Stable fixation with absorbable sutures in craniofacial surgery.

The present study analyses the exclusive use of absorbable suture material (Vicryl(®), Ethicon, Germany) in the fixation of transposed bone segments in craniofacial surgery without modification of the osteotomy design. Among 129 children up to 24 months of age, osteosynthesis was conducted exclusively with Vicryl(®) sutures. The stability of postoperative results was evaluated and possible foreign body reactions were examined within the framework of clinical and radiological routine checks. All examined children exhibited stable postoperative conditions while the length of hospital stay was not affected. X-ray examinations of the skull in two planes demonstrated good bony union in all cases. Relevant foreign body reactions were not observed. The exclusive application of absorbable suture material enables stable and cost effective osteosynthesis. Significant foreign body reactions were not observed. The exclusive use of absorbable sutures did not alter the osteotomy design.

Osteoblasts with impaired spreading capacity benefit from the positive charges of plasma polymerised allylamine.

Bone diseases such as osteoporosis, osteoarthritis and rheumatoid arthritis, impinge on the performance of orthopaedic implants by impairing bone regeneration. For this reason, the development of effective surface modifications supporting the ingrowth of implants in morbid bone tissue is essential. Our study is designed to elucidate if cells with restricted cell-function limiting adhesion processes benefit from plasma polymer deposition on titanium. We used the actin filament disrupting agent cytochalasin D (CD) as an experimental model for cells with impaired actin cytoskeleton. Indeed, the cell's capacity to adhere and spread was drastically reduced due to shortened actin filaments and vinculin contacts that were smaller. The coating of titanium with a positively charged nanolayer of plasma polymerised allylamine (PPAAm) abrogated these disadvantages in cell adhesion and the CD-treated osteoblasts were able to spread significantly. Interestingly, PPAAm increased spreading by causing enhanced vinculin number and contact length, but without significantly reorganising actin filaments. PPAAm with the monomer allylamine was deposited in a microwave-excited low-pressure plasma-processing reactor. Cell physiology was monitored by flow cytometry and confocal laser scanning microscopy, and the length and number of actin filaments was quantified by mathematical image processing. We showed that biomaterial surface modification with PPAAm could be beneficial even for osteoblasts with impaired cytoskeleton components. These insights into in vitro conditions may be used for the evaluation of future strategies to design implants for morbid bone tissue.

Head orthesis therapy in infants with unilateral positional plagiocephaly: an interdisciplinary approach to broadening the range of orthodontic treatment.

OBJECTIVE: Unilateral positional plagiocephaly is the most common deformity of the head in infants. As part of a prospective controlled clinical study, the pathomorphology of the positional plagiocephaly in early infancy was examined. The goal was to use noninvasive three-dimensional (3D) imaging to generate, for the first time ever, a standard database of infants without head deformities, to quantify the asymmetry of the positional plagiocephaly, and to evaluate the effectiveness of functional growth control using head orthesis. PATIENTS AND METHODS: In the present study, 3D soft-tissue data of the entire head were collected from a total of 40 infants: 20 with positional plagiocephaly (6.0 ± 0.97 months) and 20 infants without a head deformity (6.4 ± 0.3 months). Functional growth was controlled using a custom-made head orthesis. To evaluate the therapy, pre- and posttherapeutic scans were evaluated in three dimensions. RESULTS: Compared with the control group, infants with positional plagiocephaly demonstrated a reduced maximum length of the head, an increased head height, a shift in the ear axis as well as asymmetric anterior and posterior volumes of the neurocranium in lateral comparisons. Therapy using head orthesis led to a significant improvement of the asymmetry, with a reduction of the diagonal difference and an adjustment of the posterior volumes. CONCLUSION: Conservative growth control of extrinsically deformed infant skulls represents an interdisciplinary medical expansion of the orthodontic therapeutic spectrum. To prevent potential effects of positional plagiocephaly on the viscerocranium, head orthesis therapy is advisable in infancy.

[Criminal behavior and police records: self-reports from elderly individuals]. / Kriminelles Verhalten und polizeiliche Registrierung: Selbstberichte von Menschen im höheren Lebensalter.

As a consequence of demographic changes the crime rates of our society are increasingly influenced by the behavior of older age groups in the population. Hence, both the description and explanation of crime at advanced ages are gaining in importance. As almost no relevant self-report data are available, a regionally representative mail survey among 49 to 81-years-olds was conducted which gathered self-reports on criminal behavior, potentially explanatory variables and previous police records. Almost 50% of respondents reported that they had committed at least 1 out of 14 types of offences at least once since turning 50 years old. Younger cohorts were noticeably more crime prone than older ones, both at the present and in the past. Out of all offences asked about, driving under the influence of alcohol (DUI) was the primary behavior that showed up among the respondents. Apart from the DUI offence crime committed by the elderly is mainly characterized by fraud and property crimes in situations of everyday life by people who are well integrated and economically secure. Main predictors of criminal behavior at advanced ages are the individual sex and social learning mechanisms. The vast majority of people who have been repeatedly recorded by the police throughout their lives perpetuate criminal activities until higher ages. The proportion of offenders whose first police record took place after their 50(th) birthday is 56% which is much lower than estimates derived from official crime data.

[Antimicrobial resistance of Staphylococcus aureus and coagulase negative staphylococci isolated from mastitis milk samples from sheep and goats]. / Antibiotikaresistenz von Staphylococcus aureus und Koagulase-negativen Staphylokokken isoliert aus Mastitismilchproben von Schafen und Ziegen.

Staphylococcus aureus and coagulase negative staphylococci (CNS) were isolated from ovine and caprine mastitis milk samples originating from more than 40 Swiss farms. CNS dominated as causal microorganisms of mastitis in small ruminants. By restriction fragment length polymorphism (RFLP) analysis of the groEL gene and sequencing of 16S rDNA, various CNS species were identified, albeit certain of them predominated. For susceptibility testing of mastitis pathogens to selected antibiotics, minimal inhibitory concentrations were determined. Of the 67 S. aureus and 208 CNS strains, 31.3 % and 8.2 % were resistant to penicillin, 29.9 % and 1.0 % to ampicillin, 1.5 % and 10.6 % to erythromycin, and 3.0 % and 7.7 % to tetracycline, respectively. Moreover, 10 CNS strains (4.8 %) were resistant to oxacillin and one CNS strain to sulfamethoxazole/trimethoprim. The results obtained describe for the first time the resistance situation of mastitis pathogens from sheep and goats in Switzerland. However, accompanying and preventing measures are also of importance in mastitis control of small ruminants.

Cost-effectiveness analysis of a brief intervention delivered to problem drinkers presenting at an inner-city hospital emergency department.

OBJECTIVE: Alcohol screening and brief intervention (SBI) has gained widespread acceptance as an effective method for reducing problem drinking in at-risk populations. This study examines the cost and cost-effectiveness of an SBI pilot program delivered in an inner-city hospital emergency department (ED) to a traditionally underserved population. METHOD: A total of 1,036 subjects were screened for problem drinking during their visit to an ED. Eligible participants (N = 294) were randomly assigned to either a brief intervention group or a control group. As the result of attrition, a final sample of 194 (90 brief intervention; 104 control) participants remained at follow-up. The intervention consisted of a brief counseling session and a health information packet. The control group received only the packet. Intervention cost data were collected and analyzed using the Drug Abuse Treatment Cost Analysis Program. Selected outcomes at the 3-month follow-up included the raw Alcohol Use Disorders Identification Test score, average weekly number of drinks and engaging in heavy drinking in the past month (>6 drinks on one occasion for men, >4 for women). Outcome differences between the intervention and control groups were estimated with both bivariate and multivariate techniques. RESULTS: The average economic cost of the brief intervention was dollars 632 per subject, of which screening (dollars 497) was the largest component. In all cases, intervention subjects had better 3-month outcomes than control subjects, but the differences were not always statistically significant. Cost-effectiveness ratios were relatively small for all three outcomes, suggesting this type of intervention has the potential to be cost-effective under full implementation. CONCLUSIONS: The preliminary results demonstrate the potential advantage of further research in this area with larger samples and a longer follow-up period.

Effect of obesity and site of surgery on perioperative lung volumes.

BACKGROUND: Although obese patients are thought to be susceptible to postoperative pulmonary complications, there are only limited data on the relationship between obesity and lung volumes after surgery. We studied how surgery and obesity affect lung volumes measured by spirometry. METHODS: We prospectively studied 161 patients having either breast surgery (Group A, n=80) or lower abdominal laparotomy (Group B, n=81). Premedication and general anaesthesia were standardized. Spirometry was measured with the patient supine, in a 30 degrees head-up position. We measured vital capacity (VC), forced vital capacity, peak expiratory flow and forced expiratory volume in 1 s at preoperative assessment (baseline), after premedication (before induction of anaesthesia) and 10-20 min, 1 h and 3 h after extubation. RESULTS: Baseline spirometric values were all within the normal range. All perioperative values decreased significantly with increasing body mass index (BMI). The greatest reduction of mean VC (expressed as percentage of baseline values) occurred after extubation, and was more marked after laparotomy than after breast surgery (23 (SD 14)% vs 20 (14)%). Considering patients according to BMI (<25, 25-30, >30), VC decreased after surgery by 12 (7)%, 24 (8)% and 40 (10)%, respectively. VC recovered more rapidly in Group A. CONCLUSION: Postoperative reduction in spirometric volumes was related to BMI. Obesity had more effect on VC than the site of surgery.

On the bioisosteric potential of diazines: diazine analogues of the combined thromboxane A2 receptor antagonist and synthetase inhibitor Ridogrel.

In this SAR study the bioisosteric potential of diazines in the field of combined antithrombotic thromboxane A2 synthetase inhibitors and receptor antagonists was investigated. In this context, two series of (E)- and (Z)-omega-[[(aryldiazinylmethylene)amino]oxy]alkanoic acids were synthesized of which pentanoic acid derivatives with a 2-pyrazinyl, 4-pyridazinyl, or 5-pyrimidinyl group were found to exhibit this dual activity, while 4-pyrimidinyl as well as 3-pyridazinyl analogues showed only receptor antagonistic activity and 2-pyrimidinyl congeners were inactive. In the series of diazine analogues of Ridogrel (1), replacement of the 3-pyridyl group by a 2-pyrazinyl, 4-pyridazinyl, or 5-pyrimidinyl moiety led to compounds that inhibit thromboxane A2 synthetase in gel-filtered human platelets comparable to 1 (IC50 of 0.006, 0.016, and 0.039 microM, respectively, versus 0.007 microM). Radioligand-binding studies with [3H]SQ 29,548 in washed human platelets revealed that these diazine analogues block the thromboxane A2 receptor with an IC50 of 11, 6.0, and 1.5 microM, respectively. This compares well with the IC50 = 1.7 microM of 1. Finally, testing of inhibition of collagen-induced platelet aggregation in human platelet aggregation in human platelet-rich plasma with 2-pyrazinyl, 4-pyridazinyl, or 5-pyrimidinyl congeners of Ridogrel indicated that these heteroaromatic moieties may serve as bioisosteric substitutes of a 3-pyridyl group in dual-acting antiplatelet agents.

HDL and plasma phospholipids in coronary artery disease.

Lipid fractions of native plasma and of high-density lipoprotein (HDL) were analyzed, and the clotting times of native platelet-rich and -poor plasma were recorded in patients with coronary artery disease and age-matched control subjects not taking any medication known to alter plasma lipid levels, coagulation, or platelet aggregation. Patients with coronary artery disease had lower HDL cholesterol and particularly HDL phospholipids but elevated HDL triglycerides, plasma triglycerides and diglycerides, and fibrinogen. Plasma lysolecithin was diminished. Accelerated coagulation was observed in native plasma and may be related to these changes in plasma lipids. The HDL content in cholesterol may be less relevant than that in phospholipids, which, because of their amphiphilic properties, may be essential for the removal and transport of hydrophobic cholesterol. The lower lysolecithin levels also suggest diminished esterification of cholesterol and reduced degradation of phospholipids, which may add to the poor lysability of platelet-rich and thus phospholipid-rich thrombi. Coagulation inhibition may be related to HDL phospholipids: in control subjects they correlated directly with clotting times of platelet-rich and -poor plasma and inversely with fibrinogen. In contrast, the enhanced thrombus formation in coronary artery disease may be related to altered HDL and plasma phospholipids, in particular to increased phosphatidylethanolamine. These adverse changes, particularly diminished HDL phospholipids, may result in increased deposition and reduced degradation and transport of lipids from arteriosclerotic lesions and thrombi and may therefore be significant in the development of coronary artery disease.

Motor symptoms similar to parkinsonism in heavy smokers.

The major objective in this study was a comparison of the motor performance of young male smokers and non-smokers. We tested the endurance capacity, maximal isometric strength, speed of whole-body movements, flexibility and balancing ability of 74 smokers and 118 non-smokers. Then we measured the balancing ability, the visual reaction time and the speed of limb movements of non-smokers and heavy smokers depending on the time of abstinence from smoking. The balancing ability of heavy smokers deteriorates in comparison with non-smokers after an abstinence period of 11-120 min by 42% (p < 0.05), and after more than 120 min by 51% (p < 0.01). Heavy smokers had a longer reaction time both after 2 hours of abstinence and after smoking. The speed of limb movements is decreased after not smoking for a brief period compared to non-smokers and clearly improved immediately after smoking. This deterioration of motor performance of heavy smokers after a short period of abstinence appears similar to the motor symptoms of Parkinsonism and is "treated" by cigarette smoking.

Increased lipid binding to thrombi in coronary artery disease. Findings in patients without premedication in native (not anticoagulated) test systems.

Thrombi and clots were produced from native (i.e., not anticoagulated) platelet-rich and platelet-poor plasma from patients with coronary artery disease and control subjects who had not taken any medication known to influence plasma lipids, coagulation, or platelet aggregation. The clotting times were recorded, and the lipid content of clots, thrombi, platelets, plasma, and high density lipoprotein was analyzed. Thrombi produced from native platelet-rich plasma were 46% heavier in coronary artery disease patients and contained about 20% more phospholipids and free cholesterol and about twice the amount of triglycerides and esterified cholesterol in both absolute and relative amounts with respect to the corresponding lipids of plasma plus platelets. The elevated content of lipids not only increases the size of the thrombi but also changes their quality because of an increased content in plasmatic lipids, as platelets contain only trace amounts of triglycerides and cholesterol esters. In agreement herewith, fibrinogen and maximal amplitude on the thrombelastogram were increased in coronary artery disease patients, whereas the thrombus-forming time and clotting times of platelet-poor and platelet-rich plasma were shortened, indicating accelerated coagulation and activation of platelets. Analysis of these results suggests a disturbed interrelation in coronary artery disease between lipids and hemostasis, in which platelets, high density lipoprotein, and lipoproteins rich in triglycerides and cholesterol esters may play a role.

[An idiopathic floating left-ventricular thrombus]. / Idiopathischer flottierender linksventrikulärer Thrombus.

Four weeks after appendicectomy a 28-year-old man developed dragging pains in the left calf. Left popliteal, posterior tibial and dorsalis pedis arteries could not be palpated. Angiography revealed an embolic occlusion of the left superior femoral artery at the level of the adductor canal. Echocardiography demonstrated a pedunculated left ventricular thrombus, 3.5 x 2.0 cm, as a possible source of the embolus. After successful trifurcation embolectomy and saphenous vein patch-plasty acenocoumarol, 4 mg/d and heparin, 3 x 7500 IU/d were administered. Because the thrombus failed to shrink, systemic thrombolysis, initially 750,000 IU streptokinase and 3000 IU heparin i.v., was begun. After five days the thrombus diameter had decreased to 0.7 cm. But because thrombus movement had increased, streptokinase was replaced by 70 IU/d ancrod i.v. The thrombus completely disappeared within two weeks. The patient was symptom-free during the period of anticoagulation with acenocoumarol. Six months later echocardiography confirmed the absence of thrombus in the left ventricle.

Influence of oral contraceptives on coagulation tests in native blood and plasma.

Routine coagulation laboratory tests, clotting times in native (not anticoagulated) whole blood, platelet-rich and platelet-poor plasma, and recalcification times in citrated whole blood, platelet-rich and platelet-poor plasma were performed in 14 healthy premenopausal women. Blood was taken before and after one or two cycles of low-dose oral contraceptives. After oral contraceptives a reduction in clotting time in native platelet-rich plasma and activated partial thromboplastin time were observed. Recalcification times in whole blood and platelet-rich plasma were shorter than clotting times in their native counterparts. The observed changes are compatible with a procoagulant effect seen soon after the start of oral contraceptive use. The absence of these changes in the recalcification times in citrate systems suggests a masking effect of citrate. The reduction in clotting times in native platelet-rich but not in platelet-poor plasma indicates that the hypercoagulability in oral contraceptives users is mainly related to platelets.

[Comparison of various methods of cryopreservation of human pre-embryos]. / Vergleich verschiedener Methoden der Kryokonservierung humaner Prä-Embryonen.

A human egg and embryo freezing program for non-fertilized eggs and spare embryos has been established in our in vitro fertilization clinic. In the following we report on our first experience with different methods of human pre-embryo cryopreservation. In a simple evaluation we have compared different conventional freezing techniques using cryoprotectant substances such as glycerol, DMSO and 1.2 propanediol and an "ultrarapid" technique. So far we have achieved 6 normal ongoing and 2 biochemical pregnancies out of a total number of 61 embryo transfers. This equals 9.8% pregnancy rate per embryo transfer. Two methods seem preferable, i.e. sucrose and 1.2 propandiol which has the highest success rate and the ultrarapid method which gives a good rate of embryo survival on the one hand and a simple handling on the other.