Sex-related changes in the bone mineral content of atrophic mandibles

In 25 edentulous anatomical mandible specimens (15 female, age range 69–90 years; 10 male, age range 68–88 years), the bone mineral content (BMC) was measured by dual-photon absorptiometry (DPA) and analyzed in a standardized area of the mandibular body. The results of our BMC examinations showed that there was a significant difference (P=0.05) between the two sexes. Another notable fact was that, with advancing age, the values measured in the male mandibles tended to increase slightly but in a statistically significant way. Those of the female mandibles tended to decrease with age. A possible explanation for this observation may be derived from the fact that a reduction of the mandibular height leads to a reduction of the moment of resistance. As functional adaptation in order to preserve the stability of the atrophic body of the mandible, the amount of inner cortical bone of the male mandibles increases, leading to a reduction of the cancellous portion. In the mandibles of women, postmenopausal osteoporosis seems to prevent an analogous compensation mechanism.     

Characteristics of the cancellous bone of edentulous mandibles

Trabecular bone volume and trabecular connectivity (trabecular bone pattern factor) of edentulous mandibles were examined using undecalcified bone sections from the region of the 1st premolar to investigate atrophyrelated changes in mandibular cancellous bone. The mean trabecular bone volume was 21.8% in female mandibles and 36.4% in male mandibles. The mean trabecular bone pattern factor was ‐0.22 mm⁻¹ for female mandibles and ‐2.29 mm⁻¹ for male mandibles. The difference between the sexes was statistically conspicuous for both parameters, but did not attain statistical significance. A notable fact was the extreme range of variation in both trabecular bone volume and trabecular connectedness. A difference of 65% between the highest and the lowest trabecular bone volumes measured in the present study (min, 7.6%; max, 73.6%, both male) reflects the possible variation in trabecular density of edentulous mandibles.     

Reproducibility of three-dimensional CT-assisted model production in the maxillofacial area.

In the mid-eighties, computerised tomography (CT) assisted three-dimensional imaging, and modelling of skull structures was introduced into preoperative diagnosis in maxillofacial surgery. This new method is already being used in the preoperative planning of corrections of post-traumatic defects and craniofacial deformities as well as in tumour surgery and implantology. The aim of the present study was to collect information on the reproducibility of a skull model milled from hardened polyurethane foam, and based on the CT data of a real skull. Thirty one measurements were carried out on the model and on the original skull, leading to the result that the model showed a mean inaccuracy of 1.5 mm. The deviations ranged between 0.0 and 3.6 mm. Generally, the model structures, however, tended to be larger than those of the original. As far as the total of all measurements is concerned, the model deviated from the original skull by 1.6%. A convincing aspect of the model, which cannot be obtained by any other method, is its plasticity and the possibility of 3-D orientation on a lifesize model. However, the study indicates that surgeons using this technique should consider the possible discrepancies between the model and the real skull when making preoperative assessments.     

Triage using HPV-testing in persistent borderline and mildly dyskaryotic smears: proposal for new guidelines

In the Netherlands 2% of cervical smears in the cervical cancer screening program are read as borderline or mildly dyskaryotic cytology (BMD smear). Only in about 10% of these women a high-grade CIN lesion (CIN II-III) is present; therefore referral is for the majority unnecessary. In our study triage with high-risk HPV (hrHPV) testing was used to identify women at risk for development of high-grade CIN lesions after a repeat BMD smear. A "wait-and-see" period was incorporated allowing clearance of HPV and regression of the lesion. Women with a low-grade lesion, irrespective of their HPV status, were monitored at 12 months; women with a high-grade lesion were monitored at 6 and 12 months. Fifty-one of the 105 women (49%) were hrHPV negative at baseline; none of them showed progression of the lesion within the first year of follow-up (NPV 100%). High-grade CIN was present in 1 patient who was HPV negative at baseline (2%); she demonstrated regression after 12 months. Nineteen of the hrHPV positive women (35%) demonstrated a high-grade CIN lesion at baseline and 3 cleared hrHPV after 6 months, with a subsequent regression of CIN. Ten women remained hrHPV positive with persistence of high-grade CIN and were eventually treated. At baseline, 35 hrHPV positive women demonstrated a low-grade lesion, 19 remained hrHPV positive after 12 months and 5 developed high-grade CIN. Sixteen out of the 35 cleared the hrHPV infection without progression of the lesion. In conclusion, triage, using hrHPV testing for women with persistent BMD cytology, can select women who are not at risk for development of high-grade CIN. We recommend return to the screening program without referral for colposcopic examination if hrHPV is absent. For hrHPV positive women, a repeat hrHPV test after another 6 months is suggested. Referral is only required if persistence of hrHPV is established.     

Organisation of experimental thrombosis by blood cells

Summary To clarify whether thrombus organisation was carried out by local cell activity or by elements of the circulating blood we developed an artifical prosthesis, made of an impermeable polyurethane material with an athrombogenic surface but with a central part consisting of a DACRON velour ring which was thrombogenic. We implanted these devices into the aorta of 10 sheep. In these animals, organisation of the central thrombus by local aortic cells could be excluded. After varying periods of time (2–84 days), the device was removed and the organized thrombus investigated by light and electron microscopy. From our investigations the organisation process with the development of mesenchymal cellular elements proceeded in 3 steps: (1) The activation of the mononuclear macrophage system (2), the appearance of myofibroblastic cells and (3) endothelial formation. The activation of the mononuclear macrophage system is probably induced by chemospecific products of metabolism arising from aging thrombotic material. Apart from mononuclear elements such as monocytes, macrophages, and giant cells we observed fibroblast-like and myofibroblast-like cells. The matrix contained collagen. Endothelium developed on the surface of the organizing thrombus. The final stage was characterized by the formation of a pseudovessel wall, which followed the pattern of the vascular model. Our findings support the hypothesis that a thrombus may be organized by cells derived from the circulating blood.Dedicated to Prof. Dr. J.H. Holzner on the occasion of his 60^th birthday.Ludwig Boltzmann Institute for Cardiac Surgical Research, Spitalgasse 23     

Complete Revascularization and Survival in STEMI

Background:Complete revascularization (CR) of ST-elevation myocardial infarction patients with multivessel coronary artery disease (MVD) has proven better regarding combined endpoints than incomplete revascularization (IR) in recent randomized control trials with no impact on survival.Objective:To retrospectively evaluate the impact of complete CR during the index hospitalization on survival in STEMI patients with MVD.Methods and results:We included all patients with MVD who underwent successful primary percutaneous coronary intervention for STEMI during their index hospitalization at the University Medical Centre Ljubljana, Slovenia (from 1 January 2009 to 3 April 2011). Coronary angiograms were reviewed for non-culprit coronary arteries (>2 mm in diameter and ≥50% stenosis) treated with percutaneous coronary intervention. Rates of all-cause and cardiovascular death were compared between 235 patients who underwent CR (N = 70) or IR (N = 165). After a median follow-up of 7.0 years (interquartile range 6.0–8.2) the CR group had lower rates of all-cause death (15.7% vs 35.8%, log-rank p = 0.003) and cardiovascular death (12.9% vs 23.6%, log-rank p = 0.046). Multivariable analysis with adjustment for confounders showed no benefit of CR for all-cause death (hazard ratio [HR] 0.60, 95% confidence interval [CI] 0.31–1.18, p = 0.139) or cardiovascular death (HR 0.80, 95% CI 0.37–1.72, p = 0.560). Age, elevated serum creatinine at inclusion, diabetes and cardiogenic shock at presentation were predictors of death.Conclusions:Patients with STEMI and MVD who underwent CR showed lower all-cause and cardiovascular death during follow-up than those who underwent IR. However, after adjustment for confounders, the real determinates of survival were independent of the revascularization method.     

Informative censoring in relative survival

With changing the age distribution at the time of cancer diagnosis, the administrative censoring due to study end may be informative. This problem has been mentioned frequently in the relative survival field, and an estimator aiming to correct this problem has been developed. In this paper, we review the existing methods for estimation in relative survival, demonstrate their deficiencies, and propose weighting to correct both the recently introduced net survival estimator and the Ederer I estimator. Using simulations and real cancer registry data, we evaluate the magnitude of the informative censoring problem. We clarify the assumptions behind the reviewed methods and provide guidance to their usage in practice. Copyright © 2013 John Wiley & Sons, Ltd.     

Prognostic factors in patients with advanced hepatocellular carcinoma treated with sorafenib

Background Sorafenib is the new reference standard for patients with advanced hepatocellular carcinoma (HCC). Aim To identify prognostic factors in sorafenib‐treated HCC patients and to evaluate outcomes with respect to liver function. Methods In this retrospective study, 148 HCC patients received sorafenib 400 mg b.d. across 11 Austrian institutions. Seventy‐eight HCC patients who received best supportive care (BSC) in the pre‐sorafenib era served as a control. Results In sorafenib‐treated patients, low baseline α‐fetoprotein, low Child–Pugh (CP) score, compensated cirrhosis, and low baseline aspartate aminotransferase (AST) were associated with significantly longer overall survival (OS) on univariate analysis. CP score and baseline AST remained independent prognostic factors on multivariate analysis. In patients with Barcelona Clinic liver Cancer (BCLC) stage B or C HCC (sorafenib: n = 139; BSC: n = 39), CP‐A patients had a median OS of 11.3 (sorafenib [n = 76]) vs. 6.4 (BSC [n = 17]) months (P = 0.010), and CP‐B patients had a median OS of 5.5 (sorafenib [n = 55]) vs. 1.9 (BSC [n = 22]) months (P = 0.021). In the sorafenib group, median OS according to baseline AST was 11.8 (<100 U/L [n = 58]) vs. 3.9 (≥100 U/L [n = 15]) months for CP‐A patients (P = 0.127), and 6.5 (<100 U/L [n = 33]) vs. 2.1 (≥100 U/L [n = 21]) months for CP‐B patients (P = 0.011). There was no survival difference between sorafenib and BSC in patients with BCLC stage D HCC (1.5 vs. 1.4 months; P = 0.116). Conclusions Sorafenib was associated with improved survival in both CP‐A and CP‐B patients. In CP‐B patients, baseline AST may be helpful in determining which patients are most likely to benefit from sorafenib.