Sekundäre Rhinoplastik bei Patienten mit Lippen-Kiefer-Gaumen-Spalte

The secondary correction of cleft lip nose deformity as an ongoing stigma is an important part of surgical rehabilitation for affected patients. It also includes functional improvements. Numerous reports on surgical techniques can be found in the literature. However, the results published worldwide often show that optimal results have not been achieved in all cases. Rhinoplasty on cleft lip and palate (CLP) patients requires extensive rhinosurgical knowledge. There is no universal, generally accepted method that would be applicable to all cleft-related nasal anomalies. Each patient has individual nasal features, and there is remarkable variability of the expression of cleft nose deformity. It is therefore necessary to plan each patient’s treatment separately and to select and apply the available range of rhinosurgical techniques concretely for the individual case. By means of the surgical methods available today, esthetically pleasing results can be achieved. Nevertheless, complete elimination of all cleft-related malformations of the nose is not always possible. Pre-existing scars and skeletal anomalies of the facial skull sometimes require compromises. However, this must not be a reason to be satisfied with moderate results. The best possible functional and esthetic result enables patients with a CLP good quality of life and should be the goal of any surgical rehabilitation.     

Biotechnologische Konzepte zur Behandlung von Rückenschmerzen

In recent years, it is increasingly clear that back pain is not only caused by biomechanical problems. Currently, biologically-based local therapy concepts for the treatment of affected spinal regions as an alternative to the standard treatment with steroids are in development or in early stages of clinical application. The common features of these new therapies are to intervene in the regulation of homeostasis at various key points at the affected region and specifically to suppress or block catabolic influences as well as to provide with anti-inflammatory substances and growth factors. These include on one hand the genetically produced Biologicals such as TNF-α inhibitors and cytokine antagonists and on the other hand therapies with autologous blood preparations (Autologous Conditioned Serum [ACS], and Platelet Rich Plasma formulations [PRP]). This article presents the individual methods, gives an overview of developments and results of various studies and discusses current recommendations.     

Sekundäre Kieferspaltosteoplastik

Secondary cleft osteoplasty as part of the treatment of patients with cleft lip, jaw and palate is performed between the ages of 6 and 12 years to reconstruct the bony defect in the alveolar ridge area. Graft material is usually obtained from the iliac crest, followed by reconstruction of the nasal floor, osseous augmentation, and wound closure. This procedure serves physiological eruption of cleft-adjacent teeth during orthodontic treatment and, amongst numerous others benefits stabilizes the upper jaw segments.     

„Work hardening“ bei chronischen Rückenschmerzen

Work hardening is aimed at a reestablishment of the potentials needed in occupational everyday life. Fundamental motor abilities, such as strength, stability, flexibility and persistence, are restored and merged into the everyday life so that psychological contents, such as fear avoidance behavior will be positively affected. The design of work hardening is interdisciplinary in the sense of a holistic approach to back pain. Handling the pain under load requires sophisticated treatment and the training demands a high degree of individual design. A trusting and mutual agreement between therapist and patient is essential. Work hardening represents an important part of the therapy of chronic back pain and greatly supports regaining confidence in the physical efficiency and the ability to control the body.     

Sekundäre posttraumatische Schulterendoprothetik

Indications

Displaced proximal humerus fractures after osteosynthesis are frequently associated with complications, such as loss of reduction, displaced fragments, non-union or avascular necrosis of the humeral head. In addition, after non-operative treatment with malunion of fractures of the humeral head or in chronic shoulder dislocations, a prosthetic replacement can be necessary in order to achieve a painless shoulder function.

Choice of therapy

In these cases the choice of implant depends on the posttraumatic glenohumeral bone situation on the one hand and on the quality of the rotator cuff on the other. Especially in cases of glenoid bone loss an implanted prosthesis can be difficult to anchor, which can involve augmentation of the glenoid defect using a bone graft.

Outcome

In particular, secondary or revision arthroplasty was found in the literature to be sometimes associated with high rates of complications.

     

Sekundäre posttraumatische Schulterendoprothetik

Trauma und Berufskrankheit - Skapulafrakturen sind seltene Bruchverletzungen, welche sich prinzipiell in extra- und intraartikuläre Formen unterteilen lassen. Sie können selbst bei...     

Sekundärprävention nach urologischen Tumorerkrankungen

It is generally agreed upon that patients require a caring as well as careful medical follow-up after cancer treatment. The goal of secondary prevention is to recognize a recurrence at an early stage and to use the curative chance while the tumor mass is still small. There is evidence of a medically effective and successful follow-up for tumors of the testicle and the bladder. For quality reasons, these follow-up regimes should be adhered to for quality reasons. In other diseases, e.g., renal cell carcinoma, prospective randomized studies are missing which demonstrate the effectiveness of follow-ups. In these cases asymptomatic patients should be stratified to individualized follow-up care.     

Sekundärprävention nach urologischen Tumorerkrankungen

Secondary prevention and aftercare of urological cancers are an essential part of outpatient care provided by the urologist in private practice. More than one-half of the patients who are confronted with the diagnosis of cancer turn to so-called unconventional treatment procedures. The difficulties for those affected and caregivers lie in equal measure in distinguishing between sensible and less advisable or even counterproductive treatment options.Fixed plans of action for aftercare do not do justice to the exigencies of individualized care of cancer patients in private practice, especially with respect to longer survival. Early detection of local recurrence and metastases and the management of complications are determined by the individual disease course and have to be measured against the improvement in quality of life. Secondary preventive measures in the sense of complementary medicine can be helpful. Current evidence is quite promising only for prostate cancer and is of some importance in urological practice.     

Visualisierung von Phantom- und Rückenschmerzen durch bildgebende Verfahren

If patients with chronic low back pain are stimulated in the painful region, an expanded representation of the back in the primary somatosensory cortex becomes visible that increases with chronicity. This "pain memory" might play an important role in the chronicity process. In patients with phantom limb pain, e.g. subsequent to the amputation of an arm or leg, a shift in the representation of neighboring areas into the deafferented area in primary somatosensory cortex has been observed. This reorganization of functional brain maps is not present in congenital amputees or amputees without phantom limb pain. The magnitude of such pain is positively correlated with this reorganization. We present a model of phantom limb pain that assigns an important role to pre-existing chronic pain. The modulation of plasticity and phantom limb pain by anesthesiological manipulation, the use of NMDA receptor antagonists and opioids is presented. Behaviorally relevant stimulation, e.g. by the use of a myoelectric prosthesis or sensory discrimination training can also influence the cortical somatosensory pain memory. More recent studies focus also on brain areas such as the cingulate gyrus believed to be involved in the affective processing of pain.     

Sekundäre Bandrekonstruktion am Ellenbogen

Chronic ligamentous elbow instabilities are posttraumatic in most cases, can lead to severe functional limitations, and are a risk factor for the development of an elbow joint arthrosis. Successful treatment requires an accurate knowledge of the pathogenesis, the necessary diagnostic options and the different reconstruction procedures. According to the direction of instability, chronic posterolateral rotatory instability, lateral, medial and combined multidirectional instabilities can be distinguished. Lateral and medial collateral ligament reconstruction using autologous or allogenic tendon grafts result mainly in good clinical outcomes. However, specific complications such as recurrent instability or ulnar neuropathy are not uncommon. In cases of bilateral ligamentous instability the box-loop technique allows to reconstruct both the lateral and medial collateral ligaments using a single tendon graft circumferentially looped through the humerus and ulna. If sufficient residual ligamentous tissue is still present, a direct augmented repair of the collateral ligaments may be performed even in chronic cases. Elbow joint arthrosis is the main limiting factor for good clinical results and therefore a relative contraindication for collateral ligament reconstruction in chronic cases.     

Intraartikuläre Bupivacaingabe bei Hüftgelenkarthroskopie

The effect of intra-articular bupivacaine on postoperative pain following arthroscopy has been intensively studied for the knee joint but no data are currently available for the hip joint. The aim of the present prospective, randomized and double-blind study was to evaluate a possible effect of intra-articular bupivacaine on postoperative pain intensity following hip arthroscopy. A total of 26 patients were included: 13 received 20 ml of 0.25% bupivacaine through the trocar at the end of surgery and 13 patients received 20 ml of 0.9% NaCl as placebo. Postoperative pain intensity was assessed using a visual analogue scale (VAS) at 0.5 h, 4 h, 8 h, 12 h, 16 h and 20 h, at rest and during movement of the joint and on the basis of additional piritramide requirements. Furthermore, a mean VAS was calculated as the arithmetic mean of all VAS scores assessed over the whole study period. In the bupivacaine group, a significantly lower mean VAS was recorded at rest (17.5 vs 27.5, p=0.05) and during movement of the hip joint (23 vs. 46, p=0.001). The additional piritramide consumption tended to be higher in the placebo group. In conclusion, intra-articular bupivacaine following arthroscopic hip surgery reduces pain in the postoperative period mainly during movement and thus may possibly allow earlier mobilization.     

Frühintervention und sekundäre Prävention psychischer Unfallfolgen

The phase model on prevention and rehabilitation of the German Statutory Accident Insurance stipulates that a psychological early intervention should be initiated for psychological sequelae of accidental injury. Psychological early intervention consists of stabilization, early treatment, and secondary prevention. Evidence-based psychological programs for early intervention have been available for a few years, particularly in the field of cognitive behavioral therapy, which replaced the often ineffectual debriefing approaches. In the acute psychological consultation of the trauma emergency service in Berlin, application of the early intervention method according to Bryant et al. has proven successful, supplemented by addressing the specific needs of the clientele of the employers??liability insurance. Over the course of five therapy sessions, the basic elements of diagnostics as well as risk assessment, psychoeducation, affect control, trauma exposure, and elements of cognitive therapy incorporate the phase model customarily employed in trauma therapy consisting of stabilization ??trauma exposure ??integration. A scientifically based efficacy study analyzing the procedure described here has not yet been conducted.     

Subgruppenspezifische Therapie lumbaler Rückenschmerzen

Background

In spite of profound advances in the diagnosis and therapy, low back pain (LBP) remains one of the main challenges for health systems in western industrialized countries. Clinical trials and meta-analyses typically show heterogeneous evidence and small effect sizes. One explanation for this phenomenon is the heterogeneous nature of the population of patients with LBP, not adequately considered in clinical practice and research. Recent studies and one meta-analysis show that therapy which is specifically directed at well defined subgroups leads to improved effectiveness of interventions, especially for non-surgical interventions such as manual therapy or physiotherapy.

Aim

This article aims to describe the process of classification and to critically evaluate the underlying evidence.

Methods

Two validated and commonly used classification systems were selected and their reliability and validity were critically appraised.

Results

The treatment-based classification system was primarily developed and validated for patients with acute LBP. Based on prognostic factors and clinical prediction rules, patients are classified into one of four treatment based categories: traction, manipulation, specific exercises and stabilization. The movement and motor control impairment classification system is based on movement-related, cognitive and psychosocial factors and was developed for patients with chronic LBP. Maladaptive movement and motor control impairments are considered as underlying mechanisms. Three broad subgroups are proposed: firstly, a group with specific pathologies, such as spinal stenosis or disc prolapse with radiculopathy, secondly a group with dominant psychosocial factors and thirdly a group with maladaptive motor control patterns that drive the disorder with either movement impairments or motor control impairments.

Conclusion

The reliability of the described classification systems is moderate to good, aspects of validity have been shown. Their implementation in clinical practice seems recommendable.     

Infektionsprävention bei der Narkosebeatmung durch Einsatz von Atemsystemfiltern

An interdisciplinary working group from the German Society of Hospital Hygiene (DGKH) and the German Society for Anesthesiology and Intensive Care (DGAI) worked out the following recommendations for infection prevention during anesthesia by using breathing system filters (BSF). The BSF shall be changed after each patient. The filter retention efficiency for airborne particles is recommended to be >99% (II). The retention performance of BSF for liquids is recommended to be at pressures of at least 60 hPa (=60 mbar) or 20 hPa above the selected maximum ventilation pressure in the anesthetic system.The anesthesia breathing system may be used for a period of up to 7 days provided that the functional requirements of the system remain unchanged and the manufacturer states this in the instructions for use. The breathing system and the manual ventilation bag are changed immediately after the respective anesthesia if the following situation has occurred or it is suspected to have occurred: Notifiable infectious disease involving the risk of transmission via the breathing system and the manual bag, e.g. tuberculosis, acute viral hepatitis, measles, influenza virus, infection and/or colonization with a multi-resistant pathogen or upper or lower respiratory tract infections. In case of visible contamination e.g. by blood or in case of defect, it is required that the BSF and also the anesthesia breathing system is changed and the breathing gas conducting parts of the anesthesia ventilator are hygienically reprocessed.Observing of the appropriate hand disinfection is very important. All surfaces of the anesthesia equipment exposed to hand contact must be disinfected after each case.     

Aktuelle Therapie und Sekundärprävention der Lungenembolie

Currently strategies for risk stratification and risk-adjusted diagnostics and management algorithms of patients with pulmonary embolism are undergoing considerable progress and transition. For the new European guidelines expected in 2014, extensive changes are expected in the areas of (1) thrombolysis of normotensive patients with intermediate risk, (2) interventional ultrasound-enhanced low-dose catheter-derived (pharmacomechanical) local thrombolysis, (3) novel oral anticoagulants for therapy and (extended) secondary prophylaxis, (4) possible indications of low-dose aspirin for extended secondary prophylaxis and (5) home treatment of patients with low risk pulmonary embolism. This article summarizes the current guidelines for therapy and secondary prophylaxis of pulmonary embolism and novel clinical studies and the possible implications for therapy and secondary prophylaxis of pulmonary embolism.     

Äußere transpedikuläre Fixation bei der Behandlung von Verletzungen der Wirbelsäule und des Rückenmarks

Injuries to the spine and the spinal cord are an important problem. In the present paper the application of external transpedicular fixation of the spinal column for surgical treatment of patients in the acute phase of spinal cord injuries is described. The results of treatment obtained in 54 patients in the acute phase are presented. Decompression of the spinal cord can be accomplished by way of a dorsal approach. In this way it is possible to remove the compressing factor in stages. Positive results were achieved in the late phase in 84.22% of patients with acute spinal and spinal cord injuries.     

Die Behandlung der Sekundärheilung bei der Küntscher-Nagelung

Ohne Zusammenfassung