Biomedical subjects

S Reinert

Publications and source records attributed to S Reinert.

At least 37 records · Page 2Linked to original sources

PubMed2002

[Intraoperative computer tomography control within the scope of maxillofacial traumatology using a mobile scanner].

Advances in intra-operative imaging and the development of new minimally invasive techniques are having an ever greater impact on modern surgery. Mobile CT scanners in the operating room is a new technique that permits image-guided surgery, and helps minimize postoperative complications. We report on our initial experience with intraoperative CT scanning during surgery on patients suffering lateral midface trauma. A mobile CT unit, the Tomoscan M (Philips, Utrecht, Netherlands) set up in the operating room, was evaluated in 6 patients with zygomatic bone fractures. The patients were placed on the CT scanner table, which is detachable from the gantry. The unit is powered by batteries charged from an ordinary ring mains supply via a conventional plug. The CT images obtained were of good quality in all cases. No technical problems were observed during surgery. Using repeat CT scans, the procedure also permits accurate intraoperative monitoring of the anatomical repositioning of the bone fragments, and accurate implantation. No intraoperative or early postoperative complications were observed. This new technical aid ensures highly accurate reduction of the bone fragments, and minimizes the need for reoperation. High-quality intraoperative imaging with surgical navigation increase surgical outcome, and expand the spectrum of minimally invasive surgery.

Fracture Fixation, Internal↗

PubMed2002

Initial experience with intraoperative computed tomography in maxillofacial surgery.

With respect to the complex anatomy in the head and neck region, computed tomography has been established as a routine method for preoperative evaluation. Whereas in neurosurgery intraoperative tomographic image data acquisition (CT, MR) serves for control of therapeutic effects on a routine base, maxillofacial surgeons aren't accustomed to use the method in this way. Using a mobile Philips Tomoscan M scanner, we examined the clinical significance and especially the ergonomy of intraoperative CT scans in maxillofacial traumatology.

Adolescent↗

PubMed2002

Significance of biodegradable implants in case of midfacial fractures.

The purpose of this prospective clinical study was to evaluate new resorbable implants for bone fixation. The plates and screws are made of poly (D, L)lactide (PDLLA). Bioresorbable osteosynthesis and fixation (ResorbX) has been applied in 22 patients. Indications for operations were craniofacial trauma (malar, orbital-floor or frontal bone fractures) or orthognathic procedures (Le Fort-I-osteotomies) as well as the surgical correction in case of craniofacial syndromes. In the initial follow up, the first patients showed clinically and radiologically uneventful fixation and healing of the bone. There were no implant material related complications. Overall, the advantages of PDLLA-implants appear to be their ease of use, radiolucency and resorption, although further experience is needed to determine the longterm benefits of biodegradable implants.

Absorbable Implants↗

PubMed2002

Image-guided navigation for minimal invasive approaches in craniomaxillofacial surgery.

The use of minimally invasive procedures in maxillofacial surgery will require new technologies involving surgical navigation and techniques. The aim of our studies is to improve the efficacy of image-guided navigation in combination with endoscopically assisted techniques for minimally invasive craniomaxillofacial procedures. Prospective evaluation was made of all patients who underwent surgical procedures using image-guided navigation. The most common type of operations performed were endoscopically assisted interventions within the paranasal sinuses, fracture treatment, the resection of bone lesions and further miscellaneous interventions. Our experience to date suggest that image-data based techniques are eminently applicable, providing a feasible alternative to conventional surgical treatment.

Endoscopes↗

PubMed2001

Heroin use in adolescents and young adults admitted for drug detoxification.

PURPOSE: To examine heroin use and associated morbidity in young adults undergoing drug detoxification. METHODS: A retrospective chart review of all persons (ages 18-25) admitted to either of the two state-funded detoxification facilities in Rhode Island was conducted between June 1998 and June 1999. Only those reporting heroin as a primary drug were included in this study (N=201). RESULTS: Clients were largely male (64%), and white (79%), with a mean age of 22. Of those that reported heroin as their primary drug, 62% used primarily by injection. Mean age of initiation for heroin use was 18.3 years. Twenty-two percent reported a psychiatric diagnosis, and 80% reported a substance-abusing family member. Injection, previous overdose, and a mother with a history of substance use were associated with early initiation of heroin use. CONCLUSIONS: The majority of young adults with heroin addiction undergoing detoxification began using heroin during late adolescence. Concurrence of psychiatric and medical diagnoses with heroin addiction was common, and may contribute to the severity of drug use. Efforts to identify risk factors for heroin and other injection drug use in adolescents and young adults will be critical for the design of effective interventions to prevent injection drug use and its associated morbidities.

Adolescent↗

PubMed2001

Radiographic imaging of the mastoid process with conventional tomography: a novel positioning technique.

The Scanora (Soredex, Helsinki, Finland) is a multimodal unit for maxillofacial imaging combining narrow beam radiography and pluridirectional spiral tomography. We describe a novel technique for imaging the mastoid process based on a modification of the program for coronal tomography of the ear. This technique is of potential clinical value for implant planning and postoperative evaluation in the temporal bone.

Ear, External↗

PubMed2001

Wooden foreign bodies in facial injury: a radiological pitfall.

Foreign bodies can present a diagnostic challenge to the maxillofacial surgeon. Three patients, who suffered from a penetrating injury with a wooden foreign body, were examined and treated. Their preoperative CT and MRI scans were evaluated. In an acute case, the penetrating wooden body mimicked air bubbles. In the other two patients, the wood was retained for several months and appeared with a much higher density on CT. In MRI the wooden foreign bodies gave a low signal intensity. In all injuries removal of the foreign body was delayed, because it was initially radiologically missed or misdiagnosed. In the appropriate trauma setting a penetrating wooden body must always be considered. Its attenuation value increases with time as water is absorbed from the surrounding tissues. Although the radiological appearance may show a great variety, CT imaging is the basic diagnostic technique. MRI is the method of second choice.

Adult↗

PubMed2001

External distraction of the maxilla in patients with craniofacial dysplasia.

Patients with severe maxillary hypoplasia secondary to craniofacial dysplasia present a challenge to the craniofacial surgeon. Maxillary distraction presents a promising tool to treat these patients more successfully. Fifteen patients aged 12 to 20 years with craniofacial dysplasia and maxillary retrusion were treated with two different techniques after complete Le Fort I osteotomy: one group underwent face mask protraction (2 patients), and the other group underwent rigid external distraction (13 patients). Cephalometric evaluation was performed before and after distraction. Rigid external distraction appeared to be superior to face mask protraction. Maxillary retrusion was fully corrected in this group. The path of maxillary positioning was well controlled by changing the traction force vector. Distraction osteogenesis has certainly improved treatment of these patients.

Adolescent↗

PubMed2001

Antimicrobial resistance of Streptococcus pneumoniae recovered from outpatients with respiratory tract infections in Germany from 1998 to 1999: results of a national surveillance study.

Clinically significant pneumococcal isolates were prospectively collected from outpatients with respiratory tract infections by 19 different clinical microbiology laboratories in Germany. Resistance rates in a total of 961 isolates were as follows: penicillin, 6.6%; clarithromycin, 10.6%; tetracycline, 13.9%; and levofloxacin, 0.1%. Among 324 isolates from children, pneumococcal serotypes 19F (17.0%), 23F (13.0%), and 6B (11.7%) were the predominant types.

Adolescent↗

PubMed2000

Effect of highly active antiretroviral therapy on cervicovaginal HIV-1 RNA.

OBJECTIVES: To determine the frequency of cervicovaginal lavage and plasma HIV-1 RNA levels that are below detectable levels (< 400 copies/ml) among women on highly active antiretroviral therapy (HAART), non-HAART and on no therapy. To compare the effect of initiating HAART on the timing of HIV-1 RNA suppression in the blood plasma and genital tract among antiretroviral-naïve women. METHODS: Data were obtained from 205 HIV-infected women with paired plasma and cervicovaginal lavage viral load measurements. Seven antiretroviral-naïve women starting HAART had viral load measurements performed daily for one week, at 2 weeks and at 1 month after initiating therapy. Viral load quantification was carried out by nucleic acid sequence-based amplification assay. The lower limit of detection was 400 copies/ml. RESULTS: Plasma and cervicovaginal HIV-1 RNA was detectable in 71 and 26% of the women, respectively. Among women with plasma viral loads less than 400, 400-9999, and 10,000 copies/ml or over, genital tract HIV-1 RNA was detected in 3, 17 and 48%, respectively (P < 0.001). Fifty-one per cent of the women with CD4 cell counts of less than 200/mm3 had detectable cervicovaginal viral loads compared with 18% among women with CD4 cell counts of 200/mm3 or over (P < 0.001). Cervicovaginal HIV-1 RNA was less than 400 copies/ml in 85% of those on HAART, 69% of those on non-HAART and 69% of those on no therapy (P < 0.045). In seven antiretroviral-naïve women initiating HAART, cervicovaginal HIV-1 RNA decreased by 0.7-2.1 log10 within 1-14 days of starting therapy. CONCLUSION: The cervicovaginal HIV-1 RNA level was positively correlated with plasma HIV-1 RNA and negatively with the CD4 cell count. The use of HAART was significantly associated with below-detectable levels of HIV-1 RNA in both plasma and the genital tract. HIV-1 RNA suppression in the genital tract may occur rapidly after initiating therapy.

Adult↗

PubMed2000

Higher-dose intravenous magnesium therapy for children with moderate to severe acute asthma.

OBJECTIVE: To evaluate the efficacy of a 40-mg/kg dose of intravenous magnesium sulfate for moderate to severe asthma exacerbations in pediatric patients. STUDY DESIGN: Double-blind placebo-controlled trial. SETTING: Two urban tertiary care pediatric emergency departments. SUBJECTS: Thirty patients, aged 6 to 17.9 years, being treated for an acute asthma exacerbation. INTERVENTION: Eligible patients received either a magnesium sulfate infusion of 40 mg/kg or saline solution. RESULTS: At 20 minutes, the time at which the infusion was completed, the magnesium group had a significantly greater percentage of absolute improvement from baseline in each of the following: predicted peak expiratory flow rate (8.6% vs 0.3%, P<. 001), forced expiratory volume in 1 second (7.0% vs 0.2%,P<.001), and forced vital capacity (7.3% vs -0.7%, P<.001). The improvement was greater at 110 minutes: peak expiratory flow rate (25.8% vs 1.9%, P<.001), forced expiratory volume in 1 second (24.1% vs 2.3%; P<. 001), and forced vital capacity (27.3% vs 2.6%, P<.001). Patients who received intravenous magnesium were more likely to be discharged to their homes than those who received the placebo (8/16 vs 0/14; P=. 002). CONCLUSION: Children treated with 40 mg/kg of intravenous magnesium sulfate for moderate to severe asthma showed remarkable improvement in short-term pulmonary function.

Adolescent↗

PubMed2000

[Development of an osteoporosis animal model of the jaw area].

The aim of the following study was to develop an osteoporotic model by means of ovariectomy. Bone mineral density of the upper and lower jaw was measured by dual energy X-ray absorptiometry (DPX) before and after ovariectomy. Histomorphometric measurements were done by a microtomography system. Bone mineral density decreased significantly after ovariectomy in the upper and lower jaw.

Absorptiometry, Photon↗

PubMed2000

[Ultrasound in oromaxillofacial surgery].

Ultrasonography has gained acceptance in maxillofacial surgery as a first-choice diagnostic tool in soft tissue masses of the head and neck. To date, A-mode sonography of the maxillary sinus is only performed in children and pregnant women. However, B-mode sonography is primarily performed in the assessment of all cervical lymph nodes because of its superior sensitivity in comparison to CT and MR, as well as in diseases of the salivary glands, solid tumors, and monitoring of distraction osteogenesis of the mandible. With color-coded ultrasonography as a combination of B-mode and blood flow information, vessels of the head and neck area or of planned flaps can be examined in a noninvasive manner. This is especially important in secondary microsurgical reconstructions. Moreover, the blood flow in any soft tissue masses can be evaluated. In spite of all texture and image analysis techniques, positive and negative lymph nodes cannot be differentiated in a safe manner. Three-dimensional sonography, e.g., panoramic pictures, and contrast enhancement are new technologies that will improve diagnostic accuracy of head and neck ultrasonography.

Facial Neoplasms↗

PubMed2000

[Callus distraction of the maxilla. Supplement or alternative to advancement osteotomy].

Total or partial relapses after conventional surgical advancement of the maxilla following Le Fort I osteotomy in CLP patients are frequent and major complications. The aim of this investigation was to find out whether the technique of distraction osteogenesis in these patients shows more stability and whether maxillary distraction is able to replace conventional advancement. Maxillary distraction was performed in 12 patients. In two cases, a Delaire mask was used to bring the maxilla forward, ten patients were treated with the extraoral distraction device designed by Polley. In all patients, planned advancement of the maxilla could be achieved; one partial relapse occurred. The results indicate that distraction osteogenesis offers the possibility of advancement of the maxilla with the required stability. The technique presents a major improvement which is achieved with a relatively minor surgical procedure.

Adolescent↗

PubMed2000

[Polytopic manifestations of paragangliomas. Diagnosis, differential diagnosis and indications for therapy].

Paragangliomas of the glomus caroticum are relatively rare, but highly vascularized neoplasmas, which develop from chemoreceptors. They can be develop at any age, but most often in the third or fourth decade of life. Paragangliomas grow very slowly and are most always of benign origin. There is a familial predisposition, and an autosomal-dominant transmission is presumed. They are commonly located in the jugular region; in rare cases a polytopic manifestation is found. We describe the case of a 47-year-old male patient who was referred to our department because of a progressive swelling of the neck on both sides. Contrast-enhanced computed tomography had displayed soft tissue tumors in the jugular regions. We performed an operative exploration, which showed a highly vascularized tumor. Histopathologic analysis revealed the diagnosis of a paraganglioma. An angiography of the neck and thoracic region, furthermore, revealed an additional paraganglioma in the anterior mediastinum. Using a surgical approach via lateral cervicotomies and thoracotomy the paragangliomas were extirpated. Our case report demonstrates the rare polytopic manifestation of paragangliomas. This perivascular neoplasms have to be removed before haemodynamic complications develop. The extent of this tumors is clearly illustrated by use of an angiography. Because of the familial predisposition, clinical and radiological examinations of relatives are mandatory.

Carotid Body↗

PubMed2000

Mandibular fracture after third molar removal.

PURPOSE: Mandibular fracture after impacted lower third molar removal is a rare, but major, complication. The factors leading to a mandibular fracture secondary to third molar removal are analyzed retrospectively. PATIENTS AND METHODS: Six patients who suffered from a mandibular fracture as a complication after third molar removal were examined clinically and radiographically. RESULTS: All fractures occurred an average of 14 days postoperatively. The patients were 42 to 50 years old and were all fully dentulous. All grades of tooth impaction were included. CONCLUSIONS: The major risk factor for this complication seems to be advanced age in combination with a full dentition. The degree of tooth impaction is less important. Preexisting bone lesions weaken the mandible and further predispose to a fracture.

Adult↗

PubMed2000

Multiple odontogenic keratocysts in mental retardation-overgrowth (Simpson-Golabi-Behmel) syndrome.

We report on a 10-year-old boy with mental retardation-overgrowth (Simpson-Golabi-Behmel) syndrome. The child had the typical clinical features including, postnatal overgrowth, mental retardation, and a characteristic facial appearance. He was admitted for treatment of multiple mandibular and maxillary cysts. Histopathological examination of the cyst tissue showed keratinized epithelium. Odontogenic keratocysts may have to be added to the typical features of this syndrome.

Abnormalities, Multiple↗

PubMed2000

The free revascularized lateral upper arm flap in maxillofacial reconstruction following ablative tumour surgery.

The lateral arm flap is well established in microvascular reconstructive surgery for covering small and moderate-sized defects both of the extremities and in the head and neck region. In the last 3 years 25 patients underwent a lateral upper arm flap for primary repair of tumour related defects of the tongue (n = 10), floor of the mouth (n = 7), mandible (n = 4), inner cheek (n = 2), oropharynx (n = 1) and lower lip (n = 1). Defects extended from the anterior floor of the mouth to the oral tongue in three cases and in four cases the defect reached the pharyngeal tongue. Two flaps had neurovascular anastomoses between the posterior cutaneous nerve of the arm and the lingual nerve. In all patients the donor defect was closed primarily. Twenty four lateral upper arm flaps healed uneventfully although six patients developed severe alcoholic delirium. One flap was lost on the fourth postoperative day due to venous insufficiency. There were no significant complications at the donor site. At the time of this report 16 patients were taking a normal diet while nine patients were taking pureed food. Among the advantages of this flap are anatomically reliable vascular supply, its good aesthetic quality, and position of the donor site. Furthermore the posterior radial collateral artery is a nonessential vessel of the arm. The flap is also potentially sensate. Among the disadvantages are smaller vessels for microvascular anastomoses. In conclusion, we believe that for repair of moderate-sized defects of the maxillofacial area the lateral upper arm flap can be recommended as the first choice.

Aged↗