Pivotal role of xanthine oxidase in the initiation of tubulointerstitial renal injury in rats with hyperlipidemia.

Hyperlipidemia can induce or aggravate renal tubulointerstitial injury. Experiments in a complex rat model with chronic glomerulonephritis and long-standing, coexisting hyperlipidemia suggested that induction of xanthine oxidase (XO), with increased oxygen radical generation, is involved in aggravation of tubulointerstitial injury. To separate the role of XO in the initial events of lipid-mediated tubulointerstitial injury, short-term experiments with diet-induced hyperlipidemia over 21 and 35 days were performed in otherwise healthy rats. XO expression in relation to the antioxidant enzymes was examined in the cortical tubulointerstitium (TIS) and proximal tubules (PT). Subsequent experiments with XO inhibition were performed, examining tubulointerstitial infiltration with ED1-positive cells and expression of adhesion molecules and monocyte chemoattractant protein-1 (MCP-1) as indicators of early injurious events. Hyperlipidemia increased XO activity in TIS by 40 and 86%, and in PT by 28 and 90% at days 21 and 35, compared with controls on regular diet. This increased activity was associated with increased reactive oxygen species. Among the antioxidant enzymes, glutathione peroxidase activity increased in TIS by 40% and in PT by 90%. Histological evaluation showed a three-fold increase in ED1-positive cells and increased MCP-1 and vascular cell adhesion molecule-1 (VCAM-1) expression at day 35 in the TIS. Inhibition of XO prevented tubulointerstitial ED1 cell infiltration, together with a decreased expression of MCP-1 and VCAM-1. These results point to an important role for XO in the early stage of hyperlipidemia-associated renal injury, mediating macrophage infiltration by a putatively redox-dependent upregulation of MCP-1 and VCAM-1.

[Abnormalities of the maxillary sinus in type 1 neurofibromatosis]. / Fehlbildungen der Kieferhöhle bei Neurofibromatose Typ 1.

AIM: The aim of this study was to determine the malformations of the maxillary sinus in neurofibromatosis type 1 patients (NF1). MATERIAL AND METHODS: Twenty-two patients with NF1 were investigated clinically and radiologically: 11 had an unilateral trigeminal plexiform neurofibroma and 11 had multiple cutaneous neurofibromas. The histological type of NF was ascertained in all cases following tumor resections. The malformation of the maxillary sinus was assessed on plain radiographs and computed or magnetic resonance tomograms. Intraindividual side comparison was used to judge the size of the sinus and its position in the midface. RESULTS: In patients with cutaneous neurofibromas the maxillary sinus appeared symmetrical in size and position. The pneumatization of the sinus had no abnormalities on the radiographs. Malformations of the maxillary sinus were restricted to plexiform neurofibromas. On the side affected by a plexiform NF, the sinus appeared hypoplastic and caudally displaced due to an enlarged ipsilateral orbit. The expansion of the sinus to the lateral side was impaired, obviously due to tumor masses. Consecutively, the alveolar process of the affected side was also displaced leading to a complex malocclusion. DISCUSSION: Malformations of the face are frequently presented as case reports in the literature. Emphasis is given to the elephantiasis-like tumor growth of the face in certain patients with NF1. The underlying pathology has not yet been fully understood. This report provides evidence that in the midfacial region the overgrowth is predominantly caused by the plexiform neurofibroma itself and that the bones can even be hypoplastic and show scoliosis-like malformation compared to the nonaffected side. These findings are relevant when debulking procedures of the face are planned for NF1 patients.

[Stability of the mandible after high sagittal supraforaminal osteotomy. Roentgen cephalometric study]. / Stabilität des Unterkiefers nach hoher sagittaler supraforaminaler Osteotomie. Röntgenkephalometrische Untersuchung.

AIM OF THE STUDY: The aim of this study was to investigate the stability achieved with high sagittal supraforaminal osteotomy (HSSO) for setback and advancement procedures of the mandibular ramus. MATERIAL AND METHODS: Computerized cephalometric X-rays of 102 patients, taken at four different times during treatment, were evaluated. RESULTS: The mean postoperative relapse was 20%, depending on the extent of the surgical correction (correlation coefficient: -0.68). Mandibular setback gave more stability than mandibular advancement. The type of osteosynthesis (positional screw combined with miniplate osteosynthesis or intermaxillary fixation) did not influence the stability. Unimaxillary osteotomies were more stable than bimaxillary procedures (p < 0.001).

Prognosis of facial growth in patients with unilateral complete clefts of the lip, alveolus and palate.

AIM: Unfavourable facial growth in patients with cleft lip, alveolus, and palate may occur during puberty. Usually this development is not predictable in a young patient. The aim of the present study was to find an individual growth prediction at an early age that would allow us to decide whether later orthognathic surgery should be included in the treatment plan. MATERIAL AND METHODS: Lateral cephalograms of 41 patients with unilateral clefts of lip, alveolus and palate (uCLAP) with observation intervals of 4 years were computerized, correlations between the variables of the first and second radiograph were calculated and regression equations were established. RESULTS: The skeletal change of the intermaxillary relationship can be explained purely by the lack of midfacial growth. An individual prediction of the angle SNA over a period of 4 years is possible with a correlation coefficient of 0.95. Additional predictions for SNB, Holdaway angle and the index of anterior facial height proportions are demonstrated. CONCLUSION: The prediction procedure elaborated in this paper facilitates the decision at the age of 12 years already, whether or not orthodontic occlusal treatment has been successfully completed at an early age. The alternative is to limit orthodontic treatment to the simple alignment of the two dental arches independently of their intermaxillary relation, and then to correct the facial skeleton and the dental occlusion simultaneously by combining surgical and orthodontic treatment after the completion of growth.

[Interdisciplinary treatment of ameloblastic fibro-odontoma in a 3 1/2 year old child : Case report covering a follow-up period of over 21 years]. / Interdisziplinäre Behandlung eines 3 1/2-jährigen Kindes mit ausgedehntem ameloblastischen Fibroodontom : Fallbericht mit Verlaufsdokumentation über 21 1/2 Jahre.

Background. This report deals with a 3 1/2 year old patient with an ameloblastic fibro-odontoma of the frontal part and left corpus of the mandible. The tumor had become symptomatic 2 months prior to admittance by a local, painless swelling of the bone and the mobility of teeth. The initial findings and the progress of the disease led to the preliminary diagnosis of a malignant mesenchymal tumor. Its extent and aggressive growth prompted a continuity resection of the mandible and immediate reconstruction with a costal autograft. The definitive histological diagnosis was an ameloblastic fibro-odontoma. The patient was followed up over a period of 21 1/2 years. Therapy. Further treatment included an iliac crest onlay graft, followed by autotransplantation of three third molars into both transplants. Two of the wisdom teeth had to be replaced by dental implants because of ankylosis and infra-occlusal positioning. The prosthetic rehabilitation was carried out by a bar attachment and a partial cover denture. This report supports the concept of the interdisciplinary treatment of patients with tumors that occur during the growth phase.

[Interdisciplinary treatment of a 3 1/2-year-old child with extensive ameloblastic fibro-odontoma. Case report and follow-up documentation over 21 1/2 years]. / Interdisziplinäre Behandlung eines 3 1/2-jährigen Kindes mit ausgedehntem ameloblastischen Fibroodontom. Fallbericht mit Verlaufsdokumentation über 21 1/2 Jahre.

BACKGROUND: This report deals with a 3 1/2 year old patient with an ameloblastic fibro-odontoma of the frontal part and left corpus of the mandible. The tumor had become symptomatic 2 months prior to admittance by a local, painless swelling of the bone and the mobility of teeth. The initial findings and the progress of the disease led to the preliminary diagnosis of a malignant mesenchymal tumor. Its extent and aggressive growth prompted a continuity resection of the mandible and immediate reconstruction with a costal autograft. The definitive histological diagnosis was an ameloblastic fibro-odontoma. The patient was followed up over a period of 21 1/2 years. THERAPY: Further treatment included an iliac crest onlay graft, followed by autotransplantation of three third molars into both transplants. Two of the wisdom teeth had to be replaced by dental implants because of ankylosis and infra-occlusal positioning. The prosthetic rehabilitation was carried out by a bar attachment and a partial cover denture. This report supports the concept of the interdisciplinary treatment of patients with tumors that occur during the growth phase.

Oxidant stress in hyperlipidemia-induced renal damage.

Hyperlipoproteinemia can aggravate glomerulosclerosis and chronic tubulointerstitial (ti) damage in kidneys without primary immunologic disease. We evaluated whether the effect of hyperlipidemia on progression of renal damage differed between kidneys without preexisting glomerular disease and kidneys with mesangioproliferative glomerulonephritis and whether the renal actions of hyperlipidemia were dependent on oxidant-antioxidant balance. Hyperlipidemia was induced by high-fat and high-cholesterol diet in uninephrectomized rats. In rats without glomerulonephritis, hyperlipidemia led to a rise in glomerular and ti generation of reactive oxygen species (ROS). Oxygen radicals were mainly generated by enhanced xanthine oxidoreductase (XO), which rose with protein concentration and activity during hyperlipidemia; concurrently, glomerulosclerosis and chronic ti injury were noticed during hyperlipidemia [ti damage (% of total tubulointerstitium (TI) after 150 days): normolipidemia 0.1 +/- 0% vs. hyperlipidemia 3.4 +/- 0. 9%; P < 0.05]. In mesangioproliferative Thy-1 nephritis, ti injury was significantly accelerated by hyperlipidemia (ti damage after 150 days: normolipidemic Thy-1 nephritis 2.5 +/- 0.6% vs. hyperlipidemic Thy-1 nephritis 12.5 +/- 3.1%; P < 0.05). Antioxidant enzyme activities decreased and XO activity rose markedly in the TI (XO activity in TI after 150 days: normolipidemic Thy-1 nephritis 2.2 +/- 0.5 vs. hyperlipidemic Thy-1 nephritis 4.5 +/- 0.7 cpm/microg protein; P < 0.05). In hyperlipidemic Thy-1 nephritis rats, which had a higher urinary protein excretion than normolipidemic rats, hypochlorite-modified proteins, an indirect measure for enhanced myeloperoxidase activity, were detected in renal tissue and in urine, respectively. During hyperlipidemia, chronic damage increased in renal TI. Enhanced generation of ROS, rise in oxidant enzyme activity, and generation of hypochlorite-modified proteins in renal tissue and urine were noticed. These data suggest that oxidant stress contributed to the deleterious effects of hyperlipidemia on the renal TI.

[Premolar autotransplantation after front tooth loss in the maxilla]. / Die Prämolaren-Autotransplantation nach Frontzahnverlust im Oberkiefer.

The general rules for autotransplantation of human premolars in cases of traumatic loss of upper incisors are given. The basic conditions for tooth transplantation concerning the donor side as well as the recipient side are presented. Technical details and the principles of indication are outlined. If a correct technique is combined with a precise indication, the long-term results after tooth transplantation are excellent, with a more than 90% rate of success. Thus the concept of premolar transplantation to the front of the upper jaw in cases of traumatic loss of the upper incisors in children will need more attention in the future.

[Vertical-sagittal "peninsular" osteotomy of the body of the mandible: a concept for forward displacement and anterior rotation of the mandible]. / Die vertikosagittale Halbinselosteotomie des Unterkieferkörpers: ein Konzept zur Vorverlagerung und anterioren Rotation der Mandibula.

A new mandibular osteotomy is presented for special indications of severe mandibular retrognathia combined with a high mandibular plane angle, a dentoalveolar compensation and an open bite. The procedure allows an anterior rotation of the mandible with a maximum skeletal and minimum dental advancement.