The impact of radiation on functional outcomes in patients with rectal cancer and sphincter preservation.

Radiation therapy (RT) plays an important role in the management of patients with rectal cancer. However, there is mounting evidence that RT results in functional changes. The purpose of this study was to review the published data on bowel and sexual functional changes associated with RT and to determine the optimal strategy.

Comparative analysis of the genome sequences of Bordetella pertussis, Bordetella parapertussis and Bordetella bronchiseptica.

Bordetella pertussis, Bordetella parapertussis and Bordetella bronchiseptica are closely related Gram-negative beta-proteobacteria that colonize the respiratory tracts of mammals. B. pertussis is a strict human pathogen of recent evolutionary origin and is the primary etiologic agent of whooping cough.

Unexpected similarities between Bordetella avium and other pathogenic Bordetellae.

Bordetella avium causes an upper respiratory tract disease (bordetellosis) in avian species. Commercially raised turkeys are particularly susceptible. Like other pathogenic members of the genus Bordetella (B.

Programmed translational frameshift in the bacteriophage P2 FETUD tail gene operon.

The major structural components of the P2 contractile tail are encoded in the FETUD tail gene operon. The sequences of genes F(I) and F(II), encoding the major tail sheath and tail tube proteins, have been reported previously (L. M.

Sensory morbidity after sentinel lymph node biopsy and axillary dissection: a prospective study of 233 women.

Background: We prospectively compared the sensory morbidity and lymphedema experienced after sentinel node biopsy (SLNB) and axillary dissection (ALND) over a 12-month period by using a validated instrument.

Methods: Patients undergoing breast-conserving therapy completed the Breast Sensation Assessment Scale (BSAS) at baseline and 3, 6, and 12 months after surgery. Repeated-measures analysis of variance was used to compare ALND and SLNB over the 12-month period.

Eighteen sensations after breast cancer surgery: a comparison of sentinel lymph node biopsy and axillary lymph node dissection.

Purpose/objectives: To evaluate prevalence, severity, and level of distress of 18 sensations at 3-15 days (baseline), 3 months, and 6 months after breast cancer surgery; to compare sentinel lymph node biopsy (SLNB) to SLNB with immediate or delayed axillary lymph node dissection; to evaluate the Breast Sensation Assessment Scale(c) (BSAS(c)) for reliability and validity.

Design: Prospective, descriptive.

Setting: Evelyn H.

The role of pulmonary metastasectomy in soft tissue sarcoma.

Pulmonary metastases are common in patients with soft tissue sarcoma. The majority of patients who develop pulmonary metastases are asymptomatic and are diagnosed during routine follow-up visits. There is evidence to suggest that pulmonary metastasectomy is associated with improved overall survival but only in patients with complete surgical resection.

Randomized clinical trials in melanoma.

Efforts to improve the survival of patients with metastatic melanoma have led to 67 prospective randomized clinical trials investigating the use of agents comprising three main areas of therapy: systemic chemotherapy-based regimens, immunotherapy, and vaccine therapy

Use of bacteriophage Ba1 to identify properties associated with Bordetella avium virulence.

Bordetella avium causes bordetellosis, an upper respiratory disease of birds. Commercially raised turkeys are particularly susceptible. We report here on the use of a recently described B.

Prevalence of Bordetella avium infection in selected wild and domesticated birds in the eastern USA.

Bordetella avium is the etiologic agent of bordetellosis, a highly contagious upper respiratory disease of young poultry. Its prevalence among domesticated turkeys is well-known, but information on prevalence of this bacterium in other birds is limited. A survey of the prevalence of B.

A home-based method to reduce phytate content and increase zinc bioavailability in maize-based complementary diets.

This study aimed to develop and assess the feasibility of a home-based method to reduce the phytate content of maize and improve zinc bioavailability from maize-based complementary diets in rural Malawi. A method of extracting phytate through the soaking of pounded maize was developed, and found to reduce phytate content to 49% of unrefined maize. An educational program was used to teach the processing method to mothers of children receiving complementary foods in rural Malawian communities.

Diagnosing insulin resistance in the general population.

Objective: Difficulties in measuring insulin sensitivity prevent the identification of insulin-resistant individuals in the general population. Therefore, we compared fasting insulin, homeostasis model assessment (HOMA), insulin-to-glucose ratio, Bennett index, and a score based on weighted combinations of fasting insulin, BMI, and fasting triglycerides with the euglycemic insulin clamp to determine the most appropriate method for assessing insulin resistance in the general population.

Research Design And Methods: Family history of diabetes, BMI, blood pressure, waist and hip circumference, fasting lipids, glucose, insulin, liver enzymes, and insulin sensitivity index (ISI) using the euglycemic insulin clamp were obtained for 178 normoglycemic individuals aged 25-68 years.

Discovery, purification, and characterization of a temperate transducing bacteriophage for Bordetella avium.

We discovered and characterized a temperate transducing bacteriophage (Ba1) for the avian respiratory pathogen Bordetella avium. Ba1 was initially identified along with one other phage (Ba2) following screening of four strains of B. avium for lysogeny.

A role for lipopolysaccharide in turkey tracheal colonization by Bordetella avium as demonstrated in vivo and in vitro.

We isolated two insertion mutants of Bordetella avium that exhibited a peculiar clumped-growth phenotype and found them to be attenuated in turkey tracheal colonization. The mutants contained transposon insertions in homologues of the wlbA and wlbL genes of Bordetella pertussis. The wlb genetic locus of B.

An internet-based learning portfolio in resident education: the KOALA multicentre programme.

Context And Objectives: To describe the Computerized Obstetrics and Gynecology Automated Learning Anaalysis (KOALAtrade mark), a multicentre, Internet-based learning portfolio and to determine its effects on residents' perception of their self-directed learning abilities.

Methods: The KOALA programme allows residents to record their obstetrical, surgical, ultrasound, and ambulatory patient encounters and to document critical incidents of learning or elements of surprise that arose during these encounters. By prompting the student to reflect on these learning experiences, KOALA encourages residents to articulate questions which can be directly pursued through hypertext links to evidence-based literature.

Preventive health care, 1999 update: 3. Follow-up after breast cancer. Canadian Task Force on Preventive Health Care.

Objective: To make recommendations to physicians who provide follow-up care for women who have been treated for early-stage breast cancer.

Options: Combination of blood tests, bone scans, liver echography and chest radiography for detection of distant disease; physical examination with or without mammography for detection of contralateral breast cancer; and physical examination with or without mammography for detection of ipsilateral recurrent disease after breast-conserving therapy.

Outcomes: Survival, disease recurrence and quality-of-life measures for distant disease, local recurrence of disease and disease in the contralateral breast.

A meta-analysis of laparoscopic versus open appendectomy in patients suspected of having acute appendicitis.

Objective: To determine if any significant differences exist between laparoscopic appendectomy (LA) and open appendectomy (OA).

Design: A meta-analysis of randomized controlled trials (RCTs) comparing LA to OA.

Data Sources: An extensive literature search was conducted for appropriate articles published between January 1990 and March 1997.

Immunohistochemistry for hMLH1 and hMSH2: a practical test for DNA mismatch repair-deficient tumors.

Inactivation of deoxyribonucleic acid (DNA) mismatch repair genes, most commonly human mutL homologue 1 (hMLH1) or human mutS homologue 2 (hMSH2), is a recently described alternate pathway in cancer development and progression. The resulting genetic instability is characterized by widespread somatic mutations in tumor DNA, and is termed high-frequency microsatellite instability (MSI-H). Although described in a variety of tumors, mismatch repair deficiency has been studied predominantly in colorectal carcinoma.

Decision analysis as an aid to determining the management of early low rectal cancer for the individual patient.

Purpose: Because there are no data available from randomized controlled trials (RCT), a decision analysis was performed to aid in the decision of which option, a local excision with or without radiotherapy or an abdominal perineal resection (APR), should be offered to medically fit patients with early (suspected T1/T2) low (< 5 cm) rectal cancer.

Methods: All clinically relevant outcomes, including complications of surgery and radiotherapy, cure, salvageability after local recurrence, distant disease, and death, were modeled for both options. The probabilities of complications and outcomes after radiotherapy and/or local excision were derived from weighted averages of results from studies conducted between 1969 and 1997.

Mismatch repair gene defects contribute to the genetic basis of double primary cancers of the colorectum and endometrium.

Hereditary non-polyposis colorectal cancer (HNPCC) is a dominantly inherited cancer syndrome caused by germline defects of mismatch repair (MMR) genes. Endometrial cancer is the most common extracolonic neoplasm in HNPCC and is the primary clinical manifestation of the syndrome in some families. The cumulative incidence of endometrial cancer among HNPCC mutation carriers is high, estimated to be from 22 to 43%.

Family history characteristics, tumor microsatellite instability and germline MSH2 and MLH1 mutations in hereditary colorectal cancer.

Recent characterization of the molecular genetic basis of hereditary nonpolyposis colorectal cancer provides an important opportunity for identification of individuals and their families with germline mutations in mismatch repair genes. Cancer family history criteria that accurately define hereditary colorectal cancer are necessary for cost-effective testing for germline mutations in mismatch repair genes. The present report describes the results of analysis of 33 colorectal cancer cases/families that satisfy our modified family history criteria (Mount Sinai criteria) for colorectal cancer.

Bordetella avium virulence measured in vivo and in vitro.

Bordetella avium causes an upper-respiratory-tract disease called bordetellosis in birds. Bordetellosis shares many of the clinical and histopathological features of disease caused in mammals by Bordetella pertussis and Bordetella bronchiseptica. In this study we determined several parameters of infection in the domestic turkey, Meleagris galapavo, and compared these in vivo findings with an in vitro measure of adherence using turkey tracheal rings.

Development of a computerized telecommunication system for in-training evaluation of residents in a laparoscopic educational program.

Objective: To describe our initial experience with a computerized telecommunication system, termed the interactive voice-response system, to record resident performance of laparoscopic surgery.

Methods: After completing a laparoscopic procedure, the surgeon and resident telephone a toll-free number independently and respond to three prerecorded statements using a Likert scale of 1 to 5. The caller then is asked to describe the resident's response to critical incidents or elements of surprise that arose during the surgery.