Midcarpal arthrodesis with excision of the scaphoid for the treatment of painful carpal collapse has been performed in our hospital since 1993. A clinical study was carried out to evaluate the results and determine special factors, which might influence the results. 26 out of 29 patients operated until 1999 were reexamined after an average follow-up of 27 months. The results were evaluated according to the Mayo-modified wrist score. The DASH score and the pain-disability index (PDI) were calculated postoperatively. Standard X-rays of the wrist were analyzed for alteration of the radio-lunate joint space, the position of the lunate with respect to the radius and the correction of the carpal height as calculated by the Youm index. Carpal collapse was due to scapholunate pathology (SLAC) in 12 cases, long-standing scaphoid nonunion (SNAC) in ten cases, perilunate dislocation, which was only simply reduced, in three cases, and calcium pyrophosphate deposition disease in two cases. The Mayo-modified wrist score improved significantly from an average of 46 points before to 76 points after surgery. The DASH score postoperatively was 22, the PDI 13. All patients reported improvement of their situation after the operation, eight were completely free of pain. The average range of motion from extension to flexion was 64 degrees, which was almost identical to the average preoperative value. The average grip strength before surgery was 24 kg, after surgery 34 kg. There was a correlation between the position of the lunate to the radius in the lateral X-ray and the range of extension. If the lunate was positioned correctly, wrist extension was significantly better. The radiolunate joint space was maintained during the period of observation with only two exceptions. Apparent subchondral sclerosis was seen in most of the cases. It was not possible to restore carpal height completely. Some results after perilunate luxations and one case of calcium pyrophosphate deposition disease were unsatisfactory. Midcarpal arthrodesis with scaphoid excision is a reliable method for treating radioscaphoid arthrosis caused by carpal collapse. Correction of the hyperextended position of the lunate is important to obtain optimum results. In our hospital, a wrist arthrodesis is only rarely performed nowadays, except in the rheumatoid patient.

Surgical or multimodal therapy of tumors of the pelvis often results in complex defects leading to functional and structural deficits, with the inability to sit or even lie without pain. Multimodal therapy may cause induration of soft tissues and muscles, obstruction of the small bowel, fistulas, and infected cavities. Early soft tissue reconstruction, preferably with myocutaneous flaps, reduces postoperative problems in these patients by early coverage of defects, closure of cavities, and prevention of wound healing complications and therefore allows earlier rehabilitation.

<p class="abstract"><strong>Background:</strong> Cartilage shield tympanoplasty (CST) is seen as a good option for revision surgery in cases of myringoplasty failure. Cartilage serves as rigid material which resists retraction. However, there have been concerns regarding hearing outcome and surveillance in follow up period.</p><p class="abstract"><strong>Methods:</strong> A prospective study was conducted at our tertiary institute. 25 patients of either sex in age group of 18-50 years with one or more failed tympanoplasties underwent CST. Pre-operative and post-operative audiograms were obtained, and patients were regularly followed up to calculate graft uptake and hearing outcome. Quantitative data was analyzed by using Student t-test and for qualitative data chi square test was used.  </p><p class="abstract"><strong>Results:</strong> The mean pre-operative pure tone air-bone gap was 25.09±8.10 dB while the mean postoperative pure tone air-bone gap was 13.47±5.18 dB, one case (4%) presented with failure as there was a residual perforation antero-inferiorly. Since it was a small residual perforation, it was planned for closure by fat myringoplasty. No complications were recorded. We obtained graft take rate of 96% and mean postoperative gain of 11.62±7.11 dB in PTA-ABG.</p><p class="abstract"><strong>Conclusions:</strong> We recommend CST for revision cases of tympanoplasty.</p><p class="abstract"> </p>

On January 1st 2004, a new contract between the government, health insurance services, and hospitals was inaugurated in Germany. The aim of the contract is to decrease costs for surgical therapies by abolishing or at least minimizing hospitalization of patients. Hand surgery is widely affected by the new contract, since a very large part of surgical therapies for the hand was declared to be compulsory outdoor and another major part to be preferable outdoor. The surgeon may decide whether a patient needs inpatient or outpatient treatment but has to justify his decision. Hospitals and surgical clinics are both allowed to offer outpatient hand surgery and get the same payment under the same regulations. For most hospitals, structural changes will be necessary to offer outpatient surgery without financial loss. In our experience a personal and regular contact between patient and surgeon is most necessary for the best surgical result. Many of the compulsory outpatient operations in hand surgery can be done sufficiently and at high standard. This may not be the case for the second group to be handled not compulsory outdoor. The new contract allows hospitals to offer postoperative care for only 14 days, whereas many specific hand surgical procedures will need the surgeon's control and care for a much longer time. On the other hand, clinics and general practitioners have strict limitations for the prescription of hand therapies. We believe that the quality of hand surgery is highly dependent on sufficient postoperative treatment. If the postoperative care is neglected or restricted, secondary costs such as sick leave will increase.

BACKGROUND Mucormycosis (Black fungus) is a designated as a rare, rapidly progressive fatal disease of immunocompromised caused by saprophytic fungus of family mucorales. Early diagnosis with prompt medical and surgical treatment is the only tool available. Rhino-orbito-cerebral is the most common subtype. In India we saw a sudden rise in mucormycosis cases during second wave of COVID 19. This necessitated a systematic review of epidemic of mucormycosis in COVID 19. METHODS A Retrospective multi-centric study was conducted at various Government and Private Hospitals of Western UP comprising of 51 cases of Rhino-orbitocerebral mucormycosis with present or recent COVID19 positive status presenting to us during 14th April 2021- 31st May 2021. RESULT Either Type2 Diabetes Mellitus or history of recent use of steroids in high doses was present in all the patients. Contribution of virulence of the Delta strain B1.617.2 is significant. FESS with sino-nasal debridement contributes significantly towards mortality reduction and cost of total treatment by significantly reducing days of Liposomal Amphotericin B therapy. CONCLUSION Early diagnosis with prompt medical and surgical management along with blood sugar control and avoiding use of high dose of steroids remain to key to mortality and morbidity reduction. Keywords: Black fungus, mucor, mucormycosis, rhino-orbito-cerebral, causes, treatment, covid 19, India, sugar, steroids, steam, oxygen, surgery