 yr 10 mth) and male below-knee amputees (6 yr 7 mth) (p greater than 0.01). Similar results were found for the female patients. Operative mortality was found to be 5% over the period 1975-1989 which compared favorably with previous studies.

Age Factors

Cause of death of lower limb amputees.

A study was carried out on the cause of death of 100 lower limb amputees who had been admitted to the Dundee Limb Fitting Centre, Tayside, Scotland for prosthetic management or wheelchair training. A comprehensive database has been established in the Centre for 25 years and the database is updated regularly. The date of death was collected and recorded. One hundred sequential deaths were investigated to review the cause of their death and compare this with the recorded causes of death for the Tayside population for the year of study. Ninety three per cent had an amputation for vascular related causes, with 73% having a below-knee amputation and 17% above-knee. Heart disease was the most frequent recorded cause of death (51%) of the amputee whereas only 28.1% of the Tayside group died from this pathology (p less than 0.01). Carcinomatosis was reported as a cause of death in 14% of the amputees and 23.5% of the Tayside group. Cerebrovascular disease caused death in 6% of the amputees and in 12.3% of the Tayside group (both p less than 0.01). These findings confirm earlier suggestions that vascular amputees die from heart disease more often than the general population.

Amputation, Surgical

Tumour related lower limb amputation: a 23 year experience.

This paper records the Dundee experience over 23 years and reports on 42 cases of tumour related lower limb amputations. There were 27 males and 15 females with 37 malignant and 5 benign tumours. Four of the 'benign' tumours proved to be osteoclastoma which were locally malignant. Prosthetic rehabilitation was achieved in all but one case. All patients fitted were able to use their prostheses.

Adult

A simple inexpensive post-operative management regime following surgery for Dupuytren's contracture.

A simple regime has been devised for the post-operative management of patients following surgery for Dupuytren's contracture; this includes splintage of the hand for two weeks and active and passive mobilisation by the patient according to precise instructions. Selective help was provided by minimal occupational therapy in 5 of 50 patients. The results of the method were assessed prospectively by subjective criteria and objective assessment by measuring the deformity of the finger joints, lateral and tip pinch and grasp and shear forces.

Dupuytren Contracture

Further experience in the healing rate of lower limb amputations.

Results of lower limb amputation in the Tayside Region in the years 1981-1985 have been analysed. Three-hundred and twenty-four amputations were performed on three-hundred and eight patients. Two-hundred and thirty-six amputations were attempted at the below-knee level. Only 19 required proximal revision. Prior to amputation, all patients should have a detailed vascular assessment, and the operation should be performed by experienced amputation surgeons using meticulous technique.

Adult

Fate of the vascular patient after below-knee amputation.

50 below-knee amputations were carried out in 45 patients (25 men and 20 women), mean (SD) age 73 (10.5) years. The mean survival time was 22(16) months after the operation. In each patient the healing potential of a below-knee amputation was determined preoperatively by segmental pressure studies and thermographic delineation of skin perfusion. 33 of the stumps healed by first intention, in 14 healing was delayed but occurred without the need for further surgery, and 3 stumps healed after local wedge excision. The initial mobilisation rate was 90%. Thus, there are no grounds for carrying out an initial above-knee amputation to save the patient a further operation.

Aged

Manic depressive psychosis with mental retardation and flexion deformities: a clinical and cytogenetic study.

Five mentally handicapped patients are described in whom a bipolar manic depressive psychosis was associated with flexion deformities, involving principally the fingers. The effect of increasing degrees of retardation on the clinical presentation of the affective psychosis is discussed. Surgical treatment of the flexion deformity brought about considerable improvement in one patient. These five patients were further investigated cytogenetically using high resolution banding techniques. The results obtained were interesting but inconclusive. There would seem to be a definite place for further cytogenetic investigations of some of the more distinctive psychotic disorders using this technique.

Bipolar Disorder

A versatile hand splint.

Splintage plays a major part in the management and rehabilitation of the hand following injury, infection and operation. It is essential to have a simple, comfortable, and firm but flexible splint. This should be available "off the shelf", but be acceptable to the patient and to the treating clinician. This paper will describe a splint which not only has these qualities, but is cheap and is re-usable after washing. The splint is made of high density Plastazote and is available in two sizes for each hand. It is moulded into the shape of the functional position of the hand and can easily be trimmed with bandage scissors to give a precise fitting. The splint has been evaluated following surgery on fifty hands. Its fabrication, use and simplicity are discussed.

Casts, Surgical

Clinical assessment of hand strength using a microcomputer.

A microcomputer based system has been designed for precise, objective quantification of hand strength. Pinch, grasp and shear strengths are measured using force transducers. The system, which is quick and easy to operate, not only measures these strengths accurately, but also collects, stores and displays this data numerically or in graphical form, at the touch of a button. The data can be manipulated to answer any type of statistical question related to any group of patients. The assessment of hand strength in ninety-six people, representing normal hand function, by means of this system, is reported.

Adolescent