High Local Risk Research Articles

Mucinous adenocarcinoma within an anal fistula in a patient with Crohn’s disease

Anal mucinous adenocarcinoma is a rare entity, representing approximately 5-11% of all anal cancers. Sometimes it is associated with chronic inflammation of long-standing anal fistula as it may occur in patients with Crohn's disease. In this case, cancer usually goes unnoticed owing to the inflammatory disease; therefore, a degree of uncertainty surrounds initially the diagnosis. We report a case of a 62-year-old man with A2 L3 B3p Crohn’s disease who also presents a perianal mucinous pseudocyst that is removed. Histological examination reveals a mucinous pseudocyst. At the two-year follow-up, we observe the recurrence of the cyst within an anal fistula. Scheduled non-oncologic surgery is performed with resection of the cyst and tutoring of the fistula with seton. Histological examination reveals mucinous adenocarcinoma. With no evidence of metastasis in the extension study, the patient is subjected to radical surgery with abdominoperineal resection. After 3 years and 11 months, a follow-up is carried out and there is no evidence of recurrence or distant metastasis. Mucinous adenocarcinoma within an anal fistula is a challenge in its diagnosis and its treatment due to the anecdotal nature of the cases. Given the high local risk of recurrence, radical surgery is recommended, occasionally associating neoadjuvant chemoradiotherapy if the neoplasm is locally advanced.

Strategies to manage hail risk in apple production

PurposeHail risk management is essential for successful farm management in German fruit production, particularly because hail events and associated losses have increased in recent years. The purpose of this paper is to conduct a detailed risk analysis comparing different strategies to manage hail risk, taking into account farmers’ risk aversion and farm-specific conditions.Design/methodology/approachWithin an expected utility framework, two different strategies for managing hail risk are compared: one belonging to the group of financial instruments (hail insurance) and the other to the group of technical instruments (anti-hail net). A unique data set comprising a ten-year time series of orchard-specific hail damage and hail insurance data is used.FindingsFor orchards with low local hail risk and low yield potential, not using hail risk mitigation is most efficient. For orchards with high local hail risk and high yield potential, anti-hail nets provide the highest certainty equivalents. For orchards with high local risk, but low yield potential, hail insurance is most efficient. For orchards, with low local risk, but high yield potential, the certainty equivalents are higher for anti-hail net, when the farmer is risk neutral or slightly risk-averse. With increasing risk aversion, hail insurance is most efficient, which can be explained by the greater degree of the instrument’s flexibility.Originality/valueThe novelty of the study lies in the direct comparison of the risk effects of anti-hail nets and hail insurance in fruit production.

Spatial distribution of soil contamination by Toxoplasma gondii in relation to cat defecation behaviour in an urban area

In urban areas, there may be a high local risk of zoonosis due to high densities of stray cat populations. In this study, soil contamination by oocysts of Toxoplasma gondii was searched for, and its spatial distribution was analysed in relation to defecation behaviour of cats living in a high-density population present in one area of Lyon (France). Sixteen defecation sites were first identified. Cats were then repeatedly fed with marked food and the marked faeces were searched for in the defecation sites. Of 260 markers, 72 were recovered from 24 different cats. Defecation sites were frequented by up to 15 individuals. Soil samples were also examined in order to detect the presence of T. gondii using real-time PCR. The entire study area was then sampled according to cat density and vegetation cover type. Only three of 55 samples were positive and all came from defecation sites. In a second series of observations, 16 defecation sites were sampled. Eight of 62 samples tested positive, originating in five defecation sites. Laboratory experiments using experimental seeding of soil showed that the inoculated dose that can be detected in 50% of assays equals 100–1000oocysts/g, depending on the strain. This study shows that high concentrations of oocysts can be detected in soil samples using molecular methods and suggests that spatial distribution of contamination areas is highly heterogeneous. Positive samples were only found in some of the defecation sites, signifying that at-risk points for human and animal infection may be very localised.