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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).)

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. [ABSTRACT FROM AUTHOR]

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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.

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In most cases periprosthetic fractures of the acetabulum are complex injuries and are extremely challenging for the treating medical team. Over the years the frequency of this overall rare entity has increased due to demographic changes. In recent years several treatment algorithms were published and provided the possibility of developing standardized treatment concepts. The classification of the fractures and a dedicated preoperative strategy are highly important for the quality of patient-centered care. In the literature the frequency of intraoperative fractures was initially given as 0.4%; however, several studies have been published in which a far higher rate of intraoperative fractures was detected by computed tomography (CT), often referred to as so-called occult fractures. The causes are multifactorial and there is significant association with whether cement-free press-fit acetabular cups were used or cemented forms. In approximately 75% of the cases a low energy impact was the cause of the fracture. In these patients systemic processes, such as osteoporotic alterations of the bony substance or the possible presence of low-grade infections should be considered. This article gives an overview of the diagnostics, planning, challenges and osteosynthetic treatment options for periprosthetic fractures of the acetabulum. [ABSTRACT FROM AUTHOR]

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The paradigm shift in the treatment concept for acute appendicitis is currently the subject of intensive discussions. The diagnosis and differentiation of an uncomplicated from a complicated appendicitis as well as the selection of an adequate treatment is very challenging, especially since nonoperative treatment models have been published. The laparoscopic appendectomy is still the standard for most cases. Guidelines for the treatment of acute appendicitis do not exist in Germany. Therefore, a group of experts elaborated 21 recommendations on the treatment of acute appendicitis after 3 meetings. After initial definition of population, intervention, comparison and outcome (PICO) questions, recommendations have been finalized through the Delphi voting system. The results were evaluated according to the current literature. The aim of this initiative was to define a basic support for decision making in the clinical routine for treatment of acute appendicitis. [ABSTRACT FROM AUTHOR]

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]

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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]

Hintergrund: Neuromuskuläre Erkrankungen im Kindes‑, Jugend- und Erwachsenenalter sind seltene und sehr seltene Erkrankungen; bei vielen sind Prävalenz und Inzidenz nicht bekannt. Kausale Therapien kommen derzeit nur bei einzelnen Krankheitsentitäten zum Einsatz. Dennoch führen neue genetische Methoden, ein besseres Verständnis der Pathophysiologie und multidisziplinäre Behandlungskonzepte zu einer Verbesserung von Diagnostik und Therapie mit einer Steigerung von Lebenserwartung und Lebensqualität. Das führt dazu, dass Patienten mit frühem Erkrankungsbeginn häufiger als früher das Erwachsenenalter erreichen und eine Weiterversorgung in der Erwachsenenmedizin erforderlich ist. Dabei kommen insbesondere auf die Neurologie zunehmende Herausforderungen zu, es wachsen die Anforderungen an eine interdisziplinäre Zusammenarbeit in der Erwachsenenmedizin.Fragestellung: Wie kann die Transition sinnvoll gestaltet werden, wo zeichnen sich strukturelle und inhaltliche Probleme ab?Material und Methode: Anhand der Duchenne-Muskeldystrophie sollen die inhaltlichen und strukturellen Anforderungen an den Transitionsprozess dargestellt und auf Schwierigkeiten bei der Umsetzung hingewiesen werden.Schlussfolgerungen: Der Transitionsprozess ist komplex und erfordert zeitliche wie personelle Ressourcen. Das Ziel ist eine kontinuierliche spezialisierte medizinische Versorgung und eine Übernahme der Gesundheitsfürsorge durch den Patienten. [ABSTRACT FROM AUTHOR]

Ein Massenanfall von Verletzten (MANV) bedeutet nicht nur für den Rettungsdienst, sondern auch für die klinischen Versorgungsstrukturen eine erhebliche Herausforderung. Es liegt zumindest vorübergehend ein Missverhältnis von Patienten und Versorgungsressourcen bezüglich Personal und Material (insbesondere bei Medikamenten, Verbandsmaterial und OP-Ausrüstung) vor. Daher muss ggf. von der klassischen individualmedizinischen Versorgung abgewichen werden. MANV-Konzepte von Krankenhäusern, wie sie in den Krankenhausalarmplänen festgeschrieben sind, basieren auf 3 wesentlichen Säulen: 1. dem Personalmanagement, 2. einer speziellen Materialbevorratung und Nachschublogistik sowie 3. einem strikten medizinischen Damage-Control-Konzept. Zur erfolgreichen Vorbereitung für Großschadensereignisse aus Sicht eines Krankenhauses gehören neben der spezifischen Infrastruktur ein konsequent umzusetzendes Mitarbeiterschulungsprogramm sowie regelmäßige Übungen. [ABSTRACT FROM AUTHOR]

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The Specific Treatment of Children and Adolescents with Substance Use Disorders in a Special Setting - A Qualitative Study of the Minimum Characteristics of OPS Code 9-694 Abstract: Objective: We used a qualitative research design to evaluate the topicality and practical feasibility of applicable minimum characteristics. A draft of a treatment concept prepared by the author according to the minimum characteristics of OPS code 9-694 served as the starting material for the study. The results of the expert interviews were evaluated using qualitative content analysis. Methods: We used a qualitative research design to evaluate the topicality and practical feasibility of applicable minimum characteristics. A draft of a treatment concept prepared by the author according to the minimum characteristics of OPS code 9-694 served as the starting material for the study. The results of the expert interviews were evaluated using qualitative content analysis. Results: The minimum characteristics are assessed as being practical, with additional work becoming a burden, while resources remain the same. There is a need for adapting and defining disorder- and age-specific peculiarities as well as for designing the treatment setting and therapeutic methods. A clear setting, transparency, and the possibility of individual procedures enable practical implementation. Con clusions: This study reveals the need for specialized treatment concepts that map needs and specifications equally. Accordingly, the results of the study represent an important reference for the design of future treatment concepts. The implementation of further development potentials as well as professional transfer of theory to practice require further evaluation involving all those involved in the treatment process.

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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]

A consistent diagnosis and classification system is important to ensure a good understanding of the pathophysiology and ultimate treatment of a disorder . Insomnia is one of the more common complaints encountered in the outpatient setting. Despite the prevalence of insomnia, evaluation, treatment, and research has been hampered by a lack of a standard definition of insomnia. In recent years, there have been important advances in the definition and classification of insomnia. The ICSD-3 and DSM-5 sleep-wake disorder classifications have moved away from the causal attributions that were inherent in previous classifications. The aim is simply to acknowledge the bidirectional and interactive effects between sleep disorders and coexisting medical and psychiatric illnesses. When medical and psychiatric illnesses coexist with insomnia, diagnosis of both disorders allows the plan for the management of insomnia to address both issues and apply comprehensive treatment. [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]

The ward for the treatment of eating disorders was reconceptualized in the context of the reopening of the Kinder- und Jugendpsychiatrie, Psychotherapie und Psychosomatik in Hall in Tyrol. The focus is on systemic-family-therapeutic approaches, interdisciplinarity and groups offered for adolescents and their families struggling with an eating disorder. In addition, the ward will be expanded for adolescents with obesity who also suffer from a psychological comorbidity. Transparency, personal responsibility and voluntariness are lived in a collaboration with adolescents and their families in a multimodal treatment team.

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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]

Treatment of acetabular fractures requires extensive knowledge of the bony anatomy, the amount of possible exposure of the bone with the selected approaches and fracture type-dependent indications of operative treatment. Classification of the fracture with detailed analysis of the fracture morphology is the basis for decision making and planning. The primary treatment aim is the anatomic reconstruction of the acetabulum which results in optimal long-term results. The basis of this overview is the presentation of standard treatment concepts in acetabular fracture surgery. Beside characteristics of the acetabular bony anatomy, biomechanical and pathomechanical principles and the relevant radiological anatomy, the treatment options, both conservative and operative and basic principles of the indications for standard surgical approaches will be discussed. The special fracture type is discussed in detail regarding incidence, injury mechanism, concomitant injuries, options for conservative and operative treatment, quality of operative reduction and long-term results. Furthermore, epidemiological data on typical postoperative complications are evaluated. [ABSTRACT FROM AUTHOR]

For child-oriented treatment of fractures it is important to consider healing processes specific to children. These healing processes necessitate early treatment and a primary definitive treatment concept in line with current standards. The parents or guardians of the child should be directly included while obtaining the anamnesis, for the diagnosis and when planning the treatment concept. Specifically, the potential of spontaneous correction of the growing bone and the necessity or avoidance of imaging procedures should be thoroughly discussed. For the treatment of shaft fractures of the long bones the method of elastic stable intramedullary nailing has found common acceptance as this method significantly reduces both the duration of inpatient treatment as well as the time of immobilization. The child-oriented treatment of fractures is still in development and demands specific knowledge of the orthopedic surgeon concerning the characteristics of the growing bones, the potential of spontaneous correction and the outcome of injuries to the growth plate on the growing skeleton. [ABSTRACT FROM AUTHOR]

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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]

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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]

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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]

Copyright of HNO is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Ilizarov's technology is an internationally recognized clinical treatment method for limb orthopedics, but there are many complications related to external fixation. With the development and progress of the times, the remote-control intramedullary lengthening nails had risen to prominence on the international stage as the second generation of orthomelic technology based on Ilizarov's technology. Since the first remote-control intramedullary lengthening nail appeared in the 1980s, after more than 40 years of development, there are currently more than 3 types of extension mechanisms in remote-control intramedullary lengthening nails and a mature and stable clinical treatment model has been formed during the past long-term clinical treatment and experiments, such as the End-Point-First (EPF) program proposed by Professor Peter H. Thaller in Germany. Compared with Ilizarov's technology, the remote-control intramedullary lengthening nail has obvious advantages in convenience, comfort, risk of infection, soft tissue injury, postoperative pain, and controllability of limb lengthening. This article mainly introduces the development and clinical treatment concept of remote-control intramedullary lengthening nail and the latest clinical treatment status of limb lengthening therapy abroad, hoping to provide new cognition and ideas for the further development of limb orthopedics in China.

The paradigm shift in the treatment concept for acute appendicitis is currently the subject of intensive discussions. The diagnosis and differentiation of an uncomplicated from a complicated appendicitis as well as the selection of an adequate treatment is very challenging, especially since nonoperative treatment models have been published. The laparoscopic appendectomy is still the standard for most cases. Guidelines for the treatment of acute appendicitis do not exist in Germany. Therefore, a group of experts elaborated 21 recommendations on the treatment of acute appendicitis after 3 meetings. After initial definition of population, intervention, comparison and outcome (PICO) questions, recommendations have been finalized through the Delphi voting system. The results were evaluated according to the current literature. The aim of this initiative was to define a basic support for decision making in the clinical routine for treatment of acute appendicitis.

Background: Personalized medicine is nowadays the standard of care for patients with oncological diseases. A prime example is the lymphoma, which has substantial points of contact with ophthalmological care due to the intraocular and periocular involvement., Objective: This article provides a description of the current personalized diagnostics and treatment of ocular lymphomas., Methods: This article constructs a relationship between the current knowledge in the literature, guidelines and recommendations and the clinical experience with ocular lymphomas. It explains in particular the molecular and also individual personalized treatment concepts., Results: The primary suspicion of lymphatic or other ocular oncological diseases is raised by an ophthalmologist based on clinical symptoms. The exact diagnostic procedure is carried out with molecular biological techniques, such as immunohistology and polymerase chain reaction analyses. A staging of the mass is indispensable and the stage classification according to the Ann Arbor criteria for a correct assignment of the lymphoma is of clinical importance. Based on these precise diagnostics an individualized choice of treatment and subsequent personalized follow-up care are carried out. During the complete process from the diagnostic procedure to treatment and aftercare, psycho-oncological support should be offered to the patient., Conclusion: Personalized medicine is already actively performed in the care of ocular lymphomas. The patient is in the forefront and plays a decisive role. By considering the special features of the tumor and patient parameters, the life expectation and relapse-free interval as well as quality of life have been improved for many types of lymphoma. It must be assumed that these advantages also apply to ophthalmology.