Das Heerfordt-Syndrom — eine seltene Erstmanifestation der Sarkoidose

Sarcoidosis is a chronic, multisystem disorder of unknown cause characterized by noncaseating epithelioid granulomas. Infectious agents and genetic components have been discussed. Heerfordt’s syndrome with uveitis, enlargement of the parotid glands and optional paralysis of the Nn. facialis is a form of sarcoidosis. The diagnosis is confirmed by histology. Further analyses are fiberoptic bronchoscopy with bronchoalveolar lavage or the gallium-67 scan in combination with blood findings. The therapy of choice is glucocorticoids. We present a case report of Heerfordt’s syndrome and a review of the literature covering different aspects of sarcoidosis.     

Prospective study on titanium bar-retained overdentures: 2-year results

Within a monometallic concept 29 patients received titanium bar‐retained mandibular overdentures on 2 IMZ implants. The study had a prospective design with 3 months recall intervals. One of 58 implants failed after 11 months. There were no significant differences of the mean plaque scores (Silness, Löe) and the mean sulcus bleeding scores (Mühlemann, Son) at the abutments between baseline, 12 months and 24 months. Less than 40% of the subjects showed plaque score zero at 24 months. However, 89% exhibited sulcus bleeding score zero indicating health of the peri‐implant soft tissues in most cases. Plaque at the basal site of the bar was scored separately at additional measuring points located at the central area and the contact areas between bar and abutments. Bar plaque scores nearly doubled between baseline and 12 months and remained high at 24 months. Median maximal vertical bone loss around the implants was 1.7 mm after 2 years. Bone loss did not exceed one quarter of the implant length in 79%. The monometallic concept in bar‐retained overdentures on 2 implants proved its clinical suitability except for the applicability of pure titanium for bar clips. Plaque formation beneath the bar seems to be one of the major clinical problems.     

Median ages of eruption of the primary teeth in white and Hispanic children from Arizona

PURPOSE: The purpose of this project was to establish median eruption ages of primary teeth and evaluate eruption differences between contralateral teeth by gender, ethnicity, and household income. Data was derived from a caries study of preschool children. METHODS: A total of 4,277 white (non-Hispanic) and Hispanic preschool children from Arizona were visually examined for caries and tooth eruption status by 5 examiners between February 1994 and September 1995. Analyses of eruption status were conducted using logistic regression to produce an eruption probability distribution from which median eruption ages for the primary teeth were determined. Possible differences in eruption timing between contralateral teeth by gender, ethnicity, and household income were examined. RESULTS: Eruption status of 1 tooth was significantly predictive of the pair-matched tooth for all pairs. Differences were found for the maxillary central incisor (gender) and the mandibular second molar (ethnicity). Eruption ages did not vary by household income. Median eruption ages for each of the 10 primary teeth are presented. CONCLUSIONS: This study provides contemporary median eruption ages for primary teeth.     

Dimensional Accuracy of 7 Die Materials

PURPOSE: The purpose of this study was to compare the linear dimensional accuracy and the handling characteristics of 7 die materials. MATERIALS AND METHODS: A master die analogous to a complete veneer crown preparation was machined from medical grade stainless steel, and 3 measurements (1: vertical; 2 and 3: horizontal) were made from 3 scribed reference lines. Individual polyvinylsiloxane impressions were made (n = 10) for each of the specimens. The fabricated dies were measured (50x) to the nearest 0.0001 mm. Data were subject to ANOVA/Duncan tests at significance level 0.05 and pairwise comparisons. RESULTS: Type IV resin-impregnated dental stone and copper-plated dies most closely approximated the dimensions of the master die, and were not significantly different from each other in any of the pairwise comparisons. Conventional Types IV and V dental stone dies exhibited setting expansion within the range appropriate for gypsum. Epoxy resin die materials demonstrated shrinkage comparable to the expansion of the Types IV and V dies. Polyurethane dies displayed a combination of linear expansion and shrinkage. Bis-acryl composite resin dies had excessive shrinkage. CONCLUSIONS: Type IV resin-impregnated dental stone and copper-plated dies were more dimensionally accurate than the other die materials tested.     

Pharmacokinetic profile of a locally administered doxycycline gel in crevicular fluid,blood, and saliva

BACKGROUND: With the help of so-called controlled release delivery systems, the half-life period of locally administered antibiotics in gingival crevicular fluid (GCF) can be extended significantly. The aim of this study was to characterize the delivery profile of a new one-component 14% doxycycline free amine gel for local application. Pharmacokinetics of doxycycline (DOXY) were analyzed in GCF, saliva, and serum. METHODS: Twenty patients with persisting or recurring pockets (probing depths > or = 5 mm and bleeding on probing) after mechanical treatment (surgical or non-surgical) took part in the study. In each patient 1 periodontal defect was treated with DOXY gel. Samples of GCF, saliva, and serum were obtained before application of DOXY gel; 15 minutes after application; at 2 and 5 hours; and at 1, 2, 3, 4, 7, 9, and 11 days after application. Separation and quantitative measurement of DOXY was performed with high performance liquid chromatography and UV detection at lambda = 260 nm. RESULTS: Coefficients of variation were lower than 2% (intraassay) and 4% (interassay), respectively. For concentrations between 50 to 1000 microg/ml, we found a linear relationship between expected and measured DOXY values (linear coefficient of correlation: r = 0.998). Within the first 5 hours after application, concentration of DOXY in GCF (maximum after 15 minutes 19.97 +/- 5.85 mg/ml) and saliva (maximum after 15 minutes 17.83 +/- 2.84 mg/ml) was similar. Then concentration fell to a lower level (28.90 +/- 19.44 microg/ml) compared to GCF (577.41 +/- 127.34 microg/ml) after 3 days. Up to 10 days after application, the concentration of DOXY in GCF was 34.24 microg/ml. With the exception of 1 patient, all serum samples were DOXY-negative. CONCLUSIONS: 1) After subgingival application of biodegradable 14% doxycycline gel, mean doxycycline levels in GCF that exceeded 16 microg/ml could be maintained for at least 12 days. Thus, the antimicrobial agent may be classified as a controlled release device. 2) The antibiotic effect was limited mainly to the subgingival sites of application of the doxycycline gel. 3) The doxycycline gel possesses the pharmacokinetic and clinical properties to deliver efficacious levels of antibiotics to the periodontal pocket and to maintain these levels for at least 1 week without the need of further drug retention by a periodontal dressing.     

Comparison of various plaque parameters in individuals with poor oral hygiene

The control of plaque formation on tooth surfaces would appear to be a major goal of preventive dentistry. Several subjective scoring procedures for estimating plaque have been described. In the prresent investigation, stained and unstained plaque scorres were compared with various physical characteristics of plaque such as dry weitht, wet weight, microscopic count, absorbance of dispersed plaque suspensions, nitrogen and carbohydrate content. An institutionalized population that exhibited moderate to severe gingivitis and heavy plaque accumulations was studied. Significant correlations between the gravimetric measurements and microscopic count with either gingivitis scores or the unstained plaque scores were found. The stained plaque scorre showed no correlation with plaque weight or gingivitis scores in this population.     

Bone-implant contact and bone quality: evaluation of expected and actual bone contact on machined and osseotite implant surfaces

This article introduces a new technique using histomorphometrics to estimate the extent of bone-to-implant contact that might be expected on an implant surface in relation to the quality of the surrounding bone. Two implant surfaces, one machined and one Osseotite, were compared on the same implant in the same patient Eleven of these custom-made 2-mm-diameter implants were placed in the posterior maxilla and allowed to integrate. After 6 months of nonloaded healing, implants were trephined with surrounding bone tissue and prepared into histologic sections. Digitized images were analyzed at 50x magnification with image-analysis software. Bone surface area was calculated over the entire microscopic field, and the actual bone-to-implant contact for each implant surface was measured. The expected bone-to-implant contact was calculated by superimposing the profile of the implant threads on the bone image a small increment (0.15, 0.5, or 1.0 mm) from the actual implant site and counting the linear amount of bone that would be in contact with the implant surface. The actual bone-to-implant contact for Osseotite was greater than its expected bone-to-implant contact, whereas the actual bone-to-implant contact for the machined surface was mostly lower than the expected values. Thus, the Osseotite surface appears to exert a positive effect on the amount of bone approaching the implant surface and can be described as conductive, while the machined surface is nonconductive. This technique may serve to predict the clinical success that the Osseotite surface will demonstrate in poor-quality bone.     

Design and production of dental prosthetic restorations: basic research on dental CAD/CAM technology

Dental prosthetic restorations (crowns and FPDs) are currently produced mainly by conventional dental technology methods. The automation of the production process can be achieved by the use of CAD/CAM techniques. In addition, it has become possible to use materials that previously could not be processed for technical reasons or could not be processed economically, especially high-performance ceramics. Although CAD/CAM methods for producing fixed restorations are of increasing interest, little information has been published about their mode of operation and functionality. To date, studies have focused mostly on special systems. However, basic studies are lacking. Basic research on the most important aspects of CAD/CAM fixed dental restorations from the viewpoint of production, information technology, and dentistry/dental technology are the subject of a current research project. The aim of this study is the presentation of preliminary results. The CAD/CAM process for fixed restorations was analyzed and broken down into single steps. In order to examine the influence of the single steps in the process chain, a computer test model with the teeth of the maxilla and mandible in static occlusion was developed and reverse engineered. While producing the test model, fundamental knowledge regarding the manufacturing of dental restorations with functional occlusal surfaces was gained. The intersection of the maxillary and mandibulary occlusal surfaces allows the qualitative analysis of occlusal contacts analogous to the conventional technique. Furthermore, a quantitative assessment of the size of the occlusal contacts and the measurement of intersection is possible.     

Bone Flap Necrosis After Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Infarction

Background

Autologous bone flap reinsertion follows as a second surgical intervention after decompressive craniectomy in patients with malignant middle cerebral artery (MCA) infarction. In addition to surgery-related short-term complications, aseptic resorption of the reimplanted bone flap is a possible long-term problem which has not yet been sufficiently elucidated in these patients.

Methods

A total of 109 patients who had undergone decompressive hemicraniectomy for malignant MCA infarction in our institution between September 1994 and December 2011 were included in the study. Clinical and radiological findings were retrieved retrospectively. Aseptic bone necrosis was classified into two categories based on computer tomographic features.

Results

A total of 76 patients received their own cryoconserved bone flap (mean age 54.34 ± 10.73 years; 49 males). The overall short-term complication rate was 9.2 %. Bone flap necrosis occurred in 26 patients (22.8 %) with 7 flaps showing signs of surgically relevant type II necrosis after a median time of 14 months (interquartile range [IQR] 4–22).

Conclusions

There is a noticeable complication rate in patients undergoing bone flap reinsertion after hemicraniectomy due to malignant MCA infarction. Aseptic bone necrosis represents a significant complication during long-term follow-up. The pathophysiological mechanisms remain unclear and more efforts should be undertaken to understand and possibly prevent this complication in these patients.     

Intracranial Pressure Monitoring: Fundamental Considerations and Rationale for Monitoring

Traumatic brain injury (TBI) is a major cause of death and disability worldwide. In large part critical care for TBI is focused on the identification and management of secondary brain injury. This requires effective neuromonitoring that traditionally has centered on intracranial pressure (ICP). The purpose of this paper is to review the fundamental literature relative to the clinical application of ICP monitoring in TBI critical care and to provide recommendations on how the technique maybe applied to help patient management and enhance outcome. A PubMed search between 1980 and September 2013 identified 2,253 articles; 244 of which were reviewed in detail to prepare this report and the evidentiary tables. Several important concepts emerge from this review. ICP monitoring is safe and is best performed using a parenchymal monitor or ventricular catheter. While the indications for ICP monitoring are well established, there remains great variability in its use. Increased ICP, particularly the pattern of the increase and ICP refractory to treatment is associated with increased mortality. Class I evidence is lacking on how monitoring and management of ICP influences outcome. However, a large body of observational data suggests that ICP management has the potential to influence outcome, particularly when care is targeted and individualized and supplemented with data from other monitors including the clinical examination and imaging.