Anatomical characteristics of maxillary sinus septa visualized by cone beam computed tomography.

Proper implant positioning in the posterior region of the edentulous maxilla commonly requires sinus floor elevation. Maxillary sinus septa increase the risk of membrane perforation during sinus floor elevation. The purpose of this retrospective, cone beam computed tomography (CBCT)-based study was to examine the frequency, number, location, and orientation of antral septa in the maxillary sinus. Further, possible associated factors were assessed. Measurements were performed on CBCT scans of 301 patients (602 sinuses). The data were analysed statistically with respect to patient age, sex, and dentition type. One or more septa were detected in 117 patients (38.9%). A total of 188 septa were found in the 602 sinuses (31.2%). Septa were most often coronally oriented (53.2%), followed by sagittal (24.5%) and transverse (22.3%) orientations. Septa were most often found in the region of the first and second molar (37.2%), followed by the posterior region of the third molar (33.0%) and the anterior region of the premolars and canines (29.8%). A significant association was found between edentulism and the presence of septa. For edentulous patients, the septa were most often transversally oriented. Maxillary sinus septa are encountered in every third patient. This may have an influence on the performance of sinus floor elevation.

Computer assisted maxillofacial surgery.

Technical developments strongly influence modern medicine. This is especially obvious in imaging technology. Today, one of the most difficult tasks for surgeons is transferring all the available imaging information for their patients into one "complete picture". In the operation theatre, this picture then has to be applied to the patient. Computer-assisted surgery (CAS) promises to help in fulfilling this task and, thereby, to fully utilize the possibilities offered by modern imaging techniques. Today's standard procedures for CAS in the maxillofacial region are described in technical principles and clinical applications. They are evaluated and discussed based on the available literature and in light of practical experience of more than ten years in the field of CAS. In addition, an outlook is given into developments of the near future that have appeared in the current literature. While technical development is leading toward a complete integration of all processes surrounding the patient and his or her surgery, basic CAS has moved from research to clinical care. Before it is routinely used, more investigation about its effectiveness and benefits has to be done, especially since increasing medical care costs are an issue in all countries.

Reconstruction of orbital wall defects with calcium phosphate cement: clinical and histological findings in a sheep model.

The aim of this pilot study was to investigate the potential of calcium phosphate cement in the treatment of orbital wall defect fractures in an adult sheep model, and to compare this alloplastic material to autologous calvaria split-bone grafts. Clinical, volumetric and histological examinations were carried out of both reconstruction materials. The use of cement made intraoperative corrections easier to perform, and increased the precision of reconstruction of the orbital volume. This material also proved to be osseoconductive. The two materials were used successfully in combination. Regions of most intensive remodelling were the anterior orbital floor and the adjacent orbital rim. The preliminary results of this study demonstrate the potential of calcium phosphate cement as a useful biomaterial in the reconstruction of the anterior orbital region. Further animal and clinical trials are necessary to investigate its ability as a carrier for mediators where bone healing requires influence or support.

[Diagnosis and therapy of chronic pancreatitis]. / Diagnostik und Therapie der chronischen Pankreatitis.

Chronic pancreatitis is characterized by recurrent or persisting pain. As the exocrine pancreatic insufficiency occurs early in the progression of the disease, the endocrine function may persist intact. Imaging procedures and pancreatic function tests are used to make a diagnosis. Therapy consists of pain reduction, which might require endoscopic or surgical intervention. Treatment of exocrine and endocrine pancreatic insufficiency is based on diet and substitution of pancreatic enzymes, minerals and vitamins, as well as insulin.

[Acute pancreatitis]. / Akute Pankreatitis.

While interstitial acute pancreatitis usually takes a benign course, necrotizing acute pancreatitis takes a severe course, mainly because of severe local and systemic complications. After a quick diagnosis it is necessary to rapidly assess a degree of severity of the disease and thus the prognosis. The clinical picture and the result of imaging procedures do not always correspond. The management basically includes to treat pain as well as to administer fluid, electrolyte, protein and calories. In addition, systemic treatment of complications such as shock or respiratory and renal insufficiency--if occurring--is necessary. In case of pancreatic necrosis, prophylactic administration of pancreas-penetrable antibiotics is recommended to avoid infection. In the severely ill with infected pancreatic necrosis, surgery is the treatment of choice. In approximately 10% of all patients with alcohol-induced pancreatitis, there is a gradual transition to chronic pancreatitis.

Does gastroscopy induce myocardial ischemia in patients with coronary heart disease?

BACKGROUND AND STUDY AIMS: Gastroscopy has been reported to be dangerous for unstable patients with coronary heart disease (CHD). The aims of this study were to find out whether endoscopy is equally liable to cause myocardial ischemia in stable CHD patients, and whether this can be predicted prior to endoscopy, and to find out the frequency of abnormal findings in patients for whom a secondary prophylaxis with acetylsalicylic acid (ASA) is indicated. PATIENTS AND METHODS: Electrocardiograph recording using a Holter monitor was performed during gastroscopy in 71 patients with stable CHD, to check for silent ischemia. To predict potential ischemia during gastroscopy, the Holter monitoring ECG was applied prior to a treadmill test, and withdrawn after gastroscopy 16-22 hours later. RESULTS: During gastroscopy, 30 patients (42%) had silent ischemia, but only 1 patient (1%) became symptomatic. Ischemia was dependent on heart-rate (median heart rate with ischemia 124 beats/min, without 104 beats/min). Abnormal findings on gastroscopy were found in 53 patients (75%). They implied a potential bleeding risk in 30 patients (42%) and prevented the indication for ASA in 6 of them (8%). CONCLUSIONS: Gastroscopy is potentially a harmful procedure for CHD patients, but the incidence of ischemic periods may be reduced by conscious sedation and, if the patient is receiving beta-blocking agent therapy, by applying this medication prior to gastroscopy.

Relapsing pneumonia due to a migrating intrathoracic foreign body in a World War II veteran shot 53 years ago.

In the great majority of cases of long-standing intrathoracic foreign bodies, patients are asymptomatic. However, symptoms may occur years later from the migration of the foreign body. We report on a 70-year-old patient who developed relapsing pneumonia due to obstruction of a bronchial branch of the left apical group by a migrating infantry bullet impacting 53 years ago. This was not diagnosed until the second attack of pneumonia in 1998. The bullet remains were removed bronchoscopically and the pneumonia resolved completely without further complications.

Gallstone ileus: endoscopic removal of a gallstone obstructing the upper jejunum.

In a 91-year-old female patient admitted with an ileus, ultrasound and computed tomography demonstrated the obstruction of the upper jejunum by a large gallstone. Due to concurrent diseases the patient was unfit for surgery. An attempt was made to remove the impacted stone endoscopically. After successful mobilization and fragmentation by mechanical lithotripsy the obstruction was cleared away. Since the patient improved considerably after this procedure, the gallbladder and the cholecystoduodenal fistula were left in place.

Splenic abscess in chronic calcifying pancreatitis.

Abscess formation in chronic pancreatitis is rare and the pancreas and liver are the most frequent localizations. We present a novel case of splenic abscess in chronic pancreatitis that led to diabetic ketoacidosis in an alcoholic patient. Percutaneous drainage and antibiotic treatment sufficed to resolve completely the abscess.

Secretin-pancreozymin test (SPT) and endoscopic retrograde cholangiopancreatography (ERCP): both are necessary for diagnosing or excluding chronic pancreatitis.

Results of the SPT and the ERCP staged for their severity were compared in 202 patients. The correlation between both investigations was significant (p < 0.001); however, ERCP showed significantly more severe changes (p = 0.04). Furthermore, we found that 129 (64%) patients had parallel SPT and ERCP results, matching in all four gradings of severity. Forty-three (21%) patients had abnormal results for both SPT and ERCP, but the severity gradings did not parallel. Finally, 30 (15%) patients showed totally nonparallel results, a normal SPT and abnormal ERCP, or vice versa. Abnormal ERCP but normal SPT results were found in 23 of these 30 patients (group 1), and normal ERCP but abnormal SPT results in the seven remaining cases (group 2). In the first group, more patients had a history of acute pancreatitis compared to the second group (19 vs. one, p < 0.005). Based on medical history, laboratory and functional test results, and other morphological tests, chronic pancreatitis was diagnosed in two of 23 patients in group 1 and in all seven patients in group 2. Follow-up interviews (86 +/- 54 months) were possible in 20 of the remaining 21 patients in group 1 and showed definite chronic pancreatitis in one and probable chronic pancreatitis in another two of them, whereas in the other 17 patients no symptoms of acute pancreatitis or abdominal pain suggestive of chronic pancreatitis had occurred. In conclusion, both SPT and ERCP should be used to complement each other when chronic pancreatitis is suspected. ERCP seems to over-diagnose the disease since duct changes may only reflect scars after severe acute pancreatitis, or old age, and are not necessarily a sign of chronic pancreatitis. SPT seems to diagnose chronic pancreatitis with more reliability.

A new fine needle for easier, single handed, ultrasound-guided biopsies, requiring less advancing forces into solid organs.

A fine punch needle with a new bevelled geometry for easy, single-handed, ultrasound-guided biopsies is presented. The needle requires a significantly lower advancing force compared with the commonly used punch needles of the Menghini type. Since, therefore, our needle penetrates the organs to be investigated easier, it enables the puncture of easily movable (stomach, gut) and/or solid organs (kidney) with the yield of sufficiently long punch cylinders. The first 196 biopsies were well tolerated and histological diagnosis could be made in 94% of the cases.

Prospective study of the incidence of ultrasound-detected hepatic hematomas 2 and 24 hours after percutaneous liver biopsy.

Recently, a high incidence of hepatic hematomas following percutaneous liver biopsy was reported. This induced us to undertake this prospective ultrasound examination before, as well as 2 and 24 h after, percutaneous liver biopsy, using a Menghini needle (O 1.4 mm), in 93 patients for diagnostic purposes. Two hours after biopsy a small subcapsular fluid margin was found in one patient (1.1%) which disappeared within 24 h. We conclude that hepatic hematomas are not frequent following percutaneous liver biopsy and that it remains a safe diagnostic procedure to find out the reason for chronically elevated liver enzymes and evaluate suspected diffuse parenchymal lesions of the liver.

Synthesis and properties of new luminescent acridinium-9-carboxylic acid derivatives and their application in luminescence immunoassays (LIA).

Two new groups of chemiluminescent acridinium labels have been presented: (a) acridinium-9-thiocarboxylates, (b) acridinium-9-(N-sulphonyl)carboxamides. Both groups show higher light yields and faster emission kinetics compared with the known acridinium carboxylate. Owing to the poor storage stability of the thiocarboxylate tracers they are not suitable for commercial use. Acridinium-9-(N-sulphonyl)carboxamides allow a variation of the structure, their stability after conjugation to antibodies is in most cases clearly better than the stability of thiocarboxylate and carboxylate tracers. Light yields and emission kinetics are also superior and good immunoassays have been developed. Therefore, this new class of chemiluminescent labels seems to be suitable for use in commercial assays.