Interdisciplinary Treatment Approach Research Articles

Extracorporeal lung support in trauma patients with severe chest injury and acute lung failure: a 10-year institutional experience

IntroductionSevere trauma with concomitant chest injury is frequently associated with acute lung failure (ALF). This report summarizes our experience with extracorporeal lung support (ELS) in thoracic trauma patients treated at the University Medical Center Regensburg.MethodsA retrospective, observational analysis of prospectively collected data (Regensburg ECMO Registry database) was performed for all consecutive trauma patients with acute pulmonary failure requiring ELS during a 10-year interval.ResultsBetween April 2002 and April 2012, 52 patients (49 male, three female) with severe thoracic trauma and ALF refractory to conventional therapy required ELS. The mean age was 32 ± 14 years (range, 16 to 72 years). Major traffic accident (73%) was the most common trauma, followed by blast injury (17%), deep fall (8%) and blunt trauma (2%). The mean Injury Severity Score was 58.9 ± 10.5, the mean lung injury score was 3.3 ± 0.6 and the Sequential Organ Failure Assessment score was 10.5 ± 3. Twenty-six patients required pumpless extracorporeal lung assist (PECLA) and 26 patients required veno-venous extracorporeal membrane oxygenation (vv-ECMO) for primary post-traumatic respiratory failure. The mean time to ELS support was 5.2 ± 7.7 days (range, <24 hours to 38 days) and the mean ELS duration was 6.9 ± 3.6 days (range, <24 hours to 19 days). In 24 cases (48%) ELS implantation was performed in an external facility, and cannulation was done percutaneously by Seldinger's technique in 98% of patients. Cannula-related complications occurred in 15% of patients (PECLA, 19% (n = 5); vv-ECMO, 12% (n = 3)). Surgery was performed in 44 patients, with 16 patients under ELS prevention. Eight patients (15%) died during ELS support and three patients (6%) died after ELS weaning. The overall survival rate was 79% compared with the proposed Injury Severity Score-related mortality (59%).ConclusionPumpless and pump-driven ELS systems are an excellent treatment option in severe thoracic trauma patients with ALF and facilitate survival in an experienced trauma center with an interdisciplinary treatment approach. We encourage the use of vv-ECMO due to reduced complication rates, better oxygenation and best short-term outcome.

Esthetic management of a rare combination of dental trauma with a multidisciplinary approach: A case report

A combination traumatic injury involving avulsion and intrusive luxation type of injury is a rare clinical occurrence. This case report describes the management of an intruded central incisor along with repositioned avulsed teeth. The rationale behind this interdisciplinary treatment approach was to use orthodontic extrusion of the tooth for biological repositioning of the tooth along with esthetic management during the treatment period. Clinical Relevance to Interdisciplinary Dentistry Avulsed teeth when replanted immediately have a good prognosis. Orthodontic extrusion is a viable treatment option in cases of intrusion and subgingival fractures. It is conservative treatment with an extremely favorable prognosis. Management of traumatic injury requires a multidisciplinary approach.

Aneurysmal subarachnoid hemorrhage in elderly patients: long-term outcome and prognostic factors in an interdisciplinary treatment approach

The number of elderly patients with aneurysmal subarachnoid hemorrhage (SAH) is increasing with the aging of the population. However, management recommendations based on long-term outcome data and analyses of prognostic factors are scarce. Our study focused exclusively on elderly patients aged ≥ 60 years at the onset of SAH. Patients were selected from an in-house database and compared in cohorts of age 60-69, 70-79, and ≥ 80, regarding pre-existing medical conditions, treatment, clinical course including complications, and outcome. A multivariate analysis was conducted to identify prognostic factors for death and disability. A total of 256 patients (138 aged 60-69, 93 aged 70-79, 25 aged ≥ 80) with putative aneurysmal SAH who had been admitted to our hospital between January 1, 1996 and June 30, 2007 were extracted. The median follow-up of our total cohort was 35.5 months (range <1-154 months). Endovascular or conservative aneurysm treatment was applied more often with increasing age (p < 0.006). The 1-year survival rate was 78, 65, and 38 % in the three age groups, respectively (p = 0.0002); most of the patients died from the initial hemorrhage or from medical complications. Patients aged <70 with an initial World Federation of Neurosurgical Societies (WFNS) score of I-III showed the best clinical recovery. WFNS score, age, and clipping/coiling were extracted as prognostic factors from the Cox model. Elderly patients who get admitted with a good WFNS score (I-III) seem to benefit from aggressive treatment whereas caution seems to be warranted particularly in patients ≥ 70 years of age who get admitted in a WFNS score of IV and V because of their limited short- and long-term prognosis.

Peripartum Consultations Expand the Role of the Fetal/Neonatal Neurologist

The peripartum period entails the next prenatal interval when novel neuroprotective strategies will be designed and tested. Research development will lead to novel evaluations for maternal-fetal pairs who require inpatient treatment and possible delivery for worsening or acute neurologic problems. Future studies should critically compare serial fetal surveillance assessments with postnatal clinical findings to detect and treat more accurately fetal/neonatal brain disorders that begin or worsen during the peripartum period. Clinical management decisions require an interdisciplinary treatment approach. Protocols may begin before and during parturition, and continue through neonatal resuscitation and early postnatal periods into infancy. Appropriate choices of preventive, rescue, and repair neuroprotective interventions must consider both the timing and etiologies of encephalopathies in the context of maternal, fetal, placental, and neonatal diseases.

Adult interdisciplinary therapy

Adult patients have many preexisting conditions like tooth loss, severe skeletal dysplasia, periodontal disease, and various temporomandibular dysfunctions. In such adult patients, an interdisciplinary treatment approach is followed by customizing orthodontic treatment for the individual patient. This article shows a case that is managed in an interdisciplinary method of treatment approach.

Interventional therapy for chronic low back pain

Chronic low back pain has become a major public health problem in Korea. The lifetime prevalence of low back pain has been reported to be as high as 90%. The prevalences of discogenic pain, facet joint pain, and sacroiliac joint pain are 42%, 30%, and 18%, respectively. Increasing age is associated with a decreasing probability of discogenic pain but increasing probabilities of facet joint pain and sacroiliac joint pain as the source of low back pain. Physical examination of low back pain is limited and imaging may lack objective clues. Diagnostic interventions allow us to determine the etiology of back pain. Techniques include lumbar disc stimulation, facet joint block, medial branch block, and sacroilliac joint block. Initial therapy includes modification of activity, pharmacological analgesic therapy, and education of patients. In patients with chronic low back pain, a multimodal and interdisciplinary treatment approach is necessary. Use of interventional treatments for chronic low back pain are increasing but their utilization remains uncertain or controversial. Therefore, management of patients with chronic and disabling low back pain remains a clinical challenge.

Comparative evaluation of microleakage in Class V cavities using various glass ionomer cements: An in vitro study

Aim: The study aimed to evaluate the microleakage of nano-filled resin-modified glass ionomer restorative (nano-filled RMGI) in comparison with that of conventional glass ionomer cement (CGIC), and resin-modified glass ionomer cement (RMGIC). Materials and Methods: Forty-five standardized Class V cavity preparations were prepared on sound extracted human molar teeth. Teeth were randomly assigned to three experimental groups of 15 teeth each and restored as follows: Group 1, CGIC; Group 2, RMGIC; and Group 3, nano-filled RMGI. The specimens were placed in a solution of 2% Rhodamine-B dye for 24 h at room temperature under vacuum. Staining along the tooth restoration interface was recorded. Results were analyzed using Kruskal-Wallis and Wilcoxon tests. Results: There were no statistically significant differences in dye leakage between all the three restorative materials for occlusal margins (P = 0.464). Group 3 showed significantly less microleakage compared to Group 1 (P = 0.007) and Group 2 (P = 0.040) at the gingival margins. The degree of microleakage in the gingival margins of each group was more than that found in occlusal margins. Conclusions: No material was able to completely eliminate microleakage at enamel, dentin, or cementum margin. Nano-filled RMGI showed least microleakage compared to other two cements at gingival margins. Clinical Relevance to Interdisciplinary Dentistry Cervical lesions have been a restorative challenge for dentists for many years. An interdisciplinary treatment approach is the appropriate choice in cases where there is gingival recession and cervical lesions. Glass ionomer cements have been commonly used for restoration of cervical lesions. Nano-filled resin-modified glass ionomer cement can be used for the restoration of cervical lesions, as it has a better marginal sealing ability compared to conventional glass ionomer and resin-modified glass ionomer cements.

Functional and Esthetic Rehabilitation of a Patient with Amelogenesis Imperfecta - A Case Report

Amelogenesis Imperfecta is a hereditary condition where enamel formation is disturbed resulting in defects in mineralization or matrix formation. This case presentation deals with the multidisciplinary approach to rehabilitate a case of amelogenesis Imperfecta of the hypo calcified type. The aim of the treatment was to save the remaining teeth preserve the tooth structure as much as possible while preventing further tooth loss maintain and improve masticatory function and to improve the esthetics.A systematic and sequential interdisciplinary treatment approach was carried out and the patients functional and esthetic requirements were fulfilled.

Significance and clinical relevance of biologic width to implant dentistry

The concept of biologic width forms the basis for a successful peri-implant soft tissue integration around titanium implants. The purpose of this review is to evaluate the present knowledge about this important zone that forms the basis for a successful implant. Methodology: Electronic search of the Medline/PubMed was done using the search words and MeSH Headings including, biologic width, peri-implant soft tissue, crestal bone loss, platform switch, biologic width and dental implant, implant abutment junction. Hand search of the prosthetic,implantology, and the periodontology journals was also undertaken for the collection of the data.Clinical Relevance to Interdisciplinary Dentistry Implant dentistry involves an interdisciplinary treatment approach of prosthodontics, periodontics, and surgical aspects. A profound knowledge of the biologic response and the underlying anatomical/histologic aspects of the bone and the overlying soft tissues is critical for the success of the implant. Biologic width is a healthy self-limiting zone around implant. It acts as a mirror for the underlying health of the supporting tissues. Violation of the biologic width generates a revoking response from the tissues, which then tries to accommodate at the stake of the crestal bone. This review article tries to demystify the conveniently overlooked biologic zone and the affecting factors/variables responsible for the viability of this zone.

Palatogingival Groove: A Cause for Periapical Infection

ABSTRACTThe palatal groove is a developmental anomaly; when it is present in a tooth, it causes periodontal as well as endodontic problems. These grooves often present a challenge to the clinicians as diagnosing and treatment planning that requires an interdisciplinary treatment approach. This case report describes the successful collaborative management of a maxillary lateral incisor with an extensive palatal groove, using a combination of surgical endodontic therapy along with periodontal therapy.How to cite this articleBharti R, Chandra A, Tikku AP, Arya D. Palatogingival Groove: A Cause for Periapical Infection. Int J Prosthodont Restor Dent 2012;2(2):61-65.

Chapter III: Management of Cardiovascular Risk Factors and Medical Therapy

Critical limb ischaemia (CLI) is a particularly severe manifestation of lower limb atherosclerosis posing a major threat to both limb and life of affected patients. Besides arterial revascularisation, risk-factor modification and administration of antiplatelet therapy is a major goal in the treatment of CLI patients. Key elements of cardiovascular risk management are smoking cessation and treatment of hyperlipidaemia with dietary modification or statins. Moreover, arterial hypertension and diabetes mellitus should be adequately treated. In CLI patients not suitable for arterial revascularisation or subsequent to unsuccessful revascularisation, parenteral prostanoids may be considered. CLI patients undergoing surgical revascularisation should be treated with beta blockers. At present, neither gene nor stem-cell therapy can be recommended outside clinical trials. Of note, walking exercise is contraindicated in CLI patients due to the risk of worsening pre-existing or causing new ischaemic wounds. CLI patients are oftentimes medically frail and exhibit significant comorbidities. Co-existing coronary heart and carotid as well as renal artery disease should be managed according to current guidelines. Considering the above-mentioned treatment goals, interdisciplinary treatment approaches for CLI patients are warranted. Aim of the present manuscript is to discuss currently existing evidence for both the management of cardiovascular risk factors and treatment of co-existing disease and to deduct specific treatment recommendations.

Oromandibular dystonia: A clinical report

Oromandibular dystonia (OMD) consists of prolonged spasms caused by contraction of the muscles of the mouth and mandible and involves the muscles of mastication, facial expression, tongue, and eye lids. A multidisciplinary treatment approach is presented including the fabrication of a dental prosthesis to reduce/eliminate the symptoms of OMD. Etiology and treatment issues are discussed, emphasizing the importance of an interdisciplinary treatment approach.

An Interdisciplinary Treatment Approach Combining Orthodontic Forced Eruption with Immediate Implant Placement to Achieve a Satisfactory Treatment Outcome: A Case Report

Periodontal disease often results in severely bony defects around the teeth and leads to eventual extraction. Remaining bone morphology often compromises ideally restoration-driven positions and deteriorates the success rates for dental implants. The present investigation illustrates the clinical outcome of immediately installing an implant following orthodontic forced eruption and atraumatic extraction. The subject of this study is a 40-year-old Asian female with a right mandibular first molar that had a deep probing depth on the mesial side and mobility. Via the aid of radiographic examination, the tooth that had an angular bony defect and apical lesion was diagnosed as having deep caries and chronic periodontitis with a poor prognosis. After consultation with the patient, we developed a treatment plan incorporating a forced eruption with immediate implantation, intended to augment the alveolar bone volume and increase the width of keratinized gingivae, in a nonsurgical manner. Following 12 months of orthodontic treatment, the tooth was successfully moved occlusally in conjunction with an 8 mm vertical interdental bone augmentation. Because of sufficient volume of bone and satisfactory gingival dimensions, the implant showed adequate initial stability in the correct position to facilitate physiological and aesthetic prerequisites. After 6 months of osteointegration, a customized impression coping was utilized to transfer the established emergence profile to a definitive cast for the fabrication of a customized abutment. The final prosthesis was made using a customized metal abutment and ceramometal crown. In the face of difficult clinical challenges, meticulous inspection and a comprehensive treatment plan were crucial. Interdisciplinary treatment through the careful integration of multiple specialists suggests the possibility of optimal results with high predictability.

Surgical aspects and outcome of combined liver and kidney transplantation in children

In children with renal insufficiency and accompanying or underlying liver disease, combined liver and kidney transplantations (CLKT) are indicated. However, because of the rare indications, the number of paediatric CLKT is low. Our aim was to analyse CLKT in children with special regard to surgical aspects and outcome. All paediatric CLKT performed at our institution between 1998 and 2009 were retrospectively analysed. Between 1998 and 2009, 15 CLKT were performed in 14 paediatric patients (median age 8 years, range 1-16 years). The indications for CLKT were autosomal recessive polycystic kidney disease (n = 7), primary hyperoxaluria type 1 (n = 7) and retransplantation because of primary liver nonfunction (n = 1). In the postoperative course, six patients showed bleeding complications, thereof three patients needed operative revision for intra-abdominal bleeding. Eight of 15 patients (53%) needed dialysis. The 1- and 5-year patient survival was 100%; and 1- and 5-year graft survival was 80% for the liver and 93% for the kidney allograft. A number of different complications, especially secondary haemorrhage have to be anticipated after CLKT, requiring a timely and interdisciplinary treatment approach. With this management, our patients showed an excellent graft and patient survival.

Congenitally missing maxillary lateral incisors: Restorative replacement

A As dentists, we are often faced with the question: to close or not to close? Since maxillary lateral incisors are often congenitally missing, replacement of these teeth raises several important treatment planning concerns. Therefore, it is beneficial to use an interdisciplinary treatment approach to obtain the most predictable outcome. There are multiple treatment options for the replacement of congenitally missing lateral incisors, including canine substitution, single-tooth implants, and tooth-supported restorations. Drs Zachrisson, Rosa, and Toreskog beautifully illustrated the benefits of canine substitution by presenting the advantages and disadvantages of space closure as well as the functional and esthetic limitations that accompany this treatment choice. Like our European colleagues, our team agrees with the underlying principle to develop treatment plans that are both conservative and functional while maintaining excellent esthetics. However, the esthetic and functional success of canine substitution ultimately depends on variables such as malocclusion, crowding, profile, crown shape and color, and smiling lip level. Also, the amount of crown reduction that is often required to appropriately position these teeth esthetically and functionally in 3 planes of space can be excessive. Therefore, the optimal canine substitution patient is one who has small canines with crowns that match the shade of the central incisors. Ideally, he or she should also have a nice profile, a Class II dental relationship, and no crowding in the mandibular arch. However, many patients do not meet these criteria, and multiple veneers often need to be placed on the anterior teeth to overcome the

Efficacy of cold therapy on spasticity and hand function in children with cerebral palsy

Spasticity remains a major cause of disability among children with cerebral palsy (CP). Effective management depends on careful assessment and an interdisciplinary treatment approach. The purpose of this study was to investigate the effect of cold therapy when used in combination with conventional physical and occupational therapy to control upper limbs’ spasticity and to improve hand function in children with spastic CP. Thirty children of both sexes (12 girls and 18 boys) with spastic CP with ages ranged from 4 to 6 years (mean age 62.2 ± 7.5 months) participated in this study. They had mild to moderate spasticity in elbow and wrist flexors. Children were randomly divided into two groups of equal number: group I and group II. Children in group I received cold therapy on elbow and wrist flexors immediately before the application of conventional physical and occupational therapy. Those in group II received the same conventional occupational and physical therapy only. In both groups treatment was conducted three times per week for a successive 3 months. Spasticity, range of motion (ROM) and hand function were evaluated before and after the treatment by using the Modified Ashworth Scale, the electronic goniometer and the Peabody Developmental Motor Scale, respectively. Both groups showed a statistically significant reduction in spasticity, increase in ROM and improvement of hand function but group I showed a more significant improvement. It can be concluded that cold therapy in conjunction with conventional physical and occupational therapy significantly reduced spasticity, increased ROM and improved hand function in children with spastic CP.

Counseling Adult Clients Experiencing Chronic Pain

Chronic pain affects 35% to 57% of the adult population in the United States and results in billions of dollars spent annually in direct health‐care costs and lost productivity. Extensive research confirms the considerable role psychological factors play in the experience and expression of chronic pain. The author discusses implications for counseling adult clients experiencing chronic pain, specifically interventions, interdisciplinary treatment approaches, treatment planning, diversity, and ethical/legal considerations.

Neurologische Komplikationen in der Anästhesiologie – Teil I – Schlaganfall, Visusverlust, zentral anticholinerges Syndrom

Neurological complications following anesthesia deteriorate patients' outcome, and increase hospital costs because of prolonged hospitalization and supplemental medical care. Moreover, patients' satisfaction is negatively influenced by neurological sequelae after anesthesia. Improving anesthesiologic management based on consequent prevention measures can help to reduce the incidence of neurological complications after anesthesia. In case of neurological complications in the perioperative phase an interdisciplinary approach in immediate diagnosis and treatment may prevent patients from permanent damage. The present review article gives an overview over incidences, diagnostic and therapeutic issues of neurologic complications in operative patients, such as perioperative stroke, postoperative visual loss and the anticholinergic syndrome.

Acupuntura y dolor: una historia en tres partes: Segunda parte: La integración de la acupuntura en el tratamiento moderno del dolor

Background : In modern pain therapy, a more integral view on the patient has become prevalent. Interdisciplinary approaches for diagnosis and treatment have become established, especially regarding patients suff ering from chronic pain. Besides the application of conventional pain medicine, alternative therapy options are being implemented. Here, especially acupuncture has become important since it emphasizes the unity of body, mind, and soul. Aim : The historical evolution of the integration of acupuncture into pain therapy as well as the scientific knowledge regarding this therapeutic approach will be explained. Methods: Extant literature about the development of pain therapy, acupuncture techniques, as well as results of basic research was interpreted in the context of daily clinical practice. Results : Considering the changes pain therapy experienced over the last century, the integration of acupuncture into increasingly important interdisciplinary treatment approaches appears almost as a logical consequence. The bio-psycho-social model representing the basis of modern pain therapy emphasizes the interrelation of pain syndromes and purely physical factors, the patient's life situation, and social background, in the same way as done in acupuncture therapy. In this context, the development of western acupuncture styles besides the traditional Chinese techniques is of special interest. Discussion : The summary of the historical and scientific background of acupuncture and pain medicine reveals that interdisciplinary therapy and, especially the integral point of view represent relatively new approaches. Thus, further progress in the treatment of chronic pain patients can be expected.

Impact of Underlying Depression on Treatment of Neuropsychiatric Symptoms in Older Adults with Dementia

This article examines the moderating effect of depression on interdisciplinary treatment approaches for behaviors in dementia. A secondary analysis of data collected on tailored treatment of 105 long-term care residents with dementia found a significant relationship between treatment and passivity (p < 0.001), treatment and agitation (p = 0.001), and the mediating effect of change in passivity on change in agitation (p < 0.001). The moderating effect of depression was found as a significant factor. For participants with depression and agitation, a significant change in passive behavior was related to significant change in agitated behavior. Thus, by focusing treatment on passivity, both types of neuropsychiatric behaviors improved. The implications of thoroughly assessing not only a behavior problem such as agitation but also other neuropsychiatric symptoms that complicate the delivery of the intervention are discussed.