Treatment Concepts Research Articles

A Finite Element Analysis to Study the Stress Distribution on Distal Implants in All-on-Six Treatment Concepts as Affected Tilted and Short Implant.

The number of implants and their respective configurations for implant-supported treatment modalities have been studied for 4 implant-supported prostheses; however, it is not yet clear whether the use of tilting or short implants in rehabilitation would result in substantially improved bone/implant/prosthesis biomechanics in all-on-six concepts. This study compared the biomechanical behavior of tilted long implants and axially short implants to support fixed prostheses in an atrophic maxilla with all-on-six treatment concepts. Three different implant configurations were planned, and six models were obtained with posterior maxilla D3 and D4 bone densities in this study. Implants proper for the all-on-four concept were placed in all models. In models 1 and 2, the short implant was placed; in models 3 and 4, 30°, the mesial-angled implant was placed; and in models 5 and 6, 45°, the mesial-angled implant was placed to the molar region. In the models created, 200 N vertical and 150 N oblique (45° angled buccopalatal direction) forces were implemented to the bilateral tooth regions 4-5-6 on the rigid titanium-supported fixed hybrid prosthesis made on these models. When the stress values in the models were investigated, the oblique forces had higher stress values than the vertical forces did. When the stresses created by oblique forces were assessed, the highest values were observed in the models created with short implants, and the lowest stress values were observed in the models made with 30° angle to mesial. When bone densities were assessed, more stress values were noted in models with D4 bone density. It has been shown that mesial tilted long implants placed in the posterior molar region, in addition to all four implant treatment concepts, create less stress against undesirable oblique forces compared with short implants.

Lamellar macular holes-In the center of vitreomacular interface diseases : Pathophysiology, spontaneous courses and treatment concepts

A lamellar macular hole (LMH) is characterized by a distinct morphologic configuration and can be distinguished from related entities such as macular pseudohole (MPH) and epiretinal membrane with foveoschisis (ERM-FS) by clear morphologic features. Based on current knowledge, the pathophysiologic function of LMH in the spectrum of vitreomacular interface diseases will be described and therapeutic concepts will be presented. Current studies are supplemented by case reports to provide a schematic overview of the natural history and therapeutic concepts at the vitreomacular interface. The LMH is as a retrospective marker for pathologic posterior vitreous detachment in adult patients and may be interpreted as the pathophysiologic center of tractional maculopathies. Various vitreomacular pathologies can result in LMH: a detached vitreomacular traction, a spontaneously closed penetrating macular hole, or an epiretinal membrane with foveoschisis. Pathophysiologically, a degenerative, progressive loss of the architecture of the foveal muller cell cone may be the underlaying mechanism, resulting in the typical undermining of the hole edges and occasionally in a full thickness macular hole. The optimal timing and the appropriate surgical method are the focus of current clinical studies. The pathophysiology of LMH indicates a smooth transition of tractive maculopathies. These should be prospectively evaluated in order to develop evidence-based treatment strategies for LMH.

Prognostic impact of caspase-8 mutation in oral cavity squamous cell carcinoma: A real-world cohort study.

e18029 Background: Identifying the drive genes and inhibiting its significant signals were persistently the main concept in cancer treatment. However, for oral cavity squamous cell carcinoma (OCSCC), the most influential genes for overall survival (OS) remain unclear. Methods: A total of 120 OCSCC patients, with corresponding pathologic specimens at initial diagnosis, were collected in Taiwan. After excluding eligible patients, 95 patients were enrolled for analysis. Whole-exome sequencing was done and the prognostic impact of each gene was analyzed. The Cancer Genome Atlas (TCGA) database was used to validate. Results: The incidences of caspase-8 mutation were 22.1% and 10.9% in the Taiwan and TCGA cohort, respectively. In the Taiwan cohort, caspase-8 mutation was the most significant independent for OS with an adjusted hazard ratio (HR) [95% confidence interval (CI)]: 3.83[1.84-7.99]). It was validated by the TCGA database (HR [95% CI]: 1.51[1.00-2.29]). The 5-year OSs of the patients with or without caspase-8 mutation were 38.1% vs. 75.3% ( P < 0.001) (HR [95% CI]: 3.264[1.645-6.438]) in the Taiwan cohort, and 26.1% vs. 49.0% ( P = 0.048) (1.513[1.001-2.288]) in the TCGA cohorts, respectively. Caspase-8 mutation was also individually associated with poor prognosis for TNM stage I/II/III/IV, respectively. L81F, R127*, R472*, R494*, S174*, and T528I were the intersected point mutations of caspase-8. Most of these intersected point mutations were pathologic/likely pathologic variants in the published bioinformatic databases. Conclusions: In conclusion, caspase-8 mutation was the most significant genetic alteration impacting prognosis. Novel agent development could be considered for this candidate.

Current concepts in scoliosis treatment

Current concepts in scoliosis treatment

Primary intracranial germ cell tumors in adolescents and adults: Results of an international, multicenter, retrospective cohort study.

2061 Background: Primary Intracranial Germ Cell Tumors (iGCT) are rare. Previous prospective and retrospective studies mainly included pediatric patients (pts) with a median age of 10-14 years. The aim of this retrospective analysis was to evaluate characteristics, treatment and outcome of adolescents and adults with iGCT. Methods: Data were collected from 10 institutions in Germany and Switzerland. Pts aged >/= 16 years at first diagnosis or at relapse with a primary iGCT were included. Objective responses were evaluated by local investigators. Statistics (Cox proportional hazard model, progression-free survival (PFS) and overall survival (OS) analyzed by Kaplan-Meier method) were performed with SPSS v29. Results: We identified 75 pts (92.0% male) with a median age of 23 years (range 16-60, 94.7% >/= 18 years). At first diagnosis, histology was pure germinoma in 70.7%, pure teratoma in 10.7%, other non-germinomatous GCT (NGGCT) in 13.3%, unknown in 5.3% of pts. Localized, bifocal, and metastatic disease was found in 72.0, 6.7, and 21.3% of pts. As part of their first line (1L) treatment, 69.3%, 80.0%, and 62.7% received surgery, radiotherapy, and chemotherapy, respectively. High dose chemotherapy/ autologous stem cell transplantation (HDCT/ASCT) was part of 1L treatment in n=3 pts with NGGCT. Trimodal and bimodal treatment was performed in 48.0% and 32.0% of pts. Response to 1L therapy was complete remission (CR) in 61.3%, partial remission tumor marker negative (PRm-) in 16.0%, PRm+ in 4.0%, PR with tumor marker status unknown in 4.0%, progressive disease (PD) in 2.7%, and unknown in 12.0%. Relapse occurred in 13/75 pts (17.3%) with unknown histology (n=4), teratoma (n=2), other NGGCT (n=4), and germinoma (n=3). In 2 pts. in whom germinoma was diagnosed at time of first diagnosis, at time of recurrence PNET and Yolk sac tumor were histologically proven. Median time to relapse was 19.0 months (mo.; range 3-223). HDCT/ASCT as salvage treatment was performed in 5 pts with NGGCT and in one pt with germinoma as 2L (n=5) or 3L (n=1). NGGCT histology was associated with increased risk for recurrence or death (p=0.012 and 0.039).3-year PFS was 90.7% (germinoma: 98.1%, NGGCT: 73.9%) and 5-year OS was 92.0% (germinoma: 98.1%; NGGCT: 78.3%). Median follow-up time was 60 mo (range 0-339). Conclusions: Disease characteristics, treatment and outcomes of adolescent/ adult iGCT pts are comparable to those reported in pediatric pts. High cure rates are achieved in pts with pure germinoma and current treatment concepts. In pts with NGGCT further investigation is needed to improve survival outcomes.

Regional Anaesthesia in the Prehospital Setting

Pain is often the main symptom in trauma patients. Although peripheral nerve blocks (PNB) provide fast, safe, and adequate analgesia, they are currently only rarely used outside the perioperative setting. In Germany, intravenous analgesia with non-opioid analgesics (NOPA) and strong opioids is the main treatment concept for prehospital pain. However, the use of highly potent opioids can be associated with significant side effects, especially in emergency patients. Therefore, PNBs are used in many hospitals for the treatment of perioperative pain. As with perioperative use, the advantages of early PNB in the prehospital analgesic treatment of trauma patients are obvious, especially for elderly and multimorbid patients. Early prehospital PNB can also facilitate the reduction of dislocated fractures or dislocated joints as well as the technical rescue of trauma patients. Common geriatric fractures, such as proximal femur or humerus fractures, can be treated appropriately and adequately with PNB.In this article, we show which PNB procedures can be useful in prehospital patient care and which requirements should be met for their safe use. We also present a concept for assessing whether and to what extent the prehospital use of PNB is indicated and appropriate. The aim of this article is to draw attention to PNB as a possible part of prehospital care concepts for trauma patients and to discuss its prehospital use.

Specialised Intensive Care Treatment Concepts for Severe Chest Trauma

This review covers key elements of the critical care management of patients with thoracic trauma. Contrast-enhanced chest computertomography remains the diagnostic modality of choice, as it is more sensitive than conventional chest imaging. Regarding risk stratification, special caution is required in older patients with thoracic trauma given their high risk for posttraumatic complications. In the case of respiratory insufficiency, an attempt of non-invasive ventilation techniques is justified in most patients due to potential treatment benefits. Achieving sufficient pain control is a fundamental goal of critical care management. In this regard, erector-spinae-block and paravertebral block present potentially advantageous alternatives to thoracic epidural anaesthesia. In stable patients, the placement of small-calibre chest tubes may be a beneficial approach compared with large-bore tubes. If surgical stabilization of rib fractures is indicated, it should be done as early as possible.

Therapeutic strategies in preclinical stages of rheumatoid arthritis.

Modern therapies and treatment algorithms, such as the treat‑to‑target strategy, have significantly improved outcomes in patients with rheumatoid arthritis (RA) over the past decades. Moreover, the concept of the "window of opportunity" has led to earlier diagnosis and better treatment outcomes. Nevertheless, progressive disease remains a significant clinical issue and socioeconomic burden, which warrants investigation of novel strategies. One of such innovative therapies is primary prevention: treating patients at risk for developing RA for a short period of time to prevent the disease before it occurs. The initiation of treatment in preclinical phases of RA is expected to delay, halt, or even prevent the disease onset or progression in the long term. This review summarizes this new concept, discusses current studies including an overview of therapeutic algorithms and findings, and provides a critical evaluation of pharmacologic approach in the preclinical stages of RA.

The Role of Rehabilitation after Spinal Mesotherapy in a Three-Stage Treatment Concept.

Sedentary lifestyles, work overload, and lack of regular physical activity are risk factors for spinal pain syndrome. In everyday medical practice, spinal pain syndrome of a muscular or myofascial, or non-neurogenic, nature is diagnosed. This problem affects a large group of patients and reaches about 70-80% of spinal pain cases. Usually, one of the primary treatments is with NSAIDs (Non-steroidal Anti-Inflammatory Drugs). In this case, one treatment method that is safe and has no side effects is spinal mesotherapy. This method consists of performing multi-point intradermal microinjections with the administration of drugs or medical devices. Based on a new perspective on the treatment of spinal pathology-the so-called three-stage treatment concept-it is necessary to deal with the risk factor(s) of spinal pain syndrome and reduce or at least modify them (stage I). This is followed by a broadly understood medical therapy, in this case spinal mesotherapy (stage II), which aims to relax tense tissues, improve mobility in the spine and thus reduce pain. As a result, conditions are created for the necessary process, which is rehabilitation in the broadest sense (stage III). Movement therapy, which is crucial in spinal pain syndrome, is performed with less pain, after obtaining better patient mobility. The purpose of this article is to evaluate the role of rehabilitation of patients after spinal mesotherapy in terms of the three-stage treatment concept for spinal pathology.

Treatment outcomes of pulpotomy versus pulpectomy in vital primary molars diagnosed with symptomatic irreversible pulpitis: protocol for a non-inferiority randomised controlled trial

BackgroundPulpectomy continues to be the standard treatment recommendation for management of vital primary molars diagnosed with symptomatic irreversible pulpitis. The recent decade has seen a paradigm shift in the treatment concepts of how vital mature permanent molars diagnosed with irreversible pulpitis can be more conservatively managed using vital pulp therapy techniques like pulpotomy. However, despite emerging evidence indicating similarities between primary and permanent tooth pulp response to dental caries, there is limited research on whether pulpotomy can be similarly used as a definitive treatment modality for vital primary teeth with irreversible pulpitis. This randomised controlled trial (RCT) aims to compare the treatment effectiveness of pulpotomy versus pulpectomy in management of vital primary molars diagnosed with symptomatic irreversible pulpitis over a two-year period.Methods/designThis clinical study is a parallel, two-armed, open label, non-inferiority RCT with a 1:1 allocation ratio between the experimental intervention arm (pulpotomy) and the active comparator arm (pulpectomy). Healthy cooperative children, between 4–9 years of age, who have painful primary molars with clinical symptoms typical of irreversible pulpitis will be recruited after obtaining informed consent from their parents/legal guardians. 50 vital primary molars clinically diagnosed with symptomatic irreversible pulpitis will be randomly distributed between the two treatment arms. The primary outcomes that will be assessed are clinical and radiographic success after six-months, one-year and two-years of the trial interventions. The influence of baseline pre-operative variables (age; gender; tooth type; site of caries; pre-operative furcal radiolucency; pre-operative pain intensity) and intra-operative factors (time taken to achieve haemostasis) on treatment outcomes will also be assessed. The secondary outcome evaluated will be the immediate (24 h and 7 d) post-operative pain relief afforded by the two treatment interventions.DiscussionThis trial seeks to provide evidence on whether pulpotomy treatment can be no worse than the standard pulpectomy treatment for the management of symptomatic irreversible pulpitis in vital primary molars.Trial registrationClinicalTrials.gov (NCT06183203). Registered on 30 January 2024.

Vasculitis of the retina : Clinical aspects, diagnostics, management and treatment

Inflammatory changes in the retinal vessels can be attributed to awide range of etiologies. These include infections, intraocular and systemic autoimmune processes, general diseases and iatrogenic factors. As the endothelium of the retinal capillaries forms the inner blood-retinal barrier, adisruption of this structure is directly associated with consequences for the fluid electrolyte balance of the retina. Clinical sequelae can include leakage of the retinal vessels and macular edema, which are often functionally threatening and significantly reduce the quality of life of patients. As the eye can be affected as an "index organ", awork-up of the patient by the ophthalmologist is of great importance. In the age of "precision medicine", efforts are being made to gain new insights into the pathogenetic mechanisms of vasculitis through "omics" in order to develop innovative treatment concepts.

Care and medical costs of urticaria in children in Germany : Drugs, medical and inpatient services

Data on the course of urticaria in children exist, but there is alack of sound data on patient management to ensure high-quality care. Retrospective secondary data analysis in the field of health care and epidemiology in children with urticaria based on routine data from aGerman health insurance company (DAK-Gesundheit). Data from insured persons under 18years of age who were treated as outpatients or inpatients with adiagnosis of urticaria (according to ICD-10 classification) in 2010-2015 were included. The control group consisted of children without acorresponding diagnosis, in order to clarify health economic and care-related differences after adjusting for age and gender. In 2015, 1904 (1.3%) of 151,248 insured minors had adiagnosis of urticaria. Of the children with urticaria, 70.9% visited at least one physician on an outpatient basis. Of these visits, 70.9% were made to apediatrician, 52.5% to ageneral practitioner and 33.0% to adermatologist; 11% were treated as inpatients. With atotal of 151,248 insured persons, 1904 of whom were diagnosed with urticaria, 72.9% of children and adolescents with versus 28.9% without urticaria were treated topically or systemically in 2015, including 10.5% of children with urticaria vs. 2.6% without urticaria received topical therapy and 70.0% with urticaria received systemic therapy vs. 27.5% without urticaria with systemic therapy. The most commonly used oral medications for urticaria were cetirizine (44.2%), prednisolone (9.8%), and dimetindene (2.0%) . Topical methylprednisolone aceponate (49.8%) was prescribed most frequently. The therapy costs for systemic drugs was € 24.00 per patient, while topical drugs cost € 1.58 per patient. The lack of guidelines for the standardization of treatment in children still leads to ambiguities and different treatment concepts among the specialist groups, which must be eliminated in order to enable more efficient therapies. The treatment of chronic urticaria in children and adolescents is mainly carried out by pediatricians, general practitioners and dermatologists. Systemic and topical medications as well as inpatient services are the most important cost factors.

Verification of the accuracy of dynamic navigation for conventional and mouthpiece methods: in vivo study.

Dynamic navigation for implant placement is becoming popular under the concept of top-down treatment. The purpose of this study is to verify the accuracy of a dynamic navigation system for implant placement. Implant placement was performed on 38 patients using 50 implant fixtures. Patients in group C were treated using a conventional method, in which thermoplastic clips were fixed to the teeth, and patients in group M were treated using thermoplastic clips fixed to a mouthpiece attached to the teeth. The groups were compared to verify whether an accuracy difference existed. A treatment planning support program for dental implants was used to superimpose the postoperative computed tomography data on the preoperative implant design data to measure the entry point, apex point, and angular deviation. The accuracy of group C was 1.36 ± 0.51mm for entry point, 1.30 ± 0.59mm for apex point, and 3.20 ± 0.74° for angular deviation. The accuracy of group M was 1.06 ± 0.31mm for the entry point, 1.02 ± 0.30mm for the apex point, and 2.91 ± 0.97° for angular deviation. Significant differences were observed in the entry and apex points between the two groups. The results indicate that group M exhibited better accuracy than group C, indicating that the stability of the thermoplastic clip is important for ensuring the accuracy of the dynamic navigation system. No previous studies have verified the accuracy of this system using the mouthpiece method, and additional data is required to confirm its accuracy for dental implant placement. The mouthpiece method improves the accuracy of implant placement and provides a safer implant treatment than the conventional method. University hospital Medical Information Network Clinical Trials Registry (UMIN-CTR), Registration Number: UMIN000051949, URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view_his.cgi on August 21, 2023.

Mandibular overdenture with a single implant in the canine region (c-SIMO): a feasibility study

ObjectivesThe aim of this multi-center pilot study was to assess the viability and feasibility of a novel treatment concept – the canine-positioned single implant mandibular overdenture (c-SIMO), with the single implant placed on the patient's preferred chewing side instead of the midline.Materials and methodsParticipants received a single implant in the canine region of their preferred chewing side, based on an Asymmetry Index observed during mastication. The pre-existing mandibular denture was transformed into a c-SIMO on a spherical attachment. The primary outcome was oral health-related quality of life (OHRQoL), measured with GOHAI and OHIP-EDENT. Secondary outcomes included denture satisfaction index (DSI), chewing efficiency (CE), maximum bite force (MBF), implant survival and success, and prosthetic maintenance. Data analysis included descriptive statistics and bivariate comparison tests.ResultsFifteen participants received the c-SIMO treatment (mean age: 69.9 ± 7.0). Implant success and survival rates were 100% at 1 year. Patient-reported outcome measures improved significantly compared to pre-treatment values (OHIP-EDENT: p = 0.001; DSI: p = 0.001; GOHAI: p = 0.002). Masticatory outcomes also improved significantly (CE: p = 0.001; overall MBF: p = 0.005). Post-implant, MBF was significantly higher in the ipsilateral side compared to the contralateral side at 2 weeks (p = 0.019) and 3 months (p = 0.015), but no longer at T3 (p = 0.730). Common prosthodontic events included denture base adjustments (n = 17) and matrix activation (n = 9).ConclusionsThis pilot study concludes that c-SIMO is a promising treatment option, and a potential alternative to the single midline implant overdenture.Clinical relevanceThe novel treatment concept of a canine-positioned single implant mandibular overdenture could be a viable treatment alternative to the midline positioning.

Truth Lies in the Depths: Novel Insights into Facial Aesthetic Measurements from a U.S. Survey Panel.

Aesthetic facial bone surgery and facial implantology expand the boundaries of conventional facial surgery that focus on facial soft tissue. This study aimed to reveal novel aesthetic facial measurements to provide tailored treatment concepts and advance patient care. A total of n=101 study participants (46 females and 55 males) were presented with 120 patient portraits (frontal images in natural head posture; 60 females and 60 males) and asked to assess the facial attractiveness (scale 0-10; "How attractive do you find the person in the image?") and the model capability score (MCS; scale 0-10; "How likely do you think the person in the image could pursue a modelling career?"). For each frontal photograph, defined facial measurements and ratios were taken to analyse their relationship with the perception of facial attractiveness and MCS. The overall attractiveness rating was 4.3 ± 1.1, while the mean MCS was 3.4 ± 1.1. In young males, there was a significant correlation between attractiveness and the zygoma-mandible angle (ZMA)2 (r= - 0.553; p= 0.011). In young and middle-aged females, MCS was significantly correlated with facial width (FW)1-FW2 ratio (r= 0.475; p= 0.034). For all male individuals, a ZMA1 value of 171.79 degrees (Y= 0.313; p= 0.024) was the most robust cut-off to determine facial attractiveness. The majority of human evaluators (n=62; 51.7%) considered facial implants a potential treatment to improve the patient's facial attractiveness. This study introduced novel metrics of facial attractiveness, focusing on the facial skeleton. Our findings emphasized the significance of zygomatic measurements and mandibular projections for facial aesthetics, with FI representing a promising surgical approach to optimize facial aesthetics. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Aging behaviour assessment of cellulosic fibres in alkaline media: A green technology approach in construction materials

With the increasing demand for buildings, the utilisation of green materials represents a novel approach toward achieving sustainable development goals. Cellulose-based materials, such as jute, exemplify eco-friendly substances for civil engineering applications. The present study aims at studying the aging behavior of jute fibers in an alkaline environment. For this purpose, three alkali environments (NaOH, KOH, Ca(OH)2) with three different concentrations were selected. Samples were treated at three different periods (7 d, 14 d, and 28 d) to assess the impact of treatment on the fiber properties. This study introduces a pioneering concept of the alkali treatment of jute-based fibres to evaluate tensile strength and weight loss, marking the first of its kind. This approach incorporates various characterisation techniques, including Differential Scanning Calorimetry (DSC), Thermo-Gravimetric Analysis (TGA), and Scanning Electron Microscopy (SEM) to assess the treatment process. In our experimental procedures, we evaluated key parameters such as the type of alkali, alkali concentration, and curing time for their influence on tensile strength. Subsequently, we applied Response Surface Methodology (RSM) in conjunction with bagging techniques to develop mathematical models based on the acquired data. Results demonstrated varied tensile strengths based on alkali type, concentration, and treatment duration. Fibres treated with 15 g/L concentration of NaOH exhibited an increase in tensile strength from 7 days (79.66 MPa) to 28 days (225.05 MPa). The highest tensile strength of jute fibres treated with KOH was observed with 15 g/L concentration at 14 days (237.58 MPa). For Ca(OH)₂ treatments, the highest tensile strength was observed with 30 g/L concentration at 14 days (111.28 MPa). It was also observed that prolonged exposure to very high alkali concentrations could adversely affect the tensile strength, as observed in the case of 30 g/L concentration of NaOH at 28 days (84.73 MPa). Among the various alkali materials tested, NaOH and KOH demonstrated greater effectiveness compared to Ca(OH)2. According to RSM analysis, the time of sample curing was found to be the most significant factor in tensile strength, with a P-value of 0.009. On average, the tensile strength changes by 54 %, 52 %, and 35 % for NaOH, KOH, and Ca(OH)₂, respectively, when the curing time shifts from 7 days to 28 days.

Planned supportive bougienage is the basis for complex endoscopic treatment of refractory cicatricial strictures of the esophagus and anastomoses

Purpose of the study: the concept of complex endoscopic treatment of refractory benign cicatricial strictures of the esophagus and esophageal anastomoses is outlined, including the methodology of long-term planned supportive bougienage with intramural injections of glucocorticosteroids based on our own extensive experience. The results of an analysis of immediate and first long-term results in this group are presented, as well as detailed recommendations for the management of patients after interventions. Materials and methods. For the period from 2013 to 2023 in the endoscopic department of the Federal State Budgetary Institution “Petrovsky National Research Center of Surgery” 70 patients with refractory cicatricial strictures of the esophagus and anastomoses underwent complex endoscopic treatment, including the main course and long-term planned supportive bougienage, supplemented with intramural injections of Dexamethasone and triamcinolone according to the protocol we developed. Results. Of the total number of patients, 16 (23%) patients, after one or several courses of intramural steroid injections, did not have restenosis for 1 year or more, and 38 (54%) patients required no more than 3 sessions of prophylactic bougienage. In 49 (70%) patients, the duration of treatment was less than 1 year, and the average number of bougienage sessions was from 11 to 20. Conclusion. During the endoscopic treatment of patients with esophageal stenoses of various etiologies and strictures of the esophageal anastomoses, it is very important to assess the refractoriness of the narrowing at an early stage and determine the indications for intramural injections of glucocorticosteroids. Only if all recommendations and a regimen of long-term planned supportive bougienage are followed is it possible to achieve lasting stabilization of the lumen in the narrowing zone and avoid recurrence.

Reconstruction options for infection-related defects : Plastic surgery armamentarium

The occurrence of infections has always been feared in all surgical disciplines. Plastic reconstructive surgery faces the challenge of treating infection-related defects on apatient-specific basis, which requires amultidisciplinary treatment concept. Satisfactory treatment success can only be achieved through radical debridement for infection cleansing, optimization of the perfusion situation paired with targeted anti-infective treatment and, if necessary, with soft tissue reconstruction by plastic surgery. This article presents the current possibilities of plastic and reconstructive surgery with respect to the reconstruction of infection-related defects. Proven and reliable strategies are presented and supplemented by promising experimental approaches. Due to the often multilayered defect situation caused by infections, from the epidermis to cancellous bone, the entire armamentarium of plastic and reconstructive surgery is used for reconstruction. The early involvement of plastic surgery in the treatment of infections and the interdisciplinary and multimodal treatment approach have proven their worth in the treatment of complex infection situations.

Treatment strategies for recurrent rectal cancer

Multimodal treatment approaches with neoadjuvant radiotherapy and chemotherapy followed by oncological and total mesorectal excision (TME) have significantly reduced the recurrence rate even in locally advanced rectal cancer. Nevertheless, up to 10% of patients develop alocal relapse. Surgical R0 resection is the only chance of a cure in the treatment of locally recurrent rectal cancer (LRRC). Due to the altered anatomy and physiology of the true pelvis as aresult of the pretreatment and operations as well as the localization and extent of the recurrence, the treatment decision is individualized and remains achallenge for the interdisciplinary team. Even locally advanced tumors with involvement of adjacent structures can be treated in designated centers using multimodal treatment concepts with potentially curative intent.

Modified scoring system for the quantitative assessment of histological regression in peritoneal carcinomatosis after pressurized intraperitoneal aerosol chemotherapy: A pilot study.

Peritoneal carcinomatosis is one of the leading causes of death in patients with gastrointestinal cancer. Newer locoregional treatment concepts include pressurized intraperitoneal aerosol chemotherapy (PIPAC), the regional application of pressurized chemotherapeutic agents to the abdominal cavity, which is usually performed every 4 to 8 weeks. One of the main challenges of PIPAC therapy remains the objective assessment of treatment response. The present study describes a new scoring system to histologically assess the regression of peritoneal cancer following PIPAC therapy, quantitative assessment of histological regression in peritoneal carcinomatosis (QARP). Peritoneal biopsies from 27 patients with peritoneal metastases undergoing PIPAC were obtained and processed in a standardized fashion. Biopsies were scored according to the QARP grading system. The five-tiered system was graded as follows, Grade 0, no residual tumor cells with regressive changes present; grade 1, 1-25% viable tumor cells per tumor focus with regressive changes present; grade 2, 26-50% viable tumor cells per tumor focus with regressive changes present; grade 3, 51-75% viable tumor cells per tumor focus with few regressive changes; grade 4, >75% viable tumor cells per tumor focus with minimal or no regressive changes. Based on the new grading system, the study cohort was divided into QARP responders and QARP non-responders following PIPAC treatment. Higher QARP scores were significantly correlated with higher PCI scores (r=0.32; P=0.007). However, no difference in overall survival was detected between QARP responders and QARP non-responders. Further studies are required to ascertain the reproducibility and prognostic significance of QARP.