Oral health-related quality of life in patients with cleft lip and/or palate or Robin sequence.

PURPOSE: To compare the oral health-related quality of life (OHRQoL) in patients with cleft lip and/or palate or Robin sequence versus a healthy control group using the Child Oral Health Impact Profile (COHIP-G19). Factors such as age, gender, and cleft type were considered. METHODS: Over an 8-month period, the OHRQoL was surveyed by using the COHIP-G19 questionnaire. Included were patients with a craniofacial disorder (n = 61; average age 11.24 years) and a healthy control group (n = 70, average age 12.63 years) for a total of 131 patients (average age 11.99 years) from the Department of Orthodontics University Hospital Tübingen, Germany. These were divided into two age groups (6-11 years; 12-18 years). RESULTS: Statistically, patients with a craniofacial disorder presented a significantly lower OHRQoL than the control group (p = 0.0055). In the craniofacial disorder group, older patients revealed a significantly (p = 0.005) lower OHRQoL than the younger patients. Female patients showed in nearly all groups a better OHRQoL than male patients, but this difference was not statistically significant (p > 0.05). Males with a craniofacial disorder scored significantly lower than males without (p = 0.016); females showed no differences between the groups. Visibility, location, and severity of the craniofacial malformation did not have a significant influence on the OHRQoL. CONCLUSION: The occurrence of a craniofacial malformation impacted the OHRQoL especially in older and male affected patients, unrelated to the expression level or localization. An early instruction about oral health, rehabilitation and functional training should be considered in therapy.

Tooth agenesis in German orthodontic patients with non-syndromic craniofacial disorder: a retrospective evaluation of panoramic radiographs.

OBJECTIVES: The study objective was to evaluate the tooth agenesis in German orthodontic patients with non-syndromic cleft lip and/or palate and Robin sequence compared to a control group without craniofacial disorder. MATERIALS/METHODS: A total of 108 panoramic radiographs were examined using the binary system of Tooth Agenesis Code (TAC) (excluding the third molar). Patients were divided into the craniofacial disorder group 1 (n = 43) and the healthy control group 2 (n = 65). Parameters such as skeletal class malformation, sex, localization of the cleft, craniofacial disorder, and interobserver reliability were assessed. RESULTS: Permanent tooth agenesis was observed in 44% of group 1 and 14% in group 2 with a statistically significant higher prevalence (p = 0.00162 (χ2)). Fourteen different TAC patterns were observed in group 1, ten of these occurring only once in separate patients. The distribution of the TAC codes in group 2 showed nine different possibilities of TAC code patterns; seven TACs were unique. In group 1, the most frequently absent teeth were the maxillary lateral incisor of the left side (30%); in group 2, the second premolar of the lower jaw on the right side (9%). Male patients with craniofacial disorder showed a higher percentage of tooth agenesis than female. CONCLUSION: The data presented here shows a statistically significant higher prevalence of tooth agenesis in German patients with non-syndromic craniofacial disorder. CLINICAL RELEVANCE: Radiographic evaluation enables the diagnosis of tooth agenesis. Recognizing early on the higher prevalence of tooth agenesis in patients exhibiting a craniofacial disorder is an important issue when developing long-term and comprehensive interdisciplinary treatment.

Severe odontogenic infections with septic progress - a constant and increasing challenge: a retrospective analysis.

BACKGROUND: More than 90% of all infections in the head and neck region can be traced back to an odontogenic origin. In rare cases they can lead to sepsis, which may pose a vital threat to the patient. The purpose of this study was to analyse characteristics concerning etiology and progress of severe odontogenic infections with a fulminant development. METHODS: All patients with odontogenic infections requiring hospital admission were included in a retrospective analysis conducted from 02/2012 to 09/2017. Of 483 patients 16 patients (13 male, 3 female) showed severe exacerbation with septic progress. The average age was 52.8 years. All patients underwent at least one surgical procedure that involved an extraoral incision and drainage as well as high volume irrigation intraoperatively. At least one revision was required for four of the patients. Three patients showed an exceedingly severe disease progression with multiorgan dysfunction syndrome (MODS) and circulatory arrest. Antibiotic treatment was adjusted according to the results of an antibiogram and resistogram. Irrigation with saline was done several times a day. RESULTS: Sixteen patients showed odontogenic infections that spread over multiple maxillo-facial and cervical regions accompanied by septic laboratory signs. All these patients needed intensive care and a tracheostomy. The hospitalization period was 27.8 days on average. In 16 cases risk factors for the development of odontogenic abscesses like diabetes mellitus, obesity, chronic alcohol and nicotine abuse, rheumatism and poor oral hygiene were present. Intraoperative swabs showed a typical polymicrobial aerobic and anaerobic spectrum of oral bacteria, especially anaerobes and streptococci, mainly Streptocococcus viridans. CONCLUSION: Odontogenic infections with fulminant progression should be treated based on clinical and imaging data with immediate surgical incision and drainage including elimination of odontogenic foci as well as intensified intra- and postoperative irrigation. If needed, repeat imaging followed by further incisions should be performed. Immediate antibiotic treatment adapted to the antibiogram is of utmost importance. A combination of tazobactam and piperacillin has proven to be a good first choice and can be recommended for abscesses that spread over multiple levels with initial signs of severe infections.

Kinematics and center of mass mechanics during terrestrial locomotion in northern lapwings (Vanellus vanellus, Charadriiformes).

Avian bipedalism is best studied in derived walking/running specialists. Here, we use kinematics and center of mass (CoM) mechanical energy patterns to investigate gait transitions of lapwings-migratory birds that forage on the ground, and therefore may need a trade-off between the functional demands of terrestrial locomotion and long distance flights. The animals ran on a treadmill while high-speed X-ray videos were recorded within the sustainable speed range. Instantaneous CoM mechanics were computed from integrating kinematics and body segment properties. Lapwings exhibit similar locomotor characteristics to specialized walking/running birds, but have less distinct gaits. At slow speeds no clear separation between vaulting (i.e., walking) and bouncing (i.e., running) energy patterns exists. Mechanical energy recovery of non-bouncing gaits correlates poorly with speed and suggests inefficient use of the inverted pendulum mechanism. Speed ranges of gaits overlap considerably, especially those of grounded running, a gait with CoM mechanics indicative of running but without an aerial phase, and aerial phase running, with no preferential gait at most speeds. Compliant limb morphology and grounded running in birds can be regarded as an evolutionary constraint, but lapwings effectively make use of advantages offered by this gait for a great fraction of their speed range. Thus, effective usage of grounded running during terrestrial locomotion is suggested generally to be a part of striding avian bipedalism-even in species not specialized in walking/running locomotion.

[Experiences and difficulties in implementing immunization registries in Saxony-Anhalt]. / Erfahrungen und Schwierigkeiten bei der Implementierung von Impfregistern in Sachsen-Anhalt.

In the German Federal State of Saxony-Anhalt, the Health Department must be notified of vaccines administered to children <7 years of age including their names. The goal of this mandatory notification is to improve and stabilize the age-appropriate vaccination coverage. However, difficulties have been encountered in implementing mandatory notification. Therefore, the Health Departments of Magdeburg and Halle have launched a model project focusing on analysing and eliminating these problems. Mandatory notification requires parents' approval, endorsement of vaccantors, and availability of human and technicely resources in the Health Department. An enquiry among paediatricians and family doctors in private practice revealed widespread reservations about mandatory notification because of privacy issues related to data and legal protection. Furthermore, family doctors believed that parents disapproved of notification by name. However, a survey among young mothers revealed this not to be the case. Winning young mothers' approval depends largely on the positive attitude of the vaccinators. To implement the mandatory notification of vaccinations to the Health Department, it is necessary to dispel physicians' concerns and to inform young parents about the practical benefits. However, this places high demands on the Health Departments for maintaining immunization registries, communicating with physicians and notifying parents when immunisations are due or late.

Determination of elements by nuclear analytical methods.

The working principle of nuclear analytical methods (NAMs) is not influenced by the chemical bond. Consequently, they are independent counterparts to the well-known chemical procedures. NAMs obey fundamental laws or can be described and understood thoroughly. This qualifies them as candidates for reference methods. Although following similar nuclear reaction schemes, they comprise bulk analyzing capability (neutron and photon activation analysis) as well as detection power in surface near regions of solids (ion beam techniques). Prominent features of NAMs are sensitivity, selectivity, multielement determination and linearity of the calibration function covering a concentration range of several orders of magnitude. Moreover, ion beam techniques allow depth profiling with nm-resolution in several cases while the ion microprobe additionally offers a lateral resolution in the micron-scale. As NAMs require expensive apparatus (nuclear reactor, accelerator in radioactive control areas) their availability is restricted to a small number of suitably equipped institutes. However, they are able to solve complex analytical tasks, take part in key comparisons and play an essential role in the certification of reference materials.

Laparoscopic electrocoagulation of the ovarian surface in infertile patients with polycystic ovarian disease.

OBJECTIVE: To assess the endocrinologic and clinical outcome after laparoscopic ovarian electrocautery because of polycystic reaction to ovarian stimulation in anovulatory infertility patients. DESIGN: Between 1986 and 1989, 133 patients with polycystic ovarian disease underwent laparoscopic electrocoagulation of the ovarian surface in an outpatient clinic after conventional ovarian stimulation had led to polycystic reaction. SETTING: All patients were referred to our outpatient clinic affiliated with the university hospital. RESULTS: The reduction of androgen levels and normalization of cycle length were highly significant. The overall pregnancy rate was 70% (73 of 104), ranging from 27% in smokers to 94% in nonsmoking couples. In 26 second-look operations de novo adhesions were found in 26.9% of the patients. CONCLUSION: Laparoscopic coagulation of the ovarian surface is an effective tool to reduce elevated androgen levels and to improve the intraovarian mechanism of selecting a dominant follicle. A postoperative complication may be adhesion formation.

[Results of treatment with surface cauterization of polycystic ovaries in sterility patients]. / Behandlungsergebnisse mit der Oberflächen-kauterisierung polyzystischer Ovarien bei Sterilitätspatientinnen.

In 39 women with polycystic ovaries (PCO) and a history of sterility, laparoscopic electrocautery of the surface of the ovaries was performed by a technique adapted from Gjoennaess (1984). Previous hormonal treatment with clomiphene and/or human menopausal gonadotropins had been unsuccessful in these patients, whilst 23 of them (59%) conceived within one year after surgery. Electrocautery was followed by a decrease of mean testosterone levels from 0.95 +/- 0.064 ng/ml to 0.48 +/- 0.041 ng/ml and a similar decline of dehydroepiandrosterone sulfate from 2.9 +/- 0.136 g/ml to 1.6 +/- 0.165 g/ml respectively. Laparoscopic ovarian electrocautery is however associated with the risk of postoperative adhesion formation. Therefore we advise this form of surgery only, when hormonal therapy failed or if it presents an unacceptable high risk of hyperstimulation or a multiple pregnancy.

Melatonin and the ovulatory luteinizing hormone surge.

A newly developed 125I-radioimmunoassay allows for the accurate determination of physiological concentrations of plasma melatonin. Melatonin secretion does not change significantly on the day before and the day of the luteinizing hormone (LH) surge when compared with the early follicular phase. In addition, it was confirmed that the beginning of the LH surge frequently occurs in the morning and is associated with low melatonin values (six of nine women). Supraphysiological melatonin concentrations did not decrease the midcycle LH secretion in four women studied.

Influence of melatonin on the sleep-independent component of prolactin secretion.

Sleep has a stimulatory effect on prolactin secretion. Recent studies in the human suggest the hypothesis that prolactin has also an endogenous sleep-independent rhythm, which can be influenced by endogenous melatonin. To investigate this hypothesis, the prolactin response to nighttime exposure to bright light was studied in eight women in detail. Light exposure induces a decrease in nocturnal melatonin secretion. It was demonstrated that exposure to bright light for 2 h at night caused a decrease in prolactin secretion, which surpassed significantly the decline one would expect by sleep deprivation only (P less than 0.01). This was associated with a similar decline in melatonin secretion. Fall and rise of prolactin secretion under these conditions were always preceded by decrease and rise in melatonin levels in all eight women studied. Based on these observations, it is concluded that melatonin is associated with an endogenous circadian component of prolactin secretion. As specific melatonin receptors have been identified in the human nucleus suprachiasmaticus, which is the "master" circadian pacemaker, the observed phenomenon might be mediated through this structure. An alternative explanation of our findings could be based on the fact that melatonin influences dopamine metabolism, which in turn alters prolactin secretion. It can also not be ruled out that melatonin might act via the opioid system, which then could affect prolactin secretion. The total secretory activity for both hormones (area under the curve) did not change under experimental conditions, when compared to a control group. This suggests that acute light exposure and sleep deprivation influence the secretory process rather than the synthesis of these two hormones. This is in agreement with the observation that changes in natural light exposure throughout the year do alter the amplitude, but not the total amount of melatonin secreted. Further studies are needed to answer the question of melatonin storage definitively, as it is commonly believed that melatonin is immediately released after synthesis. It is concluded that melatonin through its external modulator light might entrain the circadian sleep-independent component of prolactin secretion and via its action on prolactin could modulate reproductive processes.

[The materials and border-zone micromorphology of a glass-ionomer cement cavity lining material]. / Werkstoff- und Grenzzonenmikromorphologie eines Glasionomer-zement-Unterfüllungsmaterials.

The combination of various possibilities for sample preparation and investigation--the tinting penetration method, the ion beam slope cutting, the light and scanning electron microscopy--allow statements at the grind after different drying of the preparation mainly to the bond but also surface and filler shape of glass-ionomer cements. The dentine in the area of enamel-dentine-junction and of superficial root area is effectively closed by Ketac-Bond. Likewise, the bond with cover filling (Visio-Molar) can be considered without gaps except a single case. Crack propagations from the cement surface seem to related to pores and occur independently of type of drying especially in case of mechanical after treatment of already hardened cavity lining [correction of underfilling] material.

[Rational hormonal diagnosis of oligomenorrhea]. / Rationelle hormonale Diagnostik der Oligomenorrhö.

In a study, conducted by two clinics in Berlin and Hamburg, specializing in reproductive endocrinology, the anamnestic, clinical, and laboratory data of 170 oligomenorrheic patients (menstrual intervals between 35 and 90 days) were evaluated in order to determine the frequency of possible causes of oligomenorrhea. Pathological hormone levels were found in two thirds of all patients. The order of frequency of abnormal hormone levels was as follows: hyperandrogenemia (testosterone and/or DHEA-sulfate) in 41.8%, hyperprolactinemia in 25.9%, abnormal thyroid function (TSH and/or TRH-induced TSH) in 21.7%, and hypergonadotropic FSH levels in 3.5% of all patients. There was an overlap of between two or more pathological conditions in one third of all patients. This study confirms results of a previous study in amenorrheic patients (Moltz et al., 1987 - see reference list), documenting hyperandrogenemia as the most frequent abnormality found in this group, followed by hyperprolactinemia. As can be expected, the percentage of women with no discernible abnormality was higher in oligomenorrheic patients when compared with the amenorrheic group (32.3% vs 7.7%). Furthermore, overweight patients were overrepresented in the oligomenorrheic group, while underweight patients were seen more frequently in the amenorrheic group. In view of these results of our study we recommend a detailed diagnostic follow-up in all younger patients with ovarian disorders who need to preserve their reproductive potential. This follow-up should include hyperprolactinemia, hypo-/hyperthyroidism, hyperandrogenemic and hypoestrogenemic states and exclusion of primary ovarian failure. In contrast to recommendations of WHO, issued in 1976, such diagnostic work allows an etiology oriented therapy decision and a therapy risk assessment in subgroups of patients, such as hyperandrogenemic patients, who receive clomiphene or gonadotropin treatment. Furthermore, it permits prophylactic considerations, for prevention of hirsutism and polycystic ovarian disease, struma and osteoporosis prophylaxis.

[Quality assurance in Riva-Rocci blood pressure measurement: simultaneous sphygmomanometry with open and covered pressure display]. / Qualitätssicherung der Blutdruckmessung nach Riva-Rocci: simultane Sphygmomanometrie mit offener und verdeckter Druckanzeige.

The indirect measurement of arterial blood pressure according to Riva-Rocci is one of the most frequently performed medical diagnostic procedures. When properly performed, this method yields accurate readings compared with intraarterial measurements. However, measurements by means of conventional sphygmomanometers are subject to observer error and variability. Therefore, to eliminate important sources of bias (terminal digit preference of the observer, rate of inflation and deflation of the cuff), and to quantify interobserver variability, a new sphygmomanometer has been developed. The new instrument makes possible "simultaneous-blind" blood pressure readings by two observers, according to the Riva-Rocci method. Simultaneous-blind blood pressure readings were made by four observers with experience in blood pressure determination. In 448 measurements made under resting conditions, values obtained by different observers with the new device were very consistent with each other: there were no differences in 50% of systolic and 43% of diastolic measurements. Differences of more than 5 mmHg were observed only in 9% of the systolic and 11% of the diastolic measurements. In 165 measurements made during exercise, the differences between blood pressure readings by different observers were larger (more than 5 mmHg in 40% of systolic and 35% of diastolic values). This variability among observers may be substantial in blood pressure readings made in therapeutic and epidemiologic studies, even when the observers are carefully selected and trained. Compared with the conventional open measurements, blind measurements (n = 100) gave mean values 2 mmHg lower, depending on heart rate and cuff deflation rate. The new sphygmomanometer allows quantification and control of the variability among observers during both open and blind measurements.

Buserelin suppression of endogenous gonadotropin secretion in infertile women with ovarian feedback disorders given human menopausal/human chorionic gonadotropin treatment.

Fifty infertile women with oligomenorrhea, anovulation, or luteal phase defects were selected for a combined therapy consisting of a gonadotropin-releasing hormone analog (Buserelin Hoechst AG, Frankfurt/Main, FRG) and human menopausal gonadotropin/human chorionic gonadotropin (hMG/hCG). Serving as their own controls, these women had been subjected to a total of 238 hMG/hCG treatment cycles with no pregnancy observed (average, 4.7 cycles; range 2 to 14). Of these 238 hMG/hCG cycles, only 98 (41.1%) appeared normal, while the others showed symptoms consistent with inadequate follicle maturation, luteal phase defects, and premature luteinization. In contrast, 89 cycles from 133 combined buserelin/hMG/hCG treatment cycles (66.9%) appeared to be normal, with no evidence of premature luteinization, and 21 patients became pregnant. These data indicate that the likelihood of group II World Health Organization (WHO) patients becoming pregnant with hMG/hCG therapy may be enhanced when endogenous gonadotropin secretion is suppressed at the same time.

Human placental lactogen and unconjugated estriol concentrations in twin pregnancy: monitoring of fetal development in intrauterine growth retardation and single intrauterine fetal death.

Human placental lactogen and unconjugated estriol concentrations in maternal serum were evaluated in 100 uneventful twin pregnancies, and these values were compared with those observed in 16 twin pregnancies associated with intrauterine growth retardation or single intrauterine fetal death. In pregnancies associated with intrauterine growth retardation (n = 8), human placental lactogen levels were at the lower limit of normal range for singleton pregnancies, whereas estriol levels were normal in most cases. When one of the fetuses had died before week 33 of pregnancy (n = 5), both human placental lactogen and estriol levels were low and they were almost at the levels in singleton pregnancy. When intrauterine fetal death occurred after week 36 of pregnancy (n = 3), both hormone levels remained normal until term. Thus human placental lactogen rather than estriol is a good indicator of intrauterine growth retardation in twin pregnancy. Both human placental lactogen and estriol are useful for the monitoring of the surviving fetus in the case of single intrauterine fetal death.

Different hormonal patterns in human menopausal gonadotropin-treated, clomiphene citrate-treated, and untreated conception cycles.

Serum concentrations of seven different hormones were analyzed during 189 singleton conception cycles. One hundred nine women were treated with human menopausal gonadotropin (hMG), 52 women received clomiphene citrate (CC), and 28 became pregnant spontaneously. Serum progesterone (P) levels in hMG-treated women started to increase on day 18 of the cycle and reached peak concentrations between days 28 and 32 of the cycle. Serum estradiol (E2) concentrations paralleled the P patterns. In hMG-treated women, there were significant correlations between serum E2 and P concentrations and the number of the mature follicles observed before ovulation (both P less than 0.01). CC-treated and spontaneous conception cycles revealed significantly lower serum levels of P, E2, testosterone, 17 alpha-hydroxyprogesterone, and prolactin, compared with hMG-treated cycles (P less than 0.05). Elevations of the gonadal steroids in hMG-treated women possibly reflect the multiple corpora lutea formed after multiple ovulations.

[Parathyroid carcinoma]. / Beobachtungen zum Epithelkörperchencarcinom.

The parathyroid carcinoma is a rare cause of primary hyperparathyroidism. It deserves special attention in regard to diagnosis and treatment. Within a period of 10 years we observed 117 patients with primary hyperparathyroidism (pHPT) at the University Hospitals of Ulm and Heidelberg. In five patients a parathyroid carcinoma was found, corresponding to an incidence of 4.4%. In four of five patients no clinical signs were evident preoperatively indicating a parathyroid malignancy.

Preliminary report about a modified gonadotropin (human menopausal gonadotropin/human chorionic gonadotropin) treatment in infertile patients with premature luteinization.

Premature luteinization is a frequent phenomenon observed in infertile women undergoing human menopausal gonadotropin/human chorionic gonadotropin (hMG/hCG) therapy for corpus luteum insufficiency or anovulatory cycles. By inducing hyperprolactinemia in these women with sulpiride, we intended to create a dysfunctional state in these women, which supposedly induces a better reaction to hMG/hCG therapy. The rationale behind this combined treatment was the observation that hyperprolactinemic amenorrheic patients have a much higher pregnancy rate under hMG/hCG treatment than the above group. Three cases are reported in detail, illustrating the altered ovarian response to combined sulpiride-hMG/hCG treatment. Of 60 infertile women with repeated premature luteinization, 12 conceived after sulpiride-hMG/hCG therapy. Their expected pregnancy rate would have been very low (5% or less) if conventional hMG/hCG treatment had been continued.

[Diagnostic value of the prolactin stimulation test in infertile women with galactorrhea]. / Die diagnostische Wertigkeit eines Prolaktin-Stimulationstestes bei infertilen Frauen mit Galaktorrhoe.

In infertile women breast secretion may be provoked in approximately 11%, although basal prolactin serum levels are only elevated (greater than 12 ng/ml) in 30% of the cases. This casts doubt on the diagnostic value of a single determination of prolactin serum concentrations in women with galactorrhea and/or infertility. Introduction of a dynamic function test of prolactin secretion into the endocrine work-up of such patients improves our diagnostic tools as can be seen by the fact that approximately two thirds of the patients with galactorrhea exhibited an exaggerated response of prolactin to metoclopramide despite normal baseline levels of prolactin.

Polymorphism of human pituitary lutropin (LH). Effect of the seven isohormones on mouse Leydig cell functions.

The effect of the 7 different molecular forms of human pituitary lutropin (LH) on mouse Leydig cells as a model of a target organ were studied. The hormone functions have been characterized by receptor binding, cAMP accumulation and testosterone production. One important finding was the similar intrinsic in vitro biological activity for all isohormones. Quantitatively, however, the potencies of the 7 hormone forms did not correlate with the activities obtained by radioimmunoassay: there was a dramatic decrease of receptor binding activity and biological activity compared to immunoactivity from the more alkaline to the more acidic LH isohormones.