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Purpose Radiochemotherapy is the standard of care for the treatment of anal carcinoma achieving good loco-regional control and sphincter preservation. This approach is however associated with acute and late toxicities including haematological, skin, bowel function and genito-urinary complications. This paper systematically reviews studies addressing the quality of life (QoL) implications of anal cancer and radiochemotherapy. The paper also evaluates how QoL is assessed in anal cancer. Methods Medline, EMBASE, CINAHL, PsycInfo, Web of Science and the Cochrane Library were searched for publications (1996–2014) reporting the effects on patients of anal cancer and radiochemotherapy. Results Of the 152 papers reporting treatment-related effects on patients, only 11 provided a formal assessment of QoL. In the absence of an anal cancer-specific measure, QoL was assessed using generic cancer instruments such as the core EORTC quality of life questionnaire (EORTC QLQ-C30) or colorectal cancer tools such as the EORTC QLQ-CR29. Bowel function, particularly diarrhoea, and sexual problems were the most commonly reported QoL concerns. The review of QoL issues of anal cancer patients treated with radiochemotherapy is limited by the QoL assessment measures used. It is argued that certain treatment-related toxicities, for example skin-induced radiation problems, are overlooked or inadequately represented in existing measures. Conclusions This review emphasises the need to develop an anal cancer-specific QoL measure and to incorporate QoL as an outcome of future trials in anal cancer. The results of this review are informative to clinicians and patients in terms of treatment decision-making.

Background and Overview: An 80-year old female with a history of surgery, cardiovascular disease, metabolic disease, urinary tract infection, and multiple medications, including levofloxacin reported to the urgent care department with signs and symptoms of delirium. Case Description: The patient was unaware of why she was present at the urgent care department and referred to the staff as “devils and witches” and uttered obscenities at the staff. Attempts to get the patient to be cooperative were futile and the patient eventually left the urgent care against the advice of the staff. The patient returned some weeks later, alert, and responsive and with no memory of her prior attendance at the clinic. He granddaughter reported that prior to coming to the clinic; the patient was hospitalized with urinary tract infection and treated with levofloxacin. Results: The required extractions were done on the patient at the last appointment, with no problem. Conclusions and Practical Implications: Delirium should be considered as a possible explanation for patients who are acting strangely and using obscenities in a dental setting. Particularly if such patients have metabolic or cardiovascular disease, history of surgery, infections, or receiving antibiotic treatment. If central nervous system toxicity to the antibiotic is suspected, then cessation of the medication should restore the patient to neurologic equilibrium.

Background and objective: The Atlanta classification of acute pancreatitis enabled standardised reporting of research and aided communication between clinicians. Deficiencies identified and improved understanding of the disease make a revision necessary. Methods: A web-based consultation was undertaken in 2007 to ensure wide participation of pancreatologists. After an initial meeting, the Working Group sent a draft document to 11 national and international pancreatic associations. This working draft was forwarded to all members. Revisions were made in response to comments, and the web-based consultation was repeated three times. The final consensus was reviewed, and only statements based on published evidence were retained. Results: The revised classification of acute pancreatitis identified two phases of the disease: early and late. Severity is classified as mild, moderate or severe. Mild acute pancreatitis, the most common form, has no organ failure, local or systemic complications and usually resolves in the first week. Moderately severe acute pancreatitis is defined by the presence of transient organ failure, local complications or exacerbation of co-morbid disease. Severe acute pancreatitis is defined by persistent organ failure, that is, organ failure >48 h. Local complications are peripancreatic fluid collections, pancreatic and peripancreatic necrosis (sterile or infected), pseudocyst and walled-off necrosis (sterile or infected). We present a standardised template for reporting CT images. Conclusions: This international, web-based consensus provides clear definitions to classify acute pancreatitis using easily identified clinical and radiologic criteria. The wide consultation among pancreatologists to reach this consensus should encourage widespread adoption. Fil: Banks, Peter A.. Harvard Medical School; Estados Unidos Fil: Bollen, Thomas L.. St Antonius Hospital; Países Bajos Fil: Dervenis, Christos. Agia Olga Hospital; Grecia Fil: Gooszen, Hein G.. Radboud Universiteit Nijmegen; Países Bajos Fil: Johnson, Colin D.. University Hospital Southampton; Reino Unido Fil: Sarr, Michael G.. Mayo Clinic; Estados Unidos Fil: Tsiotos, Gregory G.. Metropolitan Hospital; Grecia Fil: Vege, Santhi Swaroop. Metropolitan Hospital; Grecia Fil: Vaccaro, Maria Ines. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Acute Pancreatitis Classification Working Group. No especifica

A survey was carried out by postal questionnaire of the attitudes of British surgeons to pancreatic resection as palliation for ductal adenocarcinoma of the pancreas. Replies from 24 surgeons related to experience in over 700 resections. The incidence of estimated residual local disease after resection was median 12.5 percent, range 0–35 percent. Half(12) of the surgeons felt that pancreatic resection with residual macroscopic disease was justified. Only 3 (12.5 percent) surgeons accepted that palliative resection in the presence of liver metastases was sometimes justifiable. Further evidence is required of improved quality of life after resection before the majority of surgeons will accept palliative resection in the management of pancreatic ductal adenocarcinoma.

Background Postoperative portal vein infusion (PVI) of 5-fluorouracil (5-FU) is a well tolerated and widely applicable treatment for colorectal cancer that might have an enormous public health impact, even if it produced survival benefits of just a few per cent. Very large trials are required to detect such differences, and the Adjuvant X-ray and 5-FU Infusion Study (AXIS) is the largest such trial yet reported. Methods Consenting patients with presumed colorectal cancer were randomized to surgery with or without 7 days of PVI (1 g 5-FU plus 5000 units heparin in 1 litre 5 per cent dextrose infused over each 24-h period). In addition, patients with rectal cancer could be randomized to radiotherapy or no radiotherapy to be given either before or after surgery. Results Between November 1989 and December 1997, 3583 patients were randomized with respect to PVI. The survival hazard ratios (95 per cent confidence interval (c.i.)) in all patients randomized and in the curatively resected subgroup (71·2 per cent of patients) were 1·00 (0·92 to 1·11) and 0·94 (0·83 to 1·06) respectively. Tests for heterogeneity suggested a greater treatment benefit for patients with colonic cancer than for patients with rectal cancer with respect to disease-free survival (hazard ratio 0·79 versus 1·03; P = 0·07), and there was a non-significant trend with respect to overall survival (hazard ratio 0·87 versus 1·03; P = 0·17). No survival benefit was seen in the 761 patients randomized with respect to radiotherapy; although not statistically significant, the impact on local recurrence rates was similar to that reported in the literature. Conclusion No overall benefit of PVI was established in AXIS when colonic and rectal cancers were considered together, but the evidence suggesting a differential treatment effect according to site of cancer in AXIS was strongly supported by a meta-analysis incorporating the previous trials. Combining the data gave hazard ratios of 0·82 and 1·00 for colonic and rectal tumours respectively (test for interaction, P = 0·024), equating to an absolute survival benefit for patients with colonic cancer of 5·8 (95 per cent c.i. 2·8 to 8·5) per cent, a level close to that seen for prolonged systemic therapy.

The Neutrino Factory is a new concept for an accelerator that produces a high-intensity, high-energy beam of electron and muon neutrinos - the ultimate tool for neutrino oscillation studies and the only machine conceived up today that could help detect CP violation of leptons. The basic concept of the Neutrino Factory is the production of neutrinos from the decay of high-energy muons. Due to their short lifetime, these muons have to be accelerated very fast. Several new accelerator techniques, like a high-intenstiy proton linac, high-power targets, ionization cooling or recirculating muon linacs are required. This paper presents a snapshot of the accelerator design at CERN. Although some aspects of this European Neutrino Factory Scheme have been optimised for the CERN site, the basic principle is site-independent.