Understanding variation in the management of rectal cancer: the potential of a surgeon-initiated database.

Background: Administrative databases oversimplify the relationship of factors such as volume or training on surgical outcomes.

Methods: A prospective statewide surgeon-initiated database was queried to obtain incident cases of rectal cancer in Vermont from April 1999 to June 2001. Demographics, procedure performed, method of detection, American Society of Anesthesiologists classification, blood transfusions, length of stay, complications, stage, and use of adjuvant therapy were recorded by the operating surgeon.

Exercise rehabilitation of older patients with cardiovascular disease.

As the population of elderly patients with cardiovascular disease continues to increase, much research needs to be done with the goal of maintaining physical functioning and personal independence in this population. It is of particular importance to determine whether training programs can improve physical functioning in the most severely disabled older coronary patients. Effects of cardiac rehabilitation programs on other outcome measures, including psychosocial outcomes, lipid levels, insulin levels, and body composition require better study.

Effects of exercise and cardiac rehabilitation on cardiovascular outcomes.

Comprehensive cardiac rehabilitation for coronary patients includes a systematic approach to the measurement and treatment of coronary risk factors, along with the better-known exercise training component. Studies of exercise and nutritional interventions in patients with coronary heart disease have documented improved primary outcomes of decreased morbidity and mortality, decreased symptoms, and fewer cardiac rehospitalizations. Quality of life, depression scores, and physical functioning are improved after rehabilitation.

Increase in fetal breech presentation in female carriers of Duchenne muscular dystrophy.

Female carriers of Duchenne muscular dystrophy (DMD) may demonstrate elevated serum creatine kinase (CK) and reduction of muscle dystrophin in all muscle types. We hypothesized that decreased dystrophin in uterine or pelvic girdle musculature might affect the obstetrical performance of females heterozygous for a dystrophin mutation. We reviewed the outcome of 34 deliveries resulting in 35 children from 13 women who were mothers of males attending a muscular dystrophy clinic.

Pulse oximetry in infants of < 1500 gm birth weight on supplemental oxygen: a national survey.

Objective: To determine practices related to the use of pulse oximetry in monitoring infants of < 1500 gm birth weight on supplemental oxygen.

Study Design: A mailing list of all neonatal intensive care units with accredited Neonatal-Perinatal Fellowship programs was prepared. A questionnaire was prepared and mailed to collect information on the following: Method used for noninvasive monitoring of oxygen therapy, acceptable maximum and minimum arterial pulse oxygen saturation levels, high and low alarm settings, and whether oxygen was administered at a fixed or variable rate.

Echocardiographic Assessment of Dynamic Changes in Left Ventricular Shape.

Changes in resting left ventricular shape have been related to underlying left ventricular dysfunction and may precede detectable hemodynamic abnormalities. The significance of dynamic changes in left ventricular shape has only recently been examined. In patients with systolic left ventricular dysfunction, dynamic changes in heart shape correlate strongly with exercise duration.

Active hemorrhage of intracranial aneurysms: diagnosis by CT angiography.

Two cases of active hemorrhage from an intracranial aneurysm demonstrated by CT angiography are presented. In each case, extraluminal opacified blood was seen entering a recent hemorrhage surrounding the aneurysm, simulating a vascular structure. This is a potential pitfall in the interpretation of CT angiograms in patients with recent subarachnoid hemorrhage.

Evaluation of the ThinPrep processor for fine needle aspiration specimens.

Objective: To test the ThinPrep Processor for fine needle aspiration.

Study Design: One hundred unfixed, surgically removed specimens were aspirated. One pass was directly smeared, fixed and stained with the Papanicolaou technique.

Fetal RhD genotyping in fetal cells flow sorted from maternal blood.

Objective: The aim of this study was to determine the accuracy of noninvasive fetal RhD genotyping by fetal cell isolation from maternal blood.

Study Design: Candidate fetal cells from 18 pregnant women (one twin gestation) were flow-sorted. Polymerase chain reaction amplification of a 261 bp fragment of the RhD gene was performed on sorted fetal cells.

Effects of exercise on left ventricular performance determined by echocardiography in chronic, severe mitral regurgitation secondary to mitral valve prolapse.

Data on the effects of exercise on left ventricular (LV) volumes and ejection performance in patients with severe mitral regurgitation (MR) are limited. With use of a matched-pairs design, 10 asymptomatic patients with chronic, severe MR and normal LV systolic function who were not receiving vasodilator therapy (group 1) and 10 matched normal control subjects with no structural heart disease (group 2) performed symptom-limited upright bicycle ergometry with quantitative echocardiographic analysis. An additional 8 patients with severe, chronic MR and normal LV systolic function who were receiving vasodilator therapy at the time of testing (group 3) were studied for comparison.

Medial and lateral antebrachial cutaneous nerve blocks: an easily learned regional anesthetic for forearm arteriovenous fistula surgery.

Background And Objectives: Forearm arteriovenous fistula insertion is commonly performed to facilitate hemodialysis. This study was undertaken to assess the use of medial and lateral antebrachial cutaneous nerve blocks to provide anesthesia for this surgery.

Methods: Twelve patients with end-stage renal failure, presenting for insertion or revision of a forearm Gortex arteriovenous fistula, were anesthetized by local block of the medial and lateral antebrachial cutaneous nerves with a mepivacaine-bupivacaine mixture.

Uterine artery Doppler velocimetry in the detection of adverse obstetric outcomes in women with unexplained elevated maternal serum alpha-fetoprotein levels.

Objective: We hypothesized that in pregnancies complicated by unexplained elevations of maternal serum alpha-fetoprotein, second-trimester uterine artery Doppler findings would detect adverse obstetric outcomes.

Study Design: One hundred three subjects with unexplained elevations of maternal serum alpha-fetoprotein had uterine artery Doppler velocimetry studies performed at the time of targeted ultrasonographic examination (17 to 22 weeks). A resistance index > 95th percentile or the presence of a uterine notch was considered abnormal.

Relation between left ventricular shape and Doppler filling parameters in patients with left ventricular dysfunction secondary to coronary artery disease.

Left ventricular (LV) shape is an independent predictor of exercise capacity in patients with systolic LV dysfunction. Recent studies suggest that end-systolic LV shape is related to the generation of restoring forces during contraction that facilitate filling at lower LV pressure during subsequent diastole. To test the hypothesis that preservation of a more elliptical LV shape would be associated with a distribution of diastolic inflow characterized by increased early relative-to-late filling, 32 outpatients with coronary artery disease and ejection fraction < 40% underwent quantitative 2-dimensional and Doppler echocardiography.

Clinicians' perceptions of self-assessment in clinical practice.

Background And Purpose: Self-assessment may be a way for clinicians to focus on continued clinical competence. Self-assessment is the clinicians' ability to assess their skills, identify their educational needs, evaluate their progress, and determine the strengths and weaknesses of their performance. The purpose of this study was to describe selected physical therapists' perceptions of self-assessment in their clinical practice.