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Background: Day care units are an essential part of psychiatric treatment in Germany. In rheumatology they are also regularly used. Axial spondylarthritis (axSpA) is an inflammatory rheumatic disease that causes pain, diminished quality of life, limitations in activities of daily living and ability to work, especially if insufficiently treated. The multimodal rheumatologic complex treatment with at least 14 days of inpatient care is an established tool to control exacerbated disease activity. The feasibility and effect of an equivalent treatment in a day care setting has not yet been evaluated., Methods: The effect of a therapy in a day care unit comparable to the inpatient multimodal rheumatologic complex treatment was investigated using clinically established patient reported outcomes (NAS pain, FFbH, BASDAI, BASFI)., Results: Selected subgroups of axSpA patients can routinely and effectively be treated in day care units. Intensified multimodal as well as nonintensified treatment forms lead to reduced disease activity. Additionally, compared to nonintensified treatment, the intensified multimodal treatment approach leads to significantly reduced pain, and disease-related and functional limitations in daily life., Conclusion: If available, treatment in a day care unit can complement the established inpatient treatment modalities in selected axSpA patients. In cases with high disease activity and suffering, intensified multimodal treatment should be preferred due to better outcomes., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Two-year old children speaking fewer than 50 words are language delayed and at a 50 % risk for a persistent language impairment (Grimm, 2000). The present study pioneers as it presents for the first time an evaluation of the parent program "It Takes Two to Talk" (from the Hanen Early Language Parent Program, Girolametto et al., 1986) in this country. A nonrandomized controlled pre-post study design was implemented with the experimental treatment group of 9 mothers of language delayed toddlers and the matched waiting-control group of 8 mothers of language delayed toddlers. The Hanen Parent Program was carried out in the treatment group. The main outcome measures included (a) expressive language (measured with ELFRA-2, Grimm u. Doil, 2000); (b) ratings of outcome and process quality by mothers and therapist (measured with FBB, Mattejat u. Remschmidt, 1998). The central findings were as follows: (a) In the two-factor ANOVA with repeated measures on one factor no significant interaction was demonstrated between group factor and pre-post factor for the expressive language scale "vocabulary" (p = 0.18); the average gain in the treatment group (increase from M(-pre) = 13,6 to M(-post) = 62,3 words) was numerically larger than the average gain in the control group (M(-pre) = 15,5, M(-post) = 44,1), while the pre-post differences were significant in both groups (t-test: p = 0.001 in EG; p = 0.03 in CG); (b) process and outcome qualities of the parent intervention were rated "positive" or "very positive" by parents and therapist. The conclusions drawn from this study are as follows: The experimental validity of the present clinical pilot study was influenced by several methodological limitations. The overall findings at least support the assumption that the early intervention parent program examined indicates some social validity. In order to evaluate the effectiveness of this program more conclusively, further research is urgently needed.

A large part of the population suffers from halitosis. Causes can be both oral and non-oral changes. Coating of the tongue as well as marginal periodontitis are the most frequent oral causes. Non-oral causes are primarily tonsillitis and sinusitis but also general diseases as well as special diet habits. Non-real halitosis or halitophobia is unterstood by the compulsive idea to suffer from bad breath and to irritate others by this. This compulsive idea can change the complete pattern of behavior of these patients which in itself can lead to self-isolation and even to suicide. Consultation hours for halitosis should be prepared for patients with non-real halitosis and build up corresponding interdisciplinary contacts.

Purpose: The value of immunosuppressive drugs for the therapy of scleritis patients is unclear. The authors investigated the indications and effects of immunosuppression in a group of patients with scleral inflammation., Method: Retrospective study of patients treated for scleritis (n = 87) or episcleritis (n = 18). The demographic factors, clinical symptoms, visual outcome, course of inflammation, ocular complications resulting from inflammation, topical and systemic antiinflammatory medication, and associated systemic diseases were analysed., Results: Only one patient with episcleritis, but 37 with scleritis presented with ocular complications (P = 0.003). The vision was impaired in 15 patients with scleritis, but not in episcleritis patients (P = 0.022). In the group of patients with episcleritis, only those with frequent relapses required more than topical antiinflammatory drugs, especially systemic non-steroidals. In contrast, systemic therapy was indicated in all of the scleritis patients. Ocular complications were found more often in patients with necrotising (n = 7/10) or posterior scleritis (n = 10/11) than in those with diffuse (9/39) or nodular (11/27) scleritis. Compared with the other patients, associated systemic autoimmune diseases were more common in patients with necrotising scleritis (P = 0.03). The need for immunosuppression was associated with vision-threatening complications (glaucoma, uveitis, peripheral ulcerative keratitis) (P < 0.01), systemic autoimmune disease, and necrotising and posterior form of scleritis (P < 0.01). Quiescence of scleritis was obtained in 59 of the scleritis patients, and improvement of inflammation was achieved in further 21. In 26 patients, scleritis did not improve with systemic steroid or non-steroidal treatment, but with immunosuppression., Conclusions: Scleritis is often associated with life-threatening systemic diseases and vision-threatening ocular complications. In patients with severe scleritis, especially with the posterior and necrotising form, improvement can often be achieved with immunosuppression.

Background: Stentgrafts for endovascular treatment of abdominal aortic aneurysms (AAA) have been commercially available since 1994, with now large numbers of implantations all over the world., Patients and Methods: From 1994-2001, 115 patients were treated with Stentor, Vanguard and Talent stentgrafts in our institution., Results: Late complications of the first- and second-generation stentgrafts as radiologic or surgical interventions to maintain complete exclusion of the aneurysm amounted to 30% with an additional 22% for observed endoleaks and configuration changes of the stentgraft. Third-generation stentgrafts had a lower complication rate of 12.2% for interventions and 18.3% for late endoleaks and graft changes., Conclusion: High costs of the devices, a pretty high late complication rate, and the uncertain maintenance of stentgraft function to prevent aneurysm rupture currently limit the widespread application of this new technology, leaving conventional aneurysmectomy the standard for aneurysm treatment and reserving the endovascular method for selected patients.