Die Oberkieferosteotomie in der Le-Fort-I-Ebene — ein weites Indikations-spektrum zur Korrektur verschiedener skelettaler Dysgnathien

Zusammenfassung Die Osteotomie des Oberkiefers in der Le-Fort-I-Ebene, die heute routinemäßig in der Down-fracture-Technik durchgeführt wird, hat die chirurgische Behandlung skelettaler Dysgnathien grundlegend verändert. Sie ermöglicht eine dreidimensionale Korrektur des Oberkiefers und damit des gesamten Gesichtsschädels. Darüber hinaus kann der Oberkieferzahnbogen, zusätzlich zu einer Verlagerung des gesamten Oberkiefers, durch eine zusätzliche sagittale und transversale Osteotomie erweitert, verschmälert und verkürzt werden. Die Planung einer Oberkieferosteotomie erfolgt anhand des klinischen Bildes, der Kiefermodelle und des Fernröntgenbildes. Dabei muß der Unterkiefer frühzeitig mit in die Planung einbezogen werden, da er durch die Autorotation im Gelenk den Verlagerungen des Oberkiefers folgt. Erst durch eine gleichzeitige Osteotomie auch des Unterkiefers ergibt sich ein weites Indikationsspektrum für die Oberkieferosteotomie. Bei einer kombinierten Ober- und Unterkieferosteotomie ist praktisch jedes gewünschte Profil im unteren Gesichtsdrittel erzielbar.

---

Summary The osteotomy of the maxilla using the Le Fort I technique, today routinely performed in the down-fracture-technique, has changed surgical corrections of dentofacial deformities fundamentally. It offers a three-dimensional correction of the maxilla and also of the whole facial skull. Furthermore the upper dental arch can be expanded, intruded and shortened using a sagittal or transversal osteotomy in addition to a complete transposition of the maxilla. Planning of a maxillary osteotomy is performed under consideration of the clinical situation, the casts and the lateral cephalogram. The mandible must be considered at an early state of the preoperative planning, since the mandible will follow all transpositions of the maxilla by rotating with the TMJ. Only by performing a simultaneous osteotomy of the mandible, a broad spectrum of indications for maxillary osteotomy will result and practically every desired profile of the lower third of the face can be achieved using combined maxillary and mandibular osteotomies.

     

Aesthetic aspects in reconstructive microsurgery

The reconstruction of a part of the body that has lost or inhibited function has been the most important aspect of reconstructive surgery in the past. Because of the existence of better techniques and the patient's wish for social reintegration, the plastic surgeon today is forced to consider the aesthetic results of his work more than in the past. Sometimes microsurgical procedures in reconstructive surgery are the only chance for the patient to be healed or palliated. Experience with more than 350 free tissue transfers gave us the opportunity to estimate the value of a donor flap with respect to the requirements of the receiving site. To satisfy the high aesthetic demands in these cases, it was necessary for the right place and shape the flap to fit as closely as possible, even if further corrections were necessary to achieve a satisfactory result. The transfer of latissimus dorsi and radial forearm flaps to the face and lower leg is discussed in cases of tumorus diseases and severe injuries of young and old patients.Presented to the IXth Congress of the International Society of Aesthetic Plastic Surgery, New York, October 13, 1987     

Die Haftung des Ehegatten für Krankenhausbehandlungskosten nach § 1357 BGB

Ohne Zusammenfassung     

Frühes Ovarialkarzinom

Patients with early ovarian carcinoma have a much better survival outcome than patients with more advanced disease. Comprehensive surgical staging is crucial for the determination of prognosis and treatment planning. During 2003, the first randomized trials were published demonstrating that adjuvant platinum based chemotherapy improves recurrence free and overall survival. Current treatment recommendations are largely based on the results of these studies. Accordingly, systemic adjuvant therapy should be offered to patients with disease stage Ib or higher and to patients with moderately differentiated or undifferentiated tumors. Due to incomplete surgical staging, the stage of disease in the patients included in these studies is probably underestimated, and only a fraction of the actual advanced stage patients is included.     

Magenkarzinom – eine Infektionskrankheit

Gastric cancer still represents the second most common cause of gastrointestinal cancers in Germany. A disturbing issue is that at the time of diagnosis there are less than 15% of patients for whom a cure can be achieved. Nowadays, biological, histomorphological, molecular genetic and epidemiological data suggest that Helicobacter pylori eradication may lead to the prevention of gastric pre-neoplastic lesions and even gastric cancer. At present, eradication can be offered to selected patients and populations at increased risk, but more research is required before embarking on general and global H. pylori eradication for gastric cancer prevention. The main challenge is to determine how long mucosal abnormalities remain reversible and gastric cancer development can be halted.     

Three-Dimensional Soft Tissue Prediction Using Finite Elements

BACKGROUND AND AIM: The goal of this study was to analyze the validity and prediction accuracy of a newly-developed procedure for three-dimensional soft tissue prediction based on Finite Element Method, and to compare the results with prediction produced using an existing two-dimensional prediction program (Dentofacial Planner Plus). PATIENTS AND METHODS: In twelve patients who underwent combined surgical-orthodontic treatment, profile prediction was generated using both procedures preoperatively and then compared at predefined measurement points with the patient's actual postoperative soft tissue status. RESULTS: The deviations observed depended on the facial region, whereby the prediction errors for both procedures were much greater in the lower facial third than in the midfacial third. Calculating in all the measurement points, the mean horizontal prediction error was 0.32 mm for the Finite Element Method and 0.75 mm for the Dentofacial Planner Plus. Overall, we were able to demonstrate the new procedure's superior validity and quality of visualization. In addition to profile prediction, the procedure allows a differentiated three-dimensional assessment of esthetically important regions such as the cheeks, nasolabial folds and the nasal wings. Additional X-radiation is not necessary in this risk-free and stress-free procedure. CONCLUSION: Three-dimensional soft tissue prediction employing finite element modeling is a useful aid for implementing esthetically-optimized treatment planning.     

Toll-like receptor signaling inhibits structural development of the distal fetal mouse lung.

We tested the hypothesis that innate immune signaling in utero could disrupt the structural development of the fetal lung, contributing to the pathogenesis of bronchopulmonary dysplasia. Injection of Escherichia coli lipopolysaccharide (LPS) into the amniotic fluid of E15 BALB/cJ mice increased the luminal volume density of fetal mouse lungs at embryonic day (E) 17 and E18. LPS also increased luminal volume and decreased distal lung branching in fetal mouse lung explants. This effect required NF-kappaB activation and functional Toll-Like Receptor 4. Airway branching may require fibronectin-dependent epithelial-mesenchymal interactions, representing a potential target for innate immune signaling. Anti-fibronectin antibodies and LPS both blocked distal lung branching. By immunofluorescence, fibronectin localized to the clefts between newly formed airways but was restricted to peripheral mesenchymal cells in LPS-exposed explants. These data suggest that LPS may alter the expression pattern of mesenchymal fibronectin, potentially disrupting epithelial-mesenchymal interactions and inhibiting distal airway branching and alveolarization. This mechanism may link innate immune signaling with defects in structural development of the fetal lung.     

Rede zur Er?ffnungsfeier der 110.Tagung der Deutschen Gesellschaft für Innere Medizin am 18.April 2004 in Wiesbaden

Ohne Zusammenfassung