Neonatal lupus erythematosus presenting as a non-bullous histiocytoid neutrophilic dermatosis.

Histopathologic findings in neonatal lupus erythematosus (NLE) are usually congruent with those of subacute cutaneous lupus erythematosus. However, neutrophilic dermatosis-type histopathologic features are being increasingly recognized in the literature including rare cases with variant histiocytoid morphology. We report the case of a 7-week-old male presenting with figurate erythema. His mother was found to have elevated anti-nuclear antibodies and was positive for anti-SSA/Ro, anti-SSB/La antibodies and Ro52 autoantibodies. The infant had a similar serological profile. Skin biopsy showed a histiocytoid interstitial infiltrate with mild lichenoid features, sparse neutrophils and mild leukocytoclasis. The histiocytoid infiltrate showed prominent CD68, CD163, and myeloperoxidase expression. Isolated clusters of CD123+ histiocytes were also present. This case highlights the rare finding of non-bullous neutrophilic dermatosis with histiocytoid change in neonatal lupus. In neonates presenting with figurate erythemas with morphological histiocytic change on biopsy, NLE should be considered as a differential diagnosis and investigated for accordingly.

Climate drives the geography of marine consumption by changing predator communities.

The global distribution of primary production and consumption by humans (fisheries) is well-documented, but we have no map linking the central ecological process of consumption within food webs to temperature and other ecological drivers. Using standardized assays that span 105° of latitude on four continents, we show that rates of bait consumption by generalist predators in shallow marine ecosystems are tightly linked to both temperature and the composition of consumer assemblages. Unexpectedly, rates of consumption peaked at midlatitudes (25 to 35°) in both Northern and Southern Hemispheres across both seagrass and unvegetated sediment habitats. This pattern contrasts with terrestrial systems, where biotic interactions reportedly weaken away from the equator, but it parallels an emerging pattern of a subtropical peak in marine biodiversity. The higher consumption at midlatitudes was closely related to the type of consumers present, which explained rates of consumption better than consumer density, biomass, species diversity, or habitat. Indeed, the apparent effect of temperature on consumption was mostly driven by temperature-associated turnover in consumer community composition. Our findings reinforce the key influence of climate warming on altered species composition and highlight its implications for the functioning of Earth's ecosystems.

Rare Mimic of a Myxofibrosarcoma: Cutaneous Myxoid Spindle Cell Squamous Cell Carcinoma as a Complication of Chronic Osteomyelitis.

ABSTRACT: Myxoid spindle cell squamous cell carcinoma is a rare variant of squamous cell carcinoma that can pose diagnostic challenges because of its unusual morphology. In this article, we report the case of a 68-year-old man who presented with a slow-growing, fungating mass on the right tibia at the site of his long-standing draining sinus tract. Biopsy revealed a malignant spindle cell tumor with prominent myxoid stroma and areas containing thin-walled blood vessels with a curvilinear appearance. The immunohistochemical profile indicated that the neoplastic cells were positive for a variety of keratins (MNF116, Cam 5.2, AE1/AE3, 34ßE12, and CK5/6) and transcriptional markers classically expressed in squamous cell carcinomas (p63 and p40). The tumor cells were negative for melanocytic and mesenchymal markers smooth muscle antibody, S100, caldesmon-h, desmin and CD34. Together, the clinical history, histologic appearance, and immunohistochemical panel was diagnostic of a myxoid spindle cell squamous cell carcinoma. The main differential diagnosis was myxofibrosarcoma. In addition to this clinical case, we also outline the current state of knowledge on this rare entity and discuss the importance of recognizing a Marjolin ulcer in this scenario.

Low redundancy and complementarity shape ecosystem functioning in a low-diversity ecosystem.

Ecosystem functioning is positively linked to biodiversity on land and in the sea. In high-diversity systems (e.g. coral reefs), species coexist by sharing resources and providing similar functions at different temporal or spatial scales. How species combine to deliver the ecological function they provide is pivotal for maintaining the structure, functioning and resilience of some ecosystems, but the significance of this is rarely examined in low-diversity systems such as estuaries. We tested whether an ecological function is shaped by biodiversity in a low-diversity ecosystem by measuring the consumption of carrion by estuarine scavengers. Carrion (e.g. decaying animal flesh) is opportunistically fed on by a large number of species across numerous ecosystems. Estuaries were chosen as the model system because carrion consumption is a pivotal ecological function in coastal seascapes, and estuaries are thought to support diverse scavenger assemblages, which are modified by changes in water quality and the urbanization of estuarine shorelines. We used baited underwater video arrays to record scavengers and measure the rate at which carrion was consumed by fish in 39 estuaries across 1,000 km of coastline in eastern Australia. Carrion consumption was positively correlated with the abundance of only one species, yellowfin bream Acanthopagrus australis, which consumed 58% of all deployed carrion. The consumption of carrion by yellowfin bream was greatest in urban estuaries with moderately hardened shorelines (20%-60%) and relatively large subtidal rock bars (>0.1 km2 ). Our findings demonstrate that an ecological function can be maintained across estuarine seascapes despite both limited redundancy (i.e. dominated by one species) and complementarity (i.e. there is no spatial context where the function is delivered significantly when yellowfin bream are not present) in the functional traits of animal assemblages. The continued functioning of estuaries, and other low-diversity ecosystems, might therefore not be tightly linked to biodiversity, and we suggest that the preservation of functionally dominant species that maintain functions in these systems could help to improve conservation outcomes for coastal seascapes.

Effects of seascape connectivity on reserve performance along exposed coastlines.

Seascape connectivity (landscape connectivity in the sea) can modify reserve performance in low-energy marine ecosystems (e.g., coral reefs, mangroves, and seagrass), but it is not clear whether similar spatial linkages also shape reserve effectiveness on high-energy, exposed coastlines. We used the surf zones of ocean beaches in eastern Australia as a model system to test how seascape connectivity and reserve attributes combine to shape conservation outcomes. Spatial patterns in fish assemblages were measured using baited remote underwater video stations in 12 marine reserves and 15 fished beaches across 2000 km of exposed coastline. Reserve performance was shaped by both the characteristics of reserves and the spatial properties of the coastal seascapes in which reserves were embedded. Number of fish species and abundance of harvested fishes were highest in surf-zone reserves that encompassed >1.5 km of the surf zone; were located < 100 m to rocky headlands; and included pocket beaches in a heterogeneous seascape. Conservation outcomes for exposed coastlines may, therefore, be enhanced by prioritizing sufficiently large areas of seascapes that are strongly linked to abutting complementary habitats. Our findings have broader implications for coastal conservation planning. Empirical data to describe how the ecological features of high-energy shorelines influence conservation outcomes are lacking, and we suggest that seascape connectivity may have similar ecological effects on reserve performance on both sheltered and exposed coastlines.

Efectos de la Conectividad de Paisajes Marinos sobre el Desempeño de las Reservas a lo largo de Costas Expuestas Resumen La conectividad entre paisajes marinos puede modificar el desempeño de las reservas en los ecosistemas marinos de baja energía (p. ej.: arrecifes de coral, manglares, pastos marinos), pero no está claro si las conexiones espaciales similares también moldean la efectividad de las reservas en costas expuestas con alta energía. Usamos las zonas de rompimiento de las playas oceánicas en el este de Australia como sistema modelo para probar cómo la conectividad entre paisajes marinos y los atributos de la reserva se combinan para moldear los resultados de la conservación. Los patrones espaciales en los ensamblados de peces se midieron con estaciones remotas de video subacuático con carnada en doce reservas marinas y 15 playas a lo largo de 2000 km de costas expuestas. El desempeño de las reservas estuvo moldeado por las características de las reservas y las propiedades espaciales de los paisajes costeros en los cuales estaban insertadas las reservas. El número de especies de peces y la abundancia de peces recolectados fue mucho mayor en las reservas en las zonas de rompimiento que abarcaban >1.5 km de la zona de rompimiento; estaban localizadas a <100 m de cabos rocosos; e incluían playas pequeñas entre los cabos en un paisaje marino heterogéneo. Los resultados de conservación para las costas expuestas pueden, por lo tanto, mejorarse con la priorización suficiente de grandes áreas de paisajes marinos que están conectados fuertemente con hábitats complementarios colindantes. Nuestros hallazgos tienen consecuencias más generales para la planeación de la conservación costera. Los datos empíricos para describir cómo las características ecológicas de las costas con alta energía influyen sobre los resultados de conservación son muy pocos, y sugerimos que la conectividad entre paisajes marinos puede tener efectos ecológicos similares sobre el desempeño de las reservas en costas expuestas y resguardadas.

Functional plasticity in vertebrate scavenger assemblages in the presence of introduced competitors.

Introduced species may suppress or enhance ecological functions, or they may have neutral effects in ecosystems where they replace or complement native species. Few studies, however, have explicitly tested for these trajectories, and for the effect these might have for native species. In this study, we experimentally test the trajectory and scale of change in the function of 'carrion removal' at different carrion loads along ocean beaches in Eastern Australia that have different numbers of introduced red foxes (Vulpes vulpes) and several species of native raptors. We hypothesized that the 'positive' effect of foxes on carrion removal would be greatest at high carrion loads, because competition for resources between native and introduced species is lower. Scavenger abundance, fox occurrences, and carrion consumption by these species differed widely between locations and times. Despite distinct spatial differences in the structure of vertebrate scavenger assemblages, total carrion consumption was not significantly different between locations at any carrion load. This lack of variation in functional rates indicates potential functional plasticity in the scavenger assemblage and possible functional accommodation of red foxes. Neutral fox effects on ecological functions or the ecosystem more broadly are, however, very unlikely to extend beyond carrion consumption.

Long term declines in the functional diversity of sharks in the coastal oceans of eastern Australia.

Human impacts lead to widespread changes in the abundance, diversity and traits of shark assemblages, altering the functioning of coastal ecosystems. The functional consequences of shark declines are often poorly understood due to the absence of empirical data describing long-term change. We use data from the Queensland Shark Control Program in eastern Australia, which has deployed mesh nets and baited hooks across 80 beaches using standardised methodologies since 1962. We illustrate consistent declines in shark functional richness quantified using both ecological (e.g., feeding, habitat and movement) and morphological (e.g., size, morphology) traits, and this corresponds with declining ecological functioning. We demonstrate a community shift from targeted apex sharks to a greater functional richness of non-target species. Declines in apex shark functional richness and corresponding changes in non-target species may lead to an anthropogenically induced trophic cascade. We suggest that repairing diminished shark populations is crucial for the stability of coastal ecosystems.

Dredging transforms the seafloor and enhances functional diversity in urban seascapes.

Landscape modification alters the condition of ecosystems and the complexity of terrain, with consequences for animal assemblages and ecosystem functioning. In coastal seascapes, dredging is routine practice for extracting sediments and maintaining navigation channels worldwide. Dredging modifies processes and assemblages by favouring species with wide trophic niches, diverse habitat requirements and tolerances to dredge-related eutrophication and sedimentation. Dredging also transforms the three-dimensional features of the seafloor, but the functional consequences of these terrain changes remain unclear. We investigated the effects of terrain modification on the functional diversity of fish assemblages in natural and dredged estuaries to examine whether dredging programs could be optimised to minimise impacts on ecological functioning. Fish assemblages were surveyed with baited remote underwater video stations and variation in functional niche space was described using species traits to calculate metrics that index functional diversity. Terrain variation was quantified with nine complementary surface metrics including depth, aspect, curvature, slope and roughness extracted from sonar-derived bathymetry maps. Functional diversity was, surprisingly, higher in dredged estuaries, which supported more generalist species with wider functional niches, and from lower trophic levels, than natural estuaries. These positive effects of dredging on functional diversity were, however, spatially restricted and were linked to both the area and orientation of terrain modification. Functional diversity was highest in urban estuaries where dredged channels were small (i.e. <1% of the estuary), and where channel slopes were orientated towards the poles (i.e. 171-189°), promoting both terrain variation and light penetration in urban estuaries. Our findings highlight previously unrecognised functional consequences of terrain modification that can easily be incorporated into dredging programs. We demonstrate that restricting the spatial extent of dredging operations and the orientation of dredged channel slopes, wherever this is practical, could help to limit impacts on ecosystem functioning and productivity in urban seascapes.

The role of inputs of marine wrack and carrion in sandy-beach ecosystems: a global review.

Sandy beaches are iconic interfaces that functionally link the ocean with the land via the flow of organic matter from the sea. These cross-ecosystem fluxes often comprise uprooted seagrass and dislodged macroalgae that can form substantial accumulations of detritus, termed 'wrack', on sandy beaches. In addition, the tissue of the carcasses of marine animals that regularly wash up on beaches form a rich food source ('carrion') for a diversity of scavenging animals. Here, we provide a global review of how wrack and carrion provide spatial subsidies that shape the structure and functioning of sandy-beach ecosystems (sandy beaches and adjacent surf zones), which typically have little in situ primary production. We also examine the spatial scaling of the influence of these processes across the broader land- and seascape, and identify key gaps in our knowledge to guide future research directions and priorities. Large quantities of detrital kelp and seagrass can flow into sandy-beach ecosystems, where microbial decomposers and animals process it. The rates of wrack supply and its retention are influenced by the oceanographic processes that transport it, the geomorphology and landscape context of the recipient beaches, and the condition, life history and morphological characteristics of the macrophyte taxa that are the ultimate source of wrack. When retained in beach ecosystems, wrack often creates hotspots of microbial metabolism, secondary productivity, biodiversity, and nutrient remineralization. Nutrients are produced during wrack breakdown, and these can return to coastal waters in surface flows (swash) and aquifers discharging into the subtidal surf. Beach-cast kelp often plays a key trophic role, being an abundant and preferred food source for mobile, semi-aquatic invertebrates that channel imported algal matter to predatory invertebrates, fish, and birds. The role of beach-cast marine carrion is likely to be underestimated, as it can be consumed rapidly by highly mobile scavengers (e.g. foxes, coyotes, raptors, vultures). These consumers become important vectors in transferring marine productivity inland, thereby linking marine and terrestrial ecosystems. Whilst deposits of organic matter on sandy-beach ecosystems underpin a range of ecosystem functions and services, they can be at variance with aesthetic perceptions resulting in widespread activities, such as 'beach cleaning and grooming'. This practice diminishes the energetic base of food webs, intertidal fauna, and biodiversity. Global declines in seagrass beds and kelp forests (linked to global warming) are predicted to cause substantial reductions in the amounts of marine organic matter reaching many beach ecosystems, likely causing flow-on effects for food webs and biodiversity. Similarly, future sea-level rise and increased storm frequency are likely to alter profoundly the physical attributes of beaches, which in turn can change the rates at which beaches retain and process the influxes of wrack and animal carcasses. Conservation of the multi-faceted ecosystem services that sandy beaches provide will increasingly need to encompass a greater societal appreciation and the safeguarding of ecological functions reliant on beach-cast organic matter on innumerable ocean shores worldwide.

Cryptococcosis presenting as upper limb cellulitis and ulceration: a case series.

We report four cases of cryptococcosis presenting as upper limb cellulitis or ulceration, or both. Three of the four patients were on long-term prednisolone therapy at the time of presentation. In each case, the diagnosis of cryptococcosis was established by a biopsy of the skin. Only one of the four patients had conclusive evidence of disseminated disease. Our cases highlight the importance of skin biopsy in immunosuppressed individuals presenting with cellulitis, particularly when the cellulitis occurs in an atypical location and when the clinical condition fails to respond to standard antibacterial therapy.

Human modifications to estuaries correlate with the morphology and functional roles of coastal fish.

Animals can respond to human impacts by favouring different morphological traits or by exploiting different food resources. We quantified the morphology and diet of four functionally different fish species (n = 543 fish) from 13 estuaries with varying degrees of human modification in Queensland, Australia. We found differences in the responses of trophic groups to the environmental conditions of estuaries; principally the extent of seagrass in the estuary, and the amount of shoreline and catchment urbanisation. Here, seagrass and urbanisation extent correlated with the diet and morphology of zooplanktivores and detritivores; thereby indicating that human modifications may modify these species functional roles. Conversely, environmental variables did not correlate with the diet or morphology of zoobenthivores or piscivores thereby indicating that human modifications may have less an effect on these species functional roles. Our findings demonstrate that anthropogenic impacts to coastal ecosystems might extend from the traditionally measured metrics of abundance and diversity.

Landscape context and nutrients modify the effects of coastal urbanisation.

Estuaries are focal points for coastal cities worldwide, their habitats frequently transformed into engineered shorelines abutting waters with elevated nutrients in an urbanised landscape. Here we test for relationships between shoreline armouring and nutrients on the diversity and trophic composition of fish assemblages across 22 estuaries in eastern Australia. Urbanisation was associated with fish diversity and abundance, but there were differences in the effects of shoreline armouring and nutrient level on the trophic composition of fish assemblages. Fish diversity and the abundance of most trophic groups, particularly omnivores, zoobenthivores and detritivores, was greatest in highly urban estuaries. We show that estuarine fish assemblages are associated with urbanisation in more nuanced ways than simple habitat transformation would suggest, but this depends on the broader environmental context. Our findings have wider implications for estuarine conservation and restoration, emphasizing that ecological benefits of habitat measures may depend on both landscape attributes and water quality in urban settings.

Diverse land uses and high coastal urbanisation do not always result in harmful environmental pollutants in fisheries species.

Human activities in coastal catchments can cause the accumulation of pollutants in seafood. We quantified the concentration of heavy metals, pesticides and PFASs in the flesh of the fisheries species yellowfin bream Acanthopagrus australis (n = 57) and mud crab Scylla serrata (n = 65) from 13 estuaries in southeast Queensland, Australia; a region with a variety of human land uses. Pollutants in yellowfin bream were best explained by the extent of intensive uses in the catchment. Pollutants in mud crabs were best explained by the extent of irrigated agriculture and water bodies. No samples contained detectable levels of pesticides, and only six samples contained low levels of PFASs. Metals were common in fish and crab flesh, but only mercury in yellowfin bream from the Mooloolah River breached Australian food safety standards. High pollutant presence and concentration is not the norm in seafood collected during routine surveys, even in estuaries with highly modified catchments.

Drug-induced hypersensitivity syndrome with superficial granulomatous dermatitis--a novel finding.

Drug-induced hypersensitivity syndrome (DIHS) is a rare and potentially fatal reaction characterized by fever, rash, and internal organ involvement that typically occurs between 3 and 6 weeks after commencing the drug. We describe such a case in a 26-year-old woman, who developed fever, exfoliative erythroderma, facial edema, cervical lymphadenopathy, hepatitis, and leukocytosis 6 weeks after commencing carbamazepine for lower back pain. Her serum angiotensin-converting enzyme level was also raised to 144 U/L (8-52 U/L). Skin biopsies demonstrated an unusual superficial dermal perivascular inflammatory infiltrate, which included conspicuous granulomas mixed with moderate numbers of lymphocytes. Eosinophils were not a feature. Her carbamazepine was withdrawn, and oral prednisone was commenced initially at a dose of 1 mg.kg.d and slowly weaned over a 6-week period. Her fever, rash, facial edema, and hepatitis gradually resolved within this period, and her serum angiotensin-converting enzyme level returned to within the normal range. Although the patient's clinical course was consistent with a DIHS, it was accompanied by a previously unreported finding of a superficial granulomatous dermatitis. Granuloma formation as a sequel to medication use is a feature of interstitial granulomatous drug reaction. However, interstitial granulomatous drug reaction consists of localized violaceous plaques with a predilection for skin fold areas and liver function abnormalities have not been described. Granulomatous inflammation in other organ systems, including the liver and kidney, has also been described after the use of carbamazepine, but these reactions are not associated with the systemic manifestations observed in DIHS.

Direct tumor invasion in colon cancer: correlation with tumor spread and survival.

PURPOSE: This study examined the correlation between depth of local invasion in colon cancer and tumor spread and patient survival. METHODS: A cohort of 796 patients with a complete set of TNM staging information following an elective resection for colon cancer was selected. The rates of lymph node and distant metastasis, tumor differentiation, and extramural venous invasion for different tumor (T) categories were compared. The effects of initial tumor (T) category on overall patient survival were studied. RESULTS: The depth of local tumor invasion correlated strongly with nodal involvement (P = 0.0001), rates of extramural venous invasion (P = 0.0002), poor differentiation (P = 0.0001), and distant metastasis (P = 0.0001). Fifty-seven percent of the patients remained lymph node-negative and distant metastasis-negative irrespective of their depth of tumor invasion had no impact on overall survival (P = 0.49). For patients with lymph node or distant metastasis (43 percent), depth of tumor invasion had significant impact on overall survival (P = 0.001). Thirteen percent of T3N1, 33 percent of T3N2, 40 percent of T4N1, and 68.percent of T4N2 cases had distant metastasis at presentation. CONCLUSION: Two types of colon cancer were observed: locally active and tendency to metastasize. For the latter, overall mortality and the risk of metastasis increased with depth of tumor invasion.

Optimising Land-Sea Management for Inshore Coral Reefs.

Management authorities seldom have the capacity to comprehensively address the full suite of anthropogenic stressors, particularly in the coastal zone where numerous threats can act simultaneously to impact reefs and other ecosystems. This situation requires tools to prioritise management interventions that result in optimum ecological outcomes under a set of constraints. Here we develop one such tool, introducing a Bayesian Belief Network to model the ecological condition of inshore coral reefs in Moreton Bay (Australia) under a range of management actions. Empirical field data was used to model a suite of possible ecological responses of coral reef assemblages to five key management actions both in the sea (e.g. expansion of reserves, mangrove & seagrass restoration, fishing restrictions) and on land (e.g. lower inputs of sediment and sewage from treatment plants). Models show that expanding marine reserves (a 'marine action') and reducing sediment inputs from the catchments (a 'land action') were the most effective investments to achieve a better status of reefs in the Bay, with both having been included in >58% of scenarios with positive outcomes, and >98% of the most effective (5th percentile) scenarios. Heightened fishing restrictions, restoring habitats, and reducing nutrient discharges from wastewater treatment plants have additional, albeit smaller effects. There was no evidence that combining individual management actions would consistently produce sizeable synergistic until after maximum investment on both marine reserves (i.e. increasing reserve extent from 31 to 62% of reefs) and sediments (i.e. rehabilitating 6350 km of waterways within catchments to reduce sediment loads by 50%) were implemented. The method presented here provides a useful tool to prioritize environmental actions in situations where multiple competing management interventions exist for coral reefs and in other systems subjected to multiple stressor from the land and the sea.

PTEN mutations are common in sporadic microsatellite stable colorectal cancer.

The tumour suppressor gene PTEN, located at chromosome sub-band 10q23.3, encodes a dual-specificity phosphatase that negatively regulates the phosphatidylinositol 3'-kinase (PI3 K)/Akt-dependent cellular survival pathway. PTEN is frequently inactivated in many tumour types including glioblastoma, prostate and endometrial cancers. While initial studies reported that PTEN gene mutations were rare in colorectal cancer, more recent reports have shown an approximate 18% incidence of somatic PTEN mutations in colorectal tumours exhibiting microsatellite instability (MSI+). To verify the role of this gene in colorectal tumorigenesis, we analysed paired normal and tumour DNA from 41 unselected primary sporadic colorectal cancers for PTEN inactivation by mutation and/or allelic loss. We now report PTEN gene mutations in 19.5% (8/41) of tumours and allele loss, including all or part of the PTEN gene, in a further 17% (7/41) of the cases. Both PTEN alleles were affected in over half (9/15) of these cases showing PTEN genetic abnormalities. Using immunohistochemistry, we have further shown that all tumours harbouring PTEN alterations have either reduced or absent PTEN expression and this correlated strongly with later clinical stage of tumour at presentation (P=0.02). In contrast to previous reports, all but one of the tumours with PTEN gene mutations were microsatellite stable (MSI-), suggesting that PTEN is involved in a distinct pathway of colorectal tumorigenesis that is separate from the pathway of mismatch repair deficiency. This work therefore establishes the importance of PTEN in primary sporadic colorectal cancer.

Surgical management of colorectal cancer in south-western Sydney 1997-2001: a prospective series of 1293 unselected cases from six public hospitals.

BACKGROUND: The aim of the present study is to provide local data for the management of colorectal cancers in the south-western Sydney health area from 1997 to 2001. METHODS: The data were collected prospectively. Follow up was conducted in late 2001 and early 2002. Data were cross-validated with hospital and area databases and with data from the New South Wales Registry of Births, Deaths and Marriages. RESULTS: This was an unselected series of 1293 patients from 36 surgeons; 16.5% of patients presented as emergencies. Only 3% presented as a result of bowel cancer screening. Of the 1293 patients, 1270 received an operation. There were 598 elective colonic resections with the mortality rate of 1.2%, reoperation rate of 2.7% and anastomotic leak rate of 0.8%. For the 410 elective rectal resections, the rates were 2.9%, 2.7% and 1.2%, respectively. For the 290 emergency operations, the rates were much worse at 7.7%, 6.6% and 4.8%, respectively. The corrected overall 3-year survival rate was 64%. For Dukes' A, B, C and D, the figures were 94%, 87%, 61% and 7%, respectively. CONCLUSIONS: Colorectal cancer is a major cause of mortality and morbidity in our community. Very few bowel cancers were discovered at the asymptomatic stage. This paper strongly supports community bowel cancer screening and early diagnosis. The local database has provided a rich source of information to benchmark management and outcomes of bowel cancer patients treated in the South Western Sydney Area Health Service. An area-wide computer network with online data input facilities at individual workplaces will improve data integrity and data collection efficiency.