[Mental neuropathy and pathologic fracture of the mandible as initial symptoms of metastatic prostate carcinoma]. / Sensibilitätsstörung und pathologische Unterkieferfraktur als Erstsymptome bei metastasiertem Prostatakarzinom.

BACKGROUND: Distant metastases of solid tumors account for about 1% of all malign neoplasms. In about 30% of all patients who present with an oral metastasis, the distant primary tumour has not been diagnosed yet. CASE REPORT: We report the case of a 71-year-old man who clinically demonstrated unilateral mental neuropathy as well as pathologic fracture of the mandible. Prostate carcinoma was identified as a primary tumor. Clinically, there was significant hypesthesia of the skin area innervated by the left inferior alveolar nerve. X-ray examination revealed an osteolytic lesion of the ascending ramus of the mandible as well as a pathologic fracture of the mandible. Further imaging showed an extensive neoplasm of the mandible and adjacent soft tissues and significant supraclavicular lymph node enlargement. The diagnosis of metastatic carcinoma of the prostate was histopathologically confirmed. CONCLUSION: Mental neuropathy without a dental focus indicates screening for an osseous metastasis. In cases of left-sided supraclavicular lymph node enlargement in men over 45 years, metastatic prostate carcinoma must be excluded.

Image-guided navigation for minimal invasive approaches in craniomaxillofacial surgery.

The use of minimally invasive procedures in maxillofacial surgery will require new technologies involving surgical navigation and techniques. The aim of our studies is to improve the efficacy of image-guided navigation in combination with endoscopically assisted techniques for minimally invasive craniomaxillofacial procedures. Prospective evaluation was made of all patients who underwent surgical procedures using image-guided navigation. The most common type of operations performed were endoscopically assisted interventions within the paranasal sinuses, fracture treatment, the resection of bone lesions and further miscellaneous interventions. Our experience to date suggest that image-data based techniques are eminently applicable, providing a feasible alternative to conventional surgical treatment.

Morphological and functional analysis of an incomplete CNS fiber tract lesion: graded crush of the rat optic nerve.

Fiber tract lesions in the central nervous system (CNS) often induce delayed retrograde neuronal degeneration, a phenomenon that represents an important therapeutic challenge in clinical neurotraumatology. In the present study, we report an in vivo trauma model of graded axonal lesion of CNS neurons. Controlled by a newtonmeter device, we induced retrograde degeneration of adult rat retinal ganglion cells (RGCs) by graded crush of the optic nerve. The extent of secondary RGC death increased linearly with the applied crush force. Moreover, visually evoked potentials were used to characterize the consequences of controlled optic nerve lesion on the functional integrity of the visual projection. The presented model of fiber tract lesion closely resembles the clinical conditions of traumatic brain injury and could prove useful to screen for neuroprotective drugs based on both a morphological and functional read-out.

[Dental MRI. Phantom study and clinical results]. / Dental-MRT. Phantomstudie und klinische Ergebnisse.

Magnetic resonance imaging (MRI) is used as a diagnostic tool for special indications in oral and maxillofacial surgery. We describe a new MRI technique that presents images in a panoramic view analogous to orthopantomography. This technique is based on three-dimensional T1- and T2-weighted sequences. The familiar panoramic view in MRI provides better orientation and makes diagnosis faster and easier. However, the acquisition time is long (6-12 min per sequence), with a correspondingly high risk of motion artifacts. Moreover, the final workup is also time-consuming. These restrictions could be overcome by progress in hardware and software. There are promising indications for dental MRI.

[Interdisciplinary diagnosis and therapy of traumatic optic nerve damage]. / Interdisziplinäre Diagnostik und Therapie der traumatischen Sehnervenschädigung.

Traumatic optic nerve lesions (TONL) still pose a large clinical problem concerning early detection and treatment. Neuro-ophthalmology provides reliable tests to detect afferent lesions but these methods are limited to just 30% of the severely injured patients. Especially in the patient with multiple injuries, optic nerve injuries are hardly predictable. In the latter group we established well-known neurophysiological methods for early detection of afferent disorders of the visual pathway, i.e. flash-VEP ERG. Apart from these diagnostic problems of TONL, controversy still surrounds the appropriate treatment of TONL--whether conservative or surgical or even combined treatment should be advocated. Our aim was to establish a reliable diagnostic schedule, based on the combination of neuro-ophthalmological, spiral-CT and clinical findings, and a treatment plan, so that in any patient there is a distinct guideline as to whether there is a need for early treatment of the peripheral visual pathway or not. In 52 patients who were assessed by the above-mentioned schedule, we could detect any of the 20 afferent disorders of the peripheral visual pathway. Although it is difficult to prove therapeutic effects on the injured optic nerve, immediate combined conservative treatment plus optic nerve decompression helped in three patients, who reported unilaterally no light-perception at admission, to regain at least partial recovery of afferent function of the visual pathway. Most of the trauma units still handle the problem of optic nerve trauma with a 'wait and see' policy. This is not regarded as an up-to-date option, since there are alternatives, and these will be outlined.

Facial trauma in children and adolescents.

Most studies on facial trauma in the pediatric age group focus on special subgroups. This investigation encompasses all traumatic facial injuries, minor and major, of children and adolescents. Epidemiological data of the type and pattern of injury of trauma patients less than 19 years of age, treated during a 3-year-period in a large metropolitan trauma centre were reevaluated. Of the 1385 patients, 68% had soft tissue injuries, 24% had dental trauma, and 8% fractures of facial bones. More than 90% suffered from minimal or minor trauma. The leading cause of injury was a fall, predominantly at the toddler stage. In adolescents an adult mechanism of trauma prevailed: over 60% of injuries were sequelae of an assault or altercation. The male sex predominated through all age groups and for all types of injuries. The bulk of soft tissue injuries are located within a small falling zone, extending from the nose to the mental area. There was a rising incidence of fractures of facial bones towards older age groups, mandibular fractures being the most common. Condylar fractures, with their potential impact on further growth of the mandible, are seen frequently in children and adolescents, making up 80% of the fractures of the lower jaw.

[A new diagnostic schedule and reliable treatment plan for traumatic optic nerve lesions]. / Interdisziplinäre Diagnostik und Therapie der traumatischen Sehnervenschädigung*

Traumatic optic nerve lesions (TONL) still pose a large clinical problem concerning early detection and treatment. Neuro-ophthalmology provides reliable tests to detect afferent lesions but these methods are limited to just 30% of the severely injured patients. Especially in the patient with multiple injuries, optic nerve injuries are hardly predictable. In the latter group we established well-known neurophysiological methods for early detection of afferent disorders of the visual pathway, i.e. flash-VEP ERG. Apart from these diagnostic problems of TONL, controversy still surrounds the appropriate treatment of TONL - whether conservative or surgical or even combined treatment should be advocated. Our aim was to establish a reliable diagnostic schedule, based on the combination of neuro-ophthalmological, spiral-CT and clinical findings, and a treatment plan, so that in any patient there is a distinct guideline as to whether there is a need for early treatment of the peripheral visual pathway or not. In 52 patients who were assessed by the above-mentioned schedule, we could detect any of the 20 afferent disorders of the peripheral visual pathway. Although it is difficult to prove therapeutic effects on the injured optic nerve, immediate combined conservative treatment plus optic nerve decompression helped in three patients, who reported unilaterally no light-perception at admission, to regain at least partial recovery of afferent function of the visual pathway. Most of the trauma units still handle the problem of optic nerve trauma with a 'wait and see' policy. This is not regarded as an up-to-date option, since there are alternatives, and these will be outlined.

Caries prevalence and treatment needs of 7- to 10-year-old schoolchildren in southwestern Germany.

The caries status of 1784 children aged 7 to 10 years was examined in a cross-sectional, epidemiological study in the Rhine-Neckar-District. Results showed that 30.5% of the children had caries-free primary and 65.2% had caries-free permanent teeth. The d(m)ft index was 2.68, and the D(M)FT averaged 0.76. As in previous studies, a high risk caries group was found, with 10% of all children showing more than 50% of all carious and filled teeth in the permanent dentition. Overall, 45.6% of the children's primary teeth and 16.3% of their permanent teeth needed treatment. As indicated by higher dt:ft (DT:FT) ratios in younger age groups, dentists preferred treating older children. Apart from a higher caries prevalence in primary teeth in males, no significant sex differences were found. Children of rural origin had a higher caries experience. The results confirm previous data showing considerable improvements with a declining caries experience in the young population. But the caries status of German pre-teenage children is still moderately high according to WHO criteria. For further improvements, considerable efforts have to be made with special emphasis on prevention in high risk caries groups.

[Aggressive growth of hemangiopericytoma in the area of the facial skull]. / Aggressiv wachsendes Hämangioperizytom im Bereich des Gesichtsschädels.

Hemangiopericytoma is a rare tumor that originates from the pericytes. Only histology permits a reliable diagnosis. There are no known parameters to predict the biological behavior of the tumor, so every hemangiopericytoma has to be treated as potentially malignant. No age or gender prevalence of this tumor in the region of the head neck has yet been observed. Hemangiopericytoma should be treated by radical surgery; chemotherapy or radiation should be reserved for incompletely removed or metastatic tumors. Metastasis and recurrences have been described even decades after first tumor treatment, so that all patients should undergo life-long follow-up. As an example for a fulminant course of a malignant hemangiopericytoma (G3) we present the case of a 24-year-old female patient who initially presented nonspecific symptoms, was diagnosed late, and eventually died of her tumor despite chemotherapy and surgical treatment.

[Clinical and experimental study of traumatic optic nerve damage]. / Klinische und experimentelle Untersuchung zur traumatischen Sehnervenschädigung.

BACKGROUND: Traumatic optic nerve lesions (TONL) range from temporary affection of vision to avulsion of the optic nerve; often they are associated with more complex injuries. Usually Tonl are not regarded as an emergency. Up to now, we lack knowledge on the dependency of strength and duration of optic nerve lesions and the point of no return for afferent disorders of the visual pathway. MATERIALS AND METHODS: We performed a prospective study on 50 patients with severe midface and skullbase fractures in order to find characteristic ophthalmological, computer tomographic und electrophysiological findings as indicators of TONL, independent of patient cooperation. We used an animal model (Wistar rats; n = 117) to study calibrated optic nerve lesions and the resulting neurodegeneration in the retinal ganglion cell (RGC) layer quantitatively. RESULTS: The electrophysiological investigation of the visual system (flash VEP/ERG) proved to be highly specific (0.97) and sensitive (1.0) for detecting TONL (n = 18). In the rat model, we could demonstrate a linear relationship between total neuron number reduction and strength and duration of calibrated optic nerve lesion. CONCLUSIONS: Experimental results indicate that optic nerve decompression is useful only within the first hours after TONL to reduce secondary optic nerve lesion. Indication for optic nerve decompression requires early detection of TONL, which is made possible by the combination of flash VEP/ERG.

Pharmacokinetics of cefotiam in plasma, parotid saliva and mixed saliva in healthy adults.

Cefotiam (Spizef; CAS 61622-34-2) at a dose of 2 g was administered intravenously to 10 young, healthy, male volunteers. Multiple simultaneous blood, parotid saliva, and mixed saliva samples were collected for 7 h. The antibiotic assay was carried out by high-pressure liquid chromatography. Significant salivary cefotiam concentrations were found for 2 to 4 h, potentially inhibitory to a wide array of pathogens commonly isolated from the upper aerodigestive tract. Salivary cefotiam concentrations were correlated to plasma levels (p less than 0.01), but saliva/plasma ratios varied considerably. It is unlikely that passive diffusion is the applicable transfer mechanism for cefotiam secretion into saliva.

[Excretion of beta-lactam antibiotics in human parotid saliva]. / Ausscheidung von beta-Lactamantibiotika im menschlichen Parotisspeichel.

We investigated the penetration of beta-lactam antibiotics into parotid saliva after intravenous administration. Neither mezlocillin nor oxacillin could be detected in parotid saliva, but cefotaxime (CTX) and cefotiam (CTM) penetrated parotid saliva very well. While salivary CTM concentrations reached peak values (9.52 +/- 3.4 mg/l) within 30 min of the end of infusion, the highest CTX concentrations in parotid saliva (5.84 +/- 2.6 mg/l) were observed after 90 min. After 300 min the salivary CTM levels were below the limit of detection, while the mean CTX concentration even 360 min after the end of infusion was 2.27 +/- 1.23 mg/l. Both CTX and CTM achieve salivary concentrations that are inhibitory against the prevailing pathogens causing suppurative parotitis, and thus promise to be effective for the treatment of this disease. Furthermore, the excretion of comparatively high concentrations of both drugs into the mouth achieves a selective decontamination of the mucosal surfaces of the upper aerodigestive tract so that they are suitable for perioperative prophylaxis in head and neck surgery.