Esthetic evaluation of single-tooth implants in the anterior maxilla following autologous bone augmentation.

OBJECTIVES: Autologous bone augmentation to rebuild compromised alveolar ridge contour prior to implant placement allows for favorable three-dimensional implant positioning to achieve optimum implant esthetics. The aim of the present study was to evaluate peri-implant soft tissue conditions around single-tooth implants following bone grafts in the esthetic zone of the maxilla. MATERIALS AND METHODS: Sixty patients underwent autologous bone augmentation of deficient maxillary sites prior to placement of 85 implants in the esthetic zone. In case of multiple implants per patient, one implant was randomly selected. Objective evaluation of 60 single-tooth implants was performed using the Pink-Esthetic-Score (PES) and Papilla Index (PI) and supplemented by subjective patient evaluation, as well as clinical and radiologic examination. RESULTS: Objective ratings of implant esthetics were satisfactory (median PES: 11, median PI: 2) and significantly correlated with high patient satisfaction (mean VAS score: 80%). Both esthetic indices demonstrated respectable levels of inter- as well as intra-observer agreement. Poor implant esthetics (low PES and PI ratings) were significantly associated with increased anatomic crown height, while no influence of horizontal implant-tooth distance could be found. CONCLUSIONS: The present investigation indicates that favorable esthetic results may be achieved in the augmented anterior maxilla. However, bony reconstruction of compromised alveolar ridges does not guarantee optimum implant esthetics.

Endoscopic submucosal dissection in gastric neoplasia - experience from a European center.

BACKGROUND AND STUDY AIMS: Endoscopic submucosal dissection (ESD) is a promising technique for the resection of early gastric neoplasia. There are only a few data from the Western world to date. METHODS: Over a 7-year-period, 104 gastric lesions were treated with ESD in a European referral center, of which 91 were included in this study. A total of 66 lesions were early gastric cancer (EGC) and 25 were adenomas. Of the EGCs, 11 lesions (16.7 %) fulfilled the guideline criteria (EGC-GC) and 55 lesions (83.3 %) fulfilled the expanded resection criteria (EGC-EC) of the Japanese guidelines for the treatment of gastric cancer. RESULTS: ESD was technically possible in 85 lesions (93.4 %). In six lesions ESD was not possible due to non-lifting. En bloc resection rates for all lesions, ECGs-GC, ECGs-EC, and adenomas were 87.1 %, 100 %, 88.2 %, and 79.2 %, respectively. R0 en bloc resection rates were 74.1 %, 90 %, 68.6 %, and 79.2 %, respectively. Complications were: one perforation during piecemeal endoscopic mucosal resection of a lesion in which ESD was judged to be impossible (1.2 %); three clinically relevant bleedings (3.5 %); one gastric ischemia (1.2 %); and four strictures (4.7 %). No mortality was observed. There were five recurrences after piecemeal resection (50 %) compared with only one after en bloc resection (1.5 %; P < 0.05). The rate of recurrence for EGCs was 5.6 %, and this were seen exclusively after piecemeal resection. CONCLUSIONS: Our data show that ESD is a feasible technique in Europe even in patients with EGC according to the extended criteria. Resection rates are promising and complication rates are acceptable. Results are worse compared with large studies from Japan but still excellent regarding the learning curve of the method. ESD should be offered as the treatment of choice for early gastric neoplasia especially when en bloc resection cannot be performed with other resection techniques.

Distal nerve entrapment following nerve repair.

Failure of nerve repair or poor functional outcome after reconstruction can be influenced by various causes. Besides improper microsurgical technique, fascicular malalignment and unphysiologic tension, we found in our clinical series that a subclinical nerve compression distal to the repair site can seriously impair regeneration. We concluded that the injured nerve, whether from trauma or microsurgical intervention, could be more susceptible to distal entrapment in the regenerative stage because of its disturbed microcirculation, swelling and the increase of regenerating axons followed by increased nerve volume. In two cases we found the regenerating nerve entrapped at pre-existing anatomical sites of narrowing resulting in impaired functional recovery. In both cases the surgical therapy was decompression of the distal entrapped nerve and this was followed by continued regeneration. Thorough clinical and electrophysiologic follow-up is necessary to detect such adverse compression effects and to distinguish between the various causes of failed regeneration. Under certain circumstances primary preventive decompression may be beneficial if performed at the time of nerve coaptation.

[Otoneurologic findings in multiple sclerosis. Stapedius reflex, vestibular evaluation, early acoustic evoked potentials]. / Otoneurologische Befunde bei der Multiplen Sklerose. Stapediusreflex, Vestibularisprüfung, frühe akustisch evozierte Potentiale.

Symptoms such as tinnitus, hearing and taste disorders and facial palsy seldom occur in multiple sclerosis. Although ENT symptoms are few, vestibular and acoustic stapedius reflex tests combined with brainstem auditory evoked potentials (BAEPs) are available, and may give very useful evidence of the existence of MS. 52 patients with definite MS, and 13 patients with probable MS were examined (classified according to the McAlpine criteria). The vestibular and acoustic stapedius reflex tests were abnormal in 51%/61% and 61%/53% respectively of both groups. The corresponding figures for BAEP were 69% and 63%. The combination of the three tests on all patients showed at least one pathological finding.

[Micturition disorders in multiple sclerosis]. / Miktionsstörungen bei Multipler Sklerose.

103 patients with multiple sclerosis (MS) were investigated, of which 53% complained of micturition difficulties. Since these symptoms frequently are the main cause for social withdrawal of the multiple sclerosis patient, the investigation and therapy of micturition dysfunction should play a central role in the management of these patients.

Brain-stem involvement in multiple sclerosis: a comparison between brain-stem auditory evoked potentials and the acoustic stapedius reflex.

Brain-stem auditory evoked potentials (BAEPs) and the acoustic stapedius reflex (ASR) were recorded in 68 patients with definite, probable and possible multiple sclerosis (using the definitions of McAlpine). The high incidence of abnormal results, 68% and 60%, respectively, pointed to the diagnostic value of these two measures in detecting brain-stem dysfunction. Combination of the methods increased the diagnostic yield to 85%. Since in part the same brain-stem generator sites underlie BAEPs and the ASR, it was considered that a study of their correlation might serve to increase the reliability and validity of these techniques. There was 71% agreement overall between results from the two measures. Furthermore, 72% of the joint BAEP and ASR abnormalities corresponded in detection of the brain-stem lesion site. It was concluded that the combined approach may supply powerful, complementary information on brain-stem dysfunction, which may aid in establishing the diagnosis of multiple sclerosis.

Transient global amnesia as a manifestation of Epstein-Barr virus encephalitis.

A 43-year-old man developed severe global amnesia with uncinate fits and a single generalised convulsion 10 days after a febrile infection. CSF pleocytosis and serological findings indicated an acute Epstein-Barr virus encephalitis. All of the symptoms cleared within 2 weeks except for occasional generalised seizures. This seems to be the first observation of Epstein-Barr virus encephalitis presenting predominantly as transient global amnesia.