Pilonidalsinus und Analfistel: Indikationen und Methoden der chirurgischen Therapien

Zusammenfassung: Fisteln im Analbereich werden unterteilt in Pilonidalfisteln in der Rima ani und Analfisteln als Verbindung zwischen Anus und perianaler Haut. Bei der Pilonidalfistel erfolgt bei unkompliziertem Befund nach Abheilung akuter Abszesse die minimalinvasive Fistelexzision in Lokalanästhesie. Konservative Therapiekonzepte sowie die radikale Exzision mit offener Wundbehandlung haben sich nicht bewährt. Bei ausgeprägtem, großem Befund erfolgt eine weite Exzision mit plastischer Deckung mittels Limberg-Lappen. Bei der Analfistel muss unterschieden werden zwischen subkutanen und tiefen intersphinktären Fisteln ohne Sphinkterbeteiligung einerseits und hohen intersphinktären, transsphinktären, suprasphinktären und extrasphinktären Fisteln andererseits. Erstere können mit geringer Morbidität und hoher Heilungsrate fistulotomiert werden. Bei der zweiten Gruppe besteht ein erhebliches Inkontinenz- und Rezidivrisiko. Ohne Inkontinenzrisiko, bei allerdings hohem Rezidivrisiko, kann die Fistel mittels "Anal Fistula Plug" verschlossen werden. Bei Versagen dieser Therapie bietet sich eine Fistulektomie mit Verschluss der inneren Fistelöffnung durch einen anorektalen Verschiebelappen a

Fragranced consumer products: effects on asthmatic Australians

Exposure to fragranced consumer products, such as air fresheners and cleaning supplies, is associated with adverse health effects such as asthma attacks, breathing difficulties, and migraine headaches. This study investigated the prevalence and types of health problems associated with exposure to fragranced products among asthmatic Australians. Nationally representative cross-sectional data were obtained in June 2016 with an online survey of adult Australians (n = 1098), of which 28.5% were medically diagnosed with asthma or an asthma-like condition. Nationally, 55.6% of asthmatics, and 23.9% of non-asthmatics, report adverse health effects after exposure to fragranced products. Specifically, 24.0% of asthmatics report an asthma attack. Moreover, 18.2% of asthmatics lost workdays or a job in the past year due to fragranced products in the workplace. Over 20% of asthmatics are unable to access public places and restrooms that use air fresheners. Exposure to fragranced products is associated with health problems, some potentially serious, in an estimated 2.2 million asthmatic adult Australians. Asthmatics were proportionately more affected than non-asthmatics (prevalence odds ratio 3.98; 95% confidence interval 3.01–5.24). Most asthmatics would prefer workplaces, healthcare facilities, and environments that are fragrance-free, which could help reduce adverse effects

Parastomal hernia incarceration due to migrated intragastric balloon

The temporary placement of intragastric balloons is a common method to achieve rapid weight loss before planned metabolic surgery. We report the case of a 48-year-old morbidly obese patient. Ten years ago the patient underwent emergency sigmoidectomy with creation of a double-barreled ileostomy for perforated diverticulitis. Over time he developed a giant parastomal hernia. For preoperative weight reduction before planned restoration of intestinal continuity, an intragastric balloon was inserted 3years ago. The patient was admitted to our emergency department with peritonism and a septic shock. After computed tomography showing small bowel ileus, laparotomy was performed, revealing marked ischemia of incarcerated small and large intestine. Only postoperatively was the intragastric balloon found in the resected small bowel, causing a mechanical ileus with consecutive incarceration of the bowel. We review the literature on complications due to the migration of intragastric balloons. This clinical case gives a fair warning of the possible deleterious outcome of intragastric balloons, especially in hernia patient

Differential toxicological effects of natural and synthetic sources and enantiomeric forms of limonene on mosquito larvae

Common fragranced consumer products, such as cleaning supplies and personal care products, emit chiral compounds such as limonene that have been associated with adverse effects on human health. However, those same compounds abound in nature, and at similar concentrations as in products, but without the same apparent adverse human health effects. We investigated whether different types of limonene may elicit different biological effects. In this study, we investigated the mortality rate of mosquito larvae in response to changes in their environment. Specifically, we tested different sources of naturally occurring R-limonene and chemically synthetized limonene, containing one of its enantiomeric forms (R-, S-) in mortality bioassays with Aedes aegypti mosquito larvae. We found that a natural source of limonene extracted from oranges induced lower mortality of mosquito larvae compared to synthetic sources at the same concentration. However, enantiomeric forms did not differ in their effects on mortality. Our results provide novel evidence that natural sources of a chemical can cause lower rates of mortality than synthetic sources

Volatile chemical emissions from fragranced baby products

Fragranced consumer products have been associated with adverse effects on human health. Babies are exposed to a variety of fragranced consumer products, which can emit numerous volatile organic compounds (VOCs), some considered potentially hazardous. However, fragranced baby products are exempt from disclosure of all ingredients. Consequently, parents and the public have little information on product emissions. This study investigates VOCs emitted from a range of fragranced baby products, including baby hair shampoos, body washes, lotions, creams, ointments, oils, hair sprays, and fragrance. The products were analysed using gas chromatography/mass spectrometry (GC/MS) headspace analysis. Of the 42 baby products tested, 21 products made claims of green, organic, or all-natural. Results of the analysis found 684 VOCs emitted collectively from the 42 products, representing 228 different VOCs. Of these 684 VOCs, 207 are classified as potentially hazardous under federal regulations, representing 43 different VOCs. The most common VOCs emitted were limonene, acetaldehyde, ethanol, alpha-pinene, linalool, beta-myrcene, acetone, and beta-pinene. A comparison between ingredients emitted and ingredients listed reveals that only 5% of the 684 VOCs, including 12% of 207 potentially hazardous VOCs, were listed on the product label, safety data sheet, or website. More than 95% of both green and regular products emitted one or more potentially hazardous VOCs. Further, emissions of the most prevalent VOCs from green, organic, or all-natural products were not significantly different from regular products. Results from this study can help improve public awareness about emissions from baby products, with the aim to reduce pollutant exposure and potential adverse effects on babies

Volatile chemical emissions from car air fresheners

Air fresheners, used in a variety of indoor environments, emit a range of volatile chemicals, including some classified as hazardous. However, little is known about the emissions from air fresheners designed for use in cars. This study investigates the volatile organic compounds emitted from car air fresheners, identifies potentially hazardous compounds, compares emissions between so-called natural and regular versions, and assesses whether ingredients are disclosed. Using gas chromatography/mass spectrometry, 12 car air fresheners were analyzed for their volatile emissions. Air freshener types included car vent clips, wraps, hanging ornaments, cans, and spray. Results reveal that the air fresheners collectively emitted 546 VOCs with 30 VOCs classified as potentially hazardous. All air freshener types emitted one or more potentially hazardous compounds. Comparing regular air fresheners with so-called natural or green air fresheners, no significant difference was found in the emissions of hazardous compounds. Notably, all products emitted at least one VOC classified as potentially hazardous. Among all of the 546 compounds emitted, fewer than 2% of all VOCs, and none of the potentially hazardous VOCs, were disclosed on any product label or safety data sheet. This study reveals that car air fresheners can be a source of exposure to numerous volatile compounds, including potentially hazardous VOCs, most of which are undisclosed. Of particular concern for human exposure is the small and enclosed breathing space within vehicles, as well as involuntary exposure in commercial vehicles such as taxi cabs and rideshares

Volatile chemical emissions from essential oils with therapeutic claims

Essential oils emit many volatile organic compounds (VOCs), with some considered potentially hazardous. However, little is known about specific emissions from essential oils that make therapeutic claims for health and well-being. This study investigated VOCs emitted from 14 commercially available essential oils with therapeutic claims, such as beneficial for coughs, colds, flus, relaxation, sleep, tension, headaches, stress, or skin irritation. The essential oils were selected from different brands and types, such as tea tree oil, lavender oil, eucalyptus oil, geranium oil, peppermint oil, bergamot oil, orange oil, and oil blends. Analyses were performed using headspace gas chromatography/mass spectrometry (GC/MS). The analyses found 1034 VOCs emitted from the 14 essential oils, representing 378 VOC identities. The most prevalent VOCs (in more than 90% of the oils) were acetaldehyde, alpha-phellandrene, alpha-pinene, camphene, limonene, methanol, terpinolene, 3-carene, acetone, beta-phellandrene, ethanol, and gamma-terpinene. Among the 1034 VOCs emitted, 251 VOCs, representing 60 VOC identities, are classified as potentially hazardous. The most prevalent potentially hazardous VOCs were acetaldehyde, limonene, methanol, acetone, ethanol, and 3-carene. Toluene was found in more than 70% of the essential oils. Each of the essential oils emitted 9 or more potentially hazardous VOCs. Fewer than 1% of all VOCs identified and fewer than 1% of all potentially hazardous VOCs were listed on any essential oil label, safety data sheet, or website. Results from this study provide new findings on VOC emissions from essential oils with therapeutic claims, which can help to improve public awareness about potential exposures and risks

Farmers’ management of functional biodiversity goes beyond pest management in organic European apple orchards

Supporting functional biodiversity (FB), which provides natural pest regulation, is an environmentally sound and promising approach to reduce pesticide use in perennial cultures such as apple, especially in organic farming. However, little is known about farmers’ practices and motivations to implement techniques that favor FB, especially whether or not they really expect anything from FB in terms of pest regulation. In fact, FB-supporting techniques (FB-techniques) are massively questioned by practitioners due to inadequate information about their effectiveness. An interview survey was performed in eight European countries(i) to describe farmers’ practices and identify promising FB-techniques: (ii) to better understand their perceptions of and values associated with FB; and (iii) to identify potential drivers of (non-)adoption. Fifty-five advisors and 125 orchard managers with various degrees of experience and convictions about FB were interviewed and a total of 24 different FB-techniques which can be assigned to three different categories (ecological infrastructures, farming practices and redesign techniques) were described. Some were well-established measures (e.g., hedges and bird houses), while others were more marginal and more recent (e.g., animal introduction and compost). On average, farmers combined more than four techniques that had been implemented over a period of 13 years, especially during their establishment or conversion period. In general, it was difficult for farmers to evaluate the effectiveness of individual FB-techniques on pest regulation. They considered FB-techniques as a whole, targeting multiple species, and valued multiple ecosystem services in addition to pest regulation. The techniques implemented and their associated values differed among farmers who adopted various approaches towards FB. Three different approaches were defined: passive, active and integrated. Their appraisal of FB is even more complex because it may change with time and experience. These findings provide empirical evidence that the practical implementation of promising techniques remains a challenge, considering the diversity of situations and evaluation criteria. Increased cooperation between researchers, farmers and advisors should more effectively target research, advisory support and communication to meet farmers’ needs and perceptions

Deregulation of the endogenous C/EBPβ LIP isoform predisposes to tumorigenesis

Two long and one truncated isoforms (termed LAP*, LAP, and LIP, respectively) of the transcription factor CCAAT enhancer binding protein beta (C/EBPbeta) are expressed from a single intronless Cebpb gene by alternative translation initiation. Isoform expression is sensitive to mammalian target of rapamycin (mTOR)-mediated activation of the translation initiation machinery and relayed through an upstream open reading frame (uORF) on the C/EBPbeta mRNA. The truncated C/EBPbeta LIP, initiated by high mTOR activity, has been implied in neoplasia, but it was never shown whether endogenous C/EBPbeta LIP may function as an oncogene. In this study, we examined spontaneous tumor formation in C/EBPbeta knockin mice that constitutively express only the C/EBPbeta LIP isoform from its own locus. Our data show that deregulated C/EBPbeta LIP predisposes to oncogenesis in many tissues. Gene expression profiling suggests that C/EBPbeta LIP supports a pro-tumorigenic microenvironment, resistance to apoptosis, and alteration of cytokine/chemokine expression. The results imply that enhanced translation reinitiation of C/EBPbeta LIP promotes tumorigenesis. Accordingly, pharmacological restriction of mTOR function might be a therapeutic option in tumorigenesis that involves enhanced expression of the truncated C/EBPbeta LIP isoform. KEY MESSAGE: Elevated C/EBPbeta LIP promotes cancer in mice. C/EBPbeta LIP is upregulated in B-NHL. Deregulated C/EBPbeta LIP alters apoptosis and cytokine/chemokine networks. Deregulated C/EBPbeta LIP may support a pro-tumorigenic microenvironment

Suture repair of umbilical hernia during caesarean section: a case-control study

Purpose: The objective of this study was to investigate the additional burdens in terms of pain, prolongation of surgery and morbidity which is added to elective caesarean section if umbilical hernia suture repair is performed simultaneously. Secondly, patient's satisfaction and hernia recurrence rate were assessed. Methods: Consecutive women with symptomatic umbilical hernia undergoing internal or external suture repair during elective caesarean were included in this retrospective cohort-control study. Data on post-operative pain, duration of surgery and morbidity of a combined procedure were collected. These patients were matched 1:10 to women undergoing caesarean section only. Additionally, two subgroups were assessed separately: external and internal suture hernia repair. These subgroups were compared for patient's satisfaction, cosmesis, body image and recurrence rate. Results: Fourteen patients with a mean age of 37years were analysed. Internal suture repair (n=7) prolonged caesarean section by 20min (p=0.001) and external suture repair (n=7) by 34min (p<0.0001). Suture repair did not increase morphine use (0.38±0.2 vs. 0.4±02mg/kg body weight), had no procedure-related morbidity and prolonged hospitalization by 0.5days (p=0.01). At a median follow-up of 37 (5-125) months, two recurrences in each surgical technique, internal and external suture repair, occurred (28%). Body image and cosmesis score showed a higher level of functioning in internal suture repair (p=0.02; p=0.04). Discussion: Despite a high recurrence rate, internal suture repair of a symptomatic umbilical hernia during elective caesarean section should be offered to women if requested. No additional morbidity or scar is added to caesarean section. Internal repair is faster, and cosmetic results are better, additional skin or fascia dissection is avoided, and it seems to be as effective as an external approach. Yet, women must be informed on the high recurrence rat