Eines des renommiertesten Journals in der Medizin ist das wöchentlich erscheinende New England Journal of Medicine (NEJM). Sein Review und die Guideline für die Publikation der Beiträge sichern eine hohe Qualität der Beiträge.
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Anterior Cruciate Ligament Tear
High-level evidence suggests that recreational athletes can initially be treated nonoperatively or operatively for anterior cruciate ligament (ACL) tears.
ACL reconstruction is recommended for patients with increased or persistent laxity after nonoperative treatment.
For ACL reconstruction in top-level athletes, current evidence supports anatomical reconstruction with autografts of the patellar tendon, hamstring, or quadriceps tendon. Concomitant soft-tissue injuries should be repaired.
The return to sport after ACL reconstruction surgery should occur after a minimum of 9 months and should await the results of return-to-sport testing (e.g., patient performance in tests of symmetric quadriceps strength and hop tests).
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Chronic Rhinosinusitis with Nasal Polyps
Chronic rhinosinusitis with nasal polyps typically manifests as nasal obstruction, reduction in sense of smell, nasal discharge, and sleep disturbance, with adverse effects on quality of life.
In patients with mild symptoms, intranasal glucocorticoids and saline irrigation should be prescribed, and patients should be educated regarding the need for long-term adherence to therapy.
In patients with more severe symptoms, judicious short-term use of systemic glucocorticoids can ameliorate symptoms.
Surgery to remove polyps warrants consideration in patients whose symptoms are not controlled with glucocorticoids, but rates of relapse and repeated intervention are high; intranasal glucocorticoids are continued after surgery. Biologic agents targeted at the inflammatory cytokines that have been shown to be involved in polyp pathophysiology are currently under study.
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Measles
Clinicians should suspect measles in persons who have a febrile illness with rash, especially if they lack documentation of measles vaccination, have recently traveled overseas, or are part of a community with low vaccine acceptance.
Clinical specimens (e.g., serum and nasopharyngeal swab) for laboratory confirmation should be obtained from all patients suspected to have measles at their first contact with a health care provider.
All suspected cases of measles should be reported immediately to the local or state health department without waiting for diagnostic test results.
U.S. travelers to other countries account for a high proportion of imported cases of measles, which emphasizes the importance of measles vaccination of U.S. residents who are 6 months of age or older before international travel.
Serious adverse events after measles–mumps–rubella vaccination are rare and much less common than those associated with natural measles infection.
Clinicians play a critical role in managing parental concerns about vaccination and in maintaining trust in vaccines.
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