Versorgungslandschaft in der arthroskopischen Chirurgie in Deutschland

Background

The German healthcare system is subject to constant change. Arthroscopic surgery is particularly affected by this as a result of the transfer of such operations to the outpatient sector and the liberalization of the healthcare market. The aim of this study was to collect data describing the structure of the services provided in the field of arthroscopic surgery in the outpatient and inpatient sectors.

Materials and methods

A total of 496 doctors participated in the survey by means of online and offline questionnaires. After a check of the completeness and plausibility of the answers had been performed it was possible to include and statistically evaluate the datasets of 124 physicians from 114 private practices and 207 physicians from 188 hospitals.

Results

Among private practices the dominant concept is the group practice with up to four physicians in one location. Of the physicians in private practice 96?% provide outpatient and inpatient surgery and more than 44?% of these have invested in their own surgical practice. In more than 70?% of cases physicians in private practice provide inpatient surgery at a hospital as “Honorararzt” (a private physician who works independently for one or more hospitals in return for a fee). Compared with surgeons at hospitals, surgeons in private practices receive less training authority; therefore fewer residents are associated to private practices although they have a higher volume of outpatient interventions.

Conclusion

The structural data which have been collected for the first time here demonstates the high degree of flexibility of the services offered in the field of arthroscopic surgery in Germany. A future challenge will be adapting the training structures to the changed circumstances.     

Therapieresistente Otitis externa mit zusätzlicher Trommelfellperforation

Ear canal infections may not always be clinically distinguished between a bacterial otitis externa, an otomycosis or a mixed infection. In addition, tympanic membrane perforations are often not immediately apparent. The use of a broad-spectrum antiseptic agent without an inner ear toxic effect would therefore be beneficial. We report the case of a female patient suffering from intractable otitis externa with tympanic membrane perforation, who was successfully treated locally with a mixture of 1% NCT and 0.1% dexamethasone.     

Regeneration des N. facialis im Vergleich zu anderen peripheren Nerven

Despite increasing knowledge of cellular and molecular mechanisms determining the success or failure of peripheral nerve regeneration, no effective treatments for peripheral nerve injury exist. Newly developed and validated approaches for precise numerical assessment of motor deficits have recently allowed testing of novel strategies in experimental animals. One of these approaches is the daily manual stimulation of the denervated musculature. This treatment is effective in cases of cranial nerve lesions with preservation of the sensory input (facial or hypoglossal nerve) and has the potential of direct translation in clinical settings. However, manual stimulation appears to be ineffective for the treatment of mixed peripheral nerve injuries. Generally, no long-term improvement of functional recovery is achieved by electrical stimulation in rodents. While short-term post-traumatic stimulation of the proximal nerve stump has no negative effects, direct electrical stimulation of the muscle during the period of de- and reinnervation appears to hinder muscle fibre reinnervation. Finally, experimental evidence suggests that application of peptides known as glycomimetics, which mimic functional properties of carbohydrate molecules, may provide significant benefits after injuries of mixed peripheral nerves.     

Riechstörungen bei neurodegenerativen Erkrankungen

Impairment of olfaction is a characteristic feature of many neurodegenerative diseases. This review summarizes the available information about olfactory function in distinct neurodegenerative conditions and indicates the advantageous use of olfactory testing in the diagnosis of Parkinson’s disease and Alzheimer’s dementia.     

A six-year study of the Omniscience valve in four Canadian centers

Stimulated by the recent controversy over the Omniscience valve, we conducted a follow-up study on 413 hospital survivors in whom this prosthesis was implanted at four Canadian centers from 1979 to 1985. One hundred forty-seven underwent aortic valve replacement (AVR), 203 had mitral valve replacement (MVR), 10 had tricuspid valve replacement (TVR) and 53 underwent multiple valve replacement (45 AVR + MVR, 5 MVR + TVR, and 3 AVR + MVR + TVR). The mean age was 50.8 +/- 13 years (range, 2 months to 75 years). Follow-up of 96% was achieved for a mean of 2.6 years and a maximum of 6 years with a total of 1,076 patient-years. Complications were defined and graded according to severity. Analyses were performed to yield linearized and actuarial rates for complications. There were 30 late deaths (2.8% per patient-year). At 5 years, the actuarial survival was 89 +/- 3% (AVR, 89 +/- 3% and MVR, 91 +/- 3%). Percentages for freedom from each complication are as follows: endocarditis, 96 +/- 1% (AVR, 96 +/- 2% and MVR, 98 +/- 1%); periprosthetic leak, 99 +/- 0.6% (AVR, 98 +/- 1% and MVR, 99 +/- 0.6%); thrombotic complications, 87 +/- 3% (AVR, 84 +/- 6% and MVR, 90 +/- 3%); valve thrombosis 99.4% (AVR and MVR, 100%); anti-coagulant-related hemorrhage, 94 +/- 2% (AVR, 97 +/- 2% and MVR, 94 +/- 2%); and all valve-related complications, 77 +/- 3% (AVR, 77 +/- 6% and MVR, 79 +/- 4%). Reoperation was required at the rate of 1.2% per patient-year.(ABSTRACT TRUNCATED AT 250 WORDS)     

Osteoporose in der späteren Postmenopause

Osteoporosis is widespread disease. One in two women after age 50 will suffer from an osteoporotic fracture. Most fractures occur in late postmenopause. Diagnostic procedures include personal and family history, physical examination, imaging (bone densitometry and X-ray) and laboratory work-up. Fracture risk assessment with FRAX© supports individualized decision making for bone-specific treatment recommendations. However, FRAX© does not have the same significance across German speaking countries. Osteoporosis treatment involves preventive recommendations (e.g. vitamin D, calcium, protein-rich nutrition and physical activity) and bone-specific pharmacotherapy, such as bisphosphonates, strontium ralenate, denosumab and recombinant parathormone. Menopausal hormone therapy and selective estrogen receptor modulators (SERMs) do not play a major role in treatment for this age group and follow-up procedures depend on the treatment chosen.