[Can treatment with anesthetic anticonvulsive drugs worsen outcome in status epilepticus?] / Kann der Einsatz anästhetisierender Antikonvulsiva beim Status epilepticus das Outcome verschlechtern?

BACKGROUND AND OBJECTIVES: Nowadays, there is an ongoing discussion about the risks and benefits of anesthetic treatment concerning outcome in status epilepticus (SE). Therefore, we performed a retrospective database analysis to examine the influence of treatment with anesthetic drugs and narcosis in SE on mortality and disability. METHODS: All treatment episodes of SE at the Department of Neurology of the University of Rostock between 01 January 2000 and 31 December 2009 were evaluated. SE severity before treatment, mortality, and disability at discharge were taken into account. RESULTS: Of 167 treatment episodes of SE, 34 included treatment with anesthetic anticonvulsive drugs and narcosis. In the treatment episodes with use of anesthetic anticonvulsive drugs and narcosis, there was a more than twofold increased risk for death compared to the other treatment episodes. However, due to sample size this difference was not significant (p = 0.09). Cardiopulmonary complications were the cause of death in 4 of 5 patients dying during treatment episodes with anesthetic anticonvulsive drugs and narcosis. At discharge, disability as measured with the Modified Rankin Scale was higher in patients treated with anesthetic anticonvulsive drugs and narcosis than in the others (p = 0.03). A subgroup analysis revealed that especially in patients with nonconvulsive SE with impaired consciousness treatment with narcosis was associated with a higher rate of new deficits or mortality (p = 0.012). CONCLUSIONS: Especially when considering narcosis for treatment of nonconvulsive SE, risks and benefits should be carefully weighed. When treating SE with anesthetic drugs and narcosis, everything has to be done to avoid cardiopulmonary complications.

Post-treatment changes in permanent retention.

OBJECTIVES: While permanent retention is today the method of choice to stabilize orthodontic treatment outcomes, recent studies have increasingly reported posttreatment changes in tooth position during permanent retention. We conducted this study to analyze changes in the anterior mandible, whether the changes follow an underlying movement pattern, and, aiming for a preventive strategy, whether any risk factors could be identified comparing findings with the pretreatment situations. METHODS: We included 30 patients who had worn fixed Twistflex retainers (UK 3-3) extending from canine to canine in the mandible. Casts reflecting the intraoral situations before orthodontic treatment (T0), directly after completion of active therapy (T1), and 6 months later (T2) were scanned and superimposed using Imageware Surfacer software. Posttreatment changes (T2-T1) of tooth position within the retainer block were analyzed on 3D virtual models and were compared to pretreatment (T0) and treatment-related (T1-T0) findings to identify potential risk factors. RESULTS: Almost all analyzed patients revealed three-dimensional changes in tooth position within the retainer block. Comparing these movements, we repeatedly found rotated retainer blocks in labio-oral direction, while the center of rotation was located at the first incisors. This pattern was associated with intercanine expansion and excessive overjet correction during orthodontic treatment. The canines underwent the most pronounced (rotational and translational) movements. CONCLUSIONS: In general permanent lingual retainers are safe but in special clinical cases retainers can induce undesired tooth movement. Risk factors seem to be intercanine expansion and excessive overjet correction during orthodontic treatment. In specific cases an additional retention device might be needed.

3D analyses of interface voids in root canals filled with different sealer materials in combination with warm gutta-percha technique.

OBJECTIVES: The aim of the present study was to analyze the formation of voids and gaps in root canals obturated with different sealer materials in combination with warm gutta-percha vertical compaction technique by using BeeFill® 2in1. MATERIALS AND METHODS: Twenty-four single-rooted teeth were collected, and root canals were prepared by using rotary files. All teeth were randomly allocated into three groups. Each group was obturated by using the BeeFill® 2in1 system in combination with Sealapex (non-eugenol, calcium hydroxide polymeric root canal sealer; Kerr Sybron, USA), RoekoSeal (polydimethylsiloxane-based sealer; Roeko, Germany), or 2Seal (epoxy-amine resin-based sealer; VDW, Germany). Following preparation, all teeth were scanned with a micro-computed tomography (CT) scanner, and a three-dimensional reconstruction of the obturated root canals was performed to analyze the volume of interface voids and gaps in the obturated teeth. RESULTS: Statistical analysis demonstrated that the silicon-based sealer RoekoSeal induced significantly less voids and gaps than other tested materials. The amount of voids and gaps significantly was higher in the apical region. CONCLUSIONS: These data indicate that none of the root canal-filled teeth were free of gaps. Teeth obturated with RoekoSeal demonstrated to have the highest quality in terms of voids and gaps formation in combination with the BeeFill® 2in1 obturation system. CLINICAL RELEVANCE: These findings point to the potential benefit of micro-CT analyses for in vitro evaluation of root canal obturation systems and provide further information about sealer materials used in combination with a warm gutta-percha vertical compaction technique.

Inter- and intra-specific gene-density-correlated radial chromosome territory arrangements are conserved in Old World monkeys.

Recently it has been shown that the gene-density correlated radial distribution of human 18 and 19 homologous chromosome territories (CTs) is conserved in higher primates in spite of chromosomal rearrangements that occurred during evolution. However, these observations were limited to apes and New World monkey species. In order to provide further evidence for the evolutionary conservation of gene-density-correlated CT arrangements, we extended our previous study to Old World monkeys. They comprise the remaining species group to be analyzed in order to obtain a comprehensive overview of the nuclear topology of human 18 and 19 homologous CTs in higher primates. In the present study we investigated four lymphoblastoid cell lines from three species of Old World monkeys by three-dimensional fluorescence in situ hybridization (3D-FISH): two individuals of Japanese macaque (Macaca fuscata), crab-eating macaque (Macaca fascicularis), and an interspecies hybrid individual between African green monkey (Cercopithecus aethiops) and Patas monkey (Erythrocebus patas). Our data demonstrate that gene-poor human 18 homologous CTs are located preferentially close to the nuclear periphery, whereas gene-dense human 19 homologous CTs are oriented towards the nuclear center in all cell lines analyzed. The gene-density-correlated positioning of human 18 and 19 homologous CTs is evolutionarily conserved throughout all major higher primate lineages, despite chromosomal inversions, fusions, fissions or reciprocal translocations that occurred in the course of evolution in these species. This remarkable preservation of a gene-density-correlated chromatin arrangement gives further support for a functionally relevant higher-order chromatin architecture.

[Spiegeli's hernia]. / Die Spiegeli'sche Hernie

Spontaneous lateral ventral hernia (spigelian hernia) is briefly reviewed in the light of 7 patients with a total of 8 hernias. The relatively high incidence of spigelian hernia (5% of all abdominal hernias operated on in 1 year) suggests that this hernia type is not uncommon if borne in mind when diagnosing conditions with abdominal pain. Pain, tenderness and a palpable mass along the lateral edge of the rectus abdominis are the leading symptoms. Since the operation is simple and the postoperative period uneventful, operative treatment is strongly recommended. Accurate diagnosis with resultant surgery for this type of hernia spares the patient unnecessary examinations and totally relieves symptoms.

[Radiogenic sarcoma of the thyroid (author's transl)]. / Radiogenes Sarkom im Bereich der Schilddrüse

A sarcoma in the region of the thyroid, observed 30 years after radiotherapy in a patient with syringomyelia is presented. Even after low dose radiation in childhood and adolescence tumours of the thyroid frequently can be diagnosed. They rarely occur in adults, because apparently of a long latent period. This case is thought not to be a specific thyroid tumour.