Ethical issues in the application of genome-wide association studies to US military recruitment and personnel assignments.

Genome-wide association studies seek to associate an organism's genotypes with phenotypes. The goal of such research is to identify specific genetic variants that may be used to predict an individual's risk for a specific physical or mental disease. Recently, it has been recommended that policymakers in the USA should employ genomic surveillance so that it can be used for initial military personnel selection and personnel assignments. However, such a proposal highlights the necessity of subjecting such recommendations to rigorous ethical analysis, including concerns regarding recruitment, transparency and the return of genetic results.

The constant force continuous molecular dynamics for potentials with multiple discontinuities.

In this work, we present an extension of the constant force approach [P. Orea and G. Odriozola, J. Chem. Phys. 138, 214105 (2013)] to the case of potentials with multiple discontinuities. To illustrate the method, we selected the square well potential of range λ=1.5 that exhibits two discontinuities. Square well single phase properties, vapor-liquid phase diagram, and surface tension were calculated and compared with available simulation data. Besides, we analyzed the internal energies of a square well plus a square shoulder potential having three discontinuities. For both potentials, a good agreement has been found when compared with results of other simulation techniques (discontinuous molecular dynamics and Monte Carlo methods). This extension can be easily implemented to more general and efficient continuous molecular dynamics packages (HOOMD, GROMACS, NAMD, etc.).

Intususpección en el adulto. Diagnóstico por TAC / No disponible

No disponible

Pseudoquiste traumático de páncreas / Traumatic pseudocyst of the pancreas

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Limitations of the pelvic examination for evaluation of the female pelvic organs.

OBJECTIVE: To assess factors influencing an accurate pelvic examination under the best possible circumstances. METHODS: Before undergoing laparoscopy or laparotomy, 84 women under general anesthesia underwent pelvic examinations by an attending gynecologist, a gynecology resident, and a medical student blinded to the indication for surgery. Surgical findings were compared with the examiners' findings. Dependent variables (uterine size, uterine contour, and presence of adnexal masses) and effect modifiers (examiner experience and body mass index) were analyzed. RESULTS: The overall pelvic examination was accurate 70.2% of the time for attending gynecologists, 64.0% for residents, and 57.3% for medical students. The sensitivity to detect adnexal masses was much lower than the sensitivity to assess uterine size or uterine contour. Obesity noticeably reduced detection of adnexal masses. CONCLUSION: The bimanual examination appears to be a limited screening test for the female upper genital tract even under the best possible circumstances. Uterine assessment appears to be more accurate than adnexal assessment.

Oclusión intestinal por carcinoma colorrectal en el anciano. Presentación clínica y utilidad de la anamnesis y exploración física / Intestinal occlusion due to colorectal carcinoma in the aged. Clinical presentation and usefulness of anamnesis and physical examination

El síndrome de distensión visceral es el diagnóstico más frecuente en nuestro medio en pacientes ancianos que acuden a Urgencias por presentar dolor abdominal agudo (DAA). La oclusión intestinal representa el 59,6 por ciento de estos pacientes y el carcinoma colorrectal es la primera causa (46,6 por ciento) en la población de edad avanzada. Objetivos: Una exhaustiva revisión de la bibliografía nos ha llevado a verificar la escasez de trabajos que hacen referencia a la sensibilidad de la historia clínica en el proceso diagnóstico del dolor abdominal agudo en el anciano en general y en la oclusión intestinal por carcinoma colorrectal en particular, siendo éste el objetivo fundamental de nuestro estudio. Métodos: Cirujanos, gastroenterólogos y expertos en Medicina de Urgencia elaboramos un cuestionario especialmente diseñado para evaluar la semiología del DAA y que aplicamos a pacientes de edad igual o mayor a 65 años que acudían a Urgencias por este motivo. Resultados: Una historia clínica y examen físico efectuados con rigor es capaz de predecir con acierto el diagnóstico en más de la mitad de los casos de los pacientes ancianos que acuden a Urgencias presentando una oclusión intestinal por carcinoma colorrectal. Este porcentaje se eleva al 75 por ciento cuando sumamos la aportación de las pruebas complementarias rutinarias. Conclusiones: La historia clínica, aún con las limitaciones que comporta en este grupo de edad, constituye el documento principal del proceso diagnóstico en el DAA (AU)

The accuracy of the rectovaginal examination in detecting cul-de-sac disease in patients under general anaesthesia.

BACKGROUND: The rectovaginal examination is frequently used as an adjunct to a bimanual examination. The accuracy of rectovaginal examination in detecting cul-de-sac disease under ideal circumstances of the operating room was studied. METHODS: Fifty-two attending physicians and 30 residents were selected on experience and immediate availability to evaluate the presence of uterosacral nodularity and external rectal compression on 140 women undergoing general anaesthesia, followed by laparoscopy or laparotomy, at an academic medical centre. Physicians were masked to the indications for surgery and procedure ranging from diagnostic laparoscopy to laparotomy for suspected malignancy. RESULTS: Mean patient body mass index (BMI) was 26.1 kg/m2 and nearly one-third had had previous surgery. Based on the surgical findings, cul-de-sac disease was common, including uterosacral nodularity (5.8%) and rectal compression (10.1%). Both sensitivity and positive predictive value of the rectovaginal examination for detecting uterosacral nodularity were zero, whereas specificity approached 95%. Accuracy in detecting rectal compression was somewhat better with a sensitivity of 34%, specificity 96.7% and positive predictive value 55.6%. Neither examiner-years of experience nor the laterality of the dominant or examining hand affected the accuracy of the rectovaginal examination. CONCLUSIONS: The rectovaginal examination has marked limitations despite the controlled circumstances of the operating room including general anaesthesia, an empty bladder and ideal patient positioning. As suspected, the specificity of the rectal examination is high due to the low prevalence of disease. However, the sensitivity of the rectovaginal examination is very low, limiting its capacity as a screening test.

Using a belly board device to reduce the small bowel volume within pelvic radiation fields in women with postoperatively treated cervical carcinoma.

OBJECTIVE: The purpose of this study was to attempt to reduce the small bowel volume in cervical cancer patients undergoing radiation therapy using the belly board device and a four-field technique. METHODS: From 1994 through 1997, twenty-one patients with cervical cancer were referred to the University of Minnesota Medical Center and underwent surgical staging with or without radical hysterectomy followed by postoperative external beam radiotherapy for various indications including positive nodal disease (n = 11), lymph-vascular space invasion (n = 2), poor histology (n = 3), parametrial disease (n = 4), and positive vaginal margin (n = 1). RESULTS: The median age of the 21 patients was 42 years (25-54 years) and a median external beam pelvic radiation dose of 4775 cGy (range, 4200-5075 cGy) was administered. All patients were evaluated for amount of small bowel in the field in both the supine and prone positions, with and without the belly board device (BBD), using a four-field technique. With a full bladder, abdominal radiographs with contrast were obtained to evaluate the volume of small bowel within the radiation fields. In most patients, the BBD was effective at minimizing the amount of small bowel in the lateral fields, whereas a prone position on the treatment table (without the BBD) spared the most small bowel with the AP/PA fields. Therefore over a 2-day cycle, the most small bowel sparing was obtained with the patients treated prone on the BBD for the lateral fields on Day 1 and prone on the table for the AP/PA fields on Day 2. Patients had FIGO stage IB (n = 18), IA2 (n = 1), and IIA (n = 2). The median follow-up was 37 months (24-65 months). No significant acute gastrointestinal or genitourinary toxicity was experienced and no patients have experienced a bowel obstruction to date. CONCLUSIONS: The BBD may offer a means for positioning the mobile small intestine out of the radiation field and improving the tolerance of radiotherapy. The BBD provides a noninvasive technique for reduction of acute and chronic gastrointestinal morbidity.