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Schizophrenia is a complex mental disorder. Hence, the mental health system faces enormous structural, therapeutic, and health-economic challenges. Innovative models of healthcare can facilitate making treatment more efficient and effective.This paper aims to give an overview of evidence-based and innovative models of care and treatment for schizophrenia and severe mental illnesses. For this purpose, we performed a literature search covering the last 10 years of publications regarding "care or treatment models" and "schizophrenia," "psychosis," or "severe mental illness."Many publications do not provide details about the tested care model. Innovative care models for schizophrenia comprise early psychosis services (EPSs) or models for severe mental illnesses (SMI) integrating, combining and/or developing the treatment models crisis resolution team (CRT), assertive community treatment (ACT), and/or (intensive) case management (ICM). For illustration, the innovative models Early Psychosis Prevention and Intervention Centre (EPPIC) in Australia, the Flexible Assertive Community Treatment model in the Netherlands, and the Therapeutic Assertive Community Treatment model in Hamburg are explained. All three models regularly offer integrated, specialized, and assertive care.In Germany, innovative models of care have not been implemented sufficiently: neither EPS nor ACT are part of standard care; CRT can now be funded by health insurances via "ward-equivalent treatment" as defined by a new German law (§§ 39 und 115d SGB V). Regarding the implementation of CRT and ACT in Germany, a clinical study evaluating the RECOVER model is underway. This is a stepped-care, trans-sectorally coordinated and evidence-based treatment model, the evaluation of which is supported by the innovation fund of the Joint Federal Committee (Gemeinsamen Bundesausschuss, G‑BA) from 2017 to 2020.

Aneurysms of the external carotid artery can be causally for threatening late hemorrhage secondary to tonsillectomy. On the bases of typical, extended and finally dramatic bleeding course in a child the "clinical look" and the sensitivity should be raised for this bleeding cause. Characteristic after apparently inconspicuous post-operative first phase is late signal bleeding with little loss of blood which are replaced after following intervals free of bleeding from bleeding as flood with massive loss of blood. Then vessel-imaging (Angio-MRI or CT) is urgently indicated. By confirmation of the suspicion diagnosis the interventional angiography is the therapy of the choice, although after successful embolisation a fine-meshed postcontrol is necessary, because therapy failures are possible how the described case points. The highest security offers the surgical exploration with aimed vessel stopping.

Background: Nasal polyposis is treated by surgery and/or by medication but in parts without permanent remission. Fibroblasts and their proliferation are involved in the complex mechanism of polyp genesis. Therefore we have analysed the influence of 12 medications on fibroblasts from nasal polyps growing in vitro., Method: Nasal polyps, obtained during usual surgical procedure, are enzymatically digested and cultured in serum containing media. The growing cells are identified as fibroblasts using flow cytometry with a AS02-FITC antibody (Dianova). The analysis is achieved with 5 - 6 different fibroblast cultures in each medicament tested, mostly using concentrations of the active substance from 0.006 to 1.333 mg/ml. The fibroblasts are cultured 4 days in the presence of active substances or as controls. Finally the cells are trypsinated and counted., Results: Mometason, Beclomethason, Fluticason, Verapamil and Timolol are the group with the strongest reduction of fibroblasts. Mometason shows a reduction to 6 % of controls at a concentration of 30 micro g/ml whereas the reduction at this concentration amounts to 30 - 60 % in the other members of this group. Mesazalin, Methylprednisolone and Pentoxifylline demonstrate the smallest influence; Prednisolon-21-hydrogen-succinate, Pilocarpin, Piroxicam and Diclofenac show an effect on a middle level., Conclusions: A strong reduction of fibroblasts from nasal polyps in vitro is possible with usual rhinological medicaments but also with unusual substances in this field.

Unlabelled: CASUISTRY: The case of a patient with atypical carcinoid of the larynx is reported and literature about neuroendocrine tumors of the larynx (NETL) is reviewed., Background: Especially terminology, histological differentiation, diagnostics and therapy are discussed., Conclusions: Neuroendocrine tumors are rare and untypically located in the larynx. In spite of this they should to be known as an important differential diagnosis of a laryngeal neoplasia, because of possible malign or highly malign course. The typical localisation of neuroendocrine tumors (NET) are the gastrointestinal tract and the lung, but the clinical course differs from the one of laryngeal manifestation. This means diagnostics and therapy have to be adapted to this special disease. That's why it is important to explore the identity of these tumors scientifically. This is difficult because of the low rate of patients with this disease. The message of this report is the conclusion of the established and appeal for publications of new cases of NETL.