Evaluation of community readiness for change prior to a participatory physical activity intervention in Germany.

A lack of communities' readiness for change is reported as a major barrier toward an effective implementation of health promoting interventions in community settings. Adding an alternative readiness assessment approach to existing research practice, this study aimed to investigate how a selected community could be evaluated in-depth regarding its readiness for change based on multiple key informant perspectives, with the intention of using this knowledge for the preparation of improved local physical activity (PA) interventions for men above 50 years of age. We conducted semi-structured face-to-face key informant interviews with stakeholders and relevant persons from a local German community (N = 15). The interview guide was based on a comprehensive summary of community readiness dimensions. After verbatim transcription, we conducted thematic analysis to synthesize the complex results regarding community readiness related to PA. The data supported that the community disposed of a variety of resources regarding PA and showed signs of readiness for change. However, a certain degree of saturation regarding PA programs existed. The need for health enhancing PA interventions for men was only partly recognized. The local authority considered PA to be particularly important in the context of mobility and traffic safety. Including multiple stakeholders contributed to a balanced and in-depth assessment of community readiness and was helpful for determining starting points for tailored PA interventions due to the detection of complex relationships and structures. The study delivers preliminary evidence that a qualitative multi-perspective community readiness assessment adds value to quantified single-perspective readiness assessment research practice.

Increased expression of HIF2α during iron deficiency-associated megakaryocytic differentiation.

BACKGROUND: Iron deficiency is associated with reactive thrombocytosis; however, the mechanisms driving this phenomenon remain unclear. We previously demonstrated that this occurs alongside enhanced megakaryopoiesis in iron-deficient rats, without alterations in the megakaryopoietic growth factors thrombopoietin, interleukin-6, or interleukin-11. OBJECTIVES: The aim of this study was to evaluate megakaryocyte differentiation under iron deficiency in an in vitro model and to investigate potential genes involved in this process. METHODS: Human erythroleukemia and megakaryoblastic leukemia cell lines, as well as cord-blood derived hematopoietic stem cells were cultured under iron deficiency. Cell morphology, ploidy, expression of CD41, CD61, and CD42b, and proplatelet formation were assessed in iron-deficient cultures. Polymerase chain reaction arrays were used to identify candidate genes that were verified using real-time polymerase chain reaction. Hypoxia-inducible factor 1, α subunit (HIF2α) protein expression was assessed in bone marrow sections from iron-deficient rats and vascular endothelial growth factor (VEGF)-A in culture supernatants. RESULTS AND CONCLUSIONS: Iron deficiency enhanced megakaryoid features in cell lines, increasing ploidy and initiating formation of proplatelet-like structures. In cord blood cell cultures, iron deficiency increased the percentage of cells expressing megakaryopoietic markers and enhanced proplatelet formation. HIF2α and VEGF were identified as potential pathways involved in this process. HIF2α protein expression was increased in megakaryocytes from iron-deficient rats, and VEGF-A concentration was higher in iron-deficient culture supernatants. Addition of VEGF-A to cell cultures increased percentage expression of megakaryocyte CD41. In conclusion, the data demonstrate that iron deficiency augments megakaryocytic differentiation and proplatelet formation and a potential role of HIF2α in megakaryopoiesis.

[Physical activity during the transition period between occupation and retirement]. / Körperlich-sportliche Aktivität in der Übergangsphase vom Beruf in den Ruhestand.

BACKGROUND: During the transition period between occupation and retirement, different mental challenges may arise as a consequence of the numerous changes and necessary reorientation to the following phase of life. Personal well-being is a precondition to cope with these challenges. METHODS: Interviews with physically active people in the transition period between occupation and retirement, concerning the importance of physical activity in coping with mental challenges, were conducted. RESULTS: Physical activity is meant to affect well-being and the physical condition in a positive way. In addition, it should foster social contacts and make it easier to manage everyday life. Moreover, it is a measure of personal success during advanced age. CONCLUSION: Because of its influence on various physical, mental, and social aspects, physical activity can help a person to cope with mental challenges in the transition period between occupation and retirement.

The use of likelihood ratio methodology to find predictors of treatment outcome in patients with dental injury diagnoses.

The purpose of this prospective, cohort study of patients with dental injuries was to develop prediction rules to predict treatment response related to the management of dental injuries. The study comprised of 130 patients with a single permanent incisor affected by a dental displacement (n = 100) or fracture injury (n = 30). Laser Doppler flowmetry (LDF) measurements of pulpal blood flow (PBF) were taken 6 and 18 weeks after dental injury Treatment response (success or failure) was categorized based on findings of clinical and radiographical evaluation after 9 months. Forty-four (34%) subjects were categorized as treatment success (absence of loss of sensitivity, periapical radiolucency and grey discolouration of crown), 43 (33%) as treatment failures (loss of sensitivity, and periapical radiolucency and/or grey discolouration of crown) and 43 (33%) as acceptable outcome (loss of sensitivity). After using univariate analysis to determine the association between potential clinical and LDF predictor variables and treatment response status, preliminary prediction rules were developed for prediction of success [positive likelihood ratio (LR), 29.0; 95% confidence interval (CI), 1.7-496.4] and failure (negative LR, 0.55; CI, 0.4-0.7). The most important variables were subluxation, root fracture, baseline PBF level and change in PBF level at 3-month follow-up. Outcome following the management of dental injuries may be predicted from variables collected from LDF and physical examination. Predictive modelling may provide clinicians with the opportunity to identify 'at-risk' patients early and initiate specific treatment approaches.

Treatment outcomes of dental injury diagnoses as related to blood flow measurements from teeth.

The purpose of this study was to investigate whether dental injury diagnoses may predict adverse outcomes occurring 102 weeks after trauma, and to evaluate whether the severity of adverse outcome is related to laser Doppler flowmetry (LDF) measurements of blood flow from teeth. In 309 trauma patients, 404 permanent maxillary incisors and the respective contralateral homologous control teeth were investigated clinically and radiographically, and by LDF to assess local blood flow values. Dental displacement injuries were classified as grade I (subluxation), grade II (lateral or extrusive luxation), and grade III (avulsion or intrusive luxation). Dental fracture injuries were classified as uncomplicated crown fractures, complicated crown fractures, and root fracture. An adverse outcome was defined as the presence of 'periapical radiolucency and/or grey discolouration'. Significant increase in risk of an adverse outcome occurred with a grade II dental displacement injury (15.07 odds ratio; P = 0.000), a grade III dental displacement injury (28.33 odds ratio; P = 0.000), and a root fracture (106.25 odds ratio; P = 0.000). Blood flow measurements that were significantly associated with more severe outcome were blood flow levels of < or =3 perfusion units (PU; 170.72 odds ratio; P = 0.000), and those of >3 PU and < or =6 PU (76.71 odds ratio; P = 0.000). Diagnoses of displaced and root fractured teeth predicted dental injury patients who went on to show adverse treatment outcomes of splinting. Blood flow measurements from teeth were related to the severity of adverse outcome.

Adverse outcomes of dental trauma splinting as related to displacement injury and pulpal blood flow level.

Splinting of traumatically displaced permanent teeth has been described as an effective modality in the treatment of patients with dental injuries. The purpose of this study was to (i) investigate whether dental injury diagnosis may predict adverse outcomes occurring 96 weeks after splint removal, and (ii) evaluate whether the severity of adverse outcome is related to laser Doppler flowmetry (LDF) measurements of pulpal blood flow (PBF). In 206 trauma patients, 273 permanent maxillary incisors treated by repositioning and splinting, and the respective contralateral homologous control teeth were investigated clinically and radiographically, and by LDF to assess local PBF values. Dental displacement injuries were classified as grade I (subluxation), grade II (lateral or extrusive luxation) and grade III (avulsion or intrusive luxation). Outcomes were classified as 'absence of loss of sensitivity, periapical radiolucency, and/or grey discolouration of crown', type I (loss of sensitivity), type II (loss of sensitivity and periapical radiolucency or grey discoloration of crown) and type III (loss of sensitivity, periapical radiolucency and grey discoloration of crown). An adverse outcome was defined as the presence of 'periapical radiolucency and/or grey discoloration'. A multiple logistic regression analysis was used to compute the odds ratio (OR) for dental displacement injury for adverse outcome (n = 69) vs non-adverse outcome (n = 168). An ordinal stepwise regresssion was completed to assess the degree of association between PBF measurements and outcome groups. Significant increase in risk of an adverse outcome occurred with a grade II dental displacement injury (OR 14.3) (P = 0.000) and a grade III dental displacement injury (OR 19.9) (P = 0.000). PBF measurements that were significantly associated with more severe outcome were PBF levels of < or =3 perfusion units (PU) (OR 399.4) (P = 0.000), those of >3 PU and < or =6 PU (OR 100.5) (P = 0.000), and those of >6 PU and < or =9PU (OR 6.2) (P = 0.000). Diagnoses of displaced teeth predicted dental injury patients who went on to show adverse treatment outcomes of splinting. PBF measurements were related to the severity of adverse outcome.

Intraorbital plexiform neurofibroma in an NF-1-negative patient.

A 52-year-old patient presented with an orbital swelling and exophthalmos that enlarged over a period of about 40 years. The clinical examination showed massive exophthalmos and ptosis of the right eye without diplopia. The radiological investigation (MRI, CT and ultrasound) showed an unclear intraorbital mass with erosion of the orbital floor, infraorbital rim and orbital roof. The lesion was diagnosed histologically as a plexiform neurofibroma. The patient did not present any features of neurofibromatosis type 1 (NF-1) and molecular genetic analysis was unable to uncover a pathogenic sequence alteration in the NF-1 gene. Owing to the absence of clinical and ophthalmologic symptoms and the improbability of complete removal, the patient refused surgical intervention.

Effect of luxation type on pulpal blood flow measurements: a long-term follow-up of luxated permanent maxillary incisors.

Laser Doppler flowmetry (LDF) is a non-invasive method to assess pulpal blood-flow (PBF). Dental injury has been associated with significant PBF reduction. The purpose of this study was to assess whether (i) the type of luxation trauma may affect PBF measurements and (ii) whether luxation type-related measurements may show short- and long-term changes of PBF values. In 41 trauma patients, 69 maxillary incisor treated by repositioning and splinting, and the respective contralateral homologous tooth were investigated by LDF to assess local PBF values. Perfusion units were recorded in four sessions, on the day of splint removal, and 12, 24 and 36 weeks after splint removal. Statistical analysis consisted of univariate analysis of variance for repeated measurements. For the LDF measurements, the main effect of the variable 'session' was not significant (P = 0.119). However, there was a significant 'session'/'luxation type' interaction (P = 0.000). Analysis of simple session-within-luxation type effects revealed intrusive luxations to be associated with a significant decrease in PBF values (P = 0.000), while subluxations (P = 0.568), lateral luxations (P = 0.980), extrusive luxations (P = 0.910), and avulsions (P = 0.996) showed no significant difference between session-related values. The PBF measurements did not change over time for the contralateral incisors (P = 0.996). The LDF may become useful in the detection of pulpal ischaemic episodes in luxated maxillary incisors after repositioning and splinting. Further studies are warranted to assess the validity of the diagnosis of post-traumatic 'ischaemic episodes' by comparing it with histological tooth pulp changes, and by determining how well it may predict course and response to treatments in clinical trials.

Diagnostic quality of dynamic high-resolution ultrasonography of the TMJ--a pilot study.

The aim of this study was to compare sensitivity, specificity, accuracy and positive and negative predictive value for high-resolution ultrasonography (HR-US) in diagnosing degenerative changes, effusion and disk displacement using magnetic resonance imaging (MRI) as a reference. Over a period of 6 months, 100 patients with TMJ disorders (200 TMJs) were investigated by an experienced radiologist with HR-US and magnetic resonance imaging (MRI). The MRI investigation showed degenerative changes in 190 joints (95%), while an effusion was found in 59 (29.5%) joints. At closed-mouth position a disc dislocation was found in 138 joints (69%) and in maximum-mouth-opening position disc dislocation was diagnosed in 76 joints (38%). In the determination of degenerative changes HR-US showed a sensitivity of 94%, a specificity of 100% and an accuracy of 94%. In the detection of effusion HR-US yielded a sensitivity of 81%, a specificity of 100% and an accuracy of 95%. In the determination of disk displacement at closed-mouth position HR-US showed a sensitivity, specificity and an accuracy of 92% each. At maximum-mouth-opening position HR-US reached a sensitivity of 86%, a specificity of 91% and an accuracy of 90%. The results of the current study imply that HR-US is a valuable diagnostic imaging method of the TMJ which can be used as an alternative method to a MRI-investigation, but is yet not able to replace it. Further studies have to be done to reduce false-negative results.

[Interobserver variation of the sonographic diagnosis of orbital floor fractures and fractures of the infraorbital margin]. / Reliabilität der sonographischen Diagnostik von Orbitabodenfrakturen und Frakturen des Infraorbitalrandes.

PURPOSE: The aim of the study was to evaluate the interobserver variation of the ultrasound diagnosis of orbital floor fractures and fractures of the infraorbital rim. MATERIAL AND METHODS: A total of 25 patients with a clinical diagnosis of an orbital trauma were investigated prospectively by computed tomography (CT) and ultrasonography (US). Inter-observer variation was calculated using the lambda coefficient (lambda). The US images were reassessed by two inexperienced investigators. RESULTS: The lambda value for the US investigation of the orbital floor showed poor reliability comparing the US findings with the results of the re-investigators. The comparison between the two re-investigators showed a good reliability for the US evaluation of the orbital floor. The lambda for the US investigation of the infraorbital margin showed a good reliability comparing the US findings with the results of the both re-investigators. The comparison of the two re-investigators showed a good reliability as well. CONCLUSION: Ultrasound is not yet an alternative method for the evaluation of orbital floor fractures and fractures of the infraorbital margin. To replace CT which is accepted as the current gold standard, further studies have to be done to reach a better diagnostic quality of the method and to achieve a better calibration of the investigations.

Laser Doppler flowmetry of luxated permanent incisors: a receiver operator characteristic analysis.

Laser Doppler flowmetry (LDF) is a non-invasive method to assess pulpal blood-flow (PBF). Dental luxation injuries have been associated with significant PBF reduction. The purpose of this study was to describe diagnostic characteristics for different session-related threshold PBF values for detection of specific adverse outcomes. In 61 trauma patients, a single maxillary incisor treated by repositioning and splinting, and the respective contralateral homologous control tooth were investigated by LDF to assess local PBF values. Perfusion units (PU) were taken 12 weeks (session I) and 24 weeks (session II) after splint removal. The ability of session I-related PBF measurements at 2.8, 6.4 and 10.1 PU levels, and of session II-related ameasurements at 2.4, 6.3 and 10.2 PU levels to identify adverse outcomes occurring 36 weeks after splint removal was investigated. Adverse outcomes were classified as type I (periapical radiolucency), type II (grey discoloration), and type III (periapical radiolucency and grey discoloration of crown). Receiver operator characteristic curves were used to evaluate the sensitivity and specificity of PBF assessments. There was no significant difference in PBF values between session I and session II (P > 0.05) for teeth without an adverse outcome, and those with a type I, II or III outcome (P > 0.05). The PBF measurements did not change over time for the contralateral incisors (P > 0.05). A type I, II and III outcome occurred in 36, 21 and 12% of the incisors, respectively. The best likelihood ratio was found for the PBF 6.4 PU level at session I and incisors associated with a type I (20.8) and type II outcome (15.2). The PBV of 6.4 PU demonstrated a sensitivity of 96% and a specificity of 59% for type I outcomes, and a sensitivity of 100% and a specificity of 50% for type II outcomes. The data suggest the LDF test to be a valuable diagnostic adjunct for luxated teeth showing signs of adverse outcomes.

Diagnostic characteristics of pulpal blood flow levels associated with adverse outcomes of luxated permanent maxillary incisors.

Laser Doppler flowmetry (LDF) is a non-invasive method to assess pulpal blood flow (PBF). Dental injury has been associated with significant PBF reduction. The purpose of this study was (i) to describe PBF characteristics of teeth with specific clinical outcomes, and (ii) to demonstrate diagnostic characteristics for different threshold PBF values for detection of specific multiple adverse outcomes. In 80 trauma patients, a single maxillary incisor treated by repositioning and splinting, and the respective contralateral homologous control tooth were investigated by LDF to assess local PBF values. Perfusion units (PU) were taken in two sessions, on the day of splint removal (session I), and 12 weeks after splint removal (session II). The ability of session II-related PBF measurements at 2.9, 6.4 and 9.9 PU levels to identify adverse outcomes occurring 36 weeks after splint removal was investigated. Adverse outcomes were classified as type I (loss of sensitivity), type II (periapical radiolucency), type III (grey discolouration), type IV (loss of sensitivity and periapical radiolucency), and type V (loss of sensitivity, periapical radiolucency and grey discolouration of crown). Receiver-operator characteristic (ROC) curves were used to evaluate the sensitivity and specificity of PBF assessments. There was a significant increase in PBF values from session I to session II (P=0.0001) for teeth without an adverse outcome, while teeth affected by a type II-V outcome showed a significant decrease in PBF values (P <0.05). PBF measurements did not change over time for the contralateral incisors (P >0.05). A type IV and V outcome occurred in 21 and 24% of the instances, respectively. The PBF of 2.9 PU demonstrated a sensitivity of 70% and a specificity of 93% for type V outcomes. The best likelihood ratio was found for the PBF 2.9 PU level and incisors associated with a type V outcome. The data suggest that the LDF test to be a valuable diagnostic adjunct for luxated teeth showing signs of adverse outcomes including grey discolouration or a combination of other signs. However, it may also become necessary to apply clinical decision-making methods in order to correctly evaluate the value of information gathered. The clinical implication is that LDF may become useful in the prediction of adverse outcomes at a much earlier time period than may be accomplished by standard sensitivity tests.

Laser Doppler flow measurements of pulpal blood flow and severity of dental injury.

AIM: To evaluate laser Doppler flowmetry (LDF) measurements of pulpal blood flow (PBF) and severity of dental injury. METHODOLOGY: The relationship between adverse outcomes and PBF measurements was analysed in 94 permanent maxillary incisors of 71 consecutive dental trauma patients. The diagnostic adverse outcome group was comprised of 72 incisors in 52 patients with a type I (loss of sensitivity), type II (loss of sensitivity and periapical radiolucency), or type III (loss of sensitivity, periapical radiolucency and grey discoloration of crown) diagnosis. The nonadverse outcome group consisted of 22 incisors in 19 patients with the finding of an absence of an adverse outcome. At each session, when an injured permanent maxillary incisor was recorded, a contralateral homologous tooth was used as a control. An ordinal stepwise regression was completed to assess the degree of association between PBF measurements and adverse outcomes RESULTS: Using chi-square analysis for pairwise comparison, a significant relationship between PBF measurements and types of adverse outcomes (chi(2) =119.635, d.f. = 12, P = 0.000) was observed. PBF measurements that were significantly associated with more severe outcome were PBF levels of 3 PU and

Laser Doppler flow investigation of fractured permanent maxillary incisors.

Laser Doppler flowmetry (LDF) is a non-invasive method to assess pulpal blood-flow (PBF). Dental injury has been associated with losses of pulpal sensibility. The purpose of this study was to assess the outcome of splint therapy on tooth fracture type-related PBF values. In 15 trauma patients, a single maxillary incisor treated by repositioning and splinting was investigated by LDF to assess local PBF values. Perfusion units were taken in four sessions, on the day of splint removel, and 12, 24 and 36 weeks after splint removal. Analysis of the tooth fracture type-related PBF measurements revealed root fractures to be associated with a significant decrease (P < 0.05) and uncomplicated crown fractures to be associated with a significant increase in PBF values (P < 0.05), while complicated crown fractures showed no significant difference between the session-related values (P > 0.05). The main findings of this study suggest splint therapy of root fractures of the central maxillary incisor to be associated with a short- and long-term decrease in PBF values. The LDF may become useful in the detection of transient ischaemic episodes and the identification of teeth at risk for adverse sequelae such as avascular necrosis and tissue loss.

The diagnostic value of ultrasonography in the detection of orbital floor fractures with a curved array transducer.

The aim of the study was to investigate the diagnostic value of ultrasonography (US) in orbital floor fractures and orbital rim fractures with a curved array scanner. Over a period of 10 months, 60 patients with an orbital trauma have been investigated. Orbital trauma was defined by clinical and ophthalmologic investigation. Computed tomography (CT) was used as the reference method to evaluate the diagnostic value of US in the determination of an orbital floor fracture and was performed by a well-experienced radiologist. Coronal and sagittal images were made. The US investigation was performed with a 7.5 MHz curved array transducer.The US investigation of the infraorbital rim showed a sensitivity of 94% and a specificity of 92% with a diagnostic accuracy of 92%. The positive predictive value (PPV) reached 91% and the negative predictive value (NPV) reached 92%, while the US investigation of the orbital floor showed a sensitivity of 95% and a specificity of 100% with a diagnostic accuracy of 98%. PPV reached 100% and NPV reached 77%. Ultrasonography is a cost-effective and widely available method without disadvantages such as radiation exposure. The results in the current study imply that ultrasonography can be used as an alternative method in the investigation of orbital floor fractures.

Myeloid cell-associated lysosomal proteins as flow cytometry markers for leukocyte lineage classification.

Lysosomal proteins including myeloperoxidase (MPO), lysozyme (LZ), CD68 and lactoferrin (LF), represent classical immunohistology marker molecules. Additionally, flow cytometry can be used to detect and quantify their expression at the single cell level in phenotypically defined leukocyte subsets. Recent results demonstrated that expression densities of these intracellular proteins vary among myeloid cell subsets, thus enabling insights into novel subset biology and development. Additionally, whole blood staining protocols allow detection of lysosomal proteins in infrequent leukocyte subsets such as circulating CD34+ hematopoietic progenitors and dendritic cells (DC). Thus, information on leukocyte subset distribution and aberrant phenotypes might be gained for diagnositic purposes. Finally, FACS detection of MPO and LZ proved to be of high value for the lineage diagnosis of acute leukemias.

[Imaging diagnosis of medial and lateral orbital wall fractures. Sonography versus computed tomography]. / Bildgebende Diagnostik von medialen und lateralen Orbitawandfrakturen. Ultraschall versus CT.

PURPOSE: The purpose of the study was to evaluate the diagnostic value of a curved array scanner in the diagnosis of medial and lateral orbital wall fractures. MATERIAL AND METHODS: Fifty-three patients with the clinical diagnosis of an orbital trauma were investigated prospectively within a period of 16 months by CT and ultrasonography. The intraoperative findings were used as a reference. RESULTS: CT reached a sensitivity of 100% and a specificity of 96% in the diagnosis of medial orbital wall fractures, while ultrasound yielded a sensitivity of 80% and a specificity of 96%. There was no significant difference found between CT and ultrasonography ( p=0.402). In the investigation of lateral orbital wall fractures, CT reached a sensitivity of 88% and a specificity of 87%, while ultrasonography yielded a sensitivity of 97% and a specificity of 95%. Ultrasonography achieved significantly better results than CT ( p=0.008). CONCLUSION: The ultrasound investigation with a curved array scanner could be used as an additional method in the diagnosis of medial and lateral orbital wall fractures. Further technical improvements of the transducers need to be developed to increase the sensitivity of ultrasound in the diagnosis of medial orbital wall fractures.

[Temporomandibular disorders in juvenile patients with rheumatic diseases]. / Kiefergelenkbeschwerden bei juvenilen Patienten mit rheumatischen Erkrankungen.

PURPOSE: The aim of the study was to investigate the incidence of temporomandibular disorders (TMD) in juvenile patients with rheumatic diseases. Furthermore, correlations between the degree of the rheumatic disease and the clinical symptoms were evaluated. MATERIAL AND METHODS: In a prospective investigation the temporomandibular joints of 48 children with rheumatic diseases were evaluated clinically regarding clicking, crepitation, pain, duration of the rheumatic disease, and the number of affected peripheral joints. The degree of rheumatic disease was assessed with Steinbrocker's classification. RESULTS: 26 patients (54.17%) showed clinical symptoms of TMD. No significant correlation was found between the degree of the rheumatic disease and the awareness of TMD. A high number of affected peripheral joints does not lead to a significant increase of TMD. A significant correlation between the duration of the rheumatic disease and TMD could be detected. A significant correlation between the duration of the rheumatic disease and clicking or crepitation was found ( p=0.011). CONCLUSION: Rheumatic diseases lead to a higher incidence of TMD in juvenile patients. A longer duration of rheumatic diseases leads to a higher incidence of TMD.

The diagnostic value of ultrasonography to detect occult lymph node involvement at different levels in patients with squamous cell carcinoma in the maxillofacial region.

The purpose of this study was to evaluate ultrasonography (US) and computed tomography (CT) in detecting lymphnodes of the neck affected with squamous cell carcinoma. From 1987 to 1999 the data from 203 untreated patients with a diagnosis of cancer in the maxillofacial have been investigated. Of these, 115 had a primary squamous-cell carcinoma. US diagnosis was made by an oral- and maxillofacial surgeon experienced in US of the head and neck. CT diagnosis was made by a well-experienced radiologist. The following lymph node levels were assesed: level I (submental and submandibular lymphnodes), level II (lymphnodes distal to level I and confined to the region above the skin crease at or just below the level of the thyroid notch), level III (lymphnodes distal to level II and confined to the anterior cervical triangle including those deep to the sternocleidomastoid muscle), and level IV (lymphnodes distal to level III and confined to the posterior cervical triangle). For all levels US yielded a sensitivity of 71%, and a specificity of 87%, while CT showed a sensitivity of 32% and a specificity of 96%. The sensitivity of US decreased from level I to level IV, whereas the specificity increased from level I to level IV. For lymphnode levels I and II US may be useful for the detection of local metastases while for the other levels the application of advanced techniques of US may have to be investigated.

[Post-traumatic ocular motility in orbital floor fractures]. / Posttraumatische Bulbusmotilität bei Orbitabodenfrakturen.

PURPOSE: The aim of this study was to evaluate post-traumatic ocular motility in orbital floor fractures in relation to the severity of the fracture and concomitant injuries. MATERIAL AND METHODS: Over a period of 6 years, data from 435 patients with orbital floor fractures were re-evaluated. Ocular motility was divided into abduction, adduction, upgaze and downgaze movements. RESULTS: In 54.3% of the cases, there was a reduction in ocular motility. A reduced motility with a movement >20 degrees was found in most of the cases. Concomitant injuries to the eye resulted in a significant increase in the reduction of motility. This reduction depended on the severity of the orbital floor fracture. A reduced upgaze movement was the most common complication in all types of fractures. CONCLUSION: Ocular motility can act as an indication of the severity of the orbital fracture. Concomitant injuries to the eye resulted in a higher incidence of reduced ocular motility.