Global Game for Cuffs and Collars: The phase-out of the WTO Agreement on Textiles and Clothing aggravates social divisions

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Multidisciplionary Treatment of Rectal Cancer and Other Pelviv Tumours

Colorectal cancer is a major problem in the western world and has a rising incidence. [1,2] Approximately one third of these tumours originate in the rectum. Although colon and rectal cancer share similar features there is a distinct difference in clinical behaviour and therapeutical approach.[3] The treatment of primary rectal cancer has evolved into a multidisciplinary treatment with standardised imaging techniques, surgical procedures, pathological assessment, and (chemo)radiation therapeutical options.[1, 4-6] The introduction of total mesorectal excision (TME) has lead to a significant decreased local recurrence rate[7] in combination with preoperative short-term radiotherapy (5x5Gy).[8, 9] Based on the beneficial results reported in the Dutch TME trial[1] the treatment protocol in the Netherlands of patients with a tumour in the lower two-third of the rectum was changed in 2001.[10] Nowadays all patients are considered to be discussed in a multidisciplinary team and a short course of radiotherapy will be given prior to TME surgery. It is unclear if results in community hospitals are similar to the results presented in these multicenter trials. In chapter 2 we report the results of rectal cancer surgery in a low volume community hospital in the region of the Comprehensive Cancer Centre Rotterdam. The aim of the study was to identify the compliance to the new standardised treatment protocol i.e. the introduction of preoperative radiotherapy. Furthermore, the results of rectal cancer treatment in the centre were analysed and compared with reference values based on selected patients from randomised trials in the recent literature

Effects of TENS and methylphenidate in tuberculous meningo-encephalistis

Primary objective: Beneficial effects of transcutaneous electrical nerve stimulation (TENS) on cognition and behaviour were observed in a child with probable Herpes Simplex Encephalitis. Based on these positive findings, it was examined in the present case study whether a child who had been diagnosed to suffer from tuberculous meningitis would benefit from TENS. Furthermore, as aggression and overactive behaviour were also prominent clinical symptoms, the effects of methylphenidate were investigated. Methods and Procedures: Neuropsychological tests were used to assess attention/concentration and visuospatial and visuoconstructive memory. Behaviour, including the level of activity during 24 hours, was assessed by one observation scale and actigraphy. Experimental interventions: TENS and methylphenidate. Main outcomes and results: TENS particularly improved overall affective behaviour. Methylphenidate appeared to have the opposite effect on cognition and hardly any effect on patient's behaviour. Conclusions: TENS might improve the patient's behavioural functioning. Pros and cons for treatment effects are discussed

Total Pelvic Exenteration for Primary and Recurrent Malignancies

Contains fulltext : 81087.pdf (publisher's version ) (Open Access)INTRODUCTION: Complete resection is the most important prognostic factor in surgery for pelvic tumors. In locally advanced and recurrent pelvic malignancies, radical margins are sometimes difficult to obtain because of close relation to or growth in adjacent organs/structures. Total pelvic exenteration (TPE) is an exenterative operation for these advanced tumors and involves en bloc resection of the rectum, bladder, and internal genital organs (prostate/seminal vesicles or uterus, ovaries and/or vagina). METHODS: Between 1994 and 2008, a TPE was performed in 69 patients with pelvic cancer; 48 with rectal cancer (32 primary and 16 recurrent), 14 with cervical cancer (1 primary and 13 recurrent), 5 with sarcoma (3 primary and 2 recurrent), 1 with primary vaginal, and 1 with recurrent endometrial carcinoma. Ten patients were treated with neoadjuvant chemotherapy and 66 patients with preoperative radiotherapy to induce down-staging. Eighteen patients received IORT because of an incomplete or marginal complete resection. RESULTS: The median follow-up was 43 (range, 1-196) months. Median duration of surgery was 448 (range, 300-670) minutes, median blood loss was 6,300 (range, 750-21,000) ml, and hospitalization was 17 (range, 4-65) days. Overall major and minor complication rates were 34% and 57%, respectively. The in-hospital mortality rate was 1%. A complete resection was possible in 75% of all patients, a microscopically incomplete resection (R1) in 16%, and a macroscopically incomplete resection (R2) in 9%. Five-year local control for primary locally advanced rectal cancer, recurrent rectal cancer, and cervical cancer was 89%, 38%, and 64%, respectively. Overall survival after 5 years for primary locally advanced rectal cancer, recurrent rectal cancer, and cervical cancer was 66%, 8%, and 45%. CONCLUSIONS: Total pelvic exenteration is accompanied with considerable morbidity, but good local control and acceptable overall survival justifies the use of this extensive surgical technique in most patients, especially patients with primary locally advanced rectal cancer and recurrent cervical cancer

Stoma-free survival after anastomotic leak following rectal cancer resection : worldwide cohort of 2470 patients

Funding Information: The TENTACLE-Rectum study was funded by Medtronic External Research Program. The authors declare no other conflict of interest.Peer reviewedPublisher PD