[Evaluation of individual ceramic implants made of Bioverit with CAD/CAM technology to reconstruct multidimensional craniofacial defects of the human skull]. / Evaluierung individueller, in der CAD/CAM-Technik gefertigter Bioverit-Keramik-Implantate zur Wiederherstellung mehrdimensionaler kraniofazialer Defekte am menschlichen Schädel.

BACKGROUND: Restrictions in the bone structure of the craniomandibular region caused by malformation, traumata or malignant tumours are currently of interest in reconstructive oral and maxillofacial surgery. Methods of autologous bone transplantation are well established for reconstruction of those defects. The reconstruction and remodeling of contour-shaping defects is more difficult due to atrophy and resorption of free-transplantable tissues. Artificially induced harmful effects have been reported on harvesting in the donor area. Further available methods of alloplastic reconstruction are computer-assisted design and manufacturing systems (CAD/CAM). The advantages of individual design and fabrication are obvious in the manufacturing of defect-specific implants. MATERIAL AND METHODS: In the present study the application of individual CAD-based reconstructed bioceramic implants made of Bioverit II was evaluated in the region of the facial skull. Clinical results, patient acceptance and the analysis of the postoperative observation period of 30 months are reviewed. RESULTS: Altogether 25 individual Bioverit ceramics were implanted in the facial region. All patients were satisfied with the aesthetic results of the implantations after primary surgery. Three patients developed a need for further correction during the observation period; one implant fracture was observed. CONCLUSION: Finally, it can be stated that the preoperative expenditures in time, experts, technology and fabrication of individual CAD/CAM planned and manufactured implants are justified by the following advantages: fixed volume, reduced operating time, lack of donor morbidity, easy subsequent treatment of the material and the aesthetic results achieved.

Directly measured mid-depth circulation in the northeastern North Atlantic Ocean.

The circulation of water masses in the northeastern North Atlantic Ocean has a strong influence on global climate owing to the northward transport of warm subtropical water to high latitudes. But the ocean circulation at depths below the reach of satellite observations is difficult to measure, and only recently have comprehensive, direct observations of whole ocean basins been possible. Here we present quantitative maps of the absolute velocities at two levels in the northeastern North Atlantic as obtained from acoustically tracked floats. We find that most of the mean flow transported northward by the Gulf Stream system at the thermocline level (about 600 m depth) remains within the subpolar region, and only relatively little enters the Rockall trough or the Nordic seas. Contrary to previous work, our data indicate that warm, saline water from the Mediterranean Sea reaches the high latitudes through a combination of narrow slope currents and mixing processes. At both depths under investigation, currents cross the Mid-Atlantic Ridge preferentially over deep gaps in the ridge, demonstrating that sea-floor topography can constrain even upper-ocean circulation patterns.

[Tumors of the mouth cavity. Not all fluorescent tumors are malignant]. / Mundhöhlentumoren. Nicht alles was fluoresziert ist bösartig.

Early diagnosis and treatment of malignant tumors of the mouth and throat can greatly improve survival rates. Diagnostic fluorescence permits the reliable detection not only of oral cancer, but also of cancer precursor lesions. A problem here is the fact that although carcinomas can be detected with a high level of sensitivity, our own studies also demonstrate a considerable false-positive rate (35%). Possible reasons for this currently being considered are non-compliance by the patient with the required fasting period, poor mouth hygiene and the state after radiation therapy to the face. Under these circumstances, patient management is of particular importance.

[Experimental 5-aminolevulinic acid-induced photodynamic therapy (ALA-PDT) of oral carcinomas. Procedures in treatment of solid tumors and elucidation of cell death]. / Experimentelle 5-Aminolävulinsäure-induzierte photodynamische Therapie (ALA-PDT) oraler Karzinome. Verfahren zur Behandlung solider Tumoren und Aufklärung des Zelltods.

AIMS: Of our own patients suffering from oral squamous cell carcinoma (OSCC), 96% possessed a 5-aminolevulinic acid (ALA)-induced tumor fluorescence. Consequently, the ALA-induced fluorescence of OSCC is suggested as an ideal tool for selective photodynamic therapy (PDT). The aim of the study was to demonstrate selective tumor damage and to analyze the cell death mode (apoptosis vs. necrosis) of OSCC cells in cell culture and in solid, deeply invasive xenotransplants in immunodeficient nude mice using intratumoral laser illumination. MATERIAL AND METHODS: For ALA-PDT, laser light (635 nm, 0.75 W, 10 min, cooled application system) was used intratumorally as well as in cell culture. The therapeutic response was controlled by histology and immunohistochemistry (Ki-67 index). The apoptosis was evaluated by the TUNEL method and in vitro by flow cytometry. Mutations in the apoptosis-controlling p53 gene were investigated by direct genomic sequencing. RESULTS AND CONCLUSIONS: 1. Although all OSCC exhibited an ALA-induced fluorescence in vivo, the evaluation of the cell lines showed differences in intensity of the ALA-induced fluorescence. This points to a different sensitivity of OSCC for ALA-PDT. 2. The use of a cooled laser light application system allowed intratumoral radiation and treatment of deeply invasive OSCC regions. 3. The cytotoxic effect of ALA-PDT in OSCC is evidenced by a diminution of proliferative activity and necrosis but not by apoptosis. 4. Functional mutations within the p53 gene were considered a possible reason for the absence of apoptosis induction by ALA-PDT.

[Visualizing carcinomas of the mouth cavity by stimulating synthesis of fluorescent protoporphyrin IX]. / Visualisierung von Karzinomen der Mundhöhle durch Stimulierung der Synthese von fluoreszierendem Protoporphyrin IX.

The fluorescence diagnosis based on the aminolavulinic acid-stimulated porphyrin synthesis allows the detection of superficial tumors in a very early stage even when they are very small tumors. A fluorescence diagnosis of tumors in the oral cavity can be simply performed by rinsing with a 0.4% ALA solution for 20 min. This topical application avoids systemic side effects such as skin sensitization. The red fluorescent areas are visible to the naked eye; only a blue light source for fluorescence excitation is necessary and a suitable red filter for observation. In our study on 56 patients suffering from carcinoma of the oral cavity, 96% of the histologically confirmed carcinoma could be visualized via fluorescence. In 3 patients additional tumors were detected via fluorescence that were not visible otherwise. However, many patients show fluorescent areas with no correlation to the histological finding. It was verified that bacteria from the oral cavity also produce PpIX after ALA incubation, which leads to false-positive findings. Reduction of the false-positive findings was achieved by rinsing the oral cavity with hydrogen peroxide and by mechanical plaque reduction. This improves the reliability of a fluorescence-guided biopsy. However, suppression of the bacteria fluorescence is necessary for clinical use of this diagnostic method.

[Maxillary development after early secondary osteoplasty in complete unilateral cheilognathopalatoschisis]. / Die Kieferentwicklung nach früher sekundärer Osteoplastik bei einseitigen totalen Lippen-Kiefer-Gaumenspalten.

The paper presents the retrospective investigation of 99 cleft palate cases with unilateral clefts. The effects of two different lip closures procedure on the development of nasal, labial and maxilla region were investigated. In 50 cases the Le Mesurier lip closure procedure was followed, and in 49 cases the Millard procedure. In the Le Mesurier group a lengthening of lip was observed, while in the Millard group lip length was symmetrical. The cast analysis shows an even development of the anterior maxilla width. The cephalometric analysis also shows a favourable development in the Millard group.

[The effect of hadacidin, ultraviolet irradiation of blood (UVB) and thiamine on the prenatal development of Uje:WIST rats: correlation with the hepatic activity of gamma-glutamyltranspeptidase (GGT)]. / Der Einfluss von Hadacidin, Ultraviolettbestrahlung des Blutes (UVB) und Thiamin auf die pränatale Entwicklung bei Uje: WIST-Ratten: Korrelation zur hepatischen Aktivität der Gamma-Glutamyl-transpeptidase (GGT).

The influence of hadacidin, a model substance for induction of cheilognathouranoschisis in rat fetuses (2,550 mg/kg b.m. at gestation day 12), ultraviolet irradiation (UVB) of blood (1 week before gestation) and thiamine (25 mg/kg b.m. from gestation days 12 to 15) on the prenatal development of rats at the 20th day of gestation was investigated. Using the body mass and the hepatic GGT-activity as parameters. Hadacidin caused a distinct retardation of the fetal somatic development. Partially, the embryotoxic effect was compensated by UVB or thiamine. The combination of both procedures was more effective. There is a good correlation between the maturation grade of fetuses at day 20 of gestation and the hepatic GGT activity.

[Proliferative activity of mesenchyme and epithelium in teratogen- affected palatogenesis]. / Die proliferative Aktivität von Mesenchym und Epithel in der teratogen beeinflussten Palatogenese.

In mesenchymal cells of the palatal shelves there are two maxima with a 3H-thymidine labelling index of more than 30%. In the teratogenically altered palatogenesis there is only one peak in the labelling index one day before horizontalization of the palatal shelves. In the proliferative rate of epithelial cells are no principal differences between normogenesis and teratogen altered palatogenesis.

[Clinics and therapy of the osteomyelitis of the lower jaw]. / Klinik und Therapie der Unterkieferosteomyelitis.

During the last three decades the clinical picture of osteomyelitis has considerably changed. Acute cases have become rarer than in the past. The outbreak of the disease to be observed in recent times is primarily of a subacute chronic stage. These non-characteristic symptoms make diagnosis more difficult. Acute cases of osteomyelitis are treated with antibiotics; chronic cases should surgically be approached as early as possible. Surgical methods used are above all decortication as well as transplantation of autogenous spongiosa.

[Teratogen-modified palatogenesis in the Uje: WIST rat. 4. Scanning electron microscopic morphology of the epithelium during the formation of the secondary palate]. / Die teratogen beeinflusste Palatogenese bei der Uje: WIST-Ratte. 4. Mitteilung: Rasterelektronemikroskopische Morphologie des Epithels während der Bildung des sekundären Gaumens.

In normal morphogenesis age-dependent and regional differences in the surface structure of epithelial cells appear, whereas in teratogenesis no qualitative changes can be observed. During the horizontal adjustment of the palatal shelves the pronounced marking of the cellular borders with microvilli has disappeared. The reduced number of microvilli in the subsequent phase of adhesion might affect the cell-cell identification and thus disturb the further cell differentiation.

[Teratogenically altered palate formation in Uje:WIST rats. 5. Reaction mode of the mesenchyma]. / Die teratogen beeinflusste Palatogenese bei der Uje:WIST-Ratte. 5. Mitteilung: Reaktionsweise des Mesenchyms.

After administration of the teratogen the ability of the mesenchymal cells to synthesize proteoglycans is impaired. In the fusion area of the palatal shelves there is, like in normal development, an increase in lysosomal activity.

Detection of overflow events in the shag rocks passage, scotia ridge.

During an almost yearlong period of observations made with a current meter in the fracture zone between the Falkland Islands (Islas Malvinas) and South Georgia, several overflow events were recorded at a depth of 3000 meters carrying cold bottom water from the Scotia Sea into the Argentine Basin. The outflow bursts of Scotia Sea bottom water, a mixing product of Weddell Sea and eastern Pacific bottom water, were associated with typical speeds of more than 28 centimeters per second toward the northwest and characteristic temperatures below 0.6 degrees C. The maximum 24-hour average speed of 65 centimeters per second, together with a temperature of 0.29 degrees C, was encountered on 14 November 1980 at a water depth of 2973 meters, 35 meters above the sea floor.

[Treatment of juvenile haemiangiomas (author's transl)]. / Die Behandlung der Angiome im Kindesalter.

793 infants and children underwent treatment fort port-wine stains and strawberry naevi. In port-wine stains excision and plastic reconstruction were performed. In strawberry naevi sclerosing was followed by surgery. In rare cases infants and children with giant haemangiomas were treated with glucocorticoids prior to surgery. Radiotherapy of strawberry naevi in the face and neck should be omitted because of the risks involved.