Praxis最新文献

Introduction: The breast is essential to a woman's physical integrity. There are numerous techniques for breast reconstruction, so that the needs and limitations of each patient can be respected. The individual preferences of the patient play an important role in the decision of silicone implants vs. autologous tissue, size, and shape of the breast as well as the timing of the surgery. The only reasons not to perform a reconstruction are a locally incompletely removed tumor or the explicit wish of the patient against reconstruction. The costs for reconstruction are covered by the health insurance for all procedures, including symmetrizing the opposite breast, nipple reconstruction and autologous fat grafting.

Introduction: Sports medicine, as a classical cross-sectional subject, includes diverse topics which show gender-specific differences and thus require a differentiated consideration. Evidence-based research exists in the field of musculoskeletal medicine, for example, in relation to cruciate ligament injuries or concussions. Marked differences in trainability (both muscular and cardiac or pulmonary) are also emerging. Pregnancy and sport is also a topic of increasing interest. Close interdisciplinary care of female athletes, knowledge of physiological changes during pregnancy and contraindications to sports activity (especially with higher intensity) are essential here. Aspects in the field of internal sports medicine with gender differences are topics like iron deficiency or the relative energy deficit (RED-S). There are also sex and gender differences with implications for preventative aspects such as the annual screening examination (so called 'preparticipation screening').

Introduction: Misinformation about vaccination leads to vaccination hesitancy. During the SARS-CoV-2 pandemic, different patterns were observed in how misinformation spread on social media, which coined the term "infodemic." There are different approaches to counter misinformation in vaccination, some of which can be implemented in medical practice. This article is an introduction and overview of the phenomenon of misinformation in social media. The article also aims to uncover individual mechanisms that make misinformation appear credible and thus the article aims to function as an "inoculation against the infodemic."

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Introduction: A delirium can be encountered in almost all hospital sectors. The prevalence varies between 20 and 40 % in internal medicine and surgical wards and between 50 and 60 % in palliative care and intensive care units. A delirium is characterized by impaired attention, consciousness, and cognitive impairment with acute onset and fluctuating course. People with delirium have inferior clinical outcomes, including higher mortality and more need for long-term care after discharge. This article first reviews the clinical and pathophysiologic basis of delirium, followed by a detailed description of individual risk profiles based on a prospective, hospital-wide cohort study (Delir-Path) conducted at the University Hospital Zurich. We will then give a brief update on diagnosis and management of delirium and an outlook on how neurophysiology and blood biomarkers can complement delirium care in the future.

Introduction: About one fifth of all sports accidents involve the hand. Many injuries can be diagnosed and treated easily. However, some of them such as fractures of the scaphoid or the hamate of the hamulus are difficult to detect with conventional radiographs and are often missed without a CT scan. Ligament injuries such as the skier's thumb must be recognized and treated properly, often surgically. There are also sport-specific injuries, such as the closed rupture of a flexor tendon pulley in climbers, which otherwise occur rarely and are little known. These topics, pitfalls and tricks will be discussed.

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Introduction: Locally advanced rectal cancer has a high risk of local recurrence which can be reduced by multimodal therapy. Neoadjuvant radiotherapy or radiochemotherapy has been established. Nevertheless, this has not proved to improve overall survival. The benefit of adjuvant chemotherapy after neoadjuvant radiotherapy or radiochemotherapy remains unclear. Current studies are investigating total neoadjuvant therapy with different sequences of radiotherapy and chemotherapy followed by rectal resection. This procedure shows high pathologic complete remissions up to 28 % as well as an improvement in disease-free and metastasis-free survival. Under study conditions, in case of clinical complete remission, watchful waiting with close follow-up and surgery can be considered only in case of local tumor recurrence.

Introduction: Ulnar wrist pain is a frequent symptom with many possible traumatic and non-traumatic causes. The complex anatomy and biomechanics of the wrist with the ulnocarpal complex including the triangular fibrocartilaginous complex (TFCC), the distal radio-ulnar joint (DRUJ) and the ulnar carpal bones make the differentiation between the possible causes difficult. A precise clinical investigation and appropriate imaging studies are essential for detecting the most important differential diagnoses, the first therapeutical steps and an early and appropriate referral to the hand surgeon.

Introduction: Cardiovascular diseases are the leading causes of death worldwide, claiming an estimated 17.9 million lives each year. There is a dose-dependent relationship between the absolute extent of exposure of the vascular system to low-density lipoprotein cholesterol (LDL) and the risk of atherosclerotic cardiovascular disease. Meta-analyses confirm the beneficial effects of LDL reduction. In addition to lifestyle modifications, which remain the cornerstone of primary and secondary prevention, it is pharmacologically possible to lower plasma LDL levels. This article highlights where we stand with lipid-lowering drugs, more than 30 years after the first statins were used therapeutically.