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New Data on Pancreatic Cancer In pancreatic cancer there is a marked discrepancy between the recorded R0 resection rates and the long-term clinical outcome. Therefore, it seems to be necessary to find additional parameters that will be of more prognostic value here. Differences in how the R classification is applied within the studies are conspicuous. It would seem important to examine standards in histopathological preparation and to return to the `classical' R classification and, if appropriate, in line with experiences in rectum cancer, to introduce a `circumferential resection margin'. To obtain optimum long-term survival, a distance of >1.0 mm or even >1.5 mm between tumor and resection margin is required. In too few patients with vascular invasion is the tumor properly removed surgically, even though infiltration of the portal vein or the superior mesenteric vein is not an exclusion criterion according to the S3 guideline. An improvement in the quality of treatment might be achieved by establishing `high-volume' pancreas centers. The value of perioperative radiochemotherapy (RCT) is currently being examined in several large studies. Adjuvant chemotherapy is standard and is well established in routine clinical practice

The role of adjuvant chemotherapy for patients with resected pancreatic cancer: Systematic review of randomized controlled trials and meta-analysis

Background: In patients undergoing surgery for resectable pancreatic cancer prognosis still remains poor. The role of adjuvant treatment strategies (including chemotherapy and chemoradiotherapy) following resection of pancreatic cancer remains controversial. Methods: A Medline-based literature search was undertaken to identify randomized controlled trials that evaluated adjuvant chemotherapy after complete macroscopic resection for cancer of the exocrine pancreas. Five trials of adjuvant chemotherapy were eligible and critically reviewed for this article. A meta-analysis (based on published data) was performed with survival (median survival time and 5-year survival rate) being the primary endpoint. Results: For the meta-analysis, 482 patients were allocated to the chemotherapy group and 469 patients to the control group. The meta-analysis estimate for prolongation of median survival time for patients in the chemotherapy group was 3 months (95% CI 0.3-5.7 months, p = 0.03). The difference in 5-year survival rate was estimated with 3.1% between the chemotherapy and the control group (95% CI -4.6 to 10.8%, p > 10.05). Conclusion: Currently available data from randomized trials indicate that adjuvant chemotherapy after resection of pancreatic cancer may substantially prolong disease-free survival and cause a moderate increase in overall survival. In the current meta-analysis, a significant survival benefit was only seen with regard to median survival, but not for the 5-year survival rate. The optimal chemotherapy regimen in the adjuvant setting as well as individualized treatment strategies (also including modern chemoradiotherapy regimens) still remain to be defined. Copyright (C) 2008 S. Karger AG, Basel

Bridge-Pier Caisson foundations subjected to normal and thrust faulting:physical experiments versus numerical analysis

Surface fault ruptures can inflict serious damage to engineering structures built on or near them. In the earthquakes of Kocaeli, Chi-chi, and Wenchuan a number of bridges were crossed by the emerging normal or thrust faults suffering various degrees of damage. While piles have proved incapable of tolerating large displacements, massive embedded caisson foundations can be advantageous thanks to their rigidity. The paper explores the key mechanisms affecting the response of such bridge foundations subjected to dip-slip (normal or thrust) faulting. A series of physical model experiments are conducted in the National Technical University of Athens, to gain a deeper insight in the mechanics of the problem. The position of the caisson relative to the fault rupture is parametrically investigated. High-resolution images of the deformed physical model is PIV-processed to compute caisson displacements and soil deformation. A novel laser scanning technique, applied after each dislocation increment, reveals the surface topography (the relief) of the deformed ground. 3D finite element analyses accounting for soil strain-softening give results in accord with the physical model tests. It is shown that the caisson offers a kinematic constraint, diverting the fault rupture towards one or both of its sides. Depending on the caisson's exact location relative to the rupture, various interesting interaction mechanisms develop, including bifurcation of the rupture path and diffusion of plastic deformation.</p

White Stork became resident in the Johannesburg CBD in 2013

By the spring of 2009, the first White Stork Ciconia ciconia discovered [the Robinson Deep dump

The gut and the psyche

No Abstract.South African Psychiatry Review Vol. 10 (2) 2007: pp.59-6

Diagnostik und Therapie von Lebermetastasen bei kolorektalem Primärtumor

Contrast-enhanced multislice computer tomography (MSCT) has established itself as the standard tomographic imaging method both for diagnosis and for treatment monitoring of hepatic lesions. To clarify local conditions before partial liver resection, diffusion-weighted magnetic resonance tomography (DWI-MRT) can also provide important additional information. In order to meet the criteria for a R0 resection, a margin of 0.5 mm seems to be sufficient. Neoadjuvant chemotherapy aiming to reduce tumour size can be given in parallel with portal artery embolisation without adversely affecting perioperative morbidity and mortality. As far as the management of primary resectable liver metastases is concerned, there is an urgent need for more studies. Despite the relatively limited evidence, adjuvant chemotherapy is currently more widely favoured in Germany than perioperative chemotherapy. There is also considerable need for studies concerning preoperative therapy in patients with liver metastases that are not (yet) resectable. In KRAS wild-type tumours, high response rates (in terms of a reduction in the size of metastases) are achieved with a cetuximab/chemotherapy combination. Bevacizumab/chemotherapy combinations lead to high rates of pathohistological complete and partial remissions. What the best parameter for judging the success of preoperative therapy is remains unknown, and so comparison studies using survival as a `hard' endpoint must be carried out