Current Concepts In Treatment Research Articles

Current Concept of Surgical Treatment for Knee Osteoarthritis

Current Concept of Surgical Treatment for Knee Osteoarthritis

HIV-Related Cerebral Toxoplasmosis Revisited: Current Concepts and Controversies of an Old Disease.

Cerebral toxoplasmosis is the most common cause of expansive brain lesions in people living with HIV/AIDS (PLWHA) and continues to cause high morbidity and mortality. The most frequent characteristics are focal subacute neurological deficits and ring-enhancing brain lesions in the basal ganglia, but the spectrum of clinical and neuroradiological manifestations is broad. Early initiation of antitoxoplasma therapy is an important feature of the diagnostic approach of expansive brain lesions in PLWHA. Pyrimethamine-based regimens and trimethoprim-sulfamethoxazole (TMP-SMX) seem to present similar efficacy, but TMP-SMX shows potential practical advantages. The immune reconstitution inflammatory syndrome is uncommon in cerebral toxoplasmosis, and we now have more effective, safe, and friendly combined antiretroviral therapy (cART) options. As a consequence of these 2 variables, the initiation of cART can be performed within 2 weeks after initiation of antitoxoplasma therapy. Herein, we will review historical and current concepts of epidemiology, diagnosis, and treatment of HIV-related cerebral toxoplasmosis.

Neuropathic pain syndromes and channelopathies

The causes for neuropathic pain are manifold and remain unexplained in the majority of cases. In recent years agrowing number of pain syndromes have been attributed to mutations in genes encoding voltage-gated sodium channels. Hence, this group of rare diseases should be considered in the differential diagnostics of neuropathic pain. Evaluation of topic-related literature and discussion of own experiences as well as consideration of current guidelines. Alterations in the electrical excitability of nociceptive neurons by pathogenic mutations in sodium channels lead to disease patterns, such as small fiber neuropathy and various pain syndromes. This article summarizes the knowledge on these genetic diseases and discusses the differential diagnosis of neuropathic pain. Current treatment concepts are presented and the predominantly experimental approaches to targeted modulation of sodium channels are discussed. The treatment of patients with chronic neuropathic pain requires interdisciplinary cooperation and is often difficult due to an unsatisfactory treatment response. Increasing knowledge on rare genetically determined channelopathies can contribute to the development of novel pharmaceuticals since ion channels are central players in the processing of pain.

Management of meningioma

Meningiomas are the most frequent primary brain tumors, accounting for ∼37% of central nervous systems tumors. Despite being largely benign, clinicians frequently face difficult treatment decisions in cases with complex morphology or localisation, near vital brain structures such as the optic nerve or in the case of incidental tumors. Here, we review current concepts of diagnosis, treatment and follow-up with clinical decision-making informed by multimodal imaging, histology, and molecular biology.

Tennis elbow.

Tennis elbow is the most common cause of lateral-sided elbow pain with a major socioeconomic impact. The etiology of tennis elbow is not completely understood, but there are many different treatment options. This review gives an overview of the current concepts of diagnosis and treatment of tennis elbow and the impact on work participation.

Obstetric antiphospholipid syndrome

The present clinical and laboratory classification criteria for antiphospholipid syndrome (APS) were established in Sydney, Australia, in 2006. In this review, we focus on the obstetric subset of APS (OAPS),...

Spine Fractures in Ankylosing Diseases: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU).

Study Design:Review of literature and case series.Objectives:Update and review of current treatment concepts for spine fractures in patients with ankylosing spinal disorders.Methods:Case presentation and description of a diagnostic and therapeutic algorithm for unstable spinal injuries with an underlying ankylosing spinal disorder (ASD) of the cervical and thoracolumbar spine.Results:Nondisplaced fractures can be missed easily using conventional X-rays. Thus, computed tomography (CT) scans are recommended for all trauma patients with ASD. In doubt or presence of any neurologic involvement additional magnetic resonance imaging (MRI) scans should be obtained. Spine precautions should be maintained all times and until definitive treatment (<24 h). Nonoperative fracture treatment is not recommended given the mechanical instability of the most commonly seen fracture patterns (AOSpine B- and C-type, M2) in patients with ASD and inherent high risk of secondary neurologic deterioration. For patients with ankylosing spondylitis (AS) or diffuse idiopathic hyperostosis (DISH) sustaining cervical spine fractures, a combined anterior-posterior instrumentation for fracture fixation is recommended. Closed reduction and patient positioning can be challenging in presence of preexisting kyphotic deformities. In the thoracolumbar (TL) spine, a posterior instrumentation extending 2 to 3 levels above and below the fracture level is recommended to maintain adequate reduction and stability until fracture healing. Minimally invasive percutaneous pedicle screws and cement augmentation can help to minimize the surgical trauma and strengthen the construct stability in patients with diminished minor bone quality (osteopenia, osteoporosis).Conclusions:Current concepts, treatment options, and recommendations of the German Orthopedic Trauma Society–Spine Section for spinal fractures in the ankylosed spine have been outlined.

Limiting consumption in tuberculosis: current concepts in anti-tuberculosis treatment in the critically ill patient.

Limiting consumption in tuberculosis: current concepts in anti-tuberculosis treatment in the critically ill patient.

Chronic Essex-Lopresti injury: a systematic review of current treatment options.

Essex-Lopresti lesion (ELL) is a severe injury. Most of ELL is recognized in chronic phase representing a therapeutic challenge for orthopaedic surgeons. The aim of this systematic review is to highlight and criticize current concepts in the surgical treatment. The search was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline. A comprehensive research of Pubmed database was made using the following Mesh term: ((Essex-Lopresti injury) OR (Essex Lopresti) OR (distal radio ulnar dissociation) OR (distal radio ulnar dislocation) OR (longitudinal forearm instability)). Quality assessment of each article was performed according to Coleman score by two authors. Eight full articles were included to the systematic review. Surgical treatment was differentiated in five categories according to the most common procedure reported in clinical series. The mean Coleman Score was 51.13 ± 9.76. Case series reported in the literature include a limited number of patients with chronic ELL. Currently, salvage procedure devoted to treat a wrong diagnosis and an incorrect treatment is used. Radial head replacement together with ulnar shortening osteotomy and interosseous membrane reconstruction are the most common treatments of choice, but at present, there is not yet a shared scheme of management for patients with chronic ELL. According to current literature, a case-by-case treatment must always be considered. Further investigations, with higher level of evidence, quality of study design, and number of patients, are needed to better assess clinical results and complication of each technique. IV.

Nonalcoholic Fatty Liver Disease in Children.

Nonalcoholic steatohepatitis, a progressive form of nonalcoholic fatty liver disease (NAFLD), is one of the most common hepatic diseases in children who present with particular risk factors including obesity, sedentary lifestyle, and/or a predisposing genetic background. The worldwide prevalence of NAFLD in children is a worrying phenomenon because this disease is closely associated with the development of both cirrhosis and cardiometabolic syndrome in adulthood. To date, the etiopathogenesis of primary NAFLD in children is unknown. Understanding the pathogenetic mechanisms provides the basis to characterize early predictors of the disease and noninvasive diagnostic tools and to design novel specific treatments and possible management strategies. Despite a few clinical trials on the use of antioxidants combined with lifestyle intervention for NAFLD, no treatment exists for children with NAFLD. In this review, the authors provide an overview of current concepts in epidemiology, histological features, etiopathogenesis, diagnosis, and treatment of NAFLD in pediatric population.

Primary Osteosarcoma in the Elderly Revisited: Current Concepts in Diagnosis and Treatment.

Osteosarcoma is mostly seen in bones of children and young adults. When it occurs in older persons, the tumor is considered secondary usually complicating Paget disease or irradiated bone. However, there is a second incidence peak of primary osteosarcoma later in life when these tumors occur de novo. This article describes the clinical, imaging, and treatment of POS in older patients, including demographic data of patients from our institution. We present our experience with 920 cases of osteosarcoma that were seen between 1984 and 2003 at the University of Texas MD Anderson Cancer Center in Houston, TX, USA. Among the 868 primary osteosarcoma of bones, there were 100 (11.52%), which comprised 69% of the tumors in patients over the age of 50years. Older patients with primary osteosarcoma tend to have relatively more common axial skeleton involvement, have more distant disease, and are difficult to treat because of concomitant comorbidities. Despite that, most adult patients treated with chemotherapy have shown good results with longer disease-free survival. A lytic bone lesion seen in radiographs of elderly patients should include primary osteosarcoma among differential diagnoses. Radical surgery and chemotherapy seem to ensure long-term disease-free survival in most cases. The elderly patients with POS in pelvis, spine, and upper extremities and those with distant disease (metastases) have worse prognosis.

Current treatment concepts for iatrogenic ventriculitis: a nationwide survey in Germany.

Iatrogenic ventriculitis is a common complication of the external ventricular drainage. While the procedure and indications for external ventricular drains (EVD) are highly standardized, the treatment of ventriculitis is not clearly defined. To depict the treatment of iatrogenic ventriculitis currently performed in German hospitals. A standardized questionnaire consisting of 18 multiple choice questions, each with the ability to provide additional individual answers, covering the diagnosis and treatment of iatrogenic ventriculitis as well as general handling of EVDs, was sent to 121 neurosurgical hospitals registered in the German Society for Neurosurgery (DGNC). Thirty-three out of 121 hospitals returned the questionnaire. While diagnostics are performed similarly in most hospitals, the treatment varies remarkably. Ten of the 33 (30%) units never applied antibiotics intrathecally and 12 (36%) only in selected (1-20%) cases, while 7 (21%) do this routinely, and the remaining 4 centers vary their treatment. While the targeted systemic therapy after pathogen identification and resistance testing is similar, the choice of empiric antibiotics varies as does the type of drug used for intrathecal therapy. Among the applied systemic antibiotics, vancomycin [n=23 (70%)] and meropenem [n=22 (67%)] were the most common, but many others, including ceftriaxone, metronidazol, linezolid, piperacillin/tazobactam, fosfomycin and ceftazidim, are used. There is no standard practice regarding EVD handling. Twelve (36%) hospitals do not replace the EVD after a new diagnosis of ventriculitis, 13 (39%) do so once after the diagnosis, and 8 (24%) regularly switch EVDs after a defined time span (7-20days), even without signs of infection. Treatment concepts for iatrogenic ventriculitis are very heterogeneous. Thus, there is an urgent need for generating outcome data and defining a standard treatment algorithm with the recently published practice guideline being an important first step.

Current Treatment Concepts for Stress Urinary Incontinence.

Initially, stress urinary incontinence should be treated by conservative measures, such as weight reduction, hormonal substitution, physiotherapy, pelvic floor exercise and/or the use of pessaries. Incontinence surgeries are only recommended in case of unsuccessful conservative therapy. Today, tension-free suburethral sling insertions represent the gold standard of incontinence surgery yielding very good outcomes (cure rates of 80–90 %). Pelvic-floor sonography provides important information on decision of surgical methods and the management of complications. Furthermore, intra- or paraurethral injection of bulking agents is a promising, minimally invasive surgical alternative. This article discusses treatment concepts, pre-, intra- and post-operative examinations, decision on surgical methods, operational details for surgical success, and the prevention and management of complications.

Tumors of the hand.

Tumors of the hand comprise a vast array of lesions involving skin, soft tissue and bone. The majority of tumors in the hand are benign. Malignant tumors, although rare, do occur and frequently have unique characteristics in this specific anatomic location. Careful staging, histological diagnosis and treatment are essential to optimize clinical outcome. However, straightforward most of the time, hand tumor management does have pitfalls; caution is advised, as a missed or delayed diagnosis or an improperly executed biopsy may have devastating consequences. This article reviews the clinical spectrum of the most common benign and malignant bone and soft tissue tumors of the hand and discusses the clinicopathological findings, imaging features and current concepts in treatment for these tumors.

Current Concepts in Treatment of Barrett’s Esophagus With and Without Dysplasia

BackgroundAround 10–15% of patients with gastroesophageal reflux disease will develop Barrett’s esophagus (BE). The development of novel endoscopic modalities has changed the management of BE in the last decade. AimThe aim of this study was to review the current evidence for the treatment of BE with and without dysplasia. ResultsIn patients with BE without dysplasia, antireflux surgery should not be suggested as a modality to prevent the malignant transformation of BE, but its indications should be the same as for other patients with gastroesophageal reflux. Endoscopic surveillance at intervals of 3–5 years is recommended for these patients. For patients with BE with low-grade dysplasia, radiofrequency ablation (RFA) is the preferred treatment modality, while endoscopic surveillance every 12 months is an acceptable alternative in patients with life-limiting comorbidities. For most patients with BE and high-grade dysplasia, RFA is the preferred treatment strategy. Patients with intramucosal adenocarcinoma (T1a), should be treated with EMR followed by ablative therapy, in order to eradicate the remaining intestinal metaplasia. Endoscopic resection may be suitable for low-risk T1b tumors (well-differentiated, without lymphovascular invasion, and with superficial submucosal invasion); however, further data are necessary to better risk stratify this group. ConclusionsPatients with BE without dysplasia should undergo endoscopic surveillance every 3–5 years. Endoscopic ablative therapy (RFA) is the preferred treatment modality for dysplastic BE. Patients with T1a adenocarcinoma should be treated with EMR followed by ablative therapy. Low-risk T1b tumors may be suitable for endoscopic resection.

Prevalence and Therapy of Crystal Methamphetamine Dependence

Following a short overview on the epidemiology and clinical correlates of amphetamine abuse and dependence, with special emphasis on metamphetamine ("crystal"), current treatment concepts and recent results of therapy research are discussed. The efficacy of two inpatient treatment models for methamphetamine dependence are currently studied in a study funded by the German Ministry of health. The study concept is given and possible implications are discussed.

Second-Line Treatment of NSCLC-The Pan-ErbB Inhibitor Afatinib in Times of Shifting Paradigms.

In contrast to the established role of epidermal growth factor receptor (EGFR) inhibitors for the first-line treatment of patients with non-small cell lung cancer (NSCLC) harboring activating EGFR mutations, the role of EGFR blockade and of EGFR molecular testing in the second-line treatment remains less clear. The irreversible pan-ErbB family inhibitor afatinib (Gi(l)otrif®) was recently FDA- and EMA-approved for the second-line treatment of NSCLC with squamous cell histology irrespective of the EGFR mutational status (LUX-Lung 8). Contrariwise, results from the TAILOR and DELTA trials among retrospective biomarker analyses show the predictive value of the EGFR mutational status for efficacy of reversible EGFR inhibitors also as a second-line therapy. This mini review critically summarizes the current role of EGFR-targeting strategies in the second-line treatment of NSCLC with special respect to afatinib in light of emerging T790M-specific EGFR and immune check point inhibitors. The review also emphasizes the urgent need for reliable biomarkers to guide therapeutic decision-making and outlines prospective changes to the second-line landscape with some of the current second-line treatment concepts likely to be moved to the first-line.

Current Concepts in Surgical Treatment of Neuroblastoma

Current Concepts in Surgical Treatment of Neuroblastoma

Lymph node management in the treatment of oral cancer: Analysis of a standardized approach.

A supraomohyoid neck dissection (SOHND) is part of the surgical management of patients with oral cancer, even in the absence of clinical or radiographic evidence of neck disease. We have investigated a standardized approach to the management of cervical lymph nodes, in patients with a primary oral cancer. A modified surgical technique has been presented and a clinical algorithm has been described and evaluated. SOHND was performed either uni- or bi-laterally. In cases of positive nodes in levels II or III, the dissection was extended in terms of a modified radical neck dissection (MRND) and a SOHND was performed contralaterally. 112 patients were included. 42% had lymph node metastases in any level. Overall, lymph node metastases were found in 2.8% of all examined nodes. Most metastases (34.6%) occurred in level Ib. 12.6% were located in level IIb. No metastases could be detected in levels IV and V. No statistically significant difference could be shown with regard to T-stage, location, or co-factors as gender and age. SOHND is the gold-standard in patients with no preoperative evidence of lymph node metastases. The presented algorithm is able to facilitate dissection and histological analysis and might improve the surgical care in current treatment concepts. The extension to an MRND facilitates the identification of patients in need of adjuvant therapy.

Impingement of the hip

Femoroacetabular impingement (FAI) describes the repetitive painful contact between the acetabulum, the pelvis and the proximal femur. This bony abutment can lead to a characteristic pattern of chondrolabral damage and is one of the main etiological factors in the development of juvenile osteoarthritis of the hip joint. This article describes the current treatment concepts of FAI and the radiological assessment including an overview of standard measurement methods, coxometric parameters and cut-off values. Furthermore, the authors stress the importance of a profound understanding of the entire configuration of the pelvis and the dynamic interplay of its components.