[Current trends and injuries in cycling: faster, further, e-bike?] / Trends und Verletzungen im Radsport: schneller, weiter, E­Bike?

During the past decade, technical innovations (e.g., carbon as a new material, disk brakes, hydraulic shock absorbers, electric transmissions) and lifestyle changes have significantly influenced recreational and professional cycling. In contrast to the past, where ambitious leisure cyclists were primarily interested in the recreational value of nature and landscape, cyclists of all ages are nowadays increasingly focused on performance and self-optimization. Simultaneously, manufacturers have adapted to differing customer requirements: besides the traditional extremities of road and mountain bikes, many specialized models have been designed for special applications: trekking, cyclocross, gravel, full-suspension, single-track, hardtail, downhill, fatbike, etc. For biking fans who are no longer able to meet their own demands due to individual physical restrictions or defined health problems, electric-assist bikes (pedelecs or "e-bikes") were recently introduced. While these are becoming increasingly popular, they have also increased the number of accidents and injuries. The current work provides an update on relevant sport medical and orthopaedic challenges brought on by these developments in cycling.

Use of transrectal ultrasound to evaluate direct tumour spread and lymph node status in patients with rectal cancer.

The accuracy of ultrasound in predicting the extent of local tumour spread through the rectal wall and in identifying involved perirectal lymph nodes was evaluated prospectively in 25 patients with rectal cancer. For each patient, the ultrasonic appearances recorded on videotape were compared with operative findings and/or the histology of the tumour. The extent of direct spread was classified into four curable and two incurable categories and was correctly predicted in 20 of 25 patients (80% accuracy). Lymph node status was correctly predicted in 16 of 20 patients (80% accuracy). These results suggest that pre-operative assessment of patients with rectal cancer using transrectal ultrasound is a useful technique which may assist the surgeon in his choice of operation and in the selection of those patients who may benefit from pre-operative radiotherapy.

How useful is pre-operative computerized tomography scanning in staging rectal cancer?

This study evaluates prospectively the reliability of computerized tomography (CT) in the pre-operative staging of 80 patients with rectal cancer. The scans were performed and reviewed by one radiologist without knowledge of either the operative findings or the final clinicopathological stage of the tumours. Fourteen of 60 patients (23%) who had a potentially curative resection were correctly staged by CT. The tumour was understaged in 28 patients (47%) and was overstaged in 18 patients (30%). CT did not identify the one patient with histological demonstration of invasion of an adjacent organ was equivocal or incorrect in 10 others on the question of adjacent organ invasion. CT failed to define accurately local tumour spread confined to the rectal was (positive predictive value (PPV) 23%), identify venous invasion (PPV 35%) or involved regional lymph nodes (PPV 42%). However, the negative predictive value for excluding synchronous liver metastases was 90%, and 11 patients who subsequently developed histologically confirmed local recurrence were all correctly diagnosed on CT. These findings suggest that pre-operative examination of patients with rectal cancer by CT is not routinely justified specifically for purposes of staging the disease.

Morbidity, mortality and survival following resection for carcinoma of the rectum at Concord Hospital.

Colorectal cancer is the most common internal malignancy in Australia, and the rectum is the most common site. The morbidity, mortality and survival of 561 consecutive patients with rectal cancer who had a resection at Concord Hospital during the 16-year period 1971-86 were evaluated. More than half of the operations performed were low anterior resections (LAR), with total abdominoperineal excisions (APE) of the rectum comprising another third. There was a 5.1% mortality rate in LAR patients and a 3.1% mortality rate in the APE group. Respiratory complications, urinary tract infections and wound infections were the most common causes of morbidity in both LAR and APE. The median survival for patients treated by LAR and APE standardized for clinicopathological staging was 111.5 and 47.1 months (A), 79.0 and 65.5 months (B), 41.3 and 28.5 (C), and 14.7 and 12.4 (D), respectively.

Current perspectives in staging large bowel cancer.

Today, a standardized method of staging that is internationally accepted is urgently needed for the management of patients with colorectal cancer. The use of a uniform, sensitive staging system would greatly improve case selection and avoid unnecessary bias when entering patients into adjuvant therapy trials. This would allow a more accurate evaluation of new treatment protocols and assist in the development of more effective follow-up programmes.