Biomedical subjects

E L Farrar

Publications and source records attributed to E L Farrar.

5 recordsLinked to original sources

PubMed2000

Patient-oriented outcomes from low back surgery: a community-based study.

STUDY DESIGN: This study used a prospective cohort design. OBJECTIVE: To examine factors associated with favorable self-reported patient outcomes 1 year after elective surgery for degenerative back problems. SUMMARY OF BACKGROUND DATA: Many previous studies addressing the results of low back surgery have been conducted in academic institutions or by single surgeons. As part of a quality improvement effort, surgeons in private practice led a community-based outcomes management project in Washington State. METHODS: Patients ages 18 and older with the following diagnoses were eligible for the study: degenerative changes, herniated disc, instability, and spinal stenosis. Nine orthopedists and neurosurgeons enrolled a total of 281 patients. Participants were asked to complete baseline and 1-year follow-up surveys. Data concerning diagnoses, clinical signs, and operative procedures were provided by the surgeons. The researchers examined sociodemographic characteristics, self-reported symptoms before surgery, preoperative clinical signs, diagnoses, and operative procedures associated with three primary outcomes: better functioning, improved quality of life, and overall treatment satisfaction. RESULTS: Follow-up surveys were completed by 236 (84%) of the enrolled patients. Approximately two thirds of the study participants reported much better functioning (65%), a great quality of life improvement (64%), and a very positive perspective about their treatment outcome (68%). The following variables were associated with worse patient outcomes: older age, previous low back surgery, workers' compensation coverage, and consultation with an attorney before surgery. Patients undergoing a fusion procedure were more likely to report good outcomes. CONCLUSIONS: The authors' experience indicates that community-based outcomes data collection efforts are feasible and can be incorporated into usual clinical practice. The study results indicate that compensation payments and litigation are two important predictors of poor outcomes after low back surgery in community practice. Because of small numbers, varied diagnoses, and possible selection bias, the findings with respect to fusion should be interpreted cautiously.

Adult↗

PubMed1992

Mucoid degeneration of the patellar ligament in athletes.

Seven post-traumatic mucoid cysts of the patellar ligament occurred in six athletes. Non-operative treatment of two of the seven cysts was successful, as was operative resection of the remaining five cysts. The lesion, while uncommon, must be considered in the differential diagnosis for athletes who have persistent pain in the knee.

Adult↗

PubMed1983

Early surgical management of cleidocranial dysplasia: a preliminary report.

Cleidocranial dysplasia is an interesting syndrome for the dental practitioner. The failure of eruption of the permanent teeth is secondary to both a mechanical obstruction and a lack of resorption of the overlying bone. Various modes of treatment have been suggested to manage this problem. We feel that early surgical management with serial uncovering of the permanent teeth is the best choice. This treatment will probably need to be combined with orthodontics or prosthetic care, depending on the success of the surgical procedures. In both of our cases the erupting teeth have been malaligned and malrotated, necessitating subsequent use of orthodontic appliances. To our knowledge these patients are among the youngest patients with cleidocranial dysplasia to undergo this treatment. Our preliminary results are encouraging.

Child↗

PubMed1976

Inhibitory effects of catecholamines in canine cardiac Purkinje fibers.

The effect of catecholamines over a wide range of concentrations was studied on 42K uptake and efflux, as well as on spontaneous rate in canine cardiac Purkinje fibers. Low levels of catecholamines (less than 10(-10) M epinephrine; less than 10(-9) M norepinephrine) decreased automaticity. This negative chronotropic effect was blocked by phentolamine and mimicked by phenylephrine. These low levels of epinephrine and norepinephrine also inhibited 42K uptake by Purkinje fibers but had no effect on 42K efflux. The inhibition of 42K uptake was blocked by phentolamine and verapamil and mimicked by phenylephrine. The data indicate an alpha-receptor-mediated negative response of rate and 42K uptake to low levels of catecholamine. The end result is discussed in terms of a competitive increase in the influx of Ca2+ rather than Na+ and an indirect inhibition of the Na+-K+ pump.

Animals↗

PubMedDate not supplied

Avulsion of the triceps tendon.

Avulsion of the triceps tendon should be suspected in patients who have pain about the elbow following a deceleration stress to the upper extremity. In three cases, the avulsion occurred both with or without a concomitant blow to the posterior aspect of the arm. Examination revealed pain, swelling, and a palpable depression just proximal to the olecranon. Roentgenograms showed avulsed osseous material. In the evaluation and management of triceps avulsion, it was important to differentiate between complete and partial tears. Careful examination of active range of motion of the elbow was the most important factor in making this determination. An avulsion was considered partial only if normal elbow motion and extension against resistance were found on follow-up examination a few days postinjury. Nonoperative management was successful in one case of partial tear (Case 2). Surgical therapy was advisable for complete avulsions. Surgical repair was successful using heavy nonabsorbable suture through olecranon drill holes. Injuries of tendon avulsion and rupture are likely to become more common as the number of patients with chronic renal failure, on dialysis, increases. Tendo-osseous weakness and related musculoskeletal disorders in renal osteodystrophy patients are unsolved problems.

Adult↗