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Biomedical subjects

J Oakley

Publications and source records attributed to J Oakley.

15 recordsLinked to original sources
PubMed1996

Prospective, multicenter study of spinal cord stimulation for relief of chronic back and extremity pain.

STUDY DESIGN: This prospective, multicenter study was designed to investigate the efficacy and outcome of spinal cord stimulation using a variety of clinical and psychosocial outcome measures. Data were collected before implantation and at regular intervals after implantation. This report focuses on 70 patients who had undergone 1 year of follow-up treatment at the time of data analysis. OBJECTIVES: To provide a more generalizable assessment of long-term spinal cord stimulation outcome by comparing a variety of pain and functional/quality-of-life measures before and after management. This report details results after 1 year of stimulation. SUMMARY OF BACKGROUND DATA: The historically diverse methods, patient selection criteria, and outcome measures reported in the spinal cord stimulation literature have made interpretation and comparison of results difficult. Although short-term outcomes are generally consistent, long-term outcomes of spinal cord stimulation, as determined by prospective studies that assess multidimensional aspects of the pain complaint among a relatively homogeneous population, are not well established. METHODS: Two hundred nineteen patients were entered at six centers throughout the United States. All patients underwent a trial of stimulation before implant of the permanent system. Most were psychologically screened. One hundred eighty-two patients were implanted with a permanent stimulating system. At the time of this report, complete 1-year follow-up data were available on 70 patients, 88% of whom reported pain in the back or lower extremities. Patient evaluation of pain and functional levels was completed before implantation and 3, 6, 12, and 24 months after implantation. Complications, medication usage, and work status also were monitored. RESULTS: All pain and quality-of-life measures showed statistically significant improvement during the treatment year. These included the average pain visual analogue scale, the McGill Pain Questionnaire, the Oswestry Disability Questionnaire, the Sickness Impact Profile, and the Back Depression Inventory. Overall success of the therapy was defined as at least 50% pain relief and patient assessment of the procedure as fully or partially beneficial and worthwhile. Using this definition, spinal cord stimulation successfully managed pain in 55% of patients on whom 1-year follow-up is available. Complications requiring surgical intervention were reported by 17% (12 of 70) of patients. Medication usage and work status were not changed significantly. CONCLUSIONS: This prospective, multicenter study confirms that spinal cord stimulation can be an effective therapy for management of chronic low back and extremity pain. Significant improvements in many aspects of the pain condition were measured, and complications were minimal.

Adult↗
PubMed1993

Electrogalvanic stimulation for levator syndrome: how effective is it in the long-term?

Levator syndrome is a symptom complex of severe pain and pressure in the anorectal area. Electrogalvanic stimulation (EGS) has been proposed as a treatment for this condition. Several reports have described EGS as up to 90 percent "effective" in treating levator syndrome, but the length of follow-up was uncertain or short-term in these studies. The purpose of this study was to examine the long-term benefits of EGS in levator syndrome patients treated at one institution. All patients undergoing EGS for levator syndrome between 1985 and 1991 were studied. Initial complaints, physical examination, number of treatments, procedure tolerance, and long-term benefit were determined through personal interviews and chart reviews. There were 52 patients (63 percent females and 37 percent males) with a median age of 54 years (range, 24-84 years). All patients presented with anorectal pain. Tenderness was localized by examination to the left in 43 percent, to the right in 23 percent, and bilateral in 8.6 percent and was not localized in 2.6 percent. Fifty percent received fewer than four one-hour treatments, 33 percent received four to six treatments, and 17 percent received more than six treatments. Seventy-seven percent felt that the treatment was painless. Follow-up results were as follow: number, 52; percent follow-up, 88; mean follow-up, 28 months (range, 0-71 months); symptoms relieved, 19 percent; partial relief, 24 percent; no relief, 57 percent. Of four patients with a wrong diagnosis, three were ultimately diagnosed with recurrent pelvic cancer and one had an anal fissure. At our institution, EGS was a tolerable treatment, but a substantial number of patients received no benefit. An organic etiology of anorectal pain must always be excluded.

Adult↗
PubMed1992

Quality or quantity.

Explore the source record for details and available documents.

Nursing Service, Hospital↗
PubMed1992

Endoluminal ultrasound defines anatomy of the anal canal and pelvic floor.

The aims of this study were to determine whether endoluminal ultrasound (ELUS) could identify various layers of the normal anal canal and to evaluate whether a 10-MHz probe provided better image resolution than a 7-MHz probe. Sonographic anatomy of the anal canal on ELUS was directly correlated with anatomic dissection of various layers (mucosa-submucosa, internal anal sphincter, and external anal sphincter) in cadavers. Sonographic appearance of the anal sphincters was further evaluated in patients by "tagging" various layers using sonodense needles. A higher frequency 10-MHz ultrasound probe (focal length, 1-4 cm) provides improved sonographic images of the anal canal, compared with the 7-MHz probe (focal length, 2-5 cm). ELUS can also successfully identify various structures of the pelvic floor including the puborectalis, urethral sphincter, vagina, and outlines of the pelvis and ischiorectal fossae. Its role in the evaluation of anorectal disorders appears promising.

Anal Canal↗
PubMed1992

Noncytotoxic drug therapy for intra-abdominal desmoid tumor in patients with familial adenomatous polyposis.

Forty of 416 patients with familial adenomatous polyposis were noted to have intra-abdominal desmoid tumors, and a subgroup of 16 were treated with noncytotoxic drug therapy. Drugs used were sulindac (14 patients), sulindac plus tamoxifen (3 patients), indomethacin (4 patients), tamoxifen (4 patients), progesterone (DEPO-PROVERA; Upjohn Co., Kalamazoo, MI) (2 patients), and testolactone (1 patient). Therapy with these drugs for continuous periods of six months or more resulted in three complete and seven partial remissions. When treated patients were compared with untreated patients (n = 12), there were significant benefits for the treated group, both in reduction of desmoid size and in improvement of symptoms, despite the inherent selection bias against this. Sulindac was the only drug used in enough patients to permit independent evaluation of its effect, with one complete and seven partial reductions of tumor size. Some patients had a delayed response to sulindac, with tumor shrinkage occurring after an initial period of tumor enlargement. When using sulindac for the treatment of desmoid tumors, this phenomenon should be considered.

Abdominal Neoplasms↗
PubMed1991

Manometric and functional comparison of ileal pouch anal anastomosis with and without anal manipulation.

We report the results of postoperative physiologic and functional evaluation of 153 patients with ileal pouch anal-anastomosis (IPAA). Ninety-nine patients had anal manipulation for either mucosal proctectomy, transanal placement pursestring suture with stapled IPAA, or handsewn IPAA (manipulation). Fifty-four patients had stapled IPAA with anal pursestrings placed transabdominally without mucosectomy (no manipulation). Patients with transabdominal anal pursestring placement and stapled IPAA without mucosectomy had a higher mean maximum anal resting pressure than patients who had endoanal manipulation. This correlates with improved continence and a reduced need to wear a pad. Avoidance of anal manipulation preserves anal canal resting tone and improves the functional result after IPAA.

Adult↗
PubMed1988

Resolution of neurotoxicity with anticholinesterase therapy in death-adder envenomation.

A case of the reversal of death-adder (Acanthophis antarcticus) neurotoxicity by treatment with neostigmine methylsulphate in a Papua New Guinean villager is described. While antivenom remains the mainstay in the treatment of snake-bite envenomation, the possible role of anticholinesterase therapy for death-adder bites in Papua New Guinea is discussed. In addition, some problems with first-aid management are outlined.

Adult↗
PubMed1979

Identifying epileptic foci on contrast-enhanced computerized tomographic scans.

There is a statistically significant association between lateralization of interictal epileptic foci and lateralization of numerical changes between enhanced and unenhanced grossly normal computerized tomographic (CT) scans in the area of the suspected focus. This CT change, lateralized to the side of the focus compared to the homologous opposite brain, is a relative increase in CT values after enhancement. This change is seen in both right or left frontal and temporal foci, and is independent of the time of the last seizure, but is not reliably present if there is a gross abnormality on the CT scan. The technique provides additional evidence of lateralization in epileptic patients without clearly lateralized EEG findings.

Electroencephalography↗
PubMedDate not supplied

Simplifying the management of the environment of care.

In 1995, the JCAHO introduced a new chapter for its manual called "Management of the Environment of Care (EC)." The chapter provides a common-sense organization to a department by grouping similar subjects around the common goals of safety, security, hazardous materials, emergency preparedness, life safety, medical equipment and utility systems. Its focus always remains on patient care. Forty-five individual standards are listed in the EC chapter under four categories: design, implementation, measuring outcomes and implementation, and social environment. Follow the step-by-step instructions to determine the policies and procedures you'll need to generate in your own organizational plan. Teaching becomes critical and requires nearly an almost continuous effort to maintain competency and ensure safety--no one can afford to take chances and put either patients or staff in jeopardy. For each of the standards in the design section, the JCAHO manual identifies exactly what to teach. Regarding medical equipment, the EC chapter indicates what to measure, along with the necessary steps for maintaining an information collection and evaluation system. When you design your quality improvement plans, evaluate how your medical equipment might improve the quality of patient care or staff safety. Evaluate your medical equipment plan (or policies) annually by asking your staff if it works.

Data Collection↗
PubMedDate not supplied

Comparison of the effectiveness of etidocaine and lidocaine as local anesthetic agents during oral surgery.

In a double-blind study conducted in 112 patients undergoing removal of four impacted third molar teeth, etidocaine hydrochloride 1.5% solution with epinephrine 1:200,000 and lidocaine hydrochloride 2.0% solution with epinephrine 1:100,000 were used, one on each side of the face, to produce inferior alveolar nerve block, infiltration anesthesia of the maxillary tooth and hemostasis of the mucoperiosteum around each tooth.Surgically adequate anesthesia was rapidly produced by both agents but the duration of action of etidocaine was longer than that of lidocaine as reflected in more prolonged numbness of the lip and delayed onset of pain. Moreover, after etidocaine treatment fewer patients reported severe pain as the local anesthesia receded. No adverse local or systemic effects were observed in, or reported by, any of the patients.

Acetanilides↗