Jeffrey A Brinker, M.D.
- Professor of Medicine
- Joint Appointment in Radiology and Radiological Science
Ju has served as the President and a Founding Trustee of Advancing Innovation in Dermatology order ezetimibe 10 mg overnight delivery is cholesterol medication expensive, Inc order cheap ezetimibe on line free cholesterol test jacksonville fl. In addition order ezetimibe in united states online cholesterol definition medical, he has held executive positions at Pharmacia Corporation/Pfizer, Inc. Ju began his pharmaceutical career at Hoffmann-La Roche where he was a clinical leader for the development of dermatology compounds. Veru has served as Chief Investment Officer and Co-Chairman of Palisade Capital Management, an independent asset management firm, since 2000. Veru has oversight responsibilities for all the investment strategies at Palisade Capital Management involving publicly traded securities. Veru was the President and Director of Research at Awad Asset Management and helped oversee the firms growth. Veru worked at Drexel Burnham Lambert and later at Smith Barney Harris Upham where he held a variety of analytical roles. Lukes and Roosevelt Hospital, a member of the finance committee of the Dwight-Englewood School, and a member of the board of directors of the McCarton School for Autistic Children. Verus public company investment experience provides him with the qualification and skill to serve on the Companys board of directors. Samant served as President and Chief Executive Officer of Vical since November 2000. From 1990 to 1998, he served in the Merck Manufacturing Division as Vice President of Vaccine Operations, Vice President of Business Affairs and Executive Director of Materials Management. Samant was a member of the board of directors of AmpliPhi Biosciences Corporation from 2015 to 2019, a member of the board of directors of Raptor Pharmaceutical Corporation from 2011 to 2014, and a member of the board of directors for BioMarin Pharmaceutical Inc. Lyons presently serves as a member of the board of directors of Neurocrine Biosciences, Inc. Lyons holds a bachelors degree in marine biology from the University of New Hampshire and an M. Brown joined Brickell as its Chief Executive Officer and Director in January 2019 after having spent over 30 years at Eli Lilly and Company, where he most recently served as the Chief Marketing Officer and Senior Vice President of marketing from 2009 through 2018. Brown was responsible for building and leading marketing capabilities across Eli Lilly and Companys pharmaceutical business units, including diabetes, oncology, emerging markets and Lilly-BioMedicines, a business area focused on treatments for debilitating diseases. Brown was the executive director of marketing for the Intercontinental region, including responsibility for Europe. Brown was responsible for the marketing of all Eli Lilly and Companys products outside the United States. Sklawer has served as Brickells Chief Operating Officer and Secretary since its inception in 2009 and is one of its founders. He has over 20 years of experience serving as the Chief Financial Officer for publicly-traded pharmaceutical companies. Prior to this, his professional experience included serving as Chief Financial Officer of Sievers Instrument, treasurer and controller for the Waukesha division of Dover Corporation and accountant with Coopers & Lybrand. Levy held multiple Investment Banking positions at Merrill Lynch, Pierce, Fenner & Smith Incorporated, Jefferies Group and Wedbush Securities Inc. Chadha has served as Brickells Chief Research & Development Officer since 2018 and previously served as Brickells Chief Regulatory, Pre-clinical and Quality Compliance Officer from 2016 to 2018. Chadha served as Vice President, Global Regulatory Affairs at Suneva Medical, a medical technology company that develops, manufactures, and commercializes aesthetic products for the dermatology, plastic, and cosmetic surgery markets, from 2014 to 2016. Chadha also served as Vice President of Global Regulatory Affairs at Allergan Medical (f. Breton has served as Brickells Controller and Chief Accounting Officer since 2013. Breton began his career in 2012 as a Client Manager at Global Resource Partners, Inc. Breton had overall responsibility 10 for clients financial reporting, planning and budgeting, systems of internal controls, corporate and benefits accounting and administration of stock option activity. McAvoy has served as Brickells General Counsel, Chief Compliance Officer and Assistant Secretary since 2019. He previously served as General Counsel, Vice President and Chief Compliance Officer for Endocyte, Inc. McAvoy was at Eli Lilly and Company for 27 years serving in various leadership positions, including as General Counsel of Lilly Emerging Markets, and most recently, in an executive management business role running strategic alliances for the food animal production group at Lillys former Elanco Animal Health subsidiary. Employment and Consultancy Agreements Brickell had entered into employment or consultancy agreements with each of the executive officers named in this Current Report on Form 8- K. Under the terms of the employment agreement entered into between Brickell and Robert B. Brown is entitled to an annual base salary of $450,000, and is eligible for the Companys benefit programs, vacation benefits and medical benefits. The agreement provides that upon written notice, either party may terminate the employment arrangement with or without cause, but 90 days notice is required if the agreement is terminated by Mr. Under the terms of the employment agreement entered into between Brickell and Andrew D. Sklawer is entitled to an annual base salary of $350,000, and is eligible for the Companys benefit programs, vacation benefits and medical benefits. Carruthers is entitled to a monthly retainer of $20,000 per month for the provision of approximately 80 hours of services per month with no annual salary or bonus.
Despite these encouraging results 10mg ezetimibe amex reduce cholesterol yoga, 15 to 20% of operated patients further required a surgical re-intervention for diverse reasons (insufficient decompression buy ezetimibe 10 mg online cholesterol test locations, radiculopathy order discount ezetimibe cholesterol rates, increased pain or instability), needing device removal. Because these procedures were always undertaken concurrently with surgical decompression, it is difficult to ascertain what clinical benefit is derived from the implants themselves. At 4 years, positive results remained unchanged (decreasing pain and decreasing use of analgesics, increasing walking distance). Some authors observed less positive results than those obtained with fusion, others reserved this treatment in preventing post-nucleotomy segmental degradation. Main complications associated with pedicle screws insertion are neurologic and vascular: malpositioned screws, broken screws leading to screw loosening. Whereas this procedure is theoretically considered as a minimally invasive approach, surgical implantation of pedicle screw devices is as invasive as fusion, with resulting disruption of the muscle and ligamentous structures. New studies for a non fusion application are currently going on in the United States. Only one cost-minimisation analysis and one cost-outcome comparison were identified from the literature review and the quality of these studies was insufficient to draw credible conclusions. Given the lack of evidence on clinical effectiveness of interspinous implants and pedicle screw based systems, no credible cost-effectiveness analysis can be performed. Moreover, given the lack of data about the prevalence of these affections (clinical indications) and given the lack of data about frequency of surgical interventions for decompression and stabilization (dynamic stabilization or fusion) of lumbar spine, it is impossible to estimate the budget impact of a hypothetical reimbursement of these new surgical technologies for our country. However, no study allows to confirm that this price is justified compared with the real costs. It is recommended to systematically notify to the Federal Agency for Medicines and Health Products all complications observed by device. They are presented as an alternative to decompression surgery and/or fusion surgery. First, interspinous spacer devices are inserted between the spinous processes and have no rigid fixation to the vertebral pedicles, but can be optionally attached with cords. These devices function by inducing flexion in the degenerative segment and result in less buckling of the 4 ligamentum flavum, offloading of the facets, and reducing intervertebral disc pressures. Pedicle screw systems offload spinal units in a fashion similar to pedicle-based posterior 5 instrumentation. They may provide more rigid stabilization and require a more extensive surgical procedure for insertion. The structures connecting the vertebral bodies to one another are flexible and are not intended to provide rigid stability. However, no cost analysis in the Belgian setting will be performed because of a lack of available data. The main research questions are: Question 1: Is lumbar non-fusion posterior dynamic stabilization a clinically effective treatment for patients with symptomatic lumbar spinal stenosis, degenerative spondylolisthesis, degenerative disc disease, herniated disc or facet joint osteoarthritis Question 3: Is lumbar non-fusion posterior stabilisation a cost-effective treatment option for patients with symptomatic lumbar spinal stenosis, degenerative spondylolisthesis, degenerative disc disease, herniated disc or facet joint osteoarthritis The body of the vertebra is the primary area of weight bearing and provides a resting place for the fibrous discs which separate each of the vertebrae. The facet joints do slide on each other and both sliding surfaces are normally coated by a very low friction, moist cartilage. A small sack or capsule surrounds each facet joint and provides a sticky lubricant for the joint. Each sack 6 has a rich supply of tiny nerve fibres that provide a warning when irritated. Separation between the vertebral bodies is maintained by the height of the disc, which also allows the segmental nerve roots to exit without compression. The disc may place pressure on the nerve root (radiculopathy) and cause symptoms such as radiating pain, numbness, tingling and weakness. Approximately 90% of disc herniations will occur toward the bottom of the spine at L4-L5 or L5-S1, which causes pain in the L5 nerve or S1 nerve, respectively. The isthmic spondylolisthesis occurs when one vertebral body slips forward on another because of a small fracture of the pars interarticularis. The spondylolisthesis can be graded according the severity of the slippage of one vertebral body over another (Grade 1 is less than 25%; Grade 2 is 25-50%; Grade 3 is 50-75%; Grade 4 is greater than 75%). Between 5 to 7% of the population has either a spondylolysis (a fracture of the pars interarticularis without a vertebral slip) or spondylolisthesis, but in most cases it is asymptomatic. It has been estimated that 80% of people with a spondylolisthesis will never have symptoms, and if it does become symptomatic, only 15 to 20% will ever 7 need surgical correction. The most common reason for low back pain in this situation is that the disc will start to wear out. Also, as the discs break down, there is less room for the exiting nerve root (the L5 nerve root) and the patient can develop leg pain (radiculopathy or sciatica). When facet joints become worn or torn the cartilage may become thin or disappear and there may be a reaction of the bone of the joint underneath producing overgrowth of bone spurs and an enlargement of the joints. This condition may also be referred to as facet joint disease or facet joint syndrome. Recurrent painful episodes can be frequent and quite unpredictable in both timing and extent. This leads to a functional ischaemia which gives rise to neurogenic intermittent claudication (pain initiated by standing and increased with walking). Although symptoms may arise from narrowing of the spinal canal, not all patients with narrowing develop symptoms. The reason why some patients develop symptomatic stenosis and others do not is still unknown. It is a clinical syndrome of lower extremity pain caused by mechanical compression on neural elements or their vascular 8 supply. It is most common at the L4-L5 level of the lower spine, but can also happen at L3-L4.
X51R Page 114 Thoracic Spinal or Radicular Pain Remarks There is no evidence that congenital anomalies per se Attributable to Arthritis (X-5) cause pain cheap ezetimibe line what are some cholesterol lowering foods that taste good. Although they may be associated with pain purchase ezetimibe overnight cholesterol definition food, the specificity of this association is unknown order ezetimibe american express subway cholesterol chart. This clas- Definition sification should be used only when the cause of pain Thoracic spinal pain associated with arthritis that can cannot be otherwise specified and there is a perceived reasonably be interpreted as the source of the pain. Remarks Clinical Features Osteoarthritis is included in this schedule with some Thoracic spinal pain with or without referred pain, to- hesitation because there is only a weak relation between gether with features of the disease affecting the viscus or pain and this condition as diagnosed radiologically. The alternative classification to thoracic pain due to osteoarthrosis should be thoracic zygapophysial joint Diagnostic Features pain if the criteria for this diagnosis are satisfied (see Imaging or other evidence of the primary disease affect- X10), or thoracic spinal pain of unknown or uncertain ing a thoracic viscus or vessel. X2 (known infection); between the radiographic presence of this condition and Code 323. X4 bral Anomaly (X-6) Definition Thoracic spinal pain associated with a congenital verte- bral anomaly. Thoracic Spinal Pain of Unknown or Uncertain Origin (X-8) Clinical Features Thoracic spinal pain with or without referred pain. Definition Diagnostic Features Thoracic spinal pain occurring in a patient whose clini- Imaging evidence of a congenital vertebral anomaly cal features and associated features do not enable the affecting the thoracic vertebral column. Definition As for X-8, but the pain is located in the middle thoracic Diagnostic Features region. Thoracic spinal pain for which no other cause has been found or can be attributed. Diagnostic Criteria As for X-8, save that the pain is located in the midtho- Remarks racic region. This definition is intended to cover those complaints that for whatever reason currently defy conventional diagno- Pathology sis. It presupposes an organic basis for the pain, but one that cannot be or has not been established reliably by clinical Remarks As for X-8. X8gR Patients given this diagnosis could in due course be ac- corded a more definitive diagnosis once appropriate di- agnostic techniques are devised or applied. In some instances, a more definitive diagnosis might be attain- Lower Thoracic Spinal Pain of Un- able using currently available techniques, but for logistic known or Uncertain Origin (X-8. Definition As for X-8, but the pain is located in the upper thoracic Diagnostic Criteria region. Diagnostic Criteria As for X-8, save that the pain is located in the upper Remarks thoracic region. Page 116 Clinical Features lus, or as a result of excessive stresses imposed on the Spinal pain located on the thoracolumbar region. Diagnostic Criteria As for X-8, save that the pain is located in the thora- Remarks columbar region. Provocation diskography alone is insufficient to estab- lish conclusively a diagnosis of discogenic pain because Pathology of the propensity for false-positive responses, either be- As for X-8. X81R Thoracic diskography is particularly hazardous because of the risk of pneumothorax. No publications have for- Thoracic Discogenic Pain (X-9) mally described this procedure or experience with it. Until its safety and clinical utility have been established, Definition thoracic diskography should be restricted to centers ca- Thoracic spinal pain, with or without referred pain, pable of dealing with potential complications and pre- stemming from a thoracic intervertebral disk. X7cS Dysfunctional Diagnostic Criteria the patients pain must be shown conclusively to stem from an intervertebral disk by demonstrating Thoracic Zygapophysial Joint Pain either (1) that selective anesthetization of the puta- tively symptomatic intervertebral disk com- (X-10) pletely relieves the patient of the accustomed pain for a period consonant with the expected Definition duration of action of the local anesthetic used; Thoracic spinal pain, with or without referred pain, or (2) that selective anesthetization of the puta- stemming from one or more of the thoracic zyga- tively symptomatic intervertebral disk substan- pophysial joints. For the be ascribed to some other source innervated by diagnosis to be declared, all of the following criteria the same segments that innervate the putatively must be satisfied. Arthrography must demonstrate that any injection Unknown, but presumably the pain arises as a result of has been made selectively into the target joint, and chemical or mechanical irritation of the nerve endings in any material that is injected into the joint must not the outer anulus fibrosus, initiated by injury to the anu- Page 117 spill over into adjacent structures that might other- stitutes presumptive evidence that the joint may be wise be the actual source of the patients pain. The patients pain must be totally relieved following the condition can be firmly diagnosed only by the use the injection of local anesthetic into the target joint. For the diagnosis to be firmly sus- tion of local anesthetic is insufficient for the diagno- tained, all of the following criteria must be satisfied. The response must be validated by an appropriate control test that excludes false- If intraarticular blocks are used, positive responses on the part of the patient, such as: 1. A single positive response to the intraarticular injec- into the target joint on separate occasions. The response must be validated by Local anesthetic blockade of the nerves supplying a tar- an appropriate control test that excludes false- get zygapophysial joint may be used as a screening pro- positive responses on the part of the patient, such as: cedure to determine in the first instance whether a. Remarks If periarticular blocks are used, an injection of contrast See also Thoracic Segmental Dysfunction (X-15). X7eS Dysfunctional Definition Thoracic spinal pain, with or without referred pain, stemming from one or more of the costo-transverse joints. Thoracic Muscle Sprain (X-12) Clinical Features Definition Thoracic spinal pain, with or without referred pain, ag- Thoracic spinal pain stemming from a lesion in a speci- gravated by selectively stressing a costo-transverse joint. Diagnostic Criteria No criteria have been established whereby costotrans- Clinical Features verse joint pain can be diagnosed on the basis of the Thoracic spinal pain, with or without referred pain, as- patients history or by conventional clinical examination. Page 118 Diagnostic Criteria a muscle without a palpable band does not satisfy the the following criteria must all be satisfied. There is a history of activities consistent with the condition are fulfilled, or spinal pain of unknown or un- affected muscle having been strained. X7fS Dysfunctional Thoracic Trigger Point Syndrome Thoracic Muscle Spasm (X-14) (X-13) Definition Thoracic spinal pain resulting from sustained or repeated Definition involuntary activity of the thoracic spinal muscles.
Products and doses Complications / Managing complications Injection site Product Units/point Ml solution/point Procerus Xeomin 2 0 buy ezetimibe 10mg free shipping cholesterol phospholipid ratio. Even if suffcient relaxation of the relevant muscles has been achieved cheap 10 mg ezetimibe with amex cholesterol medication liver, some individuals can produce frown lines voluntarily by recruiting the medial parts of the orbicularis oculi muscle discount 10mg ezetimibe mastercard cholesterol and diet. If this Correction factor is the case, small superfcial doses can be given into the palpable Man with active expressions: Factor 2 areas of activity of the orbicularis oculi muscle. Combined treatment options Soft tissue augmentation with fllers is a possible supplementary treatment option, especially for deeper lines or in older patients. A measure that can always be considered as a possible adjuvant is na- tural skin regeneration therapy by percutaneous collagen induction Video: Treatment of glabella lines Medical Needling ). Treatment of the platysmal cords should also be considered in dose-dependent reduction of tone of the individual platysmal muscle therapy of marionette lines with botulinum toxin. Platysmal bands Treatment Injection 5 Activation Injection technique the practitioner instructs the patient to contract the muscle actively: Pull Using the thumb and index fnger, the therapist gently lifts the individual, the corners of your mouth and your lower lip hard downwards and side- tightened cords or bands. Products and doses Complications / Managing complications Injection site Product Units/point Ml solution/point Platysma Xeomin 1?2 0. Correction factor Man with active expressions: Factor 2 Age / inactive expressions: Factor 0. Combined treatment options Horizontal lines can be treated with augmentation methods. In patients with ded for the hands and feet, as the distribution of hyperhidrotic areas axillary, palmar or plantar hyperhidrosis, the condition is independent can be vary variable. The Minor test described above is recommen- Treatment regimen Treatment regimen for the foot the injections are given at intervals of about 2 cm. Between 10 to 50 injection sites will be needed on the foot (examples of injection sites are shown here ? the- re is no set injection scheme). Treatment regimen for the hand the injections are given at intervals of about 2 cm. Between 10 to 30 injection sites will be needed on the hands (examples of injection sites are shown here ? there is no set injection scheme). Treatment regimen for the axilla the injections are given at intervals of about 2 cm, but may be staggered for better coverage of the area. About 10 or more injection sites will be needed in the axilla (examples of injection sites are shown here ? there is no set injection scheme). In the armpit, the region of highest sweat production is usu- Pay particular attention to the lateral areas on the foot, as increased ally identical to the area of hair growth. Primary hyperhidrosis Treatment Injection Injection technique for the foot By preference, the injections are given intradermally, but sometimes also subcutaneously. The lateral side of the foot should also be treated if the Minor test is positive. Caution: Take care in the medial region of the foot, as paresis may occur here due to possible diffusion of the toxin. Injection technique for the hand By preference, the injections are given intradermally, but sometimes also subcutaneously. Caution: Take care in the thenar and hypothenar region, as muscle weak- ness ranging up to paresis may occur here due to possible diffusion of the toxin, making grasping diffcult. Caution: Injection into the axilla is almost free of complications, but local hematomas may develop. Products and doses Injection site Product Units/point Ml solution/point Complications / Managing complications Foot/hand/axilla Xeomin 2. Marked smoothing of the skin and reduction of the lines can be seen 16 days after the treatment with botulinum toxin. Studies demonstrate success with microneedling for skin rejuvenation, acne scars, non-acne scars, acne vulgaris, hyperpigmentation, alopecia, hyperhidrosis, and drug delivery. Introduction Microneedling is a minimally invasive procedure that is becoming widely utilized in dermatology. Microneedling can also augment transdermal drug delivery through creation of micropores. In 1995, Orentreich and Orentreich described subcision Accepted Date: 14 Aug 2017 subcutaneous incisionless surgery) or dermal needling for treatment of scars . They inserted Published Date: 21 Aug 2017 a tri-beveled hypodermic needle through a puncture in the skin surface and its sharp edges were maneuvered under the defect to make subcuticular cuts or "-cisions. Microneedling: A Primer for In 1997, Camirand and Doucet described needle dermabrasion using a tattoo pistol to treat scars Dermatologists. Based on these principles, in 2006, Fernandes developed the derma roller for percutaneous 2017; 2(2): 1014. This is an open access article distributed under Tere are two main types of microneedling instruments: derma rollers and pens. The roller is applied License, which permits unrestricted directly to skin and rolled across the desired area. It has 24 circular arrays of eight needles located on the any medium, provided the original work roller. Tere are 192 needles in total and the needles are 200 ?m in length with a 70 ?m diameter. It is an used methylene blue stain and calcein imaging to assess micropore automated micro needling device with 9-12 disposable needles that size and closure time. Tere are many more was directly related to micropore size with a range of 12 to 18hrs. Microinjuries within the dermis stimulate the recruitment of platelets and skin permeability.
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If problems arise from the screw fxation itself buy ezetimibe 10 mg mastercard free cholesterol test glasgow, it needs to be changed or reversed and not removed order 10mg ezetimibe overnight delivery cholesterol emboli syndrome definition. In case of progression of the slip due to instability of the epiphysis a second screw can be added best buy for ezetimibe cholesterol test on empty stomach. The fxation must be secured until the growth plate closes to prevent further progression of the disease. In the two presented cases the screw was removed with the idea that after a few months the epiphysis had achieved enough stability. Removal of the screw therefore causes further progression of the slip and deformity. In both cases, it had considerable consequences for the patient as an additional and more invasive procedure was required. Removal of the osteosynthesis 131 Chapter 8 material after consolidation of these fractures has never been reported and in case of any doubt it is advisable to leave the screw in place [3,4]. The growth plate does not heal within several months and the original unstable situation persists until the growth plate is closed. Given the risk of progression of the slip, the fxation of the slipped epiphysis of the hip can only be removed after closure of the growth plate. Consent Written informed consent was obtained from the patients legal guardians for publication of this case report and accompanying images. Witbreuk M, Besselaar P, Eastwood D: Current practice in the management of acute/unstable slipped capital femoral epiphyses in the United Kingdom and the Netherlands: results of a survey of the membership of the British Society of Childrens Orthopaedic Surgery and the Werkgroep Kinder Orthopaedie. Finally, the negative consequences of prematurely removing the percutaneous placed screw, i. This chapter also reviews the present literature of the global incidence and gender diferences. The fundamental problem is the lack of knowledge about the role each of these changes plays. It is unclear whether such changes are causal or adaptive, because the biopsies were taken after the slip had occurred. This creates a prolonged phase of weakness and makes the physis vulnerable to the efects of increasing load, mainly in the pre-existence of obesity. Thyroid hormones directly and indirectly afect the physis and may facilitate or delay closure at the end of puberty. An association has been described with seasonal variation and thus, indirectly changes in vitamin D levels could play a role, which 9 could interfere with the bone mineralization. Consequently, recommendations would be to test for endocrine and metabolic changes in young children (< 10 and < 12 years of age for girls and boys respectively) and where young children fall within the tenth percentile for short stature. We compared these with 11 biopsies of normal physis taken during epiphysiodesis of the distal femur or proximal tibia with leg length diferences and in diferent amputations (Syme, below knee and 6thtoe). Finally, no diferences were observed in hormonal receptor expression of the eight hormonal receptors important in puberty. Contrarily, diferences in reposition of the femoral head, prophylactic percutaneous screw fxation and removal of screw showed no consensus between pediatric orthopaedic surgeons either within a country or among countries. The predominant treatment for the mild stable group is a percutaneous screw fxation to prevent further slippage. In conclusion, subcapital osteotomy can lead to perfect anatomical reduction, but there is a high risk of development of avascular necrosis. In the intertrochanteric osteotomy, the slip will be downgraded mostly to a mild slip, but with no avascular necrosis and is mostly positive in the long-term. The direct treatment of the disorder followed an appropriate procedure, by inserting one percutaneous screw in the correct position. The removal of the screw after 9 healing, however, preceded closure of the physis. An Imhauser intertrochanteric osteotomy was required for the deteriorated function in both patients. Most likely a combination of these two will cause a load on the weak physis, which it cannot resist. The increase of incidence in Asia may be indirectly attributable to a diet change. It appears sensible given obesity is a cause of numerous other problems, like heart disease, diabetes, asthma and social discrimination. The answers may be found in the extracellular matrix, in untested hormonal receptors, or in other pathways. The cause might never be found if we look at the physes after the slip has occurred. So should we take an extra step and explore the whole human genome in order to calculate the statistical chance of developing this disease Children can report pain in the upper leg or even anterior part of the knee, but actually it is referred pain from their hip. In pediatric orthopaedic surgery we encounter many rare diseases with low prevalence and incidence. Collecting data of patients and appropriate treatment should be centralised in one registry. Further questions that need to be asked entail the types of complications that develop in diferent patients and the reason for these Should we train more surgeons in advanced techniques of hip reconstruction, like the hip dislocation with subcapital osteotomy or should we use more 3D reconstruction techniques for preoperative planning In these difcult operations one might consider centralisation of the techniques or operations considering the high levels of complication rates, which are highlighted in the literature. Should we further consider the treatment possibilities of hips afected by osteonecrosis or early arthrosis and salvage operations even, for example, by early total hip reconstruction Is there a role for bisfosfonates or more modern medication that only inhibits osteoclasts Vervolgens is er een casereport geschreven over de negatieve gevolgen van het the vroeg verwijderen van de percutaan geplaatste schroef, dat wil zeggen voor het einde van de groei van het skelet. Er zijn verschillende behandelingsmethoden tussen, maar ook binnen landen, waarschijnlijk als gevolg van historische gewoontes en meestal zonder empirisch bewijs. In dit hoofdstuk wordt eveneens de huidige literatuur besproken inzake de wereldwijde incidentie en gender verschillen. Het fundamentele probleem is het gebrek aan kennis over de rol die elk van deze veranderingen teweegbrengt. Het is onduidelijk of dergelijke veranderingen causaal of adaptief zijn omdat de biopten werden genomen nadat de slipheeft plaatsgevonden.