Division-endarterectomy-anastomosis of the internal carotid artery: a prospective randomized comparative study.

Saphenous vein patch angioplasty is reported to yield superior results for carotid endarterectomy. In order to evaluate an alternative technique, which leaves the saphenous vein intact for other possible graft purposes, 200 carotid endarterectomies were included in a prospective randomized comparative study. Patients were randomized to two statistically equivalent groups: one group underwent classical carotid endarterectomy through a longitudinal incision with saphenous vein patch angioplasty; the other had endarterectomy through an oblique division of the internal carotid followed by in situ anastomosis. Cross-clamping time was approximately 5min shorter with the division-endarterectomy-anastomosis technique. The overall perioperative (< 30 days) mortality rate was 2.5% and cumulative mortality-morbidity rate 8% in the patch group compared with 4% in the other (P > 0.05). There were significantly more cranial nerve injuries in the patch group, most of which were transient (P < 0.01). The mean follow-up was 365 days. The late mortality rate was 5.5%. There were no late permanent or fatal strokes, but 3% of patients sustained mild transient neurological events. Only three significant (> 60%) stenoses developed during follow-up, all within 9 months. Dilatation and disturbed flow were more pronounced in the patch group (P < 0.05). There were no statistically significant differences between both techniques on mortality, disabling neurological morbidity and recurrent stenosis. In conclusion, the results of the division-endarterectomy-anastomosis technique are equivalent to those with patch angioplasty, leaving the patient's venous capital intact.

Intracranial subdural hematoma after spinal anesthesia.

We describe a 68-year old male patient with late onset signs of an intracranial subdural hematoma after repetitive spinal anesthesia procedures for urethral dilatation. The proposed mechanism is that of cerebrospinal fluid efflux. The potential for the development of such complications is so important, that it must be considered in every patient.

[Influence of marginal and submarginal restoration margins on periodontal tissues]. / Der Einfluss marginaler und submarginaler Restaurationsränder auf das periodontale Gewebe.

Subgingival and irregular restoration margins have an unfavourable influence on the marginal periodont. The margins close to the gingiva of 206 restorations (age of restorations mean = 49.4 months) showed incorrectnesses in most cases with marginal inflammation as a result. That's why the demand of high precision, supragingival positioning of margin restoration and removal of all potential plaque-retentive or mechanic irritated surface is raised.

[Micro-plasma treatment of dental pulp in animal experiments]. / Die Micro-Plasma-Bearbeitung des Endodonts im Tierexperiment.

The direct and indirect effect on the endodont after thermic treatment with the micro-plasma unit from EGIDE were examined in animal experiments. The EGIDE unit is considered by its producer to be an alternative for CO2 lasers. The histological evaluation showed that both the plasma-therapy of dentin and the exposed pulp lead to massive pathological changes of endodont and was inferior to traditional methods as the indirect pulpcapping.

Division and reanastomosis of the internal carotid artery for endarterectomy.

In an attempt to meet superior hemodynamic criteria without patch angioplasty and to prevent recurrent stenosis, Division-Endarterectomy-Reanastomosis (D.E.R.) was used as a routine technique in a prospective study on 26 consecutive interventions in 25 patients. One patient had a residual technical stenosis of less than 30%. Eight patients died during the one and a half year follow-up from nonstroke-related causes. After on an average 14 months flow parameters were evaluated with Color Duplex Sonography to detect recurrent stenosis. One (5.5%) mild asymptomatic recurrent stenosis of less than 50% was diagnosed. The residual stenosis remained unchanged and all other sites showed normal flow patterns. Division-Endarterectomy-Reanastomosis of the internal carotid artery, as described, meets all requirements for safe carotid restoration.

[New demands of dental early diagnostics problems and present approaches in the field of research methodology]. / Zu neuen Erfordernissen der stomatologischen Feindiagnostik-Problemdarstellung und gegenwärtige forschungsmethodische Ansätze.

For the purpose of prevention and early therapy it is necessary to replace empiricism by a diagnostics which can be reproduced, and by objective qualitative and quantitative findings. Traditional and new methods are to be used in combination.

Perioperative intra-aortic balloon counterpulsation in cardiosurgery: a retrospective study.

From January 1986 to March 1988 50 of 1366 patients (3.7%) undergoing cardiac surgery were treated with IABP support. The 50 patients ranged in age from 43 to 79 years (mean: 63.3 years). 88% of them underwent coronary artery bypass grafting, 6% of them mitral valve replacement and the other 6% a combined procedure. IABP was inserted preoperatively in 4 patients (8%) because of cardiogenic shock, and in 18 patients because of unstable angina (36%); intraoperatively as a help during weaning from cardiopulmonary bypass in 8 patients (16%); postoperatively because of hemodynamic deterioration in 20 patients (40%). The IABP was placed by femoral puncture in 39 patients (78%), by femoral cutdown in 6 patients (12%) and by transthoracic aortotomy in 5 patients (10%). All patients received daily infusions of heparin and broad spectrum antibiotics. The overall incidence of complications was 22%. There was no mortality due to IABP-related complications.

[Caries profunda problems in past and at present]. / Anmerkungen zur Caries-profunda-Problematik in Vergangenheit und Gegenwart.

The development of profound caries therapy in relation to soft carious dentin and carious changed dentin is summed up. Because of its pulpitis preventing meaning profound carious therapy demands the scientific disputation in presence and future.

A comparison of the anaesthetic properties of propofol and methohexitone when used as the sole induction agent for thermocoagulation of the gasserian ganglion.

Methohexitone and propofol were compared when used as the sole induction agent for thermocoagulation of the Gasserian ganglion. Sleeping and apnoea times were not significantly different for both drugs, nor were they for the same drug during repetitive inductions. However, the haemodynamic data showed a better stability when propofol was used. Amnesia may be in favour of propofol. There were no significant differences concerning pre- and post-operative side-effects in both groups.

Subjective comfort vote and air temperature as predictors of performance in factory workers.

Volunteer factory workers performed a series of tests in a mobile climate laboratory. The tests simulated factory skills and were performed at 6 degrees, 12 degrees, 18 degrees or 24 degrees C at low vapour pressures. At each temperature four groups of about 30 workers were tested: black men, and women and white men and women. A first order polynomial was used to fit the data for temperature and comfort vote. The comfort vote predicted about 6% of performance, temperature about 11%. On some manual tasks air temperature predicted more than 40% of performance. There were few differences between the groups.

Finger skin temperature and manual dexterity - some inter-group differences.

The relationship between finger skin temperature (FST) and performance was demonstrated with four manual dexterity tasks all of which were performed by black and white, male and female subjects. At air temperatures below 24 degrees C the white subjects tended to have warmer FSTs than the black subjects; white subjects were also able to equal the performance of the black subjects at air temperatures as much as 6 degrees C below that required by the black subjects.

Ability of the pig to distinguish between conspecific urine samples using olfaction.

In two female pigs it has been shown using operant conditioning techniques in which the animals pushed panels with their snouts in order to obtain food, that they could distinguish between the oder from urine samples taken from other pigs. In the discrimination task, the pigs faced two panels and a tube adjacent to one of the panels emitted urine odor used as the positive discriminative stimulus while another tube adjacent to the other panel emitted the negative discriminative stimulus consisting of odor from another urine sample. Only presses on the panel associated with the positive stimulus were reinforced on a fixed ratio schedule of 6. Both positive and negative discrimination stimuli were presented simultaneously. After each reinforcement the position of the positive and negative odor stimuli was varied according to the Gellerman series. When fully trained, the pigs made very few responses on the incorrect panel.