Biomedical subjects

P Stockton

Publications and source records attributed to P Stockton.

15 recordsLinked to original sources

PubMed2003

Intratracheal cocaine induced myocardial infarction: an unusual complication of fibreoptic bronchoscopy.

A 73 year old man developed chest pains 5 minutes after fibreoptic bronchoscopy. The procedure had been performed without sedation following an intratracheal injection of 5 ml 2.5% cocaine solution and xylocaine spray to the pharynx for topical anaesthesia. A 12-lead electrocardiogram showed an evolving anterior myocardial infarction. Cardiac catheterisation revealed coronary artery spasm in the proximal left anterior descending artery at the site of non-significant plaque disease. The risk factors, mechanisms, and treatment of cocaine induced myocardial infarction following intratracheal injections are discussed.

Aged↗

PubMed2001

Loss of E-cadherin expression in gastric intestinal metaplasia and later stage p53 altered expression in gastric carcinogenesis.

Gastric cancers are commonly subdivided into intestinal and diffuse subtypes on a morphologic basis, supported by corollary evidence of differences at the pathogenetic and molecular levels. Chronic atrophic gastritis with intestinal metaplasia is a common precursor lesion for the intestinal type of carcinoma. To identify early molecular changes, in this study we have examined 13 surgical specimens both for the expression of E-cadherin, p53 and beta-catenin by immunohistochemistry and for methylation of the CDH1 promoter (E-cadherin) by bisulfite genomic sequencing of laser capture microdissected samples. Each specimen examined contained areas of normal (nonmetaplastic) gastric mucosa, as well as areas of intestinal metaplasia and/or carcinoma. Reduced or absent E-cadherin and partial to complete methylation of one to multiple CpG sites examined in the CDH1 promoter were observed in all of the metaplasia samples. Thus, the methylation status of the CDH1 promoter and expression of E-cadherin together provide strong evidence that loss of E-cadherin is an early event in intestinal type gastric carcinogenesis. In contrast, expression of p53, assumed to be mutant p53, was generally not detected (except for isolated cells) until the carcinoma stage in tissues from these patients. These results suggest that mutation of p53 is a late event in intestinal type gastric cancer. The level of beta-catenin expression did not appear to change between normal, metaplastic and carcinoma cells of intestinal type, and no nuclear staining was visible in any of the tissues. These results suggest that the Wnt signaling pathway is not upregulated in this type of cancer.

Adenocarcinoma↗

PubMed2001

Detection of HIV-1 gene sequences in hippocampal neurons isolated from postmortem AIDS brains by laser capture microdissection.

We employed laser capture microdissection to remove individual pyramidal neurons from the CA1, CA3, and CA4 regions of formalin-fixed, paraffin-embedded hippocampus from 8 AIDS brains and 2 HIV-1-seronegative normal brains. We amplified HIV-1 gag and nef gene sequences using separate, double round PCR reactions for each of the primer sets. In all 3 hippocampal regions, amplification efficiency was best with sequence length between 284 and 324 bp; HIV-1 nef gene sequences were more common than HIV-1 gag sequences; and rank order for percent positive amplification was CA3 > CA4 > CA1 samples. These results are the first to detect HIV-1 gene sequences in microdissected human tissue. They indicate that brain neurons in vivo contain HIV-1 DNA sequences consistent with latent infection by this virus, and suggest that neurons display a selective vulnerability for HIV infection. Neuronal HIV infection could contribute to neuronal injury and death or act as a potential viral reservoir if reactivated.

AIDS Dementia Complex↗

PubMed2000

Outcomes of single versus multiple trauma exposure in a screening sample.

Most studies ignore prior trauma exposure when evaluating outcomes of target events. This study explored symptom severity associated with different types of traumatic experiences occurring alone and with multiple exposure. The Stressful Life Events Screening Questionnaire categorized 1,909 sophomore women into groups including no trauma exposure, exposure to a serious non-Criterion A event only, exposure to several unique noninterpersonal and interpersonal events, and exposure to multiple interpersonal events. Women with noninterpersonal trauma did not differ from those without trauma on the Trauma Symptom Inventory. Only interpersonal trauma and non-Criterion A events were associated with elevated symptoms; multiple-exposure participants had significantly higher symptoms than all other groups. Complex trauma histories should be accounted for, even in studies of one target event.

Adolescent↗

PubMed2000

Mental status change in older surgical patients. Cognition, depression, and other comorbidity.

The authors studied patients age 60 and over to assess the effect of elective surgery as a precipitating factor for cognitive decline over the postoperative year. They found an association between change in test performance and age, physical disability, and number of depressive symptoms. However, persistent decline in Mini-Mental State Exam scores was associated with identifiable factors related to the initial surgery in only 3/ 251 (1 percent of cases). Depression and new onset of acute illness were confounding factors in the assessment of cognitive decline.

Activities of Daily Living↗

PubMed2000

Trauma history as a predictor of psychologic symptoms in women with breast cancer.

PURPOSE: To identify predictors of psychiatric problems in women with early-stage breast cancer. PATIENTS AND METHODS: One hundred sixty women with early-stage breast cancer were recruited from three treatment centers. They filled out self-report questionnaires, including a medical history and demographic survey, the Trauma History Questionnaire, Life Event Questionnaire, Brief Symptom Inventory, Beck Depression Inventory, and Duke-UNC Functional Social Support Questionnaire, and were evaluated using the Structured Clinical Interview for DSM-III-R. RESULTS: Hierarchical regression analyses indicated that four of five variable sets made a significant incremental contribution to outcome prediction, with 35% to 37% of the variance explained. Outcomes were predicted by demographic variables, trauma history variables, precancer psychiatric diagnosis, recent life events, and perceived social support. Cancer treatment variables did not predict outcome. CONCLUSION: The findings highlight the important roles of trauma history and recent life events in adjustment to cancer and have implications for screening and treatment.

Adult↗

PubMed2000

K-ras and p53 in pancreatic cancer: association with medical history, histopathology, and environmental exposures in a population-based study.

Pancreatic cancer is a highly fatal cancer with few identified risk factors. Increased risk of pancreatic cancer in tobacco smokers and among diabetic patients is well established, and some reports have suggested associations with coffee consumption and occupational exposure to organochlorines. At present, there is little information regarding the possible association of these risk factors with the known genetic alterations found in pancreatic cancers, such as activation of the K-ras oncogene and inactivation of the p53 tumor suppressor gene. Knowledge of such relationships may help to understand the molecular pathways of pancreatic tumorigenesis. We investigated the association between these molecular defects and risk factors for pancreatic cancer in 61 newly diagnosed patients identified through an ongoing study of pancreatic cancer in the San Francisco Bay Area. Interview information was obtained regarding environmental exposures, medical history, and demographic factors. Serum levels of dichlorodiphenyltrichloroethylene (DDE) and polychlorinated biphenyls were available on a subset of 24 patients. Tumor blocks were located from local hospitals and used for K-ras mutational analysis at codon 12 and for p53 protein immunohistochemistry. The molecular analyses were facilitated through the use of laser capture microdissection, which provides a reliable method to obtain almost pure populations of tumor cells. Mutations in K-ras codon 12 were found in 46 (75%) of 61 pancreatic cancers. A prior diagnosis of diabetes was significantly associated with K-ras negative tumors (P = 0.002, Fisher's exact test). The absence of this mutation was also associated with increased serum levels of DDE, although this association was not statistically significant (P = 0.16, Wilcoxon's test). There was no difference in polychlorinated biphenyl levels between the K-ras wild-type and mutant groups. Immunohistochemical staining for p53 protein did not differ by patient characteristics or clinical history, but significant associations were found with poor glandular differentiation (P = 0.002, chi2 trend test), severe nuclear atypia (P = 0.0007, chi2 trend test), and high tumor grade (P = 0.004, chi2 trend test). Our results are suggestive of the presence of K-ras codon 12 mutation-independent tumorigenesis pathways in patients with prior diabetes and possibly in patients with higher serum levels of DDE. Our results also support a role for the p53 tumor suppressor protein in the maintenance of genomic integrity.

Aged↗

PubMed1998

The validity of cognitive testing in screening for dementia.

The concept of "cognitive impairment," as an indicator of dementia, defined in 1980 as a loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning, is the model which has been adopted for a condition, which has recently been reclassified from an "organic" to a "cognitive disorder." Data derived from the assessment of a sample of older people demonstrated the extreme sensitivity of a widely employed cognitive assessment instrument to all levels of educational experience, and educational correlates, notably level of physical disability, were identified as other independent predictors of test performance. The analyses raise questions with regard to the reinterpretation of "lack of education," from a confounding factor in prevalence estimates of cognitive impairment to a "risk factor" for dementia, and support those who have questioned the validity of the one-dimensional "cognitive paradigm," and the trend to diagnosis based upon objective assessment with standardized instruments.

Activities of Daily Living↗

PubMed1996

Functioning and well-being of patients in a consultation-liaison psychiatry clinic.

Outpatient consultation-liaison (C-L) psychiatry clinics are valuable settings for research and teaching endeavors. However, little is known about psychiatric symptoms and health status of persons treated in such settings. In this study, 80 persons seen in an outpatient C-L psychiatry clinic were compared with 100 persons seen in a mood disorder clinic on a variety of self-report instruments. Outpatient C-L clinic patients were found to have significantly poorer health status than mood clinic patients on the following domains as measured by the RAND instrument: general health perception, pain, physical functioning, and role functioning due to physical problems. Both groups had poor role functioning due to emotional problems and poor social functioning. The groups did not differ in depressive symptoms but C-L patients were significantly less anxious. Thus, it appears that patients in an outpatient C-L setting not only have significant medical comorbidity, as expected, but have levels of psychiatric distress comparable to that seen in a traditional psychiatry outpatient setting. These findings indicate that such a clinic is a fertile area for research and training in the diagnosis and treatment of persons with comorbid physical and mental disorders.

Activities of Daily Living↗

PubMed1993

Medication use by the elderly.

Medication use is correlated with the age-associated onset of chronic diseases for which drug therapy offers symptomatic relief, and assists in preventing the onset of disabling and life-threatening complications. However, high rates of medication use by older people raise a number of issues, ranging from concerns with rising expenditures for individuals and third-party insurers; increased risk of adverse drug reactions; toxic or interaction effects from concomitant use of multiple pharmaceutical agents, both physician and self-prescribed; and poor compliance with complex medication regimens by the more physically and mentally impaired. Although existing data do not support the theory of age as an independent predictor of drug-specific adverse reactions, older people have typically been excluded from clinical trials in the dynamic and changing field of pharmacotherapy. Furthermore, ingestion of a greater number of different agents clearly exposes individuals to higher risk of adverse reactions and interactions. Recent advances in information technology have facilitated multicenter clinical trials and post-marketing epidemiological surveillance studies of specific and concomitant medication use by individuals of all ages. The employment of such technology by insurers to determine appropriate prescribing or to control costs in the present limited state of knowledge is, however, premature. Furthermore, such techniques will not replace the need for careful clinical review of symptoms and total drug therapy by prescribing physicians, with modification of regimens and provision of appropriate information and instructions to older individuals and their caregivers.

Aged↗

PubMed1988

Clinical predictors of outcome of acute episodes of low back pain.

In this prospective study, predictors of outcome were identified for patients (n = 116) who presented to their family physician with acute mechanical low back pain. Short-term outcome was measured by the number of days lost from work and longer term outcome was measured by disability at the six-week follow-up. Unlike other published work, this study did not find obesity or a history of previous back problems to be related to a poorer outcome from acute episodes of low back pain. Among those patients not involved in manual labor, a history of anxiety or depression was a significant predictor of both greater work loss and longer term disability. Among this same group, cigarette smoking was also found to be related to greater long-term disability from acute low back pain. Further study of this relationship is needed. The number of hours of manual labor performed daily was a strong predictor of poor outcome (both short- and long-term) of acute episodes of low back pain. Among both manual laborers and professional-technical workers, the number of days off work (at bed rest) prescribed by the physician was significantly related to greater absenteeism from work; the physician's diagnosis of an actual or possible disc problem was also related (P less than .05) to greater work loss among manual laborers. Neither of these factors, however, was related to longer term disability.

Acute Disease↗

PubMed1987

Growth and change in the funding and provision of home care for the elderly.

Home care has been promoted as an alternative to acute and long-term care in hospitals and nursing homes in the interests of controlling the high and rising costs of institutional care. This has resulted in legislative and regulatory changes to public programs, of which the elderly are the main beneficiaries. Consequently, there has been major growth and change in the home care industry with Medicare being the largest third-party payor and primary income source for many home care agencies. The industry is now coming under closer scrutiny as a result of the increasing public expenditures, and concerns regarding public accountability and the cost-effectiveness of care delivered by this fragmented and relatively unregulated sector have been expressed. There is now increasing evidence that industry expectations of future growth may not be met from publicly funded home care programs for the elderly as currently conceived, regulated, and reimbursed. Changes are likely to result in an expanded role for the physician in home health care planning and supervision.

Aged↗

PubMed1980

Vocational training and recruitment into general practice.

A recent survey of doctors in the practice year of vocational training indicates a strong preference for group practice from purpose-built premises (health centre and other) with multidisciplinary staffing and attachments. While it might be assumed that the introduction of mandatory vocational training would provide a continuing supply of well trained recruits into general practice, it may well raise recruitment problems for those areas where practice facilities and opportunities do not meet with expectations. This possibility is of particular concern for those metropolitan regions encompassing inner city areas which have traditionally been highly dependent on hospital-based services, but where deficiencies in primary care provision, particularly in terms of practice structure and premises, have been identified repeatedly over the past 30 years. In view of the present policies for changing the balance of care away from the hospitals, there is an urgent need to develop primary care facilities which will accord with the expectations of vocationally trained general practitioners and their population of patients.

Career Choice↗

PubMed1979

Nurses in the community: a manpower study.

High priority is at present being given to the expansion of health visiting and home nursing services as part of the change of emphasis from institutional to community care. The aim of this study was to provide nurse managers in two regional health authorities with basic information about community nurses with could be used for service planning and development. The results of the study emphasise the particular problems of staffing the community nursing service in inner London, where home nurse and health visitors are younger, more recently appointed, and relatively less experienced than staff in other parts of the regions. High turnover rates and chronic recruitment difficulties in inner London prevent nurse managers from maintaining both the level and the quality of the services they aim to provide. Until these problems are remedied there is little prospect of achieving any significant shift in the balance of care in inner London.

Age Factors↗

PubMedDate not supplied

Prevalence of posttraumatic stress disorder in women with breast cancer.

This study investigated whether diagnosis and treatment of breast cancer produced posttraumatic stress disorder (PTSD) in adult women. One hundred sixty women with early stage node-negative breast cancer completed self-report questionnaires and underwent a full diagnostic assessment (Structured Clinical Interview for DSM-III-R). PTSD symptoms were common; however, only 3% of the women interviewed met stringent criteria for cancer-related PTSD in the 4-12 months following the completion of their medical treatment. Thus, breast cancer produced considerable distress, but low rates of PTSD, and may not fit well as a Criterion A stressor event for PTSD. Caution is urged for an assumption of a PTSD diagnosis based on self-reported symptoms.

Adult↗