Perioperative complications with the bone-anchored hearing aid.

OBJECTIVE: To discuss perioperative complications associated with the bone-anchored hearing aid (BAHA) and their management. STUDY DESIGN AND SETTING: A retrospective review of 58 patients who underwent implantation of BAHA for unilateral conductive, mixed, or sensorineural hearing losses was performed at a tertiary referral center. RESULTS: Between September 2003 and June 2005, 58 patients underwent implantation of a BAHA. There were 30 female and 28 male patients, with a mean age of 48 years (range 8-80 years). Complications occurred in 19% (11/58) of patients. Most adverse events were seen early in the series. The most common complication, partial or complete loss of the skin graft, occurred in 10% (6/58) of patients. These were managed successfully with local wound care. Five percent (3/58) of patients had skin growth over the abutment. Two of these cases were managed with office debridement, whereas 1 patient required revision under general anesthesia. There was implant extrusion in 3% (2/58) of patients, and both of these patients later underwent successful reimplantation. All patients had their implant activated 3 months after surgery. There were no perioperative or postoperative deaths. CONCLUSION: Complications related to BAHA implantation are relatively minor and usually involve partial or complete loss of the skin graft. Most complications were successfully managed in the office.     

Erratum to: pulp bleeding color is an indicator of clinical and histohematologic status of primary teeth

Clinical Oral Investigations -     

A new model for the artificial aorta blood vessels using double-sided radial functionally graded biomaterials

Based on radial functionally graded biomaterials and inspired by the geometry of a real aorta blood vessel, a new model was proposed to fabricate the artificial blood vessels. A finite element analyzer is employed to reach the optimal and proper material properties while earlier, it was validated by two famous theories, i.e., the first shear deformation and the plane elasticity. First, the geometry of a real ascending aorta part was simulated and then solved under the axially varying blood pressure and other real and actual conditions. Since the construction of artificial blood vessels just similar to the natural one is impossible, it was tried to find the best substitutes for other materials. Due to the significant properties of functionally graded biomaterials in the reduction in sudden changes of stress and deformation, these types of materials were selected and studied. Two types of conventional single-sided and an efficient double-sided radial functionally graded vessel were proposed and simulated. The elastic behaviors of proposed vessels were obtained and compared to ones previously attained from the real vessel. The results show that all the desired behaviors cannot be achieved by using a conventional single-sided radial FG vessel. Instead and as a conjecture, a smart double-sided radial FG biomaterial is suggested. Fortunately, the proposed material can meet all the desired goals and satisfy all of the indices simultaneously.     

Nicotine Exposure Alters the mRNA Expression of Notch Ligands in Dendritic Cells and Their Response to Th1‐/Th2‐Promoting Stimuli

Dendritic cells (DCs) utilize polarizing signals to instruct the differentiation of T helper (Th) cells into Th1 and Th2 effector cells: antigen‐specific ‘signal 1’, costimulatory ‘signal 2’ and polarizing cytokines ‘signal 3’. Accumulating evidence suggests the involvement of an additional signal, the Notch signalling pathway. We reported that in response to Th1‐promoting stimuli, both mouse and human DCs generated in the presence of the immune modulator nicotine (nicDCs) fail to support the development of effector memory Th1 cells. However, in response to Th2‐promoting stimuli, these nicDCs preferentially support the differentiation of antigen‐specific IL‐4‐producing Th2 effector cells. Here, we show that when compared to their control counterparts, immature mouse and human nicDCs display higher levels of the Notch ligands D1, D4 and J2 mRNA expression. In response to Th1‐ and Th2‐promoting stimuli, mouse nicDCs display higher levels of the Notch ligands D1, D4 and J2, while human nicDCs show higher levels of D1, D4 and J1 mRNA expression. Furthermore, both stimulated mouse and human nicDCs express higher CD86 to CD80 ratio and produce lower amount of IL‐12. Collectively, our data suggest that these changes in addition to an increase in Jagged expression correlate with the ability of nicDCs to modulate the Th1/Th2 balance in favour of Th2 generation.     

Rectosigmoid Motility in Patients with Quiescent and Active Ulcerative Colitis

We studied the pathophysiology of diarrhea in ulcerative colitis by evaluating and comparing rectosigmoid motility before, during, and after a 900-cal meal in healthy subjects, patients with quiescent ulcerative colitis, and patients with active ulcerative colitis. Three intraluminal pressure transducers were used for recording of rectosigmoid motility. Motility during fasting, eating, and after eating a meal was similar in patients with quiescent disease and controls. Motility increased significantly during eating in controls, but not in patients with quiescent disease. In patients with active colitis, motility was significantly reduced during fasting, eating, and after eating, compared with controls. Motility increased significantly during eating in patients with active disease. Propagated activity was similar in the three study groups; therefore, the decreased motility was due to decrease in segmental contractions. These findings suggest that diarrhea in patients with active colitis may be related to the loss of normal segmental contractions which delay distal stool transport.     

Das myofasziale Schmerzsyndrom

Background

Pain and/or functional disorders, such as weakness or movement control disorders, often have a myofascial origin. The pathophysiological substrates of myofascial problems are myofascial trigger points (mTrP) and reactive connective tissue alterations. Typical for myofascial pain is that the site of the origin of pain and the site of pain perception often do not lie in the same place (referred pain). Myofascial disorders can have a primary or a secondary cause and often make a substantial contribution to stimulus summation problems. In the process of clinical reasoning it needs to be investigated what value mTrP and fascial alterations have for the current problem in question (e.g. primary, secondary and contribution to stimulus summation).

Methods

The causal and sustained therapy of myofascial disorders considers the contractile part of muscle (contracture knots) as well as the noncontractile parts (reactive connective tissue alterations). Predisposition and maintaining factors have to be recognized and if possible included in the therapy, depending on the necessity. The trigger point therapy IMTT® (“Interessengemeinschaft für Myofasziale Triggerpunkt-Therapie”) encompasses manual techniques and if necessary dry needling for deactivation of the disruption potential of mTrP, stretching/detonization and functional training/ergonomics.     

Use of an absorbable mesh to repair contaminated abdominal-wall defects

When polypropylene mesh (Marlex) is used to repair contaminated abdominal-wall hernias, a high incidence of mesh-related chronic infection, drainage, erosion, and bleeding is noted. As an alternative to placing polypropylene mesh in a contaminated field, in the past 18 months we have used an absorbable polyglycolic acid mesh (Dexon) to repair contaminated abdominal-wall defects in eight patients--three with necrotizing abdominal-wall infections, one with an extensive electrical burn of the abdominal wall, three with infected polypropylene mesh from a previous repair, and one whose hernia was covered by a chronically infected scar. In seven of the eight cases, a single sheet of polyglycolic acid mesh was sewn to the fascial margins. In four cases, skin was closed over the mesh; wound packing and subsequent skin grafting were required in the other four. In follow-up studies that ranged from three to 18 months, six of the eight patients developed abdominal-wall hernias at the site of absorbable mesh placement. None of the patients required an abdominal binder. Postoperative hernia development is probable in patients whose defects are repaired with absorbable mesh. However, this complication is balanced against the more serious complications of fistula, bleeding, skin erosion, drainage, and chronic infection, which require removal of the more rigid nonabsorbable meshes in 50% to 90% of cases when the latter are placed under contaminated conditions. Placement of absorbable mesh for temporary abdominal-wall support until wound contamination resolves enhances the likelihood of subsequent successful placement of a permanent mesh.