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The discussion about alternatives for tobacco cultivation is a very conflicting issue as it strikes into the heart of the tobacco industry which is the tobacco leaf. The aim of the paper is to contribute to this discussion and support the policy makers. To this end, the paper provides an evidence based approach for modeling the phasing-out of tobacco which describes the possible effects on farm income, labor demand and environmental impacts. In the context of the EU Research Project DIVTOB a model was developed to study the impacts of tobacco phasing-out on a specific region approach. The methodological approach can support the policy makers to overcome constraints related with the future implementation of alternative livelihoods to tobacco cultivation on the basis of evidence. In the broader context of tobacco control, the paper presents a method for an effective implementation of articles 17 and 18 of the WHO Framework Convention of Tobacco Control (FCTC). The paper also shows a transparent approach to overcome in an effective way the uncertainties spread by the tobacco industry and their allies about phasing-out of tobacco especially in low-income and middle-income countries. The application of the proposed model to four case studies in Greece and Spain achieves, under different scenarios, important results useful for policy makers and policy implications.

Dynamic test bench.UHF transponders comparison.UHF cattle/pig ear tag development. The electronic identification of sheep and goats has been obligatory in the European Union since 2010 by means of low-frequency radio-frequency identification systems. The identification of pigs and cattle is currently based on a visual ear tag, but electronic animal identification is gaining in importance. The European Union already offers the additional use of electronic identification systems for cattle in their council regulation. Besides the low-frequency radio-frequency identification, an ultra-high-frequency ear tag is a possibility for electronic animal identification. The benefits of the latter frequency band are the high range, the possibility of quasi-simultaneous reading and a high data transmission rate. First systematic laboratory tests were carried out before testing the ear tags in practice. Therefore, a dynamic test bench was built. The aim of the experiments presented in this study was to compare different ear tags under standardised conditions and select the most suitable for practical use. The influence of different parameters was tested and a standard test procedure to evaluate the quality of the transponder ear tag was developed.The experiments showed that neither the transponder holder material (polyvinyl chloride vs. extruded polystyrene) nor the reader settings examined (triggered read vs. presence sensing) had a significant influence on the average of readings of the different transponder types. The parameter 'number of rounds' (10 vs. 15 vs. 20) did not show a significant effect either. However, significant differences between speed (1.5ms-1,3.0ms-1), transponder orientation and the fourteen transponder types were found. The two most suitable transponder ear tags for cattle and pigs have been determined by comparison.

Background Historical data indicate that surgical resection may benefit select patients with metastatic gastric and gastroesophageal junction cancer. However, randomized clinical trials are lacking. The current RENAISSANCE trial addresses the potential benefits of surgical intervention in gastric and gastroesophageal junction cancer with limited metastases. Methods This is a prospective, multicenter, randomized, investigator-initiated phase III trial. Previously untreated patients with limited metastatic stage (retroperitoneal lymph node metastases only or a maximum of one incurable organ site that is potentially resectable or locally controllable with or without retroperitoneal lymph nodes) receive 4 cycles of FLOT chemotherapy alone or with trastuzumab if Her2+. Patients without disease progression after 4 cycles are randomized 1:1 to receive additional chemotherapy cycles or surgical resection of primary and metastases followed by subsequent chemotherapy. 271 patients are to be allocated to the trial, of which at least 176 patients will proceed to randomization. The primary endpoint is overall survival; main secondary endpoints are quality of life assessed by EORTC-QLQ-C30 questionnaire, progression free survival and surgical morbidity and mortality. Recruitment has already started; currently (Feb 2017) 22 patients have been enrolled. Discussion If the RENAISSANCE concept proves to be effective, this could potentially lead to a new standard of therapy. On the contrary, if the outcome is negative, patients with gastric or GEJ cancer and metastases will no longer be considered candidates for surgical intervention. Trial registration The article reports of a health care intervention on human participants and is registered on October 12, 2015 under ClinicalTrials.gov Identifier: NCT02578368 ; EudraCT: 2014–002665-30.

Re-anastomosis after a Hartmann procedure is associated with a higher morbidity and mortality than other elective colorectal operations. The goal of this comparative study was to evaluate whether laparoscopic reversal is a justified operative approach, although the initial operation is most often an emergency laparotomy. A retrospective analysis was conducted on data collected on all 70 patients who underwent laparoscopic and open reversal of a Hartmann procedure at the Department of Surgery, University of Schleswig–Holstein, Campus Lubeck, between January 1999 and December 2011. Together with general demographic data, the analysis included the indication for the initial Hartmann procedure, time to reversal, intraoperative findings, the choice of operative method, operating time, postoperative pain control, return of normal bowel function, length of hospital stay, and peri- and postoperative morbidity and mortality. In most patients, the Hartmann procedure was performed after a perforated sigmoid diverticulitis. We were not able to find any statistically significant differences with respect to gender, body mass index (BMI) and American Society of Anesthesiologists classification between the laparoscopic group (LG) (N = 24 patients) and the open group (OG) (N = 46). In the LG, patients were significantly younger (p = 0.019). The median operating time was 210 min (75–245) in the LG, which was significantly longer than in the OG (166 min; 66–230). The statistical analysis of the duration of postoperative analgesic therapy (LG 7 days [6–10]; OG 12 days [6–30] ), return to normal diet (LG 3 days [2–6]; OG 4 days [2–10] ), return of normal bowel function (LG 3 days [2–4]; OG 4 days [2–9] ) and length of hospital stay (LOS) (LG 10 days [8–13]; OG 15 days [8–163]) detected significant differences in advantage for the LG. Unplanned return to theatre during index admission was only necessary in the OG (N = 7, 15.2 %). With a median follow-up of 8 months (range 1–20), we observed a comparable number of minor complications in both groups but a significantly higher number of major complications in the OG (N = 27, 58.7 %) (p = 0.001). Conversion occurred in three cases (12.5 %). There was no mortality in either of the two groups. This study was able to demonstrate the feasibility of the laparoscopic approach. In terms of postoperative results it should be seen as equivalent to the open procedure. However, the laparoscopic approach requires profound surgical expertise. The indication should be made after a careful risk/benefit analysis for each individual patient.

Aim The increasing experience within the area of laparoscopic procedures has paved the way for technically-complex procedures, such as distal pancreatectomy. In order to avoid complications associated with concomitant splenectomy, these procedures are increasingly performed with spleen preservation. A drawback is the low number of cases, which does not allow for an evidence-based comparison between laparoscopic and open procedures, and spleen-preserving and concomitant splenectomy procedures. Patients and Methods Between 2006 and 2010, all data for patients who underwent a laparoscopic distal pancreatectomy (LDP) at the Department of Surgery, University of Schleswig-Holstein, Luebeck, Germany, were collected are stored in a prospectively-maintained database. Patients with tumours in the pancreatic tail and body that did not exceed the level of the portal vein were included in this database. Results A total of 22 patients who underwent LDP could be included in the evaluation. Ten of those patients underwent a laparoscopic spleen-preserving distal pancreatectomy (LSPDP), while the remaining 12 received an LDP with splenectomy (LDPwS). The median operation time was 155 min (range: 98–253) for the LSPDP group, and 201 min (range: 60–310) for the LDPwS group (P = 0.06). The median hospital stay was 8.5 days (range: 5–23) in the LSPDP group compared to 11 days (range: 4–41) in the LDPwS group (P = 0.06). Pancreatic fistula occurred in two patients from each group. It caused an intraabdominal haemorrhage in one patient of the LSPDP group, which required re-laparoscopy. Two patients experienced subphrenic abscesses in the LDPwS group and were treated interventionally. Histological examination revealed six cystadenomas and five pseudocysts (maximum diameter: 7 cm) in the LDPwS group, and six neuroendocrine tumours (maximum diameter: 2 cm) in the LSPDP group. Conclusion LDP can be performed safely. The optic magnification provided by laparoscopy facilitates LSPDP, as dissection of the splenic vessels can be avoided. Although not significant, there was a trend towards reduced hospital stay and operating time for LSPDP. Oncologic outcomes and morbidity seem to not be inferior to open procedures. The size of the tumours and the peripancreatic, as well as paraneoplastic, tissue alterations determine the indication for splenectomy.

The regular colonisation of the oesophagus with a Candida species can, after oesophageal perforation, result in a contamination of the mediastinum and the pleura with a Candida species. A patient cohort of 80 patients with oesophageal perforation between 1986 and 2010 was analysed retrospectively. The most common sources with positive results for Candida were mediastinal biopsies and broncho-alveolar secretions. Candida species were detected in 30% of the patients. The mortality rate was 41% in patients with positive microbiology results for Candida, whereas it was 23% in the remaining patient cohort. This difference did not reach statistical significance (P = 0.124). Mortality associated with oesophageal perforation was attributed mainly to septic complications, such as mediastinitis and severe pneumonia. During the study period we observed a shift towards non-albicans species that were less susceptible or resistant to fluconazole. In selected patients with risk factors as immunosuppression, granulocytopenia and long-term intensive-care treatment together with the finding of Candida, an antimycotic therapy should be started. A surgical approach offers the possibility to obtain deep tissue biopsies. The antimycotic therapy should start with an echinocandin, as the resistance to fluconazole is growing and to cover non-albicans Candida species, too.

Auch das beste IT-System kann versagen. Problematisch wird es, wenn dabei Praxisdaten verloren gehen. Wie Arzte sich ohne Mehraufwand gegen den Datenverlust absichern konnen, zeigt ein Beispiel aus der Praxis.

This work thoroughly evaluates the electric power consumption of a full scale, 3 × 923 m 3 complete stirred tank reactor (CSTR) research biogas plant with a production capacity of 186 kW of electric power. The plant was fed with a mixture of livestock manure and renewable energy crops and was operated under mesophilic conditions. This paper will provide an insight into precise electric energy consumption measurements of a full scale biogas plant over a period of two years. The results showed that a percentage of 8.5% (in 2010) and 8.7% (in 2011) of the produced electric energy was consumed by the combined heat and power unit (CHP), which was required to operate the biogas plant. The consumer unit agitators with 4.3% (in 2010) and 4.0% (in 2011) and CHP unit with 2.5% (in 2010 and 2011) accounted for the highest electrical power demand, in relation to the electric energy produced by the CHP unit. Calculations show that 51% (in 2010) and 46% (in 2011) of the total electric energy demand was due to the agitators. The results finally showed the need for permanent measurements to identify and quantify the electric energy saving potentials of full scale biogas plants.

BACKGROUND: Colorectal cancer is one of the most common malignant diseases in the industrialized nations. Despite advances in research on tumor development and biology, improved therapeutical concepts, and an increasing motivation to undergo screening examinations and surveillance programs the overall mortality remains high. METHODS: PubMed database was used to screen the current literature for the topics of epidemiology, colorectal cancer development, histopathologic features, and diagnosis in colorectal cancer. RESULTS: A general overview of epidemiologic data in terms of incidence, geographic differences in occurrence and risk factors is given. Molecular mechanisms for the formation of colorectal cancer within the adenoma-carcinoma sequence are explained and additional aspects such as ploidy-status of colorectal tumors and microsatellite instability put into perspective. Various variables of routine histopathologic evaluation are summarized, more advanced analyses explained and prognostically relevant features listed. Diagnostic workup and staging of patients with colorectal cancer are based on several different techniques which are discussed for their effectivity, sensibility and sensitivity. CONCLUSIONS: Early detection of colorectal cancer together with a more detailed understanding of tumor heterogeneity and the prospect of tailoring individualized therapeutical concepts constitute essential factors in order to further ameliorate the outcome of colorectal cancer patients.

BACKGROUND: Laparoscopic colorectal procedures for the treatment of benign disorders are increasingly appreciated and have become the standard procedure for e.g. surgical treatment for recurrent diverticulitis. METHODS: Data show that even laparoscopic surgery for left sided colon cancer is seen as oncologically equal to the classic open resection. Laparoscopic resections offer several benefits e.g. minimal impairment of gastrointestinal and pulmonary functions, lower immunosuppression, shorter hospital stay, and faster reconvalescence. RESULTS: However, laparoscopic resections for rectal cancer are still discussed controversially as concerns are raised in terms of oncologic radicality, port-site metastases, autonomic nerve preservation, and completeness of total mesorectal excision especially in obese male patients with a tight pelvis. CONCLUSIONS: The clinical reality and several studies demonstrate that laparoscopic rectal surgery for cancer is oncologically feasible, lymph node dissection is equivalent to open surgery, and the incidence of port-site recurrence is not increased compared to wound recurrence in conventional laparotomy.

A life cycle assessment model with eight potential scenarios for the conversion of energy crops into biogas and bioethanol in Germany has been developed, in order to compare energetic output/input relationships and potential environmental effects of the different pathways. The model includes parameter from the literature as well as own data collected at laboratory and semi-industrial scale trials. Corn silage and ripe triticale, both whole plants, were chosen as typical energy crops for the assessment. In addition, steam explosion as a pretreatment technique was examined. Biogas, as well as bioethanol combined with biogas, is potentially helpful to reduce the consumption of nonrenewable energy carriers and its greenhouse gas emission under the investigated scenarios and the scope set. A future task will be the development of differentiated and well-adapted concepts on the basis of a decision on liquid or gaseous fuels versus stationary supply of thermal and electrical energy from biomass.

Background Postoperative surveillance after curative resection for colorectal cancer has been demostrated to improve survival. It remains unknown however, whether intensified surveillance provides a significant benefit regarding outcome and survival. This study was aimed at comparing different surveillance strategies regarding their effect on long-term outcome. Methods Between 1990 and 2006, all curative resections for colorectal cancer were selected from our prospective colorectal cancer database. All patients were offered to follow our institution's surveillance programm according to the ASCO guidelines. We defined surveillance as "intensive" in cases where > 70% appointments were attended and the program was completed. As "minimal" we defined surveillance with < 70% of the appointments attended and an incomplete program. As "none" we defined the group which did not take part in any surveillance. Results Out of 1469 patients 858 patients underwent "intensive", 297 "minimal" and 314 "none" surveillance. The three groups were well balanced regarding biographical data and tumor characteristics. The 5-year survival rates were 79% (intensive), 76% (minimal) and 54% (none) (OR 1.480, (95% CI 1.135-1.929); p < 0.0001), respectively. The 10-year survival rates were 65% (intensive), 50% (minimal) and 31% (none) (p < 0.0001), respectively. With a median follow-up of 70 months the median time of survival was 191 months (intensive), 116 months (minimal) and 66 months (none) (p < 0.0001). After recurrence, the 5-year survival rates were 32% (intensive, p = 0.034), 13% (minimal, p = 0.001) and 19% (none, p = 0.614). The median time of survival after recurrence was 31 months (intensive, p < 0.0001), 21 months (minimal, p < 0.0001) and 16 month (none, p < 0.0001) respectively. Conclusion Intensive surveillance after curative resection of colorectal cancer improves survival. In cases of recurrent disease, intensive surveillance has a positive impact on patients' prognosis. Large randomized, multicenter trials are needed to substantiate these results.

BACKGROUND: In laparoscopic colon surgery, endostaplers generate 2 parallel rows of staples. The aim of this paper is to analyse whether the introduction of a new endostapler generating a third row of staples influences the rate of anastomotic leakage and bleedings. METHOD: 362 patients of the Department of Surgery, University Clinic of Schleswig-Holstein, Campus Lubeck, were included in this study. All patients underwent colon resection with performance of double-stapling anastomosis. In Group I (n = 148; 7 / 2004 to 12 / 2005), the Endopath® TSB 45 endostapler (2 rows of staples) was used, whereas in Group II (n = 214; 7 / 2006 to 12 / 2007), the Echelon™60 EC60 stapler (3 rows of staples) was used. All further operational steps were identical for both groups. Target parameters were the postoperative anastomotic leakage and anastomotic bleeding rates. RESULTS: Between July 2004 and December 2005, the number of anastomotic leaks (Stapler Endopath®, TSB 45) was n = 4 (2.7 %), for the second period (Stapler Echelon™60 EC60), it was n = 9 (3.7 %) (not significant). Using the Endopath® TSB 45 stapler, the number of anastomotic bleedings was n = 12 (8.1 %), and for the Echelon™60 EC60 stapler, it was n = 8 (3.7 %) (p = 0.074; not significant). Within the 18-month period between July 2006 and December 2007, the number of endoscopic colon operations (n = 214) rose by 44.6 % compared to the 18-month period between July 2004 and December 2005 (n = 148). CONCLUSION: The application of the advanced Echelon endostapler has no impact on the number of anastomotic leaks, and reduces the number of anastomotic bleedings slightly but not significantly. The increased number of endoscopic procedures in the second period results both from the growing number of indications for the application of endoscopic techniques and the positive findings of recent studies carried out by our own and other working groups.

To examine the treatment outcome for patients with acute bleeding from the lower gastrointestinal tract requiring transfusion and acute surgical care as a function of various risk factorsBetween 1999 and 2007, we collected data on 59 patients (39 male and 20 female patients) who received surgical intervention for acute lower intestinal hemorrhage requiring transfusion at our university clinic. Treatment complications and mortality were analyzed retrospectively.The average age of the patients in this study is 70.0 +/- 12.2 years (range, 39 to 97 years) with an overall mortality of 15.3%. Blood transfusions10 U (p = 0.031), postoperative need for ventilation (p = 0.004), necessary reoperations (p = 0.016), and an initial hemoglobin level80 g/L (p = 0.043) proved to be significant risk factors for death. Blood transfusions10 U (p = 0.028), necessary reoperations (p = 0.001), and an initial hemoglobin level80 g/L (p = 0.033) were found to be significant risk factors for postoperative complications. All other parameters have no significant impact.The decisive factors for the outcome of lower gastrointestinal hemorrhage requiring surgery are the severity of bleeding, beginning of treatment (initial hemoglobin level, need for packed red blood cells), and treatment efficiency (necessary reoperation).

In the past, women with Crohn’s disease (CD) as a risk factor in pregnancy were discouraged from becoming pregnant. Today, by contrast, gestation is medically acceptable in these patients despite several severe complications. We present the course of five female patients with CD requiring surgery during pregnancy and giving birth at our institution between 1998 and 2008. These cases as well as our treatment recommendations for patients wishing to have children and our approaches to the management of complications during pregnancy are discussed in the light of the literature. Three of five women had a preterm delivery (26 to 31 weeks’ gestation) with a decreased neonatal weight. Generally, the diagnosis of CD is often delayed and diagnostic errors (four of five women) are not uncommon. The symptoms vary widely and include those typical of pregnancy. Three patients had to have a cesarean and only two patients were able to deliver vaginally. Especially in pregnant patients, the course of the disease is highly variable and difficult to predict. Our experience suggests that patients should be advised to conceive during remission. Indications for surgery in pregnant patients are the same as for nonpregnant women and include perforation, obstruction, hemorrhage, and abscess. The advantages of endoscopic surgery also apply to pregnant patients with acute manifestations. A stoma is not a contraindication to vaginal delivery.

About 60% of the global methane emission is related to anthropogenic activities such as agriculture, fossil fuel use, and waste disposal. A significant part of agricultural methane emissions originates from pig husbandry, with indoor stored pig slurry as the main source. In general, the release of methane from indoor slurry storage can be influenced by availability of oxygen and volatile solids, pH value, substrate temperature, retention time, and presence of inhibiting compounds. Investigations on methane release from a pig house with indoor slurry storage were carried out from October 1999 until February 2001 and from February 2003 until July 2004, respectively. The season, in which the fattening period was accomplished, had a significant influence on the level of the methane emission rate, with increased emissions during summer. However, a clear influence of the indoor temperature – and therefore of the ventilation strategy – on the level of the methane emission rate was only found for mean daily temperatures above 25 °C. Methane emissions were reduced significantly due to complete slurry removal between the fattening periods and subsequent cleaning of the slurry pits.

Perforations of the oesophagus are characterized by a high mortality rate, varying between 7 and 49%. In the analyzed group of patients between the years 1986 and 2003, the mortality rate of 28% was caused by septic complications such as mediastinitis and pneumonia. Microbiological examinations of samples from different locations and various secretions, detected mycoses in 28% of the patients (n = 16). Compared with the total of mycoses, a higher mortality of 50% was calculated. The invasive Candida infection of the oesophagus itself can cause a perforation. In perforations of the oesophagus, simultaneous mycoses arise by fungi invading sterile compartments or by haematogenous and lymphogenous dissemination up to sepsis. Uncomplicated courses do not need antimycotic therapy. At the beginning of the treatment, a microbiological monitoring should be provided, particularly with regard to the intraoperative facts. In relation to the course and the risk factors of the patients, an antimycotic therapy is initiated. Surgical clearing and sufficient drainage of the collateral compartments such as pleural and mediastinal compartments is highly significant.

In contrast to ammonia few data about the emissions of CH4, N2O and CO2 from animal houses are yet available. To be reliable, such data should derive from investigations meeting the following minimum requirements: (1) continuous measurement of ventilation rates and gas concentrations; (2) long-term experiments, to cover diurnal and seasonal effects; (3) use of extremely exact measuring equipment. A literature review has shown that reliable data about CH4 emissions are basically only available for cattle housing systems. Data about N2O emissions from animal houses are lacking, because of the difficulties in measuring very low N2O concentrations. However, the results of existing investigations are not comparable and most of them do not meet the minimum requirements mentioned above. Our own experiments have been carried out for dairy cows in loose housing with natural ventilation. The amount of CH4 originating from cows' digestion is about 223 g per livestock unit (1 LU = 500 kg live-weight) per day and varies between 200 and 250 g per LU per day. It mainly depends on the feed intake, which is positively related to animal size, growth rate and production. There is practically no influence of outside conditions on the emission rate. N2O was emitted at about 1.6 g per LU per day.

The intention of the research project is to evaluate two housing systems for fattening pigs regarding animal welfare. The project is carried out under field conditions in a special experimental swine house for at least 100 fattening pigs. The swine house is composed of two separate compartments. The first compartment is characterized as a common housing system for fatteners with fully slatted floor and forced ventilation. The second compartment is designed as an alternative housing system with partly slatted floor, separate climatic areas with an insulated, covered lying area (kennels) and natural ventilation. Under summer conditions the natural ventilation can be supported by mechanical ventilation if necessary. The alternative system is adapted to the ethological needs of the swines. The pens are structured to ensure marked functional areas. Both housing systems are equipped with a sensor controlled liquid feeding system and ethologically enriched with occupation techniques. During four fattening periods (two each under summer and winter conditions) animal behavior, animal activity, health and growth performance of the pigs as well as indoor climate (temperature, humidity, gas and dust concentrations) and the surrounding conditions are registered. The animal behavior is observed with 14 parallel running video cameras as well as automatically working activity sensors.

Lameness is a complex economic and welfare problem in dairy cattle which is directly linked to the flooring in loose housing systems. Mobility is the most important prerequisite for the smooth operation of such system. Foot lameness is due to several factors, but the permanent excessive strains on the sole combined with poor horn quality are key issues. In addition, slippery floors impede normal locomotion. This study was based on the working hypothesis that soft rubber mats improve claw health and slip resistance. The elastic rubber mats selected were installed in two freestall dairy houses: the experimental farm of the University of Hohenheim and a commercial farm. Animal behaviour and claw diagnosis were recorded, with biological and ethological parameters, in three steps: firstly, on concrete slatted floors, secondly, on slatted floors covered with rubber mats and thirdly again on concrete slatted floors. The results concerning animal behaviour and claw health confirmed the working hypothesis. Less slipping was detected on soft floors. Step length on the soft slatted floors was similar to that measured on pastures. Activity and walking speed increased on the soft floors, indicating that cows showed confidence on soft floors. Claw diagnosis, divided into 5 severities ranging from 1 (very slight) to 5 (very severe), was the most important parameter for the comparison between hard and soft floors. Claw health was significantly improved on soft slatted floors compared with the usual slatted floors. The experiment showed that soft floors favour the requirements for the correct functioning of the claw and unimpeded cow behaviour.

Especially in growing stocks, detection of upcoming health problems in individuals when housing pregnant sows in groups is difficult. Madsen and Kristensen (2005) already demonstrated that drinking pattern could be used to detect upcoming health problems with an online-monitoring system. Therefore, the aim of this collaborative research project is to use water intake but also feed intake and animal activity as indicators for monitoring health and behavior of pregnant sows. Animal welfare should be improved by developing, implementing and evaluating an on-line monitoring system using the mentioned indicators. To gain better knowledge about influencing parameters such as drinker types and diversity of individual drinking behavior a preliminary experiment was carried out. Hence within three weeks three different drinker types were tested in a dynamic herd of 50 group housed sows. Water consumption was measured and drinking behavior was observed by a video camera. Daily pattern of drinking events seemed to show a biphasic rhythm, but levels of water flow were different. Sows showed not just different drinking behavior but also volume flow per drinking event differed considerably. Drinker types seemed to have an influence on both water spillage and drinking behavior. The results of this experiment indicate that further research is needed concerning other influences on sows` water intake such as temperature, group structure and management. Nevertheless validation of water intake as an indicator made progress. Hereafter interactions of the three indicators need to be explored and the online-monitoring system needs to be developed, implemented and evaluated.

There is need for research regarding the optimization of air supply and of air cooling systems of livestock houses for fattening pigs. A decision support project for the German Ministry of Agriculture has been established to investigate such technologies on a research farm and under practical conditions. Since January 2011, on the research farm Landesanstalt fur Schweinezucht (LSZ Boxberg) measurements on three air supply and cooling systems have been carried out: Underfloor air inlet and supply, cooling pad and high pressure evaporative indoor air cooling. The present results show differences concerning the parameters: temperature, differential pressure, air velocity and energy consumption .

Background Lymphadenectomy is performed to assess patient prognosis and to prevent metastasizing. Recently, it was questioned whether lymph node metastases were capable of metastasizing and therefore, if lymphadenectomy was still adequate. We evaluated whether the nodal status impacts on the occurrence of distant metastases by analyzing a highly selected cohort of colon cancer patients. Methods 1,395 patients underwent surgery exclusively for colon cancer at the University of Lübeck between 01/1993 and 12/2008. The following exclusion criteria were applied: synchronous metastasis, R1-resection, prior/synchronous second carcinoma, age < 50 years, positive family history, inflammatory bowel disease, FAP, HNPCC, and follow-up < 5 years. The remaining 421 patients were divided into groups with (TM+, n = 75) or without (TM-, n = 346) the occurrence of metastasis throughout a 5-year follow-up. Results Five-year survival rates for TM + and TM- were 21% and 73%, respectively (p < 0.0001). Survival rates differed significantly for N0 vs. N2, grading 2 vs. 3, UICC-I vs. -II and UICC-I vs. -III (p < 0.05). Regression analysis revealed higher age upon diagnosis, increasing N- and increasing T-category to significantly impact on recurrence free survival while increasing N-and T-category were significant parameters for the risk to develop metastases within 5-years after surgery (HR 1.97 and 1.78; p < 0.0001). Conclusions Besides a higher T-category, a positive N-stage independently implies a higher probability to develop distant metastases and correlates with poor survival. Our data thus show a prognostic relevance of lymphadenectomy which should therefore be retained until conclusive studies suggest the unimportance of lmyphadenectomy.

A variety of surgical strategies have been suggested and many surgical techniques, both abdominal and perineal, have been introduced for treatment of rectal prolapse. All these techniques and approaches are based on the attempt to restore the normal anatomy and physiologic function. In 1992, Berman et al. published the first laparoscopically performed rectopexy. Meanwhile, many different minimally invasive procedures have been described. Throughout the past century, more than 100 different surgical techniques have been introduced to treat patients with rectal prolapse. Unfortunately, there is still lack of one generally accepted standard technique for the surgical treatment of rectal prolapse. Our current data strongly supports laparoscopic resection rectopexy to be a safe, fast, and very effective procedure to improve function in patients with rectal prolapse. More evaluations of long-term outcome are needed that focus on each particular laparoscopic procedure to adequately compare different techniques. The indication to perform a laparoscopic resection rectopexy in patients with a previous perineal procedure and a recurrent prolapse should be stated critically because these patients seem to have a high risk to develop yet another recurrence.

Many different techniques to treat rectal prolapse have been introduced. Laparoscopic resection rectopexy has been shown to entail benefits regarding both perioperative results and short-term outcome, whereas data for long-term outcome are scarce. Between 1993 and 2008, all laparoscopic resection rectopexies for rectal prolapse II° or III° were selected from a prospective laparoscopic colorectal surgery database. We analyzed demographic, perioperative, and follow-up results. We defined two periods (1993–2000 and 2001–2008) for comparison of data. Long-term follow-up was obtained by sending questionnaires to all patients. Evaluation included constipation, incontinence, and recurrence of prolapse. Between January 1993 and November 2008, we performed 152 laparoscopic resection rectopexies for rectal prolapse. Median age was 64.1 years (±14.6). Conversion rate was 0.7% (1), mean operation time was 204 (±65.3) min, and was significantly shorter in the second period compared with the first (P

In pig production software and electronic systems are widely used for process control and management. Unfortunately most devices on farms are proprietary solutions and autonomically working. To unify data communication of devices in agricultural husbandry, the international standard ISOagriNET (ISO 17532:2007) was developed. It defines data formats and exchange protocols, to link up devices like climate controls, feeding systems and sensors, but also management software. The aim of the research project, "Information and Data Collection in Livestock Systems" is to develop an ISOagriNET compliant IT system, a so called Farming Cell. It integrates all electronic components to acquire the available data and information for pig fattening. That way, an additional benefit to humans, animals and the environment regarding process control and documentation, can be generated. Developing the Farming Cell is very complex; in detail it is very difficult and long-winded to integrate hardware and software by various vendors into an ISOagriNET compliant IT system. This ISOagriNET prototype shows as a test environment the potential of this new standard.

Fournier's gangrene is a necrotizing fasciitis that affects the perineal, genital, or perianal regions. The objective of this study was to highlight this uncommon condition with a particular focus on the disease course in females.From 1996 to 2008, we prospectively collected data from 38 patients with Fournier's gangrene (12 women, 26 men) and retrospectively analyzed relevant parameters.The mean age was 60.9 +/- 11.3 years for females (group I) and 56.2 +/- 11.7 years for males (group II). In both groups, the main predisposing factors were diabetes mellitus and obesity (body mass index of 30 or higher). Twelve men (46.2%), but no women, had chronic alcoholism. The most commonly isolated agents were Escherichia coli (n = 22), streptococcal species (n = 18), Pseudomonas aeruginosa (n = 9), and Staphylococcus aureus (n = 7). Mortality was significantly higher among females (50%) than males (7.7%; p = 0.011). Peritonitis was present in seven group I patients (58.3%) and in two group II patients (7.7%). The retroperitoneum was involved in seven female patients (58.3%) and four male patients (15.4%).The female gender is a risk factor for mortality in patients with Fournier's gangrene and is associated with a higher incidence of inflammation of the retroperitoneal space and abdominal cavity. Differences in male and female genital anatomy may be the reason for the rapid spread of infection to the retroperitoneum and the fatal outcome in women. Fournier's gangrene as a high-risk disease in females should attract exceeding attention.

Fournier’s gangrene is a necrotizing fasciitis involving the perineal and genital regions. Even today, this often polymicrobial infection still carries a high mortality rate and continues to be a major challenge to the medical community. The purpose of this study was to report our experience with this condition and to compare it with those reported in published studies. We also introduce our approach to treatment. We analyzed data from 33 patients with Fournier’s gangrene who were managed in our hospital from 1996 to 2007, focusing on patient gender, age, etiology, predisposing conditions, comorbidities, bacteriology, sepsis, blood results, mortality, and spread of gangrene. 18 (54.5%) of the 33 patients had been referred to our department by smaller district hospitals. The patient cohort consisted of 23 men and ten women with a median age of 59 years (range 40–79 years). The median time between the onset of symptoms and progression to gangrene was 6 days (range 2–28 days). An underlying cause was identified in 27 patients (81.8%). The commonest etiological events were perianal and perirectal abscesses (n = 13; 39.4%). Predisposing factors included diabetes mellitus in 12 cases (36.4%), chronic alcoholism in ten cases (30.3%), immunosuppression in six cases (18.2%), and prolonged immobilization in five cases (15.2%). 17 patients (51.5%) had a body mass index (BMI) of 25 or higher, and 13 patients (39.4%) had a BMI of 30 or higher. Positive cultures were obtained in 30 cases (90.9%). In 26 cases (78.8%), multiple microorganisms were recovered, including nine cases (27.3%) with both aerobes and anaerobes. Sepsis was present in 26 patients (78.8%). The mortality rate was 18.2%. Fournier’s gangrene remains a major challenge with a high mortality. Our results suggest that women are more commonly affected than has generally been assumed. Contrary to published reports, we found that anorectal sources appear to account for more cases of Fournier’s gangrene than urological sources.

To plan and design dairy housing, several calculations should be made; this requires time and efforts, with the possibility of making mistakes. The objectives of this paper are to develop a tool to assist the designers in planning and designing dairy housing in arid and semi-arid zones, to save time and efforts, and to provide a new design model. Two mathematical models were developed to plan and design corral systems and the required concrete constructions. Subsequently, an electronic spark map (decision tree) was developed for each mathematical model, and then the mathematical models were integrated into the electronic spark maps. Afterwards, C# (C Sharp) programming language was used to develop the software by integrating the electronic spark maps, and making the user interface. The developed software is able to plan and design the housing system (corrals system), specify corrals and house dimensions, and compute the required amounts of construction materials (iron rods, cement, sand, and gravels) to build the required concrete base. Furthermore, it calculates the capital investment and the fixed, variable, and total costs of the construction. Data of 6 dairy farms were used to validate the model, and to evaluate the software. The differences between actual and calculated values were determined, and the standard deviations were calculated. The coefficients of variation (COVs) range between 3% and 7%.

A rare case of hibernoma about the nipple in a 9-year-old boy is presented: the tumour was peculiar not only for the age and region, but also for its superficial, subepidermal site.

Auch in Arztpraxen nimmt der Einsatz digitaler Kameras zu. Sei es zur Fotodokumentation von Behandlungsverlaufen oder fur erlauternde Bilder, um den Patienten selbst oder einen Facharzt umfassender zu informieren. Doch auf was ist beim Kauf einer solchen Kamera zu achten?

Objective In general, chronic pancreatitis (CP) primarily requires conservative treatment. The chronic pain syndrome and complications make patients seek surgical advice, frequently after years of progression. In the past, surgical procedures involving drainage as well as resection have been employed successfully. The present study compared the different surgical strategies. Patients and Methods From March 2000 until April 2005, a total of 51 patients underwent surgical treatment for CP at the Department of surgery, University of Schleswig-Holstein, Campus Lübeck. Out of those 51 patients, 39 (76.5%) were operated according to the Frey procedure, and in 12 cases (23.5%) the Whipple procedure was performed. Patient data were documented prospectively throughout the duration of the hospital stay. The evaluation of the postoperative pain score was carried out retrospectively with a validated questionnaire. Results Average operating time was 240 minutes for the Frey group and 411 minutes for the Whipple group. The medium number of blood transfusions was 1 in the Frey group and 4.5 in the Whipple group. Overall morbidity was 21% in the Frey group and 42% in the Whipple group. 30-day mortality was zero for all patients. During the median follow-up period of 50 months, an improvement in pain score was observed in 93% of the patients of the Frey group and 67% of the patients treated according to the Whipple procedure. Conclusion The results show that both the Frey procedure as well as partial pancreaticoduodenectomy are capable of improving chronic pain symptoms in CP. As far as later endocrine and exocrine pancreatic insufficiency is concerned, however, the extended drainage operation according to Frey proves to be advantageous compared to the traditional resection procedure by Whipple. Accordingly, the Frey procedure provides us with an organ-preserving surgical procedure which treats the complications of CP sufficiently, thus being an alternative to partial pancreaticoduodenectomy if there is no suspicion of malignancy.

Electronic animal identification is an important technology in modern animal husbandry providing great benefits. Low-frequency applications are state-of-the-art within the radio frequency identification of animals. Quasi-simultaneous detection of several animals and reading of the transponders over longer distances is impossible with low-frequency systems. Ultra-high-frequency (UHF) applications are suitable for this purpose. However, UHF systems have disadvantages through their susceptibility to metallic surfaces and liquids. Thus, the reflection and absorption of electromagnetic radiation in the animals' environment is often problematic. Consequently, an adjustment of the transponder ear tags regarding mechanical stability and functionality close to water (ear tissue) is necessary. In this project, targeted adjustments and a further development of UHF transponder ear tags concerning the resonance frequency were made. Three trials with cattle and two trials with pigs were performed in this study. Cattle were driven through a reader gate for ten rounds and six different types of transponder ear tags designed in-house were tested. The influence of the environment (indoor vs. outdoor), reader orientation at the gate (sideways vs. above) and output power of the readers (1.0 vs. 0.5 W) were tested in two experiments. The average number of readings per round and the reading rates of the transponder ear tag types were taken as target variables. In the trials with pigs, three transponder ear tag types were compared. The animals were driven through the gate for five rounds per repetition, but neither the reader output power nor the reader orientation were varied. The pig experiments were performed indoors. The results of the cattle experiments showed that the average number of readings per round and the reading rates were significantly higher indoors compared to outdoors. The reader output power of 1.0 W achieved significantly better results compared to 0.5 W. The same applied to the reader orientation ‘above’ compared to ‘sideways’. It could also be shown that an improvement of the transponder and, thus, an adjustment to the animal's ear could be achieved during transponder ear tag type development. A maximum reading rate of 100% was reached with the cattle transponder types finally developed (B3-4, B4-4 and B5). In addition, an average reading rate of 100% was achieved for one pig transponder ear tag type (C2). However, these experiments have to be treated with caution due to a very low sample size.

A tool was developed to assist the cooling systems designer in designing and installing a microsprinkler and fan cooling system. The tool was developed by integrating a mathematical model into an electronic spark map in order to use the mathematical model practically. The mathematical model was developed using the designs, parameters, variables, and constant values of the microsprinkler and fan cooling system. Subsequently, MS-Excel was used to develop the spark map of the mathematical model and to show the results of the input settings automatically. The spark map, using the mathematical model, assists the designer in making decisions to specify and to calculate the required discharge of cooling system pump, length and diameter of cooling system pipelines, number of cooling fans, and number of microsprinklers. Moreover, this tool calculates the capital investment and the fixed, variable, and total costs of the cooling system. However, the mathematical model of the spark map requires some input data, such as: pressure and discharge of microsprinklers, and some other engineering parameters. Data of 4 cooling systems were used to carry out the model validation. The differences between actual and calculated values were determined, and the standard deviations were calculated. The coefficients of variation were between 2.25% and 4.13%.