Qualitative and quantitative evaluation of bony structures based on DICOM dataset.

PURPOSE: The aim of this study was to investigate bone mass using different cone-beam computed tomographies (CBCTs) combined with image analysis and to determine whether bone quantity or quality was detected. MATERIALS AND METHODS: Different measurements recorded on mandible bones of pigs in the retromolar region were evaluated on ProMax 3D (Planmeca Oy, Finland) and the ILUMA™CT (IMTEC™ Imaging, Ardmore, OK) to calculate a calibration curve. The spatial relationships of pig mandible halves relative to adjacent defined anatomical structures were assessed by means of 3D visualization software. In addition to the screenshot, their bone quality was evaluated in accordance with the Lenkholm and Zarb classification. RESULTS: The CBCT calibration curves based on the measurements taken from the ProMax and ILUMA CT showed linear correlation. Huge Hounsfield units intervals were found between the 2 CBCTs and there was no correlation with the computed tomography. Exact information on the micromorphology of the bone cylinders was not available. A subjective correlation according to Lenkholm and Zarb showed overlapping in all groups. CONCLUSIONS: CBCT is a good choice for analyzing bone mass. However, it does not provide any information on bone quality. To obtain information on the microarchitecture of the spongiosa, it is necessary to use a computed tomography with finite element analysis.

New real-time PCR detects prolonged norovirus excretion in highly immunosuppressed patients and children.

Noroviruses (NoV) are a major cause of epidemic nonbacterial gastroenteritis and affect all age groups worldwide. Three of five NoV genogroups, namely, genogroup I (GI), GII, and GIV, are associated with human disease. Unfortunately, these genogroups demonstrate a high degree of sequence diversity, complicating the design of pan-NoV diagnostic PCR tests. To decrease the risk of false-negative test results, we have developed a new one-step real-time TaqMan reverse transcription-PCR protocol. This protocol detects all human NoV genogroups in one reaction with a sensitivity of 400 virus genome equivalents/reaction for both GI and GII. The use of in vitro-transcribed NoV RNA as an external standard allows (semi)quantification of viral loads in samples. In a retrospective analysis of 206 stool samples from 77 patient episodes, the duration of NoV excretion and the amount of virus excreted were determined. Twenty (26.0%) of these episodes lasted longer than 10 days. Univariate risk factor analysis revealed the patient status after organ transplantation (odds ratio [OR], 7.49 [95% confidence interval, 2.06 to 28.32]; P < 0.001), immunosuppression (OR, 9.19 [95% confidence interval, 2.50 to 35.39]; P < 0.001), and age of less than 10 years (OR, 4.58 [95% confidence interval, 1.36 to 15.77]; P = 0.004) as risk factors for a NoV excretion period of more than 10 days. These findings were confirmed by time-dependent Kaplan-Meier analyses, whereas multivariate Cox regression analyses identified immunosuppression as the sole risk factor. Surprisingly, in contrast to the excretion periods, the viral loads in stools did not increase in connection with age or immunosuppressive status. This fact may be one important piece in the pattern of high-level NoV transmissibility and may have an impact on the development of transmission prevention strategies.

Synthetic, pure-phase beta-tricalcium phosphate ceramic granules (Cerasorb) for bone regeneration in the reconstructive surgery of the jaws.

The aim of this study was to investigate the long-term effect of the ceramic beta-tricalcium phosphate (beta-TCP) at different sites of alveolar reconstruction and to evaluate its properties. From 1997 to 2002, beta-TCP was implanted as bone substitute in 152 patients using a standardized study protocol. Main indications were the filling of large mandibular cysts (n=52), secondary and tertiary alveolar cleft grafting (n=38), periodontal defects (n=24) and maxillary sinus floor augmentation (n=16). For defects exceeding 2cm in diameter, beta-TCP was combined with autologous bone taken from the retromolar area, the maxillary tuberosity or the chin region. A radiological, clinical and ultrasonographical examination was carried out 4, 12 and 52 weeks postoperative. In 16 cases, biopsies were taken after 12 months indicating complete bony regeneration. While wound-healing disturbances occurred in 9.2% of cases, partial loss of the bone substitute material was found in 5.9%, while total loss occurred in only 2%. Complete radiological replacement of beta-TCP by autologous bone was found after approximately 12 months, indicating its osteoconductive properties. Because of its versatility, low complication rate and good long-term results, synthetic, pure-phase beta-TCP is a suitable material for the filling of bone defects in the alveolar region.

Stability of edentulous, atrophic mandibles after insertion of different dental implants. A biomechanical study.

OBJECTIVES: Fractures of the atrophic edentulous mandible are a rare complication that can become severe after the insertion of dental implants. This in vitro study investigated the effects of different implant settings varying in number, diameter, and length. and the influence of a fixed bar. MATERIALS AND METHODS: In biomechanical experiments on artificial mandibles, an unmodified reference group, four implant settings with two different implants, and the effect of adding a fixed bar to these settings were tested. All specimens were loaded with incisal biting forces until failure due to fracture. RESULTS: Implants weakened all specimens significantly compared with those in the reference group. Without a fixed bar, four short and thick implants showed the best results, with high significance. With a fixed bar, four long and thin implants withstood the highest loads. The addition of fixed bars reduced the differences between the implant settings. Fixed bars did not show increased stability for all groups; however, these groups showed a higher mean strength. CONCLUSIONS: Four implants with a short and thick design should be the first choice when implants are placed without a fixed bar in an atrophic mandible. With a fixed bar, four long and thin implants should be used.

State and health.

This paper examines the health functions of the state in the F.R.G. in their historical, political and socio-economic inter-relationships. The main focus is on the antagonistic interests of the social classes. Special emphasis is placed on an analysis of the health political state intervention of 1974 which marked the beginning of the far-reaching economic crisis. There were serious restrictions placed on utilization such as co-payments and other interventions: commercialization; privatization; individualization; and the rationalization of public services. Moreover, as the data show, there have been massive transferences within the public service system at the expense of the socially insured.

Peri-implant care of ailing implants with the carbon dioxide laser.

One of the many applications for which lasers have been proposed in implant dentistry is for the decontamination process. The purposes of this study were to assess possible alterations in titanium implants in vitro and in vivo by use of the carbon dioxide (CO2) laser and to determine whether new bone formation can occur on previously contaminated implants. In vitro, temperature changes at the bone-titanium implant interface were recorded during use of a CO2 laser-scanning system (Swiftlase). Additionally, the effects of laser irradiation on titanium implants at various power settings were examined. In 6 beagle dogs, a total of 60 implants and bony defects resulting from plaque accumulation were treated by air-powder abrasive (the conventional treatment), laser irradiation, or both. Depending on the parameters chosen, melting and other surface alterations were seen in vitro, especially in the superpulse mode. Otherwise, no alterations were found, even at high power settings in the continuous mode. In vivo, corresponding histologic examination of 4-month sections showed evidence of new direct bone-to-implant contact after laser-assisted therapy, especially when the implants had been treated concomitantly with submerged membranes. These results support the hypothesis that peri-implant defects can be treated successfully by laser decontamination without damaging the surrounding tissues in the dog model. Nevertheless, further investigations will be required to determine the clinical efficacy of the treatment.

Some remarks on the economic and political development of health care in the Federal Republic of Germany.

The economic and political development of health care in the Federal Republic of Germany is analyzed within the framework of overall social development. This will be shown describing the main components of the health care system: outpatient care, inpatient care, the dispensing of medicines, and statutory health insurance. The functions of the state and the influence of the pressure groups, i.e. the medical professional associations, are examined. Finally, an assessment of the present situation is made.

Work, disease, and occupational medicine in the Federal Republic of Germany.

The development of occupational diseases, accidents, and injuries is analyzed within the framework of social, technological, and economic development in the Federal Republic of Germany. The interaction between economic crisis and occupational accidents is described and the distribution and origins of occupational accidents discussed. Finally, the occupational health care system in the Federal Republic is analyzed.

Back to Europe: back to Bismarck?

Since 1989 there have been enormous changes in all aspects of health policy, and the Former Socialist Economies (FSEs) are facing similar challenges. The general restructuring of politics and economies has resulted in two leading orientations in the transformation of health care systems: the separation of funding and service provision from the state, and the separation of funding and service provision from each other. Many FSEs have already passed legislation establishing a sickness insurance system under a single national funding institution, or a combination of compulsory and voluntary insurance, or a system involving private sector insurance companies in generating compulsory or voluntary health care funding. Due to the peculiarities and specific features of the German health care system, the uncritical intention to implement the "Bismarck model" in the FSEs faces several problems. These can be summarized in one main point: the relative stability of the German health care system, which may be attractive to the FSEs, is based on economic prosperity and on a strong ability to assert the will of the central state institutions: these preconditions are not present in the FSEs.

[New technologies, occupational medicine and health]. / Novas técnicas, medicina do trabalho e saúde.

The present article deals with the health effects and social aspects associated with the introduction of modern microelectronic technologies within work processes, particularly in the Federal Republic of Germany. The author makes considerations on some theoretical limitations of Occupational Medicine in order to analyse and avert problems resulting from these processes.

The orally active melanocortin-4 receptor antagonist BL-6020/979: a promising candidate for the treatment of cancer cachexia.

BACKGROUND: Under physiological conditions, the melanocortin system is a crucial part of the complex network regulating food intake and energy expenditure. In pathological states, like cachexia, these two parameters are deregulated, i.e., food intake is decreased and energy expenditure is increased-a vicious combination leading to catabolism. Agouti-related protein (AgRP), the endogenous antagonist at the melanocortin-4 receptor (MC-4R), was found to increase food intake and to reduce energy expenditure. This qualifies MC-4R blockade as an attractive mode of action for the treatment of cachexia. Based on this rationale, a novel series of small-molecule MC-4R antagonists was designed, from which the orally active compound BL-6020/979 (formerly known as SNT207979) emerged as the first promising development candidate showing encouraging pre-clinical efficacy and safety properties which are presented here. METHODS AND RESULTS: BL-6020/979 is an orally available, selective and potent MC-4R antagonist with a drug-like profile. It increased food intake and decreased energy expenditure in healthy wild-type but not in MC-4R deficient mice. More importantly, it ameliorated cachexia-like symptoms in the murine C26 adenocarcinoma model; with an effect on body mass and body composition and on the expression of catabolic genes. Moreover, BL-6020/979 showed antidepressant-like properties in the chronic mild stress model in rats and exhibits a favorable safety profile. CONCLUSION: The properties of BL-6020/979 demonstrated in animal models and presented here make it a promising candidate suitable for further development towards a first-in-class treatment option for cachexia that potentially opens up the opportunity to treat two hallmarks of the disease, i.e., decreased food intake and increased energy expenditure, with one drug.

Gingival angiosarcoma mimicking necrotizing gingivitis.

The authors present a case of a rare highly malignant condition that initially appeared clinically and histologically to be the relatively common and benign condition necrotizing gingivitis. Conditions that do not follow the expected clinical course mandate further investigation because rare malignant disease is not foremost in the mind of dentists and oral and maxillofacial surgeons.

[Duodenal ileus due to an intramural duodenal haematoma. Conservative therapy using a multiple lumen intestinal probe]. / Duodenalileus bei Darmwandhämatom. Konservative Therapie mit einer mehrlumigen Intestinalsonde.

HISTORY AND ADMISSION FINDINGS: A 68-year-old woman was admitted with upper abdominal symptoms, epigastric fullness and nausea, eight days after initiation of heparin anticoagulation for deep-vein thrombosis. There were no other clinical abnormalities. INVESTIGATIONS: Abdominal ultrasound and computed tomography showed an intramural duodenal haematoma. Endoscopy revealed a stenosing lesion in the duodenum. TREATMENT AND COURSE: Instead of conventional parenteral nutrition, a triple-lumen feeding tube was placed, one lumen in the jejunum for feeding, the other for gastric decompression. Six months later the symptoms had completely disappeared and ultrasound, endoscopy and computed tomography no longer detected any lesion. CONCLUSION: Intrajejunal feeding and gastric decompression via a multi-lumen tube provided effective conservative treatment of duodenal ileus together with gastric decompression.

[Small fragment screws vs. plate osteosynthesis in condylar head fractures]. / Kleinfragmentschrauben vs. Plattenosteosynthese bei Gelenkwalzenfrakturen. Vergleich funktioneller Ergebnisse mit MRT und Achsiographie.

AIMS: This prospective study evaluates the outcome after osteosynthesis of condylar head fractures using 1.7 mm small fragment screws (2/2000 ff), which were selected according to a previous biomechanical trial to optimize condylar head traumatology. Clinical and functional results were compared to a group of fractures fixed mainly by mini- and microplates (1993-2000) and to a control group after conservative therapy with early functional training. PATIENTS AND METHODS: Functional values (axiography and MRI) regarding loss of vertical height, disk mobility, protrusive and translatory movements were assessed (a) in 34 of 83 condylar head fractures (groups V and VI according to Spiessl and Schroll, 22/69 subjects) managed by osteosynthesis with 1.7-mm small fragment screws (KFS), (b) a reference group (43/84 subjects) fixed mainly by mini- or microplates (PLO), comprising 56 of 101 fractures (1993-2000), and (c) 16 condylar head fractures after conservative therapy with early functional training (KT) as a control. RESULTS: In cases of small fragment screws, loss of vertical height (0.3 mm) was significantly reduced (p<0.01) in comparison to PLO (1.6 mm) and KT (6.9 mm). Disk mobility in KFS reached 90% of the non-fractured sides (NFS), thus clearly superior (p<0.01) to PLO (63% of NFS) and KT (40% of NFS). Translatory movements after KFS showed better results, too (p<0.05), with mediotrusion 84% and protrusion 80% of NFS. After PLO, mediotrusion was 62%, protrusion 71% of NFS, whereas KT showed only 53% (mediotrusion) and 56% (protrusion) of NFS. High-grade limitations of translatory movements presented in about 30% after PLO and <10% in KFS (p<0.01). Fragment displacements were found in <5% after small fragment screws, and in the plate osteosynthesis group in 15% (p<0.01). CONCLUSIONS: Due to better stability and reduced articular scarification osteosynthesis with 1.7-mm small fragment screws in condylar head fractures showed clearly superior functional results compared to mini- and microplates, and to conservative therapy.

German unification and European integration.

In the Winter 1990 issue of the Bulletin, Health/PAC published a report by Dr. Deppe and Dr. Winfred Beck comparing the health care systems of the two Germanies. In this article, Dr. Deppe extends that analysis to compare these systems with those of other Western European countries and to examine the lessons the absorption of Germany's socialist system into its capitalist neighbor may have for the integration of the European Community. Readers will note that what we commonly refer to as a health care system and its insurance and institutions is here termed a "sickness" system--a description used by European progressives to indicate that the health care system emphasizes care for people when they are sick rather than preventive care that would help them stay healthy.

Health and society in times of change.

Social equity and justice should not only guide health care systems towards health promotion and preventive medicine, but also, through the application of human values, help to obtain high quality and efficiency in health care delivery.

[Emission of organic substances from chip-boards]. / Emissionen von organischen Substanzen aus Spanplatten.

A relatively small number of investigations on emissions of organic substances from chip-board is available up to now. The emissions known to date are caused by glues or other additives rather than by the wood itself. As concerns aminoplast glues (urea-formaldehyde or melamine-formaldehyde resins) the most important point of public interest has been the off-gassing of formaldehyde from chip-board. Chip-board with phenol-formaldehyde glues has been known in some cases to give off phenol. The formation of diamino diphenyl methane from isocyanate glues is still a matter of discussion. A further source for possible emissions are wood and fire protectives which are added during the manufacturing process. Finally, coating of chip-board may lead to emissions of organic substances. The lack of adequate detection methods has so far delayed the treatment of questions in relation to emissions from chip-board. Even now, there are numerous problems in this field especially when investigating isocyanate glues. Problems in relation to the origin of emissions due to the kind of glue used and the manufacturing process are discussed, and proposals are made how to solve some of these problems. The question of the health risk is dealt with from the view-point of the civil engineer and in an general economic context.