Effectiveness of a new perforated 0.15 mm poly-p-dioxanon-foil versus titanium-dynamic mesh in reconstruction of the orbital floor.

INTRODUCTION: In recent years a new perforated PDS (poly-p-dioxanon) foil (0.15 mm) has become available and has not yet been proven to be successful in reconstruction of the orbital floor after blow-out-fractures in randomized studies. The main aim of this clinical trial is to compare this new PDS foil with titanium dynamic mesh (0.3 mm) (TD), which is well established in reconstruction of the orbital floor. PATIENTS AND METHODS: In a prospective multicentre randomized trial, conducted between 1997 and 1998, out of 42 patients with fractures of the orbital floor, 28 patients needing material for reconstruction were randomized to receive either PDS foil or TD. In a comprehensive preoperative and postoperative protocol patients were monitored by the surgeon, radiologist and ophthalmologist with a postoperative follow-up of least 6 months. RESULTS: Maximum defects of the orbital floor were comparable in both groups (PDS group: 13.3 mm, TD group: 13.9 mm). In both groups the surgical procedure was well tolerated, and functional and cosmetic results were evaluated as satisfactory by all patients. Ophthalmological evaluation, performed up to 6 months postoperatively, revealed double vision or vertical strabismus in nine patients (five PDS group, four titanium group). This was not confirmed subjectively in each single patient. Also ex- or enophthalmos, registered in seven patients of the PDS and four of the TD group (mainly + /- 1 mm) were not considered as relevant by the patients. CONCLUSION: The new 0.15 mm perforated PDS foil was comparable to 0.3 mm titanium mesh concerning functional and cosmetic outcome. Obviously, persisting ophthalmometric disorders were compensated very well in both groups. PDS foil is felt to be the preferred material since it is bioresorbable and more convenient to handle.

[Herpes simplex virus type 1-induced rising dbl quote, left (low)tumor" in the nasal vestibule. The problem of resistance development of herpes simplex in a patient with chronic lymphatic B-cell leukemia]. / Ein Herpes-simplex-Virus Typ 1-induzierter ,,Tumor" im Vestibulum nasi. Die Problematik der Resistenzentwicklung von Herpes-simplex-Viren im Rahmen einer chronisch-lymphatischen B-Zell-Leukämie.

Herpes simplex viruses are known to be among the most common disease-causing microorganisms. Their prevalence can exceed 90% depending on the socioeconomic status of the population. Since the number of immunocompromised patients has increased because of the increased incidence in the acquired immunodeficiency syndrome and an increase in organ transplantation, herpes virus infection may have a greater clinical significance. While treatment of otherwise healthy individuals will not usually cause any clinical problems herpes infection in an immunocompromised patient can have severe consequences. Additionally, development of viral resistance can be observed that may require alternative drugs in treatment. We present a case history of a man with a B-cell chronic lymphocytic leukemia that was associated with a very unusual herpes simplex virus infection in the nasal vestibule. Possible causes for the development of resistance in herpes infections and the use of famciclovir and forscarnet as two therapeutic alternatives to aciclovir are discussed.

[Immune status studies after one-time alcohol consumption in healthy subjects]. / Untersuchungen zum Immunstatus nach einmaligem Alkoholkonsum bei gesunden Probanden.

AIM OF STUDY: To ascertain whether once-only intake of a large amount of alcohol causes measurable effects on the immune system of healthy persons. SUBJECTS AND METHODS: Cytokine levels, lymphocyte subpopulations and mitogen stimulation were measured in eleven healthy nonalcohol drinking volunteers (eight men, three women; mean age 30.5 [26-36] years; mean weight 71.4 kg) after a single intake of 80 g ethanol (corresponding to 1.12 g/kg). RESULTS: There were no changes in the concentrations of tumour necrosis factor alpha, interleukins 1 alpha and 1 beta, 3, 6, 10, soluble interleukin-6 receptor, interleukin-1 receptor antagonist, gamma-interferon and granulocyte-macrophage colony stimulating factor. A tendency towards an increase was measured regarding the CD-4 lymphocyte counts as well as the concentration of soluble interleukin-2 receptors and intercellular adhesion molecules (ICAM-1). Interleukins 4 and 8 were low normal. Lymphocyte activity was slightly reduced in the mixed lymphocyte cytotoxicity test. No clear-cut changes were observed in the results of the other mitogen stimulation tests. CONCLUSION: These data show that once-only intake of a large amount of alcohol does not produce measurable abnormalities in the immune system of healthy persons who ordinarily abstain from drinking alcohol.