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1.
A.K. Bartella A.-K. Sander M. Kamal J. Steegmann A. Kloss-Brandstätter J. Teichmann F. Hölzle B. Lethaus 《The British journal of oral & maxillofacial surgery》2018,56(4):322-326
Despite improvements in the management of patients in critical care, about 3% patients who have an operation with curative intent for oral squamous cell carcinoma (SCC) do not survive their stay in hospital. Our aim was to assess the risk factors for postoperative death that were independent of the stage of the cancer, or the age and sex of the patients. We screened 4760 consecutive inpatients at a maxillofacial tertiary care centre from 2011 to 2016, and 34 of them had died within the first three months after operation. We matched them with a further 34 patients with the same TNM stage, age, and sex. General personal and clinical data and preoperative laboratory values were screened, and we applied a Charlson Comorbidity Score (for anaesthetic risk) for each group. Patients’ mean (SD) age was 66 (12) years old. There was no significant difference in sex (p = 1), age (p = 0.718), or TNM classification. Those who died after operation had significantly more renal (p = 0.027) and gastrointestinal (p = 0.006) diseases, but cardiac diseases (p = 0.468) and diabetes mellitus (p = 1) were not significant risk factors in themselves. Patients who died postoperatively had significantly worse risk scores (p = 0.001) overall. The most common causes of death were septic shock (n = 10) and acute cardiac (n = 9) or respiratory failure (n = 7). Our findings suggested that general diseases were not intrinsically a contraindication for operation with curative intent. The Charlson Comorbidity Score helped to detect potentially fatal courses and could be useful in the preoperative assessment of patients whose general health is not good. 相似文献
2.
M. Kamal A.H. Ziyab A. Bartella D. Mitchell A. Al-Asfour F. Hölzle P. Kessler B. Lethaus 《The British journal of oral & maxillofacial surgery》2018,56(6):453-462
The goal of reconstruction of the alveolar cleft in patients with cleft lip and palate is to improve the quality of tissue, the structural stability, and increase the volume of bone. This study is a systematic review with meta-analysis of volumetric bony filling using autogenous bone and various tissue-engineered bone substitutes. We made an electronic search on MEDLINE, EMBASE, SCOPUS, WEB OF SCIENCE, “grey” publications (materials and research produced by organisations outside traditional channels for commercial or academic publishing and distribution), and relevant cross references according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies that reported the outcomes of volumetric grafting were included in the meta-analysis. Of 1276 studies, 26 were included in the meta-analysis. Pooled analysis of 25 studies that used autogenous bone showed a significant reduction in the volume of the cleft equivalent to 62.0% bone fill (95% CI 54.3 to 69.6), in contrast to 10 studies that used a tissue-engineered material and reported bone filling of 68.7% (95% CI 54.5 to 82.8). The estimated sizes of pooled effects across studies showed that there was no significant difference between the two major intervention groups (p value 0.901). Our statistical analysis showed that autogenous bone grafts did not differ significantly from tissue-engineered materials in their ability to fill clefts.Systematic review registration: International Prospective Register of Systematic Reviews, PROSPERO (CRD42017065045). 相似文献
3.
Alexander K. Bartella Sebastian Lemmen Aida Burnic Anita Kloss-Brandstätter Mohammad Kamal Thomas Breisach Frank Hölzle Bernd Lethaus 《Infection》2018,46(2):225-230
Purpose
The adequate perioperative antibiotic prophylaxis in maxillofacial surgery is still under discussion due to the wide range of hard and soft tissue procedures as well as contaminated, semi-contaminated and clean surgical sides. Perioperative antibiosis is an easy applicable tool that can be used to decrease nosocomial morbidity and mortality by reducing the rate of infections. We compared strictly perioperative antibiosis with an extended postoperative prophylactic antibiosis.Materials and methods
In this study, 901 consecutive patients, from a tertiary care maxillofacial surgery department were included and distributed into two groups: The first group received peri- and postoperative antibiotic prophylaxis (PP; n = 365) from the day of operation until the fifth day postoperatively. The second group was treated with single shot prophylaxis with intraoperative repetition as needed (SSP; n = 536) only. Furthermore, the patients were grouped according to their main diagnosis and surgical procedure. For comparison, general anamnestic data, cultured bacteria and resistances, number of surgical site infections and duration of hospitalization were compared.Results
There were no statistically significant differences in general diseases or extent of surgery between the groups. There was no statistical difference in the surgical site infections between the groups regardless of their diagnosis. There were significant correlations between tracheotomised patients (p < 0.001) as well as patients with a higher BMI (p = 0.009) and the incidence of surgical site infections. Most common cultured bacteria were staphylococci.Conclusion
Based on the findings of the study, we believe that a perioperative antibiosis delivers a sufficient prophylaxis for patients undergoing maxillofacial surgery procedures.4.
Al-Herz Adeeba Saleh Khuloud Al-Awadhi Adel Al-Kandari Waleed Hasan Eman Ghanem Aqeel Hussain Mohammed Ali Yaser Nahar Ebrahim Alenizi Ahmad Hayat Sawsan Abutiban Fatemah Aldei Ali Alhajeri Hebah Alhadhood Naser Bahbahani Husain Tarakmeh Hoda Mokaddem Khaled Khadrawy Ahmad Fazal Ammad Zaman Agaz Mazloum Ghada Bartella Youssef Hamed Sally Alsouk Ramia Al-Saber Ahmed 《Clinical rheumatology》2021,40(5):1759-1765
Clinical Rheumatology - Biologics are indicated in rheumatoid arthritis (RA) in case of persistent high disease activity despite conventional disease-modifying anti-rheumatic drugs (cDMARDs) or... 相似文献
5.
Dirk Halama Ruth Dreilich Bernd Lethaus Alexander Bartella Niels Christian Pausch 《Journal of cranio-maxillo-facial surgery》2019,47(12):1980-1985
IntroductionRadial forearm free flaps (RFFF) are often used to replace tissue removed in head and neck surgery. In recent years, many attempts have been made to reduce donor-site morbidity and to prevent common complications such as infection, skin-graft necrosis, tendon exposure and subsequent impairment of hand function. One promising option is the use of vacuum-assisted-closure wound therapy (VAC). The objective of this study was to evaluate the effectiveness of VAC compared with a conventional bolster dressing (CBD).Material and methodsA randomized controlled trial was enrolled. Our study was prospective in design and included patients with a skin-grafted forearm defect after harvesting of RFFF. Patients who met the inclusion criteria were randomly assigned into two study arms. The predictor variable was the type of wound therapy (VAC therapy compared with CBD) and the outcome variables were (1) the size of the wound area, (2) wrist movement and (3) grip strength. Outcome variables were assessed 12 days, three weeks and eight weeks after surgery.ResultsFifty patients (33 males, mean age 61.7 years [SD 15.5]; 17 females, mean age 54.7 years [SD 10.5]) were included consecutively in the study. Patients in the VAC group experienced a faster postsurgical reduction of wound area and had better wrist movement; nonetheless, the differences between the VAC group and CBD group did not reach statistical significance. In contrast, the recovery of postsurgical grip strength was significantly faster in the VAC group.ConclusionsOur study failed to prove that VAC therapy is significantly superior to CBD for all the variable studied. Because VAC therapy has some positive effects, however, we recommend further development of this negative-pressure wound treatment, rather than the termination of its use. 相似文献
6.
Philipp Metzler Yi Sun Wolfgang Zemann Alexander Bartella Marc Lehner Joachim Anton Obwegeser Astrid L. Kruse-Gujer Heinz-Theo Lübbers 《Oral and maxillofacial surgery》2014,18(3):297-304
Purpose
The use of three-dimensional (3D) photography for anthropometric measurements is of increasing interest, especially in the cranio-maxillofacial field. Before standard implementation, accurate determination of the precision and accuracy of each system is mandatory.Methods
A mannequin head was labelled with 52 landmarks, and 28 three-dimensional images were taken using a commercially available five-pod 3D photosystem (3D VECTRA; Canfield, Fairfield, NJ) in different head positions. Distances between the landmarks were measured manually using a conventional calliper and compared with the digitally calculated distances acquired from labelling by two independent observers. The experimental set-up accounted for clinical circumstances by varying the positioning (vertical, horizontal, sagittal) of the phantom.Results
In the entire calliper measurement data set (n?=?410), a significant difference (p?=?0.02) between the directly measured and corresponding virtually calculated distances was found. The mean aberration between both modalities covering all data was 7.96 mm. No differences (p?=?0.94) between the two groups were found using a cut-off of 10 % (leaving n?=?369 distances) due to considerable errors in direct measurements and the necessary manual data translation. The mean diversity of both measurement modalities after cut-off was 1.33 mm (maximum, 6.70 mm). Inter-observer analysis of all 1,326 distances showed no difference (p?=?0.99; maximal difference, 0.58 mm) in the digital measurements.Conclusion
The precision and accuracy of this five-pod 3D photosystem suggests its suitability for clinical applications, particularly anthropometric studies. Three-hundred-and-sixty degree surface-contour mapping of the craniofacial region within milliseconds is particularly useful in paediatric patients. Proper patient positioning is essential for high-quality imaging. 相似文献7.
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Mohammad Kamal Lars Andersson Rene Tolba Adel Al-Asfour Alexander K. Bartella Felix Gremse Stefanie Rosenhain Frank Hölzle Peter Kessler Bernd Lethaus 《Journal of translational medicine》2017,15(1):263
Background
Alveolar cleft repair is performed via bone grafting procedure to restore the dental arch continuity. A suitable bone substitute materials should possess osteoinductive and osteoconductive properties, to promote new bone formation, along with a slowly resorbable scaffold that is subsequently replaced with functionally viable bone. Calcium phosphate biomaterials have long proved their efficacy as bone replacement materials. Dentin in several forms has also demonstrated its possibility to be used as bone graft replacement material in several studies. The purpose of this study was to evaluate bone regeneration pattern and quantify bone formation after grafting pre-established experimental alveolar clefts defects model in rabbits using composite xenogenic dentin and β-TCP in comparison to β-TCP alone.Methods
Unilateral alveolar cleft defects were created in 16 New Zealand rabbits according to previously described methodology. Alveolar clefts were allowed 8 weeks healing period. 8 defects were filled with β-TCP, whereas 8 defects filled with composite xenogenic dentin with β-TCP. Bone regeneration of the healed defects was compared at the 8 weeks after intervention. Quantification of bone formation was analyzed using micro-computed tomography (µCT) and histomorphometric analysis.Results
µCT and histomorphometric analysis revealed that defects filled with composite dentin/β-TCP showed statistically higher bone volume fraction, bone mineral density and percentage residual graft volume when compared to β-TCP alone. An improved surgical handling of the composite dentin/β-TCP graft was also noted.Conclusions
Composite xenogenic dentin/β-TCP putty expresses enhanced bone regeneration compared to β-TCP alone in the reconstruction of rabbit alveolar clefts defects.10.
Magnetic resonance imaging (MRI) of the breast is rapidly becoming incorporated into clinical practice. Indications for breast
MRI include staging of known breast cancer, monitoring response to chemotherapy, assessing recurrence, problem solving, and
high-risk screening. Magnetic resonance spectroscopy is a promising technique that may decrease the number of benign biopsies
generated by breast MRI in the clinical setting. 相似文献