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Outcome evaluation is of major importance to provide data to analyze the value of the chosen treatment concept. Despite an increasing effort of analyzing outcome after treatment of different pelvic ring injuries, a mixture of different outcome parameters is in use. The Majeed score is most frequently used for mid- to long-term evaluation and the quality of life is analyzed using the SF-36 score. The lack in nearly all studies is that different treatment concepts are used, and only selected evaluation parameters are reported. Until today, no well-accepted standardized measurement instruments are available to analyze the clinical and radiological results after pelvic ring injuries. Overall, stability-based long-term sequelae can be expected with increasing complaints from stable type A injuries to completely unstable type C injuries. Beside a fracture-type specific treatment, concomitant injuries of other injury regions and associated local pelvic injuries (complex pelvic trauma) seem to additionally influence the results. Results of treatment of specific fracture types are sparse as a wide range of different injury types and different treatment concepts are analyzed within these analyses. A sufficient pelvic outcome instrument which addresses relevant pelvic outcome parameters is still missing. Thus, future evaluation of long-term results after pelvic ring. injuries should include prospective, multicenter outcome studies with comparable parameters. [ABSTRACT FROM AUTHOR]

Objective: The aim was to provide epidemiological and clinical data on patients with orofacial clefts in Lower Saxony in Germany. Materials and methods: The records of 404 patients with orofacial clefts treated surgically at the University Medical Center Goettingen from 2001 to 2019 were analyzed in this retrospective study. Prevalence of orofacial clefts in general, orofacial clefts as manifestation of a syndrome, sex distribution, and prevalence of different cleft types was evaluated and associated with the need for corrective surgery, family history, pregnancy complications, and comorbidities. Results: The prevalence of orofacial clefts for Goettingen in Lower Saxony was 1:890. 231 patients were male and 173 were female. CLP was most common (39.1%) followed by CP (34.7%), CL (14.4%), CLA (9.9%), and facial clefts (2%). The left side was more frequently affected and unilateral cleft forms occurred more often than bilateral ones. Almost 10% of the population displayed syndromic CL/P. 10.9% of all patients had a positive family history regarding CL/P, predominantly from the maternal side. Pregnancy abnormalities were found in 11.4%, most often in the form of preterm birth. Comorbidities, especially of the cardiovascular system, were found in 30.2% of the sample. 2.2% of patients treated according to the University Medical Center Goettingen protocol corrective surgery was performed in form of a velopharyngoplasty or residual hole closure. Conclusions: The epidemiological and clinical profile of the study population resembled the expected distributions in Western populations. The large number of syndromic CL/P and associated comorbidities supports the need for specialized cleft centers and interdisciplinary cleft care. [ABSTRACT FROM AUTHOR]

Pancreatic neuroendocrine neoplasm (pNEN) is highly heterogeneous. Surgery is an important part of the comprehensive treatment for pNEN, however, the low incidence and strong heterogeneity of the disease retard the progress of surgical treatment. In terms of treatment concepts, the therapeutic strategy of surgery may transform from condition-orientated to prognosis-orientated treatment, and the evaluation of tumor characteristics relies more on morphology combined with molecular pathology. In addition, pNEN surgical treatment is becoming individualized, minimally invasive and delicate, and the timing of surgical intervention has extended to the entire disease period. Based on the research progresses in related fields, we analyzed the issues and challenges and discussed the evolution in the surgical treatment concepts of pNEN.

Outcome evaluation is of major importance to provide data to analyze the value of the chosen treatment concept. Despite an increasing effort of analyzing outcome after treatment of different pelvic ring injuries, a mixture of different outcome parameters is in use. The Majeed score is most frequently used for mid- to long-term evaluation and the quality of life is analyzed using the SF-36 score. The lack in nearly all studies is that different treatment concepts are used, and only selected evaluation parameters are reported. Until today, no well-accepted standardized measurement instruments are available to analyze the clinical and radiological results after pelvic ring injuries. Overall, stability-based long-term sequelae can be expected with increasing complaints from stable type A injuries to completely unstable type C injuries. Beside a fracture-type specific treatment, concomitant injuries of other injury regions and associated local pelvic injuries (complex pelvic trauma) seem to additionally influence the results. Results of treatment of specific fracture types are sparse as a wide range of different injury types and different treatment concepts are analyzed within these analyses. A sufficient pelvic outcome instrument which addresses relevant pelvic outcome parameters is still missing. Thus, future evaluation of long-term results after pelvic ring. injuries should include prospective, multicenter outcome studies with comparable parameters., Competing Interests: Declarations. Conflict of interest: The authors declare no conflict of interest., (© 2024. The Author(s).)

Abstract Background Musculoskeletal disorders (MSD) are common among dental professionals. The most common areas affected are the trunk, neck, shoulders and wrists. Current evidence suggests that the causes of MSD can be found in the physical demands of the profession. Posture and movement during treatment is influenced by the arrangement of the treatment concept (patient chair, equipment and cabinets). It has not been investigated whether the ergonomic risk differs between the treatment concepts. Methods To evaluate the prevalence of MSD in dental professionals, 1000 responses will be collected from a nationwide (Germany) online questionnaire (mod. Nordic Questionnaire and mod. Meyer questionnaire). In order to assess the ergonomic risk of the treatment techniques used in the four treatment concepts, 3D movement analyses are carried out with inertial sensors. For this purpose, 20 teams of dentists and dental assistants from four dental fields of specializations (generalists, orthodontists, endodontists and oral surgeons) and a student control group will be recruited. Each team will execute field specific standardized treatments at a dummy head. Measurements are carried out in each of the four treatment concepts. The data will be analyzed using the Rapid Upper Limb Assessment (RULA) which will be modified for the evaluation of objective data. Conclusions On the basis of these investigations, a substantial gain of knowledge regarding work-related MSD in the field of dentistry and its potential biomechanical causes is possible. For the first time, objective and differentiated comparisons between the four treatment concepts are possible for different fields of dental specialization. Up to now, statically held positions of the trunk and proximal upper extremities, but also the repetitive movements of the hands have been considered a risk for MSD. Since both are included in the RULA, dental activities can be assessed in a detailed but also global manner with regard to ergonomic risks.

Background: Musculoskeletal disorders (MSD) are common among dental professionals. The most common areas affected are the trunk, neck, shoulders and wrists. Current evidence suggests that the causes of MSD can be found in the physical demands of the profession. Posture and movement during treatment is influenced by the arrangement of the treatment concept (patient chair, equipment and cabinets). It has not been investigated whether the ergonomic risk differs between the treatment concepts. Methods: To evaluate the prevalence of MSD in dental professionals, 1000 responses will be collected from a nationwide (Germany) online questionnaire (mod. Nordic Questionnaire and mod. Meyer questionnaire). In order to assess the ergonomic risk of the treatment techniques used in the four treatment concepts, 3D movement analyses are carried out with inertial sensors. For this purpose, 20 teams of dentists and dental assistants from four dental fields of specializations (generalists, orthodontists, endodontists and oral surgeons) and a student control group will be recruited. Each team will execute field specific standardized treatments at a dummy head. Measurements are carried out in each of the four treatment concepts. The data will be analyzed using the Rapid Upper Limb Assessment (RULA) which will be modified for the evaluation of objective data. Conclusions: On the basis of these investigations, a substantial gain of knowledge regarding work-related MSD in the field of dentistry and its potential biomechanical causes is possible. For the first time, objective and differentiated comparisons between the four treatment concepts are possible for different fields of dental specialization. Up to now, statically held positions of the trunk and proximal upper extremities, but also the repetitive movements of the hands have been considered a risk for MSD. Since both are included in the RULA, dental activities can be assessed in a detailed but also global manner with regard to ergonomic risks. [ABSTRACT FROM AUTHOR]

A tooth is considered to be a split tooth if it contains a fracture line extending from the occlusal surface through both marginal ridges. Currently, the only treatment option for a split tooth is extraction. The present case report describes a novel therapeutic strategy for the preservation of a split tooth (first maxillary premolar) with a fracture in the mesiodistal direction. A systematic nonsurgical procedure involving visualization and slight widening of the fracture line is described. This procedure facilitates sealing of the fracture gap with a biocompatible calcium silicate cement (mineral trioxide aggregate) as well as internal composite resin stabilization and cuspal coverage restoration of the tooth. A 3-year follow-up showed a promising clinical and radiographic outcome. The concept presented here is an alternative treatment option for a split tooth, which allows preservation of the tooth rather than its extraction. [ABSTRACT FROM AUTHOR]

Abstract Purpose Patients with cleft lip, alveolus and palate (CLAP) may suffer from marked asymmetry with an impact on attractiveness and psychosocial aspects. The aim of this study was to assess symmetry in CLAP patients compared to non-cleft controls of similar age with regard to cleft type and treatment concept. Materials and methods In CLAP patients with different cleft forms and in healthy non-cleft subjects (control group) a three-dimensional stereophotogrammetric face scan was performed and an objective 3D asymmetry index (AI) was calculated for the whole face, the midface, the upper lip and the nose. Results In total, 305 patients were included: 140 CLAP patients (90 male, 50 female, mean age 9.9 ± 3.6 years) and 165 controls (87 male, 78 female, mean age 8.7 ± 2.1 years). In general, CLAP patients showed significantly higher asymmetry than controls, with the most severe asymmetry found in unilateral complete CLAP. Patients treated according to an actual concept considering reconstruction of all affected muscular systems had a significant lower and more favourable AI than patients not treated according to this concept (p < 0.05). Conclusion An adequate treatment concept is essential to achieve better results concerning symmetry in CLAP, but symmetry values of healthy non-cleft controls are not reached. [ABSTRACT FROM AUTHOR]

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Objectives: There is no general consensus for treatment of medication-related osteonecrosis of the jaw (MRONJ). A stage-related approach that primarily aims to minimize morbidity and preserve function was prospectively evaluated. Patients and methods: Treatment goals are stable mucosal closure and absence of clinical symptoms. Patients were enrolled between March 2010 and October 2011. MRONJ lesions were treated either by conservative means or surgically by debridement or resective surgery. Results: In total, 38 patients were treated. Six patients were healed by undergoing conservative measures; nine were treated palliatively. Four patients dropped out after surgery in the recall phase. In 17 of 19 patients (89.5 %) surgical treatment was successful. After a 1-year observation period, the success rate was 92 % (23 of 25), including all patients treated as per protocol. Conclusion: In stage-related treatment, conservative means or surgical debridement can be successful at early stages. Extensive resection is solely indicated in cases of extended necrosis. Clinical relevance: The number of patients with MRONJ is steadily increasing. Guidelines to deal with this condition are helpful for both clinicians and dental practitioners. [ABSTRACT FROM AUTHOR]

Purpose The study aims to evaluate the all-on-four treatment concept with regard to survival rates (SRs) of oral implants, applied fixed dental prostheses ( FDPs) and temporal changes in proximal bone levels. Materials and Methods A systematic review of publications in English and German was performed using the electronic bibliographic database MEDLINE, the Cochrane Library, and Google. Hand searches were conducted of the bibliographies of related journals and systematic reviews. The authors performed evaluations of articles independently, as well as data extraction and quality assessment. Data were submitted the weighted least-squared analysis. Results Thirteen (487 initially identified) papers met inclusion criteria. A number of 4,804 implants were initially placed, of which 74 failed, with a majority of failures (74%) within the first 12 months. A total of 1,201 prostheses were incorporated within 48 hours after the surgery. The major prosthetic complication was the fracture of the all-acrylic FDP. The mean cumulative SR/ SR ± (standard deviation) (36 months) of implants and prostheses were 99.0 ± 1.0% and 99.9 ± 0.3%, respectively. The averaged bone loss was 1.3 ± 0.4 mm (36 months). No statistically significant differences were found in outcome measures, when comparing maxillary versus mandibular arches and axially versus tilted placed implants. Conclusion The available data provide promising short-term results for the all-on-four treatment approach; however, current evidence is limited by the quality of available studies and the paucity of data on long-term clinical outcomes of 5 years or greater. In terms of an evidence-based dentistry, the authors recommend further studies designed as randomized controlled clinical trials and reported according to the CONSORT statement. [ABSTRACT FROM AUTHOR]

ABSTRACT Purpose: The aim of this study was to present the clinical outcomes of the immediate loading of two bar-splinted implants retaining a mandibular overdenture. Materials and Methods: In a clinical trial, 124 edentulous patients were treated according to a new treatment concept, which involves the immediate loading of two bar-splinted SLActive implants with an implant-retained mandibular overdenture. The new conventional mandibular denture is used as a template for implant positioning and as an impression tray, and for mounting the retention clip by the dental laboratory. At the same day the implants are placed, the conventional denture is converted into an implant-retained overdenture. During the healing and evaluation period, resonance frequency analysis (RFA) was undertaken to assess the effect of loading on implant stability and survival. Results: The survival rate of the implants was 98.8% during the evaluation period (12-40 months). Only 3 of the 248 implants were lost. During the healing (osseointegration) phase, the implant-stability quotient increased significantly ( p = .0001). During the evaluation period, four patients (3%) needed a relining of their mandibular overdenture, whereas 13 patients (11%) needed relining of the maxillary denture. Conclusions: Two interconnected implants can be successfully loaded by a mandibular overdenture at the same day of implant placement with a high survival rate of the implants. Only a few patients needed additional relining of the overdenture. Repeated RFA measurements can be useful in gauging implant stability and survival. [ABSTRACT FROM AUTHOR]

Abstract: Psychiatric day hospital treatment concepts have to deal with a wide spectrum of mental disorders. We raised the question, if day hospitals can be differentiated concerning their treatment concepts and if so how much this is reflected in their structural and procedural features. In 1999 a survey was initiated concerning structure, concept and method of treatment in psychiatric day hospitals for adults in Germany. Furthermore data concerning rate of utilization, patients'' characteristics and aspects of referral and further treatment were ascertained. One hundred and seventy-three (63.4%) of 273-day hospitals contacted took part in the inquiry. The data were interpreted using multivariate as well as non-parametric procedures. The results show that treatment concepts of day hospitals can be specified as three main areas of function (psychotherapy, crisis intervention orientated treatment alternative, rehabilitation) and four therapeutic orientations (psychodynamic social psychiatric, behavioral social psychiatric, psychodynamic, sociotherapeutic). Structural features are predominantly comparable and the differences found concerning the treatment concepts are especially related to patients'' characteristics and some procedural features. The conclusion is that the differentiation of day hospital treatment concepts should be taken into consideration in planning psychosocial treatment services as well as in day hospital evaluation research. [Copyright &y& Elsevier]

In the discussion on the treatment of the clinical N0 neck in head and neck cancer, the sentinel lymphonodectomy is gaining more and more in significance. Prior to a multicentre study on the value of sentinel lymphonodectomy, it seemed to be desirable to collect data on the current practice of neck dissection in German ENT departments. First a standardised questionnaire was sent to 50 hospitals in Germany. It contained questions on the respective therapeutic concepts (uni- or bilateral modified radical neck dissection versus selective neck dissection, wait-and-see policy) in histologically proven squamous cell carcinoma (G2) and defined localisation of the primary tumour (T1-T2 carcinoma of the oral cavity, the oropharynx and hypopharynx as well as larynx). Summing up the evaluation of 39 anonymously answered questionnaires, it can be stated that no uniform therapeutic concept for the treatment of the cervical lymph nodes in carcinomas of the upper aerodigestive tract based on the stage of lymphatic metastatic disease exists. It seems to be essential to elaborate such a concept in order to be able to compete in the international context. Likewise, a widespread uniform therapeutic strategy would be the basic prerequisite for the initiation and realisation of multicentric therapy studies. [ABSTRACT FROM AUTHOR]

Fractures of the carpus are frequent injuries and typically result from of a fall onto the outstretched hand. Scaphoid fractures are the second most frequent fracture type of the hand (80%). 95% of the patients with acute scaphoid fractures are male, and the average age is approximately 25 years. Conservative treatment of acute scaphoid fractures with immobilization in a plaster cast was the therapy of choice for a long time. Surgical treatment was reserved to severe dislocated fractures only. A progress could be obtained by the principle of intramedullary fixation, whose forerunner is represented by the Herbert screw, and the introduction of cannulated screws guaranteed a continuous improvement. The decision to treat the fracture by surgery requires a clear definition of the fracture type. Therefore, precise radiologic technique is mandatory to detect the fracture and to analyze the pathomorphological circumstances. In order to get an exact classification for the decision on how to proceed, three standard X-ray projections (posteroanterior [PA], lateral and Stecher projection) and a CT scan have to be performed. The most well-known classification has been defined by Herbert & Fisher which combines fracture anatomy, stability and disease history in order to derive prognostic and therapeutic criteria. Also, delayed healings and nonunions are considered. To decide on the adequate treatment, a prerequisite for conservative therapy of acute scaphoid fractures is the anatomic position of the scaphoid. Conservative therapy should be reserved to fracture types, which are stable and heal reliably in the lower-arm plaster cast within 6 weeks. All displaced and unstable acute scaphoid fractures should be operated, and whenever possible, rigid internal fixation should be achieved because of interfragmentary compression. Therefore, several intramedullary implants are available for surgical treatment of acute scaphoid fractures, e. g., Herbert screw, Mini Herbert screw, AO screw (cannulated), Acutrac screw (cannulated), or Twin-fix screw (cannulated). With improved surgical and radiologic techniques, most scaphoid fractures are amenable to minimally invasive fixation. The dorsal approach guarantees a good overview in treating proximal pole fractures. Yet, not all types of fractures can be treated in this way. Severely displaced fractures require the classic open palmar approach. In order to prevent the development of a scaphoid nonunion or an advanced carpal collapse (SNAC-wrist), an early and sufficient diagnostic algorithm is necessary. We recommend internal fixation with a cannulated Herbert screw in B1 and B2 fractures and a Mini Herbert screw in fractures of the proximal third (B3). A2 fractures can be treated conservatively. Early diagnosis and operative treatment will shorten the time off work, minimize the risk of nonunion, and reduce the costs of health care in the long term. [ABSTRACT FROM AUTHOR]

The use of ITI implants for rehabilitation of the edentulous patient has shown predictable results not only in the standard sites but also in cases of advanced alveolar ridge atrophy. Preoperative analysis, including clinical and radiological evaluation, implant selection, and determination of implant number and distribution in the edentulous maxilla and mandible, is described in this article. The surgical procedures used in standard sites are presented, the benefits of a nonsubmerged surgical approach in these cases are emphasized, and a protocol for postoperative management is recommended. Augmentation procedures in advanced osseointegration surgery call for submerged ITI implants when a simultaneous approach is chosen. Several types of advanced implant surgery that can be used are described, including membrane technique, sinus lift procedures, vertical ridge augmentation with iliac bone grafts, and correction of sagittal jaw relationship. [ABSTRACT FROM AUTHOR]

The use of ITI implants for rehabilitation of the edentulous patient has shown predictable results not only in the standard sites but also in cases of advanced alveolar ridge atrophy. Preoperative analysis, including clinical and radiological evaluation, implant selection, and determination of implant number and distribution in the edentulous maxilla and mandible, is described in this article. The surgical procedures used in standard sites are presented, the benefits of a nonsubmerged surgical approach in these cases are emphasized, and a protocol for postoperative management is recommended. Augmentation procedures in advanced osseointegration surgery call for submerged ITI implants when a simultaneous approach is chosen. Several types of advanced implant surgery that can be used are described, including membrane technique, sinus lift procedures, vertical ridge augmentation with iliac bone grafts, and correction of sagittal jaw relationship. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this work was to analyse early upper-jaw development in patients with unilateral cleft lip and palate (UCLP) treated using two different concepts and to compare shape and size developments between these two groups and a group of noncleft patients., Materials and Methods: A total of 204 maxillary casts available for this study from 50 UCLP patients were analyzed for upper-jaw development based on three-dimensional measurements performed with a Reflex Microscope from birth up to 71 months of age. Thirty-five of these 50 patients were part of an early treatment group (two-stage cleft closure with single-stage palatoplasty at an age of 10-14 months) and 15 were part of a late treatment group (two-stage cleft closure with palatoplasty at an age of 4-7 years). The control group included 39 casts of 17 noncleft patients., Results: Analysis of shape and size between the patients in the three groups yielded statistically significant differences between the cleft and the noncleft patients. In both treatment groups, we made observations typically associated with cleft formation like lateralization, asymmetry of the greater and lesser cleft segments, and pronounced vertical deviations of the segments. Viewed in all dimensions, however, the patients in the early treatment group approached the control group more closely, although a statistically significant difference was still observed., Conclusion: Our results suggest that the timing of hard-palate closure is not a decisive factor for upper-jaw development. Intrinsic factors (initial cleft width, presence of tooth buds) and the surgeon's skills appear to have a much more defining role.

Introduction: Asperger's syndrome is one of the autism spectrum disorders. Affected individuals display considerably impaired capacity for social interaction, unusual special interests, and a tendency towards ritualized behavior., Methods: The etiology, symptoms, diagnosis, and treatment of Asperger's syndrome in adulthood are outlined on the basis of a selective literature review via Medline and information in relevant reference books. Furthermore, the authors report their personal experience at a special clinic for adults., Results: Asperger's syndrome in adulthood can be diagnosed by thorough anamnesis, heteroanamnesis-with emphasis on childhood-and painstaking clinical examination. The considerable psychosocial impairments affect the patients' professional, social, and private lives. The precise etiology is still unknown, but a multifactorial origin with genetic, neurobiological, and psychosocial components appears probable. Although no specific, empirically tested treatment concepts have yet been established, psychotherapeutic elements (structuring and directive interventions) seem to be helpful, together with pharmacotherapy-if indicated-in the presence of comorbidity., Conclusions: Asperger's syndrome should be included in the differential diagnosis of adults who display the corresponding symptoms. The etiopathogenesis and treatment of Asperger's syndrome in adulthood should be further investigated.

Background: Psoriasis is one of the most prevalent chronic inflammatory diseases, affecting approximately 2 million people in Germany., Methods: Selective literature review taking into account the German S1 and S3 guidelines for the treatment of this condition., Results and Conclusions: Psoriasis is a very troublesome disease with a high economic impact. The disease often persists for life, and the patient has an increased risk of cardiovascular diseases and their complications. One out of five patients develops psoriatic arthritis. The clinical picture of psoriasis is highly variable with regard to lesional characteristics and the severity of disease. To improve the management of psoriasis the guidelines must be followed and all appropriate topical and systemic treatment options must be tried, with clearly defined treatment goals. The spectrum of established systemic treatments for psoriasis has been extended by the biologics. These can be used to achieve a good skin status and a clear-cut improvement in quality of life even in patients who do not--or no longer--respond adequately to conventional therapies.

Background: Posterior tarsal tunnel syndrome is an uncommon clinical entity which is sometimes misdiagnosed in patients with pain of the retromalleolar region and the plantar aspect of the foot. Surgical intervention is recommended for correctly diagnosed posterior tarsal tunnel syndrome., Methods: Selective literature review., Results: Surgical treatment is indicated in the presence of dysesthesias refractory to conservative treatment or of neurological deficits. If a neural tumor or tarsal tunnel ganglion is suspected, diagnostic imaging (MRI, neurosonography) should precede surgery. Division of the flexor retinaculum (ligamentum laciniatum) in the tarsal tunnel must always include distal decompression of the end branches of the tibial nerve posterior to the fascia of the abductor hallucis muscle. Only extensive exposure of the nerve guarantees adequate release., Conclusion: Accurate diagnosis requires the evaluation of relevant clinical, neurological, and neurophysiological findings along with the careful consideration of other possible diagnoses. High success rates of 44% to 91% are reported after operative treatment. The results are better in idiopathic than in posttraumatic cases. If surgery fails, re-operation is indicated only in patients with inadequate release.

Introduction: Vitamin B(12) deficiency is widespread. Among the population groups at risk are older people, vegetarians, pregnant women, and patients with renal or intestinal diseases. The neurological symptoms of vitamin B(12) deficiency are unspecific and can be irreversible. Early detection is therefore important, using the most sensitive and specific markers available., Methods: Selective literature review., Results and Discussion: Total serum vitamin B(12) is a late, relatively insensitive and unspecific biomarker of deficiency. Holotranscobalamin (holoTC), also known as active B(12), is the earliest laboratory parameter for B(12) deficiency, while methyl malonic acid (MMA) is a functional B(12) marker that will increase when the B(12) stores are depleted. Isolated lowering of holoTC shows B(12) depletion (negative B(12) balance), while lowered holoTC plus elevated MMA and homocysteine indicates a metabolically manifest B(12) deficiency, although there still may be no clinical symptoms. The diagnostic use of holoTC allows treatment to be instituted before irreversible neurological damage occurs. As the first clinical manifestations of vitamin B(12) deficiency are unspecific, those at risk should have their B(12) status checked regularly, every two to three years. Because no randomized controlled trials have yet been completed, the diagnostic and therapeutic measures proposed here are merely recommendations.

Introduction: Pertussis is not just a childhood disease, but a respiratory infection that causes persistent cough in all age groups, from newborns to the elderly., Methods: The authors performed a selective literature search and reviewed national and international recommendations for treatment and vaccination., Results: Pertussis is found principally in young unvaccinated infants, but school-age children, adolescents, and adults are also affected. Up to 1% of infants contract pertussis, and their respiratory symptoms are often accompanied by apnea. School-age children occasionally display the coughing spasms typical of the disease. Annually, 0.2% to 0.5% of all adolescents and adults are infected and suffer from prolonged, frequently non-paroxysmal coughing. Severe and fatal cases of pertussis occur mainly in newborns and infants, and 25% of affected adults experience complications. Bordetella DNA may be detected by polymerase chain reaction (PCR) for four weeks after symptom onset; except in infants, the sensitivity of this diagnostic technique is low. Although the diagnosis can be confirmed by serological tests, the methods are not well standardized. Treatment with a macrolide prevents the spread of infection, but generally does not alleviate the symptoms. Combination vaccines are the most effective means of prophylaxis., Discussion: Pertussis is usually not included in the differential diagnosis of persistent respiratory symptoms. The considerable burden of disease could be reduced in adults and young infants by vaccinating adults with acellular combination vaccines.