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Wells MD, Morse A, Barter J, Mammino K, Bay AA, Prusin T, Hackney ME. Walk with Me Hybrid Virtual/In-Person Walking for Older Adults with Neurodegenerative Disease. J Vis Exp 2023. [PMID: 37395568 DOI: 10.3791/62869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023] Open
Abstract
This study presents a protocol for virtual and in-person walking groups for older adults with neurodegenerative diseases and addresses the decline in physical activity and social connectivity during the pandemic. Physical activity, specifically moderate-intensity walking, has been shown to have multiple health benefits for older adults. This methodology was created during the COVID-19 pandemic, contributing to lower physical activity levels and social isolation in older adults. Both the in-person and virtual classes utilize technology such as fitness tracking apps and video platforms. Data are presented from two groups of older adults with neurodegenerative disease: people with prodromal Alzheimer's disease and people with Parkinson's disease. Participants in the virtual classes were screened for balance impairments before the walk, and any person deemed at risk for falls was not eligible to participate virtually. As COVID vaccines became available and restrictions were lifted, in-person walking groups became feasible. Staff and caregivers were trained in balance management, roles/responsibilities, and delivering walking cues. Both walks, virtual and in-person, consisted of a warm up, a walk, and a cool down, and posture, gait, and safety cues were given throughout. Measures of the rate of perceived exertion (RPE) and heart rate (HR) were taken pre-warm up, post-warm up, and at 15 min, 30 min, and 45 min time points. Participants also used a walking application (app) on their phones to record the distance walked and the number of steps taken. The study showed a positive correlation between HR and RPE in both groups. The participants in the virtual group rated the walking group favorably in terms of improving their quality of life during a period of social isolation and contributing to physical, mental, and emotional well-being. The methodology shows a safe and feasible way to implement virtual and in-person walking groups for older adults with neurological diseases.
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Affiliation(s)
- Meredith D Wells
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine
| | - Amy Morse
- Department of Rehabilitation Medicine, Emory University School of Medicine
| | - Jolie Barter
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine
| | - Kevin Mammino
- Atlanta VA Center for Visual and Neurocognitive Rehabilitation
| | - Allison A Bay
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine
| | - Todd Prusin
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine
| | - Madeleine E Hackney
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine; Department of Rehabilitation Medicine, Emory University School of Medicine; Atlanta VA Center for Visual and Neurocognitive Rehabilitation; Emory University School of Nursing; Birmingham/Atlanta VA Geriatric Research Education and Clinical Center;
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Rani A, Barter J, Kumar A, Stortz JA, Hollen M, Nacionales D, Moldawer LL, Efron PA, Foster TC. Influence of age and sex on microRNA response and recovery in the hippocampus following sepsis. Aging (Albany NY) 2022; 14:728-746. [PMID: 35094981 PMCID: PMC8833110 DOI: 10.18632/aging.203868] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/20/2022] [Indexed: 11/25/2022]
Abstract
Sepsis, defined as a dysregulated host immune response to infection, is a common and dangerous clinical syndrome. The excessive host inflammatory response can induce immediate and persistent cognitive decline, which can be worse in older individuals. Sex-specific differences in the outcome of infectious diseases and sepsis appear to favor females. We employed a murine model to examine the influence of age and sex on the brain's microRNA (miR) response following sepsis. Young and old mice of both sexes underwent cecal ligation and puncture (CLP) with daily restraint stress. Expression of hippocampal miR was examined in age- and sex-matched controls at 1 and 4 days post-CLP. Few miR were modified in a similar manner across age or sex and these few miR were generally associated with neuroprotection against inflammation. Similar to previous work examining transcription, young females exhibited a better recovery of the miR profile from day 1 to day 4, relative to young males and old females. For young males and all female groups, the initial response mainly involved a decrease in miR expression. In contrast, old males exhibited only upregulated miR on day 1 and day 4 and many of the miR upregulated on day 1 and day 4 were linked to neurodegeneration, increased neuroinflammation, and cognitive impairment. The results emphasize age and sex differences in epigenetic mechanisms that likely contribute to susceptibility or resilience to cognitive impairment due to sepsis.
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Affiliation(s)
- Asha Rani
- Department of Neuroscience, McKnight Brain Institute, University of Florida, Gainesville, FL 32611, USA
| | - Jolie Barter
- Department of Neuroscience, McKnight Brain Institute, University of Florida, Gainesville, FL 32611, USA
| | - Ashok Kumar
- Department of Neuroscience, McKnight Brain Institute, University of Florida, Gainesville, FL 32611, USA
| | - Julie A Stortz
- Department of Surgery, University of Florida, Gainesville, FL 32611, USA
| | - McKenzie Hollen
- Department of Surgery, University of Florida, Gainesville, FL 32611, USA
| | - Dina Nacionales
- Department of Surgery, University of Florida, Gainesville, FL 32611, USA
| | - Lyle L Moldawer
- Department of Surgery, University of Florida, Gainesville, FL 32611, USA
| | - Philip A Efron
- Department of Surgery, University of Florida, Gainesville, FL 32611, USA
| | - Thomas C Foster
- Department of Neuroscience, McKnight Brain Institute, University of Florida, Gainesville, FL 32611, USA.,Genetics and Genomics Program, University of Florida, Gainesville, FL 32611, USA
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Barter J, Kumar A, Rani A, Colon-Perez LM, Febo M, Foster TC. Differential Effect of Repeated Lipopolysaccharide Treatment and Aging on Hippocampal Function and Biomarkers of Hippocampal Senescence. Mol Neurobiol 2020; 57:4045-4059. [PMID: 32651758 DOI: 10.1007/s12035-020-02008-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 07/01/2020] [Indexed: 01/08/2023]
Abstract
Markers of brain aging and cognitive decline are thought to be influenced by peripheral inflammation. This study compared the effects of repeated lipopolysaccharide (LPS) treatment in young rats to age-related changes in hippocampal-dependent cognition and transcription. Young Fischer 344 X Brown Norway hybrid rats were given intraperitoneal injections once a week for 7 weeks with either LPS or vehicle. Older rats received a similar injection schedule of vehicle. Old vehicle and young LPS rats exhibited a delay-dependent impairment in spatial memory. Further, LPS treatment reduced the hippocampal CA3-CA1 synaptic response. RNA sequencing, performed on CA1, indicated an increase in genes linked to neuroinflammation in old vehicle and young LPS animals. In contrast to an age-related decrease in transcription of synaptic genes, young LPS animals exhibited increased expression of genes that support the growth and maintenance of synapses. We suggest that the increased expression of genes for growth and maintenance of synapses in young animals represents neuronal resilience/recovery in response to acute systemic inflammation. Thus, the results indicate that repeated LPS treatment does not completely recapitulate the aging phenotype for synaptic function, possibly due to the chronic nature of systemic inflammation in aging and resilience of young animals to acute treatments.
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Affiliation(s)
- Jolie Barter
- Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Ashok Kumar
- Department of Neuroscience, McKnight Brain Institute, University of Florida, Gainesville, FL, 32610-0244, USA
| | - Asha Rani
- Department of Neuroscience, McKnight Brain Institute, University of Florida, Gainesville, FL, 32610-0244, USA
| | - Luis M Colon-Perez
- Department of Neurobiology and Behavior, Center for Learning and Memory, University of California, Irvine, CA, 92697, USA
| | - Marcelo Febo
- Department of Neuroscience, McKnight Brain Institute, University of Florida, Gainesville, FL, 32610-0244, USA.,Department of Psychiatry, McKnight Brain Institute, University of Florida, Gainesville, FL, USA.,Center for Addiction Research and Education, University of Florida, Gainesville, FL, 32611, USA
| | - Thomas C Foster
- Department of Neuroscience, McKnight Brain Institute, University of Florida, Gainesville, FL, 32610-0244, USA. .,Genetics and Genomics Program, University of Florida, Gainesville, 32611, FL, USA.
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Febo M, Rani A, Yegla B, Barter J, Kumar A, Wolff CA, Esser K, Foster TC. Longitudinal Characterization and Biomarkers of Age and Sex Differences in the Decline of Spatial Memory. Front Aging Neurosci 2020; 12:34. [PMID: 32153384 PMCID: PMC7044155 DOI: 10.3389/fnagi.2020.00034] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 02/04/2020] [Indexed: 01/10/2023] Open
Abstract
The current longitudinal study examined factors (sex, physical function, response to novelty, ability to adapt to a shift in light/dark cycle, brain connectivity), which might predict the emergence of impaired memory during aging. Male and female Fisher 344 rats were tested at 6, 12, and 18 months of age. Impaired spatial memory developed in middle-age (12 months), particularly in males, and the propensity for impairment increased with advanced age. A reduced response to novelty was observed over the course of aging, which is inconsistent with cross-sectional studies. This divergence likely resulted from differences in the history of environmental enrichment/impoverishment for cross-sectional and longitudinal studies. Animals that exhibited lower level exploration of the inner region on the open field test exhibited better memory at 12 months. Furthermore, males that exhibited a longer latency to enter a novel environment at 6 months, exhibited better memory at 12 months. For females, memory at 12 months was correlated with the ability to behaviorally adapt to a shift in light/dark cycle. Functional magnetic resonance imaging of the brain, conducted at 12 months, indicated that the decline in memory was associated with altered functional connectivity within different memory systems, most notably between the hippocampus and multiple regions such as the retrosplenial cortex, thalamus, striatum, and amygdala. Overall, some factors, specifically response to novelty at an early age and the capacity to adapt to shifts in light cycle, predicted spatial memory in middle-age, and spatial memory is associated with corresponding changes in brain connectivity. We discuss similarities and differences related to previous longitudinal and cross-sectional studies, as well as the role of sex differences in providing a theoretical framework to guide future longitudinal research on the trajectory of cognitive decline. In addition to demonstrating the power of longitudinal studies, these data highlight the importance of middle-age for identifying potential predictive indicators of sexual dimorphism in the trajectory in brain and cognitive aging.
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Affiliation(s)
- Marcelo Febo
- Department of Psychiatry, McKnight Brain Institute, University of Florida, Gainesville, FL, United States
| | - Asha Rani
- Department of Neuroscience, McKnight Brain Institute, University of Florida, Gainesville, FL, United States
| | - Brittney Yegla
- Department of Neuroscience, McKnight Brain Institute, University of Florida, Gainesville, FL, United States
| | - Jolie Barter
- Department of Neuroscience, McKnight Brain Institute, University of Florida, Gainesville, FL, United States
| | - Ashok Kumar
- Department of Neuroscience, McKnight Brain Institute, University of Florida, Gainesville, FL, United States
| | - Christopher A Wolff
- Department of Physiology and Functional Genomics, Myology Institute, University of Florida, Gainesville, FL, United States
| | - Karyn Esser
- Department of Physiology and Functional Genomics, Myology Institute, University of Florida, Gainesville, FL, United States
| | - Thomas C Foster
- Department of Neuroscience, McKnight Brain Institute, University of Florida, Gainesville, FL, United States.,Genetics and Genomics Program, University of Florida, Gainesville, FL, United States
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Gonzalez Martin A, Rojas L, Braly P, Barter J, O'Malley D, Oza A, Haggerty A, Vulsteke C, Provencher D, Graybill W, Li Y, Malinowska I, Mirza M, Vergote I, Pothuri B, Monk B. A randomized, double-blind, placebo-controlled multicenter phase 3 trial of niraparib maintenance treatment in patients with advanced ovarian cancer following frontline chemotherapy. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx372.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Krivak T, Secord AA, Richard S, Leath C, Moore R, Coleman R, Fiorica J, Barter J, Downey G, Tian C, Lele S. A chemoresponse assay for prediction of platinum resistance in primary ovarian cancer. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.07.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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7
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Côté A, Barter J, Meehan B. Age-dependent metabolic effects of repeated hypoxemia in piglets. Can J Physiol Pharmacol 2000; 78:321-8. [PMID: 10772059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The aim of this study was to determine whether repeated exposure to hypoxemia would modify the response to hypoxemia during maturation. We exposed piglets to three 1-h cycles of hypoxemia (PaO2 = 30 to 35 mmHg; 1 mmHg = 133.3 Pa) at 1 week (n = 9), 2-3 weeks (n = 10), and 4-5 weeks of age (n = 10). O2 consumption (V(O2)) and CO2 production (V(CO2)) were measured, and alveolar ventilation (V(A)) was derived from V(CO2) and PaCO2. Levels of lactic acid (lactate) and serum catecholamines were also measured. With hypoxemia, time had a significant effect on V(O2) and body temperature in an age-dependent fashion: that is, whereas the 1 week group and the 4-5 week group showed both variables decreasing over time, the 2-3 week group showed no drop in V(O2) and a small increase in body temperature over time. Lactate levels increased with hypoxemia in all animals during the first exposure. However, with repeated exposures to hypoxemia, only the 2-3 week group continued to increase its lactate levels. Furthermore, the changes in lactate levels paralleled the changes in epinephrine levels with hypoxemia. We found, too, that although V(A) increased significantly with hypoxemia in all animals, this change was not modified by age or repeated exposures. No significant effects of age or repeated exposures were found in the cardiovascular response to hypoxemia. We concluded that, from a metabolic viewpoint, after repeated exposures to hypoxemia the 2-3 week animals responded differently.
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Affiliation(s)
- A Côté
- Department of Paediatrics, and The Jeremy Rill Centre for SIDS and Control of Breathing Disorders, Montréal Children's Hospital, McGill University, QC, Canada.
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9
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Spear SL, Pennanen M, Barter J, Burke JB. Prophylactic mastectomy, oophorectomy, hysterectomy, and immediate transverse rectus abdominis muscle flap breast reconstruction in a BRCA-2-positive patient. Plast Reconstr Surg 1999; 103:548-53; discussion 554-5. [PMID: 9950543 DOI: 10.1097/00006534-199902000-00027] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- S L Spear
- Georgetown University Medical Center, Washington, DC 20007, USA
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10
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Ikomi A, Barter J, Singer A. Persisting menorrhagia after successful thyroxine replacement in a hypothyroid patient. J OBSTET GYNAECOL 1999; 19:101-2. [PMID: 15512244 DOI: 10.1080/01443619966182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- A Ikomi
- Department of Women's Health, Whittington Hospital, London, UK
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11
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Hughes C, Gomez-Caminero A, Benkendorf J, Kerner J, Isaacs C, Barter J, Lerman C. Ethnic differences in knowledge and attitudes about BRCA1 testing in women at increased risk. Patient Educ Couns 1997; 32:51-62. [PMID: 9355572 DOI: 10.1016/s0738-3991(97)00064-5] [Citation(s) in RCA: 136] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Informed consent for BRCA1 mutation testing will require adequate knowledge of patterns of inheritance of cancer and the benefits, limitations, and risks of DNA testing. This study examined knowledge about the inheritance of breast cancer and attitudes about genetic testing for breast-ovarian cancer susceptibility in women at increased risk. Knowledge and attitudes were measured in 407 African American and Caucasian women aged 18-75 who had at least one first-degree relative (FDR) with breast and/or ovarian cancer. The average knowledge score was 6.0 out of a total of 11 (S.D. = 2.15). Compared to Caucasian women, African American women had lower levels of knowledge and had more positive attitudes about the benefits of genetic testing. There were no significant ethnic differences in attitudes about the limitations and risks of testing, however, income was negatively associated with this outcome. Ethnic differences in knowledge and attitudes about genetic testing for breast-ovarian cancer risk may be attributable to differences in exposure to genetic information and referral by health care providers.
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Affiliation(s)
- C Hughes
- Georgetown University Medical Center, Lombardi Cancer Center, Washington, DC 20007, USA
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Wojtowicz-Praga S, Low J, Marshall J, Ness E, Dickson R, Barter J, Sale M, McCann P, Moore J, Cole A, Hawkins MJ. Phase I trial of a novel matrix metalloproteinase inhibitor batimastat (BB-94) in patients with advanced cancer. Invest New Drugs 1996; 14:193-202. [PMID: 8913840 DOI: 10.1007/bf00210790] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Degradation of basement membrane and extracellular matrix by matrix metalloproteinases (MMPs) is believed to be required for tumor invasion, tumor-induced angiogenesis and vascular invasion. A synthetic hydroxamate, batimastat (also known as BB-94), inhibits MMPs by binding the zinc ion in the active site of the MMP. Batimastat inhibits at least 50% of MMP activity at concentrations less than or equal to 10 ng/ml in vitro. Batimastat retarded ascites accumulation and increased survival in mice with human ovarian tumor xenografts. Acute and long-term toxicological studies revealed no major toxicity in animals. Batimastat is poorly soluble and was administered intraperitoneally (i.p.) as a suspension. Previous studies in patients with malignant ascites have shown no major toxicities at doses as high as 1350 mg/m2.
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Affiliation(s)
- S Wojtowicz-Praga
- Department of Medicine, Georgetown University, Lombardi Cancer Center, Washington, D.C., USA
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Abstract
This report describes a new device for delivery of intraperitoneal therapy. From October 1989 through March 1991, 27 externally accessed Groshong (Bard Access Systems, UT) catheters were placed transabdominally into 24 patients with presumed epithelial ovarian cancer at the conclusion of primary or second-look laparotomy. Total duration of catheter use was 81 months (range, 1-62 weeks). Fifty-seven cycles of intraperitoneal therapy were administered through 18 catheters (range, 1-11). Nine catheters were removed without being used after patients randomized off intraperitoneal treatment arms or were ineligible for intraperitoneal protocols. There were no complications associated with catheter placement or removal. None of the catheters became obstructed or dislodged while in place. There were no cases of infectious peritonitis, although one patient developed an exit-site skin infection. Surgery is not required to remove the Groshong catheter which fosters empiric placement of the device at the time of laparotomy in all patients potentially eligible for intraperitoneal therapy. The device-related infection rate of 4.2 per 100 patients is similar to that described using other implanted devices. Catheter maintenance is easy and patient acceptance is good. The Groshong catheter is a safe, reliable, and acceptable means of delivering intraperitoneal therapy.
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Affiliation(s)
- S E Waggoner
- Georgetown University Medical Center, Division of Gynecologic Oncology, Washington, DC 20057
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Ikomi A, Tiernan C, Barter J, Singer A. Menorrhagia and endometrial resection. Lancet 1993; 342:57. [PMID: 8100331 DOI: 10.1016/0140-6736(93)91924-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Abstract
Lateral retroperitoneal approaches to abdominopelvic masses are commonly employed; the reverse hysterocolposigmoidectomy (RCHS) in addition utilizes transabdominal entry of the vaginal and rectovaginal spaces to provide medial access to the uterosacral and cardinal ligaments as well expose a tumor-free segment of the rectosigmoid for en bloc resection of panpelvic tumors. Thirty-one patients underwent reverse hysterocolpectomy for extensive, symptomatic pelvic malignancies. All patients had complete resection of pelvic tumor, and there were no perioperative deaths. Sigmoid resection was required in 25 patients with 22 primary reanastomosis and 3 end colostomies performed. In 6 patients, vaginal entry facilitated tumor resection while sparing the rectosigmoid. Average operative blood loss was 2677 cc. Early postoperative morbidity (1-30 days) occurred in 13 patients; febrile morbidity (6 patients) was the common complication. Late morbidity (1-6 months) was seen in 10 patients, including 1 fatal pulmonary embolism at 5 months. Subsequent therapy was tolerated well. Mean survival/follow-up is 15.7 months (range, 1 to 49 months). Seventeen patients are alive, seven patients without evidence of disease (average 13.4 months), and ten patients are alive with disease (average follow-up, 28.3 months). Thirteen patients are dead of disease or complication (average survival, 13.7 months). We conclude that RHCS facilitates resection of extensive pelvic tumors with acceptable morbidity.
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Affiliation(s)
- W Barnes
- Department of Obstetrics and Gynecology, Lombardi Cancer Research Center, Georgetown University Medical Center, Washington, D.C. 20007
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Barnes W, Waggoner S, Delgado G, Maher K, Potkul R, Barter J, Benjamin S. Manometric characterization of rectal dysfunction following radical hysterectomy. Gynecol Oncol 1991; 42:116-9. [PMID: 1894168 DOI: 10.1016/0090-8258(91)90329-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Bladder dysfunction thought to be due to partial denervation has been described following radical hysterectomy. Some patients experience acute and chronic rectal dysfunction characterized by difficulty with defecation and loss of defecatory urge. To define this abnormality, anorectal pressure profiles were examined in 15 patients with Stage I carcinoma of the cervix before and after radical hysterectomy. Profiles were done using standard anorectal manometry with a water-infused system. In all patients preoperative manometric profiles were normal; postoperative studies were abnormal in all patients. Features seen include altered relaxation of the internal sphincter, increased distension needed to trigger relaxation, and decreased rectal sensation; external sphincters and resting internal sphincters were unchanged. Postoperatively, 12 patients reported problems with rectal function. A physiologic defect is definable in patients undergoing radical hysterectomy; this suggests disruption of the spinal reflex arcs controlling rectal emptying. These physiologic abnormalities correlate with the clinical symptomatology experienced by some patients. Continuing definition and evaluation of management options in this situation should be useful in developing effective therapy for rectal dysfunction following radical hysterectomy.
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Affiliation(s)
- W Barnes
- Department of Obstetrics and Gynecology, Lombardi Cancer Research Center, Georgetown University Medical Center, Washington, D.C. 20007
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Barnes W, Johnson J, Barter J, Potkul R, Delgado G. Reverse hysterocolposigmoidectomy (RHCS) for resection of panpelvic tumors. Gynecol Oncol 1991. [DOI: 10.1016/0090-8258(91)90130-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Barnes W, Delgado G, Yokoe D, Maher K, Potkul R, Barter J, Waggoner S, Johnson J, Benjamin S. Manometric characterization of rectal dysfunction following radical hysterectomy. Gynecol Oncol 1991. [DOI: 10.1016/0090-8258(91)90128-r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
A combined surgical and radiotherapeutic approach is widely in Stage I endometrial adenocarcinoma. The technique and timing of the radiotherapy varies from center to center. Postoperative external-beam (EB) radiotherapy has the advantage of patient selection based upon surgical findings, comprehensive treatment of the pelvic nodal and vaginal cuff areas, and elimination of the need for an intracavitary procedure. Although frequently utilized, this technique is surprisingly poorly described in the medical literature. From 1979 to 1986, 46 surgical Stage I patients received adjuvant postoperative EB therapy at Georgetown University Hospital (GUH) (Washington, DC). Indications for treatment were Grade greater than or equal to 2 and/or depth of myometrial invasion of greater than 33%. The 5-year actuarial survival was 90% with a disease-free survival of 82%. The failure rate within the irradiated field was 6.5% with a distant failure rate of 8.7%. The rate of significant long-term complications was acceptable at 6.5%. The authors conclude that postoperative EB radiotherapy is an effective adjuvant therapy with results comparable to other available radiotherapeutic techniques.
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Affiliation(s)
- J R Torrisi
- Department of Radiation Medicine, Georgetown University Medical Center, Washington, DC 20007
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Barter J, Marlow D, Kamath R, Harbert J, Torrisi J, Foegh M, Barnes W, Newsome J, Delgado G. Lack of protective effect of thromboxane A2 synthetase inhibitor (CGS-13080) on radiated canine intestine. Gynecol Oncol 1989. [DOI: 10.1016/0090-8258(89)90937-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Barnes W, Delgado G, Holloway R, Jenson A, Weck P, Kreider J, Barter J, Potkul R, Johnson C, Lancaster W. Effects of human interferon on HPV induced lesions of human epithelial xenografts in athymic mice. Gynecol Oncol 1989. [DOI: 10.1016/0090-8258(89)90946-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Barter J. Beneath all the bustle have attitudes really changed? Health Soc Serv J 1978; 88:1140-1. [PMID: 10239154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Barter J. A Case of Very Large Calculus. Ind Med Gaz 1890; 25:71-72. [PMID: 29000419 PMCID: PMC5149183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Barter J. Miss Anna Williams. Ind Med Gaz 1888; 23:351. [PMID: 29000873 PMCID: PMC5160562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Barter J. Mayo Hospital, Nagpur-Case of Abdominal Injury. Ind Med Gaz 1887; 22:200. [PMID: 28999874 PMCID: PMC5128642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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