Surgical treatment of condylar head fractures, the way to minimize the postraumatic TMJ ankylosis

Management of condylar head fractures (CHF) of the temporomandibular joint (TMJ) remains a source of controversy. Based on established literature, group of CHFs and conservative treatment connected with period of maxillomandibular fixation (MMF) increases the risk for TMJ ankylosis. This paper presents anatomical and functional results of surgical treatment of condylar head fractures in a group of 24 patients (29 joints). Fractures were diagnosed based on conventional radiographs and computed tomography (CT) scans. Utilising an intraoperative arthroscopy authors evaluated actual intraarticular posttraumatic changes. This study presents acceptable functional and radiological results of surgical treatment of condylar head fractures with more than 3-year follow-up. The authors believe that re-establishing the pretraumatic anatomic position of the TMJ components (fragment and the disc) and early postoperative rehabilitation are inevitable to minimize the risk of postraumatic TMJ ankylosis (Tab. 2, Fig. 8, Ref. 31).

Long-term results of maxillary distraction osteogenesis in nongrowing cleft: 5-years experience using internal device

Patients with cleft lip and palate (CLP) related deformities frequently have maxillary hypoplasia in all dimensions. These patients usually present with class III malocclusions, retruded midfaces and narrow hard palates. The skeletal problems can be treated by means of Le Fort I maxillary procedures. Surgical and orthodontic correction of severe maxillary hypoplasia, as often seen in CLP patients, has however proved to be challenging. The magnitude of the advancement is often hampered and the post operative stability significantly affected by palatal soft tissue scarring. The slow distraction of bone and the histogenic abilities of distraction osteogenesis (DO) have made it an atractive alternative treatment option for the management of maxillary hypoplasia in these patients. This paper presents the treatment results of 15 nongrowing CLP patients with severe maxillary hypoplasia treated by means of intra oral distraction. The mean anterior distraction of the maxillas was 12.7 mm (9-15.0 mm). The long-term cephalometric and clinical evaluation after a minimum of 60 months (mean follow-up 71 months) proved to be stable. The treatment results revealed, that distraction osteogenesis in nongrowing CLP patients with severe maxillary hypoplasia proved to be a predictable and stable option (Tab. 2, Fig. 3, Ref. 26).

[Rupture of the common illiac artery isolated aneurysm in a high risk patient--a case review]

Rupture of isolated aneurysm of common iliac artery is a relative seldom finding in vascular surgery. Nowadays are in therapy of this severe conditions used conventional as well as endovascular procedures. Our case report document, that in high risk patients with convenient anatomical conditions endovascular therapy is a safe and effective therapy, that can reduce mortality of these patients.

Vacuum assisted closure in vascular surgery

BACKGROUND

Vacuum assisted closure (VAC-therapy) is a well established method in nearly all surgical disciplines. The aim is to present the efficiency of vacuum assisted closure in the treatment of acute and chronic wounds in patients admitted in the department of vascular surgery.

METHODS

Within the year 2008 there were 59 patients (44 men, 15 women) treated with VAC therapy in our Department of Vascular surgery (Landshut, Germany). VAC was used 22x (37.28 %) in therapy of ulcus cruris (venous, arterial, mixed genesis), 15x (25.42%) in patients with diabetic foot syndrome, 12x (20.33%) in secondary healing wounds and infected wounds, 5x (8.47%) in wounds after several injuries and soft skin tissue infections and 5x (8.47%) in wound infections connected with vascular graft infections after vascular revascularization.

RESULTS

VAC therapy seems to be very effective in the management of patients with venous ulcers, especially after a proper surgical treatment (100%), patients with soft skin tissue infections (100%) and secondary healing wounds (100%) especially in combination with MESH-Grafting. In patients with diabetic foot syndrome (80%) and peripheral arterial occlusive disease (72.7%), an evaluation of peripheral blood perfusion and revascularization prior to VAC therapy is often necessary. Although VAC was used 5x in the therapy of infected vascular grafts, successful preservation of infected graft material was observed in only one case (infection of PTFE femoro-popliteal bypass graft).

CONCLUSION

Vacuum assisted closure in vascular surgery proved to be simple and efficient method in therapy of acute and chronic wounds. The efficiency of VAC systems in therapy of infected graft material after revascularization needs further studies (Tab. 3, Ref. 10).

[Vacuum sealing in the treatment and prevention of prosthetic infections--a case review]

Positive results of usage of sub atmospheric pressure in therapy of acute and chronic wounds in vascular patients are presented in many works of contemporary surgeons and vascular specialists. Negative pressure wound therapy (NPWT, vacuum sealing) found its broad utilization in vascular surgery. Despite the fact, that in the last years was the indication of this therapy in prevention and therapy of vascular graft infections discussed many times, are works dealing with this topic still rare. Our case document, that under certain circumstances can negative pressure wound therapy be used also in this indications. Though there were surprising results achieved in our cases, we think, that these patients after a successful NPWT need a long-term follow up. To prove the efficacy of vacuum sealing in therapy of vascular graft infections needs in our opinion further observation and studies.

Retrograde endarterectomy of iliac arteries

OBJECTIVE

Authors retrospectively analyze a group of patients with symptomatic peripheral arterial occlusive disease (PAOD) who underwent an arterial reconstruction with a remote retrograde endarterectomy combined with intraoperative angiography and endovascular techniques as a hybrid procedure.

RESULTS

During the year 2007, there were 83 patients with PAOD planned for the remote retrograde endarterectomy of the iliofemoral arteries. Due to perioperative findings or complications, in 11 cases (13.25%) an alternative vascular procedure was necessary. In 52 (62.65%) patients the remote endarterectomy of iliofemoral arteries was performed separately or in connection with the endarterectomy of femoral bifurcation or bypass. In 20 (24.1%) patients, the remote endarterectomy was performed as a part of hybrid procedure. A technical success was achieved in 72 (from 83 patients - 86.7%) and a clinical success in 71 (from 72 patients - 98.6%) patients in whom a successful remote retrograde endarterecomy was performed. There were 15 operations needed in the postoperative period, but only two of them were necessary because of close relation with an unfavorable outcome after the remote endarterectomy. No perioperative and postoperative mortality was observed in the whole group of patients. During the follow up in the next 6 months, patency was proved in all patients after a successful remote endarterectomy.

CONCLUSIONS

Endovascular techniques in vascular surgery, remote endarterectomy is in our opinion a safe and durable method in the therapy of selected patients with PAOD (Tab. 4, Fig. 3, Ref. 8). Full Text (Free, PDF) www.bmj.sk.

[Comparison between hybrid surgical procedure--intraoperative angioplasty and cross-over bypass with aorto-bifemoral bypass in revascularization of iliac arteries]

OBJECTIVE

Authors analyze and compare hybrid vascular procedures (HOP) in revascularization of inflow arteries in the form of intraoperative stentangioplasty of iliac arteries combined with ilio/femoro-femoral cross-over bypass with conventional vascular procedures (KOP) in the form of aorto-bifemoral bypass.

MATERIAL AND METHODS

In all patients, admitted for bilateral revascularization of inflow arteries with hybrid or conventional procedure age, sex, comorbidity, stage according to the Fontain were reviewed prospectively. In all procedures following qualitative and quantitative data were collected: duration of the procedure, technical success (only in hybrid procedures), and peroperative mortality. In postoperative period following data were collected: wound healing problems, need for transfusion, need for observation in the ICU, duration of hospital stay, clinical success, patency and postoperative mortality 0-12 months after the operation. For statistical analysis of collected data statistical software SPSS 16 was used.

RESULTS

Within the year 2005-2007 (vascular centre Speyer - Mannheim) 20 hybrid procedures (HOP) in the form of intraoperative stentangioplasty of iliac arteries combined with ilio/femoro-femoral bypass were performed. Hybrid procedures were realized in 11 man (61.72 +/- 12.61) and 9 women (62.2 +/- 8.13). In similar indications was in the same period 14 conventional procedures (KOP) performed in the form of aorto-bifemoral bypass. Technical and clinical success were in HOP procedures achieved in 19 (95%) cases. Duration of operation was 97.36 +/- 19.04 minutes, duration of hospital stay was 8.94 +/- 4.01 days. Primary patency was in HOP procedures (0-12 months) observed in 19 (95%) cases. There was no perioperative and postoperative mortality observed during the follow up. A statistical analysis and comparison of hybrid and conventional procedures showed a significantly shorter duration of hybrid procedure (p < 0.001), significantly shorter hospital stay (p = 0.002), reduce wound healing problems (p = 0.022), need for transfusion therapy (p < 0.001) and need for observation in the ICU (p < 0.001) without a significant difference of clinical success and patency (0-12 m).

CONCLUSIONS

Hybrid procedures enormously expanded the possibilities of vascular surgery. In our opinion hybrid procedures in operative therapy of selected patients with symptomatic PAOD enable to reduce the extent of the operation, shorten the operating time, time of hospital stay and better the comfort for high risk patients. Using hybrid procedures especially in revascularization of inflow arteries enables to achieve good short-middle-term results with lower complication rates.

Squamous cell carcinoma of the oral cavity

OBJECTIVES

A number of treatment modalities are available in the management of oral cavity cancer. These are surgery (operation OP), irradiation (radiotherapy RT), chemotherapy (CHT), or complex therapy performed as a combination of the later three methods with various survival rates. A multidisciplinary team approach in every individual case is required.

BACKGROUND AND METHODS

Authors analysed retrospectively a group of 622 patients (553 men, 69 women), mean age 58.6 years (range 23-88 years) hospitalised in the Department of Oral and Maxillofacial Surgery, Faculty Hospital and Faculty of Medicine Comenius University in Bratislava within the years 1992-2001 with primary untreated histologically confirmed squamous cell carcinoma of oral cavity (beside cancer of the lip and salivary glands). Gender, age, location and TNM staging of the disease, clinical and histopathological evaluations of the neck lymph nodes and relationship to the treatment modalities were recorded. The authors compared some parameters of the results obtained during their previous study within the years 1977-1986 (453 patients).

RESULTS

The number of cases with squamous cell carcinoma of oral cavity increased by 37.31% in total as well as that of cases with advanced disease, especially stage IV (318 patients = 56.6%) increased by 7.6%. In the studied group there occurred cases that were clinically falsely negative by NO (11.04%) as well as falsely positive by N1 (39.1%) when examined by palpation of lymph nodes. The overall 5-year survival rate remained at the same level (55.4 %), the early and late stages did not change the survival rate at the 5th year (I = 75.1%, II = 69.9%, III = 47.5%, IV = 25.1%). Regarding the complexity of treatment, the best 5-year survival rates showed the complex three-modal therapy (CHT + OP + RT = 23.5%), comparing to the dual (OP + RT or CHT + RT = 19.4%) and mono-modal therapy (OP or RT alone = 17.2%). In the complex therapy, the mean disease-free interval improved (30.2 vs 39.4 months) due to a change in the sequence of therapy modalities.

CONCLUSION

The increase in the number of cases with advanced disease has a warning trend. The reasons of this trend remain unclear. In spite of the fact that the overal 5-year survival was found not to improve, the quality of life regarding the mean disease-free interval in the group of patients under the complex treatment is considered to be a positive result (Tab. 3, Fig. 4, Ref. 27). Full Text (Free, PDF) www.bmj.sk.

Some lung cellular parameters reflecting inflammation after combined inhalation of amosite dust with cigarette smoke by rats

Cellular changes were followed in lung cell suspensions after 175 day inhalation by rats of concentrations 30 mg/m3 or 60 mg/m3 of amosite asbestos every second day combined with daily exposure to cigarette smoke at 30 mg of total particulate matter (TPM)/m3 air. Concomitantly, lung inflammation was assessed by changes in the bronchoalveolar lavage fluid (BALF). A dose-dependent rise in the BALF inflammatory parameters was found. The rise of the proportion of binucleate (BNC) and multinucleate cells (MNC) in lung cell suspensions was also dose-dependent. It is concluded that, in the experimental assessment of effects of fibrogenic dusts, the number of BNC and of MNC in lung cell suspensions may serve as a useful semiquantitative biomarker of the inflammation.

Evaluation of bronchoalveolar lavage fluid cytotoxic parameters after inhalation exposure to amosite and wollastonite fibrous dusts combined with cigarette smoke

The aim of this work was to compare the influence of amosite-asbestos and wollastonite fibrous dusts combined with cigarette smoke on chosen cytotoxic parameters of bronchoalveolar lavage fluid (BALF) in rats. Fisher 344 rats inhaled wollastonite or amosite fibrous dusts (60 or 30 mg x m(-3) air) one hour every two days combined with daily breathing of diluted mainstream tobacco smoke (30 mg of TPM x m(-3) air). The experiment lasted 6 months. After sacrifying the animals bronchoalveolar lavage (BAL) was performed and the viability and phagocytic activity of alveolar macrophages (AM), lactate dehydrogenase (LDH) and alkaline phosphatase activity (in the cell-free BALF), acid phosphatase (ACP) and cathepsin D activity (in cell-free BALF and BAL cell suspension) were examined. Exposure to amosite without tobacco smoke significantly decreased the viability of AM and increased the cathepsin D activity in BAL cells. Exposure to wollastonite significantly increased only the cathepsin D activity in BAL cells. Smoking significantly depressed the phagocytic activity of AM and amplified the amosite-induced increase of lysosomal enzyme activities--especially the activity of cathepsin D in BAL cells.

Nutritional supplementation with antioxidants decreases chromosomal damage in humans

In order to investigate the effects of antioxidant supplementation on chromosome damage, a 3 month antioxidant supplementation trial was conducted on groups of 28 myocardial infarction survivors and 57 rural controls, all male. The supplement consisted of vitamin C (100 mg/day), vitamin E (100 mg/day), beta-carotene (6 mg/day) and selenium (50 microg/day). Dietary antioxidants in plasma were measured, as well as the ferric reducing ability of plasma (a measure of total plasma antioxidant status) and the concentration of malondialdehyde as an indicator of oxidative stress. Lymphocytes collected at the beginning and end of the supplementation period were stimulated to proliferate and metaphases accumulated for scoring of chromosome aberrations: per cent aberrant cells and chromatid and chromosome breaks. Supplementation with antioxidants was associated with a decrease in the percentage of cells with chromosome aberrations in the group of rural controls (0.63% before compared with 0.27% after supplementation; P = 0.03). The largest effect of supplementation was seen in smokers in this group (0.12% aberrant cells in supplemented compared with 0.81% in placebo group; P > 0.001). The results support the hypothesis that antioxidants decrease genetic damage.

Fine structure of hippocampal dendrites in the dentate fascia of LS/SS-mice after chronic ethanol treatment

1. The effect of ethanol and its withdrawal on the dendritic microtubules in the dentate fascia of male mice was studied in the ethanol-sensitive, long-sleep (LS) line and the ethanol-insensitive, short-sleep (SS) line. 2. Both mouse lines were treated with a liquid ethanol diet. Dendrites in the dentate molecular layer (DML) of the right hippocampus were examined. 3. They revealed marked changes in microtubule density as compared with the controls. While the microtubule density in LS mice was significantly reduced by 15% and 18% in the middle and distal third of the DML, respectively, in SS mice the reduction (by 12%) took place in the distal third only. During withdrawal a recovery of the microtubule density has been observed in both lines.

Additivity test for composition of binomial effects in chromosome aberrations after radiation injury

Additivity of clastogenic effects of two doses of radiation to human peripheral blood lymphocytes is considered. We compare the effects of combined tritium and gamma irradiation with the sum of the effects of either irradiation administered separately. Our solution is based on combination of de Moivre and Cramèr-Slucky theorems. The results for 14 subjects where the deletion types of chromosome aberrations were counted indicate a Normal distribution of the sample additivity index, oscillating non-significantly around zero, with one outlier towards adaptivity and another towards synergism of the effect of the two doses absorbed by the cells.