Neurosensory and functional evaluation in distraction osteogenesis of the anterior mandibular alveolar process.

Neurosensory status and craniomandibular function of 19 patients (mean age 35.2 years, range 17.8-58.8 years) treated by combined surgical orthodontic treatment with distraction osteogenesis of the mandibular anterior alveolar process (DO group) was compared with that in 41 orthodontically treated patients (mean age 22.9 years, range 15.1-49.0 years; control group). Clinical examination took place on average 5.9 years (DO group) and 5.4 years (control group) after treatment ended. Neurosensory status was determined by two-point discrimination (2-pd) and the pointed and blunt test. Lateral cephalograms evaluated advancement of the mandibular alveolar process and possible relapse. There was no significant difference in craniomandibular function and neurosensory status between the groups. Age was significantly correlated with 2-pd at the lips (DO: p=0.01, R=0.575; control group: p=0.039, R=0.324) and chin (DO: p=0.029, R=0.501; control group: p=0.008, R=0.410). Younger patients had smaller 2-pd values. Gender, age, the amount of advancement, and relapse at point B or incision inferior show no correlation with craniomandibular function and neurosensory impairment. DO of the mandibular anterior alveolar process is a valuable and safe method with minor side effects regarding neurosensory impairment.

Skeletal and dental stability of segmental distraction of the anterior mandibular alveolar process. A 5.5-year follow-up.

17 patients (14 female; 3 male) were analysed retrospectively for skeletal and dental relapse before distraction osteogenesis (DO) of the mandibular anterior alveolar process at T1 (17.0 days), after DO at T2 (mean 6.5 days), at T3 (mean 24.4 days), at T4 (mean 2.0 years), and at T5 (mean 5.5 years). Lateral cephalograms were traced by hand, digitized, superimposed, and evaluated. Skeletal correction (T5-T1) was mainly achieved through the distraction of the anterior alveolar segment in a rotational manner where the incisors were more proclined. The horizontal backward relapse (T5-T3) measured -0.3mm or 8.3% at point B (non-significant) and -1.8mm or 29.0% at incision inferior (p<0.01). Age, gender, amount and type (rotational vs. translational) of advancement were not correlated with the amount of relapse. High angle patients (NL/ML'; p<0.01) showed significant smaller relapse rates at point B. Overcorrection of the overjet achieved by the distraction could be a reason for dental relapse. Considering the amount of long-term skeletal relapse the DO could be an alternative to bilateral sagittal split osteotomy for mandibular advancement in selected cases.

Soft tissue stability after segmental distraction of the anterior mandibular alveolar process: a 5.5 year follow-up.

Soft tissue changes were analysed retrospectively in 17 patients following distraction osteogenesis (DO) of the mandibular anterior alveolar process. Lateral cephalograms were traced by hand, digitized, superimposed, and evaluated at T1 (17.0 days), after DO at T2 (mean 6.5 days), at T3 (mean 24.4 days), at T4 (mean 2.0 years), and at T5 (mean 5.5 years). Statistical analysis was carried out using Kolmogorov-Smirnov test, paired t-test, Pearson's correlation coefficient, and linear backward regression analysis. 5.5 years postoperatively, the net effect for the soft tissue at point B' was 88% of the advancement at point B while the lower lip (labrale inferior) followed the advancement of incision inferior to 24%. Increased preoperative age was correlated (p<0.05) with more horizontal backward movement (T5-T3) for labrale inferior and pogonion'. Higher NL/ML' angles were significantly correlated (p<0.05) to smaller horizontal soft tissue change at labrale inferior (T5-T3). The amount of advancement at point B was significantly correlated with an upward movement (T5-T3) of labrale inferior (p<0.01) and stomion inferior (p<0.05). It can be concluded that further change in soft tissues occurred between 2.0 and 5.5 years postoperatively. The physiological process of ageing and loss of soft tissue elasticity should be considered as possible reasons.

Skeletal and dental stability of segmental distraction of the anterior mandibular alveolar process. A 2-year follow-up.

33 patients (27 females; 6 males) were retrospectively analysed for skeletal and dental relapse before distraction osteogenesis (DOG) of the mandibular anterior alveolar process at T1 (17.0 days), after DOG at T2 (mean 6.5 days), at T3 (mean 24.4 days), and at T4 (mean 2.0 years). Lateral cephalograms were traced by hand, digitized, superimposed, and evaluated. Skeletal correction (T3-T1) was mainly achieved through the distraction of the anterior alveolar segment in a rotational manner where the incisors were more proclined. The horizontal backward relapse (T4-T3) measured -0.8mm or 19.0% at point B (p<0.001) and -1.6mm or 25.0% at incision inferior (p<0.001). Age, gender, amount and type (rotational versus translational) of advancement were not correlated with the amount of relapse. High angle patients (NL/ML'; p<0.01) and patients with large gonial angle (p<0.05) showed significantly smaller relapse rates at point B. Overcorrection of the overjet achieved by the distraction was seen in a third of the patients and could be a reason for relapse. Considering the amount of skeletal relapse the DOG could be an alternative to bilateral sagittal split osteotomy for mandibular advancement in selected cases.

Soft tissue stability in segmental distraction of the anterior mandibular alveolar process. A 2-year follow-up.

This study evaluated soft tissue changes in adult patients treated with distraction osteogenesis (DOG) of the anterior mandibular alveolar process and related it to different parameters. 33 patients (27 females; 6 males) were analysed retrospectively before surgery at T1 (17.0 days), after surgery at T2 (mean 6.5 days), at T3 (mean 24.4 days), and at T4 (mean 2.0 years). Lateral cephalograms were traced by hand, digitized, superimposed, and evaluated. Statistical analysis was carried out using Kolmogorov-Smirnov test, paired t test, Pearson's correlation coefficient, and linear backward regression analysis. 2 years postoperatively (T4), the net effect of the soft tissue at point B' was 100% of the advancement at point B whilst the lower lip (labrale inferior) followed the advancement of incision inferior to 46%. Increased preoperative age was correlated (p<0.05) with more horizontal backward movement (T4-T3) for labrale superior and pogonion'. Higher NL/ML' angles were significantly correlated (p<0.05) with smaller horizontal soft tissue change at point B'. Gender and the amount of skeletal and dental advancement were not correlated with postoperative soft tissue changes (T4-T3). DOG of the anterior mandibular alveolar process is a valuable alternative for mandibular advancement regarding soft tissue change and predictability.

Prognostic factors affecting long-term outcomes in patients with resected stage IIIA pN2 non-small-cell lung cancer: 5-year follow-up of a phase II study.

The aim was to investigate the efficacy of neoadjuvant docetaxel-cisplatin and identify prognostic factors for outcome in locally advanced stage IIIA (pN2 by mediastinoscopy) non-small-cell lung cancer (NSCLC) patients. In all, 75 patients (from 90 enrolled) underwent tumour resection after three 3-week cycles of docetaxel 85 mg m-2 (day 1) plus cisplatin 40 or 50 mg m-2 (days 1 and 2). Therapy was well tolerated (overall grade 3 toxicity occurred in 48% patients; no grade 4 nonhaematological toxicity was reported), with no observed late toxicities. Median overall survival (OS) and event-free survival (EFS) times were 35 and 15 months, respectively, in the 75 patients who underwent surgery; corresponding figures for all 90 patients enrolled were 28 and 12 months. At 3 years after initiating trial therapy, 27 out of 75 patients (36%) were alive and tumour free. At 5-year follow-up, 60 and 65% of patients had local relapse and distant metastases, respectively. The most common sites of distant metastases were the lung (24%) and brain (17%). Factors associated with OS, EFS and risk of local relapse and distant metastases were complete tumour resection and chemotherapy activity (clinical response, pathologic response, mediastinal downstaging). Neoadjuvant docetaxel-cisplatin was effective and tolerable in stage IIIA pN2 NSCLC, with chemotherapy contributing significantly to outcomes.

[Invasive diagnosis of coronary heart disease in patients over 75 years old]. / Invasive Abklärung der koronaren Herzkrankheit bei über 75-jährigen Patienten.

Between January 1, 1993, and August 31, 1995, 268 patients over 75 years underwent coronary angiography at the University Hospital of Bern. Their clinical reports were analyzed in order to determine whether invasive diagnosis of coronary artery disease (CAD) is justifiable also in the elderly considering risks and complications. The main indication for coronary angiography were symptoms of ischemic heart disease. Twenty-nine underwent the procedure for planned cardiac surgery, mostly valve replacement. In 79% of patients, coronary angiography revealed CAD. In the remaining 21% there were no significant coronary stenoses, but 82% of them had valvular heart disease. Only 4% had neither coronary nor valvular heart disease. Following coronary angiography 63% of patients had a therapeutical intervention: 24% coronary angioplasty (PTCA), 13% bypass-grafting, 17% valve replacement, 8% combined surgery (revascularization and valve-replacement), and 1% another intervention. Four percent had no cardiac disease, 1% died before a planned surgery. The remaining 32% were continued on medical therapy. As indicators of appropriateness and success of the invasive procedure the rates of complications and the duration of hospitalization were analyzed. The incidence of deaths, myocardial infarctions, cerebral complications, and arrhythmias was five to ten times higher for cardiac surgery than for PTCA or conservative treatment. Invasive diagnosis and therapy of CAD in patients over 75 years can nevertheless be reasonable and successful if the decision is taken carefully considering risk factors and concomitant disease.

A simple and fast method for the isolation of basolateral plasma membranes from rat small-intestinal epithelial cells.

A method was developed for the analytical and preparative isolation of basolateral plasma membranes from rat small intestine. They were separated on a self-orientating Percoll (modified colloidal silica) gradient starting with a heavy microsomal-membrane fraction and involving centrifugation at 48,000 g for 1 h. (Na+ + K+)-stimulated ATPase activity, used as a marker enzyme for the basolateral plasma membrane, is enriched 20-fold compared with that found in the homogenate of isolated intestinal epithelial cells.

[Uptake of L-(+)lactate by cell membrane (luminal and contraluminal) isolated from rat small intestine microvilli]. / Uptake di L-(+)lattato in membrane plasmatiche (luminali e contraluminali) isolate de enterociti di intestino tenue di ratto.

L-lactate uptake was measured in vesicles formed by intestinal brush border and baso-lateral membranes, using a rapid filtration technique. In the presence of a Na+ gradient directed into the vesicle, L-lactate can be transiently accumulated in brush border vesicles, but not in baso-lateral ones. The transient L-lactate accumulation does not occur in the presence of a KCl gradient. alpha-cyanocinammic acid strongly inhibits L-lactate uptake in brush border vesicles, but not in baso-lateral ones. These results support the existence of a carrier mediated, Na+ dependent, transport of L-lactate across the brush border membrane.