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Biomedical subjects

John Stokes

Publications and source records attributed to John Stokes.

9 recordsLinked to original sources
PubMed2005

Thoracolumbar vertebral reconstruction after surgery for metastatic spinal tumors: long-term outcomes.

OBJECT: Metastatic spinal tumors continue to represent a major problem for patients and treating physicians. The purpose of this study was to assess quantitatively the functional outcome, quality of life, and survival rates of patients after major reconstructive spine surgery. METHODS: A prospective database was established and 58 patients were identified who had undergone thoracolumbar vertebral reconstruction for metastatic spinal tumors between March 1993 and October 1999. Surgical indications included disabling pain (92%) and/or progressive neurological dysfunction (60%). Forty-nine patients (85%) had clinical improvement in pain as determined based on the Oswestry pain scale (p < 0.05); 60% demonstrated improvement in their neurological status. The mean neurological improvement in Frankel grade was 1.2 (p < 0.05). The 12-month survival rate was 65%, and all patients who were ambulatory after surgery remained so until the time of death. Instrumentation failure requiring repeated operation occurred in two patients (3.5%), and in 12 patients (21%) local tumor recurrence necessitated repeated surgery. There were no cases of neurological deficit or death related to surgery. CONCLUSIONS: Major anterior thoracolumbar vertebral reconstruction is an effective treatment for local tumor control. More importantly, the authors have demonstrated that surgical treatment can significantly improve the quality of life by improvement of pain control and maintenance of ambulation during the patient's remaining life span.

Humans↗
PubMed2003

Clinical phenomenology of episodic rage in children with Tourette syndrome.

OBJECTIVE: Episodic rage of unknown etiology causes significant morbidity in children with Tourette's syndrome (TS). Using modified Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for intermittent explosive disorder (IED), we developed a screen and symptom questionnaire to explore rage attack phenomenology and to preliminarily investigate whether symptom clusters can identify clinical subgroups of TS children with rage attacks. METHODS: 48 children with TS between ages 7 and 17 years consecutively presenting with rage attacks completed the Rage Attacks Screen and Questionnaire. Data was subjected to factor analysis. Cluster analytic procedures were used to identify clinical subgroups. RESULTS: Final cluster solution revealed four homogeneous subgroups of TS children with rage who were differentiated by predominant clinical characteristics: specific urge resolution, environmentally secure reactivity, nonspecific urge resolution or labile nonresolving. CONCLUSION: Episodic rage in TS has stereotypic features, but diverse and complex etiologies. Identifying particular symptom clusters may facilitate improved treatment strategies.

Adolescent↗
PubMed2003

Development and validation of a brief screening version of the Childhood Trauma Questionnaire.

OBJECTIVE: The goal of this study was to develop and validate a short form of the Childhood Trauma Questionnaire (the CTQ-SF) as a screening measure for maltreatment histories in both clinical and nonreferred groups. METHOD: Exploratory and confirmatory factor analyses of the 70 original CTQ items were used to create a 28-item version of the scale (25 clinical items and three validity items) and test the measurement invariance of the 25 clinical items across four samples: 378 adult substance abusing patients from New York City, 396 adolescent psychiatric inpatients, 625 substance abusing individuals from southwest Texas, and 579 individuals from a normative community sample (combined N=1978). RESULTS: Results showed that the CTQ-SF's items held essentially the same meaning across all four samples (i.e., measurement invariance). Moreover, the scale demonstrated good criterion-related validity in a subsample of adolescents on whom corroborative data were available. CONCLUSIONS: These findings support the viability of the CTQ-SF across diverse clinical and nonreferred populations.

Adolescent↗
PubMed2003

Necrotizing scleritis after intraocular surgery associated with the use of polyester nonabsorbable sutures.

We present 2 elderly patients who developed necrotizing scleritis after cataract extraction in which the wound was sutured with polyester. In the first case, a 73-year-old woman who had right phacoemulsification via a limbal incision developed necrotizing scleritis 8 months after surgery. The eye became progressively painful and phthisical, necessitating enucleation. Microscopic examination of the enucleated globe showed a predominantly lymphocytic infiltration of the ocular tissues with no evidence of an infectious agent. In the second case, a 78-year-old woman had bilateral extracapsular cataract extraction through a limbal incision closed with a polyester suture. The patient presented 3 years later with bilateral necrotizing sclerokeratitis. No underlying systemic vasculitis or autoimmune condition was identified in either patient. To our knowledge, the association of necrotizing scleritis after intraocular surgery and polyester fiber suture material (Mersilene) has not been described.

Aged↗
PubMed2003

Convergence of different versions of the continuous performance test: clinical and scientific implications.

The Continuous Performance Test has been used for the last 40 years to measure sustained attention or vigilance in many different populations. Different versions of the test have been developed, but little is known about how similar these tests are, and to what extent performance on different versions of these tests overlaps. In order to examine convergence of the different versions of the CPT, three different CPTs were administered in both the Auditory and Visual Sensory Modalities. Subjects were selected from consecutive admissions to adolescent acute care units at a private psychiatric hospital (n=100). Auditory test modalities uniformly elicited poorer performance than visual tests, while each set of task demands consistently elicited differences in performance. Despite the high test-retest reliability of the individual subtests, the average correlation between tests was r=.42, with the average correlation between visual tests at r=.48 and the average correlation between the auditory tests was r=.45. The correlations within task demands across sensory modalities ranged from a low of.37 to a high of.52. Controlling for IQ did not influence the correlations to a substantial degree. These data suggest different versions of the CPT are correlated with each other at a level consistent with construct validity, but that they do not constitute alternate forms of the same test.

Acoustic Stimulation↗
PubMed2003

A new socially responsible medical school for regional Australia.

BACKGROUND: Northern Australia is a geographically large region that has too few medical graduates and is a long way from Australia's metropolitan medical schools. This paper describes the establishment of a new medical school to serve these needs. METHODS: The paper describes the steps in development and presents an overview of the innovative educational approach, based on best available educational evidence, that aims to produce a medical workforce that understand the health care needs of the region and want to practice there. CONCLUSION: The result is an innovative, highly integrated programme with different aspirations and a different student profile from other Australian medical schools.

Australia↗
PubMed2003

Altered peripheral sensitivity to glucocorticoids in primary open-angle glaucoma.

PURPOSE: Increased levels of glucocorticoids are associated with raised intraocular pressure (IOP). The activity of glucocorticoids is regulated at a prereceptor level by 11beta-hydroxysteroid dehydrogenases (11beta-HSD). This study was an investigation of the central and peripheral sensitivity to glucocorticoids in patients with POAG or ocular hypertension (OHT) and the differential metabolism of glucocorticoids by 11beta-HSDs. METHODS: Patients with POAG or OHT and normal control subjects were studied. Peripheral sensitivity to glucocorticoids was assessed as dermal blanching and central sensitivity by dexamethasone suppression testing. Daily production rates of glucocorticoids were determined by quantifying metabolites in 24-hour urine. Plasma cortisol levels were determined at baseline (9 AM) and after an overnight low-dose dexamethasone suppression test. In a separate study, plasma and aqueous humor cortisol levels were determined in patients with POAG and normal subjects. RESULTS: Patients with POAG exhibited a greater cutaneous vasoconstrictor response to glucocorticoids than patients with OHT and normal subjects (20.7 +/- 3.1 vs. 8.5 +/- 4.4 and 8.6 +/- 4.5 arbitrary units, respectively; P < 0.05 in each case). Total glucocorticoid production rates were not different between groups, nor were total circulating cortisol levels before or after suppression of the hypothalamic-pituitary-adrenal axis by dexamethasone or concentrations in aqueous humor. The ratio of urinary cortisol to cortisone metabolites was elevated in POAG versus normal control and OHT (1.74 +/- 0.13 vs. 1.34 +/- 0.11 and 1.32 +/- 0.14; P < 0.05 in each case), indicating a change in the balance of 11beta-HSDs, without a change in other metabolic pathways. CONCLUSIONS: Patients with POAG exhibit increased peripheral vascular sensitivity to glucocorticoids. Increased sensitivity of glucocorticoid receptors, may enhance local glucocorticoid action in the eye and exacerbate the adverse effects of glucocorticoids in this condition.

Administration, Oral↗