Pharyngoesophageal diverticulum

Over the last 20-30 years, treatment of pharyngoesophageal diverticula was subject to a number of fundamental changes. Considering the classical open transcervical approaches, the necessity for myotomy of the upper esophageal sphincter with the goal of interrupting the pathogenesis of the disease has become a standard component of the operation. On the other hand, with the growing popularity of rigid and flexible endoscopic techniques, pharyngoesophageal diverticula are increasingly being treated by gastroenterologists and otorhinolaryngologists, often with the argument of a technically easier and less invasive procedure; however, it remains unclear whether this shift towards endoscopic techniques truly translates into better outcome quality. This aim of this CME article is to summarize the available scientific evidence on the complex pathophysiology, diagnostics and treatment of pharyngoesophageal diverticula and to provide the reader with an updated guide to best clinical practice for diagnostics and treatment

Governance of Complex Socio-Environmental Risks: The Case of Hazardous Chemicals in the Baltic Sea

Complex socio-environmental risks challenge society. In response to scientific uncertainty and socio-political controversies, environmental governance, precaution, and the ecosystem approach to management are held forward as complements to governmental risk-based sector-restricted regulation. We analyze this development for hazardous substances in the Baltic Sea. Based on interviews and policy analysis, we study informal governance and, in particular, four central EU and international policies, and investigate how present governance relates to risks and objectives at hand. While showing emergence of broader governance approaches, we conclude that central objectives will not likely be met. Furthermore, we question the quest for broad environmental governance and emphasize the value of command and control regulation, if it implements precaution. These findings contribute to the theorizing on environmental (risk) governance. Finally, we provide some ideas that could help development and implementation of risk policies for hazardous chemicals in the Baltic Sea as well as other complex risks