Sozialstiftung Bamberg

Phytotherapeutika werden in Deutschland häufig nachgefragt, sind jedoch nicht immer in medizinischen Leitlinien verankert. Ziel dieser Arbeit ist eine systematische Auswertung deutschsprachiger Leitlinien zu Atemwegserkrankungen hinsichtlich Empfehlungen zu Phytotherapeutika. 36 AWMF-Leitlinien (S1–S3) zu Erkrankungen der oberen und unteren Atemwege wurden hierfür gescreent. In 6 der 36 Leitlinien konnten Phytotherapeutika in den Empfehlungen oder dem Hintergrundtext gefunden werden. Die Leitlinien zu Rhinosinusitis und zu akutem/chronischem Husten bieten die detailliertesten Darstellungen inkl. konkreter Präparate und Evidenzbewertung. Weitere Erwähnungen finden sich in den Leitlinien zu Halsschmerzen, Asthma und Riech- und Schmeckstörungen. Phytotherapeutika sind demnach in einigen Leitlinien zu Atemwegserkrankungen berücksichtigt, mit einer Schwerpunktsetzung auf Husten- und Rhinosinusitis. Für viele Atemwegserkrankungen fehlen bislang jedoch Evidenzen für systematische Empfehlungen. Dies verdeutlicht den Bedarf an weiterer Forschung und Integration evidenzbasierter Phytotherapie in Leitlinienprozesse.

There are two basic techniques to surgically reconstruct peripheral nerves for the recovery of function after traumatic nerve injuries. The end-to-end (EtE) neurorrhaphy, and in case of loss of the proximal stump, the end-to-side (EtS) neurorrhaphy, where the distal end of the acceptor nerve is connected to the side of a donor nerve. The current study was designed to further contribute to finding the best surgical technique for an EtS neurorrhaphy, comparing the functional outcome in a rat model.Using a rat sciatic nerve model, qualitative and quantitative analyses were performed to evaluate peripheral nerve regeneration after EtS. A total of 22 female Lewis rats (Charles River Wiga, 190 g, 8 weeks old) were used for this study. In one test group (E1/n = 6), an EtS was conducted without, and in the other (E2/n = 8) with performing a partial neurotomy (PN) through the epineurial partial flap (EPF).In the test groups (E1/E2), animals with EtS neurorrhaphy without PN reached the best mean functional score of 1.8 points according to our grading scale. Animals with EtS and PN scored with a mean of 2.2 points. These rats with EtS neurorrhaphy and PN had the poorest outcome. The control group C1 with EtE neurorraphies showed the best functional outcome with an average score of 1.The EtE represents the best surgical option for reconstruction of a nerve's anatomical continuity after transection if both ends are preserved. The EtS, on the other hand, represents a good alternative with almost equally good functional outcome in cases where the proximal nerve stump was lost. Results also indicate that an EPF should be created for optimal collateral axonal sprouting and the best possible results when performing an EtS. However, all other additional injuries of the donor nerve, such as a PN, should be avoided.

Der Klettersport ist eine Sportart, die bis ins hohe Alter ausgeübt werden kann. In Studien hat sich gezeigt, dass sie gesundheitsfördernd und verletzungsarm ist. Dennoch kommt es auch beim Klettern regelmäßig zu akuten und chronischen Verletzungen, insbesondere im Bereich der Hände. Am häufigsten treten Ringbandrupturen der Finger, Kapselentzündungen der kleinen Fingergelenke (Kapsulitis) sowie Tenosynovitiden der Beugesehnen auf. Zudem führt langjähriges Klettern im hohen Schwierigkeitsbereich zu physiologischen Anpassungsvorgängen aber auch zu vermehrten degenerativen Veränderungen im Bereich der Finger. Durch eine korrekte Diagnose und Therapie der o.g. Pathologien lässt sich bei den meisten Patienten die Sportfähigkeit dennoch auf einem hohen Niveau erhalten. Rock climbing is a sport that can be practiced into old age. Studies have shown that it promotes good health and is low-risk in terms of injuries. Nevertheless, acute and chronic injuries occur regularly in climbing, especially in the hands. The most common injuries are finger flexor pulley lesions, chronic capsulitis of the small finger joints and tenosynovitis of the flexor tendons. In addition, many years of climbing at a high level of difficulty lead to physiological adaptations but also to increased degenerative changes in the fingers. With correct diagnosis and treatment of the above-mentioned pathologies, most patients can still maintain a high level of athletic ability.

IntroductionPrimary Periphyseal Stress Injuries (PPSI) of the hand and fingers are relatively uncommon but are most frequently seen in adolescent rock climbers. A major limitation in the current literature on PPSIs is the lack of a standardized nomenclature and radiological classification. This gap complicates the accurate diagnosis, treatment, and comparison of outcomes across studies.MethodsWe conducted a comprehensive structured literature review of the relevant PPSI literature in climbers using Pubmed, SPORTDiscus, and Web of Science to identify the relevant studies on PPSI in adolescent rock climbers. Based on the findings from existing research and our own data, we propose a new classification system for these injuries.ResultsA five-grade classification system, with subgroups, has been developed based on both clinical and radiographic data. The classification is presented in a table, along with figures illustrating examples of the various injury types.ConclusionAdditional research is required to assess the reliability and reproducibility of this classification system. We plan to conduct these evaluations in future studies.

Current available outcome data following laparoscopic intraperitoneal onlay mesh repair (IPOM) for incisional hernia (IH) are comparable to a limited extent only because of a huge number of variability particulary in surgical technique and use of medical devices. In this prospective observational multicenter cohort study we evaluate the impact of a consensus driven standard protocol for IPOM, that is mesh fixation with absorbable tacks in double crown technique enforced by additional non-absorbable transfascial sutures at the edges of the mesh along with the use of Physiomesh™, on clinical and patient reported outcome measures. A total of 102 consecutive patients were screened for eligibility between September 2013 and October 2014. 85 patients (IH: EHS W1: n=39, W2: n=46) were included into the study. Clinical examination and PROM for pain and quality of life measure (Carolina Comfort Scale, CCS) were performed at baseline, during hospital stay and at 6 weeks, 6 months and 1 year follow-up. The follow-up rate was 87,1% for the primary endpoint. The Kaplan-Meier estimate for freedom-of-recurrence at 1 year was 95.9% (95%-CI: 87.9-98.7%), the cumulative recurrence rate at 1 year was 4.1% (95%-CI: 0.9-11.7%). There was no intraoperative complication. One seroma (type I; 1/84 (1,2%), 95%-CI: 0-7.1%) was diagnosed during hospital stay. 12 seroma (n=12/74 (16,2%), 95%-CI: 9.4-26.4%; n=10 type II and n=2 type IV) were diagnosed during follow-up requiring surgical intervention in 1 patient (1,4%, Clavien Dindo grade IIIb). Subcutaneous hematoma were found during follow-up in 8 patients (8/75 (10.7%); 95%-CI: 5.3-19.9) with need for surgical intervention in 2 patients (2,7%, Clavien Dindo grade IIIb). There were 3 superficial surgical site infections (3/74 (4,1%); 95%-CI: 0.9-11.7%, Clavien-Dindo grade I) without need for reoperation. Patient reported pain as measured by numeric rating scale at baseline was 1.36±1.53 and 0.35±1.04at 1 year follow-up. CCS total scores indicated a good outcome with a decrease to 2.80±6.47 (Min: 0, Q1: 0, Median: 0; Q3: 3.0; Max: 38.0) at 1 year follow-up. Subscore sensation of mesh decreased from 4.01±6.76 (min: 0, Q1: 0, Median: 0; Q3: 5.0; Max: 28.0) at 6 weeks to 1.67±3.99 (Min: 0, Q1: 0, Median: 0; Q3: 1.0; Max: 21.0) after 6 months and 0.90±2.69 (Min: 0, Q1: 0, Median: 0; Q3: 0; Max: 14.0) after 1 year follow-up. Subscores pain and movement limitation both decreased during follow-up and were significantly reduced at 1 year compared to preoperative assessment (p<0.001). This study showed favourable clinical and patient reported outcomes and a low rate of recurrences at 1 year follow-up after IPOM for elective IH applying a standardized surgical technique including the use of Physiomesh™. In view of the data leading to the market withdrawal of the Physiomesh™, one might conclude, that the described standard may have contributed to a compensation of the suspected delay in tissue integration of the Physiomesh™ resulting in a more proper mesh fixation compared to absorbable tack fixation with/without absorbable TFS. This may lead to the general appraisal, that the fixation technique has to be adapted to the individual characteristics of type of mesh and fixation devices and the planned anatomic landing zone of the mesh.