Die Beeinflussung des Wachstums mit der Vorschubdoppelplatte im Vergleich zu anderen funktionskieferorthopädischen Geräten

Zusammenfassung Der dentale und skelettale Einfluß der Vorschubdoppelplatte konnte im Vergleich zu anderen funktionskieferorthopädischen Geräten gezeigt werden. Dabei ergaben sich folgende Besonderheiten: 1. Die Vorschubdoppelplatte übt einen skelettalen Einfluß auf den Oberkiefer aus. Dieser ist vergleichbar mit der Wirkung, die funktionskieferorthopädische Geräte in Kombination mit extraoralen Kräften zeigen (SNA-Winkel). 2. Der Einfluß auf den Unterkiefer (SNB-Winkel) entsprach in der Größenordnung dem elastisch offenen Aktivator nach Klammt und dem Teuscher-Aktivator. 3. Die Reduzierung des ANB-Winkels war bei der Vorschubdoppelplatte, verglichen mit den anderen Geräten, am größten. 4. Die Beeinflussung der Neigung der Spinaebene zur Nasion-Sella-Linie war nahezu Null. 5. Die Neigung der Unterkieferschneidezähne zur Gonion-Menton-Ebene wurde praktisch nicht beeinflußt. 6. Im Oberkiefer fand eine Retrusion der Schneidezähne statt. 7. Die Veränderung des Winkels UK zu NB im Vergleich zu UK zu GoMe zeigt, daß tatsächlich eine Vorverlagerung des Unterkiefers stattgefunden hat. Die besondere Wirkung der Vorschubdoppelplatte gegenüber anderen funktionskieferorthopädischen Geräten erklärt sich aus folgenden Aspekten: a) Durch die langen Stege ist auch bei einer größeren Mundöffnung eine sagittale Beeinflussung des Unterkiefers vorhanden [29]. b) Die Reibung zwischen den Stegen und der schiefen Ebene des Unterkiefers ist außerordentlich gering und nicht zu vergleichen mit der Reibung zwischen den Zähnen und dem Kunststoff bei sonstigen funktionskieferorthopädischen Geräten [28]. c) Patienten, die mit der Vorschubdoppelplatte im Munde sprechen, nehmen eine Position des Unterkiefers ein, die weiter sagittal liegt, als es der Konstruktionsbiß vorgibt [30].

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Summary The bite-jumping-appliance BJA is a special functional appliance which affects the upper jaw comparably to activator-headgear combinations (SNA angle). Concerning its influence on the lower jaw (SNB angle) the BJA can be compared with the Teuscher-activator and the Klammt-activator. The change in the inclination of the upper jaw (ANS-PNS to Nasion-Sella) proved to be negligible because the vector of the force passed through the center of resistance of the upper jaw. The extend of the dental influence was the largest with the activator, the smallest with the Fränkel II appliance. The inclination of the lower incisors ( to Gonion-Menton) was hardly affected. The upper incisors were retruded however not be the same extend as with the Teuscher-activator which even has torque springs (to avoid the retrusion). The treatment of all the patients ended in all cases excepting those that were treated with an activator in a nearly ideal IIW angle. Our findings encourage us to say that the BJA is an appliance with a far better working mechanism than the working mechanism of other functional appliances.

     

Taxing the income of the elderly

If we agree that retirement income means those receipts past the age limit of 64 years, there will be a comparable situation for taxation. Such comparison shows that membership in the public annuity insurance gives strong advantages because of lower taxation. This uneven situation should be ended in the future by the opinion of the Bundesverfassungsgericht (Supreme court of constitutional affairs). There are two ways to solve this problem. Either the whole taxation of seniority income follows the rules of social security taxation, or the taxation of social security must loose its priority. The author prefers the second, because he argues that the social security taxation is wrong and irreparable: The author offers a general application of the "intertemporal correspondence principle" of taxation. This means that income can be taxed only once. Under this rule he prefers the "ex post taxation" of retirement income for reasons of justice, practicality, and economic principles.     

Progress in care and treatment of multiple trauma patients during the last twenty years

During the last 20 years, the increase in polytrauma has stimulated scientific development and brought about new activities in the field of patient can, Of these new activities, the early treatment of shock by first aid measures and intensive therapy are of greatest importance. In the operative approach, the atraumatic method of operation with the help of new technical devices, instruments, and implants has stood the test of time. A remarkable development arose in the operative treatment of fractures, which plays a decisive role in polytrauma on account of the high rate of bone injuries as well as for reasons of general patient support. The operative treatment of abdominal, craniocerebral, and thoracic injuries was improved not so much by changing operative technics, but rather by vigorous treatment of shock and intensive medical support which have decisively changed the magnitude and timing of the surgery that can be performed to aid the patient. By this means, as well as by newly developed diagnostic possibilities, the necessary conditions for an effective operative treatment have been greatly improved. Thus, at present, more complete primary care of the injured may be carried out successfully in a large percentage of trauma victims.     

Dreidimensionale computergestützte Modell- und Hologrammauswertung

Zusammenfassung Es wird ein selbstgebautes Vermessungsgerät für die dreidimensionale Vermessung von Modellen und Hologrammen vorgestellt. Folgende Besonderheiten weist dieses Meßsystem auf: 1. Alle Vermessungen erfolgen ohne Zuhilfenahme von optischen Instrumenten (Lupe, Mikroskop, Fernglas) und ermöglichen so ein ermüdungsfreies Messen. 2. Für die Vermessung der dreidimensional getrimmten Modelle ist lediglich das Einbohren von zwei Löchern mit 3 mm Durchmesser in die Modelle notwendig. 3. Die Benutzeroberfläche des Programmes ist menü- und fensterorientiert aufgebaut und läßt somit die Erstellung einer Datenbank zu. 4. Die mit diesem Gerät erzielte Genauigkeit übertrifft selbst bei der Hologrammauswertung die übliche Vermessung von Modellen um ein Vielfaches. 5. Hologramme stehen hinsichtlich ihrer Genauigkeit und ihres Informationsgehaltes den üblichen Modellen kaum nach. 6. Die Durchzeichnungen der Modelle und die Berechnungen der Strecken und Winkel erlauben dem Behandler einen schnellen Überblick über die zu behandelnde Problematik. 7. Durch die Transferierung der Modellanalyse in die seitlichen Fernröntgenaufnahmen sowie in die posterior-anterioren Aufnahmen entstehen neue diagnostische Möglichkeiten.

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Summary For the three-dimensional measurement of plaster casts and hologramms a self-fabricated measurement device will be introduced. This measurement device has the following specialities: 1. All measurements will be done without any subsidiary optical instruments like spectacles, microscope, binoculars or any thing else. Therefore a tire of measuring can be carried out. 2. Only two 3 mm deep wholes should be grinded in the base of the pflaster casts as preparatory measures for the three-dimensional measurements of the plaster casts. 3. The menue- and window orientated software gives the possibility for the collecting of datas in a data bank. 4. The precision of these measurement results, even in the case of measuring hologramms, are frequently better than the common way of measuring plasters casts. 5. The precision and information by the hologramms are nearly the same, compared with the common plaster casts. 6. The tracing and measuring of the angles and lines by this newly measurement device guaranties the doctor a quick overview concerning the therapeutic measures. 7. The transfer of these datas in the lateral-rays and in the posterior-anterior findings leads to a better diagnostic. That means the diagnostic horizont will be widened with this new method.

     

Assessment of intracranial hemodynamics in sleep apnea syndrome.

BACKGROUND AND PURPOSE: Sleep apnea syndrome may lead to changes in cerebral hemodynamics due to altered alveolar ventilation. We investigated the dynamics of CO2- and blood pressure-regulated alterations of cerebral blood flow velocities during apneic episodes and evaluated CO2 reactivity during different sleep stages. METHODS: A computer-assisted pulsed Doppler system (2 MHz) was used for continuous overnight recordings of middle cerebral artery flow patterns together with simultaneous polysomnography, continuous blood pressure recordings, and measurements of end-expiratory CO2 in six patients with sleep apnea syndrome. RESULTS: Increases in mean flow velocity of 19-219% and in blood pressure of 12.5-83.1% could be observed during the apneic episodes, with maximum increases during rapid eye movement (REM) sleep. CO2 reactivity was in the normal range (4.4 +/- 1.2%) in the waking state and was markedly increased during sleep stages 1 and 2 (p less than 0.005 compared with awake). The greatest increase was found during REM sleep, with a rise of up to three times the waking value (p less than 0.0001 compared with sleep stage 2). CONCLUSIONS: The changes of mean flow velocity could be interpreted as reactive adaptation processes because of CO2 and blood pressure increases corresponding to apnea. The increased CO2 reactivity during sleep may indicate a "hypersensitivity" of intracranial vascular CO2 or pH receptors and a disturbance of central catecholaminergic and cholinergic systems. The pronounced velocity changes during apneic episodes and the concomitant alterations of vessel wall tension might lead to microangiopathies and macroangiopathies due to chronic strain on the brain vessels.     

The "Lower Saxony/Northern Rhine-Westphalia" Neuroblastoma Screening Project: on the need for epidemiologic comparison]

The proof for the general evolution of metastatic neuroblastoma from localized disease by a low-speed process is lacking. The epidemiological approach would require the decrease of neuroblastoma related mortality by reduction of the number of metastatic cases per population unit as a result of a screening program. During 1983 through 1990 the neuroblastoma incidence in the FRG was 0.85-1.09 cases per 100,000 children less than 15 years of age. The mortality rate ranged between 0.25 and 0.49 deaths per 100,000 children. The project "Niedersachsen/Nordrhein-Westfalen" started April 1st, 1992 and is investigating urinary catecholamine metabolite excretion in infants at the age of 10-12 months and for a second time in toddlers at 17-19 months. The target population includes 24.7 million inhabitants with 267,000 births per year. The urine sampled on filter paper is analyzed using thin layer chromatography. Positive and questionable positive results are confirmed by HPLC and GC-MS. The aim of the study is to demonstrate the feasibility of the chosen approach. Furthermore first epidemiological data will be obtained. Until a population-based study on neuroblastoma mortality in screened versus controlled populations has proven the usefulness of the screening it cannot be recommended as a general service to the public.     

Defining the patient population: one of the problems for palliative care research

There is a lack of clear definition and clear inclusion criteria in palliative care research. The aim of this study was to describe consequences of three inclusion criteria in the build up of different study populations, studied in terms of size, number of doctor-patient contacts and demographic characteristics. General practitioners received a questionnaire for all patients who died during the second Dutch National Survey of General Practice (n=2194), to determine whether (1) patients received non-curative treatment; (2) patients received palliative care; and (3) death was expected (total response rate =73%). The criterion 'death was expected' included most patients (62%) followed by 'palliative care' (46%) and 'noncurative treatment' (39%). Similarity between the definition-based populations was fair to moderate. More 'palliative care' and 'death was expected' in patients who had cancer than 'non-curative treatment' patients. The conclusions show substantial differences in populations according to the different inclusion criteria used to select them. Future research in palliative care should acknowledge the limitations of using certain inclusion criteria and explore potential bias.     

The Derotation of Premolars and Canines with NiTi Elements

BACKGROUND: Canines or premolars must often be derotated during fixed appliance therapy. If such derotation is carried out on the continuous archwire during the leveling phase, it may lead to unwanted side effects on the neighboring teeth. MATERIAL AND METHODS: At the University of Ulm a .018" x .018" nickel-titanium segmental derotation archwire was developed to start derotation as early as possible. This wire can be inserted during leveling. This system consists of a vertical slot bracket, an elastic ligature, and the derotation archwire. We tested the derotation archwire under clinical application. The occurring forces and torquing moments were measured in vitro via a hexapode and a sensor working in three dimensions. RESULTS: In this investigation, a derotation moment of 12 Nmm occurred in the canine with a 140 degrees archwire rotation and a force in lingual direction. This archwire also made overcorrection possible, since it remains active after complete derotation. A complete derotation of the tooth was effected with no reactivation, due to the wire's superelasticity.     

Adult epilepsy

The epilepsies are one of the most common serious brain disorders, can occur at all ages, and have many possible presentations and causes. Although incidence in childhood has fallen over the past three decades in developed countries, this reduction is matched by an increase in elderly people. Monogenic Mendelian epilepsies are rare. A clinical syndrome often has multiple possible genetic causes, and conversely, different mutations in one gene can lead to various epileptic syndromes. Most common epilepsies, however, are probably complex traits with environmental effects acting on inherited susceptibility, mediated by common variation in particular genes. Diagnosis of epilepsy remains clinical, and neurophysiological investigations assist with diagnosis of the syndrome. Brain imaging is making great progress in identifying the structural and functional causes and consequences of the epilepsies. Current antiepileptic drugs suppress seizures without influencing the underlying tendency to generate seizures, and are effective in 60-70% of individuals. Pharmacogenetic studies hold the promise of being able to better individualise treatment for each patient, with maximum possibility of benefit and minimum risk of adverse effects. For people with refractory focal epilepsy, neurosurgical resection offers the possibility of a life-changing cure. Potential new treatments include precise prediction of seizures and focal therapy with drug delivery, neural stimulation, and biological grafts.