The prospective experience of a maxillofacial surgeon with the percutaneous endoscopic gastrostomy technique.

Insertion of a percutaneous endoscopic gastrostomy (PEG) was attempted on 225 occasions, mainly for oral malignancy. Seventy-five percent (169/225) were inserted at the time of definitive surgery. There were significant incidental findings during 5% (11/225). The rate of successful insertion was 97% (219/225). The incidence of minor complications was 12% (26/225) and major complications 3% (7/225). There was no procedure-related mortality. The 30-day mortality rate, including those with terminal malignant disease, was 6% (14/225). An increased risk of death was associated with age of 65 years and over (P=0.004). The median PEG duration was 337 (SE 31) days. Duration was significantly longer for stage T3-4 tumours (P=0.028), N1 or greater neck disease (P=0.034), following surgery with radiotherapy when compared to surgery alone (P<0.001), particularly glossectomy (P=0.038) and maxillectomy procedures (P=0.003), after two separate surgical procedures and radiotherapy (P=0.046) and following a composite bone resection (P=0.031), or radiotherapy alone when compared to surgery alone (P=0.003). There was no relationship to the type of flap used for reconstruction. Four patients have a long-term PEG. Only two patients did not use the PEG. The early insertion of a PEG in all patients undergoing free or pedicled flap reconstruction appears to be appropriate. The PEG procedure may be safely performed by an appropriately trained maxillofacial surgeon.

Influence of donor age and culture conditions on tissue engineering of mucosa autografts.

In oral surgery the transplantation of tissue engineered mucosa is used more frequently. The conventional single cell suspension culture method (SCSM) involves murine feeder cells and foetal calf serum. The explant technique (ET) has been used as alternative culture procedure. Aim was to study the efficacy of the ET and the SCSM without feeder cells to grow primary cultures and to test the effects of donor age, of extracellular matrix proteins (ECMP), and of autogenous serum on cell growth in explant cultures. These factors were assessed in cultures of 58 patients overall. In 48 cultures of 12 patients primary cell growth was compared between the ET and the SCSM. Eighteen of 24 cultures were established with the ET whereas only 3 of 24 were established with the SCSM. To test the influence of donor age on cell multiplication, the proliferation rate (DNA synthesis measured by bromodeoxyuridine uptake) and the overall growth (DNA content) was determined in cultures of five young and five old donors. In cultures from old donors (mean age 56 years) proliferation was lower but more sustained relative to the cultures from the young donors (mean age 25 years). In old donors overall in vitro cell growth was only 2/3 of that in young donors. In cultures of 20 donors the influence on cell adhesion and growth of the ECMP fibronectin and laminin was assessed by planimetry. While ECMP augmented explant adhesion, these substances did not enhance keratinocyte growth significantly. Comparing the influence of autogenous and foetal calf serum on cell growth no differences were observed in all cultures of the six donors. In conclusion, the ET without additional ECMP coating and with autogenous instead of foetal calf serum are now used to culture gingival keratinocytes for tissue engineering mucosa grafts. Consequently xenogenous components are avoided, being a considerable advantage.

Sensory and motor function impairment after brachial plexuscord compression by a pedicled latissimus dorsi flap.

A case of neuropraxia of the sensory and motor nerve fibres of the brachial plexus is reported after successful transfer of an ipsilateral pedicled myocutaneous latissimus dorsi flap to reconstruct a large-volume tissue defect in the neck resulting from a shotgun injury.

[Measles as a rare cause of parotid swelling in childhood. Case presentation, differential diagnosis and discussion]. / Masern als seltene Ursache einer Parotisschwellung im Kindesalter. Fallvorstellung, Differenzialdiagnostik und Diskussion.

Unilateral parotid enlargements in children are very rare compared with their incidence in adulthood. Besides epidemic parotitis, juvenile hemangioma, a highly differentiated type of capillary hemangioma, is the most common reason for parotid enlargement in childhood. Parotid enlargement or changes in the adjacent tissue structures may also represent symptoms of systemic diseases. A very rare manifestation of a rubeola (measles) infection in its preexanthematic state in the parotid region is demonstrated in the following case presentation. The subsequent discussion will focus on a variety of differential diagnoses. In order to ensure an early therapeutic intervention, careful clinical examination, sufficient radiological diagnosis, and if necessary an additional diagnostic excision are essential to determine the exact diagnosis in uni- or bilateral parotid enlargement in childhood.

[3D SPECT reconstruction - a diagnostic method in oral and maxillofacial surgery]. / 3-D-SPECT-Rekonstruktion zur Diagnostik in der Mund-, Kiefer- und Gesichtschirurgie.

Computer-aided three-dimensional (3D) reconstruction of conventional (99m)Tc-DPD SPECT data was used for basic investigations of different disease entities of the orofacial area, with the aim of improving primary diagnosis and, in selected cases such as microvascular bone reconstruction, for a more comprehensive control after therapy. So far, the new 3D technique has been applied in 49 patients with different indications based on commonly acquired sets of data without any further hazard for the patients. In comparison to conventional planar scintigrams, the advantage of this sophisticated technique is a higher image contrast and a clear-cut signal of the investigated bone areas without any superimposing effects. Therefore, the anatomical description of the process is better, which is particularly important in cases of osteomyelitis and after microvascular reconstruction of skull bone defects. In addition, the follow-up investigations can assess treatment results far better and outcome predictions are much more reliable. A higher sensitivity and specificity in cases of squamous cell carcinoma as regards bone infiltration could not be achieved so far. In summary, computer-aided 3D reconstruction of conventionally acquired (99m)Tc-DPD-SPECT data represents a significant improvement in radionuclide imaging technique, providing a much better diagnostic interpretation of selected disease entities in the oral and maxillofacial area.

Activating beta-1-adrenoceptor antibodies are not associated with cardiomyopathies secondary to valvular or hypertensive heart disease.

OBJECTIVES: We investigated whether autoantibodies against the human beta-adrenergic receptor (beta-AR) might be involved in cardiomyopathies secondary to valvular heart disease (VHD) or hypertensive heart disease (HHD). BACKGROUND: Autoimmunity to beta-AR has been proposed as a pathogenic principle in human cardiomyopathy. Recently, by the use of intact recombinant human beta-AR, we were able to confirm the existence of functionally active anti-beta-1-AR autoantibodies in patients with dilated cardiomyopathy (26% prevalence) or ischemic cardiomyopathy (10% prevalence); however, their prevalence in other (secondary) cardiomyopathies remained to be determined. METHODS: Immunoglobulin G (IgG) was prepared from the sera of 28 VHD and 19 HHD patients and first screened by a peptide-based enzyme-linked immunosorbent assay (antigens: aminoterminus, second extracellular loop [ECII] and carboxyterminus of human beta-1- and beta-2-AR). IgG from 108 gender- and age-matched healthy subjects served to define the threshold for positive immunoreactions. Positive sera were further screened for their ability to recognize and activate native human beta-AR situated in a cell membrane. RESULTS: Twenty-five percent (VHD) or 11% (HHD) of the patients and 4% of the healthy controls had IgG antibodies randomly directed against all the three domains tested and both beta-AR subtypes. Only one patient with aortic valve and concomitant coronary heart disease and one healthy subject had functionally active anti-b1-AR (targeting beta-1-ECII). Moreover, one HHD patient with concomitant collagenosis had IgG that was cross-reacting with recombinant beta-AR in immunological assays but was unable to affect receptor function. CONCLUSIONS: Autoimmune reactions against the human beta-AR do not appear to be associated with cardiomyopathies secondary to VHD or HHD.

Percolation theory, conductivity and dissolution of hydrophilic suppository bases (PEG systems).

We investigated the conductivity of binary mixtures of different volume to volume ratios of liquid polyethylene glycol 200 (PEG 200) and solid PEG 6000. The conductivity was measured using a specially designed cell, which could be filled with the sample to be analysed. The results were analysed by the help of the percolation theory and its basic equation: X=S(p-p(c))(q) with X=gamma the conductivity and X=k the dissolution rate constant of binary mixtures with p the concentration of PEG 200 including Mepyraminmaleat as a marker substance. The intrinsic dissolution rate was determined spectrophotometrically. The simultaneous determination of the critical exponent q and the percolation threshold p(c) of the conductivity experiment yielded the following values q=1.83+/-0.05 and p(c)=11.6+/-1.1% with a squared correlation coefficient R(2)=0. 9986. For q=mu=2.00 fixed the percolation threshold is equal to p(c)=8.4+/-1.3% with R(2)=0.9984. Thus if the same percolation threshold p(c)=8.4+/-1.3% is adopted for the dependence of the dissolution process q becomes equal to q approximately mu=1. 94+/-0.045. R(2)=0.9991. This result is in excellent agreement with the theoretical prediction that the permeability of a porous network scales in the same way as the conductivity.

Autoantibodies activating human beta1-adrenergic receptors are associated with reduced cardiac function in chronic heart failure.

BACKGROUND: Autoantibodies against synthetic peptides of beta-adrenergic receptors have been observed in human cardiomyopathy. However, it has never been shown that such antibodies really interact with native human beta-adrenergic receptors, nor has the clinical impact of such an interaction been investigated in larger groups of patients. METHODS AND RESULTS: We screened 104 patients with dilated or ischemic cardiomyopathy (NYHA functional classes II to IV) and 108 healthy subjects for IgG antibodies reacting with beta-receptor peptides. Such IgGs were further analyzed for binding and functional interactions with native recombinant human beta-adrenergic receptors. Antibodies reacting with synthetic receptor peptides were present in 51% of the patients. However, only a subgroup directed against the second extracellular receptor domain also recognized native human beta-adrenergic receptors situated in a cell membrane. All antibodies of this subgroup impaired receptor ligand binding and enhanced receptor-mediated signaling, which could be blocked by 5 micromol/L bisoprolol in vitro. Their prevalence was 1% in healthy subjects and 10% in ischemic cardiomyopathy, whereas it amounted to 26% in dilated cardiomyopathy and was associated with a significantly poorer left ventricular function. CONCLUSIONS: Our data show that activating autoantibodies against human beta-adrenergic receptors exist in approximately 25% of patients with dilated cardiomyopathy. Counteraction of such autoantibodies might contribute to the beneficial effects of beta-adrenergic receptor blockade in chronic heart failure.

Probing human beta1- and beta2 -adrenoceptors with domain-specific fusion protein antibodies.

In order to generate antibodies suitable for immunological studies on beta-adrenoceptors constitutively expressed at low levels in cells or tissues we have produced fusion proteins of the amino- and carboxy-terminus, and the second extracellular loop of the human beta1- or beta2-adrenoceptors with bacterial glutathione-S-transferase in E. coli. Rabbit antibodies raised against these fusion proteins strongly reacted with intact human beta1- or beta2-adrenoceptors in a subtype- and domain-specific manner. Antibodies directed against the second extracellular loop of the beta1-adrenoceptor reacted stronger with non-denatured receptors and decreased the affinity of the 3H-labelled antagonist (-)-4-(3-t-butylamino-2-hydroxypropoxy)-[5,7-3H]benzimidazol-2-one ([3H]CGP 12 177), indicating a specific interaction with the native receptor. In contrast, antibodies directed against carboxy- and amino-terminal receptor domains reacted strongly both with denatured and non-denatured receptors but did not interfere with binding of [3H]CGP 12 177. Affinity purified antibodies were used for detecting the beta1- or the beta2-adrenoceptor subtype heterologously produced in Sf9 cells by enzyme-linked immunosorbent assay, Western blotting, immunoprecipitation, and indirect immunofluorescence microscopy. Moreover, we could demonstrate that avidity, titers, and specificity of these antibodies were high enough for studying beta-adrenoceptors constitutively expressed in human A431 cells, where we observed a patched membrane distribution of the receptors.

Probing human beta 1- and beta 2-adrenoceptors with domain-specific fusion protein antibodies.

In order to generate antibodies suitable for immunological studies on beta-adrenoceptors constitutively expressed at low levels in cells or tissues we have produced fusion proteins of the amino- and carboxy-terminus, and the second extracellular loop of the human beta 1- or beta 2-adrenoceptors with bacterial glutathione-S-transferase in E. coli. Rabbit antibodies raised against these fusion proteins strongly reacted with intact human beta 1- or beta 2-adrenoceptors in a subtype- and domain-specific manner. Antibodies directed against the second extracellular loop of the beta 1-adrenoceptor reacted stronger with non-denatured receptors and decreased the affinity of the 3H-labelled antagonist (-)-4-(3-t-butylamino-2-hydroxypropoxy)-[5,7-3H]benzimidazol-2-one ([3H]CGP 12 177), indicating a specific interaction with the native receptor. In contrast, antibodies directed against carboxy- and amino-terminal receptor domains reacted strongly both with denatured and non-denatured receptors but did not interfere with binding of [3H]CGP 12 177. Affinity purified antibodies were used for detecting the beta 1- or the beta 2-adrenoceptor subtype heterologously produced in Sf9 cells by enzyme-linked immunosorbent assay, Western blotting, immunoprecipitation, and indirect immunofluorescence microscopy. Moreover, we could demonstrate that avidity, titers, and specificity of these antibodies were high enough for studying beta-adrenoceptors constitutively expressed in human A431 cells, where we observed a patched membrane distribution of the receptors.

Measurement of interleukin 1 alpha and 1 beta (IL-1 alpha and IL-1 beta) in human cystic lesions of the jaw. Implications for the pathogenesis of radicular cysts.

Human radicular cystic tissue of jaws was found to contain between 0.823 pg/mg to 18.026 pg/mg interleukin 1 beta and from 0.34 pg/mg to 0.708 pg/mg interleukin 1 alpha. No IL-1 beta and alpha could be found in specimens from healthy patients. A finding which may be extremely relevant in cystic growth and episodes of alveolar bone resorption around the cystic lesion.

Increased interleukin-1 beta (IL-1 beta) concentration in gingival tissue from periodontitis patients.

Human gingival tissues from periodontitis patients were found to contain from 126 fg/mg to 2161 fg/mg interleukin-1 beta as determined by a sensitive enzyme linked immunoassay. No IL-1 beta could be found in normal gingival tissue. This finding may have important consequences relevant to connective tissue destruction and episodes of alveolar bone resorption characteristic of chronic periodontitis.