Drilling simulated temporal bones with left-handed tools: a left-hander's right?

Objectives: Left-handed trainees can be at a disadvantage in the surgical environment because of a right-handed bias. The effectiveness of teaching left-handed trainees to use an otologic drill designed for their dominant hand versus the conventional right-handed drill was examined.

Methods: Novice medical students were recruited from the university community.

Effectiveness of emergency department asthma management strategies on return visits in children: a population-based study.

Background: Emergency departments play an important role in the care of children with asthma. Emergency department return-visit rates provide a measure of the quality of acute asthma care.

Objective: Our goal was to describe the characteristics of children treated in emergency departments for asthma, the resources and asthma management strategies used by emergency departments, and their effect on return visits within 72 hours.

Characterizing blood volume fraction (BVF) in a VX2 tumor.

Objectives: Neovascular proliferation of a tumor's blood supply is an important precursor of malignant growth. Evaluation of blood volume may provide useful information for the characterization, prognosis and response of tumors to therapy. The purpose of this study was to determine and compare the blood volume of tumor tissue measured noninvasively by MRI and microbubble contrast ultrasound imaging.

First-line treatment options for patients with HER-2 negative metastatic breast cancer: the impact of modern adjuvant chemotherapy.

The management of early breast cancer has evolved rapidly in recent years. Consequently, the range of first-line treatment options for metastatic breast cancer (MBC) is becoming increasingly complicated and therapy depends on a complex interaction of tumor, patient, and physician variables. Arguably one of the most important factors determining choice of first-line chemotherapy is prior adjuvant therapy.

Urban emergency department overcrowding: defining the problem and eliminating misconceptions.

Study Objective: To develop an operational definition and a parsimonious list of postulated determinants for urban emergency department (ED) overcrowding.

Methods: A panel was formed from clinical and administrative experts in pre-hospital, ED and hospital domains. Key studies and reports were reviewed in advance by panel members, an experienced health services researcher facilitated the panel's discussions, and a formal content analysis of audiotaped recordings was conducted.

Survival differences observed in metastatic breast cancer patients treated with capecitabine when compared with vinorelbine after pretreatment with anthracycline and taxane.

Objectives: The optimal treatment of metastatic breast cancer patients previously treated with anthracycline and taxane is unknown. Common therapeutic alternatives include capecitabine and vinorelbine. This retrospective chart review compares overall survival following treatment with capecitabine, vinorelbine, or both agents sequentially in this group of women.

Comparison of biphasic and reordered fat suppression for dynamic breast MRI.

Purpose: To optimize a reordered k-space acquisition that applies intermittent fat saturation (FS) pulses to allow for a time-efficient reduction of fat signal in breast MR images, and compare it with an elliptic-centric biphasic FS method in terms of the degree of fat suppression and speed.

Materials And Methods: The behavior of the fat and water signals under the influence of the reordered sequence was characterized. This allowed us to optimize the flip angle and visualize the expected artifacts by deriving the point spread function (PSF) of the fat signal.

Detecting vascular changes in tumour xenografts using micro-ultrasound and micro-ct following treatment with VEGFR-2 blocking antibodies.

Blockade of vascular endothelial growth factor (VEGF) binding to its receptors on endothelial cells has been shown preclinically to induce tumour growth inhibition. Using ultrasound biomicroscopy (UBM) or micro-ultrasound imaging and micro-computed tomography (micro-CT) analysis, we have examined the effects of DC101, a highly specific vascular endothelial growth factor receptor-2 (VEGFR-2)-targeting antibody, in inducing growth inhibition and functional vascular changes in established melanoma (MeWo) xenografts in mice. Postprocessing of UBM imaging loops for speckle variance was introduced to estimate the level of functional blood flow in tumours.

A novel susceptibility locus on rat chromosome 8 affects spontaneous but not experimentally induced type 1 diabetes.

Objective: The biobreeding diabetes-prone (BBDP) rat spontaneously develops type 1 diabetes. Two of the genetic factors contributing to this syndrome are the major histocompatibility complex (Iddm1) and a Gimap5 mutation (Iddm2) responsible for a T-lymphopenia. Susceptibility to experimentally induced type 1 diabetes is widespread among nonlymphopenic (wild-type Iddm2) rat strains provided they share the BBDP Iddm1 allele.

Multidisciplinary cancer conferences: a systematic review and development of practice standards.

Background: Multidisciplinary cancer conferences (MCCs) are a forum for health care providers to discuss diagnostic and treatment aspects of a cancer patient's care. In Ontario, we have found that very few hospitals have developed cancer conferences or forums for the prospective discussion of patient cancer care. In this paper, we describe the process of creating a province-wide standards document for MCCs.

Overexpression of SOCS-2 and SOCS-3 genes reverses erythroid overgrowth and IGF-I hypersensitivity of primary polycythemia vera (PV) cells.

Polycythemia vera (PV), an acquired, chronic, clonal disorder arising in a multipotential hematopoietic progenitor cell, is characterized by hyperplasia of three major myeloid lineages, with a pronounced increase in cells of the erythroid lineage. Erythroid progenitor cells in PV are strikingly hypersensitive to insulin-like growth factor-I (IGF-I); this effect is specific and is mediated through the IGF-I receptor. To investigate the possibility that in PV the increase in number of erythroid progenitors and their hypersensitivity to IGF-I result from a defect in negative regulation of cytokine activity, we examined the expression of members of the SOCS gene family.

Fourteen-year study of hospital admissions for diverticular disease in Ontario.

Background: Diverticular disease is one of the most common gastrointestinal conditions affecting the Canadian population, yet very little is known about its epidemiology.

Objective: The aim of the present study was to measure the rate of hospital admission for diverticular disease by age and sex over a 14-year period in the population of Ontario.

Patients And Methods: The present study was a retrospective, population-based cohort study of all hospital admissions for diverticular disease from 1988 to 2002.

Efalizumab in the treatment of psoriasis.

Background: Efalizumab (anti-CD11a), a targeted, reversible T-cell modulator, is a humanized monoclonal antibody that provides a rapid onset of action of clinical benefit and has been studied up to 36 months, showing continuous control of plaque-type psoriasis. Efalizumab has recently been approved in Canada for this indication.

Objective: To examine the efficacy and safety of efalizumab by presenting the latest data in the treatment of psoriasis.

Surgery as a bridge to palliative chemotherapy in patients with malignant bowel obstruction from colorectal cancer.

Background: Malignant bowel obstruction (MBO) is a feature of the clinical course of 10-28% of colorectal cancer (CRC) patients and is associated with a poor prognosis. Recent advancements in palliative chemotherapy regimens have prolonged survival in patients with stage IV CRC. Few reports exist that describe outcomes in patients who have had surgery for MBO and subsequent chemotherapy as part of their treatment.

Whole-specimen histopathology: a method to produce whole-mount breast serial sections for 3-D digital histopathology imaging.

Aims: To develop a method for preparing diagnostic-quality, whole-mount serial sections of breast specimens while preserving 3-D conformation. This required supporting the fresh specimen prior to breadloafing and refining the conventional tissue processing method. The overall goal is to use digital images of whole-specimen histopathology to improve the estimation of extent of disease.

Transfusion-related acute lung injury in patients with burns.

Transfusion-related acute lung injury (TRALI) has not been systematically described in patients with burn injury, and the characterization of TRALI in patients with pre-existing acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) also is lacking. Our aim was to identify TRALI in burn patients and to attempt to characterize transfusion (TXN)-related pulmonary deterioration in burn patients with pre-existing ALI or ARDS. We undertook a retrospective review of mechanically ventilated and transfused burn patients at an adult regional burn center between January 1, 2003, and January 5, 2005.

Several therapies may prevent or reduce the severity of oral mucositis associated with cancer treatment.

Data Sources: The Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials, Medline and Embase were searched to April 2006. Reference lists from relevant articles were scanned and the authors of eligible studies were contacted to identify trials and obtain additional information.

Study Selection: For inclusion, an article had to satisfy the following criteria: document a randomised controlled trial (RCT); participants should be people receiving chemotherapy or radiotherapy treatment for cancer; prescribe agents to prevent oral mucositis; and have the primary outcome of preventing mucositis.

Association between alcohol and mortality in patients with severe traumatic head injury.

Hypothesis: Admission blood alcohol concentration (BAC) is associated with in-hospital death in patients with severe brain injury from blunt head trauma.

Design: Retrospective cohort study.

Setting: Academic level I trauma center in Toronto, Ontario.

Multiply relapsing hairy cell leukemia responsive to repeated courses of rituximab: a case report.

While cladribine is a highly effective therapy for patients with symptomatic hairy cell leukemia (HCL), up to 37% of patients ultimately relapse and incompletely responding patients relapse more frequently. Rituximab is a monoclonal antibody against CD20 that has been shown to be effective in patients with relapsed HCL. We present an unusual case of successful multiple re-treatments with rituximab in a patient with heavily pre-treated HCL and briefly review the relevant literature.