Patient- and clinician-reported outcomes for the additively manufactured sub-periosteal jaw implant (AMSJI) in the maxilla: a prospective multicentre one-year follow-up study.

The clinical outcomes of maxillary rehabilitation with the additively manufactured sub-periosteal jaw implant (AMSJI; CADskills BV) were evaluated in edentulous patients with a Cawood-Howell atrophy classification ≥5 in all regions of the maxilla. Fifteen consecutive patients were included in the study and followed up for 1 year. They were interviewed using a survey protocol and were examined clinically and radiographically preoperatively (T0) and at 1 (T1), 6 (T2), and 12 (T3) months after permanent upper prosthesis placement. The patients reported an increased oral health-related quality of life. The overall mean Oral Health Impact Profile-14 score at T0 was 17.20 (standard deviation (SD) 6.42). When results at T0 were compared to those at T1 (mean 8.93, SD 5.30), a statistically significant difference was seen (P = 0.001). At T3, the mean value was 5.80 (SD 4.18). Compared to T0, there was also a statistically significant difference at T3 (P = 0.001). General satisfaction based on the numerical rating scale was a mean 49.93 at T1, which was less than patient expectation prior to treatment at T0 (52.13). A higher overall value was seen at T3 (53.20) when compared to T0. Within the constraints of the short follow-up, the AMSJI appears to be a promising tool for patients with extreme jaw atrophy. The high patient expectations were met without complications.

Molecular markers of the endothelium, the coagulation and the fibrinolytic systems in healthy newborns.

Endothelium derived substances may play a role in the physiological adaptation processes at the time of birth. The aim of this study was to investigate plasma concentrations of activation markers of the endothelium (endothelin-1, thrombomodulin, von Willebrand factor), of the coagulation and the fibrinolytic systems (thrombin-antithrombin III complex, D-dimer, plasmin-alpha2-antiplasmin complex) during the first days of life. Venous blood from peripheral veins was collected from 79 healthy newborns and for comparison from 38 healthy infants and schoolchildren, as well as from 17 healthy adults. Except for endothelin and von Willebrand factor, the concentrations of activation markers were significantly higher in the newborn group. During the first 12 days of life thrombomodulin, thrombin-antithrombin III complex, and plasmin-alpha2-antiplasmin complexes showed a continuous decline whereas the concentrations of endothelin, von Willebrand factor and D-dimer did not change. The highest D-dimer concentrations were found at low umbilical arterial pH and after birth by vaginal operation suggesting an influence of birth stress. Thrombomodulin was correlated with endothelin (r=+0.471) and with von Willebrand factor (r=-0.415). In conclusion, endothelial, coagulation, and fibrinolytic systems are activated in newborns which might occur during birth by the mechanical stress, the adaptation of circulation, and the short-term hypoxic state. An additional intrauterine activation should also be considered.

[Primary pancreatic lymphoma. A rare cause of pain-free icterus]. / Primäres Pankreaslymphom. Seltene Ursache eines schmerzlosen Ikterus.

HISTORY AND FINDINGS: A 54-year-old man was admitted because of increasing pain-free jaundice during the preceding two weeks. There was no resistance on palpation of the abdomen. The liver was palpable and of normal consistency, two finger-breadths below the right costal margin. Neither spleen nor lymph nodes were palpable. INVESTIGATIONS: Total bilirubin was 7.9 mg/dl, alkaline phosphatase 467 U/l, gamma-GT 850 U/l. WBC and differential counts were normal. The tumour marker CA 19-9 was raised to 117 U/l. Ultrasonography revealed dilatation of the intra- and extrahepatic bile ducts and a 3 cm echo-poor tumour in the head of the pancreas. Colour Doppler sonography showed both portal and splenic veins to be patent. Endoscopic retrograde cholangiopancreatography demonstrated a mild stenosis of the main pancreatic duct at the transition between the head and body of the pancreas, and a filiform stenosis of the choledochal duct. CT showed an nonhomogeneous head of the pancreas. As the suspected malignant tumour of the head of the pancreas seemed resectable no preoperative fine-needle biopsy was performed. TREATMENT AND COURSE: Whipple's operation (partial duodenopancreatectomy) was performed, but a small tumour infiltration in the portal vein had to be left. The resected specimen surprisingly showed a 2.5 cm centroblastic-centrocytic lymphoma which had infiltrated the head of the pancreas. Postoperative imaging showed para-aortic lymph nodes in the abdomen, maximally 1 cm in diameter. Subsequent radiotherapy was without complication. CONCLUSION: Primary pancreatic non-Hodgkin lymphoma is a rare lesion with special therapeutic consequences. The difficult differential diagnosis from pancreatic carcinoma is usually possible only, in operable cases, from the resected specimen. Every inoperable pancreatic tumour should be biopsied in case it is a malignant lymphoma.

-Severe hemobilia after percutaneous transhepatic biliary drainage. Successful treatment by arterial catheter embolization-. / Schwere Hämobilie nach perkutan-transhepatischer biliärer Drainage. Erfolgreiche Behandlung durch arterielle Katheterembolisation.

We report on an 44-year-old man with Billroth-I-reoperation and transformation into Roux-Y-anastomosis, which was performed because of ulcer-relapse. The postoperative course was complicated by obstructive jaundice and cholangitis. Ultrasound and computed tomography could not clarify the cause. The subsequently performed percutaneous transhepatic cholangiography showed several small concrements in the biliary tract. For decompression of the dilated bile ducts percutaneous transhepatic biliary drainage was applied. Following that the patient developed recurrent episodes of hemobilia, which made the transfusion of altogether 17 units of blood necessary. Angiography clarified the bleeding source showing leakage of the right hepatic artery. By means of repeated selective transcatheter embolization definite hemostasis was achieved. Transcatheter embolotherapy is recommended as initial treatment to control serious iatrogenic hemobilia.

[Ulcerative colitis as a primary manifestation of Churg-Strauss syndrome]. / Ulzeröse Kolitis als primäre Manifestation eines Churg-Strauss-Syndroms.

A 29-year-old woman with chronic bronchial asthma and inflammatory bowel disease, previously classified as idiopathic, was hospitalized because of bouts of fever and increasing dyspnoea and diarrhoea. Chest radiograph showed extensive bilateral pulmonary infiltrates. Thought to be suffering from bacterial pneumonia she was treated with broad-spectrum antibiotic, but without improvement even after a change of antibiotics. Numerous diagnostic tests failed to find any causative organism. Subsequently she was found to have peripheral eosinophilia and pericardial effusion associated with echocardiographic and electrocardiographic signs of myocarditis, which raised the suspicion of allergic granulomatous vasculitis (Churg-Strauss syndrome). The patient's acute illness contraindicated a lung biopsy, but the clinical picture left no doubt of the true diagnosis. Treatment with methylprednisolone (initially 250 mg, then 80 mg daily) rapidly improved the clinical, radiological and biochemical findings. But four months later, under maintenance treatment with 15 mg methylprednisolone daily, she experienced another bout of colitis and, a few days later, pulmonary recurrence of the Churg-Strauss syndrome, both clinically and radiologically. The dose of methylprednisolone was raised to 60 mg daily. The inflammatory bowel disease, endoscopically manifesting as ulcerative colitis, was most likely part of the systemic vasculitis.-This case demonstrates that colitis can be the primary manifestation of Churg-Strauss syndrome.

[Successful treatment of a life-threatening ileostomy diarrhea with the somatostatin analog octreotide]. / Erfolgreiche Behandlung einer lebensbedrohlichen Ileostoma-Diarrhoe mit dem Somatostatin-Analogon Octreotid.

A 72-year-old man with Crohn's disease for about 6 years was urgently hospitalized in hypovolaemic shock. On admission, serum creatinine concentration was 4.2 mg/dl, serum sodium 124 mmol/l, as a result of massive fluid and electrolyte loss via a loop ileostomy which had been placed 4 weeks previously because of a complicated perianal fistula. The basic aetiology of the diarrhoea probably lay in the previous resection of 30 cm of terminal ileum, other possible causes having been excluded. The ileostomy diarrhoea persisted despite the administration of loperamide, ranitidine, glucocorticoids, opium and pancreatic enzymes. Metronidazole, given in case the diarrhoea was due to a change in bacterial flora, also failed to achieve improvement. But when the somatostatin analogue octreotide was administered, the fluid loss via the ileostomy was quickly reduced so that both fluid and electrolyte infusions could be stopped. In subsequent months the initially required daily octreotide dosage of three times 100 micrograms could be reduced to once 50 micrograms subcutaneously. But it was not possible to stop this drug completely: it has now been continued and well tolerated for 2 years.

[Severe osteoporosis in a young female patient with Crohn's disease]. / Schwere Osteoporose bei einer jungen Patientin mit Morbus Crohn.

Increasing pain in the region of the lumbar vertebrae occurred in a 23-year-old woman known for the past 6 1/2 years to have Crohn's disease affecting the ileocolon. Radiology revealed marked osteopenia with collapse and deformation of the vertebral bodies. The only pointer to a bone disease was a markedly lowered serum level of 25-OH-vitamin D (less than 10 ng/ml). Biopsy from the ileal crest revealed pure osteoporosis without osteomalacia. Decisive pathogenetic factors were, in the main, glucocorticoid medication, malnutrition and the long duration of Crohn's disease. During treatment with monofluorophosphate, 152 g daily, in fixed combination with 600 mg calcium as well as calcitonin (initially 100 I.U. daily subcutaneously for two weeks, then 100 I.U. every other day s.c.) and vitamin D (3 x 1,000 I.U. daily by mouth) she became free of symptoms, and she has remained so for 9 months.

Large scale purification of intralumenal alkaline phosphatase from calf intestine by immunosorbent affinity chromatography.

Electrophoretically and immunologically homogeneous alkaline phosphatase (AP) can be obtained by a simple and rapid two-step procedure. Step 1: Immunosorbent affinity chromatography using immobilized polyclonal anti-AP-antibodies and elution of the bound enzyme by triethylamine solution, pH 11.4. After affinity chromatography the specific activity of the extracted crude material increases from 3.5 to 793 IU/mg. Step 2: Final purification to a specific activity of 1524 IU/mg by DEAE-cellulose ion exchange chromatography. One investigator is able to purify 100 mg AP within 3 days. The overall recovery is 65%. Methods for characterization and selection of anti-AP-antiserum using immunoinhibition of AP are described.

Enzymeimmunoassay of unconjugated estriol in serum and saliva during pregnancy.

An enzymeimmunoassay (EIA) for unconjugated estriol was developed. Estriol-6-CMO-BSA was used as antigen for the antiserum production with low cross reactivities to estrone (0.3%) and estradiol (0.17%). The enzyme conjugate (estriol-peroxidase) was prepared using the mixed anhydride reaction. The antibody bound estriol fraction was separated from the free fraction with the double antibody technique. The test requires a simple photometer for the measurement of enzyme label. The developed estriol-EIA needs a short incubation time (2 hrs). The normal values of estriol in serum were determined. The results are in good agreement with the results of RIA. Furthermore, we found an inverse diurnal rhythm of serum and salivary estriol in comparison to the cortisol level. Low estriol levels in the morning and high estriol concentration in the evening are indices of fetal health. Decreased estriol levels in the morning of several days were found in pathological pregnancies (intrauterine fetal death, fetal distress, hepatose).

Studies on the quality of pancreatic preparations: enzyme content, prospective bioavailability, bile acid pattern, and contamination with purines.

Of the 72 pancreatic preparations currently on the market 24 were randomly selected for study and compared with 3 US preparations with different dosage forms. The activities of amylase, lipase, and proteases were measured with natural substrates. Prospective bioavailability was determined using amylase as indicator enzyme. Total bile acid content and distribution pattern were analyzed. The risk of renal changes due to prolonged ingestion of purines was estimated by qualitative and quantitative determination of these contaminants. Enzyme activities differed up to 16-fold. At pH 6, the drugs released the indicator enzyme with very different velocities. The efficacy of the drugs varied between 0.78% and 80.9%. The bioavailability of capsules was generally better than that of coated tablets; pellet capsules were not absolutely superior in this regard. All pancreatic preparations contained the purine bases guanine and hypoxanthine; only one drug had no adenine. Fifteen drugs contained 2.2%-10.6% bile acids by weight. Monohydroxy bile acids, which should not be administered to patients with liver disease, were detected in eight of these preparations.

A simple solid phase enzyme immunoassay for aldosterone in plasma and saliva.

A sensitive, solid phase enzyme immunoassay for the determination of aldosterone in plasma and saliva has been developed. For this purpose anti-aldosterone coated tubes were used. The enzyme marker was a covalently linked aldosterone/horseradish peroxidase conjugate. The assay had a limit of detection of 5 pg/assay tube. The test requires neither centrifuge nor gamma or beta counter, but only a simple photometer. The free/bound separation is based on the solid phase technique with a simple washing step. The normal values for aldosterone in plasma and saliva before and after ACTH application were determined. Saliva, being easily collected by a non-invasive, stress-free technique, is an alternative to plasma. The aldosterone levels in patients with Conn's syndrome were significantly increased in plasma and also in saliva.

[Uric acid determination in dilute serum with an enzyme electrochemical and enzyme-free sensor]. / Harnsäurebestimmung in verdünntem Serum mit enzymelektrochemischem und enzymlosem sensor.

The paper describes the development of electrochemical methods for analytical determination of uric acid basing on amperometric sensors: with an uricase enzyme electrode, termed "electrochemical-enzymatic" method; with an enzyme-free electrode by indication of the anodic oxidation of uric acid, termed "electrochemical" method. The comparison of analytical quality of both methods shows a sufficient specificity, precision, and accuracy. They show a good correlation with regard to the specific uricase-catalase reference method (UCM): yelectr./enz. = (0.943 xUCM + 19.8) mu mol/l; r = 0.9948 yelectr. = (0.964 xUCM + 6.31) mu mol/l; r = 0.9917 The analysis by the "electrochemical" method can be done with a higher frequency of samples per hour completely without need of enzyme. Both methods are principally suitable for an application in analytic biochemical laboratories.