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Contains fulltext : 137861.pdf (publisher's version ) (Closed access), BACKGROUND: Care for patients with colon and rectal cancer has improved in the last 20years; however considerable variation still exists in cancer management and outcome between European countries. Large variation is also apparent between national guidelines and patterns of cancer care in Europe. Therefore, EURECCA, which is the acronym of European Registration of Cancer Care, is aiming at defining core treatment strategies and developing a European audit structure in order to improve the quality of care for all patients with colon and rectal cancer. In December 2012, the first multidisciplinary consensus conference about cancer of the colon and rectum was held. The expert panel consisted of representatives of European scientific organisations involved in cancer care of patients with colon and rectal cancer and representatives of national colorectal registries. METHODS: The expert panel had delegates of the European Society of Surgical Oncology (ESSO), European Society for Radiotherapy & Oncology (ESTRO), European Society of Pathology (ESP), European Society for Medical Oncology (ESMO), European Society of Radiology (ESR), European Society of Coloproctology (ESCP), European CanCer Organisation (ECCO), European Oncology Nursing Society (EONS) and the European Colorectal Cancer Patient Organisation (EuropaColon), as well as delegates from national registries or audits. Consensus was achieved using the Delphi method. For the Delphi process, multidisciplinary experts were invited to comment and vote three web-based online voting rounds and to lecture on the subjects during the meeting (13th-15th December 2012). The sentences in the consensus document were available during the meeting and a televoting round during the conference by all participants was performed. This manuscript covers all sentences of the consensus document with the result of the voting. The consensus document represents sections on diagnostics, pathology, surgery, medical oncology, radiotherapy, and fo

Care for patients with colon and rectal cancer has improved in the last 20years; however considerable variation still exists in cancer management and outcome between European countries. Large variation is also apparent between national guidelines and patterns of cancer care in Europe. Therefore, EURECCA, which is the acronym of European Registration of Cancer Care, is aiming at defining core treatment strategies and developing a European audit structure in order to improve the quality of care for all patients with colon and rectal cancer. In December 2012, the first multidisciplinary consensus conference about cancer of the colon and rectum was held. The expert panel consisted of representatives of European scientific organisations involved in cancer care of patients with colon and rectal cancer and representatives of national colorectal registries.

Some interesting shifts have taken place in the diagnostic approach for detection of colorectal lesions over the past decade. This article accompanies the recent EURECCA consensus group reccomendations for optimal management of colon and rectal cancers. In summary, imaging has a crucial role to play in the diagnosis, staging assessment and follow up of patients with colon and rectal cancer. Recent advances include the use of CT colonography instead of Barium Enema in the diagnosis of colonoic cancer and as an alternative to colonoscopy. Modern mutlidetector CT scanning techniques have also shown improvements in prognostic stratification of patients with colonic cancer and clinical trials are underway testing the selective use of neoadjuvant therapy for imaging identified high risk colon cancers. In rectal cancer, high resolution MRI with a voxel size less or equal to 3 × 1 × 1 mm3 on T2-weighted images has a proven ability to accurately stage patients with rectal cancer. Moreover, preoperative identification of prognostic features allows stratification of patients into different prognostic groups based on assessment of depth of extramural spread, relationship of the tumour edge to the mesorectal fascia (MRF) and extramural venous invasion (EMVI). These poor prognostic features predict an increased risk of local recurrence and/or metastatic disease and should form the basis for preoperative local staging and multidisciplinary preoperative discussion of patient treatment options. Copyright © 2013. Published by Elsevier Ltd. KEYWORDS: Colon cancer, Consensus, Guidelines, Rectal cancer

Laminated veneer products consist of veneers bonded together with adhesive into apredetermined shape. Since wood is a hygroscopic material and also anisotropic bynature, laminated veneer products are especially shape-sensitive to changes in moisturecontent. A deviation from the intended shape is a problem for both the manufacturersand users of the final products and annually such deviations cause great economic lossesin the manufacturing industry.To illustrate the influence of moisture on distortion and shape stability, studies havebeen performed in industrial conditions and in a laboratory environment. Veneers ofbeech and birch and a seat shell moulded from these veneers were used in the study.Distortion, i.e. spring-back, position and twist, has been determined directly aftermoulding and during subsequent moisture and drying cycles.The distortion follows more or less slavishly the changes in relative humidity around theproduct. The distortion is generally small directly after moulding but, after the laminateshave been exposed to a variation in relative humidity, the distortion increases. Some ofthe problems of poor shape stability that may arise later in the bending process can bereduced if attention is paid to moisture content and fibre orientation already in theproduction of the veneer.To achieve good shape stability of laminated veneer products in practice, the followingshould be followed by the manufacture industry:• develop cooperation with suppliers of veneer and set requirements of veneerwith regard to deviation of the fibre orientation, and require that the veneer bedried and conditioned to a moisture content consistent with production,• control incoming veneers with respect to fibre orientation and moisture content,• plan warehousing of veneers and ensure adequate conditioning, and• consider the orientation of the veneers and the species., Godkänd; 2013; 20131112 (ysko)

Contains fulltext : 125368.pdf (publisher's version ) (Closed access), BACKGROUND: Care for patients with colon and rectal cancer has improved in the last twenty years however still considerable variation exists in cancer management and outcome between European countries. Therefore, EURECCA, which is the acronym of European Registration of cancer care, is aiming at defining core treatment strategies and developing a European audit structure in order to improve the quality of care for all patients with colon and rectal cancer. In December 2012 the first multidisciplinary consensus conference about colon and rectum was held looking for multidisciplinary consensus. The expert panel consisted of representatives of European scientific organisations involved in cancer care of patients with colon and rectal cancer and representatives of national colorectal registries. METHODS: The expert panel had delegates of the European Society of Surgical Oncology (ESSO), European Society for Radiotherapy & Oncology (ESTRO), European Society of Pathology (ESP), European Society for Medical Oncology (ESMO), European Society of Radiology (ESR), European Society of Coloproctology (ESCP), European CanCer Organisation (ECCO), European Oncology Nursing Society (EONS) and the European Colorectal Cancer Patient Organisation (EuropaColon), as well as delegates from national registries or audits. Experts commented and voted on the two web-based online voting rounds before the meeting (between 4th and 25th October and between the 20th November and 3rd December 2012) as well as one online round after the meeting (4th-20th March 2013) and were invited to lecture on the subjects during the meeting (13th-15th December 2012). The sentences in the consensus document were available during the meeting and a televoting round during the conference by all participants was performed. All sentences that were voted on are available on the EURECCA website www.canceraudit.eu. The consensus document was divided in sections describing evidence based algorithms of diagnostics, patholo

Contains fulltext : 117650.pdf (publisher's version ) (Open Access), BACKGROUND: Current standard for most of the locally advanced rectal cancers is preoperative chemoradiotherapy, and, variably per institution, postoperative adjuvant chemotherapy. Short-course preoperative radiation with delayed surgery has been shown to induce tumour down-staging in both randomized and observational studies. The concept of neo-adjuvant chemotherapy has been proven successful in gastric cancer, hepatic metastases from colorectal cancer and is currently tested in primary colon cancer. METHODS AND DESIGN: Patients with rectal cancer with high risk features for local or systemic failure on magnetic resonance imaging are randomized to either a standard arm or an experimental arm. The standard arm consists of chemoradiation (1.8 Gy x 25 or 2 Gy x 25 with capecitabine) preoperatively, followed by selective postoperative adjuvant chemotherapy. Postoperative chemotherapy is optional and may be omitted by participating institutions. The experimental arm includes short-course radiotherapy (5 Gy x 5) followed by full-dose chemotherapy (capecitabine and oxaliplatin) in 6 cycles before surgery. In the experimental arm, no postoperative chemotherapy is prescribed. Surgery is performed according to TME principles in both study arms. The hypothesis is that short-course radiotherapy with neo-adjuvant chemotherapy increases disease-free and overall survival without compromising local control. Primary end-point is disease-free survival at 3 years. Secondary endpoints include overall survival, local control, toxicity profile, and treatment completion rate, rate of pathological complete response and microscopically radical resection, and quality of life. DISCUSSION: Following the advances in rectal cancer management, increased focus on survival rather than only on local control is now justified. In an experimental arm, short-course radiotherapy is combined with full-dose chemotherapy preoperatively, an alternative that offers advantages compared to concomitant chemoradi

OBJECTIVES: To develop guidelines describing a standardised approach regarding the acquisition, interpretation and reporting of magnetic resonance imaging (MRI) for clinical staging and restaging of rectal cancer. METHODS: A consensus meeting of 14 abdominal imaging experts from the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) was conducted following the RAND-UCLA Appropriateness Method. Two independent (non-voting) chairs facilitated the meeting. Two hundred and thirty-six items were scored by participants for appropriateness and classified subsequently as appropriate or inappropriate (defined by ≥ 80 % consensus) or uncertain (defined by < 80 % consensus). Items not reaching 80 % consensus were noted. RESULTS: Consensus was reached for 88 % of items: recommendations regarding hardware, patient preparation, imaging sequences, angulation, criteria for MRI assessment and MRI reporting were constructed from these. CONCLUSIONS: These expert consensus recommendations can be used as clinical guidelines for primary staging and restaging of rectal cancer using MRI.

Care for patients with colon and rectal cancer has improved in the last twenty years however still considerable variation exists in cancer management and outcome between European countries. Therefore, EURECCA, which is the acronym of European Registration of cancer care, is aiming at defining core treatment strategies and developing a European audit structure in order to improve the quality of care for all patients with colon and rectal cancer. In December 2012 the first multidisciplinary consensus conference about colon and rectum was held looking for multidisciplinary consensus. The expert panel consisted of representatives of European scientific organisations involved in cancer care of patients with colon and rectal cancer and representatives of national colorectal registries.

BACKGROUND: To determine whether the change in tumor diameters at the first follow-up computed tomography (CT) examination after baseline examination (first change) correlates with outcome in patients with metastatic colorectal cancer (mCRC) treated with combination chemotherapy. PATIENTS AND METHODS: The first change was analyzed in a multicenter randomized phase III trial (Nordic VI, N = 567) comparing first-line irinotecan with either bolus or infused 5-fluorouracil. Cox proportional hazards multiple regression model and Kaplan-Meier survival analyses after correction for guarantee-time bias were carried out to evaluate correlations between first change, objective response according to RECIST 1.0, progression-free survival (PFS), and overall survival (OS). RESULTS: The hazard ratios for PFS and OS decreased along with first change. A decrease between 10% and <30%, albeit RECIST does not regard this as a partial response, was a positive prognostic factor for PFS and OS. Patients who had new lesions or unequivocal progression of nonmeasurable lesions had a worse prognosis than those with only an increase in size of >20%. CONCLUSIONS: The change in tumor size at the first follow-up CT is strongly prognostic for PFS and OS in mCRC.

Contains fulltext : 96093.pdf (publisher's version ) (Closed access)

No abstract available

BACKGROUND: Magnetic resonance imaging (MRI) in rectal cancer is sometimes performed after radiotherapy (MRI 2) to evaluate tumor response and to choose alternative forms of surgery. The accuracy of MRI 2 in distinguishing tumor delineation might be difficult due to fibrosis. PURPOSE: To evaluate the morphological changes in the interface between the tumor and neighboring organs on MRI 2 performed after radiotherapy, and to assess the accuracies of MRI before and after radiotherapy compared to histopathology after surgery. MATERIAL AND METHODS: Sixteen patients with locally advanced primary rectal cancer, with MRI before and after radiotherapy, were retrospectively studied, concerning the interface between the tumor and neighboring structures. The accuracies of MRI before and after radiotherapy were compared based on histopathology as a reference. RESULTS: The accuracies of both MRI before and after radiotherapy were moderate, with no additional value of MRI after radiotherapy compared to MRI before radiotherapy. The most predictive form of interface for involvement of a neighboring organ after radiotherapy was nodular growth of the tumor into a neighboring structure. CONCLUSION: The morphological assessment of pelvic MRI after preoperative radiotherapy does not provide any significant new information about tumor extent in patients with locally advanced rectal cancer.

BACKGROUND: The aim of this study was to determine the sites of local recurrence following radical (R0) total mesorectal excision (TME) for rectal cancer in an effort to elucidate the reasons for recurrence. METHODS: Thirty-seven patients with recurrence following curative resection for rectal cancer were identified from a population of 880 patients operated on by surgeons trained in the TME procedure. Two radiologists independently examined 33 available computed tomograms and magnetic resonance images taken when the recurrence was detected. RESULTS: Twenty-nine of the 33 recurrences were found in the lower two-thirds of the pelvis. Two recurrent tumours appeared to originate from lateral pelvic lymph nodes. Evidence of residual mesorectal fat was identified in 15 patients. Fourteen of the recurrent tumours originated from primary tumours in the upper rectum; all of these tumours recurred at the anastomosis and 12 of the 14 patients had evidence of residual mesorectal fat. CONCLUSION: Lateral pelvic lymph node metastases are not a major cause of local recurrence after TME. Partial mesorectal excision may be associated with an increased risk of local recurrence from tumours in the upper rectum.

The aim of the study was to study the effect, for older license holders, of taking a driving test with an unfamiliar vehicle, as compared to their own cars. The study population consisted of licensed patients 65-85 years referred to the Traffic Medicine Centre (TrMC), Huddinge University Hospital, for an evaluation of their medical and cognitive fitness to drive. In the clinical practice of TrMC, driving tests have been used since 1997, with inspectors from the Swedish National Road Administration (SNRA) acting as evaluators. Initially, patients were allowed to use their own cars. From the beginning of the year 2000, however, dual brakes were made mandatory and most evaluations were then made with SNRA cars. When comparing the outcomes of driving tests from the period prior to 2000 (n=96) and after 2000 (n=69), it was found that the number of drivers who failed the test increased by 16%. Also, those who passed the test after more than one trial decreased by 20%. The potential of the neuropsychological assessment to correctly classify drivers in outcome groups was considerably reduced in the period after 2000. These results support the view that, for older drivers with cognitive deterioration, the need to adapt to an unfamiliar vehicle represents a supplementary cognitive load that may compromise their driving ability and the validity of the assessment. A measure aimed only at increasing the safety of examiners and examinees thus had an unintended side-effect that is detrimental to older clinical populations. © 2003 Elsevier Ltd. All rights reserved.

The British Stroke Driver Screening Assessment (SDSA) is a set of four simple cognitive tests to evaluate driving fitness in stroke patients. To evaluate its usefulness in a Scandinavian context, we adapted the tests and assessed a group of 97 stroke patients from Sweden and Norway, using a driving test as the criterion. When results were calculated according to the original method, based on a discriminant function, less than 70% of the participants were correctly classified. To improve the predictive potential, a new discriminant analysis was performed, using the scores of a subsample of 49 patients, and validated on the remaining 48 participants. In total, 78% of the patients were correctly classified, but specificity was superior to sensitivity. We conclude that the Nordic version of the SDSA is a useful instrument, provided that test scores are interpreted in a balanced manner, taking into account the possibility of compensatory traffic behavior.

AGILE - AGed people Integration, mobility, safety and Quality of Life and Management of Living Resources. Funded by the European Commission Research Programme"Quality of Life" Key Action "The Ageing Population".

Based on Finnish survey data, older (65+, n=1559) and younger (26-40, n=310) drivers' accident rates were compared. In accordance with earlier studies, the rates were similar per driver (0.1) but there was a non-significant trend towards older drivers having more accidents per distance driven (10.8 vs. 8.3 per 1 million km). However, when the accidents-per-km comparison was made in groups matched for yearly exposure, there is no evidence for higher risk with increasing age. In both age groups, risk per km decreased with increasing yearly driving distance. We suggest that the previous perception of an age-related risk increase of accidents per distance driven arises from a failure to control for low mileage bias at all ages. © 2003 Elsevier Science Ltd. All rights reserved.

The present study used a mail survey addressed to Swedish drivers aged between 55 and 92 years (n = 939) to study the relationship between driving exposure, health, and four types of self-reported aberrant driving behaviour as measured with a Swedish version of the driver behaviour questionnaire. Age and gender were the most important predictors of the tendency to sometimes avoid driving. However, even after accounting for age and gender, reports of own erroneous driving behaviour because of inattention (e.g., failure to notice a signal) and inexperience errors (viz., handling the car), as well as impaired health, were related to self-imposed driving limitations, whereas the violations and mistakes factors were not. Problems with activities of daily living were only marginally associated with self-imposed driving limitations, mediated through inattention and inexperience errors. The results support the notion that older drivers adjust their driving in response to their health and to the problems they experience while driving. © 2002 Elsevier Science Ltd. All rights reserved.

The aim of this study was to examine whether behavioral style and cognitive performance predict cognitive development in ELBW children. The children were assessed at age 2 (40 girls, 41 boys) with the Bayley Scales of Infant Development. At age 4 they were assessed with the WPPSI-R, and with the word fluency, visual attention and recognition of incomplete figures subsets of the Finnish Neuropsychological Investigation for Children (NEPSY-R, Korkman et al. 1997). The results indicated that there was stability in cognitive performance from 2 to 4 years of age. Along with cognitive performance, behavioral style, especially orientation-engagement at age 2, was an important predictor of subsequent cognitive performance (WPPSI-R). Significant gender differences were also found. For boys, orientation-engagement factor at time one was the best predictor of subsequent nonverbal cognitive performance, arithmetical abilities and word fluency at time two. In contrast, girls' cognitive performance measured at the 2-year assessment was the most powerful predictor of nonverbal performance and word fluency at 4 years. As a whole, it seems that behavioral factors merit more consideration in understanding cognitive development than has been thought before. © 2001 Elsevier Science Inc.