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Biomedical subjects

J Zöller

Publications and source records attributed to J Zöller.

At least 37 records · Page 2Linked to original sources
PubMed1996

Case report. Microcephalic osteodysplastic primordial dwarfism type II: a child with unusual symptoms and clinical course.

UNLABELLED: We report on a 13-month old boy with microcephalic osteodysplastic primordial dwarfism (MOPD), whose radiographic signs correspond with type II of this entity. Some of his clinical signs, such as the anomalies of the external genitalia and the urinary tract, are common to this subgroup of MOPD, but he also shows unusual clinical signs including bilateral knee dislocation and hypoplasia of the anterior corpus callosum. His clinical course was unusual with several episodes of breathing difficulties and increased intracranial pressure secondary to craniosynostosis at the age of 16 months. After front-orbital advancement for the treatment of brachycephaly, his psychomotor development improved remarkably. CONCLUSION: MOPD type II may have a wider range of expression than previously delineated.

Abnormalities, Multiple↗
PubMed1995

Intraoperative navigation in oral and maxillofacial surgery.

Surgical procedures in the oral and maxillofacial region may be difficult in areas of complex anatomy. Up to now, surgical planning has been based almost exclusively on the surgeon's experience and on the interpretation of 2-dimensional (2D) radiologic information. Our experiences with a commercially available 3D navigation system (Viewing Wand, ISG, Mississauga, Ontario, Canada) is reported upon. The system consists of a mechanical operating arm with 6 joints and 6 degrees of freedom working as a 3D digitizer and is interfaced to a computer graphics workstation. After registration of the position of the patient's head in relation to the tip of the instrument on the navigation arm, the surgeon can observe the 3D position and direction of the instrument in use on the monitor, i.e. on the computed tomography and/or magnetic resonance tomography images of the patient taken before. In 40 interventions performed so far, the accuracy was 2 mm and better. 3 cases are presented in this paper. The system facilitates surgery especially in anatomically complicated situations without the risk of damaging neighbouring structures. Planning of surgical interventions is much easier. By using computer assisted simulation and navigation systems, we expect an improvement in quality and a reduction in surgical risks. Thus, "looking ahead" surgery has become possible. More extensive and more radical interventions are likely to be performed in the near future. Responsibility for the surgical intervention, however, remains exclusively with the surgeon.

Carcinoma, Adenoid Cystic↗
PubMed1995

Repair of human skull defects using osteoinductive bone alloimplants.

To estimate the efficacy of cranioplasty in clinical practice, autolyzed, antigen-extracted, allogenic (AAA) bone was prepared from cortical bones of human organ donors. AAA bone implants consisted of completely demineralized bone powder, completely demineralized pliable bone chips, surface-demineralized bone chips with pliable crevices, surface-demineralized rigid bone chips, or combinations thereof. 21 patients received AAA bone cranioplasties and were followed-up for between 12 and 58 months (average: 29 months). No infection or rejection of any of the AAA bone implants occurred. X-ray assessments as well as bone scintigraphies revealed osseous integration and remodelling of the AAA bone implants with minimal resorption, with the exception of completely demineralized AAA bone chips which showed partial resorption (2 cases). However, the partial resorption of completely demineralized AAA bone chips ceased after the implants had been remodelled. In 4 cases, the osteosynthesis material was removed between 10 and 18 months after the cranioplasty. In another case, a re-entry was necessary because of recurrence of an intracranial tumor. All of these five AAA bone reconstructions showed bleeding surfaces and osseous consolidations at the time of re-entry. A bone biopsy taken from one of these cranioplasties showed osteoinduction on the surface of the AAA bone implants. This first clinical review of cranial reconstructions using osteoinductive AAA bone implants emphasizes the therapeutical application of AAA bone for cranioplasty. Large AAA bone chips from human skull bones facilitate the reproduction of the skull's convexity especially when combined with preoperative stereolithography-based planning.

Adolescent↗
PubMed1995

Maintenance of cell-type-specific cytoskeletal character in epithelial cells out of epithelial context: cytokeratins and other cytoskeletal proteins in the rests of Malassez of the periodontal ligament.

We have determined the patterns of synthesis of cytokeratins and other epithelial marker proteins in the "rests of Malassez" of the periodontium of rabbits and humans, by immunofluorescence microscopy of cryosections prepared from fixed and decalcified rabbit teeth with attached ligament or from manually isolated human periodontal ligaments. Proteins of the major cell structures characterizing epithelial differentiation are present in Malassez cells: a complex set of cytokeratins as well as desmosomal, hemidesmosomal and basal lamina proteins. In addition, we have shown these cytoskeletal and extracellular matrix structures by electron microscopy. The cytokeratin complement of Malassez cells was found to be highly complex, as 8 of the total of 20 known epithelial cytokeratins were detected (nos. 5, 7, 8, 14, 15, 17, 18, 19). This pattern, together with the presence of the desmosomal cadherins Dsg2 and Dsc2 and the cytoplasmic desmosome plaque-associated protein plakophilin 1, indicates that the cells of the rests of Malassez are derived from the basal cell layer of a stratified squamous epithelium rather than from simple epithelial or neuroendocrine epithelial cells. Our observations show that Malassez cells retain the major characteristics of epithelial cells throughout their differentiation from the root sheath epithelium into the rests of Malassez, even though the surface location and the polar tissue architecture that typify epithelial are lost during this process. From this study we further conclude that the specific cytoskeletal complement of the Malassez cells represents an intrinsic gene expression program that neither depends on nor causes the formation of a stratified epithelium. We also compare the specific cytoskeletal features of Malassez cells with those of other persisting epithelial residues and discuss the potential value of these findings in relation to the histogenesis and diagnostic classification of dental and periodontal cysts and tumors.

Adolescent↗
PubMed1994

Influence of cisplatinum and 5-fluorouracil on the oral mucosa.

In a prospective study we examined the effect of preoperative chemotherapy with cisplatinum and 5-fluorouracil (5FU) in 40 patients with a carcinoma of the oral cavity. Histopathological grading, cell kinetic and immuno-histochemical parameters of the mucosa were determined at two different locations. Prior to therapy histological dysplasias "close" to the tumour were observed in the mucosa of 75% of the patients. Dysplastic changes of the mucosa "far" from the tumour were also found in more than one third of the patients. Our results show that more advanced dysplasias improve under the influence of preoperative systemic chemotherapy only temporarily. Moreover, new dysplasias which appeared during chemotherapy and persisted after its termination are probably induced.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1994

The use of the 'de-epithelialized' scapular flap for soft tissue augmentation--a case report.

For the augmentation of maxillo-facial soft tissue deficiencies, microsurgical 'pure' fat transplants have proven effective. In this paper, we present the 'de-epithelialized' scapular flap and discuss its significance in comparison with other microvascular fat transfers. Consistency of transplant vessels and minimal dependence of volume on the overall nutritional condition are its specific advantages. The transplant can be securely fixed at the retained corium.

Adipose Tissue↗
PubMed1994

Effect of chronic alcohol consumption on the morphology of the oral mucosa.

Chronic alcohol consumption is a major risk factor for oral and pharyngeal cancer. Besides other mechanisms a toxic effect of ethanol and/or its metabolite acetaldehyde on the oral mucosa and resulting increased cell regeneration seem to play an important role in tumor promotion. In the present study the effect of chronic ethanol consumption on the morphology of the oral mucosa of 40 male wistar rats that had been fed nutritionally adequate liquid diets containing 36% of total calories either as ethanol or isocaloric carbohydrates for 6 months was investigated. Morphometric analysis showed that in the ethanol rats the size of the basal cell nuclei of the oral mucosa from the floor of the mouth, the edge of the tongue and the base of the tongue were significantly enlarged (p < 0.001). The size of the basal cell layer in these rats was increased, and the stratification of the cells was altered. The percentage of cells in the S-phase of the cell cycle was significantly higher in the ethanol-fed rats (p < 0.01). Mean epithelial thickness of the mucosa from the floor of the mouth was significantly reduced in the ethanol rats (p < 0.01). In conclusion, the reported findings indicate, that chronic ethanol consumption causes oral mucosal atrophy associated with hyper-regeneration, which may result in an enhanced susceptibility of the mucosal epithelium toward chemical carcinogens.

Alcohol Drinking↗
PubMed1994

[Effect of a cisplatin-5-fluorouracil combination chemotherapy on malignant transformation of the epithelium of mouth mucosa].

In a prospective study we examined the effect of preoperative chemotherapy with cisplatinum and 5-fluorouracil (5-FU) in 40 patients with advanced carcinoma of the oral cavity. Histopathologic grading, cell kinetics and immunohistochemical parameters of the mucosa were determined at two different locations. Prior to therapy, histologic dysplasias in the mucosa "close" to the tumor were observed in 75 percent of the patients. Dysplastic changes of the mucosa "far" from tumor were also found in more than one-third of the patients. Our results show that more advanced dysplasias improve only temporarily under the influence of preoperative systemic chemotherapy. Moreover, new dysplasias appearing during chemotherapy and persisting after its termination are probably induced. The results point to a possible carcinogenic potential of the combined chemotherapy schema used.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1993

Dental status and oral hygiene in patients with head and neck cancer.

Poor oral hygiene is believed to play a role as a risk factor for head and neck cancer, especially for oral cancer. Only few epidemiologic data exist about dental status and oral hygiene in these patients. We performed a case-control study involving 100 patients with squamous cell carcinoma of the upper aerodigestive tract and 214 age- and sex-matched control subjects with no known tumorous disease. In the tumor patients, oral hygiene and dental status proved to be significantly worse: the majority of the tumor patients seldom or never brushed their teeth and the frequency of dental visits was significantly lower. Tartar of 3 mm or more was found in 40.9% of the tumor patients and in 22% of the control subjects. In the tumor group, the incidence of decayed teeth was significantly higher compared with the control subjects. Chronic inflammation of the gingiva was observed in 28% of the tumor patients vs. 13.5% in the control group. Oral hygiene was negatively correlated with alcohol as well as with tobacco consumption. The social status of subjects also correlated with oral hygiene, which was found to be worst in subjects from the lower social strata. The present study revealed a poor dental status and oral hygiene in patients with head and neck cancer. The pathogenetic mechanism being associated with this suspected risk factor remains to be investigated.

Adult↗
PubMed1992

Intraoral cheek transposition flap for primary reconstruction of the soft palate.

A method for primary reconstruction of the soft palate following radical tumor resection is described. The resulting defects can be repaired with 2 layers of tissue by combination of a cranial pedicled pharyngeal flap and a cranial pedicled intraoral cheek transposition (IOCT-) flap. For additional resection of the lateral pharyngeal wall the technique can be combined with a masseter crossover flap. The method allows satisfying restoration of swallowing and speech with relatively small operative effort.

Deglutition Disorders↗
PubMed1992

The combined masseter muscle/intraoral cheek transposition (IOCT) flap for primary reconstruction of the dorsal oral cavity.

A method for primary reconstruction of the dorsal oral cavity after tumor resection of T2 or small T3 tumors is presented. By combination of the masseter muscle flap with a cranial pedicled intraoral cheek transposition (IOCT) flap, a reconstruction of the defects with two layers of tissue is possible. This easy and functional reconstruction method is especially useful for high-risk patients because of the markedly reduced operating time.

Aged↗
PubMed1992

[The value of "tumor markers" in the therapy and aftercare of carcinoma of the oral mucosa].

Biochemical Markers (alpha-1-acid glycoprotein, ferritin, transferrin) and tumor associated markers (TPA, CEA, SCC-antigen) are described. Concerning the screening of oral carcinoma, the use of tumor markers is to be considered with criticism. The SCC-antigen seems to be the most useful for detection of recurrence in the follow-up. But no tumor marker can replace exact physical and ultrasound examinations.

Aftercare↗
PubMed1992

[Combination of velopharyngoplasty and transposition flap of buccal mucosa for primary reconstruction of the soft palate].

Reconstruction of the soft palate after tumor surgery can present a challenge in closing the defect created and achieving a sufficient functional result. We present a new technique for primary reconstruction after partial or total resections of the soft palate. The method is based on the combination of a cranially pedicled pharyngeal mucosa muscle flap with an oral mucosal transposition flap. If partial resection of the lateral pharyngeal wall is also required, the method can be combined with a masseter crossover flap. Our present experience has shown that the surgical technique used will result in an uncomplicated and rapid primary two-layer reconstruction of the soft palate with a comparatively low postoperative complication rate and satisfactory functional results in speaking and swallowing.

Carcinoma, Squamous Cell↗
PubMed1992

[Sonography in therapy-oriented diagnosis and after-care of primary bone and soft tissue tumors].

Based on the results of 150 patients with primary tumors or the suspicion of malignant lesions of the locomotor system the perspectives and limits of the sonographic diagnosis under the therapeutic aspects of interdisciplinary oncologic cooperation is demonstrated. As the ideal adjunct to conventional roentgenograms, ultrasound is the first-line imaging procedure in the fields of primary diagnosis, follow-up, post-therapeutic care as well as tumor exclusion for methodic, patient-related and economic/logistic reasons. Its consequent application will markedly reduce the number of more invasive and expensive methods.

Adult↗
PubMed1992

[Comparison of two methods for conscious sedation in maxillofacial surgery with local anesthesia].

A randomised, prospective study was conducted to compare the efficiency and safety of methods for intravenous conscious sedation in patients undergoing oral surgery under local analgesia. 150 systemically healthy patients (ASA Class I and II) participated. Three groups were formed: group 1 received 0.05 mg/kg midazolam; group 2 0.05 mg/kg midazolam, 1.5 mg/kg tramadol, 50 mg alizaprid; group 3 0.05 mg/kg midazolam, 0.2 mg/kg nalbuphine, 50 mg alizaprid. Blood pressure, heart rate and oxygen saturation were measured throughout the procedure. The results confirmed that the use of nalbuphine (group 3) allows a reduction in the mean dosage of midazolam required to produce satisfactory sedation and effected a more rapid recovery time compared to group 12 and 2. With the combination nalbuphine and alizaprid nausea and vomiting could be reduced for the most part compared to group 2.

Procedural Sedation↗
PubMed1992

[Septic granulomatosis (chronic granulomatous disease = CGD) in the jaw area. A case report].

A rare case of chronic granulomatous disease with manifestation in the mandible is presented. A 10-year-old boy showed the clinical picture of osteomyelitis without paresthesia (Vincent syndrome). Diagnosis was done by the nitroblue tetrazolium test (NBT) and by demonstration of a complete cytochrome-b deficiency of the granulocytes. In septic granulomatosis a continuous application of Sulfamethoxazol-Trimetoprim is recommended for prophylaxis of infection. For treatment of infection further antibiotics who pass into the granulocytes like rifampicin and fosfomycin are necessary. Oral surgical procedures request a careful tissue handling and a tight wound closure.

Child↗