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Objective and Background:  Data on incidence of in-hospital pulmonary embolisms (PE) after catheter ablation (CA) are scarce. To gain further insights, we sought to provide new findings through case-based analyses of administrative data., Methods:  Incidences of PE after CA of supraventricular tachycardias (SVT), atrial fibrillation (AF), atrial flutter (AFlu), and ventricular tachycardias (VT) in three German tertiary centers between 2005 and 2020 were determined and coded by the G-DRG (German Diagnosis Related Groups System) and OPS (German Operation and Procedure Classification) systems. An administrative search was performed with a consecutive case-based analysis., Results:  Overall, 47,344 ablations were analyzed (10,037 SVT; 28,048 AF; 6,252 AFlu; 3,007 VT). PE occurred in 14 (0.03%) predominantly female ( n  = 9; 64.3%) patients with a mean age of 55.3 ± 16.9 years, body mass index 26.2 ± 5.1 kg/m 2 , and left ventricular ejection fraction of 56 ± 13.6%. PE incidences were 0.05% ( n  = 5) for SVT, 0.02% ( n  = 5) for AF, and 0.13% ( n  = 4) for VT ablations. No patient suffered PE after AFlu ablation. Five patients (35.7%) with PE after CA had no prior indication for oral anticoagulation (OAC). Preprocedural international normalized ratio in PE patients was 1.2 ± 0.5. Most patients with PE following CA presented with symptoms the day after the procedure ( n  = 9) after intraprocedural heparin application of 12,943.2 ± 5,415.5 IU. PE treatment included anticoagulation with either phenprocoumon ( n  = 5) or non-vitamin K-dependent OAC ( n  = 9). Two patients with PE died after VT/AF ablation, respectively. The remaining patients were discharged without sequels., Conclusion:  Over a 15-year period, incidence of PE after ablation is low, particularly low in patients with ablation for AF/AFlu. This is most likely due to stricter anticoagulation management in these patients compared with those receiving SVT/VT ablation procedures and could argue for continuation of OAC prior to ablation. Optimizing periprocedural anticoagulation management should be subject of further prospective trials., Competing Interests: None declared., (Thieme. All rights reserved.)

Background: Unprecedented numbers of migrants have arrived in Europe, including children and adolescents. Little is known about their unique health needs. Prospective data collection has been sparse. Mobile applications may help to facilitate global health surveillance., Methods: A pre-validated survey instrument was converted into a mobile application covering self-reported exposures and disruptions of healthcare before/during migration, communicable and non-communicable diseases. Participation was voluntary, anonymous and confidential., Results: Data were obtained from 405 migrant children and adolescents in Berlin, Germany, between 7 October 2015 and 15 March 2016 (median age 19 years, range: 1-24; 80.7% males) with the majority from Syria (62.5%), Afghanistan (9.1%) and Iraq (8.2%). In total, 55% were without family, 64% registered asylum-seekers with access to healthcare; 54% had seen a doctor since arrival, with colds or respiratory complaints (37.5 and 13.6%), followed by pain (26.7%) gastrointestinal (12.4%) and skin problems (11.1%). Underlying conditions were reported in 15.6%, predominantly asthma. Overall, 73% reported being up-to date on immunizations, but only 22% held a vaccination record with 46.4% having lost it during migration., Conclusions: The lack of medical and immunization records among newly arrived migrants provides a challenge to healthcare systems. Mobile applications offer rapid screening tools in times of crisis, helping stakeholders with timely information., (© The Author(s) 2019. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Providing the hip with an endoprosthesis is one of the most common orthopedic interventions in Germany. The long-term success of such a procedure depends on the consideration of the loads due to muscle and joint forces in the planning and operative care. Patient-specific information of forces acting in vivo is not available to the surgeon in clinical routine today. This is where biomechanical modeling comes in., Procedures: A field of activity of biomechanical modeling is the development of methods and procedures for the precise analysis and simulation of endoprosthetic supplies. The aim was to show the possibilities of biomechanical modeling in total hip arthroplasty by means of two examples (sensitivity analysis and pre-/postoperative comparison of intervention outcome)., Results: The results of the sensitivity analysis showed that by modeling the position of an optimal reconstruction of the hip rotational center can be found and the forces acting on the hip joint minimized. In the case of the pre-/postoperative comparison, it can be analyzed whether there has been a decrease or increase of load postoperatively, respectively, or whether the conditions are considered to be approximately equal to the preoperative situation. In the future, biomechanical modeling will be able to significantly improve long-term function by reducing wear and optimizing muscular function of the joint. Therefore, the routine use of validated musculoskeletal analysis in the context of standardized preoperative planning and intraoperative navigation-based implementation should be considered. Thus, validated analyses of musculoskeletal loads not only contribute to the extension of basic knowledge but also to the optimization of endoprosthetic care through their integration into the clinical workflow.

Background: Spondylodiscitis is a rare disease which is associated with high mortality. No guidelines for treatment exist and the available studies are not homogeneous. Attempts have been made in recent years to structure therapy using algorithms. Early recognition of the disease is above all important for its later outcome. Therapy takes place in not only orthopaedic/trauma surgery clinics but also in neurosurgical clinics., Material and Method: We sent an online survey on this subject to orthopaedic clinics, trauma surgery and neurosurgery clinics in Germany. The aim was to ascertain current care strategies in Germany. A further objective was to elicit differences between the specialist fields., Results: A total of 164 clinics responded to the survey. The response rate was 16% of the orthopaedic/trauma surgery clinics and 32% of the neurosurgical clinics. Differences between the two specialist fields can be found particularly in the use of systemic and local antibiotics, in the choice of surgical access to the thoracic spine and the lumbar spine and in post-operative imaging. In both specialist fields, patients with neurological dysfunctions are treated primarily in clinics with high case numbers. In terms of surgery, 2/3 of the responding clinics choose a one-stage operative treatment. Minimally invasive procedures and the use of cages are widespread. The participants estimate that, on the whole, a better outcome and higher patient satisfaction tend to exist after operative treatment., Conclusions: The lack of homogeneity regarding treatment strategies which is indicated here clearly shows the need for therapy guidelines as an aid to orientation. This will be a challenge for the future due to the low incidence and the situation regarding currently available studies., (Georg Thieme Verlag KG Stuttgart · New York.)

Aim: In a monocentric study, we investigated patient satisfaction, clinical outcome and isokinetic muscle torque in dependence on the body mass index (BMI) in the mid-term outcome after total knee arthroplasty., Patients and Methods: A group-matched study with two groups (each 40 knee arthroplasties in 40 patients) with a normal body mass index (BMI 20-25) and above 25 was conducted. The groups were matched for sex, diagnosis and age. Satisfaction, HSS score and isokinetic torque parameters with the Cybex 340 system were measured., Results: There were no differences in the demographic data except for BMI. The HSS score was significantly lower in the overweight group (p = 0.04). Also there were more patients with an HSS score below 60 (bad result) in the group with the higher BMI (0 vs. 9, p = 0.002). Only one patient was not satisfied in the normal weight group, whereas 9 patients in the group BMI > 25 were not satisfied (p = 0.014). No differences between the groups could be found in maximum torque, work and power., Conclusion: The patient satisfaction was much lower in patients with BMI higher than 25. There were no differences between the groups in isokinetic torque parameters., (Georg Thieme Verlag KG Stuttgart · New York.)

Background and Objective: The purpose of this prospective evaluation of electrocardiographic (ECG) parameters was to identify predictive parameters for cardiac resynchronization therapy (CRT) response., Methods: One hundred two patients undergoing first CRT implantation were evaluated prospectively. Symptomatic response was defined as improvement in New York Heart Association functional class of at least 1 class within 3-month follow-up. Twelve-lead ECG of the intrinsic rhythm during biventricular (BIV), right ventricular (RV), and left ventricular (LV) pacing was obtained and analyzed in terms of QRS width and QRS axis (Datinf Measure Software, Datinf GmbH, Tübingen, Germany). In total, 77.5% (n = 79) of patients fulfilled the predefined clinical criterion for response. Patients with dilated cardiomyopathy were more likely to respond to CRT than were patients with ischemic cardiomyopathy (85% vs 71.8%, P = .034). A shorter QRS duration during LV pacing and, in particular, a shorter LV paced than RV paced QRS width were strong and independent predictors for response (-20.13 ± 33.2 ms in responders vs 6.05 ± 27.3 ms in nonresponders, P = .001). No statistically significant differences were found in RV and BIV paced QRS width or in QRS axis (P >.5)., Conclusion: This study describes novel and easily obtainable ECG measurements that can be performed during LV lead positioning to optimize clinical outcome of CRT in heart failure patients., (Copyright © 2012 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Aim: Total knee arthroplasty is one of the standard procedures in severe osteoarthritis of the knee. Computer-assisted navigation systems became more popular in the last decade. Navigation systems improve the component positioning and the alignment in total knee arthroplasties. The aim of this survey was to capture the actual trend in computer-assisted total knee arthroplasties in Germany and to discuss the results in comparison to the current literature., Methods: A questionnaire form was sent to 506 orthopaedic and trauma surgery departments in Germany. The first part of the survey included general questions about the department and total knee arthroplasties. The surgeons were asked about their application behaviour and their rating of computer-assisted navigation in total knee arthroplasty in the second part. Questions concerning total knee arthroplasties, unicondylar knee arthroplasties and revision total knee arthroplasties were included in the form., Results: 194 of the departments returned the questionnaire. A total of 39 941 knee arthroplasty surgeries were performed in these departments. 35 624 of these surgeries were primary knee arthroplasties including 32 789 total knee arthroplasties and 2835 unicondylar knee arthroplasties. In addition, 4317 revision total knee arthroplasties were performed by the respondents. 60 % of the departments used a computer-assisted navigation system. In synopsis 29 % of the primary total knee arthroplasties, 4 % of the unicondylar knee arthroplasties and 7 % of the revision knee arthroplasties were performed with a computer-assisted navigation system. Minimal invasive surgery was performed in 31 % of the departments and 36 % of these surgeries were done with navigation-assistance. The "ligament-balanced" procedure was the most common used technique to determine the femur rotation in navigated total knee arthroplasties. In 75 % of navigated total knee arthroplasties cemented components were implanted. Overall 65 % of respondents approved of navigation-assisted surgeries and 77 % saw an improved precision by this technique. The number of computer-assisted navigation uses in surgeries is increasing in 34 % of the departments and decreasing in 13 %., Conclusion: The computer-assisted navigation in total knee arthroplasties is a frequently used technique. The most respondents support the application of navigation-assisted knee arthroplasties and indicate an improved outcome measured by the postoperative alignment. Nevertheless, long-term results are needed for a final evaluation of navigation-assisted surgery., (© Georg Thieme Verlag KG Stuttgart · New York.)

Congenital dyserythropoietic anemia type I (CDA I) is a rare autosomal recessive disorder with ineffective erythropoiesis and iron overloading. More than 100 cases have been described, but with the exception of a report on a large Bedouin tribe, these reports include only small numbers of cases, and no data on the lifetime evolution of the disease are available. Since 1967, we have been able to follow 21 cases from 19 families for up to 37 years. Twenty-one patients with a confirmed diagnosis of CDA I exhibited chronic macrocytic anemia of variable severity, requiring regular red cell transfusions only in 2 individuals. Four developed gallstones before the age of 30 years. Fifteen of 16 cases alive at the time of analysis showed mutations of at least one allele from exons 6 to 28 within CDAN1. Iron overloading is to be expected in all patients. In 9 patients, iron depletion was started between the ages of 7 and 36 years. Splenectomy, which was performed in 7 patients, did not result in improvement of hemoglobin values. Five patients were treated with interferon alpha-2a, and all responded with a rise in hemoglobin concentration of between 25 and 35 g/L (2.5 and 3.5 g/dL) starting within 4 weeks.

Purpose: To further reduce therapy-related late effects in patients with pediatric Hodgkin's disease (HD) while maintaining the high cure rates achieved with vincristine, prednisone, procarbazine, and doxorubicin (OPPA) or OPPA/cyclophosphamide, vincristine, prednisone, and procarbazine (COPP) chemotherapy and involved-field radiotherapy. The risk of testicular dysfunction was addressed by substituting etoposide for procarbazine (OEPA) in the induction therapy for boys. Radiation doses and fields were further reduced., Patients and Methods: Three hundred nineteen boys and 259 girls younger than 18 years with previously untreated HD, enrolled onto the study between 1990 and 1995, were allocated to treatment group (TG)1 (early stages), TG2 (intermediate stages), or TG3 (advanced stages). All groups underwent two cycles of OEPA (boys) or OPPA (girls) for induction chemotherapy. TG2 and TG3 continued on additional two or four cycles, respectively, of COPP. Low-dose radiotherapy was given to the initially involved sites, ie, reduced involved fields., Results: Initial response to OPPA or OEPA induction was virtually identical. Eight of 578 patients experienced early progression of HD. Thirty-seven relapses, three secondary tumors, and no secondary leukemias have been recorded, with a median follow-up duration of 5.1 years (maximum, 8.1 years). Thirteen of 578 patients died. The probability of 5-year event-free survival/overall survival is 91%/98% in the total group, 94%/97% with OPPA, and 89%/98% with OEPA induction therapy. Risk factor analysis showed two significant prognostic factors: histologic subtype NS2 and "B" symptoms. OEPA induction therapy, large mediastinal tumor, and age were not significant. Preliminary studies of testicular function indicate a lower risk of germ cell damage than previously documented with OPPA., Conclusion: OEPA is a satisfactory alternative to OPPA. Radiotherapy can be confined to involved sites when combined with appropriate chemotherapy. The DAL-HD-90 regimen represents a comprehensive treatment program for all stages of pediatric HD and offers a favorable benefit/risk ratio, combining excellent disease control, moderate acute toxicity, and reduced long-term toxicity.