Reinforcement of lumbosacral instrumentation using S1–pedicle screws combined with S2–alar screws

Objective

Increasing construct stability of lumbosacral instrumentations using S2–ala screws as an alternate to iliac screws.

Indications

Revision surgery after failed lumbosacral fusion; long instrumentations to the sacrum; L5–S1 fusion without anterior support.

Contraindications

Lack of sacral bone stock.

Surgical technique

Midline approach. The entry point for S2–ala screws is caudal to the posterior S1 foramen and close to the lateral sacral crest. Screw tract preparation for S2–ala screws necessitates 30–45° angulation in the axial plane. Biplanar fluoroscopy with inlet and outlet views ensure screw accuracy. With S2–ala screws, bicortical fixation is the goal.

Postoperative management

Patients are mobilized under the surveillance of physiotherapists on day 1 and released from the hospital after 10 days. Clinical and radiographic controls are performed at 6, 12 and 24 months.

Results

Retrospective review of 80 patients undergoing S2–ala screw fixation. Main diagnosis was degenerative lumbar instability, adult scoliosis, high-grade listhesis, and nonidiopathic scoliosis. In 66% of patients, the instrumentation using S2–ala screws was part of a major lumbosacral revision surgery. Follow-up averaged 26 months. There were no deaths or major neurovascular complications. First time fusion rate at L5–S1 was greater than 90%. Eight patients (10%) experienced a complication which could be related to the S2–ala screws. Out of 160 S2-ala screws, 16 screws were judged to cause focal irritation and were removed, indicating a survival rate of 90% for the S2–ala screw.     

Kieferorthopädische Ziele und Ergebnisse der Behandlung von Lippen-Kiefer-Gaumen-Spalten nach dem „Wiener Konzept”

Zusammenfassung Die vorliegende Arbeit beschreibt die Vorgangsweise des Wiener Konzeptes zur Behandlung von Lippen-Kiefer-Gaumen-Spalten: 1. Lippenrotverschluß am Ende der ersten Lebenswoche, 2. Verlorrhaphie am Endes des ersten, 3. Rehabilitation von Oberlippe und Nase am Ende des vierten und 4. Palatorrhaphie am Ende des sechsten Lebensjahres. Die konservative kieferorthopädische Behandlung setzt erst nach der Verlorrhaphie mit einer Oberkieferabdeckplatte ein und wird bis zum Verschluß des harten Gaumens fortgesetzt. Ziele des Wiener Konzeptes sind 1. normale Entwicklung des Oberkiefer- und Mittelgesichtskomplexes, 2. rechtzeitig normalisierte Funktion der orofazialen und velaren Muskulatur für Sprach- und Gehörentwicklung, 3. frühzeitige Minderung der ästhetischen Beeinträchtigung, um psychische Spätschäden zu vermeiden. Zur Objektivierung des Oberkieferwachstums wurden Modellvermessungen durchgeführt. Die Ergebnisse zeigen ein ungestörtes Wachstum des Oberkiefers bis zum zwölften Lebensjahr an.

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Summary The present paper describes the procedure of the Viennese Concept in the treatment of cleft lip and palate: 1. Prolabium closure at the end of the first week of life, 2. velorrhaphy at the end of the first year of life, 3. rehabilitation of upper lip and nose at the end of the fourth year, 4. palatorrhaphy at the end of the sixth year of life. Conservative orthodontic treatment is only begun following velorrhaphy with a maxillary cover plate and continues until closure of the hard palate. The goals of the Viennese Concept are as follows: 1. Normal development of the maxilla and of the middle parts of the face, 2. normalized function of the orofacial and velar muscles in due time to provide normal speech and auditory development, 3. early reduction of aesthetic impairments in order to avoid late psychological sequelae. To obtain objective assessment of maxillary growth measurements on models were done. The results show unimpaired growth of the maxilla up to the age of twelve.

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Résumé La publication suivante décrit le procédé du traitement des fentes labiales et palatines selon le «Concept de Vienne»: 1. La fermeture uniquement du prolabium à l'âge d'une semaine, 2. velorrhaphie à la fin de la première année, 3. correction esthétique de la lèvre supérieure et du nez à la fin de la quatrième année et 4. palatorrhaphie à la fin de la sixième année. Ce n'est qu'après la fermeture du voile du palais (velorrhaphie) que le traitement orthodontique commence avec une plaque supérieure et se poursuit jusqu'à la fermeture de la voûte du palais (palatorrhaphie). Les buts du «Concept de Vienne» en sont les suivants: 1. Développement normal du maxillaire supérieur, 2. fonction normalisée à temps des muscles orofaciaux et vélaires pour l'évolution du langage et de l'ouïe, 3. amélioration à temps de l'aspect esthétique du patient pour éviter des troubles psychiques ultérieurs dans la vie. On a effectué des mesures sur les modèles pour contrôler objectivement le développement du maxillaire. Les résultats indiquent une croissance régulière jusqu'à l'âge de douze ans.

     

Vertikale Veränderungen am Fernröntgenseitenbild nach funktions-kieferorthopädischer Therapie

Zusammenfassung Fernröntgenseitenbilder von Patienten, welche mit dem Distalbißaktivator nachAndresen undHäupl behandelt wurden, wurden auf vertikale Veränderungen untersucht. Danach hat eine Therapie mit funktionskieferorthopädischen Apparaturen folgende Auswirkungen auf die vertikalen Verhältnisse innerhalb des Gesichtsschädels: 1. Die Alveolarfortsätze zeigen ein zusätzliches vertikalwachstum im Bereich der Oberkieferinzisivi und der Unterkiefermolaren. 2. Ein gesteigertes Längenwachstum aller vorderen Gesichtshöhen im Vergleich zur hinteren Gesichtshöhe verursacht im Zusammenwirken mit 1. eine Bißöffnung, welche sich in derJarabak-Ratio jedoch nicht signifikant zeigt. 3. Es kommt zu einer Beeinflussung der Spinaebene, darüber hinaus ergibt sich ein aktiver Wachstumszuwachs für den Bereich beider oberer Gesichtshöhen, also für den gesamten nasomaxillären Komplex. Dieser Zuwachs ist anterior etwas ausgeprägter als posterior. Die Wirkung funktionskieferorthopädischer Apparaturen auf den nasomaxillären Komplex scheint somit komplexer zu sein, als bisher angenommen. 4. Zusätzliches Wachstum im Bereich der aufsteigenden Äste und/oder Kondylen des Unterkiefers während der Aktivatortherapie konnten wir nicht beobachten. Nach unseren Untersuchungen ist der Einfluß der funktionskieferorthopädischen Therapie auf die Vertikalentwicklung des Unterkiefers eher unbedeutend, die wesentlichen vertikalen Veränderungen konnten wir im Bereich der Unterkiefermolaren und der vorderen Gesichtshöhen beobachten. 5. Unsere Untersuchungsergebnisse bestärken somit die Annahme, daß die hauptsächliche Wirkung des Aktivators in einerrelativen Hemmung der Entwicklung des nasomaxillären Komplexes bei gleichzeitig fortschreitendem normalen Unterkieferwachstum anzusehen ist. Die Ergebnisse der Studie sollten anhand eines homogeneren und größeren Untersuchungsgutes nochmals überprüft werden.

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Summary We looked for vertical changes in lateral cephalometric X-rays of patients who had been treated withAndresen andHäupl appliances to correct distal occlusion. Thus, a therapy using functional appliances for orthodontic correction has the following effects on the vertical proportions of the visceral cranium. 1. The alveolar processes show additional vertical growth in the area of the incisors of the upper jaw and the molars of the lower jaw. 2. In conjunction with 1, increased vertical growth of the anterior facial heights compared to the posterior facial height causes an opening of the bite which, however, is not significant in terms of theJarabak ratio. 3. Functional therapy has an effect on the spina plane, and, in addition, causes active vertical growth in the area of both upper facial heights, i. e., of the entire nasomaxillary complex. This additional growth is a little bit more pronounced anteriorly than posteriorly. Therefore the effect of functional orthodontic appliances on the nasomaxillary complex seems to be more complex than previously believed. 4. We did not observe any additional growth in the area of the ascending rami and/or condyles of the lower jaw during activator treatment. Our studies showed that the influence of functional orthodontic therapy on the vertical growth of the lower jaw is rather insignificant; the significant vertical changes were seen in the area of the mandibular molars and of the anterior facial heights. 5. Our findings thus support the assumption that the main vertical effect of the activator can be described as arelative inhibition of the development of the nasomaxillary complex with simulatenous normal progression of mandibular growth. The results of our study should be verified by means of a larger and more homogenous group of patients.

     

Zur Frage der Lückenverengungen im unteren Seitenzahngebiet

Zusammenfassung Das Behandlungsproblem der Lückenverengungen im unteren Seitenzahngebiet wird im allgemeinen abgehandelt. Für besonders starke Einengungen der Prämolarenlücken wird ein festes Gerät empfohlen, das aus dem Angleschen Gewindebogen entwickelt wurde.Bei der Modellauswertung von 63 hiermit behandelten Patienten fiel auf, daß bei einer ganzen Reihe von Fälle, bei denen schon vor der Behandlung ein Neutralbiß bei einem annähernd normalen Oberkiefer vorlag, auch nach der Lückenaufdehnung und der Beseitigung der sagittalen Stufe die Neutralverzahnung der 6-Jahrmolaren unverändert weiter bestand.Es wird daraus die Schlußfolgerung gezogen, daß es sich hierbei um einen Längenzuwachs zumindest im alveolären Bereich der Lückenverengung handelt und nicht um eine Distalverschiebung der 6-Jahrmolaren.Die dabei beobachtete Abflachung der Speeschen Kurve wird durch eine Aufbiergun des horizontalen Unterkieferknochens erklärt.An Hand einiger Abbildungen werden diese Mitteilungen erläutert.Mit 7 Abbildungen     

Sensory gating in the human hippocampal and rhinal regions.

OBJECTIVE: The objective of this work was to ascertain if sensory gating can be demonstrated within the human medial temporal lobe. METHODS: Eight patients with intractable epilepsy with depth electrodes implanted in the medial temporal lobe for pre-surgery evaluation underwent evoked response recording to auditory paired-stimuli (S1-S2). Each of the eight subjects had a diagnosis of left medial temporal lobe epilepsy (MTLE). RESULTS: Data from the non-focal right hippocampi revealed a large negative response on S1 (starting at about 190 ms and lasting for approximately 300 ms from stimulus onset). Rhinal region recordings revealed a positive response (starting at about 240 ms with a rapid incline, followed by a long-lasting decline). A significant attenuation of both responses to S2 stimuli was observed. CONCLUSIONS: Data are suggestive of an involvement of the human medial temporal lobe in the processing of simple auditory information which occurs in a time frame later than the neocortical auditory evoked components. The exact role of these anatomical structures in the sensory gating process remains to be defined. SIGNIFICANCE: This study provides the first evidence of an activation of the rhinal cortex after simple auditory stimulation and provides new evidence that the activation of the medial temporal lobe structures occurs at a later stage than that of the neocortex.     

The extract of Mucuna pruriens possesses histamine activity

ObjectiveTo investigate the activity of the active principle in the spines of the seed pods of Mucuna pruriens using contraction of guinea pig ileum as index of pharmacological activity.MethodsThe active principle was extracted with 0.0015 M NaCl. Muscle strips of guinea pig ileum were prepared and contractile responses were measured using a Kymograph. Two sets of experiment were conducted: (1). The contraction of the ileum in presence of different concentrations of histamine, 2-methylhistamine and the extract of Mucuna pruriens. (2). The contractile response of the ileum in presence of different concentrations of the extract and antagonists including diphenhydramine, atropine and methysergide.Results(1) The extract of Mucuna pruriens hair, 2-methylhistamine and histamine produced dose dependent contraction of guinea pig ileum (Extract ED₅₀ = 13.0 μg/mL, 2-methylhistamine ED₅₀ = 8.5 μg/mL and histamine ED₅₀ = 10.0 μg/mL). (2) Diphenhydramine, an H₁ antagonist competitively blocked the contractile response of the Mucuna pruriens extract. (3) Coadminstration of the Mucuna pruriens extract either with different doses of antimuscarinic agent atropine or 5-hydroxytryptamine blocking agent methysergide did not alter the extract induced contractile response of the guinea pig ileum.ConclusionThese results demonstrate that the spines of Mucuna pruriens possess histamine activity which may contribute to its itching and painful irritation effects.     

Overweight and obesity among patients attending a Nigerian oral surgery clinic: implications for oral surgical practice in Nigeria

Aim

To determine the prevalence of overweight and obesity among patients attending oral and maxillofacial outpatient clinic of the Lagos University Teaching Hospital, Nigeria; and discuss the clinical and surgical implications that obesity has on the delivery of oral and maxillofacial surgical and anaesthetic care.

Methods

Consecutive patients presenting to the oral and maxillofacial surgery outpatient clinic at the Lagos University Teaching Hospital, Nigeria over a 4-month period (May–August 2004) were screened for age, sex, height and weight. All of the patients were treated for dentoalveolar surgical procedures (routine and surgical extractions), incisional and excisional biopsies, and enucleation under local anaesthesia.

Results

The BMIs of the studied patients ranged from 16.7 to 39.8 kg/m², with a mean of 24.6 ± 4.5 kg/m². Prevalence of excess weight was 39.1%. Thirty-one (11.4%) patients were obese and 75 (27.7%) patients were overweight. A significant difference was observed in the BMIs of male and female patients (P=0.000). The age groups < 30 years had mean BMIs that were considered normal; whereas other age groups above 30 years had mean BMIs that were considered overweight. Prevalence of obesity increases with increasing age. Obese individuals were seen in all the age groups except those < 20 years.

Conculsions

The prevalence of excess weight (overweight and obesity) in patients presenting in the studied oral and maxillofacial outpatient setting was 39.1%. Oral and maxillofacial surgeon needs to be aware of obesity-/overweight-related medical and surgical issues and take them into consideration when treating these patients.     

Trace elements and Vitamin E status in Nigerian patients with prostate cancer

Background

Prostate cancer is the most common type of cancer among men.

Objectives

To investigate the trace elements (Se, Zn, Cu and Cd) and vitamin E status of some Nigerian prostate cancer (PCa) patients relative to their prostate-specific antigen (PSA) values.

Methods

Prostate cancer patients were assigned into groups 1, 2 and 3 with PSA of 5–10 ng/ml, 11–20 ng/ml and > 20 ng/ml, respectively.

Results

The results showed that the levels of whole blood superoxide dismutase (SOD) and serum Se and Zn were significantly lower (p< 0.05) in the PCa patients. Specifically, levels of SOD, Se and Zn decreased by 67%, 30% and 35%; 70%, 52% and 41%; 81%, 58% and 47%, in subjects with PSA of 5–10 ng/ml, 11–20 ng/ml and > 20 ng/ml, respectively. There were no significant differences (p> 0.05) in levels of Cu and Cd. Serum Cu/ Zn ratio were significantly higher in PCa patients. The Cu/ Zn ratios were 1: 1.2: 1.3 for subjects in groups 1, 2 and 3, respectively. Vitamin E levels in PCa patients were significantly lower and followed the order; normal > PSA (5–10) > PSA (11–20) > PSA (> 20).

Conclusions

Deficiency of vitamin E, Zn and Se may be risk factors for development of PCa.Key words: Lipid peroxidation, Prostate cancer, PSA values, Trace elements, Vitamin E