bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of T4 tumours: the role of radiotherapy
Authors: Sebag‐Montefiore David 
Published: August 2003

AbstractPatients with T4 rectal cancer may be increasingly defined by the use of pelvic MRI. This approach has the potential to classify patients who have tumour extending beyond the mesorectal fascia and those very close to but not beyond the mesorectal fascia (for example 1–2 mm). Prospective studies of MRI are required to validate such an approach.It is important that the full extent of local disease is defined prior to the commencement of radiation. Assessment after radiation is much more difficult. Even if tumour regression has occurred, if invasion of another organ was originally present, then surgical removal is required as only a small minority of patients will have a histopathologically complete response after CRT.Many investigators are developing improved CRT regimens that integrate either oxaliplatin or irinotecan with a fluoropyrimidines and radiation. There are two choices that allow intensification of pre‐operative radiation. One approach is to escalate the dose of radiation and the other is to exploit the interaction between chemotherapy and radiation by adding more chemotherapy during the period of irradiation. Current interest predominantly is focused on the latter approach. Future studies are likely to assess agents directed against molecular targets. Careful consideration is required to define the best end points for successful pre‐operative chemo‐radiation leading to surgical excision.
Isolated chemotherapeutic perfusion of the pelvis for advanced rectal cancer
Authors: Wanebo H. J. , Belliveau J. , Begossi G. , Levy A. 
Published: August 2003

AbstractObjective  Isolated pelvic perfusion exposes tissue to high doses of drug without the toxicity of high‐dose systemic therapy and may benefit patients with advanced malignancy.Patients and methods  There were 32 patients with locally advanced, previously irradiated cancer of the rectum and 5 patients with anal canal cancer. These patients underwent a total of 65 isolated pelvic perfusions using 5‐Fu (1500 mg/m2) for 60 min; cisplatinum (100 mg/m2) and mitomycin (10–20 mg/m2) were added to some perfusions. Hospital stay averaged 3–5 days.Results  Palliative perfusion in 15 patients with advanced rectal cancer resulted in symptomatic relief from 1 to 4 months in 11 of 14 with pelvic pain and limited benefit in 6 patients with mass, but no pain. Pre‐operative perfusion in 16 rectal cancer patients achieved a complete response (no tumour in pelvis) in 1 patient and significant tumour regression in 8 patients rendering them potentially resectable. Five were resected with clear margins. Three patients with recurrent epidermoid cancer had significant tumour regression and were resected with clear margins.Conclusion  Isolated chemotherapeutic perfusion of the pelvis provides excellent palliation for patients with advanced or pelvic recurrence of rectal cancer or epidermoid cancer of anorectum and may potentiate resection in selected patients.
Transverse coloplasty pouch and colonic J‐pouch for rectal cancer – a comparative study
Authors: Pimentel J. M. , Duarte A. , Gregório C. , Souto P. , Patrício J. 
Published: August 2003

AbstractObjectives  The introduction of the colonic J‐pouch has markedly improved the functional outcome of restorative rectal cancer surgery. However colonic J‐pouch surgery can be problematic and may present some late evacuatory problems. To overcome these limitations a novel pouch has been proposed: the transverse coloplasty pouch. The purpose of our study was to compare the functional outcomes of these two different types of pouches – the transverse coloplasty pouch (TCP) and the colonic J‐pouch (CJP) – during the first 12 months postoperatively.Patients and methods  A prospective randomized trial was conducted in which a total of 30 patients with mid and low rectal cancer were submitted either to a transverse coloplasty pouch or a colonic J‐pouch. Clinical defaecatory function was assessed and anorectal physiological assessment was carried out, pre‐operatively and at 3, 6 and 12 months postoperatively, by means of a standard clinical questionnaire and by anorectal manometry.Results  No statistically significant differences were found between the two groups regarding bowel function. The postoperative frequency of daily bowel movements was lower in the TCP group in all the phases of the study (3.9 vs. 4.1 at 3 months; 3.1 vs. 3.4 at 6 months; 2.1 vs. 2.8 at 12 months), the same occurring with fragmentation (33%vs. 40% at 3 months; 26.6%vs. 33.3% at 6 months; 7.1%vs. 14.3% at 12 months). Less urgency was also seen in the TCP group during the first 6 months (20%vs. 26.7%), with identical values at 12 months (14.3%vs. 14.3%). No significant differences were also found concerning incontinence grading and scoring, with TCP patients having less nocturnal leaks. At one year two CJP patients (14.3%) needs the use of enemas to evacuate the pouch and provoke defaecation, a problem never seen in TCP patients. The anorectal manometry data was similar in both types of pouches. The local complication rates were also identical in the two groups (20%); more anastomotic leaks were seen in TCP patients (13.2%vs. 6.6%), without reaching a statistical significance.Conclusion  The transverse coloplasty pouch has similar functional results but fewer evacuation problems than the J‐Pouch, making it a safe and reliable alternative to the colonic J‐pouch.
Can neoadjuvant radiochemotherapy improve the results of multivisceral resections in advanced rectal carcinoma (cT4a)
Authors: Göhl J. , Merkel S. , Rödel C. , Hohenberger W. 
Published: August 2003

AbstractObjective  To investigate the influence of neoadjuvant radiochemotherapy (nRCT) in advanced rectal carcinoma (cT4a), the prospectively collected data of all patients treated by extended multivisceral resections during the last 16 years were analysed.Methods  Between 1985 and 2000, 113 patients with clinical T4a rectal carcinoma (invasion of adjacent organs or structures), were treated by extended multivisceral surgery. In 1995 nRCT was introduced as a standardized treatment modality in cT4a carcinomas and applied in 32 patients. Six weeks after completion of nRCT, resection was performed. In all patients at least one additional organ was removed because of clinically evident tumour infiltration. In one third of patients (36/113) more than one organ had to be removed.Results  The rate of curative (R0) resections was 89% (101/113). It was similar in patients with and without nRCT (91 vs. 89%). In 40 (35%) patients histopathological examination could verify tumour invasion in adjacent organs (34% with vs. 36% without nRCT). The 3‐year rate of locoregional recurrence after R0‐resection was 12.7%. In multivariate Cox regression analysis the regional lymph node status was the most important prognostic factor (relative risk 5.8, P = 0.007). Neoadjuvant or adjuvant treatment reduced the risk by factor 0.4 (P = 0.211). The 3‐year cancer‐related survival rate of all patients with curative resection was 72.9%. It was 89.4% in the series treated with nRCT, while it was only 66.7% in patients with neither neoadjuvant nor adjuvant therapy. The relative risk for patients with lymph node metastases was 7.0 (P < 0.001) while it was only 0.2 in patients treated with nRCT (P = 0.049).Conclusions  Together with curative extended multivisceral resection nRCT can improve prognosis in patients with advanced rectal carcinoma (cT4a).
Comparison of CT and MRI in the pre‐operative staging of rectal adenocarcinoma and prediction of circumferential resection margin involvement by MRI
Authors: Mathur P. , Smith J. J. , Ramsey C. , Owen M. , Thorpe A. , Karim S. , Burke C. , Ramesh S. , Dawson P. M. 
Published: August 2003

AbstractObjective  It has been suggested that MRI may be used as the sole modality of choice in pre‐operative staging in rectal cancers. Knowledge of tumour stage and a threatened Circumferential Resection Margin (CRM) pre‐operatively are essential for planning neo‐adjuvant therapy and as predictors of local recurrence. At present most units utilize CT scanning to assess these parameters. The aim of our study was two fold: firstly to examine the accuracy of preop CT and MRI staging of rectal cancers compared with final histology and secondly to assess the accuracy of MRI in predicting penetration of the mesorectal envelope (ME).Patients and methods  All patients with biopsy proven rectal adenocarcinoma underwent thin slice MRI and CT scan pre‐operatively. Forty‐seven patients have been prospectively entered into the study: 24 male (median age 68 years; range 38–91 years). Eleven patients were unsuitable for surgery leaving 36 patients available for study.Results  CT correctly staged patients with T1/T2 rectal cancers more often than MRI (77%vs. 43%, P = 0.226). Patients with T1/T2 tumours were overstaged more often by MRI compared with CT (54%vs. 23%, P = 0.226). A greater proportion of patients with T3 tumours were correctly staged by MRI than CT (76%vs. 41%, P = 0.08); and more T3 disease was understaged by CT than MRI (54 vs. 18%, P = 0.032). CT and MRI staged T4 disease equally. In the assessment of mesorectal envelope integrity, MRI had a sensitivity of 80% and a specificity of 84%. The positive predictive value was 44% and the negative predictive value 96%.Conclusions  These results suggest significant differences between accurate pre‐operative ‘T’ staging by CT and MRI for rectal cancer. MRI has the potential however, to accurately assess mesorectal envelope invasion. Further analysis is required to assess whether MRI can be used as the sole modality in pre‐operative staging of rectal cancers.
Rectal resection with low anastomosis: functional outcome
Authors: Matzel K. E. , Bittorf B. , Günther K. , Stadelmaier U. , Hohenberger W. 
Published: August 2003

AbstractObjective  Function after anterior, low anterior and intersphincteric resection for rectal cancer was studied.Method  Of 139 patients 122 responded to a standardized questionnaire (Cleveland Clinic Continence Score) 108 ± 46 weeks postoperatively and 70 underwent anorectal manometry at 26 ± 15 weeks.Results  The postoperative continence score was dependent on the procedure (anterior resection 4.1 ± 4.6, low anterior resection 6.9 ± 5.6, intersphincteric resection 11.5 ± 5.2; P < 0.0001). It was poorer after radiochemotherapy (9.0 vs. 5.7; P = 0.030), but after colonic pouch reconstruction there was no significant difference between low anterior resection (5.6 vs. 7.3) and intersphincteric resection (10.0 vs. 12.5). Mean and maximal resting pressures were significantly reduced after intersphincteric resection (24 ± 9 and 40 ± 13 mmHg, respectively, P < 0.001) and further reduced by radiochemotherapy. Squeeze pressure was unaffected by the operative procedures and radiochemotherapy. Maximum tolerable volume and rectal compliance were reduced, after both low anterior and intersphincteric resection. Statistical correlation between continence score and maximal resting pressure (P = 0.014), mean resting pressure (P = 0.002), urge volume (P = 0.037), and neorectal compliance (P = 0.0018) reached significance. Satisfaction with the functional outcome was expressed by 71% of patients.Conclusion  After rectal resection the degree of impaired continence depended on the operative procedure and the form of reestablishment of intestinal continuity. Radiochemotherapy affected the outcome adversely. Despite reduced function, overall patient satisfaction was high.
Localization – an alternative to corporate‐led globalization
Authors: Lucas Caroline 
Published: August 2003

AbstractIn the aftermath of 11 September, there has been a growing recognition that an increasingly unequal world is not only morally unacceptable but also deeply insecure. This paper defines globalization as economic, corporate‐led globalization, a process that impacts every facet of our life. For illustrative purposes, this paper will briefly examine the role played by the globalization process in exacerbating the gap between rich and poor. It will make the case that, contrary to popular wisdom, there is nothing inevitable about this process. One such alternative is localization – a set of interrelated and self‐reinforcing policies that actively discriminate in favour of the more local, whenever it is feasible and reasonable.
Biotechnology in the agricultural sector: a challenge to consumer welfare
Authors: Smith David E. , Skalnik J. Robert 
Published: August 2003

AbstractThe promises and pitfalls of agricultural biotechnology have long been debated. The public is often thwarted because consumers frequently perceive as risky, and therefore undesirable, those advances that they do not understand or of which they are unaware. A comparative study of the introduction of a biotechnology innovation in the United States (US) and in the European Union (EU) is a case in point. In the US, despite concerns of consumer protection and environmental groups that the use of genetically produced growth hormone in milk‐producing cows will adversely impact the safety of the milk supply, scientific evidence and governmental findings appear to indicate that milk from treated cows is identical in quality, taste and nutritional value to milk from untreated cows. Experience to date in the US demonstrates some consumer resistance to milk from those cows that have received the growth hormone, which typically leads to a 10% increase in milk production. In fact, if there is no perceived differentiation between the two forms of milk, the issue offers little choice to consumers at large, and may result in economic benefit only to selected dairy farmers, as well as the producers of the genetically produced growth hormone. This situation in the US is an example of dysfunctional technology transfer, with perceived desirable benefits to a few, and perceived undesirable benefits to society‐at‐large. The information suggests that the US may have reacted hastily in approving the use of bovine growth hormone in milk‐producing cows. The EU has taken a divergent approach by enacting moratoriums against its use. The differences identified in this study, contrasting responses to the bovine somatotrophin issue in the US and EU – driven in part by general consumer attitudes towards biotechnology – may provide insights into the issues and challenges that will be faced by both advocates and opponents of global proliferation of certain advances in biotechnology.
A comparative analysis of patients’ rights: an international perspective
Authors: Rider Mary Ellen , Makela Carole J. 
Published: August 2003

AbstractConsumer rights are used as a framework comparing the patients’ rights of selected countries. Patients’ right documents of geographically dispersed countries, regional coalitions and international organizations were selected for analysis and comparison reflecting health and consumer policy. The content of patients’ rights policies, including populations addressed, basic consumer rights, dignity and privacy or confidentiality were analysed. The inclusion of consumer responsibilities and enforcement of patients’ rights was evaluated. Countries used comprehensive laws and charters to address patients’ rights. The consumer rights most often noted in the patients’ rights analysed were the rights to information, choice and redress. Five countries lacked inclusion of consumer responsibilities and the responsibility for enforcement. Suggestions for action on the part of family and consumer educators and scientists were offered.
Understanding the factors related to concerns over generically engineered food products: are national differences real?
Authors: Kolodinsky Jane , DeSisto Thomas Patrick , Labrecque Joanne 
Published: August 2003

AbstractAlong with the rapid introduction of genetically engineered (GE) foods into the marketplace have come concerns about possible risks associated with this new technology. This study expands on previous research by exploring the relationships between certain sociodemographic, attitudinal and behavioural variables and North American college students’ levels of concern over GE foods. Six index scales are created from the data and a series of anovas are conducted, and displayed visually using bar graphs, to examine the relationships between the explanatory variable and the students’ levels of concern. The findings indicate that attitudinal and behavioural variables should be included in future models for predicting levels of concern for GE foods in addition to the sociodemographic variables currently used.
Family meals and disparities in global ecosystem dependency. Three examples: Ghana, Russia and Sweden
Authors: Shanahan Helena , Carlsson‐Kanyama Annika , Offei‐Ansah Christina , Ekström Marianne P. , Potapova Marina 
Published: August 2003

AbstractThis article highlights globalization in terms of dependency on local and global ecosystems when it comes to family diets. In an exploratory case study, one typical meal in three household settings in different parts of the world: Ghana, Russia and Sweden, is examined. Food paths are traced to compare the scale of ecosystem dependency. The result shows that ecosystem dependency varies greatly with implications for environmental impact. The Swedish household, as opposed to the Ghanaian and the Russian, is not dependent on local ecosystems for food provision, but increasingly on global systems. Opportunities and constraints for lowering environmental impacts related to diets in different economies are discussed. It is concluded that it is of great importance to create awareness in high‐income countries of the dependency on the global ecosystem and the resulting environmental impacts. It is in these countries that opportunities are available for change towards more sustainable diets. It is suggested that further research need to explore in greater depth how ecosystem dependency differs and how that translates into broad spectra of environmental impacts, considering other dimensions of sustainable development as well.
Changes in food provision in Russian households experiencing perestroika
Authors: Ekström Karin M. , Ekström Marianne P. , Potapova Marina , Shanahan Helena 
Published: August 2003

AbstractThe purpose of this article is to describe how households in Novgorod the Great, Russia, deal with food provision in everyday life. The study focuses on changes experienced in food provision and consumption in Russian society, in order to illustrate how households respond to the transformation towards a market economy. The study reflects women's perspective on food provision. Students from Novgorod the Great visited 105 households and asked the women in the household to answer a questionnaire. Results from the study show that in order to cope with changes in society related to economic reforms, Russian households had changed both their food consumption and food production patterns. There was no big difference between urban and rural households. Nearly all of the households were self‐sufficient in the provision of vegetables and potatoes. Many households had a ‘dacha’ (plot), where they produced most of what they needed. Among the changes experienced during recent years (i.e. during the end of the 1990s), a decade after perestroika was initiated, households mentioned the rise in food prices and the decrease of income. Households reported that they consumed less fruit and/or meat. Some households also mentioned that the quality of nourishment had decreased, thereby indicating lower general quality, lower nutrition value, or less healthy foodstuffs.
Fair Trade and the consumer interest: a personal account
Authors: Gould Nicholas J. 
Published: August 2003

AbstractAbject poverty and rampant consumerism are twin ills of global capitalism. This short paper serves to encourage discussion on the role of Fair Trade in healing those ills. After describing the benefits of Fair Trade for producers, a paradox concerning the joys and blights of contemporary consumption is presented. Drawing on an autoethnographic method, the author indicates how Fair Trade resolves this paradox in the consumer interest.
From the margins: globalization with(out) home economics
Authors: Pendergast Donna 
Published: August 2003

AbstractPies and peas, noughts and crosses, fish and chips, chicken and egg, teaching and learning, home economics and . . .  globalization? In psychotherapy, this simple technique of providing a word and another automatically coming to mind is called free association and some of the internationally accepted pairings are noted above. Do we want ‘home economics’ and ‘globalization’ to have an automatic association? In this paper, I argue that home economics must make a shift from the margins of patriarchy by re‐thinking the ways in which the field is legitimized and positioned if it is to be a key player in taking on the challenges and dilemmas raised by globalization.
Bringing a perspective of transformative learning to globalized consumption
Authors: O'Sullivan Edmund 
Published: August 2003

AbstractThis article examines the development of market‐driven values and the creation of consumer‐driven lifestyles. It critically examines the effect of market globalization and its creation of negative quality of life indicators. Several resistance movements are given as examples as to how market values are challenged. The movement away from market desires involves a deep change in perspective which is identified as transformative learning.
Food or ‘virtual’ food? The construction of children's food in a global economy
Authors: Coakley Anne 
Published: August 2003

AbstractThis paper explores the pattern of change and development in the marketization and reconstitution of food products for children. It is in the past few decades that global corporations’ search for new markets has come to focus intensely on children. In the eyes of global corporations, children are a huge, multibillion dollar market. Childhood may be understood as a social construction but its form is historically specific. At present, the market is defining and reconstituting cultural meanings of childhood without being contested by other significant groups in society. The paper goes on to explore how transnational corporations have transformed the production and marketing of food. The paper discusses the food risks and the challenges faced by the fast food industry which specifically targets children. The reconstitution and the rebranding of popular children's food is producing ‘virtual’ food rather than real food. We live in an era where childhood offers untold opportunities in the northern hemisphere. However, the global market has come to dominate and define the social construction of childhood. Other cultural forms of identity outside of consumerism are not making the same impression. The food risks associated with the global processing of food and the health risks that have been linked to these new food forms ultimately has consequences not only for children but for society as a whole.