Of guinea pigs and men--an unusual case of jaundice.

A 21-year-old male presented at the emergency room with jaundice, itching, dry cough, malaise and weight loss of 10 kg during the preceding four weeks. Eighteen months earlier, the patient had suffered an automobile accident leading to polytrauma. Serological markers for viral or other causes of hepatitis were absent. For suspected secondary sclerosing cholangitis, ultrasound and ERCP were performed but failed to reveal pathological findings. A liver biopsy showed cholestatic liver disease without signs of portal field-associated hepatitis. Hepato-biliary scintigraphy demonstrated hepatocellular dysfunction. The patient finally mentioned his guinea pig farm with around 50 animals, 20 of which had recently died for unknown reasons. The patient and three of his guinea pigs were subsequently tested for serological evidence of leptospirosis. IgG and IgM antibodies reacting with Leptospira interrogans were detected in the patient's serum, and all 3 guinea pigs were serologically positive for serovar Bratislava. Bacterial culture was not successful, and also PCR tests remained negative. The clinical symptoms quickly resolved after the initiation of antibiotic therapy with amoxicillin.

Internet-capable publication database system.

Scientific databases are generally accessible to the public via the Internet. Reports of most peer-reviewed (quotable) research is thus available to researchers and others. However, other reports and information of interest to researchers and teachers such as poster presentations at congresses, articles describing techniques and teaching material, and details of vocational and continuing education courses (nonquotable literature) generally do not appear in such databases. This nonquotable literature is often of great use to teachers. A project was therefore initiated at the Münster Dental Clinic which aimed to address the problem by developing a database of all publications and other printed material produced by the staff (faculty). After a systematic search, all such publications (quotable and nonquotable) were entered in the database which is partially accessible via the Internet and fully accessible via the Münster Dental Clinic's Intranet. The complete list can be found in the protected Intranet areas, which can be accessed by all the Dental Clinic's staff members. The database also permits Münster Clinic staff to access the Internet and locate those publications that are on the Internet by year of publication and topic.

Combined space management through Delaire/Joos osteotomy and postoperative orthodontic treatment. A retrospective longitudinal study.

The diagnostic records of all patients who had undergone Delaire/Joos osteotomy with mandibular setback at the Muenster University Hospital (period 1995-2000, n=22) were used for space management evaluation in the context of combined surgical-orthodontic treatment.Twenty-eight dental spaces were present prior to the start of treatment and 14 were created by extracting teeth as a pretreatment measure. In two patients, unilateral setback was performed according to Obwegeser/Dal Pont. Thus, 42 tooth-bounded spaces were present at the time of Delaire/Joos osteotomy with mandibular setback, most of them in the first molar region, followed by the second premolar region. A significant space reduction was achieved by the surgical intervention, but not by the subsequent orthodontic treatment. The best results with respect to complete space closure by orthognathic surgery/orthodontic treatment without the need for subsequent prosthetic rehabilitation were recorded in the second premolar region. In the absence of spaces and with a similar long-term prognosis for all potentially extractable teeth and adequate space for the necessary surgical repositioning, the second premolars should therefore be regarded as the 'extraction teeth of choice' for mandibular setback within the context of Delaire/Joos osteotomy.

Polymorphisms of the carcinogen detoxifying UDP-glucuronosyltransferase UGT1A7 in proximal digestive tract cancer.

Cancer of the proximal digestive tract is associated with tobacco smoke and ethanol exposure. The UDP-glucuronosyltransferase (UGT) 1A7 is a detoxifying enzyme capable of tobacco-borne carcinogen detoxification and cellular protection and has been implicated as a cancer risk gene. In this study, UGT1A7 expression is demonstrated in oral, esophageal, and gastric tissue, which are the principle sites of proximal digestive tract cancer. Genomic DNA from the blood of 76 patients with esophageal, orolaryngeal and gastric cancer as well as from 210 healthy blood donors was analysed for the presence of UGT1A7 polymorphisms by sequencing and temperature gradient gel electrophoresis. Wild type UGT1A7 alleles were equally distributed between controls (19 %) and cancer patients (22 %). However, the UGT1A7*3 allele combining W208R, N129K and R131K missense mutations and exhibiting substantially reduced carcinogen detoxification activity was significantly associated with proximal gastrointestinal cancer and identified as a risk allele present in 32 % of cancer patients and 19 % of controls (P = 0.0008, OR 2,02 (95 %-CI 1.33-3.07)). We identify the significant association of the UGT1A7*3 allele encoding a low catalytic activity protein as a risk gene in proximal digestive tract cancer and as a potential marker for cancer susceptibility.

Technical implementation of an Internet address database with online maintenance module.

The article describes the technical implementation and management of the Internet address database of the center for ZMK (University of Münster, Dental School) Münster, which is integrated in the "ZMK-Web" website. The editorially maintained system guarantees its topicality primarily due to the electronically organized division of work with the aid of an online maintenance module programmed in JavaScript/PHP, as well as a database-related feedback function for the visitor to the website through configuration-independent direct mail windows programmed in JavaScript/PHP.

Piloting a digital event manager in the Intranet of a department of orthodontics.

The present article describes the development and piloting of an Internet-accessible, database-supported event management system at the University of Münster orthodontic clinic. As an important component of the quality management of the clinic, the database centralizes appointments and events and displays these transparently and clearly in the form of a HTML-GUI (= HTML Graphical User Interface) in the local Intranet. The event overviews are also accessible in the global Internet arranged in tabular form with password protection.

Genetic link of hepatocellular carcinoma with polymorphisms of the UDP-glucuronosyltransferase UGT1A7 gene.

BACKGROUND & AIMS: Hepatocellular carcinoma is associated with risk factors including hepatitis C, hepatitis B, cirrhosis, genetic liver diseases, and environmental carcinogens. Uridine 5'-diphosphate-glucuronosyltransferases are a superfamily of detoxifying enzymes capable of tobacco-borne carcinogen detoxification and cellular protection. This study examines the association of UGT1A7 and UGT1A9 gene polymorphisms with hepatocellular carcinoma. METHODS: Genomic DNA from the blood of 59 patients with hepatocellular carcinoma and 70 control subjects without evidence of cancer was analyzed by UGT1A7- and UGT1A9-specific PCR, sequencing analysis, and temperature gradient gel electrophoresis. RESULTS: Three UGT1A7 missense mutations were detected defining the UGT1A7*2, UGT1A7*3, and UGT1A7*4 alleles. Wild-type UGT1A7 alleles were present in 41.4% of controls but only in 6.8% of cancer patients (P < 0.001; odds ratio [OR], 9.73; 95% confidence interval [CI], 3.17-29.83). UGT1A7 polymorphisms were present in 93.2% of hepatocellular cancer patients, 74.5% carried the UGT1A7*3 allele (P < 0.001; OR, 10.76; 95% CI, 4.75-24.38), which combines the W208R, N129K, and R131K mutations and encodes a protein with low carcinogen detoxification activity. No UGT1A9 polymorphisms were detected. CONCLUSIONS: The significant association of hepatocellular carcinoma with the UGT1A7*3 allele encoding a low detoxification activity protein is identified and implicates UGT1A7 as a risk gene of hepatocarcinogenesis in addition to a role as potential marker for cancer risk assessment in chronic liver disease.

[Planning orthodontic surgery with the Hexapod system]. / Planung orthognather Chirurgie mit dem Hexapod.

Treatment of maxillofacial dysgnathia using a combined surgical/orthodontic approach requires careful orthodontic and orthognathic diagnosis and treatment planning. In the present study, a system enabling on-line presentation of the necessary displacements of the jaw during surgery, while improving the accuracy of the planning, is described. Using the hexapod principle, it is possible to plan operations with six degrees of freedom and to measure the three-dimensional movements of jaws and jaw segments within the planning stage. Routinely prepared casts are employed for simulation of the operation. The displacements of the jaw are presented in a manner familiar to the orthodontic surgeon, namely in a surgical record. The accuracy achieved with the hexapod is superior to that achievable intra-operatively.

Prospective study on the reproducibility of cephalometric landmarks on conventional and digital lateral headfilms.

The introduction of digital X-ray techniques offered a variety of new possibilities for digital image enhancement and exposure reduction. In order to compare the reproducibility of cephalometric landmarks on conventional and digital lateral headfilms 100 digital and 100 conventional lateral headfilms of patients attending our clinic were randomly selected. The digital cephalograms were obtained using storage phosphor plates in standard X-ray cassettes. All X-rays had been taken at 77 kV. For the digital images the mAs settings for conventional images minus 4 mAs were used. Two orthodontists traced each X-ray twice (21 reference points) at an interval of at least 1 week. The tracings were superimposed and the distances between the tracings of identical reference points were registered. The average reproducibility of cephalometric landmarks was significantly higher on the digitally obtained images, despite a reduction of radiation exposure of 23.7% in the digital images.

Three-dimensional magnetic resonance imaging of the orbit in craniofacial malformations and trauma.

Craniofacial malformations and trauma often lead to changes in orbital soft tissues, requiring surgical correction of both hard and soft tissues. Computed tomographic scans and 3-dimensional reconstructions are the optimal tools for evaluation of the bony structures. However, there is no equivalent method for the orbital soft tissues. The aim of this study was to establish a 3-dimensional magnetic resonance imaging (3-D MRI) technique that allows a differentiated visualization of the different types of soft tissue in the orbit. A total of 8 patients with different pathologic conditions of the orbit was examined. Five of these patients underwent secondary correction after trauma, and 3 had craniofacial malformations. The 3-D reconstruction was performed in the volume-rendering technique after acquisition of 3-mm axial slices. It was shown that a differentiated visualization of the orbital soft tissues is possible. Although the thin bony structures have a weak signal and, therefore, the imaging is poor, reliable reconstruction of the globe was achieved by different radiologists because of its circular delimitation from the bone. This technique is an additional support in the planning of orbital surgery.

An international comparison of early treatment of angle Class-II/1 cases. Skeletal effects of the first phase of a prospective clinical trial.

The University of North Carolina at Chapel Hill has established an extensive randomized trial to evaluate early treatment of Class-II/1 cases. As presented in this part of the study, a German treatment group was selected in parallel, based on identical prospective criteria, in the context of international cooperation with the Westfälische Wilhelms-Universität, Münster. One essential aspect of this study is the degree to which initially comparable groups can be established by careful alignment of selection criteria and of compilation and analysis of diagnostic records. Nine skeletal analysis parameters initially indicated that it is possible to select very similar though not absolutely identical groups in the context of international cooperation. The further results of the initial 15-month phase comprising functional orthodontic treatment in severe Class-II/1 cases showed significant mandibular effects in both treatment groups (USA UNC, Chapel Hill: modified Balters appliance; Germany WWU Münster: U-bow activator Type I). The groups were compared to a randomized control group with similar untreated malocclusions, established at Chapel Hill (USA, UNC, Chapel Hill). The results of this cooperative study reveal opportunities for critical evaluation of different treatment methods through international cooperation, utilizing existing prospective randomized studies.

Short-term and long-term results after early treatment with the Castillo Morales stimulating plate. A longitudinal study.

The present study is divided into 2 parts: The first explains the concept of stimulating plate therapy at the Muenster Clinic and the second presents a longitudinal study of mouth and tongue posture in trisomy 21 children treated with this concept. 47 children underwent a pre-treatment examination (Rec1), and 38 attended a first follow-up examination (Rec2) after an average of 4 months of stimulating plate treatment. The second follow-up examination (Rec3) was on average 53 months after the end of treatment and covered 18 patients. Data acquisition was based on standardized parent questionnaires and standardized clinical examination records. Rec2 showed in part a highly significant improvement in orofacial appearance. These results were confirmed by the parent interview, according to which the mouth and tongue posture improved in 76.3% of the children during the time they were wearing the plate. Even when the plate was not in place, the result remained stable in 65.8% of the patients. Up to Rec3, further improvement was recorded in some results. The symptoms: "mouth mostly wide open" and "tongue mostly protruding way over lips" were reduced. The number of children whose tongue was "mostly in the oral cavity" increased correspondingly. At Rec3, the parents also rated the mouth posture in 88.9% and the tongue posture in 77.7% of the children as stable or further improved.

Articulation in children with Down's syndrome. A pilot study.

The articulation of children with Down's syndrome (trisomie 21, T21) in comparison to a group of age-matched normal probands was investigated in a clinical study, using digital sonagraphics (recording of frequency, amplitude and time of the speech signal), with peripheral factors taken into consideration. The T21-Group (n = 10) revealed a higher variability as well as a longer articulation of the test word "Tasse" than the Control Group (n = 10). There was no clear-cut dependence of speed and quality of articulation on all of the peripheral factors evaluated (Angle Class, overbite, oral motor ability, hearing disorder, logopedics, Castillo-Morales stimulating plate treatment). The results of our investigation show differing patterns of articulation in T21 children compared with normal probands, using a reproducible method. A clear-cut influence of various influencing peripheral factors as reported in the literature could not be found for the T21-Group. Thus, central factors seem to have a great impact on articulation in T21 patients.

Computer-aided axiography of asymptomatic individuals with Class II/2.

UNLABELLED: The condylar axiographic tracings of 23 asymptomatic adult volunteers (Helkimo-index DiO) with Class II/2 axiography relationships were compared to tracings of an analogous group (DiO; n = 30) with normal occlusion. The obtained measurements were evaluated statistically and discussed with respect to possible recording errors. RESULTS: The open-close movement proceeded uncharacteristically, differences existed only in protrusion, mediotrusion and their combined rotation component. In Class II/2 cases an approximately 7 degrees higher angle of the condylar path inclination (CPI) was measured. The Class II/2 group rotated to a significantly higher angle in protrusive and mediotrusive movements and showed longer condylar path lengths than the control group. Another significant difference was found in the location of maximum CPI values and maximum rotation angles within the condylar path, because in no case was isolated rotation or translation of the hinge axis observed. CONCLUSION: The temporomandibular joint of Class II/2 individuals shows a wider range of motion than joints of subjects with normal occlusion. The reduced capacity of motion which was assumed to exist in a so-called hack-bite could not be backed up for Class II/2 deep bite cases. The investigated differences cannot be seen as pathomechanisms, because all participants were clinically free of dysfunction. The neuromuscular engram to overcome the overbite controls a complex spatial motion pattern which cannot be described by a simplified mechanical abstraction of motion in the sagittal plane. The temporomandibular joint with its complex pattern of movement is able to create physiological mechanisms of compensation to react to different dental and skeletal features.

Computer-aided automated landmarking of cephalograms.

The computer-aided method presented is able to interpret and measure radiological structures automatically and reproducibly on a large number of randomly selected lateral head films of different film quality. For example the hard and soft tissue expression of the profile is used to discuss method, application and disadvantages. The performance of the system depends on image quality. The algorithm cannot be influenced by opacifications due to metal structure. In 90% of all cases the contours are identified correctly. Even if the image quality is poor, the recognition rate is about 84%. The selected cephalometric landmarks are placed in the right way in 85% of all cases. The constraint mathematical conditions and the high reproducibility improve the quality process of the cephalometric analysis. Recognition rates of 84% to 90% justify even nowadays the routine use of semi-automatic systems in PC-based analysis. With advancing digital radiography and improved computer performance, image interpreting systems will certainly become established.

[A prefabricated, calibrated double-base procedure--KDMMS. For the simulation and 3-dimensional planning using an articulator in orthognathic surgery]. / Le procédé de double socle calibré préfabriqué--KDMMS. Pour simulation et planification tridimensionnelle dans l'articulateur en chirurgie orthognathique.

A tight cooperation between the orthodontist and oral surgeon is a key factor for success in orthognathic surgery. The quality of the final result is determined a great deal by the pre-operative model-surgery. The KDMMS is a planning tool which allows, even in the most complex cases, accurate and quick model-surgery. The two main components of the KDMMS are the double base plates and the model positioning system, which resemble a "fixation extérieure". The double base plates enable the operator to reproduce the original, pre-operative situation at all times. This allows multiple set-ups for one case, three dimensional measurement and positioning of models with occlusal control can be achieved by use of the positioning system. Especially, in complex surgery cases, the KDMMS is an effective aid in three dimensional planning of orthognathic surgery.

Effects of the Castillo-Morales stimulating plate on speech development of children with Down's syndrome. A retrospective study.

Within the scope of a follow-up examination, the speech development of 2 different groups of children with trisomy 21 was compared. The patient group (n = 20) was treated with a Castillo-Morales stimulating plate in early childhood (average treatment time = 10.8 months, average age at follow-up examination: 55 months). The control group (average age 47.4 months) comprised 18 children with Down's syndrome who had ceased stimulating plate treatment after one month or had received no treatment because, although treatment proved in retrospect to be indicated, parents were not adequately informed. Two specially developed standardized forms were used, one to document parents' concepts of speech development, and the other to record relevant medical data. Other factors evaluated included motoricitiy and hearing ability, which also have an effect on speech. Follow-up examination revealed that the patient group had better results concerning oral motoricity than the control group. Within the patient group, mouth and tongue position improved in 75% of the patients compared with the first examination. Despite a poorer average general somatic development and hearing ability, the patient group had a faster speech development than the control group with respect to 1-, 2- and multi-word sentences. We therefore believe that treatment with the Castillo-Morales stimulating plate has a positive effect at least on initial speech development due to long-term improvement of peripheral conditions in the orofacial region. Thus, not only improved oral motoricity but also earlier speech development can be interpreted as a positive social factor.

The extent of enamel surface fractures. A quantitative comparison of thermally debonded ceramic and mechanically debonded metal brackets by energy dispersive micro- and image-analysis.

This clinical study investigated the practical value of two methods for debonding brackets attached by the adhesive Concise to acid-etched enamel surfaces. Forty-two Ultratrimm Standard metal brackets and 42 Fascination ceramic brackets were collected from juvenile patients undergoing orthodontic treatment. All metal brackets were mechanically debonded by a conventional bracket removal plier, whereas the ceramic brackets were thermally debonded by a commercial Dentaurum ceramic debonding unit. All brackets were evaluated by scanning electron microscopy for the morphology of their adhesive fracture surfaces and for the occurrence of mineral-like particles attached to the adhesive fracture surfaces. These particles were analysed by an energy dispersive X-ray microprobe for their Ca/P ratios and by image analysis of scanning electron micrographs for measurement of their areas. The scanning electron micrographs showed 4 types of debonding fractures. The most frequent fracture was type 1 (between adhesive and bracket base) and type 2 (between adhesive and enamel surface). In the group of mechanically debonded metal brackets type 1 (38 per cent) and type 2 (45 per cent) showed a similar frequency, whereas thermally debonded ceramic brackets predominantly showed fracture type 1 (79 per cent) and only a minor percentage of type 2 (11 per cent). A statistical evaluation was applied to estimate the range of reproducibility of fracture types with a 95 per cent confidence interval (level of significance alpha = 5 per cent). In both groups the microprobe analysis of fracture surfaces lying completely or partly between adhesive and enamel surface identified the mineral-like particles as enamel mineral. They occurred partly as single particles (range of thickness: 5-25 microns, mean area: 3500 microns2) and partly as a coherent covering with a total area of 1.9-5.8 mm2. It is concluded that the thermodebonding technique is superior to conventional mechanical debonding, because the frequent occurrence of fracture type 1 after thermodebonding affords a protection for the enamel surface, whereas mechanical debonding entails a comparatively high risk of enamel fractures.